History: A 44-year-old man presents with a history of chronic migraines and fatigue. The patient was found to have low testosterone levels on further workup.
正确答案：Multinodular and vacuolating neuronal tumors (MVNT)
- Multinodular and vacuolating neuronal tumors are indolent, subcortical tumors with a small and “bubbly” appearance.
- Most frequently identified in the temporal lobe, although this relationship is likely due to the location being more likely to result in seizures and subsequent imaging than a true representation of tumor predilection for the temporal lobe.
- Macroscopically, they will appear as small, gray, well-formed, coalescent nodules.
- Microscopically, mature neurons will be seen embedded within a fibrillary background, with large cytoplasmic vacuoles.
- True epidemiological information is currently unknown, as MVNTs have only recently been described.
- Reported cases are commonly seen in young to middle-aged adults who usually present with adult-onset seizures.
- Many MVNTs are likely asymptomatic and found incidentally on imaging performed for other reasons.
- When symptomatic, adult-onset seizures and seizure equivalents (e.g., episodic confusion) are the principal clinical manifestations. Focal, complex partial, grand mal seizures, and status epilepticus have all been described in association with MVNTs.
- CT: CT demonstrates nonenhancing low-attenuation lesions in the subcortical white matter.
- T1: Appear hypointense to adjacent gray and white matter.
- T2: Appear as hyperintense “bubbles” when compared with gray and white matter. Signal almost as high as cerebral spinal fluid.
- FLAIR: Does not suppress.
- T1 with contrast: Show faint focal enhancement, or most commonly no enhancement.
- MVNTs are indolent, benign tumors that can be followed with imaging alone if not causing symptoms.
- If symptomatic (seizures), surgical resection is often performed with resulting control of seizures for a majority of patients, and no tumor regrowth reported to date.