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Improved Turnaround Times | Median time to first decision: 12 days

Research ArticleAdult Brain

The Variable Appearance of Third Ventricular Colloid Cysts: Correlation with Histopathology and the Risk of Obstructive Ventriculomegaly

S.D. Khanpara, A.L. Day, M.B. Bhattacharjee, R.F. Riascos, J.P. Fernelius and K.D. Westmark
American Journal of Neuroradiology October 2020, 41 (10) 1833-1840; DOI: https://doi.org/10.3174/ajnr.A6722
S.D. Khanpara
aDepartments of Diagnostic and Interventional Imaging (S.D.K., R.F.R., K.D.W.)
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A.L. Day
bNeurosurgery (A.L.D.)
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M.B. Bhattacharjee
cPathology (M.B.B.), McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
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R.F. Riascos
aDepartments of Diagnostic and Interventional Imaging (S.D.K., R.F.R., K.D.W.)
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J.P. Fernelius
dDepartment of Quality and Outcomes Management (J.P.F.), Texas Children’s Hospital, Houston, Texas
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K.D. Westmark
aDepartments of Diagnostic and Interventional Imaging (S.D.K., R.F.R., K.D.W.)
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  • FIG 1.
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    FIG 1.

    An overview of the imaging appearance of third ventricular colloid cyst on CT and corresponding MR imaging characteristics.

  • FIG 2.
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    FIG 2.

    An overview of the imaging appearance of third ventricular colloid cyst on MR imaging.

  • FIG 3.
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    FIG 3.

    Homogeneously hyperintense cyst: 13-year-old boy found unconscious after complaining of headache for 2 days. Initial CT demonstrates dilation of the lateral ventricles. However, the colloid cyst was difficult to detect as it was isointense relative to the adjacent brain. Subsequent MR imaging showed a colloid cyst homogeneously hyperintense on T2 (B) and T2-FLAIR weighted images (C) and hypointense on T1-weighted axial image (D). Also, note the presence of periventricular edema associated with ventriculomegaly.

  • FIG 4.
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    FIG 4.

    Cyst with rim: 55-year-old woman with a 6-week history of headache. Non-contrast CT (A) shows a hyperattenuated colloid cyst measuring 13 mm at the roof of third ventricle. On T2WI (B), the colloid cyst has a hypointense core with a thin hyperintense rim, which is more pronounced on T2-FLAIR (C). The cyst is mildly heterogeneous and isointense centrally on T1-weighted image (D). There was no evidence of hemorrhage on the GRE sequence (image not shown). There is associated enlargement of the lateral ventricles with periventricular edema.

  • FIG 5.
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    FIG 5.

    Hematoxylin and Eosin staining of a typical homogeneously hyperintense cyst on T2 and T2-FLAIR images. The cyst wall is composed of columnar, ciliated epithelial cells. The wall was not thickened and there was not an abnormal increase in goblet cells or any cellular atypia. Contents of the cysts consisted of a mucoid material with detached epithelial clusters of cells.

  • FIG 6.
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    FIG 6.

    Pathologic examination of a cyst that had the “cysts with rim” appearance revealed a viscous plug of colloid material which was PAS-positive. The cyst wall consisted of a thin fibrous capsule and a lining of partly ciliated cuboidal to columnar epithelium (A). The fibrous wall, and the associated choroid plexus stroma are highlighted by the Masson trichrome stain (B). The cyst epithelium is positive for CAM 5.2, pankeratin (C), EMA, and CK7; it is negative for CDX2. The peripheral cyst wall was not unusually thickened and was approximately 1–3 microns thick, and therefore would not have been visible on MR imaging.

Tables

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  • Demographic and imaging characteristics of 64 colloid cyst

    Signal Intensity on T2-FLAIRHyperintense (n = 34)Hypointense(n = 30)Total
    Homogeneously Hyperintense“Dot Sign”Hyperintense Rim
    Number of patients126163064
     Sex (Male)6 (50%)3 (50%)9 (56.2%)13 (43.3%)31 (48%)
    Patient age (years)
     Mean (+/− SD)37.0 (23.4%)37.5 (15.6%)52.1 (22%)55.2 (14.7%)49.8 (19.8%)
     Median25.531.549.55350
    Cyst size (mm)
     Mean10.616.811.16.89.6
     Median11.015.012.56.39.0
    Obstructive ventriculomegaly8 (67%)5 (83.3%)8 (50%)3 (10%)24 (37.5%)
    CTa (hyperattenuated/iso-hypoattenuated)4/40/514/020/038/9
    T1 signal (hyper-/iso-/hypointense)1/5/65/1/010/5/116/14/032/25/7
    Zone II302611
    Histopathology availablefor review8310728
    • ↵a CT was not available in all cases.

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American Journal of Neuroradiology: 41 (10)
American Journal of Neuroradiology
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1 Oct 2020
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S.D. Khanpara, A.L. Day, M.B. Bhattacharjee, R.F. Riascos, J.P. Fernelius, K.D. Westmark
The Variable Appearance of Third Ventricular Colloid Cysts: Correlation with Histopathology and the Risk of Obstructive Ventriculomegaly
American Journal of Neuroradiology Oct 2020, 41 (10) 1833-1840; DOI: 10.3174/ajnr.A6722

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The Variable Appearance of Third Ventricular Colloid Cysts: Correlation with Histopathology and the Risk of Obstructive Ventriculomegaly
S.D. Khanpara, A.L. Day, M.B. Bhattacharjee, R.F. Riascos, J.P. Fernelius, K.D. Westmark
American Journal of Neuroradiology Oct 2020, 41 (10) 1833-1840; DOI: 10.3174/ajnr.A6722
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