Ganglioglioma

KEY FACTS

TERMINOLOGY

• Well-differentiated, slowly growing neuroepithelial tumor

composed of neoplastic ganglion cells and neoplastic glial

cells

• Most common neoplastic cause of temporal lobe epilepsy

(TLE)

IMAGING

• Best diagnostic clue: Partially cystic, enhancing, cortically

based mass in child/young adult with TLE

• Can occur anywhere, but most commonly superficial

hemispheres, temporal lobe (> 75%)

• Circumscribed cyst with mural nodule most common

• May be solid and appear well circumscribed

• Calcification is common (up to 50%)

• Superficial lesions may expand cortex, remodel bone

• ~ 50% enhance

• Protocol advice: Contrast-enhanced MR to include coronal

T2 images for better evaluation of temporal lobes

TOP DIFFERENTIAL DIAGNOSES

• Pleomorphic xanthoastrocytoma

• Dysembryoplastic neuroepithelial tumor

• Astrocytoma

• Oligodendroglioma

• Neurocysticercosis

PATHOLOGY

• WHO grade I or II (80% grade I)

• Uncommon: Anaplastic ganglioglioma (WHO III)

• Rare: Malignant with glioblastoma multiforme-like glial

component (WHO IV)

CLINICAL ISSUES

• Occurs at all ages (peak: 10-20 years)

• Most common mixed neuronal-glial tumor

• Cortical dysplasia is commonly associated with

ganglioglioma

• Excellent prognosis if surgical resection complete

(Left) Coronal graphic shows a

discrete cystic and solid

temporal lobe mass expanding

the overlying cortex. Calvarial

remodeling is seen, typical of a

superficially located

ganglioglioma.

Gangliogliomas are the most

common tumors to cause

temporal lobe epilepsy. (Right)

Coronal T1WI C+ MR in a

young adult with temporal

lobe epilepsy shows a

circumscribed, cystic, and solid

temporal lobe mass with

intense enhancement of the

mural nodule ſt. This is the

classic enhancement pattern

of a ganglioglioma.

(Left) Axial CT shows a

partially calcified frontal lobe

mass ﬈ in a 25-year-old

patient with headaches and

seizures. The lack of

surrounding edema is typical

for ganglioglioma. Imaging

mimics an oligodendroglioma.

Calcification is seen in 30-50%

of gangliogliomas. (Right)

Coronal T1WI C+ MR shows

subtle enhancement ﬇ within

a right temporal lobe

ganglioglioma in a female

patient with seizures. The

differential diagnosis for this

lesion includes DNET,

astrocytoma, PXA, and

oligodendroglioma.

Cysts, and Disorders

Brain: Pathology-Based Diagnoses: Neoplasms,

139