DIFFUSE PONTINE GLIOMA

HISTORY


A young child presented to our hospital with multiple cranial nerve palsies.


IMAGING

Intially a CT Scan was done for him followed by MRI.

CT SCAN

There was diffuse hypodensity seen involving the brainstem and a mass was suspected. The brainstem was also expanded.

MRI

The MRI revealed a diffuse non enhancing mass involving the pons mainly with expansion of the pons and compression of the surrounding cisterns.

It was diagnosed as a case of Diffuse Pontine Glioma.

DISCUSSION :

These tumours typically present in childhood (3 to 10 years of age) and make up 10 - 15% of all pediatric brain tumors. 

Presentation :

• Multiple cranial nerve palsies
• Signs of raised intracranial pressure. 
• Cerebellar signs like ataxia, dysarthria, nystagmus and sleep apnoea.

Radiographic features

• Enlarged pons 
• Basilar artery  displaced anteriorly 
• Flat floor of the fourth ventricle 
• Obstructive Hydrocephalus  

Treatment and prognosis

• Treatment commenced without histological confirmation. 
• Chemotherapy only 
• Children over 3 years of age - radiotherapy may be considered. 
• Initial response can be dramatic and falsely reassuring.

Differential diagnoses

• Rhombencephalitis
• ADEM
• NF1
• Osmotic demyelination

GOSSYPIBOMA...

HISTORY
A 28 year old female presented to our hospital with a one day history of pain abdomen and vomiting.

She had got opearted about 10 days back - hysterectomy was done.

IMAGING


X-RAY

Plain X-Ray revealed - multiple air fluid levels suggesting intestinal obstruction and a vague mass in the left lumbar region with air foci within it.

CT - SCAN

CT Scan confirmed a heterogenous mass in the left lumbar region. It was seen separate from the bowel loops and was not showing enhancement and was diagnosed as Gossypiboma.

LAPAROTOMY was done for this patient and the surgical mop was retrieved. The patient came for follow up at 1 month and was having no symptoms subsequently.

DISCUSSION

Gossypiboma is the technical term for a surgical complications resulting from foreign materials, such as a surgical sponge , accidentally left inside a patient's body. The term "gossypiboma" is derived from the Latin gossypium (“cotton wool, ”) and the Swahili boma (place of concealment).

GI tract surgery and gynecologic surgery account for about 75% of reported gossypibomas

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žDifferential Diagnosis

—Post-operative collection

—Abscess

—Hematoma