Brain Tumor in Newborn/Infant
Susan I. Blaser, MD, FRCPC
DIFFERENTIAL DIAGNOSIS
Common
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Anaplastic Astrocytoma
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Teratoma
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Medulloblastoma (PNET-MB)
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Supratentorial PNET
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Supratentorial Ependymoma
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Choroid Plexus Papilloma
Less Common
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Subependymal Giant Cell Astrocytoma
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Desmoplastic Infantile Ganglioglioma
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Desmoplastic Infantile Astrocytoma
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Glioblastoma Multiforme
Rare but Important
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Choroid Plexus Carcinoma
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Atypical Teratoid-Rhabdoid Tumor
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Neurocutaneous Melanosis (Melanoma/Melanocytoma)
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Pineoblastoma
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Brainstem Glioma, Pediatric
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Medulloepithelioma
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
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Newborn/infant brain tumors
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Typically large, bulky, inhomogeneous
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Supra- > infratentorial (infratentorial more common in older children)
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Helpful Clues for Common Diagnoses
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Anaplastic Astrocytoma
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Infiltrating mass, predominantly white matter (WM)
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Hemispheric WM (frontotemporal)
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Ca++ rare; heterogeneous on MR
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No or variable enhancement
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Ring enhancement, bleed, necrosis, flow voids suggest GBM
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Teratoma
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Midline, supratentorial
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Small lobular or holocranial
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Contents
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Ca++, cysts, fat
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Enhancing soft tissue
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Look for associated congenital brain anomalies
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Medulloblastoma (PNET-MB)
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4th ventricle mass with hydrocephalus
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Restricts on DWI (best MR clue)
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Sparse Ca++ ≈ 20%
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Enhancement usual (may be late/slow)
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Hemorrhage rare
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Hypercellularity reflected on imaging
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Hyperdense (NECT), hypointense (T2)
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Medulloblastoma with extensive nodularity
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Subtype with expanded lobular architecture
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Grape-like enhancement
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Better prognosis
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Supratentorial PNET
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Large complex mass
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Restricts on DWI (differentiates from ependymoma)
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Heterogeneous signal, enhancement
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Ca++ more common than in posterior fossa PNETs
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Hemorrhage, necrosis common
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Hemispheric
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Mean diameter 5 cm
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Especially newborn/infants
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Minimal peritumoral edema
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Suprasellar
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Early neuroendocrine, visual disturbances
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Pineal (pineoblastoma)
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Hydrocephalus, Parinaud syndrome
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Supratentorial Ependymoma
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Peri/extraventricular > intraventricular
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Periventricular ependymal rests
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Large, bulky
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Ca++ ≈ 50%
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Variable necrosis, hemorrhage
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Choroid Plexus Papilloma
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CPP: Lobulated intraventricular mass
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Lateral > 4th > 3rd
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NECT: Iso- to dense
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Iso- to slightly hyperintense on T2WI
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Vividly enhancing
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Hydrocephalus common
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Helpful Clues for Less Common Diagnoses
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Subependymal Giant Cell Astrocytoma
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Enhancing mass near foramen of Monro
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Found in tuberous sclerosis complex
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Look for
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Subependymal Ca++ nodules
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Tubers (best on FLAIR)
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Desmoplastic Infantile Ganglioglioma
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Desmoplastic Infantile Astrocytoma
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Similar to (but rarer than) DIG
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Glioblastoma Multiforme
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Bulky irregular enhancing tumor
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Peritumoral edema, mass effect
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Hemorrhage, central necrosis, cysts
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↑ glucose metabolism, avid FDG accumulation on PET
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Helpful Clues for Rare Diagnoses
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Choroid Plexus Carcinoma
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Similar to CPP PLUS
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Brain invasion
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Ca++, cysts, bleed
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Ependymal, subarachnoid space seeding (can be seen with both CPP, CPC)
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Atypical Teratoid-Rhabdoid Tumor
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PNET-MB-like PLUS
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Metastases at diagnosis more common
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Cysts, hemorrhage more common
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Cerebellopontine angle cistern location more common
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Neurocutaneous Melanosis (Melanoma/Melanocytoma)
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Giant or multiple cutaneous melanocytic nevi PLUS
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Melanosis: Bright T1 amygdala, cerebellum
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Melanoma: Melanosis + diffuse leptomeningeal enhancement
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Pineoblastoma
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Large heterogeneous pineal region mass
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Peripheral Ca++
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Small cysts
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Inhomogeneous enhancement
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Invades adjacent structures
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Corpus callosum, thalamus, midbrain, vermis
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Hydrocephalus usual at diagnosis
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Brainstem Glioma, Pediatric
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Imaging appearance, prognosis vary with tumor type, location
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Tectal
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Pilocytic astrocytoma
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Clinically indolent course (may cause obstructive hydrocephalus)
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Variable enhancement/Ca++
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Focal tegmental mesencephalic
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Pilocytic astrocytoma
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Cyst + nodule
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Surgery, radiation, or chemotherapy
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Patients generally do well
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Diffuse pontine glioma
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Diffusely infiltrating fibrillary astrocytoma
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Nonenhancing early in course
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Enhancement with malignant progression
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Survival generally poor
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Medulloepithelioma
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Rare malignant embryonal brain tumor
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Young children (< 5 years)
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Histologic differentiation varies
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Neuronal, astrocytic, ependymal, melanotic, etc.
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Imaging appearance reflects variable differentiation
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Image Gallery
![]() Coronal T2WI MR in same case shows the mass
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