Imaging characterization of an adult H3 K27M-altered diffuse midline glioma of the medulla oblongata with a confounding steroid response

Claudia Godi, MD; Paolo Garofalo, MD; Marcella Callea, MD; Paolo Vezzulli, MD; Maurizio Barbera, MD; Carlo Mandelli, MD; Elena Mazza, MD; Bianca Pollo, MD; Maria Rosa Terreni, MD; Antonella Castellano, MD PhD; Nicoletta Anzalone, MD; Andrea Falini, MD PhD

Radiology Case Reports (Mar 2023)

Imaging characterization of an adult H3 K27M-altered diffuse midline glioma of the medulla oblongata with a confounding steroid response

Claudia Godi, MD,
Paolo Garofalo, MD,
Marcella Callea, MD,
Paolo Vezzulli, MD,
Maurizio Barbera, MD,
Carlo Mandelli, MD,
Elena Mazza, MD,
Bianca Pollo, MD,
Maria Rosa Terreni, MD,
Antonella Castellano, MD PhD,
Nicoletta Anzalone, MD,
Andrea Falini, MD PhD

Affiliations

Claudia Godi, MD: Neuroradiology Unit and CERMAC, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy; Corresponding author.
Paolo Garofalo, MD: Policlinico Universitario di Monserrato, Cagliari University, Cagliari, Italy
Marcella Callea, MD: Department of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy
Paolo Vezzulli, MD: Neuroradiology Unit and CERMAC, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
Maurizio Barbera, MD: Neuroradiology Unit and CERMAC, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
Carlo Mandelli, MD: Department of Neurosurgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
Elena Mazza, MD: Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
Bianca Pollo, MD: Neuropathology, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
Maria Rosa Terreni, MD: Department of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy
Antonella Castellano, MD PhD: Neuroradiology Unit and CERMAC, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
Nicoletta Anzalone, MD: Neuroradiology Unit and CERMAC, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
Andrea Falini, MD PhD: Neuroradiology Unit and CERMAC, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy

Journal volume & issue: Vol. 18, no. 3
pp. 788 – 793

Abstract

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We report an uncommon, infratentorial localization of adult H3 K27M-altered diffuse midline glioma arising in a particularly rare site (medulla oblongata). In addition to this unusual presentation, the lesion exhibited a substantial contrast enhancement and size decrease after dexamethasone, generating diagnostic dilemmas. Histology, molecular details, advanced Magnetic Resonance imaging features and differential diagnoses are here described and discussed, as well as common misconceptions about steroid-sensitive mass lesions, and practical difficulties for clinicians involved in the process of making diagnosis.

Published in Radiology Case Reports

ISSN: 1930-0433 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine
Website: https://www.sciencedirect.com/journal/radiology-case-reports

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