Dysembryoplastic neuroepithelial tumor (DNET)

Findings

Brain MRI shows T2 hyper intense lesion in a right parietal cortex with multiple small "cystic" components, extension into subcortical white matter. FLAIR hyperintense, but without perilesional edema or mass effect. No contrast enhancement.


Diagnosis: Dysembryoplastic neuroepithelial tumor (DNET)


Key points

Benign intracortical mass, superimposed on a background of cortical dysplasia.
Typical appearance: small, wedge-shaped "bubbly" mass which is based in a single gyrus, extends towards the ventricle. Characteristic features are a lack of mass effect, surrounding edema, or post-contrast enhancement. There should be little/no growth of the lesion over time.
Frequently scallops inner table of skull, sometimes calcifies, and infrequently hemorrhages. Associated cortical dysplasia is common.
Usually found in children/adolescents, comprises 1-2% of primary brain tumors (age <20). Patients commonly present with partial seizures. Most commonly location is in temporal lobe, followed by parietal cortex, caudate nucleus, septum pellucidum. From 5-80% of epilepsy brain specimens show DNETs.


Radiographic Findings

CT: Thickened gyrus, slightly hypo attenuating. May mimic acute ischemia.
MR: T1 - hypo intense with gyral architectural distortion. T2 - strikingly hyper intense, with bubbly cystic components, extends towards ventricle. FLAIR - characteristic "bright rim," but no perilesional edema. T1+C = minimal / no enhancement. DWI = no diffusion restriction.

Choroid plexus papilloma

Findings

MRI imaging demonstrates a large, 7 x 4 x 4 cm (craniocaudal, AP, and transverse) heterogeneous mass within the 4th ventricle, with associated marked obstructive hydrocephalus. This mass extends below the 4th ventricle into the foramen magnum. There is no significant surrounding cerebellar edema.


Diagnosis: Choroid plexus papilloma (pathologically proven)


Key points

Choroid plexus papilloma is a relatively rare pediatric intracranial neoplasm, accounting for approximately 3% of such tumors.
Most common in patients under 1 year of age, and more common in males.
Arise from cuboidal epithelium of choroid plexus.
Associated with Li-Fraumeni and von Hippel Lindau syndromes.
Increased intracranial pressure can result from both tumor secretion of CSF, as well as by CSF outflow obstruction due to the intraventricular mass.
Presenting symptoms may include headache, N/V, ataxia, visual changes, or drowsiness.
On CT and MR, typical findings include a heterogeneously enhancing mass, potentially with cystic areas. On CT, punctuate calcifications may be seen in up to 20% of cases.
Treatment is typically by attempted total resection.

The Parade of the Sikhs

The Parade of the Sikhs to commemorate the birth anniversary of the Indian Lord Sri Guru Gobind Singh Ji, 3rd of January 2009.*

Banda Zamora provided the parade's drum and bugle. This band is reputedly one of the oldest bands in the Philippines, established in 1894. Already four generations have played in it.

The Saint-Warriors are atop a garlanded float

The Holy Men.

They sing chants and lively songs during the entire procession, using a microphone and a PA system.



The truckload of food and goodies that will be distributed during the parade



Distribution of food and groceries to the community during the parade



They sweep the parade route so that the barefooted Sikhs will not step into filthy objects



A very beautiful child. I am uncertain if he/she was a girl/boy. What do you think?



One of the longest beards I have ever seen. Despite the width of my Nikkor lens, I was still unable to get a complete picture of his beard. The Indian Sikhs take pride of their long and beautiful beards.

Pretty Indian girls. They have some of the most beautiful eyes I have ever seen



Filipinos love parades, and here they lined up in the street to watch the Parade of the Sikhs. Many of them didn't know what the parade was for. But everyone sure loved to witness this colorful parade. After this photo was taken, they received foods from the Indian Sikhs, to their delight.



A parade spectator. Despite his sad look, he also received grocery items.

*I have decided to post all my pictures in larger sizes so that you will be able to view them much more clearly and without the effort of clicking on them to view the enlarged versions. This, however, comes at a cost. The photos takes slow to appear on your computer screens, but they eventually will. Sorry for this minor inconvenience.

To be continued...

Small Bowel Obstruction-Imaging

Semilobar holoprosencephaly

Findings

Partial formation of the interhemispheric fissure and falx cerebri in the posterior portions of the brain. Fusion of the frontal lobes. Rudimentary temporal horns of the lateral ventricles. Absent septum pellucidum. Lack of a corpus callosum genu or anterior body. Partial fusion of the thalamus and caudate and hypothalamus are not clearly separated resulting in a small third ventricle.


Diagnosis: Semilobar holoprosencephaly


Key points

There are three types of holoprosencephaly: alobar, semilobar, and lobar.
Semilobar holoprosencephaly represents a congenital brain malformation with severity between alobar and lobar holoprosencephaly.
Clinical findings include microcephaly, macrocephaly, developmental delay, spasticity, or other motor abnormalities.
Imaging findings: Interhemispheric fissure and falx cerebri are partially formed posteriorly, and the anterior portions of the brain are fused and underdeveloped. Septum pellucidum is absent. The splenium of the corpus callosum is present with absence anteriorly of the genu. Anterior extent of corpus callosum formation correlates with remainder of the brain's formation. The hypothalami, caudate, and thalami are partially unseparated resulting in a small 3rd ventricle. Dorsal cysts may be seen, always when the thalami are fused.

Hemophilic Arthropathy- MRI

Known case of hemophilia.
Findings-There is evidence of significant synovial collection involving the knee joint distending the suprapatellar bursa with inhomogeneous appearance with septae & areas of haemosiderin deposition seen as signal suppression on GRE. There is evidence of erosive destruction involving the tibio-femoral & patello-femoral articulation. Secondary degenerative changes noted in the tibio-femoral & patello-femoral articulation with reduction in joint space. Areas of marrow edema noted in knees in relation to bones forming the knee joint appearing hyperintense on T2 fat sat images. Anterior cruciate ligament is not well seen. Posterior cruciate ligament is stretched but intact. Internal architecture of the knee is distorted with haemosiderin deposition in relation to synovium.
Opinion-Significant synovial collection involving the knee joint & suprapatellar bursa with extensive haemosiderin deposition, erosive arthropathy involving tibiofemoral & patellofemoral articulation with marrow edema involving the bones surrounding knee joint, distorted internal architecture of knee. Likely suggestive of sequelae of long standing hemarthrosis. Patient is a known case of hemophilia. Consistent with hemophilic arthropathy.

Dr.Sumer K Sethi, MD

Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences)

Sri Guru Gobind Singh Ji(1666-1708)

The Indian Lord Sri Guru Gobind Singh Ji ਗੁਰੂ ਗੋਬਿੰਦ ਸਿੰਘ (1666-1708) is one of the most beloved figures in the religion of Sikhism. He was a warrior, a poet, and a philosopher. He abolished the inhuman Caste System among the Indian Sikhs, declaring that all men and women are equal to each other. He gave all Sikhs a single identifiable surname "Singh", meaning "lion".

Born in 1666, Guru Gobind Singh inherited the title of the 10th Guru from his father Guru Tegh Bahadur, who was beheaded in 1675 under the orders of the Mughal Emperor Aurangzeb for refusing to submit to Islamic religion. Gobind Singh became the last living Guru of Sikhism. Prior to his death in 1708, he destroyed the succession of Gurus, and established the Holy Book, Sri Guru Granth Sahib*, as the next permanent Guru.

In 1699, Guru Gobind Singh established the Order of the Khalsa, a military order of Saint-Warriors, to defend the Sikh religion against the persecution of the Mughal Emperors.

The Khalsa Saint-Warrior is characterized by the Five K's:

Kesh-Uncut Beard/Hair
Kirpan-Strapped sword/dagger
Kanga-Wooden comb
Kara-Steel bracelet
Kacch-underwear

Throughout his life, Guru Gobind Singh was persecuted by the Mughals, fearing that the Sikh religion was getting larger and thus threathening the Islamic religion in India. The Guru was assassinated on October 7, 1708 at the age of 42.

The pictures below are the Gurdwara preparations for the Procession for the Birth Anniversary of Sri Guru Gobind Singh Ji.

The Holy Men are the guardians of the Sikh Faith.

The Saint-Warriors. They are the defenders of the Faith. They are carrying the Kirpan, the traditional sword of Sikhism. Some people think that Sikhism is a terrifying religion because of the existence of these swords. It is actually a very peaceful religion with the aim of equality and goodwill to all men. The Kirpan is just a symbol, just as in Christian religions the Crucifix is a symbol of torture.

Washing of the hands before handling the Holy Book Sri Guru Granth Sahib for the procession

The Saint-Warriors carrying the Holy Book, Sri Guru Granth Sahib, for procession

Next post: The Parade of the Sikhs

*The Sri Guru Granth Sahib is the Holy Book of Sikhism. It contained the writings and hymns of the Ten Sikh Gurus from Guru Nanak Dev up to Sri Guru Gobind Singh Ji.