0:00

Dr. Laser,

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we've been following this hemangioblastoma

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for six years on up.

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Patient is now about 35 years of age.

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We're talking about how these change and grow and mature.

0:11

You already established in a prior vignette

0:13

that when they come back, they could have been solid.

0:15

Now, they're cystic.

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They were cystic.

0:16

Now, they're solid.

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And this one, not only has it grown,

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but for you gen rads out there,

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general radiologists, residents and fellows,

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look at what it's done.

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It is compressed the fourth ventricle.

0:27

You can see the nodulus of the cerebellum

0:30

pressed right up against the medulla.

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And as we come up,

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we see the ventricles are dilated.

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So this patient has developed obstructive

0:38

hydrocephalus at the level of the fourth ventricle.

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And we've got a much larger lesion if you look

0:45

at the earlier vignettes,

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and the lesion has actually changed.

0:49

So Dr. Laser, tell me about the characteristics

0:52

of hemangioblastoma.

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So, hemangioblastomas are a true neoplasm

0:56

of endothelial origin.

0:58

They are...

0:59

they have intense hypervascular character.

1:01

So they can be capillary to sinusoidal,

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they can have a dilating feeding artery,

1:05

they can have a dilated feeding vein,

1:07

they can have slow flow.

1:09

Typically, they're made up of stromal cells.

1:11

They have foamy lipid-laden properties,

1:14

and they do not contain any amyloid.

1:16

So, what do we see inside this one?

1:19

I mean, it's got a very heterogeneous character

1:20

that it didn't have so much before.

1:22

What are we looking at?

1:23

So, we're looking at a couple of things.

1:24

One of them is that this lesion has

1:27

changed character.

1:27

Now it has it's predominantly solid with several

1:30

different cystic areas.

1:31

It has all these tiny little serpiginous flow voids

1:33

and cystic components.

1:35

Yeah, these little dark squiggly

1:36

things are flow voids.

1:37

And that is really inconsistent with, say,

1:40

a pilocytic tumor, and many other tumors.

1:43

Sometimes you'll actually see a nodule in a

1:46

classic scenario where you've got a cyst and

1:48

then the nodule is pretty good size.

1:50

And then inside that nodule are flow voids

1:52

that are dotted and somewhat serpiginous,

1:55

and that's very typical of a hemangioblastoma.

1:58

So this one has recurred with a very

2:01

bizarre internal character to it.

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Cystic components, dark on T1,

2:04

bright on T2,

2:05

and serpiginous flow void components,

2:07

you can see a little bit of them right there.

2:09

And you can see them a little better on the

2:12

susceptibility-weighted or blood-sensitive image right there,

2:14

especially there and there,

2:16

denoting the hypervascularity of this lesion.

2:19

Any other comments?

2:20

Nope.

2:20

Laser and P out.

2:21

All right.