case_images: PMC11227680_01
case_images: Images A and B: Ultrasonographic study showing multiple well-defined hyperechoic focal lesions diffusely distributed throughout the hepatic (A) and renal (B) parenchyma. Images C and D: Abdominopelvic CT without contrast, axial (C) and coronal (D) cuts, where multiple hypodense focal lesions with fat attenuation (< -20 UH) are visualized, diffusely distributed throughout the hepatic and renal parenchyma. Lesions are consistent with angiomyolipomas.
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case_images: PMC11227680_01_amed-31-061-g001.jpg
case_images: F1
case_images: Abdominal radiological studies showed hepatic and renal lesions with macroscopic fat, consistent with angiomyolipomas (Figure 1).
case_images: Brain MRI study. Image A and B: Axial T2 cut (A) and gradient (B) where the subependymal nodules (yellow arrows) in both lateral ventricles are identified with a drop in signal intensity in the gradient sequence due to calcification. Image C: Coronal T2 FLAIR cut, where several hyperintense cortical-subcortical lesions compatible with cortical tubers are identified (red head arrows).
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case_images: F2
case_images: In the brain MRI, multiple cortical-subcortical hyperintense lesions in T2 FLAIR (Fluid attenuated inversion recovery) were identified, compatible with cortical tubers and multiple subependymal nodules, some calcified, in both lateral ventricles (Figure 2).
case_images: Brain MRI study from successive biannual controls. The upper images are axial T2 cuts, and the lower corresponding images are in T1 sequence with gadolinium. There is an identified enhancement with progressive increase in the size of the subependymal nodule (blue arrows) and the progressive enlargement of the right lateral ventricle.
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case_images: F3
case_images: Comparing with previous studies, an increase in size of a subependymal nodule at the anterior aspect of the right lateral ventricle adjacent to Monro's foramen was observed, associated with an increase in the size of the right lateral ventricle causing monoventricular hydrocephalus (Figure 3).
case_images: Hematoxylin-eosin stained histological section of the subependymal giant cell astrocytoma (A: image at 10x magnification and B: image at 40x magnification). There is a prominent cellular proliferation with multinucleated giant cells, interposed fibrillary septa, and a stroma rich in vessels. The cells exhibit large and pleomorphic nuclei with eosinophilic cytoplasm.
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case_images: F4
case_images: The histopathological examination of the surgical specimen confirmed the clinical suspicion of SEGA (Figure 4).
case_images: Brain MRI study, axial T2 cuts. Image A: Initial study showing normal ventricular size. Image B: Four years later compared to Image A, showing the presence of right monoventricular hydrocephalus and SEGA (blue arrow). Image C: Postoperative study displaying complete resection of the lesion and normalization of ventricular size.
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case_images: PMC11227680_01_amed-31-061-g005.jpg
case_images: F5
case_images: Subsequent radiological controls after total resection of the lesion showed normalization of the size of the right lateral ventricle and stability of the remaining subependymal nodules (Figure 5).