IS case 478: Hypothalamic hamartoma

Lisa Siripun, MD

University of Rochester

Imaging Sciences URMC 2010
Publication Date: 2010-08-30

History

Patient is an-11-year-old male presenting with gelastic seizures.

Findings

Axial and sagittal T1, coronal T2 and axial T1 fat saturation post-contrast images demonstrated an ovoid, mass measuring in the region of the tuber cinereum of the hypothalamus between the infundibular stalk, anteriorly, and the mamillary body, posteriorly, which extends upward within the third ventricle. There was no evidence of enhancement of the mass on post-contrast image.

Diagnosis

Hypothalamic hamartoma

Discussion

Hypothalamic hamartomas are developmental malformations located in the tuber cinereum of the hypothalamus. Most of the neurons in a hamartoma are similar to normal hypothalamic neurons. Most patients present in the first or second decade of life, with boys being more commonly affected than girls. Boyko, et al. [4] classified hypothalamic hamartomas into two types: the pedunculated type which is more likely to be associated with precocious puberty, and the sessile type often associated with gelastic seizures. Hypothalamic hamartomas < 1 cm usually present with precocious puberty, whereas lesions >1 cm usually present with gelastic seizures. The most common tumoral cause of central precocious puberty is hypothalamic hamartoma, the incidence ranging from 14–58%.

Findings on MRI include well-defined pedunculated or sessile lesions at the tuber cinereum and are isointense or mildly hypointense on T1-weighted images and iso- to hyperintense on T2-weighted images, with no contrast enhancement or calcification. Proton MR spectroscopy shows normal choline and creatine but mildly to moderately decreased NAA.The absence of any long-term change in the size, shape, or signal intensity of the lesion strongly supports the diagnosis of hypothalamic hamartoma.

Differential diagnosis of hypothalamic hamartoma may include craniopharyngioma and optic-hypothalamic gliomas

References

  1. Saleem SN, Said AH, Lee DH. Lesions of the hypothalamus: MR imaging diagnostic features. Radiographics. 2007 Jul-Aug;27(4):1087-108. PMID: 17620469
  2. Kizilkilic O, Yalcin O, Yildirim T, et al. Hypothalamic hamartoma associated with a craniopharyngeal canal. AJNR Am J Neuroradiol. 2005 Jan;26(1):65-7. PMID: 15661703
  3. Castillo M. The Core Curriculum: Neuroradiology. Philadelphia: Lippincott Williams and Wilkins, 2002; 175.
  4. Boyko OB, Curnes JT, Oakes WJ, Burger PC. Hamartomas of the tuber cinereum: CT, MR, and pathologic findings. AJNR Am J Neuroradiol. 1991 Mar-Apr;12(2):309-14. PMID: 1902033

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