Presenter

Shervin Pejhan

Authors

Shervin Pejhan¹, Ryan Wang², Sachin Pandey³, Joseph Megyesi², Claire Coire⁴, Lee Cyn Ang^1,2

¹ Department of Pathology & Lab Medicine, Western University, ON, Canada

² Department of Clinical Neurological Sciences, Western University, ON, Canada

³Department ofMedical Imaging, Western University, ON, Canada

⁴ Department of Pathology, Trillium Health Partners, Mississauga Hospital, ON, Canada

Conflict of Interest

I do not have a relationship with a for-profit and/or a not-for-profit organization to disclose.

Clinical Summary

A 76-year-old gentleman presented to the hospital with nausea, and vomiting, after his diabetes medication was switched from Empagliflozin to metformin. He had also a worsening gait instability for more than a year, and a coincidental headache during that admission that ended up in a CT-head which showed a mass in the 4^th ventricle without obstructive hydrocephalus. His past medical history was curious for a low-grade prostatic adenocarcinoma (stage pT1a), diagnosed by TURP more than 4 years ago, left lower lung lobectomy of unknown reason in 2011, and a spinal tumor resected in 2002. The MRI showed a T2 weighted hyperintense mass centered in the 4th ventricle (2.9 x 2.9 x 2.5 cm). The lesion demonstrated heterogeneous enhancement, with apparent solid and cystic components. He underwent suboccipital craniectomy and resection of the 4th ventricular mass.