Lateral ventricle central neurocytoma with lipidization: a case report of an underrecognized presentation

A 38-year-old male patient with a 2-week history of intermittent somnolence, recent headaches, and blurred vision presented with a heterogeneous lateral ventricular lesion containing intralesional fat (Figures 1–2). Histopathology confirmed a central neurocytoma (Figure 3), a rare World Health Organization (WHO) grade 2 neuronal tumor, with lipidized cells displaying fat vacuoles but no true adipose metaplasia. Immunohistochemistry showed strong synaptophysin positivity and a low K_i-67 index. This case highlights the rarity of lipidization in lateral ventricular neurocytomas and emphasizes the critical role of neuroradiologists in identifying these features. The presence of fat alone does not confirm liponeurocytoma, and a detailed diagnostic correlation is required.¹–³

Figure 1
Noncontrast (A) and postcontrast (B) axial head computed tomography (CT) scans. Lobulated intraventricular solid lesion (orange arrows), predominantly on the right and centered on the septum pellucidum, with faint enhancement. Adjacent fat foci (white asterisks) demonstrated in the left frontal horn. Fluid entrapment of the left lateral ventricle (blue stars) was noted, secondary to obstruction of the left foramen of Monro (not shown).

Figure 2
Axial brain magnetic resonance (MR) images on T1-weighted (A), T2-weighted (B), fluid-attenuated inversion recovery (FLAIR) (C), T2*-weighted (D), diffusion (E), apparent diffusion coefficient (ADC) map (F), and fat-saturation postcontrast (G) sequences. The intraventricular lobulated solid lesion (orange arrows), predominantly on the right and centered on the septum pellucidum, shows greater conspicuity, with features of microcystic degeneration, hemosiderin foci (white dashed arrow), restricted diffusion (red dashed arrows), and heterogeneous enhancement (G). A small adjacent fat focus (white asterisks) was also observed in the anterior septum pellucidum. There was fluid entrapment of the left lateral ventricle (blue stars) secondary to obstruction of the left foramen of Monro (not shown).

Figure 3
Histopathological features of the central neurocytoma. Hematoxylin and eosin (H&E) stained slides (A 40X; B: 200X) show a neoplasm composed of monomorphic cells with round enlarged nuclei with a stippled chromatin distribution and moderated amounts of eosinophilic cytoplasm. Intimately associated with the neoplastic cells are adipocytes (black arrows). There is no mitotic activity, necrosis, or microvascular endothelial proliferation. Neoplastic cells, but not the adipocytes, are positive for synaptophysin (C: 200X), and essentially negative for glial fibrillary acidic protein (GFAP) (D: 200X), which decorates mainly reactive astrocytes and background gliosis in focal areas. Adipocytes are positive for S100 protein (not shown).

Data Availability Statement

The data used to support the findings of this study are included within the article.

References

• ¹ Al-Umran MR, Al-Umran SR, Arab AF, Dababo MA, Alotaibi FA. Lateral ventricular liponeurocytoma: Review of literature and case illustration. Neurochirurgie 2021;67(06):579–586. Doi: 10.1016/j.neuchi.2021.03.004
  » https://doi.org/10.1016/j.neuchi.2021.03.004
• ² George DH, Scheithauer BW. Central liponeurocytoma. Am J Surg Pathol 2001;25(12):1551–1555. Doi: 10.1097/00000478-200112000-00013
  » https://doi.org/10.1097/00000478-200112000-00013
• ³ Pankaj R, Jindal A, Banerjee AK. Liponeurocytoma of lateral ventricle. Neurology 2010;58(05):805–806. Doi: 10.4103/0028-3886.72195
  » https://doi.org/10.4103/0028-3886.72195

Edited by

• Editor-in-Chief:
  Ayrton Roberto Massaro.

• Associate Editor:
  Antonio José da Rocha.

Publication Dates

• Publication in this collection
  23 May 2025
• Date of issue
  2025

History

• Received
  14 Dec 2024
• Accepted
  23 Jan 2025