December 2000: 6 month old boy with 2 week history of progressive lethargy- Diagnosis - Desmoplastic infantile ganglioglioma (DIG).

The December COM: This 6-month-old Caucasian boy presented with a in-day hi story of lethargy, obtundation, inability to hold his head up and mild tort icollis. MRI and CT scans showed a large solid and cystic mass involving th e right temporal, parietal and occipital lobes, pineal, superior pens, mese ncephalon and posterior right thalamus. He underwent craniotomy initially f or a partial tumor resection with an intraoperative diagnosis of desmoplast ic astrocytoma. With immunohistochemistry and special stains the diagnosis of desmoplastic infantile ganglioglioma (DIG) was made. A near total resect ion was performed a week after initial resection. The patient then was trea ted with chemotherapy. Two months later an MRI showed tumor growth. Followi ng additional aggressive chemotherapy, an MRI at 5 months post-resection in dicated further tumor progression. This case illustrates that some DIGs may behave more aggressively than typical WHO grade I lesions.