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DNET — SCE Neurology MCQ

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HardNeuro-oncologyDNETSCE Neurology

A 30-year-old has infrequent focal seizures controlled on lamotrigine. MRI reviewed by a specialist neuroradiology MDT shows a radiologically typical dysembryoplastic neuroepithelial tumour with no high-grade features. Serial imaging over 18 months is unchanged and there is no progressive deficit. Which management option is supported?

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Correct answer: B — Continue active MRI monitoring without immediate histological confirmation

NICE allows active monitoring without histological diagnosis for lesions with the typical radiological appearance of a very-low-grade tumour such as DNET when the clinical context is suitable. Stability, controlled seizures and absence of concerning features make surveillance reasonable. If clinical or radiological progression occurs, the MDT should discuss biopsy or resection. Routine radiotherapy and metastatic surveillance are inappropriate for a typical DNET, while antiseizure treatment is determined by the epilepsy rather than by static tumour imaging alone.

Reference: NICE NG99, brain tumours in adults: https://www.nice.org.uk/guidance/ng99/resources/brain-tumours-primary-and-brain-metastases-in-adults-pdf-1837763558341