Solid - Cystic CNS Neoplasm: Histopathological and Radiological Correlation Study

Introduction: Solid-cystic neoplasms of the central nervous system (CNS) present a diagnostic challenge due to overlapping imaging features and broad differential diagnoses. These lesions, which may be primary or metastatic, can affect patients across all age groups and often necessitate histopathological correlation for accurate diagnosis. Aims and Objective:To analyze the radiological and histopathological characteristics of solid-cystic intracranial neoplasms, assess diagnostic concordance, and highlight the importance of radiologic-pathologic correlation in clinical decision-making. Method: A retrospective observational study was conducted on 15 patients diagnosed with solid-cystic CNS lesions at B.J. Medical College, Ahmedabad, from January to May 2025. MRI findings were correlated with histopathological diagnoses based on the WHO 2021 CNS tumor classification. Data regarding demographics, imaging features, tumor location, and histological subtype were analyzed. Results: Patients ranged from 5 to 74 years, with a male predominance (80%). Lesions involved various brain regions, predominantly the fourth ventricle, sellar region, and temporal lobe. MRI showed mixed solid-cystic components, perilesional edema, septations, and occasional calcifications or hemorrhage. Histopathology revealed diverse diagnoses: craniopharyngioma (20%), ependymoma, pleomorphic xanthoastrocytoma, oligodendroglioma, astrocytoma, pilocytic astrocytoma, rosette-forming glioneuronal tumors, and pituitary neuroendocrine tumors. Concordance between imaging and histopathology was observed in 12 of 15 cases. Conclusion: Solid-cystic CNS tumors share overlapping imaging characteristics, often making MRI-based diagnosis inconclusive. Histopathological analysis remains the gold standard for accurate tumor classification and grading. This study underscores the critical role of combined radiologic and histopathologic evaluation in guiding diagnosis and management.