Figure 4.

Neurological and head and neck manifestation in a 64-year-old with PTEN hamartoma tumor syndrome (Cowden syndrome). FLAIR (a) and T2 (b) axial images through the posterior fossa reveal characteristic imaging findings of dysplastic cerebellar gangliocytoma (Lhermitte-Duclos disease). This is seen as widened cerebellar folia with a striated/tigroid appearance, also described as “corduroy/laminated” appearance with diffusely increased T2 signal (arrow). Oral papilloma along the hard palate on CT (c, arrow), seen as a nodular enhancing well-defined mass. Photograph of the lobulated smooth papilloma along the hard palate (d, arrow). Oral papillomas are a major diagnostic criterion for Cowden syndrome and are present in virtually all patients.