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Neuropathology
Tuesday, March 27, 2007, 7:30 PM
Convention Center 10
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Moderator:
GREGORY N. FULLER
M.D. Anderson Cancer Center
Houston, TX
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Submitted by: Suzanne Z. Powell - The Methodist Hospital, Houston, TX
A 24-year-old woman with history of acute lymphoblastic leukemia that was non-responsive to chemotherapy underwent an allogenic stem cell transplant from a matched unrelated donor. She developed graft-versus-host disease and was treated with steroids. Clinical findings at the current presentation included elevated liver function tests of unknown etiology, joint pain, nausea and vomiting. MR imaging of the brain showed multiple lesions in the cerebral hemispheres bilaterally, corpus callosum and cerebellum, including a large (4.5 cm diameter) ring-enhancing mass of the right fronto-parietal region. MR images of the head and neck revealed a necrotic mass (0.7 cm diameter) in the superior aspect of the left orbit. Biopsy of the right fronto-parietal lesion was performed.
Case 1 - Slide 1
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Case 1 - Slide 2
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Submitted by: Bette K. Kleinschmidt-DeMasters - University of Colorado School of Medicine, Denver, CO
A 59-year-old male presented with a six-month history of intermittent weakness of his right foot, which had progressively worsened. Past medical history was positive for surgery for a left parotid gland basal cell adenoma ("carcinoma") in 1994 (records unclear), and for removal of multiple benign cutaneous scalp lesions. Family history was positive for several family members who also had similar multiple benign skin lesions.
His intermittent weakness was initially felt to be ischemic in origin, but he subsequently had two additional episodes of expressive aphasia that prompted further workup. Magnetic resonance imaging studies revealed a large 4.0 x 3.9 cm contrast-enhancing parasagittal mass suspicious for a bony-erosive meningioma (Case2 - Figure 1). The intracranial lesion appeared to be in continuity with a bulging, fixed cutaneous scalp lesion measuring 5 x 4 cm. The patient was taken for neurosurgical resection of the mass. Intraoperatively, the tumor extended across dura but did not appear to invade the underlying brain; a near gross-total resection was achieved.
Case 2 - Slide 1
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Submitted by: Tarik Tihan - The University of California, San Francisco, CA
A 67-year-old woman with a history of a T7-T8 "malignant peripheral nerve sheath tumor" that had been resected twice followed by a T5-10 posterior spinal fusion presented with a two-week history of worsening left lower extremity weakness, headache, loss of coordination, difficulty walking, nausea and vomiting. A head CT scan preformed at the referring hospital revealed a 5 x 5 x 3 cm right parietal parasagittal mass accompanied by significant edema and right-to-left midline shift. Craniotomy with resection of the mass was performed.
Case 3 - Slide 1
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Submitted by: Mark A. Edgar - Memorial Sloan Kettering Cancer Center, New York, NY
A 50-year-old man with a clinical history of neurofibromatosis presented to MSKCC for a second opinion regarding treatment of a soft tissue tumor. A longstanding left arm mass had become painful and enlarged over the course of several months and open biopsy had been performed at an outside medical center. Several months after biopsy of the arm mass the patient developed a T2 spinal tumor with epidural compression. The mass was subsequently resected.
Case 4 - Slide 1
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Submitted by: Anthony T. Yachnis - University of Florida College of Medicine, Gainesville, FL
A 37-year-old HIV-positive African-American male presented with a six-month history of progressively worsening vision on the left and recent development of persistent bifrontal headaches. On examination, he was almost completely blind on the left. MRI revealed a 5.5 x 5.0 x 4.0 cm heterogeneously enhancing mass involving much of the left anterior cranial fossa, which extended to the right cerebral hemisphere and involved the skull base. There was significant mass effect and vasogenic edema of the adjacent brain.
The past medical history was significant for a diagnosis of AIDS two years prior to admission, for which the patient was treated with Combivir, Viramune and Azithromycin. About a year before the current admission, he presented with back pain of two weeks duration and was found to have a 10 cm mass involving the T6 and T7 vertebral bodies with cord compression at T7. Biopsy revealed a plasma cell neoplasm that was CD79a and CD138 immunoreactive and was lambda light-chain restricted by in situ hybridization. Radiation therapy produced marked reduction in the size of this lesion with disappearance of circulating paraprotein.
A craniotomy was performed for resection and diagnosis of the intracranial tumor. Intra-operatively, the mass was noted to be entirely extra-axial and appeared to invade the floor of the anterior cranial fossa. The neoplasm was firm and somewhat elastic peripherally but softer and gelatinous internally and could be readily separated from the adjacent cerebral surface. A near total resection was performed, which provided diagnostic material
Case 5 - Slide 1
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During the meeting the slides and protocols will be available for study in the microscope
room in the Manchester Grand Hyatt (Betsy A-C) for participants who wish to review them prior to the
evening session.
Handouts for all Specialty Conferences will be accessible via the
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copies of the handout will not be available at the meeting. However, we will provide a booklet at the
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for the important "take home messages".
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