—  SPECIALTY CONFERENCE  — Neuropathology Wednesday, March 5, 2008 , 7:30 PM Convention Center 103 Click the button above to add this event to your Itinerary Planner... Moderator: GREGORY N. FULLER M.D. Anderson Cancer Center Houston, TX Clinical histories are displayed below. For the fastest viewing of virtual slides, click: under each thumbnail image below. You must have Aperio ImageScope installed on your PC. If you do not already have Aperio ImageScope, Windows users with administrator privileges may download and install a free version in order to view USCAP Virtual Slides. Click the icon on the right to get your free copy:   Or, click on slide thumbnail images to view each slide in a Web-based slide viewer, which is somewhat slower. If you have any difficulties viewing these slides, email or call George Clay at +1.724.449.1137. Case 1 Submitted by: Anthony T. Yachnis - University of Florida College of Medicine, Gainesville, FL Clinical Summary: A previously well 35-year-old man presented with new onset tonic clonic seizures. Imaging revealed bilateral, contrast-enhancing masses that were thought to represent meningiomas. There was no family history of neurofibromatosis (types 1 or 2), and the past medical history was unremarkable. The patient underwent a craniotomy with complete excision of the larger, symptomatic, right-sided lesion together with a margin of uninvolved dura mater. No intra-operative frozen section was requested. The second (left) lesion was surgically removed at a later time. Case 1 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Case 1 - Figure 1 Case 1 - Figure 2 Case 1 - Figure 3 Case 1 - Figure 4 Case 1 - Figure 5 Case 1 - Figure 6 Case 1 - Figure 7 Case 1 - Figure 8 Case 2 Submitted by: Thomas J. Cummings - Duke University, Durham, NC Clinical Summary: An otherwise healthy 43-year-old man presented with a one-year history of persistent neck pain. There was no history of trauma. On physical examination, pain was elicited on lateral neck rotation, and his neck had limited range of motion. The remainder of the neurologic examination was unremarkable. MRI of the cervical spine showed a 1.8 x 1.7 cm intradural, extramedullary, heterogeneously-enhancing mass at the level of the foramen magnum. There was mass effect upon the cervical spinal cord and medulla, with lateral displacement of the spinal cord. The patient underwent a suboccipital craniectomy and C1 laminectomy. Intraoperatively, the tumor was described as "rock hard" and was removed in a piecemeal manner. Case 2 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Case 2 - Figure 1 Case 2 - Figure 2 Case 2 - Figure 3 Case 2 - Figure 4 Case 2 - Figure 5 Case 2 - Figure 6 Case 2 - Figure 7 Case 2 - Figure 8 Case 2 - Figure 9 Case 2 - Figure 10 Case 3 Submitted by: Suzanne Powell - The Methodist Hospital, Houston, TX Clinical Summary: A 71-year-old man presented with a 4-week history of word finding difficulty. An initial screening head CT followed by an MRI scan revealed a large ring-enhancing mass of the left temporal lobe that abutted the dura. The patient was referred to a tertiary care hospital where craniotomy and surgical resection of the mass were performed. Case 3 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Case 3 - Figure 1 Case 3 - Figure 2 Case 3 - Figure 3 Case 3 - Figure 4 Case 3 - Figure 5 Case 3 - Figure 6 Case 3 - Figure 7 Case 3 - Figure 8 Case 3 - Figure 9 Case 3 - Figure 10 Case 3 - Figure 11 Case 4 Submitted by: Bette K. Kleinschmidt-DeMasters - University of Colorado School of Medicine, Denver, CO Clinical Summary: The patient is a 46-year-old man who presented with approximately 1-2 years of shaking in the right hand, which progressed to increasing clumsiness of the hand, with dropping things. This prompted a visit to a neurologist. Neuroimaging studies showed several non-contiguous, intracerebral, non-dural based abnormalities in the left frontal lobe, associated with cerebral edema. These were interpreted as likely to be metastatic carcinoma or infectious in etiology. Case 4 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Case 4 - Figure 1 Case 4 - Figure 2 Case 4 - Figure 3 Case 4 - Figure 4 Case 4 - Figure 5 Case 4 - Figure 6 Case 4 - Figure 7 Case 5 Submitted by: Tarik Tihan - The University of California, San Francisco, CA Clinical Summary: The patient is a 51-year-old right-handed female who recently underwent a fine needle aspiration/drainage of a thyroid cyst, after which she developed low-grade but persistent headaches. Due to the prolonged nature of her headaches she was readmitted to determine a possible cause. She had a history of thyroid cysts, cesarean section 16 years previously, and a history of iron deficiency anemia. A CT imaging study showed a calcified mass in the left frontal lobe, consistent with neoplasm. MRI studies revealed a large, wedge-shaped, well-demarcated T2/FLAIR-hyperintense lesion measuring approximately 5.2 x 5.3 in transaxial dimension located in the left middle and inferior frontal lobe area extending from the cortical surface to the adjacent ventricle. The lesion also involved a portion of the left external/extreme capsule, the subinsular region, and the anterior limb of the left internal capsule. This lesion demonstrated areas of T2 hypointensity, which was attributed to possible calcification. The mass did not demonstrate significant enhancement except for a small focus located in the inferior aspect of the left gyrus rectus. The degree of mass effect for a lesion of the size imaged was minimal. Perfusion imaging demonstrated increased cerebral blood volume within the mass compared to adjacent normal brain, and this raised the possibility of oligodendroglioma. The patient was admitted for elective resection and underwent a left frontotemporal craniotomy. During the course of language mapping, frequent brief and self-limited after-discharges were elicited from multiple sites. Spontaneous epileptiform discharges were also recorded adjacent to the mass. Post-operative MRI showed a near gross total resection of the T2-hyperintense lesion in the left frontotemporal lobe, with residual FLAIR hyperintensity in the medial and posterior resection cavity walls, as well as a thin area of reduced diffusion around the resection cavity. Case 5 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Case 5 - Slide 2 Click to view with ImageScope Click to view with a Web-Based Viewer Case 5 - Figure 1 Case 5 - Figure 2 Case 5 - Figure 3 Case 5 - Figure 4 Case 5 - Figure 5 Case 5 - Figure 6 Case 5 - Figure 7 Case 5 - Figure 8 Case 5 - Figure 9 Case 5 - Figure 10 Case 5 - Figure 11 Case 5 - Figure 12 If there are glass slides for a conference, they will be available for study in the microscope room in the Convention Center Room 101 for participants who wish to review them prior to the evening session. Handouts for all Specialty Conferences will be accessible via the "Educational Materials" section on the homepage the morning after each respective conference. Printed copies of the handout will not be available at the meeting. However, we will provide a booklet at the meeting which will have a page for each Specialty Conference, listing the names of speakers and space for the important "take home messages".