—  SPECIALTY CONFERENCE  — Neuropathology Monday, March 22, 7:30 PM Maryland Neuropathology for the General Surgical Pathologist Moderator: DAVID N. LOUIS Massachusetts General Hospital, Boston, MA Disclosure: In accordance with ACCME guidelines regarding disclosure, the USCAP policy requires that faculty members who have a significant financial or other relationship with a commercial company, entity, or service (which will be discussed in this Symposium) must disclose this to attendees. The Academy also requires that speakers disclose any products that are not labeled for the use under discussion. The speakers listed below have indicated they have nothing to disclose. Panelists: M. BEATRIZ LOPES, University of Virginia Health Sciences Center, Charlottesville, VA REBECCA FOLKERTH, Brigham and Women's Hospital, Boston, MA ELISABETH RUSHING, Armed Forces Institute of Pathology, Washington, DC DANIEL J. BRAT, Emory University Hospital, Atlanta, GA DAVID ELLISON, St. Jude Children's Research Hospital, Memphis, TN 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: M. Beatriz Lopes - University of Virginia Health Sciences Center, Charlottesville, VA Clinical Summary: The patient is a 51-year-old who was incidentally found to have pituitary macroadenoma on workup for nasal bleeding and sinusitis. A sellar lesion was noticed on the CT scan which prompted an MRI. The MRI demonstrated a 1.8 x 1.6 x 1.7 cm tumor (Figure 1), most consistent with a macroadenoma. This lesion was displacing the optic chiasm superiorly. In retrospect, the patient has been having blurry vision on the left side associated with headaches for a few months. The patient denies any symptoms consistent with pituitary excess or deficiency syndromes. Her menstrual cycles have been abnormal for the last 3 years. She denies any breast discharge, changes to her hands or feet size or facial appearance, and she denies a significant weight gain. She denies any significant mood disturbances. Her physical examination was unremarkable. The scalp has no focal alopecia. The bony structures of the face are within normal limits. There is no prognathism of the lower jaw. There is no dental malocclusion in the mandibular teeth. Pupils are equal, round, and reactive to light. Extraocular muscles are intact. The neck exam does not reveal any thyromegaly or thyroid nodules. Her laboratorial exams showed a cortisol of 14 at 7:45 in the a.m., growth hormone 0.1, prolactin 9.1, free T4 0.8, TSH 3.1, and ACTH 25; all values within the normal range. FSH and LH were 12.6 and 4.2 respectively, adequate for a peri-menopausal age. The patient underwent a sublabial trans-sphenoidal surgical resection of the lesion. Case 1 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Case 1 - Figure 1 Case 2 Submitted by: Rebecca Folkerth - Brigham and Women's Hospital, Boston, MA Clinical Summary: 18-gestational-week fetus found on prenatal ultrasound and MR to have: Cystic posterior fossa c/w Dandy-Walker malformation (DWM) Bilateral germinal matrix and intraventricular hemorrhage Hydrocephalus Amniocentesis with FISH for trisomies 13, 18, and 21 were normal Mother was 20-year-old G1P0, healthy Case 2 - Figure 1 Case 2 - Figure 2 Case 2 - Figure 3 Case 2 - Figure 4 Case 2 - Figure 5 Case 3 Submitted by: Elisabeth Rushing - Armed Forces Institute of Pathology, Washington, DC Clinical History: The patient is a 29 year-old male who experienced low-back pain of increasing severity that radiated down both legs. Subsequently, he was discovered to have a mass in the region of the cauda equina. Magnetic resonance (MR) imaging showed an intradural mass localized to the conus medullaris and proximal cauda equina. The mass was isointense with spinal cord on all pulse sequences and enhanced prominently after administration of contrast material. At surgery, the tumor appeared as a soft, sausage-shaped and well-encapsulated vascular mass. Case 3 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Case 4 Submitted by: Daniel J. Brat - Emory University Hospital, Atlanta, GA Clinical Summary: A 56-year-old female noticed progressive left-sided weakness in her upper extremity. Her husband stated that she had also had some personality changes and difficulty with verbal expression. An MRI of the brain revealed a large contrast-enhancing mass within the right parietal region, surrounded by T1-hypointense, T2-hyperintense signal changes. A craniotomy was performed and the lesion was subtotally resected. 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 4 - Figure 8 Case 5 Submitted by: David W. Ellison - St. Jude Children's Research Hospital, Memphis, TN Clinical Summary: Child aged 5 years presenting with symptoms and signs of raised intracranial pressure over one week. Signs of mild ataxia on examination. Focally enhancing mass in fourth ventricle. Case 5 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Case 5 - Figure 1 H&E Case 5 - Figure 2 H&E Case 5 - Figure 3 synaptophysin Case 5 - Figure 4 MRI 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.