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Neuropathology
Monday, March 22, 7:30 PM
Maryland
Clinical histories are printed below.
Click on the case numbers for text and references of each case.
Click on each slide thumbnail image for an enlarged view
Neuropathology for the General Surgical Pathologist
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Moderator:
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DAVID N. LOUIS
Massachusetts General Hospital, Boston, MA
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Disclosure:
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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.
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Panelists:
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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
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Clinical histories are displayed below.
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for Text and References
Submitted by: M. Beatriz Lopes - University of Virginia Health Sciences Center, Charlottesville, VA
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
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Case 1 - Figure 1
T1-weighted sagittal MRI and T1-weighted MRI with gadolinium (left) showing a sellar-suprasellar lesion with compression of the optic chiasma.
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Case 1 - Figure 2
Elongated, fibrillary cells arranged in fascicular pattern.
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Case 1 - Figure 3
High magnification highlights the fibrillary nature of the tumor cells.
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Case 1 - Figure 4
Sharp demarcation with normal anterior pituitary is seen on H&E and reticulin (Figure 5).
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Case 1 - Figure 5
The tumor cells lack pericellular deposition of reticulin. Reticulin impregnation highlights the sharp demarcation with the anterior pituitary.
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Case 1 - Figure 6
Tumor cells are strongly immunoreactive for GFAP.
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Case 1 - Figure 7
A subset of cells shows immunoreactivity for vimentin.
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Case 1 - Figure 8
The majority of tumor cells are immunoreactive for S-100.
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Case 1 - Figure 9
Ultrastructural analysis reveals spindle cells with abundant intermediate filaments. There is no pericellular deposition of basal lamina-like materials.
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Case 1 - Figure 10
The cells lack neurosecretory granules and abundant mitochondria.
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for Text and References
Submitted by: Rebecca Folkerth - Brigham and Women's Hospital, Boston, MA
- 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
for Text and References
Submitted by: Elisabeth Rushing - Armed Forces Institute of Pathology,
Washington, DC
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
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for Text and References
Submitted by: Daniel J. Brat - Emory University Hospital, Atlanta, GA
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
Coronal, post-contrast magnetic resonance (MR) image showing a contrast-enhancing mass involving the right parietal lobe surrounded by T1-hypointensity.
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Case 4 - Figure 2
Histologic section revealing a mixed neoplastic population of moderate cellular density dominated by astrocytoma cells but also showing scattered oligodendroglioma cells.
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Case 4 - Figure 3
Histologic sections showing a mixed population of astrocytoma and oligodendroglioma cells.
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Case 4 - Figure 4
Histologic sections showing a mixed population of astrocytoma and oligodendroglioma cells.
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Case 4 - Figure 5
Histologic section showing neoplastic cells with predominantly oligodendroglioma differentiation.
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Case 4 - Figure 6
Histologic section demonstrating microvascular hyperplasia within this glial neoplasm.
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Case 4 - Figure 7
Histologic sections demonstrating focal necrosis within this glial neoplasm.
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Case 4 - Figure 8
Histologic sections demonstrating focal necrosis within this glial neoplasm.
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for Text and References
Submitted by: David W. Ellison - St. Jude Children's Research Hospital, Memphis, TN
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
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