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Slide Seminar 07 - Pitfalls in Surgical Neuropathology
Monday, September 18, 2006 08:00 - 12:00
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Moderators:
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Dr. Arie Perry and Dr. Richard A. Prayson
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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 Slide Seminar) must disclose this to attendees. The Academy also requires that speakers disclose any products that are not labeled for the use under discussion. Dr. Gregory N. Fuller indicated he receives book royalties from Lippincott, Williams & Wilkins and Jones & Bartlett. All other faculty members for this Slide Seminar have indicated they have no disclosures to make.
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Clinical histories are displayed below.
Click on the case numbers to display the text and references for each case.
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- Multifocal Glioblastoma (WHO Grade IV)
Submitted by: Pieter Wesseling, M.D., Ph.D
A 63-year-old woman presented with a history of disturbed ocular motility and nausea. MRI scans revealed multiple, contrast-enhancing intracerebral lesions (corpus callosum, left frontal lobe, left cerebellar peduncle and hemisphere; see MR images below). A needle biopsy was taken of the lesion in the corpus callosum (Pieter Wesseling, MD, PhD, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands).
Case 1 - Figure 1
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- Combined Granular Cell and Small Cell Malignant Astrocytoma
Submitted by: Teresa Ribalta, M.D., Ph.D
A 58-year-old woman developed headaches and speech difficulties over the course of three weeks. MRI scan of the brain showed a 3 cm mass with focal enhancing areas in the left frontal lobe. A gross total resection of the lesion was performed (Teresa Ribalta, MD, PhD, Hospital Clinic, University of Barcelona, Barcelona, Spain).
Case 2 - Figure 1
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- Monomorphous Angiocentric Glioma/angiocentric Neuroepithelial Tumor
Submitted by: Gregory N. Fuller, M.D., Ph.D.
A 4-year-old girl presented with a 2-month history of medically-intractable seizures. An MRI scan revealed the presence of a 1.5cm diameter non-enhancing mass of the right fronto-parietal cerebral cortex. The mass was gross totally resected (Gregory N. Fuller, MD, PhD, M D Anderson Cancer Center, Houston, TX, USA).
Case 3 - Figure 1
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- Anaplastic Clear Cell Ependymoma, WHO Grade III
Submitted by: Arie Perry, M.D.
A 36-yo man presented with headache and progressive left sided weakness. MRI revealed an enhancing right temporal lobe mass, composed of 6 x 3.5 cm. solid and 7 x 5 cm. cystic components. A complete resection was performed and the patient was subsequently treated on protocol with PCV chemotherapy and radiation. He is free of disease at last followup 5 years later (Arie Perry, MD, Washington University School of Medicine, St. Louis, MO, USA).
Case 4 - Figure 1
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- If it Looks Like a Tumor, but it Isn't...
Submitted by: Paul Van Der Valk, M.D, Ph.D.
The patient was a woman of 31 years, on holiday in Sri Lanka, when she suddenly experienced loss of function of the right side of her body. She was transported back home to The Netherlands, where a MRI showed a fairly large lesion deep in the left hemisphere, ring-shaped and enhancing, and suspicious of glioblastoma multiforme or an abscess. No systemic signs, such as fever. Stereotactic biopsy was performed. During the work-up the patient reported possible improvement in strength and function of here right arm and leg (Paul van der Valk, MD, PhD, VU Medical Center, Amsterdam, The Netherlands).
Case 5 - Figure 1
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- Primary Nonhodgkin’s Lymphoma of the CNS – Diffuse Large B Cell Type
Submitted by: Dr. Richard A. Prayson
The patient is a 64 year old male with a history of pituitary adenoma resected 28 years ago. He was treated with radiation therapy at that time and developed panhypopituitarism. His residual pituitary adenoma has remained stable on followup imaging studies. He was treated with steroids and testosterone. Four months prior to his most recent surgery, he presented with complaints of progressive left-sided hearing loss with tinnitus, diplopia, left lid ptosis and imbalance difficulties (which the family attributed to the patients hearing loss). A MRI study indicated that the sellar lesion appeared stable; a new lesion measuring 2.5 x 2.0 x 2.0 cm was present in the left cerebellum and was interpreted as a meningioma. Two months preoperatively, another MRI study indicated that the lesion in the cerebellum had grown (3.0x2.5x2.0cm). A cerebrospinal fluid study showed reactive lymphocytosis. The patient's dosage of steroids was increased. His balance problem became progressively worse. He underwent a suboccipital craniotomy with excision of the left cerebellar lesion (Richard A. Prayson, MD, Cleveland Clinic Foundation, Cleveland, OH, USA).
Case 6 - Figure 1
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- Intracranial Olfactory Neuroblastoma
Submitted by: Dr. H.K. Ng
A 61-year-old taxi driver, a known alcoholic, presented to the Accident and Emergency Department following a minor head injury with drowsiness, confusion and double incontinence. CT scan of the brain demonstrated a huge mixed density left frontal lobe tumour. A left frontal craniotomy was performed for tumour excision and the origin of the tumour was thought to be dural (H-K Ng, MD, Chinese University of Hong Kong, Shatin, NT, China).
Case 7 - Figure 1
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