Clinical Neuroradiology–Neuropathology Conference. December 2010. Patrick Farley, MD (Neuroradiology Fellow) and Thomas Bouldin, MD ( Neuropathologist ). Case #1. CLINICAL HISTORY: 59-year-old man with history of altered mental status and hearing loss. Differential diagnosis.
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Patrick Farley, MD (Neuroradiology Fellow) andThomas Bouldin, MD (Neuropathologist)
CLINICAL HISTORY: 59-year-old man with history of altered mental status and hearing loss.
Brain biopsy revealed a poorly differentiated neoplasm within the leptomeninges and around several intracortical blood vessels. The immunophenotype of the neoplastic cells was consistent with a melanoma. The histologic features do not permit distinction between metastatic melanoma (common) and primary leptomeningeal melanoma (rare).
CLINICAL HISTORY: 21-year-old postpartum woman with a sellar mass.
Biopsy revealed a dense lymphoplasmacytic infiltrate within the anterior pituitary. The gland also showed interstitial fibrosis and a loss of secretory cells. The remaining secretory cells form the clusters of larger, more eosinophilic cells in the photomicrograph.
CLINICAL HISTORY: 73-year-old female with acute headache and right-sided weakness.
Postmortem examination of the brain in this case revealed numerous cortical and leptomeningeal vessels infiltrated by amorphous, eosinophilic amyloid. Inset shows the immunohistochemical staining of the amorphous material for beta amyloid.
Beta Amyloid IHC
CLINICAL HISTORY: 65-year-old man with history of renal cell carcinoma first diagnosed in 1994. He has since had numerous surgeries for metastases to the brain. He also had stereotactic radiosurgery for an olfactory groove-based lesion, which was presumed to be a meningioma.Case #4
CLINICAL HISTORY (continued): A few months later the presumed meningioma developed surrounding edema, became larger, and demonstrated areas of different enhancement intensity and T2 signal.
Biopsy of the olfactory-groove lesion revealed a meningioma (right half of photomicrograph). Also present within the meningioma was a focus of metastatic renal cell carcinoma (left half of photomicrograph).
Lanotte M, et al. Systemic cancer metastasis in a meningioma: Report of two cases and review of the literature. Clinical Neurology and Neurosurgery 111 (2009) 87–93.
CLINICAL HISTORY: 2-year-old African-American girl with left eye strabismus for 9 months.
The intraocular lesion is a small blue cell tumor with neuroblastic (Homer Wright) rosettes (arrows). The histological features of the tumor are typical of a retinoblastoma.