Case 83

Clinical history

45 year old woman with a lesion in the left temporal lobe.

Primary image

Supratentorial lesion. H&E stain.

Intermediate magnification
Intermediate magnification. H&E stain.

High magnification
High magnification. H&E stain.

Differential diagnosis

Differential diagnosis
Astrocytoma, Oligodendroglioma, pilomyxoid astrocytoma, dysembryoplastic neuroepithelial tumor

Additional tests

More history

More history
The lesion shows no enhancement after CM application.

Ask a friend

Ask a friend
Extensive microcyst formations and mucoid degeneration is indicative of a protoplasmic glial brain tumor.

Stains

Alcian blue/PAS to Bilirubin Test Result Alcian blue/PAS I'm sorry but this is of no help. Alican blue pH 1.0 I'm sorry but this is of no help. Alcian blue pH 2.5 I'm sorry but this is of no help. Auramine I'm sorry but this is of no help. Bielchowsky I'm sorry but this is of no help. Bilirubin I'm sorry but this is of no help.	Colloidal iron to Fontana-Masson Test Result Colloidal iron I'm sorry but this is of no help. Congo red I'm sorry but this is of no help. Cresyl violet I'm sorry but this is of no help. Dieterle I'm sorry but this is of no help. Diff Quik I'm sorry but this is of no help. Fontana-Masson I'm sorry but this is of no help.	Gallyas to Gremelius Test Result Gallyas I'm sorry but this is of no help. Giemsa I'm sorry but this is of no help. GMS I'm sorry but this is of no help. Gomori's trichrome I'm sorry but this is of no help. Gram I'm sorry but this is of no help. Gremelius I'm sorry but this is of no help.	JMS to Mucicarmine Test Result JMS I'm sorry but this is of no help. Jones I'm sorry but this is of no help. Kinyoun I'm sorry but this is of no help. Luxol fast blue I'm sorry but this is of no help. Masson trichrome I'm sorry but this is of no help. M-MAS I'm sorry but this is of no help. Movat I'm sorry but this is of no help. Mucicarmine I'm sorry but this is of no help.	Oil red O to Prussian blue Test Result Oil red O I'm sorry but this is of no help. Orecein I'm sorry but this is of no help. PAS I'm sorry but this is of no help. PASD I'm sorry but this is of no help. PASF I'm sorry but this is of no help. PTAH I'm sorry but this is of no help. Prussian blue I'm sorry but this is of no help.	Reticulin to Ziehl-Neelsen Test Result Reticulin This stain highlights the capillaries within the tumor Sudan black B I'm sorry but this is of no help. Toluidine blue I'm sorry but this is of no help. Verhoeff I'm sorry but this is of no help. Von Kossa I'm sorry but this is of no help. Warthin-Starry I'm sorry but this is of no help. Ziehl-Neeslen I'm sorry but this is of no help.

IHC

Alpha-1 AT to Cathepsin K Test Result alpha-1 AT I'm sorry but this is of no help. ACTH I'm sorry but this is of no help. AE1/AE1 NEGATIVE alpha-fetoprotein I'm sorry but this is of no help. Alk-I I'm sorry but this is of no help. AMACR I'm sorry but this is of no help. AR I'm sorry but this is of no help. ATRX Beta2-microglobulin I'm sorry but this is of no help. B72.3 I'm sorry but this is of no help. Beta-catenin I'm sorry but this is of no help. BCL2 I'm sorry but this is of no help. BCL6 I'm sorry but this is of no help. BCLxL I'm sorry but this is of no help. C3 comp I'm sorry but this is of no help. CA9 I'm sorry but this is of no help. Calcitonin I'm sorry but this is of no help. Calponin I'm sorry but this is of no help. Calretinin I'm sorry but this is of no help. CAM5.2 I'm sorry but this is of no help. Cathepsin K I'm sorry but this is of no help.	CD10 to Chromogranin Test Result CD10 I'm sorry but this is of no help. CD117 I'm sorry but this is of no help. CD138 I'm sorry but this is of no help. CD15 I'm sorry but this is of no help. CD1a I'm sorry but this is of no help. CD20 I'm sorry but this is of no help. CD21 I'm sorry but this is of no help. CD23 I'm sorry but this is of no help. CD3 I'm sorry but this is of no help. CD30 I'm sorry but this is of no help. CD31 I'm sorry but this is of no help. CD34 NEGATIVE CD35 I'm sorry but this is of no help. CD4 I'm sorry but this is of no help. CD43 I'm sorry but this is of no help. CD45 (LCA) NEGATIVE CD5 I'm sorry but this is of no help. CD56 I'm sorry but this is of no help. CD57 I'm sorry but this is of no help. CD68 I'm sorry but this is of no help. CD7 I'm sorry but this is of no help. CD79a I'm sorry but this is of no help. CD8 I'm sorry but this is of no help. CD99 I'm sorry but this is of no help. CDX2 I'm sorry but this is of no help. CEA-m I'm sorry but this is of no help. Chromogranin I'm sorry but this is of no help.	CK17 to Glypican 3 Test Result CK17 I'm sorry but this is of no help. CK19 I'm sorry but this is of no help. CK20 I'm sorry but this is of no help. CK34betaE12 I'm sorry but this is of no help. CK5/6 I'm sorry but this is of no help. CK7 I'm sorry but this is of no help. CMV I'm sorry but this is of no help. c-MYC I'm sorry but this is of no help. Cyclin D1 I'm sorry but this is of no help. D2-40 I'm sorry but this is of no help. Desmin I'm sorry but this is of no help. DOG1 I'm sorry but this is of no help. EBV I'm sorry but this is of no help. EMA NEGATIVE ER and PR I'm sorry but this is of no help. Factor VIII I'm sorry but this is of no help. Factor XIIIa I'm sorry but this is of no help. Fascin I'm sorry but this is of no help. FH I'm sorry but this is of no help. FSH I'm sorry but this is of no help. Gastrin I'm sorry but this is of no help. GATA3 I'm sorry but this is of no help. GCDFP-15 (BRST2) I'm sorry but this is of no help. GFAP GH I'm sorry but this is of no help. Glucagon I'm sorry but this is of no help. Glypican-3 I'm sorry but this is of no help.	HBME-1 to IgM Test Result HBME-1 I'm sorry but this is of no help. HBV core I'm sorry but this is of no help. HBV surface I'm sorry but this is of no help. H-caldesmon I'm sorry but this is of no help. HCG I'm sorry but this is of no help. Helicobacter I'm sorry but this is of no help. Hepatocyte I'm sorry but this is of no help. HER2/neu I'm sorry but this is of no help. HHV-8 I'm sorry but this is of no help. HMB-45 I'm sorry but this is of no help. HNF1beta I'm sorry but this is of no help. HPV I'm sorry but this is of no help. HSV-I I'm sorry but this is of no help. HSV-II I'm sorry but this is of no help. IDH-1 Inhibin I'm sorry but this is of no help. INI1 (BAF47) I'm sorry but this is of no help. Insulin I'm sorry but this is of no help. Kappa I'm sorry but this is of no help. Ki-67 Lambda I'm sorry but this is of no help. Leu 7 I'm sorry but this is of no help. IgA I'm sorry but this is of no help. IgG I'm sorry but this is of no help. IgM I'm sorry but this is of no help.	LH to PDGFR Test Result LH I'm sorry but this is of no help. LIN28 I'm sorry but this is of no help. Lysozyme I'm sorry but this is of no help. mammoglobin I'm sorry but this is of no help. MAP2 MCV I'm sorry but this is of no help. Melanin A I'm sorry but this is of no help. MHC class I I'm sorry but this is of no help. MITF I'm sorry but this is of no help. MUM1 I'm sorry but this is of no help. Myeloperoxidase I'm sorry but this is of no help. MYO D1 I'm sorry but this is of no help. Myoglobin I'm sorry but this is of no help. Napsin I'm sorry but this is of no help. NF NEGATIVE NKX3.1 I'm sorry but this is of no help. NSE NEGATIVE OCT3/4 I'm sorry but this is of no help. p16 I'm sorry but this is of no help. P501S I'm sorry but this is of no help. p53 I'm sorry but this is of no help. p57 I'm sorry but this is of no help. p63 I'm sorry but this is of no help. Pankeratin NEGATIVE PAX2 I'm sorry but this is of no help. PAX5 I'm sorry but this is of no help. PAX8 I'm sorry but this is of no help. PCNA I'm sorry but this is of no help. PDGFR I'm sorry but this is of no help.	PLAP to WT1 Test Result PLAP I'm sorry but this is of no help. PNL-2C I'm sorry but this is of no help. Prolactin I'm sorry but this is of no help. PSA I'm sorry but this is of no help. PSAP I'm sorry but this is of no help. RCC I'm sorry but this is of no help. S-100 POSITIVE SALL4 I'm sorry but this is of no help. Smooth muscle actin I'm sorry but this is of no help. Somatostatin I'm sorry but this is of no help. STAT6 I'm sorry but this is of no help. Synaptophysin I'm sorry but this is of no help. TdT I'm sorry but this is of no help. TFE3 I'm sorry but this is of no help. TFEB I'm sorry but this is of no help. Thyroglobulin I'm sorry but this is of no help. Toxoplasma I'm sorry but this is of no help. TSH I'm sorry but this is of no help. TTF-1 I'm sorry but this is of no help. Ubiquitin I'm sorry but this is of no help. UCHL1 (PGP9.5) I'm sorry but this is of no help. Ulex Europaeus I'm sorry but this is of no help. Vimentin I'm sorry but this is of no help. VIP I'm sorry but this is of no help. VZV I'm sorry but this is of no help. WT-1 I'm sorry but this is of no help.

Other molecular tests

Molecular tests (A-B) Test Result ALK sequencing Dr Torres would ask why! B cell clonality Southern / PCR Dr Torres would ask why! BCL2 PCR Dr Torres would ask why! BRAF sequencing Dr Torres would ask why!	Molecular tests (C-H) Test Result EBV PCR Dr Torres would ask why! EGRF sequencing Dr Torres would ask why! H3F3A sequencing NEGATIVE HHV-8 PCR Dr Torres would ask why!	Molecular tests (I-J) Test Result Identity testing PCR Dr Torres would ask why! IDH1/2 PCR IDH1 R132H mutation JAK2 V617F ARMS Dr Torres would ask why!	Molecular tests (K-Z) Test Result KIT sequencing Dr Torres would ask why! LOH 1p/19q PCR NEGATIVE T cell clonality Southern / PCR Dr Torres would ask why!

Diagnosis

Diagnosis
Diffuse Astrocytoma, WHO grade II. Comment: This protoplasmic variant has scant GFAP expression and thus is often misdiagnosed as oligodendroglioma, but nuclear ATRX loss and absence of deletions in chromosomal arms 1p/19q confirm the diagnosis.