Difference between revisions of "Case 120"

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Case 120 (view source)

Revision as of 09:38, 29 February 2016

208 bytes added ,  09:38, 29 February 2016
case 121
(case 120 - heavy)
 
(case 121)
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===Provided clinical history===
===Provided clinical history===
3 year old child with hydrocephalus and slight leptomeningeal enhancement.
43 year old female with thoracic lesion .


===Site===
===Site===
Leptomeningeal (arachnoid) biopsy.
Exision of dura-based, calcified tumor.


===Primary image===
===Primary image===
[[Image:Neuropathology case DOLN HE I.jpg |500px|link=|center|]]
[[Image:NP_psammomatous_meningioma_0001.jpg|500px|link=|center|]]
<center>Intermediate magnification. [[H&E stain]].</center>
<center>Intermediate magnification. [[H&E stain]].</center>


{{hidden|Intermediate magnification|[[Image:Neuropathology case DOLN HE II.jpg |500px|link=|center|]]
{{hidden|Intermediate magnification|[[Image:NP_psammomatous_meningioma_0002.jpg|500px|link=|center|]]
<center>Intermediate magnification. [[H&E stain]].</center>}}
<center>Intermediate magnification. [[H&E stain]].</center>}}


{{hidden|High magnification|[[Image:Neuropathology case DOLN HE III.jpg |500px|link=|center|]]
{{hidden|High magnification|[[Image:NP_psammomatous_meningioma_0003.jpg.jpg |500px|link=|center|]]
<center>Intermediate magnification. [[H&E stain]].</center>}}
<center>Intermediate magnification. [[H&E stain]].</center>}}


===Differential diagnosis===
===Differential diagnosis===
{{hidden|Differential diagnosis|<center>Reactive astrocytosis, meningeal infection, [[astrocytoma]], [[oligodendroglioma]], [[pilocytic astrocytoma]]</center>}}
{{hidden|Differential diagnosis|<center>Lesions with [[Psammoma bodies]] present.</center>}}


===Additional tests===
===Additional tests===
====More history====
====More history====
{{hidden|More history|<center>Diffuse thickening of leptomeninges and progressive spread of the signal alterations along leptomeningeal structures and into the lateral ventricles. The alterations are superficially without contact to the central canal of the spinal cord.  No solid mass lesion.</center>}}
{{hidden|More history|<center>No further information available. The neurosurgeon is currently away.</center>}}


====Ask a colleague====
====Ask a colleague====
{{hidden|Ask a colleague|<center> No primary intraparenchymal or meningeal mass lesion? Think of a diffuse growing glial neoplasm.</center>}}
{{hidden|Ask a colleague|<center> These round, calcified structures look like [[Psammoma bodies]].</center>}}


====Stains====
====Stains====
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| dog1=  
| dog1=  
| ebv=  
| ebv=  
| ema=  
| ema= '''POSITIVE'''
| erpr=  
| erpr=  
| f_viii=  
| f_viii=  
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| gata3=  
| gata3=  
| gcdfp=  
| gcdfp=  
| gfap= '''POSTIVE'''
| gfap= '''NEGATIVE'''
| gh=  
| gh=  
| glucagon=  
| glucagon=  
Line 166: Line 166:
| insulin=  
| insulin=  
| kappa=  
| kappa=  
| ki67= '''6%'''
| ki67= '''1%'''
| lambda=  
| lambda=  
| leu7=  
| leu7=  
Line 175: Line 175:
| lysozyme=  
| lysozyme=  
| mammogl=
| mammogl=
| map2= '''POSITIVE'''
| map2= '''NEGATIVE'''
| mcv=  
| mcv=  
| melanin_a= '''NEGATIVE'''
| melanin_a= '''NEGATIVE'''
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| psap=  
| psap=  
| rcc=  
| rcc=  
| s100= '''POSITIVE'''
| s100= '''NEGATIVE'''
| sma=  
| sma=  
| somatsatin=  
| somatsatin=  
| stat6=  
| stat6= '''NEGATIVE'''
| synapto= '''NEGATIVE'''
| synapto= '''NEGATIVE'''
| tdt=  
| tdt=  
Line 257: Line 257:
| b_cell_clone =  
| b_cell_clone =  
| bcl2 =  
| bcl2 =  
| braf = '''KIAA1549 (Exon15)-BRAF (Exon9) fusion found'''
| braf = '''NO MUTATION'''
| EBV_pcr =  
| EBV_pcr =  
| egrf =  
| egrf =  
| h3f3a = '''NEGATIVE'''
| h3f3a =  
| hhv8_pcr =  
| hhv8_pcr =  
| identity_test =  
| identity_test =  
| idh1_2 = '''NEGATIVE'''
| idh1_2 =  
| jak2_v617f =  
| jak2_v617f =  
| kit =  
| kit =  
| loh_1p19q = '''LOH 1p/19q present'''
| loh_1p19q =  
| t_cell_clone =  
| t_cell_clone =  
}}
}}


===Diagnosis===
===Diagnosis===
{{hidden|Diagnosis|<center>[[Disseminated oligodendroglial-like leptomeningeal tumour]]</center>
{{hidden|Diagnosis|<center>Psammomatous [[meningioma]], WHO grade I</center>
<br>
<br>
Comment: DOLN may look very similiar (being histologically indistinguishable) to pilocytic astrocytoma but absence of solid lesion and molecular profile (combined chromosomal 1p loss + presence of a KIAA1549-BRAF fusion) are diagnostic.}}
Comment: It is said, that psammoma bodies represent a process of dystrophic calcification or as an active biologic barrier to tumor spread ultimately leading to degeneration/death of tumor cells.  <ref>{{Cite journal  | last1 = KEPES | first1 = J. | title = Observations on the formation of psammoma bodies and pseudopsammoma bodies in meningiomas. | journal = J Neuropathol Exp Neurol | volume = 20 | issue =  | pages = 255-62 | month = Apr | year = 1961 | doi =  | PMID = 13752577 }}</ref> <ref>{{Cite journal  | last1 = Das | first1 = DK. | title = Psammoma body: a product of dystrophic calcification or of a biologically active process that aims at limiting the growth and spread of tumor? | journal = Diagn Cytopathol | volume = 37 | issue = 7 | pages = 534-41 | month = Jul | year = 2009 | doi = 10.1002/dc.21081 | PMID = 19373908 }}</ref>
}}


===Other cases===
===Other cases===
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[[Category:Cases in neuropathology]]
[[Category:Cases in neuropathology]]
[[Category:Cases in neuropathology - fellow and expert]]
[[Category:Cases in neuropathology - junior]]


[[Category:Cases difficulty 7]] <!-- difficulty 1-7 -- should roughly correspond to the PGY level -->
[[Category:Cases difficulty 1]] <!-- difficulty 1-7 -- should roughly correspond to the PGY level -->
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