Difference between revisions of "Case 120"

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Case 120 (view source)

Revision as of 09:40, 29 February 2016

208 bytes removed ,  09:40, 29 February 2016
Undo revision 42778 by Jensflorian (talk) wrong case #
(case 121)
(Undo revision 42778 by Jensflorian (talk) wrong case #)
 
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===Provided clinical history===
===Provided clinical history===
43 year old female with thoracic lesion .
3 year old child with hydrocephalus and slight leptomeningeal enhancement.


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


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


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


{{hidden|High magnification|[[Image:NP_psammomatous_meningioma_0003.jpg.jpg |500px|link=|center|]]
{{hidden|High magnification|[[Image:Neuropathology case DOLN HE III.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>Lesions with [[Psammoma bodies]] present.</center>}}
{{hidden|Differential diagnosis|<center>Reactive astrocytosis, meningeal infection, [[astrocytoma]], [[oligodendroglioma]], [[pilocytic astrocytoma]]</center>}}


===Additional tests===
===Additional tests===
====More history====
====More history====
{{hidden|More history|<center>No further information available. The neurosurgeon is currently away.</center>}}
{{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>}}


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


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


===Diagnosis===
===Diagnosis===
{{hidden|Diagnosis|<center>Psammomatous [[meningioma]], WHO grade I</center>
{{hidden|Diagnosis|<center>[[Disseminated oligodendroglial-like leptomeningeal tumour]]</center>
<br>
<br>
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>
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.}}
}}


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


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