Clinical history
45 year old woman with a lesion in the left temporal lobe.
Primary image
Supratentorial lesion. H&E stain.
Differential diagnosis
Expand Differential diagnosis
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Astrocytoma, Oligodendroglioma, pilomyxoid astrocytoma, dysembryoplastic neuroepithelial tumor
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Additional tests
More history
Expand More history
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The lesion shows no enhancement after CM application.
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Ask a friend
Expand Ask a friend
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Extensive microcyst formations and mucoid degeneration is indicative of a protoplasmic glial brain tumor.
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Stains
ExpandAlcian blue/PAS to Bilirubin |
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Alcian blue/PAS | Expand I'm sorry but this is of no help. |
Alican blue pH 1.0 | Expand I'm sorry but this is of no help. |
Alcian blue pH 2.5 | Expand I'm sorry but this is of no help. |
Auramine | Expand I'm sorry but this is of no help. |
Bielchowsky | Expand I'm sorry but this is of no help. |
Bilirubin | Expand I'm sorry but this is of no help. |
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ExpandColloidal iron to Fontana-Masson |
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Colloidal iron | Expand I'm sorry but this is of no help. |
Congo red | Expand I'm sorry but this is of no help. |
Cresyl violet | Expand I'm sorry but this is of no help. |
Dieterle | Expand I'm sorry but this is of no help. |
Diff Quik | Expand I'm sorry but this is of no help. |
Fontana-Masson | Expand I'm sorry but this is of no help. |
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ExpandGallyas to Gremelius |
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Gallyas | Expand I'm sorry but this is of no help. |
Giemsa | Expand I'm sorry but this is of no help. |
GMS | Expand I'm sorry but this is of no help. |
Gomori's trichrome | Expand I'm sorry but this is of no help. |
Gram | Expand I'm sorry but this is of no help. |
Gremelius | Expand I'm sorry but this is of no help. |
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ExpandJMS to Mucicarmine |
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JMS | Expand I'm sorry but this is of no help. |
Jones | Expand I'm sorry but this is of no help. |
Kinyoun | Expand I'm sorry but this is of no help. |
Luxol fast blue | Expand I'm sorry but this is of no help. |
Masson trichrome | Expand I'm sorry but this is of no help. |
M-MAS | Expand I'm sorry but this is of no help. |
Movat | Expand I'm sorry but this is of no help. |
Mucicarmine | Expand I'm sorry but this is of no help. |
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ExpandOil red O to Prussian blue |
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Oil red O | Expand I'm sorry but this is of no help. |
Orecein | Expand I'm sorry but this is of no help. |
PAS | Expand I'm sorry but this is of no help. |
PASD | Expand I'm sorry but this is of no help. |
PASF | Expand I'm sorry but this is of no help. |
PTAH | Expand I'm sorry but this is of no help. |
Prussian blue | Expand I'm sorry but this is of no help. |
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ExpandReticulin to Ziehl-Neelsen |
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Reticulin | Expand This stain highlights the capillaries within the tumor |
Sudan black B | Expand I'm sorry but this is of no help. |
Toluidine blue | Expand I'm sorry but this is of no help. |
Verhoeff | Expand I'm sorry but this is of no help. |
Von Kossa | Expand I'm sorry but this is of no help. |
Warthin-Starry | Expand I'm sorry but this is of no help. |
Ziehl-Neeslen | Expand I'm sorry but this is of no help. |
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IHC
ExpandAlpha-1 AT to Cathepsin K |
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alpha-1 AT | Expand I'm sorry but this is of no help. |
ACTH | Expand I'm sorry but this is of no help. |
AE1/AE1 | Expand NEGATIVE |
alpha-fetoprotein | Expand I'm sorry but this is of no help. |
Alk-I | Expand I'm sorry but this is of no help. |
AMACR | Expand I'm sorry but this is of no help. |
AR | Expand I'm sorry but this is of no help. |
ATRX | Expand |
Beta2-microglobulin | Expand I'm sorry but this is of no help. |
B72.3 | Expand I'm sorry but this is of no help. |
Beta-catenin | Expand I'm sorry but this is of no help. |
BCL2 | Expand I'm sorry but this is of no help. |
BCL6 | Expand I'm sorry but this is of no help. |
BCLxL | Expand I'm sorry but this is of no help. |
C3 comp | Expand I'm sorry but this is of no help. |
CA9 | Expand I'm sorry but this is of no help. |
Calcitonin | Expand I'm sorry but this is of no help. |
Calponin | Expand I'm sorry but this is of no help. |
Calretinin | Expand I'm sorry but this is of no help. |
CAM5.2 | Expand I'm sorry but this is of no help. |
Cathepsin K | Expand I'm sorry but this is of no help. |
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ExpandCD10 to Chromogranin |
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CD10 | Expand I'm sorry but this is of no help. |
CD117 | Expand I'm sorry but this is of no help. |
CD138 | Expand I'm sorry but this is of no help. |
CD15 | Expand I'm sorry but this is of no help. |
CD1a | Expand I'm sorry but this is of no help. |
CD20 | Expand I'm sorry but this is of no help. |
CD21 | Expand I'm sorry but this is of no help. |
CD23 | Expand I'm sorry but this is of no help. |
CD3 | Expand I'm sorry but this is of no help. |
CD30 | Expand I'm sorry but this is of no help. |
CD31 | Expand I'm sorry but this is of no help. |
CD34 | Expand NEGATIVE |
CD35 | Expand I'm sorry but this is of no help. |
CD4 | Expand I'm sorry but this is of no help. |
CD43 | Expand I'm sorry but this is of no help. |
CD45 (LCA) | Expand NEGATIVE |
CD5 | Expand I'm sorry but this is of no help. |
CD56 | Expand I'm sorry but this is of no help. |
CD57 | Expand I'm sorry but this is of no help. |
CD68 | Expand I'm sorry but this is of no help. |
CD7 | Expand I'm sorry but this is of no help. |
CD79a | Expand I'm sorry but this is of no help. |
CD8 | Expand I'm sorry but this is of no help. |
CD99 | Expand I'm sorry but this is of no help. |
CDX2 | Expand I'm sorry but this is of no help. |
CEA-m | Expand I'm sorry but this is of no help. |
Chromogranin | Expand I'm sorry but this is of no help. |
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ExpandCK17 to Glypican 3 |
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CK17 | Expand I'm sorry but this is of no help. |
CK19 | Expand I'm sorry but this is of no help. |
CK20 | Expand I'm sorry but this is of no help. |
CK34betaE12 | Expand I'm sorry but this is of no help. |
CK5/6 | Expand I'm sorry but this is of no help. |
CK7 | Expand I'm sorry but this is of no help. |
CMV | Expand I'm sorry but this is of no help. |
c-MYC | Expand I'm sorry but this is of no help. |
Cyclin D1 | Expand I'm sorry but this is of no help. |
D2-40 | Expand I'm sorry but this is of no help. |
Desmin | Expand I'm sorry but this is of no help. |
DOG1 | Expand I'm sorry but this is of no help. |
EBV | Expand I'm sorry but this is of no help. |
EMA | Expand NEGATIVE |
ER and PR | Expand I'm sorry but this is of no help. |
Factor VIII | Expand I'm sorry but this is of no help. |
Factor XIIIa | Expand I'm sorry but this is of no help. |
Fascin | Expand I'm sorry but this is of no help. |
FH | Expand I'm sorry but this is of no help. |
FSH | Expand I'm sorry but this is of no help. |
Gastrin | Expand I'm sorry but this is of no help. |
GATA3 | Expand I'm sorry but this is of no help. |
GCDFP-15 (BRST2) | Expand I'm sorry but this is of no help. |
GFAP | Expand |
GH | Expand I'm sorry but this is of no help. |
Glucagon | Expand I'm sorry but this is of no help. |
Glypican-3 | Expand I'm sorry but this is of no help. |
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ExpandHBME-1 to IgM |
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HBME-1 | Expand I'm sorry but this is of no help. |
HBV core | Expand I'm sorry but this is of no help. |
HBV surface | Expand I'm sorry but this is of no help. |
H-caldesmon | Expand I'm sorry but this is of no help. |
HCG | Expand I'm sorry but this is of no help. |
Helicobacter | Expand I'm sorry but this is of no help. |
Hepatocyte | Expand I'm sorry but this is of no help. |
HER2/neu | Expand I'm sorry but this is of no help. |
HHV-8 | Expand I'm sorry but this is of no help. |
HMB-45 | Expand I'm sorry but this is of no help. |
HNF1beta | Expand I'm sorry but this is of no help. |
HPV | Expand I'm sorry but this is of no help. |
HSV-I | Expand I'm sorry but this is of no help. |
HSV-II | Expand I'm sorry but this is of no help. |
IDH-1 | Expand |
Inhibin | Expand I'm sorry but this is of no help. |
INI1 (BAF47) | Expand I'm sorry but this is of no help. |
Insulin | Expand I'm sorry but this is of no help. |
Kappa | Expand I'm sorry but this is of no help. |
Ki-67 | Expand |
Lambda | Expand I'm sorry but this is of no help. |
Leu 7 | Expand I'm sorry but this is of no help. |
IgA | Expand I'm sorry but this is of no help. |
IgG | Expand I'm sorry but this is of no help. |
IgM | Expand I'm sorry but this is of no help. |
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ExpandLH to PDGFR |
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LH | Expand I'm sorry but this is of no help. |
LIN28 | Expand I'm sorry but this is of no help. |
Lysozyme | Expand I'm sorry but this is of no help. |
mammoglobin | Expand I'm sorry but this is of no help. |
MAP2 | Expand |
MCV | Expand I'm sorry but this is of no help. |
Melanin A | Expand I'm sorry but this is of no help. |
MHC class I | Expand I'm sorry but this is of no help. |
MITF | Expand I'm sorry but this is of no help. |
MUM1 | Expand I'm sorry but this is of no help. |
Myeloperoxidase | Expand I'm sorry but this is of no help. |
MYO D1 | Expand I'm sorry but this is of no help. |
Myoglobin | Expand I'm sorry but this is of no help. |
Napsin | Expand I'm sorry but this is of no help. |
NF | Expand NEGATIVE |
NKX3.1 | Expand I'm sorry but this is of no help. |
NSE | Expand NEGATIVE |
OCT3/4 | Expand I'm sorry but this is of no help. |
p16 | Expand I'm sorry but this is of no help. |
P501S | Expand I'm sorry but this is of no help. |
p53 | Expand I'm sorry but this is of no help. |
p57 | Expand I'm sorry but this is of no help. |
p63 | Expand I'm sorry but this is of no help. |
Pankeratin | Expand NEGATIVE |
PAX2 | Expand I'm sorry but this is of no help. |
PAX5 | Expand I'm sorry but this is of no help. |
PAX8 | Expand I'm sorry but this is of no help. |
PCNA | Expand I'm sorry but this is of no help. |
PDGFR | Expand I'm sorry but this is of no help. |
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ExpandPLAP to WT1 |
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PLAP | Expand I'm sorry but this is of no help. |
PNL-2C | Expand I'm sorry but this is of no help. |
Prolactin | Expand I'm sorry but this is of no help. |
PSA | Expand I'm sorry but this is of no help. |
PSAP | Expand I'm sorry but this is of no help. |
RCC | Expand I'm sorry but this is of no help. |
S-100 | Expand POSITIVE |
SALL4 | Expand I'm sorry but this is of no help. |
Smooth muscle actin | Expand I'm sorry but this is of no help. |
Somatostatin | Expand I'm sorry but this is of no help. |
STAT6 | Expand I'm sorry but this is of no help. |
Synaptophysin | Expand I'm sorry but this is of no help. |
TdT | Expand I'm sorry but this is of no help. |
TFE3 | Expand I'm sorry but this is of no help. |
TFEB | Expand I'm sorry but this is of no help. |
Thyroglobulin | Expand I'm sorry but this is of no help. |
Toxoplasma | Expand I'm sorry but this is of no help. |
TSH | Expand I'm sorry but this is of no help. |
TTF-1 | Expand I'm sorry but this is of no help. |
Ubiquitin | Expand I'm sorry but this is of no help. |
UCHL1 (PGP9.5) | Expand I'm sorry but this is of no help. |
Ulex Europaeus | Expand I'm sorry but this is of no help. |
Vimentin | Expand I'm sorry but this is of no help. |
VIP | Expand I'm sorry but this is of no help. |
VZV | Expand I'm sorry but this is of no help. |
WT-1 | Expand I'm sorry but this is of no help. |
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Other molecular tests
ExpandMolecular tests (A-B) |
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ALK sequencing | Expand Dr Torres would ask why! |
B cell clonality Southern / PCR | Expand Dr Torres would ask why! |
BCL2 PCR | Expand Dr Torres would ask why! |
BRAF sequencing | Expand Dr Torres would ask why! |
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ExpandMolecular tests (C-H) |
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EBV PCR | Expand Dr Torres would ask why! |
EGRF sequencing | Expand Dr Torres would ask why! |
H3F3A sequencing | Expand NEGATIVE |
HHV-8 PCR | Expand Dr Torres would ask why! |
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ExpandMolecular tests (K-Z) |
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KIT sequencing | Expand Dr Torres would ask why! |
LOH 1p/19q PCR | Expand NEGATIVE |
T cell clonality Southern / PCR | Expand Dr Torres would ask why! |
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Diagnosis
Expand Diagnosis
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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.
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Other cases
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| Number | |
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| Subspecialty (Difficulty) |
Autopsy pathology (jr,sr, f/e)
Breast pathology (jr,sr, f/e)
Cardiovascular pathology (jr,sr, f/e)
Cytopathology (jr,sr, f/e)
Dermatopathology (jr,sr, f/e)
Endocrine pathology (jr,sr, f/e)
Forensic pathology (jr,sr, f/e)
Gastrointestinal pathology (jr,sr, f/e)
Genitourinary pathology (jr,sr, f/e)
Gynecologic pathology (jr,sr, f/e)
Hematopathology (jr,sr, f/e)
Head and neck pathology (jr,sr, f/e)
Lymph node pathology (jr,sr, f/e)
Medical kidney pathology (jr,sr, f/e)
Molecular pathology (jr,sr, f/e)
Neuropathology (jr,sr, f/e)
Pediatric pathology (jr,sr, f/e)
Pulmonary pathology (jr,sr, f/e)
Placental pathology (jr,sr, f/e)
Soft tissue pathology (jr,sr, f/e) |
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| Difficulty | |
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