Case 83

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Clinical history

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

Primary image

Neuropathology case II 01.jpg
Supratentorial lesion. H&E stain.
Intermediate magnification 
Neuropathology case II 02.jpg
Intermediate magnification. H&E stain.
High magnification 
Neuropathology case II 03.jpg
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/PASI'm sorry but this is of no help.
Alican blue pH 1.0I'm sorry but this is of no help.
Alcian blue pH 2.5I'm sorry but this is of no help.
AuramineI'm sorry but this is of no help.
BielchowskyI'm sorry but this is of no help.
BilirubinI'm sorry but this is of no help.
Colloidal iron to Fontana-Masson
Test Result
Colloidal ironI'm sorry but this is of no help.
Congo redI'm sorry but this is of no help.
Cresyl violetI'm sorry but this is of no help.
DieterleI'm sorry but this is of no help.
Diff QuikI'm sorry but this is of no help.
Fontana-MassonI'm sorry but this is of no help.
Gallyas to Gremelius
Test Result
GallyasI'm sorry but this is of no help.
GiemsaI'm sorry but this is of no help.
GMSI'm sorry but this is of no help.
Gomori's trichromeI'm sorry but this is of no help.
GramI'm sorry but this is of no help.
GremeliusI'm sorry but this is of no help.
JMS to Mucicarmine
Test Result
JMSI'm sorry but this is of no help.
JonesI'm sorry but this is of no help.
KinyounI'm sorry but this is of no help.
Luxol fast blueI'm sorry but this is of no help.
Masson trichromeI'm sorry but this is of no help.
M-MASI'm sorry but this is of no help.
MovatI'm sorry but this is of no help.
MucicarmineI'm sorry but this is of no help.
Oil red O to Prussian blue
Test Result
Oil red OI'm sorry but this is of no help.
OreceinI'm sorry but this is of no help.
PASI'm sorry but this is of no help.
PASDI'm sorry but this is of no help.
PASFI'm sorry but this is of no help.
PTAHI'm sorry but this is of no help.
Prussian blueI'm sorry but this is of no help.
Reticulin to Ziehl-Neelsen
Test Result
ReticulinThis stain highlights the capillaries within the tumor
Sudan black BI'm sorry but this is of no help.
Toluidine blueI'm sorry but this is of no help.
VerhoeffI'm sorry but this is of no help.
Von KossaI'm sorry but this is of no help.
Warthin-StarryI'm sorry but this is of no help.
Ziehl-NeeslenI'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/AE1NEGATIVE
alpha-fetoprotein I'm sorry but this is of no help.
Alk-I I'm sorry but this is of no help.
AMACRI'm sorry but this is of no help.
ARI'm sorry but this is of no help.
ATRX
Neuropathology case II ATRX immunohistochemistry.jpg
Beta2-microglobulin I'm sorry but this is of no help.
B72.3 I'm sorry but this is of no help.
Beta-cateninI'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.
CA9I'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.
CAM5.2I'm sorry but this is of no help.
Cathepsin KI'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.
CD138I'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.
CD57I'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.
CDX2I'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
CK17I'm sorry but this is of no help.
CK19I'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.
CK5/6I'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.
D2-40I'm sorry but this is of no help.
Desmin I'm sorry but this is of no help.
DOG1I'm sorry but this is of no help.
EBV I'm sorry but this is of no help.
EMANEGATIVE
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.
FHI'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.
GATA3I'm sorry but this is of no help.
GCDFP-15 (BRST2)I'm sorry but this is of no help.
GFAP
Neuropathology case II 06.jpg
GH I'm sorry but this is of no help.
Glucagon I'm sorry but this is of no help.
Glypican-3I'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-caldesmonI'm sorry but this is of no help.
HCG I'm sorry but this is of no help.
HelicobacterI'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-8I'm sorry but this is of no help.
HMB-45I'm sorry but this is of no help.
HNF1betaI'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
Neuropathology case II 05.jpg
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
Neuropathology case II 04.jpg
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.
mammoglobinI'm sorry but this is of no help.
MAP2
Neuropathology case II 07.jpg
MCVI'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.
MITFI'm sorry but this is of no help.
MUM1I'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.
MyoglobinI'm sorry but this is of no help.
NapsinI'm sorry but this is of no help.
NFNEGATIVE
NKX3.1I'm sorry but this is of no help.
NSE NEGATIVE
OCT3/4I'm sorry but this is of no help.
p16I'm sorry but this is of no help.
P501SI'm sorry but this is of no help.
p53 I'm sorry but this is of no help.
p57I'm sorry but this is of no help.
p63 I'm sorry but this is of no help.
PankeratinNEGATIVE
PAX2I'm sorry but this is of no help.
PAX5I'm sorry but this is of no help.
PAX8I'm sorry but this is of no help.
PCNA I'm sorry but this is of no help.
PDGFRI'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.
PSAPI'm sorry but this is of no help.
RCCI'm sorry but this is of no help.
S-100POSITIVE
SALL4I'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.
TFE3I'm sorry but this is of no help.
TFEBI'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.
VimentinI'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-1I'm sorry but this is of no help.


Other molecular tests
Molecular tests (A-B)
Test Result
ALK sequencingDr Torres would ask why!
B cell clonality Southern / PCR Dr Torres would ask why!
BCL2 PCR Dr Torres would ask why!
BRAF sequencingDr Torres would ask why!
Molecular tests (C-H)
Test Result
EBV PCR Dr Torres would ask why!
EGRF sequencingDr Torres would ask why!
H3F3A sequencingNEGATIVE
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.


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