The section shows numerous large veins that have thickened walls and arteries with intervening brain parenchyma. There is a small focus of monocytoid cells, hemosiderin-laden macrophages and necrosis consistent with prior bleeding.
BRAIN, RIGHT TEMPORAL:
- ARTERIOVENOUS MALFORMATION.
- NEGATIVE FOR MALIGNANCY.
The biopsy, containing epidermis, dermis and subcutaneous tissue, is technically satisfactory. Immunostains utilizing a monoclonal antibody 1E4 (anti-Notch-3) at dilution 1:50 shows the absence of granular deposits in the walls of small arteries and veins in the dermis and subcutaneous tissue. Immunostains are strongly positive on positive control tissue from a patient known to have CADASIL.
- ABSENCE OF NOTCH-3 IMMUNOSTAINING.
The section shows white matter and grey matter with regions of increased cellularity, consisting predominantly of regularly-spaced (glial) cells with bland-appearing, uniform, non-ovoid nuclei. Glial cells, focally, have fine, eosinophilic, branching processes. A small subset of cells have moderate nuclear enlargement.
Numerous axonal swellings are noted. There is no mitotic activity and no necrosis. No calcifications are identified.
The section shows medium-sized back-to-back blood vessels surrounded by hypercellular white matter without nuclear atypia (gliosis).
There is extensive hemosiderin deposition, focal calcifications, and focal axonal swelling, consistent with prior bleeding and focal tissue compression.
BRAIN: -CAVERNOUS MALFORMATION.