1 / 9

Case 18 History: A 56 year-old man presented with headache and a pineal mass.

Diagnostic Challenge Pathology for Neurosurgery & Neurology Residents Department of Pathology University of Oklahoma Health Sciences Center, Oklahoma City, OK, U.S.A. Case 18 History: A 56 year-old man presented with headache and a pineal mass.

hayes-travis
Télécharger la présentation

Case 18 History: A 56 year-old man presented with headache and a pineal mass.

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Diagnostic ChallengePathology for Neurosurgery & Neurology ResidentsDepartment of PathologyUniversity of Oklahoma Health Sciences Center,Oklahoma City, OK, U.S.A. Case 18 History: A 56 year-old man presented with headache and a pineal mass. Contributor: Kar-Ming Fung, M.D., Ph.D., karming-fung@ouhsc.edu Last updataded: 1/9/2009

  2. MRI T1 post contrast MRI T2 A B

  3. Permanent Section C D

  4. Permanent Section Cytologic Preparation à E F

  5. Glial Fibrillary Acidic Protein (GFAP) Synaptophysin G H

  6. Neurofilament Proteins Ki67 I J

  7. What is your diagnosis?

  8. Diagnosis: Pineal parenchymal tumor of intermediate differentiation (WHO Grade II). • Discussion: • First, germinoma is the most common one and must be ruled out. The characteristic histologic features are large geminoma cells in a benign background of reactive lymphocytes. • Although the round nuclei and high cellularity suggest lymphocytes, the overall morphology and the presence of neuropils (arrow) does not. Besides, there is a complete ablsence of large geminoma cells. • There is a lack of necrosis or high grade pleomorphism. At the same time, there is a lack of pineocytomatous rossettes or morphological features that suggest neuronal differentiation. • There is a lack of necrosis or high grade pleomorphism. At the same time, there is a lack of pineocytomatous rossettes or morphological features that suggest neuronal differentiation.

  9. The overall histology is a high cellularity of cells with montonous round nuclei. There is no necrosis and no rossettes. There is a lack of mitosis or high grade pleomorphism. See the small islands of neuropils (arrow). The cells also appears monotonous in cytologic preparation. • The tumor cells are strongly and diffusely positive for synaptophysin and neurofilament protein. Immunohistochemistry for GFAP demonstrate only reactive astrocytes in the background. • There is a lack of mitosis and the Ki67 labeling is low. • The overall features is most consistent with a pineal parenchymal tumor of intermediate differentiation of WHO grade II. The MRI reveals a rather well demarcated, enhancing lesion. These features, together with the age of this patient, also support the diagnosis.

More Related