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21st European Congress of Pathology
Istanbul, Turkey, September 08-13, 2007
http://www.ecp2007istanbul.org/
Slide Seminar 12, September 12th
New Entities of the Nervous System Tumors
Chairpersons: F. Giangaspora, S. Zorludemir |
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Case 1
Presented by: Marco Gessi
Clinical and neuroradiological findings
This 45-year-old female presented to clinical examination for headache. MRI displayed a 3 cm lesion affecting the pineal region, causing hydrocephalus.
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Diagnosis & discussion |
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Case 2
Presented by: Arie Perry
Clinical History
A two-year old boy was admitted to the hospital with macrocephaly and global developmental delay. Family history was significant for consanguinity (parents were first cousins) and a sibling with Trisomy 21. Several abnormalities were noted on clinical exam. Head circumference was 57 cm ( 5 cm above the 98 th percentile). He could crawl in an abnormal “commando” style although unable to stand without support.
CT revealed a large heterogeneous, partially calcified and cystic mass within the left cerebral hemisphere. An MRI localized the 12.5 x 10 x 5.5 cm mass to the temporo-parietal area. The mass was predominantly isointense on T1 and slightly hyperintense on T2. Only minimal enhancement was seen. Due to the hydrocephalus, the cerebral mantle was severely thinned and a thin rim of hyperintensity on T2 suggested transependymal CSF flow. The tumor was debulked and after one year, a large recurrence was seen in the posterior fossa by MRI. Further progression of the tumor was detected 5 months after the second surgery and the patient died several months later.
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Diagnosis & discussion |
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Case 3
Presented by: Figen Soylemezoglu
Clinical History
A 9-year-old boy was admitted to the hospital with complaints of head and back pain. He had been having headaches and nausea attacks for the 15 days with progressive worsening. His neurological examination was normal except for bilateral papilledema. Magnetic resonance (MR) images revealed a third ventricular mass lesion with obstructive hydrocephalus. The lesion seen in the anterior recesses of the third ventricle was mildly hyperintense relative to CSF on T1 weighted images and heterogenously hyperintense on FLAIR images relative to the brain tissue. No contrast enhancement was observed. The tumor was best defined in TRACE images of DWI. Subtotal resection of the tumor was performed by anterior interhemispheric transcallosal approach. Diffuse leptomeningeal contrast enhancement at the spinal MR images was regarded as seeding. Regardless of the subtotal resection and the spinal lesions, the patient is doing well one year after the operation.
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Diagnosis & discussion |
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Case 4
Presented by: Dominique Figarella Branger
Clinical History
A 23-year old man was admitted for a 4-week history of constant headaches. He also complained of visual disturbances, horizontal diplopia, dorsialgias, difficulties in comprehension and expression and unsteady gait. Clinical examination showed a paresis of the VIth cranial nerve and an abolition of the tendon reflexes. MRI showed a cystic tumor with a mural nodule enhanced after gadolinium injection, located in the left parieto-occipital lobe. Peritumoral oedema was obvious. The patient underwent a craniotomy and total excision. On macroscopic examination, the tumor was greyish and friable. The wall of the cyst was yellow, suggesting an old haemorrhage.
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Diagnosis & discussion |
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Case 5
Presented by: Felice Giangaspero
Clinical History
Twenty-nine year-old man with seizures since age 14. MRI showed a non-enhancing lesion, hiperintense in T2 weighted signal, located superficially in the left fronto-basal area and involving the adjacent white matter. The lesion was surgically excised and a pathological diagnosis of pilocytic astrocytoma was performed. No post surgical adjuvant treatment was performed. The patient is alive and well and free of seizures after four years from surgery.
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Diagnosis & discussion |
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Case 6
Presented by: Tarik Tihan
Clinical History
A 6 month-old baby was brought to the pediatrician by his parents due to poor weight gain, restlessness, abnormal movements in her right eye, which progressively worsened and involved both eyes over a period of two months. She had nystagmus, but no other findings on physical examination. MRI showed a large, enhancing suprasellar mass involving the optic chiasm and extending into the optic radiations particularly on the right side. The imaging was compatible with a low grade glioma, and she received a 12-month regimen of carboplatin and vincristine chemotherapy without a biopsy. Follow-up MRI scan at 2 ½ years, showed marked interval increase in abnormal enhancement, and a 3 cm homogeneously enhancing mass centered in the left lateral geniculate with moderate mass effect. She received two additional trials of chemotherapy including vinblastine, temozolomide, and TPCV. MRI showed marked progression in both optic tracts after chemotherapy, and she underwent a decompression surgery and a biopsy of the tumor.
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Diagnosis & discussion |
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Case 7
Presented by: Johan Kros
Clinical History
A 46-years old man was admitted with variable neurological signs including dysarthria, dysphagia, drooping of the right facial half and right-sided hemiplegia. The patient had a history of acute pancreatitis due to hypercalcaemia due to hyperparathyroidism ten years before.
T2 weighed MRI images revealed hyperintense lesions in the left frontal lobe including the cingular gyrus, right temporal lobe, left insular region and the pons. All lesions show space-occupying properties, particularly in the gray matter. The lesions in the left frontal lobe and the pons show some attenuation after contrast enhancement. The radiological differential includes infection, for instance Listeria or Herpes.
Laboratory investigation did not reveal infection with Borrelia, Lues, Listeria, Micoplasma, HIV, EBV, VZV, HSV. A stereotactic biopsy procedure was performed targeting the lesion in the left frontal lobe.
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Diagnosis & discussion |
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