USCAP 104th Annual MeetingNeuropathology Evening

Subspecialty Conference 2015

Gregory N. Fuller, MD, PhDProfessor

Chief Neuropathologist

M D Anderson Cancer CenterHouston, Texas

gfuller@mdanderson.org

Case 3

Clinical History

A 38-year-old man presented with left facial numbness. MR imaging revealed a contrast-enhancing dura-based mass of the left middle cranial fossa. Subsequent craniotomy with gross total resection of the mass was performed.

Case 4

Pre-Operative MR Imaging

Axial T1 with contrast Coronal T1 with contrast Sagittal T1 with contrast

Case 3

H&E Histology

Reticulin

pHH3

Ki-67

IHC 1

IHC 2 lp

IHC 2 hp

IHC 3 lp

Pertinent Negative IHCs

IHC 4 lp

IHC 4 hp

Case 3

Panelist Diagnoses ?

Case 3

Diagnosis

Anaplastic Solitary Fibrous Tumor (Hemangiopericytoma)

WHO grade III

IHC 1

Bcl-2

IHC 2 lp

CD34

IHC 3 lp

CD99

IHC 4 hp

STAT6

Case 3

Pre-Operative MR Imaging

Axial T1 with contrast Coronal T1 with contrast Sagittal T1 with contrast

Case 3

Pre-Op Imaging Differential Diagnosis

Meningioma (favor angiomatous; favor grade II or III)

Solitary Fibrous Tumor (Hemangiopericytoma)Primary Meningeal Sarcoma (multiple subtypes)

Dural MetastasisOther Dura-Based Mass Lesions

Case 3

Case 3

H&E (Histologic) Differential Diagnosis

Anaplastic Solitary Fibrous Tumor (Hemangiopericytoma)

Angiomatous Meningioma (Atypical, 7 m /10HPF)

Fibrous Meningioma (Atypical, 7 m / 10HPF)

Primary Meningeal Sarcoma (multiple subtypes)

Synovial SarcomaMalignant Peripheral Nerve Sheath TumorMesenchymal ChondrosarcomaMetastasis (multiple possible primary sites)

Bcl-2Bcl-2

CD34

Bcl-2Bcl-2

CD34

STAT6

Bcl-2Bcl-2

CD34

STAT6

Classical SFT

Classical Hemangiopericytoma

Fuller GN. Neural Tumors. In: Czerniack BA, ed. Dorfman and Czerniak’s Bone Tumors, 2nd Ed. 2016

Summary of ISN-Haarlem Colloquium Conclusions

Louis DN, et al. International Society for Neuropathology-Haarlem Consensus Guidelines for Nervous System Tumor Classification and Grading. Brain Pathology 24(5):429-435,2014.

Summary of ISN-Haarlem Colloquium Conclusions

Louis DN, et al. International Society for Neuropathology-Haarlem Consensus Guidelines for Nervous System Tumor Classification and Grading. Brain Pathology 24(5):429-435,2014.

Thank You