harbor ucla neuroradiology conference
DESCRIPTION
Ongoing, monthly Neuroradiology Conference by the staff at Harbor UCLA Medical CenterTRANSCRIPT
Harbor-UCLA Neuro-Radiology Case Conference
Sahar Farzin, M.D.Department of Radiology, Harbor UCLA Medical Center
Thu Tran, M.D.Department of Pathology, Harbor UCLA Medical Center
History: 62 year old male presents with headache, nausea and vomiting
Imaging
Axial head CT with contrast
Imaging
Axial T1WIs post-gadolineum
Imaging
Coronal T1WIs post-gadolineum
Imaging
Sagital T1WI post-gadolineum
Imaging
Axial FLAIR
Discussion of Imaging Findings
CT with contrast shows a lobulated, peripherally enhancing mass in the left parietal-occipital lobe. Surrounding vasogenic edema extends to the splenium of the corpus callosum. There is mass effect on the trigone of the left lateral ventricle.
MR images show a 3.7 x 3.8 x 4.0cm lobulated mass with heterogenous peripheral enhancement and central low signal intensity in the left parietal-occipital lobe with extension to the cortex. Anteriorly there is vasogenic edema extending into the splenium of the corpus callosum. There is no morphologic evidence of tumor extension into the corpus callosum.
Differential Diagnosis based on imaging: Glioblastoma Multiforme vs. Metastasis
Operative procedure performed:Left parieto-occipital craniotomy and resection of mass
Pathology
Hematoxylin-Eosin, 4x: The tumor is comprised of sheets of uniform small blue cells with focal necrosis
Pathology
Hematoxylin-Eosin, 20x: The tumor cells are rounded with irregular hyperchromatic nuclei and small amounts of eosinophilic or clear cytoplasm
Pathology
MIB-1 Immunohistochemical Stain, 4x: Proliferation index is 20% to 50%
Pathology
CD99 Immunohistochemical Stain, 10x: Strong membranous staining of tumor cells
Pathology
Glial Fibrillary Acidic Protein (GFAP) Immunohistochemical Stain, 4x: Tumor component showing focal positivity
Pathology
CAM 5.2
Synaptophysin
AE1-3
CD45
Immunohistochemical Stains, 4x: No immunoreactivity
Diagnosis
Primitive Neuroectodermal Tumor, (PNET) WHO GRADE 4
Discussion
Supratentorial PNETs were once known as cerebral neuroblastomas. They are classified as a WHO grade IV, aggressive tumor. These tumors are typically solitary, well-circumscribed with irregular enhancement, and show cytic or necrotic areas. Calcifications and hemorrhagic components are not uncommon. PNETs are usually seen in children, and 80% occur in those less than 10 years of age. Only sporadic cases of PNETs in adults have been reported in the literature. Less than 1% of adult brain tumors are PNETs.