Harbor UCLA Neuroradiology Conference
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Transcript of Harbor UCLA Neuroradiology Conference
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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
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History: 62 year old male presents with headache, nausea and vomiting
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Imaging
Axial head CT with contrast
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Imaging
Axial T1WIs post-gadolineum
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Imaging
Coronal T1WIs post-gadolineum
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Imaging
Sagital T1WI post-gadolineum
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Imaging
Axial FLAIR
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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
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Operative procedure performed:Left parieto-occipital craniotomy and resection of mass
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Pathology
Hematoxylin-Eosin, 4x: The tumor is comprised of sheets of uniform small blue cells with focal necrosis
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Pathology
Hematoxylin-Eosin, 20x: The tumor cells are rounded with irregular hyperchromatic nuclei and small amounts of eosinophilic or clear cytoplasm
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Pathology
MIB-1 Immunohistochemical Stain, 4x: Proliferation index is 20% to 50%
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Pathology
CD99 Immunohistochemical Stain, 10x: Strong membranous staining of tumor cells
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Pathology
Glial Fibrillary Acidic Protein (GFAP) Immunohistochemical Stain, 4x: Tumor component showing focal positivity
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Pathology
CAM 5.2
Synaptophysin
AE1-3
CD45
Immunohistochemical Stains, 4x: No immunoreactivity
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Diagnosis
Primitive Neuroectodermal Tumor, (PNET) WHO GRADE 4
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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.