Transcript Case Study 55 - University of Pittsburgh

Clayton Wiley MD/PhD
Question 1
• This is a 37-year-old woman who presented to the
emergency room following minor accidental head
trauma. An MRI of the head was performed.
• Describe the MRI findings.
Axial T1
Axial T1 + Contrast
Sagittal T1
Axial T2 FLAIR
Coronal T1 + Contrast
Question 2
• What is the differential diagnosis
of an intraventricular mass
lesion?
Answer
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Choroid Plexus Tumor
Ependymoma
Subependymoma
Meningioma
Central Neurocytoma
Oligodendroglioma
Astrocytoma
Medulloblastoma
Question 4
• The lesion was resected and submitted for
pathologic examination. Describe the H&E
sections.
• Click here to see the H&E slide
Question 5
• What is your diagnostic impression?
Answer
• Neuroendocrine tumor
• Choroid plexus tumor (adenoma, carcinoma)
• Metastatic tumor (lung, kidney, thyroid,
melanoma)
• Unusual meningioma
• Unusual lymphoid neoplasm
• Hemangioblastoma
Question 6
• The differential diagnosis is broad. What stains
would you order in order to better characterize
this lesion and limit your differential?
Answer
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Keratins (CK7, CK20, Cam5.2, AE1/3)
S100, MelanA, HMB45 (r/o melanoma)
Synaptophysin, Chromogranin (neuroendocrine markers)
EMA, p63, GFAP (meningioma, glial)
CD20, CD3, CD68, Pax-8 (inflammatory, lymph)
CD10, TTF1, Thyroglobulin (renal, lung, thyroid)
Transthyretin (choroid plexus tumors)
Ki67 (proliferation index)
• Click to see Cam5.2, AE1/3, CK7, Transthyretin,
Synaptophysin, Ki67, p53, GFAP, S100, Reticulin
Answer
• Choroid Plexus Papilloma, WHO grade 1
Question 8
• How are choroid plexus tumors
graded?
Answer
• Choroid Plexus Papilloma – WHO grade 1
• Atypical Choroid Plexus Papilloma – WHO grade 2
• Choroid Plexus Carcinoma, WHO grade 3