Transcript Case Study - University of Pittsburgh

Clayton Wiley, M.D., PhD
Question 1
Clinical history: 40-year-old female with complaint of low
back pain radiating to the lower extremities. Describe the
abnormal spinal MRI findings?
Sag T2
Sag T1+C
Question 2
What are your differential diagnoses based on the patients’
age and the radiological findings?
Answer
1.
2.
3.
4.
5.
Ependymoma
Subependymoma
Astrocytoma
Paraganglioma
Infection?
Question 3
The neurosurgeon performs a L1-2 decompressive
laminectomy with resection of the focally encapsulated mass
within the cauda equina and/or conus medullaris, and
requested an intraoperative consultation. Describe the
microscopic findings on this frozen section slide?
Click here to view slide.
Question 5
The permanent section has returned from histology. Describe
the microscopic findings on this H&E slide?
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Question 6
What additional immunohistochemical
studies would a neuropathologist need to
confirm the final diagnosis?
Answer
1. GFAP
2. EMA
3. Ki-67
Question 7
What do you see on this GFAP immunostain slide?
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Question 9
What do you see on this Ki-67 (MIB-1) immunostain slide?
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Question 10
What is your final diagnosis in this case?
Answer
Myxopapillary Ependymoma
Question 11
What is the corresponding WHO grade of this lesion?
Answer
WHO Grade 1