8/8/2006 Case 1: Low Grade Glioneuronal Neoplasm

Clinical History:

A 40 year old man had a first seizure while on his honeymoon in Las Vegas. An MRI showed a non-enhancing mass in the left temporal lobe, which was resected .

Diagnostic Notes:

The resected lesion had multiple nodules in gray and white matter composed of small to medium-size oligodendroglioma-like cells, with intervening areas of more diffuse infiltration at a lower cell density . There was reactive gliosis admixed with the oligodendroglioma like cells. Additionally there were peculiar weakly eosinophilic inclusions in some cells, not typical of Rosenthal fibers.

Discussion centered around a differential diagnosis of hamartoma versus lowgrade neoplasm. Some favored the forme r , and the demonstrated MIBl immunostain showed a very low proliferative index i n s up port of that. Others, including Dr Miller who presented the case , thought that ultimately this was more likely a low grade glioneuronal neoplasm. No one recogn ized the inclusions and it was thought that an a lpha-B cry s t all ine i mmuno s t ain might be helpful.

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