7/27/2010 Case 3

Presented by: Dr. Faust - Columbia University

Clinical History:

A 56-year-old woman who was in usual health until December 2009 when she noted an unusual smell sensation. She then developed word finding difficulty and sleepiness. At a local emergency room, an initial CT scan was interpreted as normal with no evidence of hemorrhage or stroke. MR angiogram was performed
and reported as normal. An MRI scan was then performed, revealing a diffuse infiltrating lesion involving the entire anterior aspect of the left temporal lobe, extending along the parahippocampal and hippocampal gyri and resulting in impending uncal herniation and some compression of the left cerebral peduncle. There was no significant contrast enhancement. DWI showed no restricted diffusion to suggest an acute CVA. A repeat pre-operative MRI scan (two days later) identified a tiny focus of contrast enhancement in the temporal lobe lesion. She underwent an open biopsy at this outside hospital. Slides were sent for consultation to Mayo Clinic and the diagnosis revised. Two months after the biopsy, MRI at Columbia University Medical Center showed an area of low signal intensity with possibly some punctate enhancement at the margin, suggestive of residual tumor. A second surgery was performed for decompression prior to initiation of adjuvant therapy. The submitted slide is from this second surgery.

A 17-year-old male with a large brain tumor. He first underwent an open biopsy. The tumor was more completely resected at CHOP. Slides of the second resection were sent to Columbia University Medical Center for further consultation. Images provided are from the second surgery.

Slide Image:

view high resolution slide image