Oligodendroglioma?

Un cordial saludo.

Podría ser un meningioma de células claras, indicaría un PAS para evidenciar glucogeno, EMA y otra IHQ para el diagnostico diferencial que puede ser extenso.

Saludos David

Dear Drs. Giorgio and Francesca

In my opinion this is a malignant neoplasm. I think the presence of some large eosinophilic nucleoli, the excentric eosinophilic cytoplasm of some epithelioid calls, and principally, the fine brown cytoplasmic granularity (figure 7) favor the diagnosis of MELANOMA, possibly primary, according to the prolonged duration of symptoms.

Best regards

Romualdo

Atypical teratoid/rhabdoid tumor.

Diferential diagnosis of CNS germinoma.

Beatifull and rare case.

Muy agradecido por presentarlo.

From near the Pacaya volcano.

Hernan

Tumor maligno con rasgos rabdoides. No descarto la metástasis de un melanoma. Gracias

This is classical example of Atypical teratoid/rhabdoid tumor

tumore atipico teratoide/rabdoide (ATRT)

Tumor Rabdoide. Considerarse los diagnóstico diferenciales de cuadros rabdoides de otros tumores, tal como gliomas y meningiomas, ante todo por edad de paciente.

Coincido con el dgtco morfológico de t. Rabdoide / Teratoide.En contra:

Edad, evolución pre operatoria 2 años para una lesión grado 4, localizado cerebelo (adulto.

Ciertamente difícil.

Saludos David

Tumor rabdoide/teratoide atípico, es una magnífica posibilidad. El estudio citogenéteico, con deleción o alteraciones del cromosoma 22(q11.2), o inmunohistoquímico con pérdida de la expresión de hSNF5/INI1 deben ser de gran utilidad para confirmar o descartar esa entidad.

This is an update to the case: immunostains for Actin, Desmin, EMA, GFAP, PlAP, S100P, HMB-45, CD57 gave negative results, while immunostain for Cytokeratin 8,18 disclosed the reactivity seen in Fig. 8. I wish also to point out that according to the radiologist reporting the CT-scan this is most probably an "extracerebral mass".

Ciao a tutti

I would like to know the neurosurgeon opinion about the tumor location. On the images it looks attached to the dura but there is more parenchimal infiltrate.

What about the results on Vimentin, CD99 and INI1?

Me gustaría conocer la opinión del neurocirujano acerca de la localización del tumor. En las imágenes da la impresión de que se encuentra adherido la dura pero existe marcad infiltración del parenquima cerebeloso.

¿Tiene resultados de la Vimentina,CD99 y el INI1?

Haberler C y cols.

Immunohistochemical analysis of INI1 protein in malignant pediatric CNS tumors: Lack of INI1 in atypical teratoid/rhabdoid tumors and in a fraction of primitive neuroectodermal tumors without rhabdoid phenotype.

Am J Surg Pathol. 2006 Nov;30(11):1462-8.

Perry A y cols.

INI1 expression is retained in composite rhabdoid tumors, including rhabdoid meningiomas.

The majority of malignant rhabdoid tumors and atypical teratoid/rhabdoid tumors have a polyphenotypic

immunoprofile that includes epithelial membrane antigen (EMA), vimentin, smooth muscle actin, and

CD99 positivity, as well as variable immunoreactivities for cytokeratins, glial fibrillary acidic protein

(GFAP), synaptophysin, neurofilament, S-100 protein, and desmin. In contrast, most composite

rhabdoid tumors retain the same or a slightly altered immunoprofile of the parent neoplasm.

Mod Pathol. 2005 Jul;18(7):951-8.

Desde este terruño en mesoamerica.

Hernan

Apesar da aparente ausência de focos cartilaginosos (que às vêzes são escassos e difíceis de demonstrar) acho que pode ser um condrossarcoma mesenquimal, pelos seguintes motivos:

1.A idade é compatível

2.Condrossarcomas mesenquimais frequentemente ocorrem em meninges

3.Há um padrão hemangiopericítico, melhor visto nas Figuras 3 e 4

4.Casos intracranianos podem ser positivos para citoqueratinas.

Abraços

Alyssandra

Just to be clear Mesenchymal Chondrosarcoma is extremely rare as primary or not primary meningeal tumor a fact easily corroborated with literature search through pubmed.

In my opinion there is a vascular component but it is not even remotely hemangiopericytic.

Es importante dejar en claro que el condrosarcoma mesenquimal es extremadamente raro como primario o involucrando a las meniges, puntual que se puede corroborar fácilmente con una revisión de literatura en pubmed.

En mi opinión el componente vascular presente no presenta caracteristicas hemangiopericitoides.

Saludes desde este promontorio volcánico del medio de la América.

Hernán Molina Kirsch

As meninges são, sim, classicamente referidas como uma das principais localizações do condrossarcoma mesenquimal:

1."Mesenchymal chondrosarcoma has a predilection for the meninges, orbit, neck, spine, and the lower extremities, although it has been reported in a wide variety of other sites". Kempson RL et al. Tumors of Soft Tissues, AFIP Atlas of Tumor Pathology, Series 3, page 405

2."Although it commonly has its origin in bone or soft tissue, it may arise in the meninges to produce a discrete mass that can compress brain and invade bone". Burger PC, Vogel FS. Surgical pathology of the nervous system and its coverings, ed. 2, 1982, Wiley Medical, page 131

3."Aproximately one-fifth to one-third of the lesions primarily affect the somatic tissssues and the meninges are one of the most common sites of extraskeletal involvement". Fletcher CDM et al. Pathology and Genetics . Tumors of Soft Tissue and Bone, 2002, IARC Press, page 255

4."This rare highly aggressive variant of chondrosarcoma may impinge upon the nervous system from a primary locus in the surrounding skull or spine, or arise directly from the dura or within brain parenchyma". Burger PC and Scheithauer BW. Tumors of the central nervous system. AFIP Atlas of Tumor pathology, Series 3, page 306

5."A high percentage of these neoplasms involve extraosseous structures, such as the orbit, paraspinal region, meninges or soft tissues of the extremities". Rosai and Ackerman's Surgical Pathology, ed 9, 2004, Mosby, page 2169.

Acredito que a possibilidade de um tumor rabdóide/ teratóide atípico seja extremamente improvável. A ocorrência em adultos é excepcional. Quase todos os casos ocorrem em crianças pequenas e apenas dois casos adultos haviam sido descritos à época da publicação da penúltima edição do fascículo da OMS sobre tumores do sistema nervoso central. No mesmo livro lê-se que apenas 10% dos tumores rabdóides/ teratóides atípicos ocorrem na região do ângulo cerebelo-pontino e que as células neoplásicas rabdóides quase sempre expressam EMA e actina. Esses marcadores foram negativos no presente caso.

Felicitaciones a los autores. Es un hermosísimo caso, con alto grado de doficultad,incluso en los tejidos blandos, mucho más en una localización intracraneal. El diagnóstico con la inmunohistoquímica y la demostración de la traslocación (X;18)(p11;q11)es claro.

Congratulations to the authors. This es a beautiful case with a high grade of difficulty even in soft tissue and of course. The diagnosis is clear with the immunohistochemistry and the translocation t(X;18)(p11;q11).

Extraordinario caso. Felicitaciones y gracias por compartirlo.