Contributed by Alicia F Liang, MD and Geoffrey Murdoch, MD, PhD
An 18-year-old female presented to the emergency room at Children's Hospital after three episodes of seizure activity involving her entire body, with associated loss of consciousness, followed by a post-ictal state. The first two seizures lasted five minutes each with five-minute period of confusion following; the third episode lasted ten minutes, and was followed by a ten-minute period of confusion. After the second episode the patient's mother called EMS, but the patient refused transport. However, after the third episode the patient was then transported to the ED. She did not have any history of nausea, vomiting, fever, chills or headache. While in the ER the patient experienced another seizure lasting approximately thirty seconds. She has a history of a right supramarginal gyrus brain mass which has been present for approximately one year. She is followed by neurology and neurosurgery, and has repeatedly been scheduled for resection of the mass, but has not been compliant. The patient had been having seizure activity for the past five months, for which she was placed on appropriate medications. The patient was scheduled for resection of tumor on one month later.
Magnetic resonance imaging (MRI) using multiple modalities demonstrated a cortical-based mass involving the right supramarginal gyrus. The mass had both a solid component with an adjacent cystic component. There was no significant surrounding brain edema.
The specimen was received in multiple parts. Each part consisted of multiple fragments of smooth glistening soft tissue that ranged in color from pink-tan to dark brown.
The specimen consisted of multiple fragments of tissue with spindled cells arranged predominantly in fascicles. These cells have ovoid nuclei and a heterogeneous chromatin pattern. There are occasional mitotic figures. The vessels are notable for a perivascular chronic inflammatory infiltrate. Eosinophilic granular bodies are seen throughout the specimen; no Rosenthal fibers are seen. Some of the cells have a xanthomatous appearance, with vacuolated cytoplasm. Part 3 contains many bizarre atypical nuclei.
Reticulin stain was performed on part 2 to evaluate for reticulin deposition in the lesion; this showed regions of staining surrounding individual and nests of tumor cells. Ki67 proliferative index was determined as less than 2%.