Contributed by 1Brian H. Le, MD, 2Raymond C. Truex, MD
1Department of Pathology, Reading Hospital and Medical Center, West Reading, PA
2Spine & Brain Neurosurgery Center, West Reading, PA
A 29 year-old male with limited health care interactions, previously diagnosed hypertension, and history of tobacco use presented following rapid onset nausea, dizziness, blurry vision, and tremors, resulting in a syncopal episode. At the initial formal assessment, physical examination revealed no specific abnormalities. Specifically, the neurologic examination demonstrated no focal deficits. Laboratory values were within normal limits, and toxicology studies were all negative. A CT scan of the brain revealed a 1.3 cm solitary, ring-enhancing lesion in the right temporal-parietal region, with associated vasogenic edema.
The patient subsequently underwent a craniotomy with attempt at gross total resection, yielding a discrete, 1.4 cm intact nodular tissue fragment. Concurrent infectious disease evaluations later reported negative results.
Histologic examination shows a nodular tissue fragment (Figure 1) composed of an eosinophil-rich infiltrate admixed with histiocytes (Figure 2). The histiocytes are characterized by grooved, reniform nuclei (Figure 3). Histiocytic elements show diffuse, intense nuclear and cytoplasmic reactivity for S-100 protein (Figure 4) and for CD1a (Figure 5).