Contributed by Isidro Ferrer1; Fina Climent2; Noemi Vidal1; Luis Alberto Escobar1; Juan José Sánchez3; Alejandro Fernandez-Coello4
Institute of Neuropathology1, Service of Pathology2, Service of Neuroradiology3, Service of Neurosurgery4, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
A 74-year-old woman suffered from progressive weakness, paresis of the right hemisphere and occasional headache during the last three months. The patient denied having had nausea, vomiting, fever or weight loss. Nuclear magnetic resonance showed round lobular lesions involving the frontal lobe and corpus callosum, protruding into the lateral ventricle. Lesions were enhanced with the contrast medium exhibiting a ring-like appearance (Figs. 1a, 1b, 1c). A stereotactic brain biopsy was performed using VarioGuide system.
Microscopically, the lesion infiltrated the brain and was composed of large, atypical cells with hyper-chromatic nuclei and abundant cytoplasm (Fig. 2). Mitoses were observed as well as focal necrosis without formation of secondary structures; endothelial hyperplasia and vascular proliferation forming glomeruli were absent. Immunohistochemical staining showed negativity for GFAP, S-100, CD1a, CD20, CD3, CD8, CD34, CD117, MPO and CD15. Proliferation index, measured by Ki67 expression was 60% (Fig. 3). Cells were positive for LCA (CD45) (Fig. 4), CD163 (Fig. 5), CD4 and CD68 (Fig. 6)