Brain Pathology Case of the Month - December 2008

Contributed by Julio César Gutiérrez Morales, MD, PhD1, Sandra Gutiérrez Morales, Biol. Sci2 and Aurora Astudillo González, MD, PhD3
1 Department of Neurosurgery, Hospital Universitario Central de Asturias, Oviedo, Spain
2 Faculty of Biological Sciences, University of Oviedo, Spain
3 Department of Clinical Neuropathology, Hospital Universitario Central de Asturias, Oviedo, Spain


A 72-year-old man presented abruptly with a grand mal seizure while he was dancing. He was admitted to our hospital and physical examination detected mild left upper limb paresis. His medical history included idiopathic hypertension and non insulin-dependent diabetes, both under specific drug therapy. Cranial magnetic resonance imaging (MRI) revealed a 4 x 4 x 3-cm extraaxial lesion, isointense on T1-weighted images and hyperintense on T2-weighted images, with heterogenous enhancing. It was located in the posterior right frontal convexity with poorly defined boundaries and remarkable perilesional edema (Fig. 1). The patient then underwent total microsurgical resection of the hypervascular intracranial mass. During operation, the tumor was found to be a mass partially encapsulated with dural attachment. The surgical appearance was felt to be atypical for meningioma. The dissection showed a prominent and arterialized venous drainage and no evident cleavage plane in some areas. A small piece of tumor was submitted for frozen section (Fig. 2).


On macroscopic examination, the tumor was irregularly spherical (17 gm weight and 4 x 4 x 3 cm mass). Under a rough gray surface, an extensive solid and soft yellowish area emerged. Serial sections showed that this area occupied two-third of the tumor. Histological examination showed a large central soft area that consisted of polyhedral cells with clear cytoplasm and mild atypia, arranged in alveolar and glandular patterns with scarce fibrovascular stroma (Fig 2). The peripheral zone was composed of uniform sheets of polygonal and spindle cells (fig 2 and 3). Psammoma bodies were also identified in the tumor (Fig. 3). Immunohistochemical staining for cytokeratin 8 (Fig. 4) and CD 10 (Fig. 5) showed positivity only in the clear cell component


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