Brain Pathology Case of the Month - February 2009

Contributed by Laura Aón Bertolino, MD2; Pía Lépore, MD2; Mónica Carassai, MD2, Roberto González, MD3;
    Gustavo Sevlever, MD, PhD1; Miguel A. Riudavets, MD1
1Department of Neuropathology. Institute for Neurological Research, FLENI. Buenos Aires, Argentina.
2Departments of Pathology, and 3Neurosurgery. Hospital Churruca-Visca. Buenos Aires, Argentina.


A 1-year old male (with no significant past medical history) presented to the Department of Plastic Surgery for evaluation and eventual resection of a subcutaneous frontal mass. Imaging of the head revealed a second intracranial mass and he was referred to the Department of Neurosurgery. Subsequently, Magnetic Resonance Imaging (MRI) detected two T-1-hyperintense masses. One was the extra-cranial frontal mass noted clinically and the other was an intra-axial, interhemispheric frontal mass. Additionally, partial agenesis of posterior corpus callosum was found. (Figure 1) At that time, only the subcutaneous mass was resected and physical examination was normal.

Four years later a follow-up MRI revealed that the intracranial lesion had doubled in size (Figure 2). It was hyperintense on both T1 and T2 (Figures 2 and 3). Craniotomy was performed and a soft yellow mass was partially resected. Focal attachment to the cingulate gyri was appreciated.


Macroscopically, surgical fragments from both specimens were yellow, lobulated and soft. Permanent sections from the extracranial frontal mass are shown in figure 4. Sections from the intracranial lesion are shown in Figures 5, 6, 7 and 8. No normal cortex was appreciated. Some areas were positive for GFAP (glial fibrillary acidic protein).(Figure 9)


International Society of Neuropathology