Brain Pathology Case of the Month - February 2011

Contributed by Ioannis Venizelos1, Eleftherios Anagnostou1, Thomas Papathomas1, Vasilios Spandos1, Dimitrios Marinopoulos2, Parmenion Tsitsopoulos2, Christos Tsonidis2
1Department of Pathology, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece
2Department of Neurosurgery, Aristotle University of Thessaloniki, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece


A 57-year-old woman with past medical history of a uterine leiomyosarcoma was referred to the department of Neurology due to recurrent episodes of nausea and vomiting, as well as instability during walking. In particular, the patient had underwent a hysterectomy and oophorectomy 8 months ago. Neurological physical examination revealed disorientation, horizontal nystagmus, equilibrium imbalance and ataxia. On CT scan, an extra-axial calcified mass, located in the left cerebellar hemisphere, accompanied with mild edema and measuring 4.5 cm in maximum diameter, was visualized (Figures 1, 2). A suboccipital craniectomy with segmental surgical excision of the lesion was subsequently performed.


Histopathologic examination of multiple tissue fragments displayed infiltration of cerebellar tissue by pleomorphic neoplastic cells (Figures 3, 4). The neoplastic cells were mononuclear, with irregular, atypical nuclei and mildly eosinophilic cytoplasm (Figure 5). Mitotic figures were frequent (Figure 6). Tumor cells were immunoreactive for vimentin, desmin (Figure 7) and SMA (Figure 8), but not for GFAP, Neuron-Specific Enolase (NSE), synaptophysin, S100 protein, cytokeratins AE1/AE3, LCA, CD99 and type IV collagen. The Ki-67 proliferation (labelling) index was approximately 20%.


International Society of Neuropathology