Brain Pathology Case of the Month - January 2020

Contributed by Marcos Devanir Silva da Costa¹, MD, MSc, Mauricio Isaac Panicio¹, MD, Gregório Wrublevski Pereira^1,3, MD, PhD, Patricia Alessandra Dastoli¹, MD, PhD,
     Jardel Mendonça Nicácio¹, MD, Andrea Maria Cappellano², MD, Nasjla Saba-Silva², MD, Maria Teresa de Seixas Alves³, MD, PhD, Sergio Cavalheiro¹, MD, PhD
¹Department of Neurosurgery, Federal University of Sao Paulo, Sao Paulo, Brazil.
     ²Pediatric Oncology Institute/GRAACC, Department of Pediatrics, Federal University of Sao Paulo, Sao Paulo, Brazil.
     ³Department of Pathology, Federal University of Sao Paulo, Sao Paulo, Brazil.

CLINICAL HISTORY

Our patient is a 15 year-old boy, with a previous diagnosis of neurofibromatosis type 2, who had undergone surgical resections of olfactory groove tumors, at five and 13 years of age. Both resections had histopathologically-confirmed meningothelial meningioma (WHO grade I).The patient also had other intracranial lesions bilaterally in the cerebellopontine angle, and in the left Mackel cave, involving the vestibular and trigeminal nerves. All of these lesions showed enhancement with MRI. The patient suffered left hearing loss and left hemiparesis since the first surgery 10 years ago. Three months before admission, the patient developed seizures and antiepileptic drugs were introduced. MRI showed relapse in the olfactory groove lesion (Fig. 1a). At this time, a third microsurgical approach of the olfactory groove lesion was performed, achieving satisfactory resection (Fig. 1b). The patient's condition did not worsen postoperatively.

GROSS AND MICROSCOPIC PATHOLOGY

H&E stained setions revealed a tumor withf two distinct histological patterns (Figs. 1c, 1d). The predominant pattern is shown in Figure 1d. These cells were S100-positive (Fig. 1g), SOX-10-positive (Figs. 1h, 1i), and progesterone receptor-negative (Fig. 1j); and the reticulin stain also exhibited rich reticulin fibers (Fig. 1k). In contrast, the minor is shown in Figures 1e and 1f. These cells were S100-negative (Fig. 1g), SOX-10-negative (Fig. 1h, 1i), and progesterone receptor-positive (Fig. 1j). The reticulin stain was weak. (Fig. 1k). What is/are your diagnosis/diagnoses?

FINAL DIAGNOSIS

Brain Pathology Case of the Month - January 2020

International Society of Neuropathology