Saturday 1 October 2016

Frontal lobe SOL on MRI

A 40 y o male with seizures and fall.
Previous CT shows right frontal hypo density, clinical query was right frontal contusion or something else.


This MRI brain shows an intra axial ~ 74x40mm lesion involving right superior frontal gyrus, adjacent cingulate gyrus and calloso septal groove. Corpus callosum uninvolved. Lesion show ill defined infiltrative margins, mild to moderate heterogeneous enhancement on post contrast due to areas of necrosis, no obvious cystic component. No sub falcine herniation of lesion. ACAs compressed, mid line shift of ~3mm to left.
No e/o bleed in lesion on GRE.
On MR Angiogram of Brain and neck vessels no hemodynamically significant major vessel stenosis or occlusion.
Superior sagittal sinus show normal T2 flow voids. Normal MR Venogram of Brain, CVT ruled out.
Previous CT shows no obvious calcification in lesion.

Imaging wise diagnosis : Glioma  _ Intermediate grade.


Specimen         :   Biopsy – Right frontal lobe, SOL
Gross Appearance    : The specimen consists  few soft pieces of dull grey white tumourous tissue; together 1.0X1.0X0.5 cm. The entire tissue is submitted for processing.

Microscopy        : Section and additional made serial deeper section a moderately cellular oligodendroglial neoplasm amidst reactive glial tissue. The tumour comprise of fairly uniform appearing intermediate sized, round to oval cells having hyperchromatic nuclei with subtle pleomorphism and finely stippled or coarse nuclear chromatin. The cells have scanty eosinophilic to vacuolated cytoplasm. The interstitium shows short capillaries with angulations. An occasional high power field shows a doubtful mitosis. Also seen are few scattered foci of calcification.

Diagnosis         :  Biopsy – Right frontal lobe, SOL :   Oligodendroglioma.

(Adv. Immunohistochemical ancillary studies for confirmation and definite lineage typing).

1 comment:

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