Challenges in the Intraoperative Consultation of Low-Grade Epilepsy-Associated Neuroepithelial Tumors by Cytomorphology in Squash Preparations

2022 ◽  
pp. 1-7
Author(s):  
Olcay Kurtulan ◽  
Burçak Bilginer ◽  
Figen Soylemezoglu
Keyword(s):  
Ganglion Cells ◽  
Case Reports ◽  
Daily Practice ◽  
Individual Case ◽  
Glioneuronal Tumor ◽  
Dysembryoplastic Neuroepithelial Tumor ◽  
Low Grade ◽  
Diagnostic Challenge ◽  
Neuroepithelial Tumors ◽  
Tumor Types

<b><i>Introduction:</i></b> Low-grade epilepsy-associated neuroepithelial tumors (LEATs) create a diagnostic challenge in daily practice and intraoperative pathological consultation (IC) in particular. Squash smears are extremely useful in IC for accurate diagnosis; however, the knowledge on cytopathologic features of LEATs is based on individual case reports. Here, we discuss the 3 most common and well-established entities of LEATs: ganglioglioma (GG), dysembryoplastic neuroepithelial tumor (DNT), and papillary glioneuronal tumor (PGNT). <b><i>Methods:</i></b> Thirty patients who underwent surgery for GG, DNT, and PGNT between 2001 and 2021 were collected. Squash smears prepared during intraoperative consultation were reviewed by 1 cytopathologist and an experienced neuropathologist. <b><i>Results:</i></b> Among the 30 tumors, 16 (53.3%) were GG, 11 (36.6%) DNT, and 3 (10%) PGNT. Cytomorphologically, all of the 3 tumor types share 2 common features such as dual cell population and vasculocentric pattern. GG smears were characteristically composed of dysplastic ganglion cells and piloid-like astrocytes on a complex architectural background of thin- to thick-walled vessels. DNT, on the other hand, showed oligodendroglial-like cells in a myxoid thin fibrillary background associated with a delicate capillary network. Common cytological features of PGNT were hyperchromatic cells with narrow cytoplasm surrounding hyalinized vessels forming a pseudopapillary pattern and bland cells with neuroendocrine nuclei dispersed in a neuropil background. <b><i>Conclusion:</i></b> A higher diagnostic accuracy can be obtained when squash smears are applied with frozen sections. However, it is important to integrate clinical and radiologic features of the patient as well as to know the cytopathologic features of the LEAT spectrum in the context of differential diagnosis to prevent misinterpretation in the IC.

scholarly journals Rosette-forming glioneuronal tumor: an illustrative case and a systematic review

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Caleb P Wilson ◽  
Arpan R Chakraborty ◽  
Panayiotis E Pelargos ◽  
Helen H Shi ◽  
Camille K Milton ◽  
...  
Keyword(s):  
Systematic Review ◽  
Aggressive Behavior ◽  
Case Reports ◽  
World Health ◽  
Glioneuronal Tumor ◽  
Illustrative Case ◽  
Low Grade ◽  
Search Term ◽  
Who Grade ◽  
Mri Features

Abstract Background Rosette-forming glioneuronal tumors (RGNTs) are rare, low-grade, primary CNS tumors first described in 2002 by Komori et al. RGNTs were initially characterized as a World Health Organization (WHO) grade I tumors typically localized to the fourth ventricle. Although commonly associated with an indolent course, RGNTs have the potential for aggressive behavior. Methods A comprehensive search of PubMed and Web of Science was performed through November 2019 using the search term “rosette-forming glioneuronal tumor.” Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. English, full-text case reports and series with histopathological confirmation were included. Patient demographics, presentations, MRI features, tumor location, treatment, and follow-up of all 130 cases were extracted. Results A 19-year-old man with a history of epilepsy and autism presented with acute hydrocephalus. MRI scans from 2013 to 2016 demonstrated unchanged abnormal areas of cortex in the left temporal lobe with extension into the deep gray-white matter. On presentation to our clinic in 2019, the lesion demonstrated significant progression. The patient’s tumor was identified as RGNT, WHO grade I. One hundred thirty patients were identified across 80 studies. Conclusion RGNT has potential to transform from an indolent tumor to a tumor with more aggressive behavior. The results of our systematic review provide insight into the natural history and treatment outcomes of these rare tumors.

Endobronchial Mucus Gland Adenoma: A Case Report

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S45-S45
Author(s):  
A D Sandhu ◽  
Y Liu
Keyword(s):  
Frozen Section ◽  
Case Reports ◽  
Bronchial Epithelium ◽  
Benign Tumors ◽  
Low Grade ◽  
Sleeve Resection ◽  
Diagnostic Challenge ◽  
Epithelial Tumor ◽  
Mucus Gland ◽  
The Right

Abstract Introduction/Objective Mucus Gland Adenoma (MGA) is a rare benign epithelial tumor with few case reports. They arise from submucosal glands and ducts of large proximal airways, but have been reported peripherally and within lung parenchyma. MGAs form an exophytic mass that causes obstructive symptoms, occurring in all ages without gender predilection. MGAs have low to no malignant potential, but may be confused with more aggressive entities. Thus, MGA may present a diagnostic challenge on frozen section. Methods We present the case of a 66-year-old male with recurrent right pneumonia and empyema. Bronchoscopy revealed an obstructing mass in the right bronchus intermedius. Biopsies and cytology were insufficient showing only benign bronchial epithelium. Therefore, the patient underwent surgical sleeve resection of the right bronchus intermedius for diagnosis and treatment. It was received in two pieces measuring 1.0 x 0.6 x 0.5 and 2.0 x 1.5 x 0.9 cm - a well-circumscribed, firm white nodule with a smooth exterior and pushing borders. Cut surfaces were mucoid, homogenous and rubbery, with cysts measuring up to 2 mm. Histology showed crowded mucus-filled acini and tubules lined by bland cuboidal to columnar cells without atypia or mitosis. The stroma showed smooth muscle bundles and lymphocytic infiltrate. Benign bronchial epithelium lined the surface. A preliminary diagnosis of “adenoma” was made, with final classification pending permanent section. Results It showed positivity for s100, CK5/6, and CAM5.2. DOG1 showed a luminal staining pattern. NapsinA was negative and TTF-1 was patchy. P63, P40, CK5/6 and calponin highlighted myoepithelial cells, underlining the benign nature of the process. Conclusion MGA may resemble adenocarcinoma, low-grade mucoepidermoid carcinoma, and other benign adenomas. It presents a diagnostic challenge on frozen section as its malignant differentials are more common. Thus, it is important to recognize and be aware of these rare, benign tumors.

scholarly journals Frequent FGFR1 hotspot alterations in driver-unknown low-grade glioma and mixed neuronal-glial tumors

2022 ◽  
Author(s):  
Sophie Engelhardt ◽  
Felix Behling ◽  
Rudi Beschorner ◽  
Franziska Eckert ◽  
Patricia Kohlhof ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Mapk Pathway ◽  
Glioneuronal Tumor ◽  
Dysembryoplastic Neuroepithelial Tumor ◽  
Low Grade ◽  
Sequencing Analysis ◽  
Diffuse Astrocytoma ◽  
Glial Tumors ◽  
Hotspot Mutations ◽  
Fgfr1 Mutation

Abstract Purpose Low-grade gliomas (LGG) and mixed neuronal-glial tumors (MNGT) show frequent MAPK pathway alterations. Oncogenic fibroblast growth factor receptor 1 (FGFR1) tyrosinase kinase domain has been reported in brain tumors of various histologies. We sought to determine the frequency of FGFR1 hotspot mutations N546 and K656 in driver-unknown LGG/MNGT and examined FGFR1 immunohistochemistry as a potential tool to detect those alterations. Methods We analyzed 476 LGG/MNGT tumors for KIAA-1549-BRAF fusion, IDH1/2, TERT promotor, NF1, H3F3A and the remaining cases for FGFR1 mutation frequency and correlated FGFR1 immunohistochemistry in 106 cases. Results 368 of 476 LGG/MNGT tumors contained non-FGFR1 alterations. We identified 9 FGFR1 p.N546K and 4 FGFR1 p.K656E mutations among the 108 remaining driver-unknown samples. Five tumors were classified as dysembryoplastic neuroepithelial tumor (DNT), 4 as pilocytic astrocytoma (PA) and 3 as rosette-forming glioneuronal tumor (RGNT). FGFR1 mutations were associated with oligodendroglia-like cells, but not with age or tumor location. FGFR1 immunohistochemical expression was observed in 92 cases. FGFR1 immunoreactivity score was higher in PA and DNT compared to diffuse astrocytoma, but no correlation between FGFR1 mutation in tumors and FGFR1 expression level was observed. Conclusion FGFR1 hotspot mutations are the fifth most prevailing alteration in LGG/MNGT. Performing FGFR1 sequencing analysis in driver-unknown low-grade brain tumors could yield up to 12% FGFR1 N546/K656 mutant cases.

scholarly journals Distribution of GOPC:ROS1 and other ROS1 fusions in glioma types

2021 ◽  
Author(s):  
Philipp Sievers ◽  
Damian Stichel ◽  
Martin Sill ◽  
Daniel Schrimpf ◽  
Dominik Sturm ◽  
...  
Keyword(s):  
Single Case ◽  
Case Reports ◽  
Comprehensive Analysis ◽  
Low Grade ◽  
Full Width ◽  
Who Grade ◽  
Chromosomal Alterations ◽  
Attractive Therapeutic Target ◽  
Tumor Types ◽  
Specific Inhibitors

The ROS proto-oncogene 1 (ROS1) gene is rearranged in various cancers. The translated fusion protein presents an attractive therapeutic target, since specific inhibitors have been approved for several tumor types. In glioma, ROS1 fusions are frequent within infantile hemispheric glioma, and single case reports on occurrences in other glioma types exist. However, a comprehensive analysis spanning the full width of glioma types and subtypes is lacking. We here assessed the spectrum and distribution of ROS1 fusions by screening >20,000 glioma cases for typical chromosomal alterations, with subsequent RNA-sequencing for confirmation of candidate cases. ROS1 fusions were identified in 16 cases, from low grade pilocytic astrocytoma WHO grade 1 to glioblastoma, IDH wildtype WHO grade 4. Thus, despite being enriched in some tumor types, ROS1 fusions are not pathognomonic for specific glioma types and may constitute a relevant target in a variety of cases.

Herpetic Whitlow of the Hand in Infants

2020 ◽  
Author(s):  
Mohammad M. Al-Qattan ◽  
Nada G. AlQadri ◽  
Ghada AlHayaza
Keyword(s):  
Bacterial Infection ◽  
Case Reports ◽  
Case Series ◽  
Individual Case ◽  
Senior Author ◽  
Secondary Bacterial Infection ◽  
Clinical Appearance ◽  
History Of ◽  
Mode Of Transmission ◽  
Time Of Presentation

Abstract Introduction Herpetic whitlows in infants are rare. Previous authors only reported individual case reports. We present a case series of six infants. Materials and Methods This is a retrospective study of six cases of herpetic whitlows in infants seen by the senior author (MMA) over the past 23 years (1995–2017 inclusive). The following data were collected: age, sex, digit involved in the hand, mode of transmission, time of presentation to the author, clinical appearance, presence of secondary bacterial infection, presence of other lesions outside the hand, method of diagnosis, treatment, and outcome. Results All six infants initially presented with classic multiple vesicles of the digital pulp. In all cases, there was a history of active herpes labialis in the mother. Incision and drainage or deroofing of the vesicles (for diagnostic purposes) resulted in secondary bacterial infection. Conclusion The current report is the first series in the literature on herpetic whitlows in infants. We stress on the mode of transmission (from the mother) and establishing the diagnosis clinically. In these cases, no need for obtaining viral cultures or polymerase chain reaction; and no medications are required. Once the vesicles are disrupted, secondary bacterial infection is frequent and a combination of oral acyclovir and intravenous antibiotics will be required.

Prognostic histopathologic features of canine glial tumors

2021 ◽  
pp. 030098582110257
Author(s):  
Joshua L. Merickel ◽  
G. Elizabeth Pluhar ◽  
Aaron Rendahl ◽  
M. Gerard O’Sullivan
Keyword(s):  
Brain Tumor ◽  
Median Survival ◽  
Low Grade ◽  
Astrocytic Tumors ◽  
Translational Model ◽  
Poor Survival ◽  
Whole Brain ◽  
Tumor Types ◽  
Tumor Biopsies ◽  
Prognostic Data

Gliomas are relatively common tumors in aged dogs (especially brachycephalic breeds), and the dog is proving to be useful as a translational model for humans with brain tumors. Hitherto, there is relatively little prognostic data for canine gliomas and none on outcome related to specific histological features. Histologic sections of tumor biopsies from 33 dogs with glioma treated with surgical resection and immunotherapy and 21 whole brains obtained postmortem were reviewed. Tumors were diagnosed as astrocytic, oligodendroglial, or undefined glioma using Comparative Brain Tumor Consortium criteria. Putative features of malignancy were evaluated, namely, mitotic counts, glomeruloid vascularization, and necrosis. For biopsies, dogs with astrocytic tumors lived longer than those with oligodendroglial or undefined tumor types (median survival 743, 205, and 144 days, respectively). Dogs with low-grade gliomas lived longer than those with high-grade gliomas (median survival 734 and 194 days, respectively). Based on analysis of tumor biopsies, low mitotic counts, absence of glomeruloid vascularization, and absence of necrosis correlated with increased survival (median 293, 223, and 220 days, respectively), whereas high mitotic counts, glomeruloid vascularization, and necrosis correlated with poor survival (median 190, 170, and 154 days, respectively). Mitotic count was the only histological feature in biopsy samples that significantly correlated with survival ( P < .05). Whole-brain analyses for those same histologic features had similar and more robust correlations, and were statistically significant for all features ( P < .05). The small size of biopsy samples may explain differences between biopsy and whole-brain tumor data. These findings will allow more accurate prognosis for gliomas.

scholarly journals Leptomeningeal Carcinomatosis: A Clinical Dilemma in Neuroendocrine Neoplasms

Biology ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 277
Author(s):  
Leonidas Apostolidis ◽  
Jörg Schrader ◽  
Henning Jann ◽  
Anja Rinke ◽  
Sebastian Krug
Keyword(s):  
Brain Metastases ◽  
Median Overall Survival ◽  
Case Reports ◽  
Individual Case ◽  
Leptomeningeal Carcinomatosis ◽  
Neuroendocrine Neoplasms ◽  
Cns Involvement ◽  
Ki 67 ◽  
Sensory Deficits ◽  
Clinical Dilemma

Central nervous system (CNS) involvement by paraneoplastic syndromes, brain metastases, or leptomeningeal carcinomatosis (LC) in patients with neuroendocrine neoplasms (NEN) has only been described in individual case reports. We evaluated patients with LC in four neuroendocrine tumor (NET) centers (Halle/Saale, Hamburg, Heidelberg, and Marburg) and characterized them clinically. In the study, 17 patients with a LC were defined with respect to diagnosis, clinic, and therapy. The prognosis of a LC is very poor, with 10 months in median overall survival (mOS). This is reflected by an even worse course in neuroendocrine carcinoma (NEC) G3 Ki-67 >55%, with a mOS of 2 months. Motor and sensory deficits together with vigilance abnormalities were common symptoms. In most cases, targeted radiation or temozolomide therapy was used against the LC. LC appears to be similarly devastating to brain metastases in NEN patients. Therefore, the indication for CNS imaging should be discussed in certain cases.

scholarly journals A Case of False-PositiveMycobacterium tuberculosisCaused byMycobacterium celatum

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Edward Gildeh ◽  
Zaid Abdel-Rahman ◽  
Ruchira Sengupta ◽  
Laura Johnson
Keyword(s):  
High Performance ◽  
Case Reports ◽  
Public Health Intervention ◽  
Signs And Symptoms ◽  
Clinical History ◽  
Nucleic Acid Amplification ◽  
Nontuberculous Mycobacterium ◽  
Diagnostic Challenge ◽  
Reliable Differentiation ◽  
Oligonucleotide Sequence

Mycobacterium celatumis a nontuberculous mycobacterium shown to cause symptoms similar to pulmonaryM. tuberculosis. Certain strains have been shown to cross-react with the probes used to detectM. tuberculosis, making this a diagnostic challenge. We present a 56-year-old gentleman who developed signs and symptoms of lung infection with computed tomography scan of the chest showing right lung apex cavitation. Serial sputum samples were positive for acid-fast bacilli and nucleic acid amplification testing identifiedM. tuberculosisribosomal RNA, resulting in treatment initiation. Further testing with high performance liquid chromatography showed a pattern consistent withM. celatum. This case illustrates the potential forM. celatumto mimicM. tuberculosisin both its clinical history and laboratory testing due to the identical oligonucleotide sequence contained in both. An increasing number of case reports suggest that early reliable differentiation could reduce unnecessary treatment and public health intervention associated with misdiagnosed tuberculosis.

scholarly journals Dysembryoplastic neuroepithelial tumor and oligodendroglioma: the diagnostic value of magnetic resonance spectroscopy

1998 ◽  
Vol 4 (4) ◽  
pp. E8 ◽  
Author(s):  
Eric W. Sherburn ◽  
Mark M. Bahn ◽  
Murat Gokden ◽  
Daniel L. Silbergeld ◽  
Keith M. Rich
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Spectroscopy ◽  
Treatment Options ◽  
Diagnostic Value ◽  
Low Grade Glioma ◽  
Resonance Spectroscopy ◽  
Dysembryoplastic Neuroepithelial Tumor ◽  
Low Grade ◽  
Radiological Findings ◽  
Similar Treatment

Preoperative differentiation between dysembryoplastic neuroepithelial tumor (DNT) and low-grade glioma is often not possible. Dysembryoplastic neuroepithelial tumor is a recently described entity of uncertain origin; however, the diagnosis has important clinical implications. Clinical and radiological findings of DNT and low-grade glioma, especially oligodendroglioma, may be similar. Treatment options and prognosis differ significantly between these two lesions; consequently, accurate diagnosis is imperative. The authors describe two individuals who presented simultaneously at their institution: one patient with an oligodendroglioma and a second patient with DNT. The natural history, neurodiagnostic, and pathological features of each are reviewed with special emphasis on the potential utility of magnetic resonance spectroscopy in differentiating these lesions.

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