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Clayton Wiley MD/PhD. 38-year-old male with progressive weakness of upper and lower extremities, in addition to confusion. Describe the MRI findings (location,

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Presentation on theme: "Clayton Wiley MD/PhD. 38-year-old male with progressive weakness of upper and lower extremities, in addition to confusion. Describe the MRI findings (location,"— Presentation transcript:

1 Clayton Wiley MD/PhD

2 38-year-old male with progressive weakness of upper and lower extremities, in addition to confusion. Describe the MRI findings (location, enhancement, mass effect).

3 MRI T2 FLAIR images

4 MRI T1 pre and post contrast

5 MRI side-by-side FLAIR and postcontrast images

6 Question 1 What additional clinical information would you like to know?

7 Is there any significant past medical history? signs/symptoms of infection previous malignancy (Fam Hx) Previous treatments PE- evidence of peripheral lesions or infections? Lab- Blood and CSF analysis Answer

8 Give a differential diagnosis based on MRI. Question 2

9 Infectious disease (Toxoplasmosis, Amebic encephalitis, Viral, PML) Lymphoma Demyelinating lesion (Multiple sclerosis) Metastasis Gliomatosis cerebri Multiple infarcts (Embolic / Vasculopathy) Answer

10 The surgeon tells you that a full body CT showed no masses, an HIV test was positive and the CSF showed lymphocytes. You receive 2 cores of tissue in consultation for intraoperative guidance. Describe the cytologic features of the touch prep and smear. Click here to view slides.here Question 3

11 What is your intraoperative diagnosis? Question 4

12 What can a neuropathologist do to validate their diagnosis? Question 5

13 LCA, CD20/L26 & CD3. Other hematopoietic markers (ie CD79a, kappa, lambda, CD10, MUM-1, etc) and vimentin/GFAP (to highlight gliosis) might also be helpful in certain cases. Answer

14 Review the permanent section and describe the microscopic features. Click here to view slide.here Question 6

15 What is your final diagnosis? Question 7

16 Secondary involvement by lymphoma is most common in what part of the CNS? Question 8

17 Dura / leptomeninges Answer

18 What are some diseases associated with PCNSL? Question 9

19 HIV infection Immunosuppressive therapy (post transplantation) Hodgkin's disease Epstein-Barr virus Primary immunodeficiency syndromes: Wiskott-Aldrich, X- linked lymphoproliferative, Severe combined immunodeficiency, Ataxia-telangiectasia Answer

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