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Case 16

Diagnostic Challenge Pathology for Neurosurgery & Neurology Residents Department of Pathology University of Oklahoma Health Sciences Center, Oklahoma City, OK, U.S.A. Case 16

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Case 16

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  1. Diagnostic ChallengePathology for Neurosurgery & Neurology ResidentsDepartment of PathologyUniversity of Oklahoma Health Sciences Center,Oklahoma City, OK, U.S.A. Case 16 History: A 13 year-old boy presented with a pineal mass and mild hydrocephalus. A stereotactic biopsy was performed. The followings are the representative images. Contributor: Kar-Ming Fung, M.D., Ph.D., karming-fung@ouhsc.edu Last updated: 5/5/2008

  2. Cytologic Preparation Cytologic Preparation

  3. Frozen Section Frozen Section

  4. Paraffin Section Paraffin Section

  5. Placental alkaline phosphatase (PLAP) CD117 (c-kit)

  6. What is your diagnosis?

  7. Diagnosis: Pineal germinoma. • Discussion: • The characteristics of a germinoma is well demonstrated in this case. Namely, it is composed of a mixture of large cells with large nuclei, obvious nucleoli and a small amount of cytoplasm admixed with a variable amount of reactive lymphocytes. • These features are well illustrated in the cytologic preparation as illustrated here. The large cells (white arrows) and small reactive lymphocytes (black arrows) can be easily recognized in the cytologic preparation. • Similar features are present also in the frozen and permanent sections. Immunohistochemistry demonstrates strong positive reactivity for both PLAP and CD117 which are also classic features of germiniomas.

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