Department of Pathology, University of Oklahoma Health Sciences Center

September, 2004. Case 409-1. Quiz set! Click here to see.

A 13 year-old boy with three years history of seizure

Clinical information: A 13-year-old boy presented with increasingly frequent and severe simple partial seizures since age 10 years. There was no history of prematurity, perinatal injury, febrile seizure, trauma, meningitis, encephalitis  or developmental delay. Neurological and visual field examination were normal. Scalp EEGs showed no epileptiform activity. Head MRI showed a 2 cm plaque like intra-axial cortical lesion in the right frontal lobe with features suggestive of a vascular malformation. No calcification was identified on CT scan. The lesion was excised. The patient remains seizure-free without antiepileptic drugs 5 years after.

Gross pathology: In the cortex, there was a 2.0 cm wide poorly demarcated cortex that appeared unusually firm, pale, and thickened.

Histopathology:

Click thumbnails to see pictures.

• Hematoxylin-Eosin stained Sections: Panel A is a low-magnification picture of the cortex and white matter. Panel B to D are taken from the thickened cortex.
• Masson's Trichrome Stained Sections: Pane E and F are low-magnification pictures of the cortex and white matter. Panel G and H are medium-magnification pictures at the gray white junction. Panel I is high-magnification pictures  taken from the thickened cortex. 

What is your diagnosis? Discussion

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