Department of Pathology, University of Oklahoma Health Sciences Center

June 2007, Case 706-1. Quiz set! Click here to see.

A 67 year-old woman with a cerebellar and a parietal enhancing lesions.

Clinical informationThis patient was a  67 year-old Caucasian woman, who presented to our institution with ataxia and headache. Brain CT scan and MRI revealed two enhancing lesions: one in the lateral aspect of left cerebellar hemisphere and one in the deep white matter in the left parietal lobe. The initial clinical impression was metastatic malignancy but an extensive workup did not find any primary lesion. Neurological examination showed normal bulk, tone and strength. She had wide-based gait, with reflexes +1. The function of cranial nerve was within normal limits. She had no history of HIV infection, prior history of cancer or chemotherapy, connective tissue diseases, or prolonged steroid treatment. A biopsy on the cerebellar lesion was performed. The following images are representatives of the biopsy material.

The biopsy material is obtained from the cerebellum. Panel A to C are intraoperative cytologic preparations, Panel D and E are intraoperative frozen sections, Panel G and H are permanent sections. Click thumbnails to see pictures.

What is your empirical diagnosis? What other investigation would you perform? Discussion

Cases of the Month Coordinator: KarMing-Fung@ouhsc.edu