1Department of Neuropathology, Southmead Hospital, NBT NHS, Bristol, United Kingdom
This 17 year old boy presented to the emergency department of Southmead Hospital, Bristol, UK on 7 July 2017 after having experienced a sudden onset of generalised seizures. He complained of a severe headache following the seizures. He had no significant medical history or family history. A CT scan was performed which revealed a high density lesion in the right temporal lobe with surrounding vasogenic oedema. An MRI was consequently arranged which shows a right temporal lesion with apparent ring-enhancement.
He subsequently underwent a biopsy on 9 July 2017 and a further resection on 25 July 2017.
He represented on 9 August complaining of altered sensation and a repeat MRI showed increasing vasogenic oedema with associated mass effect, including compression of the right lateral ventricle and subfalcine herniation. A CT chest/abdo/pelvis showed multiple small lesions within the lungs but no generalised lymphoadenopathy was detected and the liver, spleen and kidneys appeared normal. No bony lesions were detected.
Materials submitted: One scanned H&E slide
Additional information: Negative IHC staining for cytokeratins (CAM 5.2, AE1/AE3, MNF116, CK7,CK20), desmin, melanoma markers (HMB45, melanA, s100), GFAP, Olig2, haematopoietic markers (including PAX5, CD20), germ cell markers (CD30, PLAP, CD117, Oct4). INI-1 was retained.
Questions: What further studies would you order?