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CANP_2019_C01

Case 1

KD Langdon1, E Finger2 & LC Ang1,2

Departments of 1Pathology and Laboratory Medicine and 2Clinical Neurological Sciences, LHSC, Western University, London, Ontario

Clinical Summary

The deceased is an 80-year old man with a six year history of progressive cognitive decline (memory, attention) and behavioural changes (impulsivity, disinhibition, loss of empathy). Diagnosed clinically with behavioural variant frontotemporal dementia (bvFTD). Past medical history: multiple concussions (hockey); Paget’s; T2DM; dyslipidemia; prostate cancer. Family history: parents died at a young age (father -40’s; mother 60’s); sister with ALS; brother healthy. Social history: retired Air Force radar communications technologist & chemist . Neuroimaging revealed three suspected meningiomas, the largest of which was right parietal, 2.5 x 2.1 cm and associated vasogenic edema. There was no focal atrophy.

Material Submitted

  1. Radiological images (Figure 1; T1 MRI with contrast)
  2. H&E of dural-based lesion
  3. H&E/LFB of representative parenchymal changes (basal ganglia)

Questions

1. Diagnosis of dural-based lesion?

2. Thoughts, diagnosis and/or differential of parenchymal lesions?

3. Lesions within the context of the clinical neurological symptoms