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canp2019c06

Case 6

B AlYamany 1, H Al-Ghefari1, E Tweedie1,2, P Yang 1,2, LC Ang 1,2

1 Department of Pathology and Laboratory Medicine, London Health Sciences Centre

2 Department of Pathology and Laboratory Medicine, Western University

 

Clinical History: This is a 41-year-old gentleman, with a known seizure disorder on Vimpat and Carbamazepine. He was found by his friend without vital signs, lying face down and hugging a pillow on the floor. He was pronounced dead at scene. His postmortem examination revealed a generally unremarkable brain, apart from the leptomeninges which appeared thickened and gelatinous most prominently around the optic chiasm, mammillary bodies, interpeduncular fossa and brainstem. Coronal sections of the cerebrum and brainstem, and sagittal sections of the cerebellum revealed no additional findings, or distinct lesions. No anatomic, toxic, or metabolic cause of death was identified.

Pathological examination revealed the presence of oligodendroglial-like cells, diffusely infiltrating the leptomeninges and invading the brain parenchyma, with both neuronal and glial immunohistochemical features.

Material submitted: H&E section, gross image #1, gross image #2

Questions: Diagnosis?