Christopher Newell is a PGY-3 in Neuropathology at the University of Calgary. He grew up in Southern-Ontario before moving to Nova Scotia for his BSc at St. Francis Xavier University. Afterwards, he travelled to Calgary where he enrolled in the MD-PhD program with his graduate training focused on diagnostic and therapeutic techniques in primary mitochondrial disease. Outside of his ongoing residency training, Chris can be found biking (mountain/road), running, playing hockey/basketball/soccer, golfing, or skiing!


Christopher Newell 1, Adrian Box 1, John J. Kelly 2, Jeffrey T. Joseph 1

1 Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada

2 Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada

A 66-year-old woman, presented with amnestic mild cognitive impairment, and brain MRI five months later demonstrated increased T2-FLAIR signal without gadolinium enhancement in the left superior cerebellum and dentate nucleus. The initial radiologic impression favored a neoplastic process because the lack of enhancement would have been unusual for an infectious or inflammatory etiology. Repeat MRI twelve months later revealed mild interval progression of the left cerebellar lesion to involve the left middle cerebellar peduncle and a small portion of the posterolateral left pons. The patient had no new symptoms referable to the cerebellar lesion. Brain MRI nine months later demonstrated significant progression of the cerebellar lesion, which now fully involved the left middle cerebellar peduncle and extended into the left central pons, left midbrain, and left inferior cerebellar peduncle. The patient now had mobility difficulties. On physical examination, she had an unsteady gait and left dysdiadochokinesia on finger-to-nose testing. The patient underwent stereotactic biopsy of the lesion.

Discussion points

  1. What are the major findings and H&E diagnosis?
  2. What is the differential diagnosis?
  3. What further investigations are warranted?