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Presented by Jonathan Epstein, M.D. and prepared by Angelique W. Levi, M.D.
Case 5: 66 year old female with a brain mass
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1. Question
Week 4: Case 5
66 year old female with a brain mass
Correct
Answer: Pituitary adenoma
Histology: The lesion is cellular and is composed of uniformly monotonous round cells with a fine chromatin pattern containing at most small nucleoli. The cells contain eosinophilic cytoplasm, which in areas is eccentrically located. Mitotic figures are not identified. Architecturally, evenly distributed thin walled vessels punctuate the tumor cells. Focally surrounding the vessels, the lesion assumes more of a columnar appearance.
Discussion: Although the cells focally resemble plasma cells, in other areas both the nuclear and cytoplasmic features do not bear striking resemblance to plasma cells. Areas where the tumor forms a more columnar appearance surrounding the vessels would not be consistent with a plasmacytoma. If necessary, differentiating these two entities can readily be accomplished using antibodies to light chain as well as to various hormonal peptides. Metastatic carcinoma would be expected to have a greater degree of pleomorphism and mitotic figures especially given the lack of any differentiation. Meningiomas may also have a bland cytologic appearance. However, the nuclei within meningiomas tends to be more oval and the cells have varying degrees of spindle cell morphology ranging from meningothelial meningiomas to fibroblastic meningiomas.
Incorrect
Answer: Pituitary adenoma
Histology: The lesion is cellular and is composed of uniformly monotonous round cells with a fine chromatin pattern containing at most small nucleoli. The cells contain eosinophilic cytoplasm, which in areas is eccentrically located. Mitotic figures are not identified. Architecturally, evenly distributed thin walled vessels punctuate the tumor cells. Focally surrounding the vessels, the lesion assumes more of a columnar appearance.
Discussion: Although the cells focally resemble plasma cells, in other areas both the nuclear and cytoplasmic features do not bear striking resemblance to plasma cells. Areas where the tumor forms a more columnar appearance surrounding the vessels would not be consistent with a plasmacytoma. If necessary, differentiating these two entities can readily be accomplished using antibodies to light chain as well as to various hormonal peptides. Metastatic carcinoma would be expected to have a greater degree of pleomorphism and mitotic figures especially given the lack of any differentiation. Meningiomas may also have a bland cytologic appearance. However, the nuclei within meningiomas tends to be more oval and the cells have varying degrees of spindle cell morphology ranging from meningothelial meningiomas to fibroblastic meningiomas.
