Clinical History:
This 65-year-old patient presented with new onset seizures. Their past medical history was significant for atrial fibrillation. MRI demonstrated a poorly circumscribed, focally contrast enhancing 4.5 x 3.8 x 3.0 cm lesion involving left frontal lobe.
Based on Figures #1 and #2 which of the following is most likely?
A. Astrocytic neoplasm
B. Gangliocytoma
C. Oligodendroglioma
D. Normal brain
Correct answer: A
The overall cytomorphologic features are consistent with the presence of an astrocytic neoplasm.
Low magnification image showing variably dispersed abnormal cells with moderate amounts of eosinophilic cytoplasm, relatively abundant fine cytoplasmic fibrillary processes and variation in nuclear size (pleomorphism). No obvious necrotic debris is noted in the background.
Higher magnification image demonstrating oval to round nuclei of variable size, with small nucleoli. Note the mitotic figure (arrow), and background red blood cells which serve as a size reference in cytology preparations.
Reference(s) / additional reading:
Burger PC. Use of cytological preparations in the frozen section diagnosis of central nervous system neoplasia. Am J Surg Pathol. 1985 May;9(5):344-54. doi: 10.1097/00000478-198505000-00004. PMID: 3004242.
Hamasaki M, Chang KHF, Nabeshima K, Tauchi-Nishi PS. Intraoperative Squash and Touch Preparation Cytology of Brain Lesions Stained with H+E and Diff-Quik™: A 20-Year Retrospective Analysis and Comparative Literature Review. Acta Cytol. 2018;62(1):44-53. doi: 10.1159/000480063. Epub 2017 Oct 5. PMID: 28977789.
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