Digital Slide Seminar:

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Dr Nor Haizura Abd Rani

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Day 1

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Case 1:

• A 68-year-old female who is presented with left sided weakness and headache.

• MRI brain: Right parietal mass 6.2x4.8x5.5cm with displacement / distortion of cortico spinal tract.

• Clinical impression was given as right parietal high-grade glioma.

• Tumor excision was done.

• SP-21-6327-HE

• SP-21-6327-GFAP

• SP-21-6327-KI67

• SP-21-6327-IDH-1

• SP-21-6327-ATRX

• SP-21-6327-P53

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Case 2:

• 49yo gentleman with altered behaviour and seizures for 2 months.

• No raised intracranial pressure symptoms.

• No fever, constitutional symptoms, or neurological deficit.

• MRI brain: right frontal large enhancing predominantly cystic lesion, 7x4.4x4.4cm, compressing the right frontal horn of lateral ventricle, and crossing the midline, infiltrating the contralateral frontal lobe. Radiological impression: most likely right frontal lobe cystic astrocytoma.

• Intraoperatively, noted yellowish solid cystic component.

• R-21-268-HE

• R-21-268-GFAP

• R-21-268-S100

• R-21-268-KI67

• R-21-268-IDH-1

• R-21-268-ATRX

• R-21-268-P53

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Case 3:

• 60 y.o Malay man presented with history of headache on and off for a year and left limb weakness for a week.

• MRI Brain : A well-defined irregular intra-axial heterogenous tumor mass measuring 5.9x4.9x4.5cm. Isointense on T1W1, with hyperintense on T2 with minimal intralesional enhancement post-contrast.

• Intra-operative: Greyish tumor with poor brain interface. Tumor is soft and highly vascularized.

• R-21-211-HE

• R-21-211-GFAP

• R-21-211-S100

• R-21-211-KI67

• R-21-211-IDH-1

• R-21-211-ATRX

• R-21-211-P53

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Day 2

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Case 1:

• 39 yo Punjabi, male. Seizure and vomiting. GCS E4V5M6.

• MRI brain: butterfly glioma (R>L).

• Underwent right craniectomy and excision biopsy.

• Intraop: tumour whitish pale in color, sticky tumour, xanthochromic fluid came out,

• Poor irregular border, moderate vascularized.​

• SP-21-7406-1-1-HE

• SP-21-7406-GFAP

• SP-21-7406-KI67

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Case 2:

• 3-yo-girl known case of anaplastic ependymoma, WHO G3 of right parieto-temporal post surgical resection of tumour in 2019 and 2020, completed chemotherapy in 2020 radiotherapy in 2021.

• Now presented with left sided hemiparesis, right craniectomy site bulging.​

• Recent MRI: enhancing solid lobulated lesion at medial aspect surgical cavity 1.2x1.9x2.3cm, lateral postero-superior aspect surgical cavity 1.7x1.5cm.

• Done right re-craniectomy excision of tumor. Intraop: tumour solid cystic, mainly cystic. Cyst is multiloculated with yellowish fluid content. Small tumour nodule adjacent to choroid plexus, bounded laterally by temporal horn and medially by lateral ventricle.

• Clinical imp: recurrent right temporal parietal anaplastic ependymoma.

• ER-20-3268-HE

• ER-20-3268-GFAP

• ER-20-3268-EMA

• ER-20-3268-KI67

• SP-21-7974-HE

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Case 3:

• 6-yo-boy. Had history of episodes of unsteady gait at age 5yo with frequent fall.​

• MRI brain and spine: well-defined midline posterior fossa mass with cystic component measured 3.9x2.6x2.9cm. Differentials: ependymona, medulloblastoma, ATRT, pilocytic astro, choroid plexus papilloma.

• Intra op: poorly defined, attached at roof of 4th ventricle (contra dg radio)

• 11055-HE

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