PMC1239923_01
A. Biopsy of an intradural extramedullary lesion at T12/cauda equina, showing highly pleomorphic cells with a hint of fibrillary cytoplasm growing in an infiltrating fashion (H&E, x100). B. Diffuse cytoplasmic staining of tumor cells with antibody for GFAP (GFAP, x200).
1742-6413-2-16-1.jpg
PMC1239923_01_1742-6413-2-16-1.jpg
F1
Dense, wavy collagen bands were noted throughout the tumor, and seemed particularly apparent in the vicinity of blood vessels (Figure 1A). The neoplastic cells had variable amounts of fibrillary cytoplasm which was diffusely positive for glial fibrillary acidic protein (GFAP) (DakoCytomation, Carpinteria, CA, 1:3000 dil; Figure 1B).
A. Postcontrast sagittal T1-weighted MR image of the cervical spine shows diffuse leptomeningeal enhancement along the surface of the spinal cord. B. Axial contrast-enhanced CT image through the abdomen demonstrates extensive ascites and an enhancing midline mass (arrows) adjacent to the shunt catheter (arrowhead).
1742-6413-2-16-2.jpg
PMC1239923_01_1742-6413-2-16-2.jpg
F2
At this time, MRI showed peripheral contrast enhancement of the meninges surrounding the entire spinal cord (Figure 2A) as well as prominent thickening and enhancement of the cauda equina, consistent with diffuse leptomeningeal disease. Five months later, he developed massive ascites and an anterior peritoneal mass (Figure 2B).
CT-guided FNA of anterior peritoneal mass, showing a somewhat cohesive large cluster of highly pleomorphic cells (Diff-Quik, x200).
1742-6413-2-16-3.jpg
PMC1239923_01_1742-6413-2-16-3.jpg
F3
Cytoplasmic borders were indistinct (Figure 3).
Cytomorpholgy of primary diffuse leptomeningeal gliomatosis involving the peritoneum. A. Single bizzare multinucleated neoplastic cells display "partial wreath-like" nuclear configuration, coarse chromatin clumping and multiple nucleoli (TP, Pap stain, x1000). B. Clusters of smaller tumor cells showing variation in size, high nuclear to cytoplasm ratio, scant homogeneous cytoplasm, with even chromatin distribution and occasional clefting of the nuclear membrane (TP, Pap stain, x1000).
1742-6413-2-16-4.jpg
PMC1239923_01_1742-6413-2-16-4.jpg
F4
The TP showed scattered single bizarre, very large multinucleated neoplastic cells with "partial wreath-like" or "horse shoe" nuclear configuration, coarse chromatin clumping, prominent nucleoli, and fibrillary cytoplasmic tails (Figure 4A). Clusters or nests of smaller, mononuclear neoplastic cells were also seen featuring high nuclear to cytoplasm ratio, scant homogeneous cytoplasm, occasional nuclear clefting and more even chromatin distribution (Figure 4B).
CSF cytology. A. Nests of anaplastic tumor cells are seen with round to oval eccentric nuclei, coarse chromatin, prominent nucleoli and moderate homogeneous cytoplasm (Diff-Quik, x1000). B. Single giant malignant cells with similar morphology are also seen (Diff-Quik, x1000).
1742-6413-2-16-5.jpg
PMC1239923_01_1742-6413-2-16-5.jpg
F5
It showed a cytomorphology similar to that of the peritoneal mass FNA (Figures 5A and 5B).