An exploration was considered necessary Michael N. Needle, MD (Pediatric Neuro-Oncologist)
and the tumor was again excised completely via a right This case concerns a 32-year-old woman first seen at occipital-temporal craniotomy. Postoperatively, the pathis hospital at the age of 9. At that time she presented tient's major finding is a left homonymous hemianopia, with personality changes over several months and a leftdenser superiorly than inferiorly. The patient has been sided hemiparesis of short duration. A cerebral angiogram prescribed a 30 diopter base-out prism over the left half demonstrated a large right temporal lobe mass, and at of the left lens. surgery, a tumor measuring 4 cm in diameter was completely removed. The pathologic diagnosis was malignant Lucy Rorke, MD (Pediatric Neuro-Pathologist) teratoma. The child was treated with 51 Gy to the right
The lesion in 1961 showed nests of cells with central temporal lobe using 2 MeV photons.
necrosis (Fig. 2A). Looking at only the histopathology, She apparently fared well, and at age 19 a CT scan one could easily make the diagnosis of comedo carcinoma showed no evidence of tumor. One year later she develof the breast, which has this appearance. At that time, oped episodes of staring and chewing movements. Inithe best diagnosis was teratocarcinoma. Of course, the tially they were not reported by the patient, but when lesion is not really teratomatous being monophasic insofar brought to medical attention she was started on phenytoin. as cellular type is concerned. The individual nests are She subsequently developed a rash and was switched to sharply marginated, of varying size, and are distributed valproic acid. A number of MRIs were done at this time, within a vascular stroma, the many vessels being thinand none revealed tumor until three months prior to her walled (Fig. 2B). Paraffin blocks were available and imrecent presentation, when a lesion was noted distant to munoperoxidase stains were performed on both the old the original operative site. A repeat scan 3 months later and the new lesions. The tumor nests were negative for (22 years after the first craniotomy) revealed that the right all markers, but the stroma was strongly positive for occipital-temporal mass was growing.
vimentin and keratin. All markers for germ cell tumors were negative. The lesion had a low mitotic index. The proliferating cell nuclear antigen (PCNA) stain was nega-Peter Winkler, MD (Fellow, Neuro-Radiology) tive in the first lesion, but it is not known whether this We have an MRI performed 2 years ago. On the T2is a function of the long period of time that elapsed weighted image, there is a large area below the glomus between the operation and the application of the antibody; that is either intraventricular or in the wall that at most this could be a false-negative result. I mention this beis only suspicious of a lesion. It is best seen with the cause the current lesion is homogeneous, consisting of a "retrospectoscope." Eighteen months ago, the same area population of monotonous small round cells, some of appeared questionably larger, but now there is obvious which arrange themselves around vessels (Fig. 3A). Now, growth of an enhancing tumor (Fig. 1). Again, it is not clear whether this is intraventricular or paraventricular in 1 Division of Pediatric Neuro-Oncology and the 2 Departments of Pathol-the temporal lobe. The lesion is marked by hemorrhage ogy and