Abstract #15

by | Sep 22, 2022 | 2022 Abstracts

Abstract 15- 1100-1115
Category: Clinical

At the end of the session,
participants will be able to:

  1. Recognize the diagnostic entity presented in clinical practice

COI Disclosure:

None to disclose

Presenter

Gianluca Lopez is an anatomic pathology trainee from Italy, currently at UCLA as a visiting neuropathology fellow.

Authors

Gianluca Lopez1,2, Karam Han1, Shino D. Magaki1, Sophie X. Song3, Noriko Salamon4, Kanwarpal S. Kahlon5, Inna Keselman 6, Ausaf A. Bari7, Harry V. Vinters1

 

Authors’ affiliations:

  1. Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, CA, USA
  2. University of Milan, Milan, Italy
  3. Section of Hematopathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, CA, USA
  4. Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
  5. Division of Hematology-Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
  6. Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
  7. Department of Neurosurgery, David Geffen School of Medicine, Los Angeles, CA, USA

Target Audience:

Pathologists, Residents

CanMEDS:
Medical Expert (the integrating role)

Lymphoid and plasma-cell infiltrates with amorphous eosinophilic material deposition in the leptomeninges: a challenging case

Abstract

A 65-year-old female with a resolved history of epilepsy due to a motor vehicle accident and hippocampal sclerosis presented with recurrent, de novo seizures. Brain imaging demonstrated enhancement in the left parieto-occipital lobe. At histopathological examination, the lesion displayed a diffuse lymphoid infiltrate comprised of small atypical lymphocytes, plasmacytoid lymphocytes, and scattered plasma cells, with amorphous eosinophilic material deposition.

Clinical summary

A 65-year-old female presented with recurrent seizures. She had a history of intractable epilepsy after a motor vehicle accident, which was treated several decades ago with left anteromedial temporal lobectomy and hippocampectomy; hippocampal sclerosis was noted at the time. At the time of her last hospital presentation, she underwent magnetic resonance imaging, which showed a leptomeningeal enhancement in the left parieto-occipital lobe. She underwent a biopsy for diagnostic purposes, which showed a diffuse lymphoid infiltrate predominantly involving the leptomeninges, with extension into the Virchow-Robin spaces and with deposits of amorphous eosinophilic material. The lymphoid population comprised small atypical lymphocytes, scattered plasma cells, and plasmacytoid lymphocytes. With immunohistochemistry, the lymphoid infiltrate was positive for CD20, CD19, and BCL2; a subset of cells were positive for CD138 and MUM1; lambda light chain restriction was noted on RNA in situ hybridization. Negative stains included CD3, CD5, CD10, CD21, CD23, and BCL6. The Ki-67 proliferative index was estimated at 5%. On Congo red stain, the amorphous material showed green birefringence under polarized light. MYD88 mutation was not detected. The patient had no evidence of systemic amyloidosis, monoclonal IgM gammopathy, urinary Bence Jones protein, or bone marrow or other organ sites involvement.