Diagnostic ChallengePathology for Neurosurgery & Neurology

ResidentsDepartment of Pathology

University of Oklahoma Health Sciences Center,Oklahoma City, OK, U.S.A.

Case 1History: A 53 year-old woman presented with a frontal-parietal lobe intra-axial tumor.

Contributor: Kar-Ming Fung, M.D., Ph.D., karming-fung@ouhsc.edu Last updataded: 1/9/2009

Cytologic PreparationFrozen Section

A B

Paraffin Section Paraffin Section

C D

Thyroid transcription factor-1 (TTF-1)

Gross cystic disease fluid protein-15 (GCDFP-15)

E F

What is your diagnosis?

Diagnosis: Metastatic adenocarcinoma of breast origin.Discussion: • The cells are highly pleomorphic with large nuclei

and nucleoli (Panel A and B). The cytologic features are best appreciated in the cytologic preparation (Panel B).

• The tumor cells form solid sheets. In between the tumor cells are small glands that contain mucin (arrow in the panel on the right).

• The glandular structure are well demonstrated in permanent sections (Panel C). There are also necrosis (Panel D).

• Putting all of these together, the features are most consistent with a metastatic adenocarcarcinoma.

• The patient has a history of breast carcinoma. The positive immunoreactivity of GCDFP-15 confirmed the breast origin. Breast carcinoma are usually negative for TTF-1.