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Recurrent intraventricular ganglioglioma: a case report and review of literature
ABSTRACTS
lesions has high specificity, and, although the sensitivity is good, the technique shows greater specificity than sensitivity. Objectives: To evaluate the diagnostic accuracy of FNAC of salivary gland lesions, to emphasise its value as a diagnostic tool in patient management and highlight some of the diagnostic pitfalls. Method: We retrospectively studied cytology reports of salivary gland FNAs during a 5-year period in two tertiary hospitals in the South Metropolitan Health Service in Western Australia. Outcome was determined by correlation with subsequent surgical excision biopsy results, and clinical and radiological findings. Findings: We reviewed 174 salivary gland FNA reports and ninety-seven specimens met the search criteria. The sensitivity of FNAC for the diagnosis of malignancy was 94% with a specificity of 98%. There were two false-positives and one falsenegative result. Conclusions: Our study shows FNAC of salivary glands has a sensitivity of 94% and specificity of 98%. FNAC is a reliable method in the assessment of salivary gland lesions however, cytopathologists should be aware of the diagnostic pitfalls in order to minimize the possibility of diagnostic error. 32. RECURRENT INTRAVENTRICULAR GANGLIOGLIOMA: A CASE REPORT AND REVIEW OF LITERATURE M. Brown1, F. Ziad1, P. Gan2 1 Department of Histopathology, and 2Department of Neurosurgery, Waikato Hospital, Hamilton, New Zealand Introduction: Ganglioglioma is a low grade glioneuronal tumour of the central nervous system, first described in 1926, composed of neoplastic ganglion cells and astrocytes predominantly occurring in the cerebral parenchyma. To date, only 21 cases occurring in an intraventricular location have been reported in the literature, with only two of these showing recurrences. Studies have shown that BRAF V600E mutations are associated with a shorter recurrence-free survival. Case report: We report a case of intraventricular ganglioglioma in an 18 year old male who presented with headache and vomiting. Microscopy showed a biphasic lesion composed of glial and neuronal components diagnostic of a ganglioglioma. The lesion recurred after 3 months requiring re-excision. Both specimens showed positivity for BRAF V600E which was more prominent in the neuronal component. Conclusion: This case is being presented due to its rare location, rapid recurrence and detection of a mutation with prognostic implications. Consideration of this entity in an intraventricular location, monitoring for recurrence and performance of additional molecular studies are important features to consider when making this diagnosis. 33. CANCER LENGTH IN PROSTATE BIOPSIES B. Allsopp1,2,3, M. Frydenberg4, A. Longano5 1 Melbourne Health, Melbourne, 2Monash University, Clayton, 3 Scholarships in Pathology for Medical Schools, RCPA, 4 Australian Urology Associates, Malvern, and 5Monash Health, Clayton, Australia Background: The Gleason Grade is central to the decision of how to proceed with the management of prostate cancer. When the
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length of cancer seen on biopsy is small, the quantity of malignant cells to assess is lower than for longer cancer lengths. It is not known how this should influence the interpretation of the Gleason Grade. Aims: To determine the minimum length (mm) of cancer on a prostate core biopsy that can accurately predict Gleason Grade in subsequent radical prostatectomy specimens. Methods: The total combined length of the Gleason Grade 4 or 5 in the hemi-prostate of 361 biopsies (TRUS n = 224, transperineal n = 137) was compared with the ipsilateral Gleason Grade on subsequent radical prostatectomy. Biopsies were considered accurate if the radical prostatectomy demonstrated the presence of either Gleason Grade 4 or 5 on that side. Results and Conclusions: There was a significant difference (p = 0.0003) between cancer lengths in not-downgraded and downgraded biopsies. The minimum combined cancer length of Gleason Grade 4 or 5 for a hemi-prostate that can accurately predict Gleason Grade 4 or 5 on subsequent radical prostatectomy specimens is 1.3 mm. Above this length, there is a 100% (95% CI 75.3–100) chance that there will be Gleason Grade 4 or 5 on that side. Conversely when the combined cancer length is less than 0.19 mm, there is a 92.5% (95% CI 88.6–94.6) chance that there will be no Gleason Grade 4 or 5 on that side on subsequent radical prostatectomy. These findings may assist the interpretation of biopsies with small cancer lengths. 34. INFLAMMATORY MYOFIBROBLASTIC TUMOURS OF THE HEAD AND NECK H. Narayanappa1, A. C. Vargas Calderon1, C. Selinger1, H. Low2, A. Clifford2, S. O’Toole1,3, R. Gupta1,3 1 Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, 2Head and Neck Surgery, Chris O’Brien Lifehouse, Sydney, and 3Central Clinical School, The University of Sydney, NSW, Australia Background: Inflammatory myofibroblastic tumour (IMT) is a rare mesenchymal tumour of intermediate biologic potential (World Health Organization 1994). Only limited studies have described IMTs in the head and neck and addressed the diagnostic challenges. Objectives: We present 2 cases of inflammatory myofibroblastic tumours of the head and neck and highlight the useful clinicopathologic features, the role of the ancillary diagnostic tests and diagnostic pitfalls. Findings: Case 1: A 35 year old male presented with a 7 × 6 mm non-healing ulcer on the lateral aspect of the tongue. Case 2: A 21 year old female presented with haemoptysis and endoscopy demonstrated a 6 mm polypoid nodule in the trachea. Haematoxylin and eosin stained sections showed fascicles of spindle shaped cells with plump nuclei with distinctive nuclei embedded in oedematous stroma with a sprinkling of inflammatory cells. Mitoses were rare and necrosis was absent. The tongue lesion showed strong immunostaining with SMA and ALK1 while the tracheal lesion was negative with both stains. Interestingly, the cases also showed weak, patchy staining with cytokeratin. Fluorescent in situ hybridisation (FISH) studies showed ALK rearrangement in both cases, though the evaluation was particularly challenging in the tongue lesion due to the presence of large number of inflammatory cells and intervening stromal cells. Both patients were treated with conservative local surgery only and are disease free at a follow up of approximately 30–36 months.
lesions has high specificity, and, although the sensitivity is good, the technique shows greater specificity than sensitivity. Objectives: To evaluate the diagnostic accuracy of FNAC of salivary gland lesions, to emphasise its value as a diagnostic tool in patient management and highlight some of the diagnostic pitfalls. Method: We retrospectively studied cytology reports of salivary gland FNAs during a 5-year period in two tertiary hospitals in the South Metropolitan Health Service in Western Australia. Outcome was determined by correlation with subsequent surgical excision biopsy results, and clinical and radiological findings. Findings: We reviewed 174 salivary gland FNA reports and ninety-seven specimens met the search criteria. The sensitivity of FNAC for the diagnosis of malignancy was 94% with a specificity of 98%. There were two false-positives and one falsenegative result. Conclusions: Our study shows FNAC of salivary glands has a sensitivity of 94% and specificity of 98%. FNAC is a reliable method in the assessment of salivary gland lesions however, cytopathologists should be aware of the diagnostic pitfalls in order to minimize the possibility of diagnostic error. 32. RECURRENT INTRAVENTRICULAR GANGLIOGLIOMA: A CASE REPORT AND REVIEW OF LITERATURE M. Brown1, F. Ziad1, P. Gan2 1 Department of Histopathology, and 2Department of Neurosurgery, Waikato Hospital, Hamilton, New Zealand Introduction: Ganglioglioma is a low grade glioneuronal tumour of the central nervous system, first described in 1926, composed of neoplastic ganglion cells and astrocytes predominantly occurring in the cerebral parenchyma. To date, only 21 cases occurring in an intraventricular location have been reported in the literature, with only two of these showing recurrences. Studies have shown that BRAF V600E mutations are associated with a shorter recurrence-free survival. Case report: We report a case of intraventricular ganglioglioma in an 18 year old male who presented with headache and vomiting. Microscopy showed a biphasic lesion composed of glial and neuronal components diagnostic of a ganglioglioma. The lesion recurred after 3 months requiring re-excision. Both specimens showed positivity for BRAF V600E which was more prominent in the neuronal component. Conclusion: This case is being presented due to its rare location, rapid recurrence and detection of a mutation with prognostic implications. Consideration of this entity in an intraventricular location, monitoring for recurrence and performance of additional molecular studies are important features to consider when making this diagnosis. 33. CANCER LENGTH IN PROSTATE BIOPSIES B. Allsopp1,2,3, M. Frydenberg4, A. Longano5 1 Melbourne Health, Melbourne, 2Monash University, Clayton, 3 Scholarships in Pathology for Medical Schools, RCPA, 4 Australian Urology Associates, Malvern, and 5Monash Health, Clayton, Australia Background: The Gleason Grade is central to the decision of how to proceed with the management of prostate cancer. When the
S133
length of cancer seen on biopsy is small, the quantity of malignant cells to assess is lower than for longer cancer lengths. It is not known how this should influence the interpretation of the Gleason Grade. Aims: To determine the minimum length (mm) of cancer on a prostate core biopsy that can accurately predict Gleason Grade in subsequent radical prostatectomy specimens. Methods: The total combined length of the Gleason Grade 4 or 5 in the hemi-prostate of 361 biopsies (TRUS n = 224, transperineal n = 137) was compared with the ipsilateral Gleason Grade on subsequent radical prostatectomy. Biopsies were considered accurate if the radical prostatectomy demonstrated the presence of either Gleason Grade 4 or 5 on that side. Results and Conclusions: There was a significant difference (p = 0.0003) between cancer lengths in not-downgraded and downgraded biopsies. The minimum combined cancer length of Gleason Grade 4 or 5 for a hemi-prostate that can accurately predict Gleason Grade 4 or 5 on subsequent radical prostatectomy specimens is 1.3 mm. Above this length, there is a 100% (95% CI 75.3–100) chance that there will be Gleason Grade 4 or 5 on that side. Conversely when the combined cancer length is less than 0.19 mm, there is a 92.5% (95% CI 88.6–94.6) chance that there will be no Gleason Grade 4 or 5 on that side on subsequent radical prostatectomy. These findings may assist the interpretation of biopsies with small cancer lengths. 34. INFLAMMATORY MYOFIBROBLASTIC TUMOURS OF THE HEAD AND NECK H. Narayanappa1, A. C. Vargas Calderon1, C. Selinger1, H. Low2, A. Clifford2, S. O’Toole1,3, R. Gupta1,3 1 Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, 2Head and Neck Surgery, Chris O’Brien Lifehouse, Sydney, and 3Central Clinical School, The University of Sydney, NSW, Australia Background: Inflammatory myofibroblastic tumour (IMT) is a rare mesenchymal tumour of intermediate biologic potential (World Health Organization 1994). Only limited studies have described IMTs in the head and neck and addressed the diagnostic challenges. Objectives: We present 2 cases of inflammatory myofibroblastic tumours of the head and neck and highlight the useful clinicopathologic features, the role of the ancillary diagnostic tests and diagnostic pitfalls. Findings: Case 1: A 35 year old male presented with a 7 × 6 mm non-healing ulcer on the lateral aspect of the tongue. Case 2: A 21 year old female presented with haemoptysis and endoscopy demonstrated a 6 mm polypoid nodule in the trachea. Haematoxylin and eosin stained sections showed fascicles of spindle shaped cells with plump nuclei with distinctive nuclei embedded in oedematous stroma with a sprinkling of inflammatory cells. Mitoses were rare and necrosis was absent. The tongue lesion showed strong immunostaining with SMA and ALK1 while the tracheal lesion was negative with both stains. Interestingly, the cases also showed weak, patchy staining with cytokeratin. Fluorescent in situ hybridisation (FISH) studies showed ALK rearrangement in both cases, though the evaluation was particularly challenging in the tongue lesion due to the presence of large number of inflammatory cells and intervening stromal cells. Both patients were treated with conservative local surgery only and are disease free at a follow up of approximately 30–36 months.