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Poyuran R, Nair P, Chandrasekharan K, Abraham M, Narasimhaiah D. Endolymphatic sac tumour: a case series. Pathology 2024; 56:612-615. [PMID: 38341303 DOI: 10.1016/j.pathol.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/21/2023] [Accepted: 10/09/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Rajalakshmi Poyuran
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India
| | - Prakash Nair
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India
| | - Kesavadas Chandrasekharan
- Department of Imaging Sciences and Intervention Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India
| | - Mathew Abraham
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India
| | - Deepti Narasimhaiah
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India.
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Manisha KY, Poyuran R, Narasimhaiah D, Kumar Paramasivan N, Ramachandran H, Erat Sreedharan S, Er J, Kumar S, Vinoda Thulaseedharan J, Sylaja PN. Thrombus histology does not predict stroke etiological subtype but influences recanalization. J Clin Neurosci 2024; 124:54-59. [PMID: 38643652 DOI: 10.1016/j.jocn.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/13/2024] [Accepted: 04/12/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND There is conflicting data on whether clot retrieved from mechanical thrombectomy can predict stroke etiology or the success of recanalization. We aimed to analyse the relation between thrombus histology and stroke aetiology as well as recanalization. METHODOLOGY Histopathological analysis of clots retrieved from patients with acute ischemic stroke and large vessel occlusion was done. Quantification of the amount of fibrin, red blood cells(RBC), platelets and white blood cells (WBC) in the clots were done. The clinical, imaging data and recanalization parameters were collected. The correlation between clot composition and stroke etiology as well as recanalization were analysed. RESULTS Of the 77 patients, the mean age was 58. 67 ± 12.96 years. The stroke etiology were cardioembolism 44(57.1 %), large artery atherosclerosis 13(16.8 %), other determined aetiology 4(5.1 %) and undetermined in 16(20.7 %) patients. There was no significant correlation between the proportions of RBC-rich, platelet-rich and fibrin-rich thrombi and the stroke etiology. The susceptibility vessel sign was associated with RBC-rich clot(92.3 % vs 7.7 %, p = .03). All RBC-rich clots(100 %) had good recanalization(p = .05). Platelet-rich clots needed less number of passes(64.7 % vs 35.3 %, p = .006) and reduced groin puncture to recanalization time(87.9 % vs 12.1 %, p = .033). WBC-rich clots required lesser number of passes(57.5 % vs 42.5 %, P = .044). In multivariate analysis, WBC-rich clots (OR 0.230, CI 0.07-0.78, p = .018) showed an independent association with reduced recanalization attempts, while platelet-rich clots showed reduced recanalization time(OR 0.09, CI 0.01-0.63, p = .016). CONCLUSION There was no correlation between thrombus histology and the etiological stroke subtype. However, clot composition predicted the degree of recanalization and number of passes.
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Affiliation(s)
- K Y Manisha
- Comprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
| | - Rajalakshmi Poyuran
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
| | - Deepthi Narasimhaiah
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
| | - Naveen Kumar Paramasivan
- Comprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Harikrishnan Ramachandran
- Comprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Sapna Erat Sreedharan
- Comprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
| | - Jayadevan Er
- Department of Imaging Science and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
| | - Santhosh Kumar
- Department of Imaging Science and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
| | - Jissa Vinoda Thulaseedharan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
| | - P N Sylaja
- Comprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
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Jayakrishanan R, Valakkada J, Ayyappan A, Poyuran R, Pitchai S. Femoral Vein Intravascular Synovial Sarcoma Mimicking Primary Deep Vein Thrombosis-A Rare Cause of Deep Vein Thrombosis. Indian J Radiol Imaging 2024; 34:156-159. [PMID: 38106856 PMCID: PMC10723955 DOI: 10.1055/s-0043-1771521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Synovial sarcomas are rare malignant mesenchymal soft tissue tumors. We presented the case of a 53-year-old woman patient presenting with acute deep vein thrombosis, later diagnosed as a deep synovial sarcoma of the femoral vein wall. The tumor was identified through cross-sectional magnetic resonance angiography and computed tomography, followed by ultrasound-guided core biopsy. The case report emphasized the importance of considering the possibility of an intravascular neoplasm mimicking thrombus, particularly if calcifications, vein expansion with intravascular cystic spaces, fluid-fluid levels, and septations within a thrombosed vein are seen in imaging.
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Affiliation(s)
- R. Jayakrishanan
- Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Jineesh Valakkada
- Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Anoop Ayyappan
- Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Rajalakshmi Poyuran
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Shivanesan Pitchai
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Mondal S, Sivadasanpillai H, Poyuran R. Olfactory schwannoma with hypertrophic cardiomyopathy: incidental association? Acta Cardiol 2023; 78:1149-1150. [PMID: 37698132 DOI: 10.1080/00015385.2023.2256184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 09/01/2023] [Indexed: 09/13/2023]
Affiliation(s)
- Sudipta Mondal
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | - Rajalakshmi Poyuran
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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Nekkanti RK, Venkat EH, Matham G, Gowda G B A, Poyuran R. Atypical teratoid rhabdoid tumour in the third ventricle of a young adult - a rare presentation. Br J Neurosurg 2023:1-5. [PMID: 37493240 DOI: 10.1080/02688697.2023.2239919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Atypical teratoid/rhabdoid tumours (AT/RT) are malignant CNS tumours predominantly seen in infants and children. Adult AT/RTs have a predilection for mid-line structures, such as the pineal and pituitary glands. We report a case of AT/RT in a young adult, with its origin from the third ventricle. This is the first documented case of adult AT/RT in the third ventricle. CASE PRESENTATION A 20-year-old male presented with acute onset headache and vomiting. MRI showed a lesion involving the optic chiasm, hypointense on T1, and heterogeneously hyperintense on T2, with stippled post-contrast enhancement. He underwent a right peri-coronal parasagittal craniotomy, transforaminal and sub choroidal approach with gross total tumour resection. Histopathological report was ATRT, WHO grade 4, with loss of SMARCB1 (INI1) protein. He later underwent a ventriculo-peritoneal shunt placement for postoperative hydrocephalus and was later given adjuvant chemoradiotherapy. No recurrence was noted on follow up MRI. CONCLUSION AT/RTs are not limited to the paediatric age group, and their incidence among adults is being increasingly reported. Occurrence of AT/RT in the third ventricle of a young adult male has never been reported in the past. It merits consideration as a differential diagnosis of any midline lesion with malignant appearance in adults.
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Affiliation(s)
- Ram Kishan Nekkanti
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Easwer Hariharan Venkat
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Gowtham Matham
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Akhilesh Gowda G B
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Rajalakshmi Poyuran
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Pavuluri H, Kv V, Thomas B, Vilanilam GC, Nair P, Narasimhaiah DA, Poyuran R, Menon RN. Clinical Reasoning: A Teenager With Chronic Meningitis-Does Occam's Razor Apply? Neurology 2023; 100:828-835. [PMID: 36746637 PMCID: PMC10136020 DOI: 10.1212/wnl.0000000000206783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 11/21/2022] [Indexed: 02/08/2023] Open
Abstract
A 14-year-old girl presented with subacute onset headache, fever, and vomiting and was managed initially with antibiotics for suspected bacterial meningitis. Her symptoms further evolved over the next few weeks with systemic signs and symptoms favoring chronic meningitis with raised intracranial pressure. After the etiologic workup was unrevealing, she was started on empirical antituberculous therapy. After a period of partial improvement, symptoms recurred with a new-onset focal seizure. Her imaging findings evolved from features suggestive of focal leptomeningitis to multifocal heterogeneous enhancing cortical and subcortical lesions with hemorrhagic foci, leading to brain biopsy that confirmed diagnosis. Our case highlights the utility of diagnostic biopsy in patients with "chronic meningitis" in uncertain cases rather than confining the approach to the law of parsimony. The decision to initiate empirical therapy in chronic meningitis should be considered on a case-by-case basis and take into account factors, such as clinical examination findings, immune status, recent exposures, and potential risks of treatment. Atypical MRI features should lower the threshold for meningocortical biopsy when indicated.
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Affiliation(s)
- Harini Pavuluri
- From the Department of Neurology (H.P., V.K.V., R.N.M.), Department of Imaging Sciences & Interventional Radiology (B.T.), Department of Neurosurgery (G.C.V., P.N.), and Department of Pathology (D.A.N., R.P.), Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, India
| | - Vysakha Kv
- From the Department of Neurology (H.P., V.K.V., R.N.M.), Department of Imaging Sciences & Interventional Radiology (B.T.), Department of Neurosurgery (G.C.V., P.N.), and Department of Pathology (D.A.N., R.P.), Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, India
| | - Bejoy Thomas
- From the Department of Neurology (H.P., V.K.V., R.N.M.), Department of Imaging Sciences & Interventional Radiology (B.T.), Department of Neurosurgery (G.C.V., P.N.), and Department of Pathology (D.A.N., R.P.), Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, India
| | - George C Vilanilam
- From the Department of Neurology (H.P., V.K.V., R.N.M.), Department of Imaging Sciences & Interventional Radiology (B.T.), Department of Neurosurgery (G.C.V., P.N.), and Department of Pathology (D.A.N., R.P.), Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, India
| | - Prakash Nair
- From the Department of Neurology (H.P., V.K.V., R.N.M.), Department of Imaging Sciences & Interventional Radiology (B.T.), Department of Neurosurgery (G.C.V., P.N.), and Department of Pathology (D.A.N., R.P.), Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, India
| | - Deepti A Narasimhaiah
- From the Department of Neurology (H.P., V.K.V., R.N.M.), Department of Imaging Sciences & Interventional Radiology (B.T.), Department of Neurosurgery (G.C.V., P.N.), and Department of Pathology (D.A.N., R.P.), Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, India
| | - Rajalakshmi Poyuran
- From the Department of Neurology (H.P., V.K.V., R.N.M.), Department of Imaging Sciences & Interventional Radiology (B.T.), Department of Neurosurgery (G.C.V., P.N.), and Department of Pathology (D.A.N., R.P.), Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, India
| | - Ramshekhar N Menon
- From the Department of Neurology (H.P., V.K.V., R.N.M.), Department of Imaging Sciences & Interventional Radiology (B.T.), Department of Neurosurgery (G.C.V., P.N.), and Department of Pathology (D.A.N., R.P.), Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, India.
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Nair P, Honavalli Murali S, Harihara Venkat E, Poyuran R. Endoscopic Endonasal Transethmoidal Inferomedial Orbitotomy and En Bloc Excision of an Intraorbital Intraconal Cavernous Hemangioma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023:01787389-990000000-00657. [PMID: 36972425 DOI: 10.1227/ons.0000000000000678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/17/2023] [Indexed: 03/29/2023] Open
Affiliation(s)
- Prakash Nair
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Sanjay Honavalli Murali
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Easwer Harihara Venkat
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Rajalakshmi Poyuran
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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Nair P, Honavalli Murali S, Harihara Venkat E, Poyuran R. Endoscopic Endonasal Transcavernous Posterior Clinoidectomy With Interdural Pituitary Transposition for a Suprasellar Optic Pathway Pilocytic Astrocytoma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 24:e380. [PMID: 36715990 DOI: 10.1227/ons.0000000000000614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/04/2022] [Indexed: 01/31/2023] Open
Affiliation(s)
- Prakash Nair
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Sanjay Honavalli Murali
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Easwer Harihara Venkat
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Rajalakshmi Poyuran
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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Narasimhaiah D, Nair P, Kesavadas C, Poyuran R. Rapid malignant transformation of an intracranial epidermoid cyst: Report of a case. Neuropathology 2022. [DOI: 10.1111/neup.12884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 10/23/2022] [Accepted: 10/25/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Deepti Narasimhaiah
- Department of Pathology Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum India
| | - Prakash Nair
- Department of Neurosurgery Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum India
| | - Chandran Kesavadas
- Department of Imaging Sciences and Interventional Radiology Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum India
| | - Rajalakshmi Poyuran
- Department of Pathology Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum India
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Poyuran R, Shah SP, Kesavapisharady K, Chandrasekharan K, Narasimhaiah D. Intracranial mesenchymal tumour with EWSR1 gene rearrangement: the first report of intracranial mesenchymal tumour with FET-CREB fusion from India. Pathology 2022; 54:945-948. [PMID: 35570029 DOI: 10.1016/j.pathol.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/31/2022] [Accepted: 02/07/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Rajalakshmi Poyuran
- Departments of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | - Krishnakumar Kesavapisharady
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Kesavadas Chandrasekharan
- Department of Imaging Sciences and Intervention Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Deepti Narasimhaiah
- Departments of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
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Poyuran R, Kalaparti VSVG, Thomas B, Kesavapisharady K, Narasimhaiah D. Nonneoplastic and noninfective cysts of the central nervous system: A histopathological study. Neuropathology 2022. [PMID: 36210745 DOI: 10.1111/neup.12867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/28/2022]
Abstract
Nonneoplastic epithelial cysts involving the central nervous system are diverse and are predominantly developmental in origin. This study represents a surgical series describing the histopathological features of 507 such epithelial cysts with clinical and imaging correlation. Age at surgery ranged from 7 months to 72 years (mean: 33 years) affecting 246 male and 261 female patients. Colloid cyst was the most frequently resected cyst, followed by epidermoid cyst, arachnoid cyst, Rathke cleft cyst, dermoid cyst, neurenteric cyst, Tarlov cyst, and choroid plexus cyst. Diagnosis was based on the location of the cysts and the nature of the lining epithelium. Rathke cleft cyst showed the highest propensity for squamous metaplasia, significant inflammation, and xanthogranulomatous reaction. Ulceration of lining epithelium and calcification were most frequent in dermoid cyst. Radiopathological concordance was maximal for colloid cyst, followed by epidermoid and arachnoid cysts. Epidermoid and dermoid cysts exhibited the highest propensity for local tumor progression, followed by Rathke cleft cyst.
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Affiliation(s)
- Rajalakshmi Poyuran
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India
| | | | - Bejoy Thomas
- Department of Imaging Sciences & Intervention Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India
| | - Krishnakumar Kesavapisharady
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India
| | - Deepti Narasimhaiah
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India
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Poyuran R. Pathology of surgically remediable epilepsy: How to evaluate. INDIAN J PATHOL MICR 2022; 65:S176-S188. [PMID: 35562148 DOI: 10.4103/ijpm.ijpm_1026_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
Epilepsy surgery is a well-established treatment modality in selected cases of medically refractory epilepsy. Advances in neuroimaging technology has greatly facilitated detection of lesions that are surgically amenable. Hippocampal sclerosis is the most common pathology encountered among specimens from epilepsy-related surgeries. Other common pathologies are malformations of cortical development including focal cortical dysplasia, neoplasms, vascular malformations, inflammatory conditions including Rasmussen encephalitis and glial scars. Proper handling of surgical specimens is necessary for microscopic evaluation. Accurate interpretation and classification of lesions will help define clinically relevant etiologies. In this review, neuropathological aspects of the common etiologies underlying drug-resistant epilepsies are discussed.
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Affiliation(s)
- Rajalakshmi Poyuran
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India
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13
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Lotlikar R, Menon RN, Thomas B, Poyuran R, Narasimhaiah D, Ponnambath DK. MOG-Antibody Mediated Clinically Isolated Syndrome after COVID-19 in a Post Partum Woman- A Veritable 'Double Hit'! Neurol India 2022; 70:1281-1282. [PMID: 35864691 DOI: 10.4103/0028-3886.349651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Radhika Lotlikar
- Department of Neurology, Sree Chitra Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Ramshekhar N Menon
- Department of Neurology, Sree Chitra Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Bejoy Thomas
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Rajalakshmi Poyuran
- Neuropathology, Sree Chitra Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Deepti Narasimhaiah
- Neuropathology, Sree Chitra Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Dinoop K Ponnambath
- Microbiology, Sree Chitra Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Sivadasan S, Poyuran R. Tumefactive demyelination—A rare presentation of Anti-MOG Syndrome. Ann Indian Acad Neurol 2022; 25:138-140. [PMID: 35342234 PMCID: PMC8954315 DOI: 10.4103/aian.aian_185_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/06/2021] [Indexed: 11/22/2022] Open
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Darshan HR, Patel BK, Singh A, Nair P, Poyuran R, Easwer HV. Simultaneous trigonal and spinal meningioma with varied histology: A rare case report. Surg Neurol Int 2021; 12:611. [PMID: 34992927 PMCID: PMC8720455 DOI: 10.25259/sni_1051_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Meningioma is one of the most common neoplasms of the central nervous system. Multiple meningiomas without neurofibromatosis are not a usual occurrence. Intraventricular meningioma with spinal meningioma is rare and not been reported in the literature. Case Description: We report a case of a 63-year-old male with the left trigonal and spinal meningioma. Both the meningiomas were resected in different settings. The histological examination of tumors revealed to be of varied histology, that is, meningothelial and atypical meningioma, respectively. Conclusion: Although various cases with multiple cranial and spinal meningiomas are described, this is the first case of an intraventricular and spinal meningioma. With varied histology, the case also reaffirms the theory of polyclonal origin of multiple meningiomas.
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Affiliation(s)
- H. R. Darshan
- Department of Neurosurgery, Sree Chitra Tirunal Institute of Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - Biren Khimji Patel
- Department of Neurosurgery, Sree Chitra Tirunal Institute of Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - Ajit Singh
- Department of Neurosurgery, Sree Chitra Tirunal Institute of Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - Prakash Nair
- Department of Neurosurgery, Sree Chitra Tirunal Institute of Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - Rajalakshmi Poyuran
- Department of Pathology, Sree Chitra Tirunal Institute of Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - H. V. Easwer
- Department of Neurosurgery, Sree Chitra Tirunal Institute of Medical Science and Technology, Thiruvananthapuram, Kerala, India
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16
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Poyuran R, Chandrasekharan K, Easwer HV, Narasimhaiah D. Glioblastoma with primitive neuronal component: An immunohistochemical study and review of literature. J Clin Neurosci 2021; 93:130-136. [PMID: 34656236 DOI: 10.1016/j.jocn.2021.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/31/2021] [Accepted: 09/02/2021] [Indexed: 12/13/2022]
Abstract
Glioblastoma with primitive neuronal component, a rare neoplasm, is recognized as a distinct histological pattern of glioblastoma. In this study we report the morphological and immunohistochemical features of three cases of glioblastoma with primitive neuronal component diagnosed at the Institute along with a comprehensive literature review. The cases include: (1) 11-year-old girl with right fronto-parietal lesion, (2) 48-year-old male with right parietal lesion, and (3) 36-year-old male with left fronto-parietal lesion. Case 1 had prior history of glioblastoma. All the cases had classic morphology of glioblastoma along with GFAP-negative and synaptophysin-positive primitive neuronal component. The latter was poorly demarcated from the glial component in case 1, while well-defined in the remaining two. All the three cases exhibited diffuse p53 positivity and a higher MIB-1 labelling index in the neuronal component compared to the glial component. One of them (case 3) was IDH1 R132H-mutant with loss of ATRX expression. None were positive for K27M-mutant H3 or G34R-mutant H3.3. Literature review of 50 published cases of glioblastoma with primitive neuronal component was performed. The age of onset ranged from 3 months to 82 years (mean: 50 years) with M:F of 1.5:1. 18.8% of tumors were IDH-mutant, 87.5% were p53 positive and three cases showed H3F3A gene mutations. There was a greater propensity for neuraxial dissemination, noted in 20% of cases. Overall survival of glioblastoma with primitive neuronal component was similar to that of IDH-wildtype glioblastoma (13 months) which was significantly shorter compared to the overall survival of IDH-mutant glioblastoma (33.6 months).
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Affiliation(s)
- Rajalakshmi Poyuran
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum 695011, Kerala, India.
| | - Kesavadas Chandrasekharan
- Department of Imaging Sciences and Intervention Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum 695011, Kerala, India.
| | - H V Easwer
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum 695011, Kerala, India.
| | - Deepti Narasimhaiah
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum 695011, Kerala, India.
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17
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Narasimhaiah D, Sudhir BJ, Poyuran R. Balloons in Filum Terminale Ependymoma. Neurol India 2021; 69:1123-1124. [PMID: 34507479 DOI: 10.4103/0028-3886.325343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Deepti Narasimhaiah
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram (or Trivandrum), Kerala, India
| | - B Jayanand Sudhir
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram (or Trivandrum), Kerala, India
| | - Rajalakshmi Poyuran
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram (or Trivandrum), Kerala, India
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18
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Narasimhaiah D, Sreedharan SE, Anoop A, Radhakrishnan NR, Poyuran R. Myasthenia Gravis with Thymoma and a Rare Serological Profile-Report of a Case and Review of Literature. Neurol India 2021; 69:528-529. [PMID: 33904500 DOI: 10.4103/0028-3886.314552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Deepti Narasimhaiah
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Thiruvananthapuram, Kerala, India
| | - Sapna E Sreedharan
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Thiruvananthapuram, Kerala, India
| | - A Anoop
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Thiruvananthapuram, Kerala, India
| | | | - Rajalakshmi Poyuran
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Thiruvananthapuram, Kerala, India
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19
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Narasimhaiah D, Thomas B, Abraham M, Poyuran R. Mosaic Pattern of H3 K27M-Mutant Protein Expression in a Diffuse Midline Glioma-A Diagnostic Dilemma for the Pathologist. J Neurosci Rural Pract 2021; 12:596-598. [PMID: 34295118 PMCID: PMC8289546 DOI: 10.1055/s-0041-1728231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Diffuse midline glioma, H3 K27M-mutant, is a World Health Organization (WHO) grade IV glioma arising in pons, thalamus, and spinal cord. They show mutations resulting in replacement of lysine at position 27 by methionine (K27M) of histone genes,
H3F3A
,
HIST1H3B,
and
HIST1H3C.
The H3 K27M mutant protein is identified in tumor tissue by immunohistochemistry. As these mutations are clonal and homogeneous, the mutant protein is normally identified in all tumor cells. Here we report a case of diffuse midline glioma with mosaic pattern of expression of H3 K27M mutant protein and discuss the diagnostic and therapeutic implications of this unusual pattern.
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Affiliation(s)
- Deepti Narasimhaiah
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Bejoy Thomas
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Mathew Abraham
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Rajalakshmi Poyuran
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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20
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Poyuran R, Ponnambath DK, Vilanilam GC, Chandrasekharan K, Narasimhaiah D. Mycobacterial spindle cell pseudotumour of the brain in an immunocompetent adult. Pathology 2021; 53:782-785. [PMID: 33838921 DOI: 10.1016/j.pathol.2020.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 11/04/2020] [Accepted: 11/20/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Rajalakshmi Poyuran
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India
| | - Dinoop K Ponnambath
- Department of Microbiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India
| | - George C Vilanilam
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India
| | - Kesavadas Chandrasekharan
- Department of Imaging Sciences and Intervention Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India
| | - Deepti Narasimhaiah
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India.
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21
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Sudhir BJ, Honavalli Murali S, Gohil J, Poyuran R, Sethuraman M, Harihara Venkat E. Cyanosis and Clipping: Noninfectious Aneurysm in a Patient with 22q11.2 Deletion Syndrome. Pediatr Neurosurg 2021; 56:45-49. [PMID: 33550290 DOI: 10.1159/000512581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/27/2020] [Indexed: 11/19/2022]
Abstract
Noninfectious cerebral aneurysms are rare in patients with congenital cyanotic heart disease. We present a patient with DiGeorge/velocardiofacial syndrome with a complex congenital cyanotic heart disease with a ruptured anterior communicating artery aneurysm. The 10-year-old child was managed by surgical clipping of the aneurysm. Surgical challenges included prominent veins in the Sylvian fissure, difficulty in differentiating arterial and venous bleed, and anesthetic risks. The patient recovered without any neurological deficits. This is the first report of a patient with 22q11.2 deletion syndrome, with a noninfectious cerebral aneurysm.
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Affiliation(s)
- Bhanu Jayanand Sudhir
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India,
| | - Sanjay Honavalli Murali
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Jaypalsinh Gohil
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Rajalakshmi Poyuran
- Department of Neuro-Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Manikantan Sethuraman
- Department of Neuro-Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Easwer Harihara Venkat
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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22
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Alex A, Ayyappan A, Valakkada J, Pillai VV, Sreekantan R, Poyuran R. Pericardial pseudocyst along atrioventricular groove. BJR Case Rep 2020; 7:20200122. [PMID: 33841901 PMCID: PMC8008468 DOI: 10.1259/bjrcr.20200122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 11/22/2022] Open
Abstract
Cystic lesions in relation to the pericardium are a rare congenital lesion with an estimated incidence of 1 per 100,,000. Pericardial cysts may be classified as congenital or acquired. Here, we present a case of a pericardial pseudocyst having a horseshoe configuration along the atrioventricular groove in a middle-aged subject with no previous relevant medical history. The patient underwent open surgery for the same with histopathological diagnosis being established. This paper highlights the differentials for a cystic pericardial lesion in imaging in addition to the histopathological entity of a pericardial pseudocyst.
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Affiliation(s)
- Ajay Alex
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Anoop Ayyappan
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Jineesh Valakkada
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Vivek V Pillai
- Department of Cardiovascular & Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Renjith Sreekantan
- Department of Cardiovascular & Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Rajalakshmi Poyuran
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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23
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Abstract
Gastrointestinal mucormycosis is a rare form of invasive mucormycosis with high fatality rate due to difficulty in establishing its diagnosis. The classic risk-factors include immunosuppression and metabolic derangement. A case of ileocecal mucormycosis following intracardiac repair of congenital heart disease in a 17-year-old boy is described here who lacked the typical risk-factors for mucormycosis. Ileocecal mucormycosis affecting an individual without the classic risk-factors is uncommon.
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Affiliation(s)
- R Poyuran
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - B S Dharan
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - S Sandhyamani
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - D Narasimhaiah
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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24
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Narasimhaiah D, Nair P, Poyuran R. Unusual finding in a cerebral cavernous malformation of the temporal lobe. Cardiovasc Pathol 2020; 49:107245. [PMID: 32663731 DOI: 10.1016/j.carpath.2020.107245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/20/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Deepti Narasimhaiah
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Prakash Nair
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Rajalakshmi Poyuran
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
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25
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Poyuran R, Thomas B, Abraham M, Narasimhaiah D. Meningioma with rosettes: A rare morphologic pattern. Neuropathology 2019; 40:202-205. [DOI: 10.1111/neup.12623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 10/17/2019] [Accepted: 10/17/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Rajalakshmi Poyuran
- Department of Pathology Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum Kerala India
| | - Bejoy Thomas
- Department of Imaging Sciences and Intervention Radiology Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum Kerala India
| | - Mathew Abraham
- Department of Neurosurgery Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum Kerala India
| | - Deepti Narasimhaiah
- Department of Pathology Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum Kerala India
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26
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Sekar S, Vinayagamani S, Thomas B, Poyuran R, Kesavadas C. Haemosiderin cap sign in cervical intramedullary schwannoma mimicking ependymoma: how to differentiate? Neuroradiology 2019; 61:945-948. [PMID: 31197414 DOI: 10.1007/s00234-019-02229-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 05/20/2019] [Indexed: 12/20/2022]
Abstract
A 37-year-old female presented with gradually progressive asymmetric ascending paraesthesia and weakness involving bilateral upper and lower limbs. The MRI spine images revealed expansile intramedullary, solid cystic, peripherally enhancing lesion with a haemosiderin cap along the lower margin. The lesion extended into the left C5 and C6 nerve root exit zones, along with thickening and enhancement of the nerve roots. She underwent excision of the lesion, which revealed intramedullary schwannoma on histopathological examination. Presence of the cap, an extension of the lesion into the nerve root exit zone, with associated thickening and enhancement of the dorsal nerve roots should alert the radiologist to consider the possibility of intramedullary schwannoma rather than ependymoma. Schwannoma showing compact Antoni A area with Schwannian whorls and nuclear palisades (A,B) and loose Antoni B area with haemosiderin pigment (C). The tumour exhibits diffuse positivity for S-100 protein (D) and negativity for GFAP (E). [Stain: A-C: Haematoxylin and Eosin; D,E: Immunoperoxidase. Magnification = Scale Bar, A-E: 100μm].
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Affiliation(s)
- Sabarish Sekar
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, 695011, India.
| | - S Vinayagamani
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Bejoy Thomas
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Rajalakshmi Poyuran
- Department of Pathology, Sreechitra Institute of Medical Sciences and Technology, Kerala, Trivandrum, 695011, India
| | - Chandrasekharan Kesavadas
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
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27
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Poyuran R, Mahadevan A, Arimappamagan A, Nandeesh BN, Nagappa M, Saini J, Narasinga Rao KVL, Chickabasaviah YT. Cerebrovascular pathology in cerebral amyloid angiopathy presenting as intracerebral haemorrhage. Virchows Arch 2019; 474:235-245. [PMID: 30617647 DOI: 10.1007/s00428-018-2505-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 11/27/2018] [Accepted: 12/03/2018] [Indexed: 12/14/2022]
Abstract
Cerebral amyloid angiopathy (CAA) is the second most common cause of non-traumatic intracerebral haemorrhage (ICH) accounting for 12-15% of lobar haemorrhages in the elderly. Definitive diagnosis of CAA requires histological evaluation. We aimed to evaluate the spectrum of cerebrovascular changes in CAA-related ICH. Between 2011 and 2015, biopsy-confirmed cases of CAA were retrieved and clinical, radiological and pathological features were reviewed. The spectrum of vascular alterations was evaluated and amyloid deposition was graded in accordance with the Greenberg and Vonsattel scale. Seven cases of sporadic CAA [5 males and 2 females] were diagnosed, none of whom were suspected to have CAA pre-operatively. Six presented with large intracerebral haematoma (ICH) requiring neurosurgical intervention (age range: 56-70 years) and one had episodic headache and multiple microhaemorrhages requiring a diagnostic brain biopsy (45 years). In the presence of large ICH, vascular amyloid deposits were of moderate to severe grade (grade 4 in 4, grades 2 and 3 in 1 case each) with predominant involvement of medium (200-500 μm) to large (> 500 μm) leptomeningeal vessels. Fibrinoid necrosis was noted in four. Two were hypertensive and on antiplatelet agents. β-Amyloid plaques were detected in two, one of whom had symptomatic dementia. MRI performed in 3 of 6 cases with ICH did not reveal any microhaemorrhages. Amyloid deposits in small (50-200 μm) to medium (200-500 μm) calibre intracortical vessels produced parenchymal microhemorrhages. Histopathological examination of ICH is essential for diagnosing CAA. The vascular calibre rather than grade of amyloid deposits dictates size of the bleed. Presence of co-morbidities such as antiplatelet agents may predispose to haemorrhage.
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Affiliation(s)
- Rajalakshmi Poyuran
- Department of Neuropathology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, Karnataka, 560029, India
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, Karnataka, 560029, India.
| | - Arivazhagan Arimappamagan
- Department of Neurosurgery, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, Karnataka, India
| | - B N Nandeesh
- Department of Neuropathology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, Karnataka, 560029, India
| | - Madhu Nagappa
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, Karnataka, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, Karnataka, India
| | - K V L Narasinga Rao
- Department of Neurosurgery, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, Karnataka, India
| | - Yasha T Chickabasaviah
- Department of Neuropathology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, Karnataka, 560029, India
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28
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Mahadevan A, Poyuran R, Moudgil N, Arimappamagan A, Bharath R. Pigmented variant of pleomorphic xanthoastrocytoma - A rare long-term epilepsy associated neoplasm. INDIAN J PATHOL MICR 2019; 62:445-447. [DOI: 10.4103/ijpm.ijpm_723_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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29
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Affiliation(s)
| | - B H Srinivas
- 2 Assistant Professor, Department of Pathology, JIPMER, Puducherry, India
| | - Bhawana A Badhe
- 3 Professor and Head of Department, Department of Pathology, JIPMER, Puducherry, India
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30
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Poyuran R, Bn N, Reddy YVK, Savardekar AR. Intraventricular gliosarcoma with dual sarcomatous differentiation: A unique case. Neuropathology 2017; 37:346-350. [PMID: 28261869 DOI: 10.1111/neup.12369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/09/2017] [Accepted: 01/10/2017] [Indexed: 10/20/2022]
Abstract
Gliosarcoma, a variant of isocitrate dehydrogenase-wildtype glioblastoma, is largely a lobar surfacing neoplasm often with dural attachment. In this biphasic neoplasm, the sarcomatous component usually takes the form of fibrosarcoma or malignant fibrous histiocytoma. Heterologous sarcomatous differentiation is a rare phenomenon. Here, we present a case of gliosarcoma with liposarcomatous and myosarcomatous differentiation in a 68-year-old man which was purely intraventricular. This is the first report of such a morphologic pattern in this location. Varied histological components with their immunohistochemical profile are discussed. Of note was the presence of a p53 negative giant cell glioblastoma component, as was the expression in the rest of the tumor.
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Affiliation(s)
| | - Nandeesh Bn
- Department of Neuropathology, NIMHANS, Bangalore, Karnataka, India
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31
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Poyuran R, Mahadevan A, Sagar BKC, Saini J, Srinivas D. Chordoid Glioma of Third Ventricle With an Epidermoid Cyst: Coexistence or Common Histogenesis? Int J Surg Pathol 2016; 24:663-7. [PMID: 27194402 DOI: 10.1177/1066896916650256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Chordoid glioma (CG) is a World Health Organization classified grade II tumor located exclusively in the region of anterior third ventricle. Association of CG with other lesions is extremely rare. We report a case of CG in a 45-year-old male coexisting with an epidermoid cyst in the third ventricle. Ultrastructural examination of the CG revealed microvilli, junctional complexes, and intermediate filaments within the cytoplasm suggesting origin from specialized ependyma. The association of the 2 lesions appears coincidental as convincing evidence for a common histogenesis was not found.
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Affiliation(s)
| | - Anita Mahadevan
- Department of Neuropathology, NIMHANS, Bangalore, Karnataka, India
| | | | - Jitender Saini
- Department of Neuroimaging & Interventional Radiology, NIMHANS, Bangalore, Karnataka, India
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