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Slot#Case#CategoryDiagnosisHistoryNotes
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1162NeuroanatomyN/ANormal brain - Frontal LobeIdentify and be able to distinguish the following structures: 1) Arachnoid mater, 2) Six layers of neocortex, and 3) Subcortical white matter. Be able to identify all types of represented cells: Neurons, astrocytes, oligodendrocytes, microglia, endothelial cells, and arachnoid fibroblasts. Recognize the concept and make-up of "neuropil".
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2162NeuroanatomyN/ANormal brain - Hippocampus, rostralThis is the ideal section for viewing the hippocampus, taken at the level of the lateral geniculate nucleus ("Napolean's hat"), seen in the lower left hand corner. Also present is a small tuft of choroid plexus in the temporal horn of the lateral ventricle - of interest here because of how close it sits to the subarachnoid space (< 0.1 cm). Starting at the dentate gyrus, you should be able to trace the CA4 through CA1 regions, subiculum, entorhinal cortex, and finally into the six-layer medial temporal lobe neocortex. The CA1 regions are very susceptible to hypoxic-ischemic injury, hypoglyocemia, excitotoxic injury, and neurodegenerative changes).
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3162NeuroanatomyN/ANormal brain - Hippocampus, caudalThis level of hippocampus is more caudal ("anterior"), and is best for viewing CA1 and entorhinal cortex. It is otherwise not a good section of hippocampups, as it lacks the classic hippocampal anatomy and many of the components described above are lacking.
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4162NeuroanatomyN/ANormal brain - ThalamusOrient the section (top = medial, bottem = lateral, right = ventral, left = dorsal). There are many important structures present on this section that you should try to identifiy… 1) tail of caudate, 2) posterior limb of internal capsule, 3) thalamus, 4) anterior thalamic nucleus, 5) subthalamic nucleus, 6) substantia nigra, 7) third ventricle with ependymal lining, and 8) interthalamic adhesion. This section allows a "second look" at the substantia nigra if the midbrain section is unevaluable at autopsy, a common occurrence due to rough brain removals...
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5162NeuroanatomyN/ANormal brain - Basal gangliaOrient the section (top = lateral, bottom = medial, right = dorsal, left = ventral). Again, this section is full of interesting structures that you should be able to identify. Starting at the
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6162NeuroanatomyN/ANormal brain - Rostral hippocampus and amygdalaOrient the section - Amygdala is the almond-shaped and sized, bisected on the right side of this section. The bottom of the image comprises entorhinal cortex, characterized by "layer 2 pre-alpha" neuronal clusters in the superficial neocortex. The left side of the image is dominated by normal six layer neocortex. The amygdala is the "canary in the gold mine", in that it is susceptible to a wide variety of neurodegenerative processes, and as such is a useful seciton to take in these diseases.
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7162NeuroanatomyN/ANormal brain - cingulate gyrus and hippocampusThe cingulate gyrus, part of the limbic system, occupies the left side of the scanned slide. The right side is the corpus callosum, with a small fragment of septum pellucidem attached at the bottom. In this section, the axons of the callosum are seen in longitudinal sections. This section is useful for demyelinating conditions, as well as in cases of known or suspected trauma. This is also a good section to evaluate the ependymal lining of the ventricles. Finally, there is a seldom noticed gray matter structure that sits on top of the corpus callosum called the induseum griseum that is well seen on this section.
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8162NeuroanatomyN/ANormal brain - MidbrainThere are a lot of interesting and useful structures on this section… For orientation, ventral is to the right, and dorsal is on the left side of the image. Starting from the ventral aspect, the midline cleft is the interpeduncular fossa, which is there the oculomotor nerve (CNIII) exits the midbrain. The two large anterior white matter structures that border the interpeduncle fossa are the paired cerebral peduncles, which are the corticospinal tracts. Behind these tracts lie the pigmented neurons of the substantia nigra, which are one of the typical sites of involvement in Lewy body disease. Behind these lies the decussation of the superior cerebellar peduncles (white matter tract). The cerebral aqueduct is the small CSF containing tract in the dorsal aspect. The two paired bumps on the dorsal side are the inferior colliculi.
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9162NeuroanatomyN/ANormal brain - PonsFor orientation, the right side of the image is the ventral pons, the left side of the image is the dorsal pons. On the right, the bulk of the pons is striated and resembles "sliced bacon", with the pontine crossing fibers (transverse white matter strips), corticospinal tracts (rounded white matter tracts cut in cross section), and intrinsic pontine nuclei (neuronal aggregates). The dorsal side shows the open fourth ventricle with ependymal lining (on the floor is seen here), locus coerulei (paired rounded pigmented nuclei below the fourth ventricle), and superior cerebellar peduncles (white matter tracts) protruding from the sides of the fourth ventricle. A the top and bottom of the image, the pontine crossing fibers are beginning to coalesce to form the middle cerebellar peduncles.
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10162NeuroanatomyN/ANormal brain - MedullaThis is a cross section from the mid medulla, right above the point of closure of the fourth ventricle. The top of the image is the ventral surface, the bottom is dorsal. The most ventral aspect comprises the medullary pyramids, the structures containing the corticospinal tracts at this level. The wavy nuclei that bulge out just lateral to the pyramids are the inferior olivary nuclei (ION). More dorsal are the vestibular nuclei and the nucleus/tract solitarus. The dorsal aspect is the open fourth ventricle. The paired nuclei immediately below the ependyma adjacent to midline are the hypoglossal nuclei, and lateral to that lies the dorsal motor nucleus of the vagal nerve (pigmented similar to the locus coeruleus and substantia nigra).
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11162NeuroanatomyN/ANormal brain - CerebellumTo orient, the left side is superficial cerebellar cortex, the right is deep cerebellar white matter. Note the folded configuration of the cerebellar folia, without much empty space between folia. From superficial to deep, the following layers are encountered: 1) Leptomeninges, 2) Molecular layer, 3) Purkinje cell layer, 4) Granular layer with numerous parvocellular neurons (small and blue), and 5) deep white matter. The Purkinje cell also contains the cell bodies of the Bergmann glia, specialized supporting astrocytes that form the lattice framework of the cerebellar cortex. Note the eosinophilic synptic glomeruli in the granular layer - these small nuclear free zones comprise aggregates of synaptic terminals, and are useful when trying to distinguish normal cerebellum from small round blue cell tumors of the cerebellum (glomeruli are lacking in tumors). Finally, the undulating ("raisinoid") dentate gyrus is seen in the deep white matter. This is a good time to try and remember the names of all four deep cerebellar nuclei...
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12162NeuroanatomyN/ANormal brain - Dura materThis section shows three strips of dura mater. Orienting the dura mater (outer versus inner aspects) can be challenging. Clues include the fact that the vessels are on the outer aspect, and occasionally there are adherent leptomeninges and meningothelial rests present on the inner aspect. On this seciton, there is a thin layer of subdural hemorrhage with focal hemosiderin deposits, making orientation easier on this section. The majority of the dura comprises bland fibrous tissue.
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13117ANeuroanatomyN/ANormal brain - Cerebellar smearThis is a smear of normal cerebellar cortex, comprising a uniform layer of monotomous round granular neurons without cytologic atypia or proliferative activity. The lack of these features helps to distinguish between smears of normal cerebellum from small round blue cell tumors of the posterior fossa (such as lymphoma, AT/TR, medulloblastoma, etc).
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14117BNeuroantomyN/ANormal brain - Cerebral smearThis is a smear of normal cerebral tisssue, comprising primarily cellular processes, glia, and rounded corpora amylacea. Neurons are not well visualized in this smear, suggesting that is is from white matter. There is separation of the coverslip in the center, making evaluation in this area difficult. The main utility of this section smear is familiarizing yourself with the cellularity of normal brain tissues versus tumor - in general, tumors are much more cellular than normal brain cerebral tissues.
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15740NeuroanatomyN/ANormal brain - Pineal glandThe pineal gland shows lobulated parenchyma comprising prmarily pineocytes, specialized cells that produce and secrete melatonin. The normal pineal gland shows lower cellularity than tumors of the region. In older patients, the pineal gland often calcifies with age, and bland simple cysts of the pineal gland are also common. Reviewing this histology is helpful for surgical pathologists and neuropathologists, as most are unfamiliar with the normal pineal appearance, and frozens from this area can be challenging.
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16104NeuroanatomyN/ANormal brain - Infant brainThis section of the cerebral cortex is from a preterm infant. While it is well formed and appropriate for age, there are several major differences between this and adult brain. The neocortex is thin, and the neurons are smaller than mature adult neurons (less perinuclear cytoplasm). In addition, there is very little myelination of the subcortical white matter. The vessels are congested, and there are numerous aggregates of migrating immature neuronal precursors (neuroblasts) present in the subcortical white matter. These often get "stuck" around blood vessels, and will regress with age (not heterotopic neurons). These are often confused with inflammatory cells due to their small size and scant cytoplasm.
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17777Glial TumorsOligodendroglioma, WHO grade II54-year-old woman with a non-enhancing and infiltrative tumor of the left frontal lobeWhat is your diagnosis and WHO grade? _________________________________________________________________. What specific FISH alteration is characteristic of this tumor? __________________________________________________. What is the expected IDH status of this tumor? _____________________________________________________________.
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18645Glial TumorsDysembryoplastic neuroepithelial tumor (DNT)8-year-old female with epilepsy and lobulated mass in the anterior aspect of the right temporal lobeWhat is your diagnosis and WHO grade? _________________________________________________________________. What are the characteristic histologic findings that are classic for this tumor? _____________________________________. What is the most common molecular alteration that is seen in this tumor? ________________________________________.
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20171Glial TumorsSubependymoma, CNS WHO grade 154-year-old female with an exophytic tumor of the fourth ventricleWhat is your diagnosis and WHO grade? _________________________________________________________________. What is the classic clinical presentation for this tumor (often asked at board examinations). _________________________.
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21224Glial TumorsEpendymoma with sarcomatoid differentiation, CNS WHO grade 316-year-old female with large cerebellar tumorWhat is your diagnosis and WHO grade? _________________________________________________________________. What is the classic histologic finding that allows for diagnosis on H&E staining? __________________________________.
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23381Glial TumorsPilocytic astrocytoma, CNS WHO grade 117-year-old male with a cystic mass of the cerebellum and an enhancing mural noduleWhat is your diagnosis and WHO grade? _________________________________________________________________. What is the name of the helpful elongate eosinophilic structures in this tumor? ____________________________________. What is the most common molecular alteration in this tumor? _________________________________________________.
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24347Glial TumorsChoroid plexus carcinoma5-year-old female child with right temporoparietal lobe intraventricular tumorWhat is your diagnosis and WHO grade? _________________________________________________________________. What immunohistochemical stains would be positive in this tumor?
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25979Glial TumorsAstrocytoma, IDH-mutant, CNS WHO grade 333-year-old male with non-enhancing temporal lobe massWhat is your diagnosis and WHO grade? _________________________________________________________________. What specific molecular study must be performed prior to rendering this diagnosis? _______________________________.
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26432Glial TumorsAtypical choroid plexus papilloma, CNS WHO grade 219-year-old male with lateral ventricular massWhat is your diagnosis and WHO grade? _________________________________________________________________.
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27814Glial TumorsAstrocytoma, IDH-mutant, CNS WHO grade 232-year-old male with a non-enhancing left frontal lobe massWhat is your diagnosis and WHO grade? _________________________________________________________________. What molecular studies are helpful in rendering this diagnosis? _______________________________________________.
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28915Glial TumorsGlioblastoma, IDH-wildtype, CNS WHO grade 4, with prominent gemistocytic features61-year-old male with mass in the cerebellar peduncleWhat is your diagnosis and WHO grade? _________________________________________________________________. What molecular studies should be performed on this tumor to aid in treatment planning? ___________________________. What histologic feature in the tumor correlates with contrast enhancement on MRI? ________________________________.
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2962Meningeal TumorsMeningioma, meningothelial subtype, CNS WHO grade 152-year-old female with a homogenously-enhancing mass overlying the left frontal lobeWhat is your diagnosis and WHO grade? _________________________________________________________________. What histologic features are most helpful in arrriving at this diagnosis? __________________________________________. What is the typical immunostaining pattern for this tumor? ____________________________________________________.
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3094Meningeal TumorsMeningioangiomatosis, overlying fibrous meningioma, CNS WHO grade 124-year-old male with parietal region mass, the subjacent cortex is thickened in a "plaque-like" fashionWhat is/are your histologic diagnosis/diagnoses? ___________________________________________________________. What syndrome might this finding be associated with? _______________________________________________________.
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31155Meningeal TumorsExtranodal marginal zone lymphoma34-year-old female with a frontal lobe dural-based massWhat is your diagnosis based upon the H&E stain? __________________________________________________________. What stains would you like to perform on this tumor? _________________________________________________________.
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32157Meningeal TumorsMeningioma, secretory subtype, CNS WHO grade 145-year-old man with a left-sided sphenoid wing massWhat is your diagnosis and WHO grade? __________________________________________________________________. What is the name of the rounded eosinophilic bodies seen in the tumor cells? _____________________________________. What stains are uniquely positive in this subtype of tumor? ____________________________________________________.
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33391Meningeal TumorsSolitary fibrous tumor55-year-old male with a homogeneously-enhancing dural-based mass overlying the parietal lobeWhat is your diagnosis? _______________________________________________________________________________. What stain is both sensitive and specific for this tumor? ______________________________________________________.
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34810Meningeal TumorsMeningioma, rhabdoid subtype, CNS WHO grade _ 80-year-old man with a right frontal lobe dural based mass. Adjacent brain shows prominent edemaWhat is your diagnosis and WHO grade? __________________________________________________________________.
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3524Posterior Fossa TumorsMedulloblastoma with extensive nodularity, CNS WHO grade 410-year-old male with solid tumor of the cerebellumWhat is your diagnosis and WHO grade? __________________________________________________________________. What syndrome is this tumor occasionally seen in? __________________________________________________________. What is the prognosis of this tumor in relationship to the more typical tumors of this type? ___________________________.
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3652Posterior Fossa TumorsHemangioblastoma, CNS WHO grade 135-year-old woman with a cystic mass in the cerebellum. Enhancing mural nodule seen at edge of cyst.What is your diagnosis and WHO grade? _________________________________________________________________. What immunohistochemical stain(s) is/are useful in making this diagnosis? ______________________________________. What syndrome is this tumor associated with? _____________________________________________________________. What other tumors present as cysts with enhancing mural nodules? ____________________________________________.
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37150Posterior Fossa TumorsAtypical teratoid/rhaboid tumor (AT/RT), CNS WHO grade 42-year-old male infant with solid mass of the cerebellumWhat is your diagnosis and WHO grade? _________________________________________________________________. What is the diagnostic molecular abnormality of this tumor type? _______________________________________________.
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38256Posterior Fossa TumorsPilocytic astrocytoma, CNS WHO grade 115-year-old female with a cystic mass of the cerebellumWhat is your diagnosis and WHO grade? _________________________________________________________________. What characteristic "bodies" may be present and helpful for this diagnosis? ______________________________________.
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39737Posterior Fossa TumorsEpidermoid cyst50-year-old male with posterior fossa tumorWhat is your diagnosis for this tumor? ____________________________________________________________________. What is a feared complication of this tumor that may result in significant morbidity and mortality? _____________________.
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40437Sellar TumorsPituitary neuroendocrine tumor (PitNET), null cell (previously pituitary adenoma)60-year-old woman with sellar massWhat is your diagnosis for this tumor? ____________________________________________________________________. What stains would you perform to subtype this tumor? _______________________________________________________. What other information would be helpful in the workup in this case? ______________________________________.
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41247Sellar TumorsGerminoma20-year-old male with a mass of the pituitary stalkWhat is your diagnosis? _______________________________________________________________________________. What stains would you perform on this case? ______________________________________________________________. What other location in the brain is commonly affected by this tumor? ____________________________________________.
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43273Sellar TumorsCraniopharyngioma, adamantinomatous subtype, CNS WHO grade 150-year old man with a mass in the suprasellar regionWhat is your specific diagnosis for this tumor? _____________________________________________________________. There is another subtype of this tumor - what are the expected features of that tumor? _____________________________.
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4463Non-Native CNS TumorsMetastatic carcinoma, breast primary50-year-old woman with a frontal lobe dural-based massWhat is your diganosis for this tumor? ____________________________________________________________________. Metastases from which organs preferentially metastasize to the dura mater? _____________________________________.
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4571Non-Native CNS TumorsLeptomeningeal B-cell ALL20-year-old woman with diffuse leptomeningeal enhancementWhat is your diagnosis? _______________________________________________________________________________. What stains would you perform on this case? ______________________________________________________________.
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46252Non-Native CNS TumorsMetastatic choriocarcinoma30-year-old woman with occipital lobe parenchymal hemorrhage and uterine massWhat is your diagnosis? _______________________________________________________________________________. What stains would you do to confirm your diagnosis? ________________________________________________________. What non-primary tumors of the brain are most often hemorrhagic? _____________________________________________.
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47265Non-Native CNS TumorsPrimary CNS Lymphoma (DLBCL)62-year-old male with multiple areas of white matter T2/FLAIR signal abnormality on MRIWhat is your diagnosis? ________________________________________________________________________________. What stains would you perform to confirm your diagnosis? ____________________________________________________. What is a predisposing feature that is often seen in patients with this tumor? ______________________________________.
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48266Non-Native CNS TumorsMetastatic carcinoma, lung primary60-year-old man with ring-enhancing mass in the right parietal lobe?What is your diagnosis? ________________________________________________________________________________. What stains would you perform on this tumor? ______________________________________________________________. What studies would help to confirm the site of origin in this tumor? ______________________________________________.
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49277Non-Native CNS TumorsMetastatic carcinoma, clear cell renal origin55-year-old female with hemorrhage of the left cerebral hemisphere, also with tumors in lung and left kidneyWhat is your diagnosis? _______________________________________________________________________________. What stain would you perform on this specimen? ___________________________________________________________.
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501070Non-Native CNS TumorsMetastatic melanoma79-year-old male with left temporal lobe tumorWhat is your diagnosis? ________________________________________________________________________________. What stains would you perform on this tumor to confirm your diagnosis? _________________________________________.
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51114Skeletal Muscle PathologyNecrotizing vasculitis40-year-old woman with elevated serum CK, myalgia, and positive pANCAWhat is your diagnosis? _______________________________________________________________________________. What are the specific diagnostic criteria for this disease process? ______________________________________________.
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52152Skeletal Muscle PathologyCentronuclear myopathy, central cores on NDHTR and EM42-year-old female with proximal muscle weakness for six years. Patients mother had muscle problemsWhat is your diagnosis for this case? _____________________________________________________________________. What category of muscle disease does this case fit into? _____________________________________________________. What is the long-term prognosis for this disease? ___________________________________________________________.
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53208Skeletal Muscle PathologyJuvenile dermatomyositis3 yo F c muscle weakness and elevated CK
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54215Skeletal Muscle PathologyGranulomatous myositis ("sarcoidosis")66 yo M c asymetric prox muscle weakness, mildly elevated CK; no significant systemic dz
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55295Skeletal Muscle PathologyChronic denervation atrophy with reinnervation82 yo M c LE weakness
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56306Skeletal Muscle PathologyDysferlinopoathy ("Myoshi myopathy")25 yo M c calf weakness
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57161Skeletal Muscle PathologyMitochondrial myopathy (MELAS)28-year-old F with history of progressive extremity weakness, abnormal FLAIR signal on brain MRI
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6055Nerve Sheath TumorsNeurofibroma, cellular37 yo M c mass involving a lumbar spine outlet foramen
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6161Nerve Sheath TumorsSchwannoma47 yo F c mass involving a thoracic spine outlet foramen
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6296Spinal Region TumorsMyxopapillary ependymoma52 yo F c mass in the cauda equina region
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63122Spinal Region TumorsCauda equina neuroendocrine tumor (previously paraganglioma)52-year-old male with mass in the cauda equina region(1) What is the characteristic pattern seen? (2) How do these things behave?
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64237Spinal Region TumorsEpendymoma, CNS WHO grade 242 yo M c mass involving the spinal cord
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65260Spinal Region TumorsMeningioma, meningothelial subtype, CNS WHO grade 164 yo M c mass in the cerebellopontine angle - no involvement of the foramen
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66293Spinal Region TumorsChordoma65 yo F c mass in the clivus
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671064Spinal Region TumorsLangerhan cell histiocytosis10-year-old male with left parietal skull mass
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6832NeurodegenerationCreutzfeldt-Jakob Disease (CJD)72 yo M c hx of rapidly-progressing cognitive decline, pyramidal symptoms, and ataxia. Brain was diffusely firm and gliotic
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6948NeurodegenerationMultiple system atrophy (MSA)68 yo M c long hx of progressive ataxia, Parkinsonism, and autonomic dysfunction. No significant cognitive decline. Gross examination revealed prominent cerebellar, medullary, and pontine atrophy, as well as slight nigral depigmentation
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70174NeurodegenerationFrontotemporal lobar degeneration with abnormal TDP-43 (FTLD-TDP)74 yo F c hx progressive cognitive decline and significant personality disturbances (not as severe as case #201). No significant gross abnormalities seen.
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71201NeurodegenerationPick's disease62 yo F c prolonged (>10 yr) hx of cognitive decline, dominated by prominent personality disturbances (paranoid, hoarding). Brain showed prominent atrophy of anterior temporal and frontal lobes
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74207NeurodegenerationCorticobasal degeneration (CBD)64 yo F with progressive cognitive decline, apraxia, and the curious claim that her left arm belonged to someone else. "It's not mine!", she would emphatically state when asked… Only slight frontal atrophy noted at brain cutting
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77213NeurodegenerationAlzheimer disease (AD)58-year-old male with progressive cognitive decline, primarily characterized by memory loss
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78795NeurodegenerationProgressive supranuclear palsy (PSP)79-year-old female with dementia, including difficulty swallowing and gaze palsy
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80821NeurodegenerationDementia with Lewy bodies (DLB)66-year-old female with a resting tremor, progressive memory loss, visual hallucinations
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81480NeurodegenerationAmyloid angiopathy with burst lobe, background of Alzheimer disease85-year-old demented female with large right-sided brain parenchymal hemorrhage
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82170Infectious DiseaseInvasive Aspergillosis56-year-old female with a history of lung transplant several years prior to death. Infection noted in lungs at autopsy
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8495Infectious DiseaseCysticercosis53-year-old female with a third ventricular mass, hydrocephalus. Recent travel to Mexico
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85106Infectious DiseaseViral encephalitis17-year-old male with rapidly progressive decline in mental status and brain edema, died five days after presentation to hospital. No focal lesions seen at autopsy
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86112Infectious DiseaseCrytococcal meningitis56-year-old female with HIV, slightly thickened meninges
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87115Infectious DiseasePurulent meningitis with encapsulated diplococci (Pneumococcal meningitis)2-year-old female who presented with fever and signs of meningismus
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88805Infectious DiseaseTuberculous meningitis52-year-old male, prison inmate, with night sweats, weight loss, and cranial neuropathies
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892MiscellaneousCentral pontine myelinolysis63-year-old alcoholic male, who presented to ED with altered mental status. After correction of hyponatremia, had progressive decline in mental status. Comatose prior to death.
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9023MiscellaneousMultiple sclerosis (MS)58-year-old female with history of widespread, somewhat random motor and sensory deficits.
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9138MiscellaneousNeuronal heterotopia38-year-old male with history of seizures, found dead in bed
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9251MiscellaneousAqueductal gliosis1-year-old male with hydrocephalus
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9373MiscellaneousSyringomyelia38-year-old male with Chiari type I malformation
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94172MiscellaneousOrganized periventricular leukomalacia (PVL)11-month-old male infant, born at 29 weeks EGA
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95187MiscellaneousCrooke's hyaline change of corticotrophs52-year-old female with AHLE, treated with corticosteroids for presumed PRES
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9660MiscellaneousGlobal hypoxic/ischemic brain injury62-year-old male who was found unresponsive, revived after prolonged cardiopulmonary resuscitation
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97957MiscellaneousArterovenous malformation (AVM)14-year-old female with posterior temporal lobe mass
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98166MiscellaneousSturge-Weber syndrome - leptomeningeal angiomatosis38-year-old male with cutaneous facial vascular abnormality restricted to V2 distribution
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100160MiscellaneousRemote neocortical contusion54-year-old male with a remote history of a motor vehicle collision
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