{"id":45103,"date":"2025-08-05T14:04:46","date_gmt":"2025-08-05T06:04:46","guid":{"rendered":"https:\/\/medicine.nus.edu.sg\/pathweb\/?page_id=45103"},"modified":"2025-08-05T17:03:21","modified_gmt":"2025-08-05T09:03:21","slug":"cns-1","status":"publish","type":"page","link":"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/cns-1\/","title":{"rendered":"Mystery cases &#8211; Central Nervous System 1"},"content":{"rendered":"\n<h2>\n\t\tCentral Nervous System 1\n\t<\/h2>\n\t<h1>A spine-tingling mass<\/h1>\n\t<p><strong>Clinical history<\/strong>: A 20-year-old male with no past medical history presented with lower back pain and tingling sensation in both lower limbs. MRI showed an intradural mass within the lumbar spine; imaging findings were suggestive of a schwannoma. The patient underwent excision of the mass with intraoperative frozen section. Intra-operative crush prep smears were made.<\/p>\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/cns1-300x300.jpg\" alt=\"Central Nervous System case 1\n\" itemprop=\"image\" height=\"300\" width=\"300\" title=\"cns1\" onerror=\"this.style.display='none'\"  \/>\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/cns3-300x300.jpg\" alt=\"cns3\" itemprop=\"image\" height=\"300\" width=\"300\" title=\"cns3\" onerror=\"this.style.display='none'\"  \/>\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/cns2-300x300.jpg\" alt=\"cns2\" itemprop=\"image\" height=\"300\" width=\"300\" title=\"cns2\" onerror=\"this.style.display='none'\"  \/>\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/cns4-300x300.jpg\" alt=\"cns4\" itemprop=\"image\" height=\"300\" width=\"300\" title=\"cns4\" onerror=\"this.style.display='none'\"  \/>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-0\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-0\">Cytologic findings<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--icon-0\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a>\n\t\t\t\t\t<p>&nbsp;<\/p>\n<ul>\n<li>Cellular smears showing monotonous cells occurring in papillary-like tissue fragments, as discohesive aggregates and as singly dispersed cells, on a fibrillary background<\/li>\n<li>Some blood vessels seen within the cores of papillary fragments<\/li>\n<li>Rosette-like structures seen<\/li>\n<li>Tumour cells display round to ovoid nuclei, inconspicuous nucleoli and finely speckled chromatin, with fibrillary cytoplasmic processes<\/li>\n<\/ul>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-1\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-1\">Differential diagnoses<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--icon-1\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a>\n\t\t\t\t\t&nbsp;<br \/>\nHere are some differential diagnoses based on the imaging findings:\n<ul>\n<li>Intradural\u00a0<em>extramedullary<\/em>\u00a0spinal lesions\n<ul>\n<li>Meningioma\n<ul>\n<li>Uneven smears with large irregular clusters, small groups and single cells<\/li>\n<li>Cells display ovoid nuclei, fine chromatin, small nucleoli, nuclear pseudoinclusions, and abundant cytoplasm with broad borderless cytoplasmic processes<\/li>\n<li>Cells may be arranged in whorls<\/li>\n<li>+\/- Psammoma bodies<\/li>\n<\/ul>\n<\/li>\n<li>Schwannoma\n<ul>\n<li>Clusters of spindle cells with slender, wavy nuclei associated with fibrillary stroma<\/li>\n<li>Nuclear palisading may be seen<\/li>\n<li>Generally lack single cells in the background<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Intradural\u00a0<em>intramedullary<\/em>\u00a0spinal lesions\n<ul>\n<li>Ependymoma\n<ul>\n<li>Fibrillary tissue fragments and discohesive sheets of small and uniform cells with round to ovoid nuclei and finely speckled chromatin<\/li>\n<li>Ependymal rosettes and perivascular pseudorosettes<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Others\n<ul>\n<li>Metastatic tumour\n<ul>\n<li>Morphology depends on the primary tumour<\/li>\n<li>Less likely given the young age and absence of previous history of malignancy<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>\u00a0<\/strong><\/p>\n<p>Reference: Lacruz C. R., et al.\u00a0<em>Central Nervous System Intraoperative Cytopathology<\/em>. 2nd Edition. Springer International Publishing, 2018.<\/p>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-2\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-2\">Histologic findings<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--icon-2\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a>\n\t\t\t\t\t<p>&nbsp;<\/p>\n<table>\n<tbody>\n<tr>\n<td><img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/cns5-low-power.jpg\" alt=\"\" \/><\/td>\n<td><img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/cn6-perivas-rosette.jpg\" alt=\"\" \/><\/td>\n<td><img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/cns7-GFAP.jpg\" alt=\"\" \/><\/td>\n<td><img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/cn8-EMA.jpg\" alt=\"\" \/><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<ul>\n<li>Cellular tumour composed of sheets of monomorphic-appearing cells with uniform round nuclei<\/li>\n<li>Perivascular pseudorosettes are seen<\/li>\n<li>No hypercellularity, increased mitotic activity, necrosis or microvascular proliferation is identified<\/li>\n<li>The neoplastic cells show cytoplasmic dot-like expression of EMA and D2-40. They are also positive for GFAP and S100 (patchy). SOX10 immunostain is negative.<\/li>\n<\/ul>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-3\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-3\">Diagnosis<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--icon-3\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a>\n\t\t\t\t\t&nbsp;<br \/>\n<strong>Ependymoma<\/strong>\n\t<p><em>Case writer: Dr Hui Min Tan<\/em><\/p>\n\n","protected":false},"excerpt":{"rendered":"<p>Central Nervous System 1 A spine-tingling mass Clinical history: A 20-year-old male with no past medical history presented with lower back pain and tingling sensation in both lower limbs. MRI showed an intradural mass within the lumbar spine; imaging findings were suggestive of a schwannoma. The patient underwent excision of the mass with intraoperative frozen [&hellip;]<\/p>\n","protected":false},"author":828,"featured_media":0,"parent":44933,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-45103","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>NUS Pathweb<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/cns-1\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:description\" content=\"Central Nervous System 1 A spine-tingling mass Clinical history: A 20-year-old male with no past medical history presented with lower back pain and tingling sensation in both lower limbs. 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