Qap (Anatomical Pathology) 

QAP Peer Review

AP323
Case History: M/14. Left temporal tumor. MRI: Avidly enhancing mass in left temporal region complicated by hemorrhage. Aggressive or atypical meningioma, or even glioma needed to be excluded
Intended diagnosis: Atypical teratoid/rhabdoid tumor. Contributed by:PC
Code Diagnosis Comment Score
anonymous Chordoid meningioma (70%), atypical teratoid/rhabdoid tumour (AT/RT)(30%) Chordoid meningioma: EMA+, CK-, S100 variable Atypical teratoid/rhabdoid tumour: loss of expression of INI 1, EMA+, CK+, GFAP+  100
anonymous Chordoid meningioma nil  50
anonymous 1. Rhabdoid meningioma (50%) 2. Atypical teratoid/rhabdoid tumour (30%) 3. Chordoid meningioma (20%) Perform immunohistochemistry for INI-1. If tumour cells are negative for INI-1, the diagnosis will be atypical teratoid/rhabdoid tumour.  100
anonymous Epithelioid hemangioendothelioma 40% Chordoid meningioma 40% Atypical teratoid rhabdoid tumor 20% Immunostaining for: CD31, CD34, ERG - positive in epithelioid hemangioendothelioma EMA - positive in maningioma INI1 - lost in atypical teratoid rhabdoid tumor.  100
anonymous Chordoid meningioma, grade 2 (WHO), with brain invasion. 100% Dx can be confirmed by EMA+. Brain invasion can be confirmed and highlighted by background GFAP stain.  50
anonymous Rhabdoid neoplasm Atypical teratoid/rhaboid tumor vs Rhabdoid meningioma ATRT is characterized by loss of INI1 stain, while rhabdoid meningioma shows retained nuclear stain of INI1 stain in the tumor cells  100
anonymous Malignant (Ansplastic) Meningioma (WHO Grade III) 100% There are chordoid areas and foci of dubious rhabdoid cell configuration  50
anonymous Atypical teratoid/rhabdoid tumour 50% Chordoid meningioma WHO G2 50% perform immunostain for INI1 to cofirm ATRT vs meningeal differentiation.  100
anonymous 70% chordoid meningioma 30% ATRT (atypical teratoid/rhabdoid tumour) nil  100
anonymous Favoring Atypical Epithelioid Haemangioendothelioma. Differential diagnosis - Chordoid meningioma. nil  50
anonymous Left temporal tumor:- Myxoid tumour with neoplastic cells having rhabdoid morphology, differential diagnoses including: 1) Meningioma, chordoid/rhabdoid variant, WHO grade III (probability 50%) 2) Atypical teratoid/rhabdoid tumor, WHO grade IV (probability 50%) Definitive diagnosis cannot be made without support of immunohistochemistry: 1) Meningioma, chordoid/rhabdoid variant (WHO grade III) - confirmed by positive EMA stain 2) Atypical teratoid/rhabdoid tumor (WHO grade IV) - confirmed by loss of INI-1 by immunostain  100
anonymous Atypical teratoid rhabdoid tumor. nil  100
anonymous Malignant neoplasm with chordoid features, with the differential diagnosis including atypical teratoid/rhabdoid tumour (70%) and chordoid meningioma (30%). Immunohistochemical staining would be performed, including INI1, EMA and GFAP. INI1 would be negative in atypical teratoid/rhabdoid tumour and positive in chordoid meningioma. For chordoid meningioma the expected pattern is EMA positive, GFAP negative.  100
anonymous atypical teratoid/rhabdoid tumor (100%) nil  100
anonymous Brain ?Malignant neoplasm, differential diagnoses included Chordoid meningioma and Atypical teratoid and rhabdoid tumor, need to perform immunohistochemistry of keratin and molecular study of INI1. (100% probability). nil  100
anonymous Chordoid Meningioma nil  50
anonymous Chordoid meningioma, grade II (WHO) 100% nil  50
anonymous Chordoid meningioma. W.H.O. Grade 2. nil  50