NEUROIMAGES Disseminated cystic lesions

A case of disseminated oligodendroglial-like leptomeningeal tumor A 22-year-old woman was evaluated after a seizure manifesting as tonic posturing of the left hand, head and eye deviation to the left, and a secondarily generalized tonic-clonic seizure. Brain MRI revealed multiple cystic and nodular lesions, some of which enhanced with gadolinium, and hydrocephalus (figure 1). CSF was notable only for elevated opening pressure of 35 cm CSF. Pathologic evaluation showed superficial cortical involve-ment by oligodendroglial-like bland cells, positive for S100 protein and negative for neuronal nuclear antigen, synaptophysin, phosphoneurofilament (pNF), glial fibrillary acid protein, CD34, mutations of mutant IDH-1, and p53 with low Ki-67. Alcian blue staining highlighted the myxoid stroma. Morphologic evaluation (figure 2) resembled disseminated oligodendroglial-like leptomeningeal tumor, a rare form of low-grade neoplasm.