Clear cell neoplasms and pseudoneoplastic lesions of the central nervous system.
Mass lesions of the central nervous system (CNS) that may assume a clear cell appearance are diverse in nature. Primary conditions in this category include oligodendroglioma, hemangioblastoma, germinoma (seminoma), clear cell and chordoid meningioma, pleomorphic xanthoastrocytoma, and lipid-rich glioblastoma. These proliferations usually can be identified by attention to clinical presentation, topographic location, radiographic details, and histological nuances. Occasionally, however, electron microscopy or immunohistological analysis may be necessary. A recommended panel of reagents for the evaluation of clear cell primary CNS lesions include antibodies to glial fibrillary acidic proteins, S-100 protein, epithelial membrane antigen, vimentin, keratins, placental-like alkaline phosphatase, and synaptophysin. This article reviews the salient clinicopathologic attributes of such proliferations, elaborates a practical approach to their diagnosis, and discusses important differential diagnostic considerations. The latter include malformative lesions, infarcts, inflammatory conditions, and secondary lymphomas, carcinomas, and melanomas.
Gökden
M
M
Department of Pathology, Washington University School of Medicine, St Louis, MO 63110-0193, USA.
Roth
K A
KA
Carroll
S L
SL
Wick
M R
MR
Schmidt
R E
RE
D000469:Alkaline Phosphatase / Q000032:analysis; D002292:Carcinoma, Renal Cell / Q000556:secondary; D016543:Central Nervous System Neoplasms / Q000737:chemistry / Q000473:pathology* / Q000556:secondary; D003937:Diagnosis, Differential; D018237:Germinoma / Q000737:chemistry / Q000473:pathology; D005904:Glial Fibrillary Acidic Protein / Q000032:analysis; D018325:Hemangioblastoma / Q000737:chemistry / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D007633:Keratins / Q000032:analysis; D008579:Meningioma / Q000737:chemistry / Q000473:pathology; D018396:Mucin-1 / Q000032:analysis; D009837:Oligodendroglioma / Q000737:chemistry / Q000473:pathology; D009418:S100 Proteins / Q000032:analysis; D016708:Synaptophysin / Q000032:analysis; D014746:Vimentin / Q000032:analysis; D014973:Xanthomatosis / Q000473:pathology
D005904:Glial Fibrillary Acidic Protein; D018396:Mucin-1; D009418:S100 Proteins; D016708:Synaptophysin; D014746:Vimentin; D007633:Keratins; D000469:Alkaline Phosphatase