Virtual Microscope
A 28 year-old man with protracted, intermittent headache
Clinical Information: The patient is a 28 year-old man who complained of protracted, intermittent headache for over two years of time. A CT scan was performed and a lesion was noted in the cerebellum. The followings are the CT scan of the posterior fossa, the gross photograph of the surgically excised specimen and virtual microscopic image.
Diagnosis: Lhermitte-Duclos Disease.
Pathology: The CT scan shows an expanding mass in the left cerebellar hemisphere and this lesion is characterized by a alternating lamination of hypodensity and isodensity. There is also mild mass effect.
The gross specimen maintains the shape of the folia of cerebellum but the folds are abnormally thickened.
On scanning magnification, the specimen appears to have maintained the general outline of the cerebellar folia. The gray matter appears to be thickened in an exaggerated manner but the white matter is rarefied. On higher magnification, the normal three-layer (internal granule layer, Purkinje cell layer, and molecular layer) architecture of a mature cerebellum is lost. The gray matter is replaced by a ribbon of disorganized, medium sized to large ganglion cells distributed in a variable density. There is a tendency for them to cluster close to pial surface. Substantial vacuolization is also present in the white matter.