Presentation
Seizure
Patient Data
Diffuse area of increased signal involving the precuneus on the left, with considerable cortical involvement.
Diffuse area of increased signal involving the precuneus on the left, with considerable cortical involvement has not changed over the preceding 28 months.
Case Discussion
The patient went on to have an eventual biopsy (after the second scan).
Histology
MICROSCOPIC DESCRIPTION: The sections from all the specimens show features of moderately cellular glial tumor. There is a proliferation of predominantly neoplastic astrocytes of the fibrillary and protoplasmic types. They have round to elongated and hyperchromatic nuclei. A second minor population of neoplastic oligodendroglial cells is also present (about 10%). These
cells have round nuclei and perinuclear haloes. The tumor cells extend into the cortex with secondary structuring including perineuronal satellitosis and perivascular aggregation. Rare mitoses are seen (less than 5 per 10 high power fields). No microvascular proliferation or necrosis is present. The features are those of oligoastrocytoma. The tumor cells are p53 and IDH-1 positive. The neoplastic astrocytes are ATRX positive. The Ki-67 index is about 8%. They are MGMT negative.
DIAGNOSIS: Oligoastrocytoma (WHO Grade II).
Discussion
This case illustrates the typical 'benign' biological behavior of IDH1 positive low grade tumors. Note, 1p19q was not, but would now, be routinely performed in this case.
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