A region of high T2 signal with low T1 and minor possible enhancement involves the frontal lobe on the right. Prominent cortical involvement.
Histology demonstrates a mixture of oligodendroglial cells and malignant astrocytic cells.
Fig 1. Mostly oligodendrocytes and a few astrocytes
Fig 2. Some oligodendrocytes around neurons
Fig 3 and 4. GFAP staining astrocytes
Fig 5. GFAP negative oligodendrocytes
Fig 6. Low index around oligodendroglial component
Fig 7. higher index, staining the astrocytic component
Case Discussion
This case demonstrates how heterogeneous these tumors can be.
NOTE: This case predates the 2016 WHO classification of CNS tumor revision. As no IDH or 1p19q co-deletion status is available a formal diagnosis cannot be reached and the NOS is therefore used (not otherwise specified) - which is recognized in the current classification for cases where molecular information is unavailable. It should also be noted, that under the new classification both an astrocytic and oligodendroglial component needs to be identified, each with its own molecular markers. True oligoastrocytomas are therefore going to be rare, and this case would most likely be classified as either an astrocytoma or an oligodendroglioma.
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