Angiocentric glioma

Angiocentric gliomas are rare superficial slow-growing brain tumours typically presenting in young patients with intractable partial epilepsy 1-6. They were first introduced in the 2007 (4th) edition of the WHO brain tumour classification, and are classified as WHO grade I tumours 1

For a general discussion of clinical presentation, epidemiology, and treatment, please refer to the article on low-grade astrocytomas.

Angiocentric gliomas are very rare tumours with relatively few reported cases. They usually affect children and young adults 1,6. No reported gender predilection has been reported 1

Seizures are the classical presentation, with over 95% of patients presenting with intractable seizures 3.

Angiocentric gliomas are designated as WHO grade I tumours 1-3. The exact aetiology of angiocentric gliomas remains unclear although some features are similar to ependymomas 1,6. In fact, sometimes, a distinct ependymoma component may co-exist 1.

These tumours demonstrate a monomorphic population of elongated spindle-shaped bipolar cells with a strikingly perivascular orientation, somewhat reminiscent to perivascular pseudorosettes 1,6. Although tumour cells do extend into the surrounding parenchyma, a strong predilection for perivascular spread is evident 6. Subpial growth along the surface of the cortex is also a prominent feature 1,6.

The immunophenotype shares some similarities to ependymomas 1

  • GFAP: positive
  • EMA: both surface and perinuclear cytoplasmic dot may be present

Ki-67 index is usually <5% 1

They do not demonstrate neuronal markers (e.g. synaptophysin, chromogranin-A, neuronal nuclear antigen) and they are isocitrate dehydrogenase (IDH) negative.

Cortical dysplasia may be associated.

Angiocentric gliomas are usually cortical or subcortical (grey-white matter junction), typically well-delineated, supratentorial tumours that tend to expand affected gyri. They exhibit a propensity to spread horizontally in the subpial plane and deeply along vessels 1.

Typically appear as an expansile non-enhancing cortical tumour.

  • T1
    • hypointense
    • hyperintense rim may be seen
  • T2 / FLAIR
    • hyperintense
    • extension toward the ventricles along vessels
    • may have cystic-appearing areas
  • T1 C+ (Gd): no enhancement

Angiocentric glioma was initially identified in 2005 in two separate case reports 2,5 and then introduced in the WHO classification of CNS tumours in 2007. It remains an entity in the current (2016) WHO classification 1.

Given their rarity, on purely imaging grounds it is difficult to distinguish these tumours from more common diffuse gliomas (both astrocytoma and oligodendroglioma). Other imaging differential considerations include:

Astrocytic tumour
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Article information

rID: 21730
Tag: cases
Synonyms or Alternate Spellings:
  • ANET
  • Angiocentric gliomas
  • Angiocentric neuroepithelial tumor (ANET)
  • Monomorphous angiocentric glioma

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