Anaplastic oligodendroglioma: haemorrhagic

Case contributed by A.Prof Frank Gaillard
Modality: MRI

Right frontal intra axial space occupying lesion with intralesional hemorrhage, surrounding edema and marginal enhancement.

Modality: DSA (angiography)

Note displacement of vessels on angiography.


Microscopic Description:

All sections show a diffusely infiltrating glial neoplasm. The majority of the tumor is composed of cells with uniform small round nuclei surrounded by a clear perinuclear halo. These areas are associated with delicate branching capillary vasculature, macrocalcification, and focal microcystic architecture. Where the tumor diffusely infiltrates into the neocortex, there are prominent Sherer's secondary structures in the form of perineuronal, perivascular, and subpial aggregation of cells. In addition, there are focal nodular areas of marked hypercellularity where the cells have greater variation in nuclear size and shape and much more mitotic activity (up to 5 mitoses in a single high power field). Some of these cells have visible cytoplasm with either short delicate processes or micro-gemistocytic morphology. The hypercellular regions are also associated with and at least some endothelial proliferation and focal tumor necrosis. There are much larger confluent areas of acute necrosis associated with hemorrhage that more likely represents acute hemorrhagic infarction of part of the tumor. GFAP immunohistochemistry stains the minigemistocytes as well as reactive astrocytes in the cortex. MIB-1 labeling in significantly higher in the hypercellular nodules.

Final Diagnosis:

Right frontal lesion: anaplastic oligodendroglioma (grade 3/4).

Case Discussion

Haemorrhagic right frontal lobe tumour - note displacement of vessels on angiography - with a final diagnosis of anaplastic oligodendroglioma. 

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Case Information

rID: 6065
Case created: 15th Apr 2009
Last edited: 9th Jul 2016
Inclusion in quiz mode: Included

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