Ganglioglioma

Case contributed by Assoc Prof Frank Gaillard

Presentation

Medication resistant epilepsy.

Patient Data

Age: Young adult.
Gender: Male
MRI

The right mesial temporal lobe, involving the medial aspect of the hippocampal head and the amygdala, is expanded by an ill-defined mass with increased T2 signal. No enhancement, blood products or calcification. Increased DWI signal may represent T2-shine-through (no ADC available, unfortunately). 

The differential diagnosis is primarily between a DNET and other low-grade cortical tumors (e.g. ganglioglioma/gangliocytoma). 

Case Discussion

The patient went on to have a temporal lobectomy. 

Histology

Mesial temporal tissue, partly infiltrated by astrocytic cells, with an admixture of large cells, with variable amounts of cytoplasm and one or more large nuclei. The features are consistent with an abnormal ganglion cell population. Some of these cells show positive staining for CD34. The nuclei of the astrocytic population are moderately pleomorphic. No mitotic activity is identified. There is no necrosis and microvascular proliferation is not seen. There is, however, some vessel wall thickening, with occasional vessels showing mild perivascular lymphocytic cuffing. The features are consistent with a ganglioglioma.


FINAL DIAGNOSIS: right medial temporal lobe and uncus - ganglioglioma (WHO grade 1)

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