Ganglioglioma

Case contributed by A.Prof Frank Gaillard

Presentation

History not available. Seizures would be a good guess.

Patient Data

Age: 35 years
Gender: Female
MRI

MRI brain

Scan was obtained at an outside institution and digitised from printed film, thus the lack of stacks and somewhat degraded image quality.  MRI demonstrates a right temporal lobe mass which is isointense to brain on T1, hyperintense on T2 and FLAIR, has no restricted diffusion or calcification. A solid nodule vividly enhances. 

Pathology

Histology

Paraffin sections show a moderately hypercellular tumour which appears to be composed of a mixture of fibrillary astrocytes and cells with features of neurocytes and ganglion cells.  Many multinucleated immature ganglion cells are noted throughout the tumour.  Tumour cells have a haphazard arrangement.  No mitotic figures are identified and there is no evidence of vascular endothelial cell hyperplasia or necrosis.  Prominent vessels with hyalinised walls are noted in some areas of the tumour.  Tumour cells show moderately strong surface immunostaining for synaptophysin and fibrillary astrocytes show strong staining for GFAP. An occasional ganglion cell shows nuclear NeuN staining.  The features are of a low grade glioneuronal tumour favouring ganglioglioma. The topoisomerase labeling index is <1%. 

DIAGNOSIS: Low grade glioneuromal tumour with features favouring ganglioglioma (WHO Grade I)

Case Discussion

This case illustrates the differential of a temporal lobe tumour. In this case the presence of a vividly enhancing nodule favours either a ganglioglioma (the diagnosis in this case) or a pleomorphic xanthoastrocytoma. (see this companion case)

DNETs usually do not enhance this vividly and usually have a bubbly appearance. Although pilocytic astrocytomas can have this appearance, they usually have a cystic component, are usually found in younger patients and the temporal lobe is not a characteristic location. 

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Case information

rID: 14371
Case created: 18th Jul 2011
Last edited: 13th Nov 2015
Inclusion in quiz mode: Included

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