Glioblastoma - haemorrhagic

Case contributed by A.Prof Frank Gaillard
Modality: MRI

Case Discussion

Glioblastoma multiforme with a predominant oligodendroglial component

MICROSCOPIC DESCRIPTION:

Paraffin sections show fragments of a densely hypercellular tumour. This is composed predominantly of cells with pleomorphic, eccentrically located round and oval vesicular nuclei and a moderate amount of dense eosinophilic cytoplasm which shows moderately strong immunostaining for GFAP.  These cells have features of gliofibrillary oligodendrocytes and are admixed with a quantitatively smaller population of strongly GFAP immunoreactive fibrillary and gemistocytic astrocytes.  Frequent mitotic figures are noted in the gliofibrillary oligodendrocytes. In addition there are several foci of vascular endothelial cell hyperplasia as well as scattered areas of necrosis.

Much of the tumour is situatad as a layer superficial to the surface of cerebral cortex deep to the pia-arachnoid with extension down Virchow-Robins spaces. Perivascular aggregation of tumour cells is prominent more deeply in the cortex.  In several fragments, however, tumour is present in white matter and is seen to merge gradually with adjacent brain parenchyma. Areas of recent haemorrhage are seen and there are collections of haemosiderin-filled macrophages, indicating past haemorrhage. One fragment is composed largely of low grade oligodendroglioma and shows prominent calcification. No immunostaining for cytokeratins (AE1/AE3, CAM 5.2), CD34 or the melanocyte markers, tysosinase and melan A is seen in tumour cells.  In some areas, the gliofibrillary astrocytes show strong surface staining for CD138.

This is interpreted as cross-reactivity and not indicating a plasma cell tumour as no kappa or lambda light chain immunoglobulin restriction is demonstrated and there is no staining in these cells for CD20 or CD79a. 

The overall features are of glioblastoma multiforme with a predominant oligodendrocyte component.

COMMENT:

This tumour is composed predominantly of gliofibrillary oligodendrocytes with a quantitatively small component of fibrillary and gemistocytic astrocytes, has an area of low grade oligodendroglioma with calcification i.e. features of oligoastrocytoma. However, there are frequent mitotic figures, areas of necrosis and vascular endothelial cell hyperplasia. The recommendation of the 2007 WHO Classification of Tumours of the Central Nervous System is that glial tumours with these features, in particular, necrosis, be classified as glioblastomas with an oligodendroglial component. Data from several studies indicate that these tumours have a better prognosis than conventional astrocytic glioblastoma multiforme particularly if there is deletion of chromosome 1p or combined deletion of chromosomes 1p and 19q.

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Case Information

rID: 9969
Case created: 3rd Jun 2010
Last edited: 29th Mar 2017
Inclusion in quiz mode: Included

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