Presentation
Generalized tonic-clonic seizure. Pregnant.
Patient Data
Right frontal lobe intra-axial lesion is demonstrated that involves cortex as well as subcortical white matter, expanding both, without mass effect, it is not compressing the frontal horns of the lateral ventricles. No hydrocephalus. Scattered within the tumor are very small nodular areas of contrast enhancement, particularly centrally, with no discrete mass enhancing mass demonstrated. The tumor has no abnormal restricted diffusion. No susceptibility artifact. Surrounding T2 FLAIR hyperintensity in the right frontal lobe.
Case Discussion
The patient was in the second trimester of gestation, who had no symptoms of relevance until half an hour before admission, presenting with seizures.
It is interesting that the tumor does not have a magnetic susceptibility artifact, which should be better seen by CT, but because of its pregnancy it was not performed.
Five days after admission, surgery was performed, resecting the entire tumor macroscopically.
Histology:
Primary glial neoplasm consistent with oligodendroglioma with extension to cortical. Immunohistochemistry study: Ki-67: Proliferative index by 10% PGAF: Positive in glial cells.
Conclusion: Immunohistochemical findings are compatible with focal grade 3 oligodendroglioma and predominantly grade 2.
Note: This case does not include IDH or 1p19q co-deletion status, both of which are required for complete diagnosis by the updated 4th edition (2016) and 5th edition (2021) WHO classification of CNS tumors. As such this tumor should be classified as an oligodendroglioma not otherwise specified (NOS).
Unable to process the form. Check for errors and try again.