Oligodendroglioma (anaplastic)

Case contributed by A.Prof Frank Gaillard

Presentation

Headache for two weeks and confusion.

Patient Data

Age: 70 years
Gender: Male
MRI

Large heterogeneous intra-axial mass involving grey and white matter (but with extensive cortical involvement) occupying the entire right temporal lobe, including the mesial temporal lobe. This extends into the insula, right basal ganglia, right frontal operculum and posterior frontal white matter, right parietal, and right occipital lobes.

There is marked mass effect with diffuse sulcal effacement in the right hemisphere, almost complete effacement of the right lateral ventricle, uncal herniation and swelling of the right hippocampus and 1.3 centimeters of midline shift to the left. Midline shift has resulted in entrapment of the left lateral ventricle which is enlarged. Abnormal surrounding FLAIR hyperintensity in keeping with transependymal fluid shift.

The lesion is predominantly FLAIR hyperintense with regions of susceptibility related signal loss corresponding to calcification demonstrated on recent CT. Minimal patchy contrast enhancement.

Marked elevation of relative cerebral blood volume within the lesion. Marked elevation of choline with depression of NAA in the lesion.

Conclusion: Features are those of a glial series tumor with oligodendroglial histology. 

CT

CT demonstrates that the mass has extensive calcification, further supporting the diagnosis of an oligodendroglioma. 

 

Case Discussion

The patient went on to have debulking. 

Histology

Sections show a moderately cellular glial tumor composed of sheets of tumor cells with a "chicken-wire" capillary network and scattered psammomatous microcalcification. Tumor cells demonstrate perinuclear cytoplasmic clearing, hyperchromatic round-to-oval nuclei with vesicular chromatin and inconspicuous nucleoli. There is prominent secondary structuring with perineuronal satellitosis and subpial condensation of tumor cells. There are up to 8 mitoses per 10 hpf. No necrosis or microvascular proliferation are seen.

Immunohistochemical results show tumor cells stain:

  • GFAP Negative
  • Nestin Low
  • NogoA Positive
  • IDH-1 Positive (mutated)
  • ATRX Positive (not mutated)
  • MGMT Negative (likely methylated)
  • p16 Positive
  • p53 Negative
  • Topoisomerase proliferation index 10%.

1p19q codeletion detected. 

FINAL DIAGNOSIS: Oligodendroglioma (anaplastic) WHO grade III.

 

Discussion

As of the 2016 WHO classification of CNS tumors to be designated an oligodendroglioma a tumor must be shown to have both IDH mutation and 1p19q codeletion. Also note, that an oligodendroglioma cannot ever be called a glioblastoma. 

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Case information

rID: 44520
Published: 24th Jun 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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