Oligodendroglioma NOS (grade 3) - hemorrhagic

Case contributed by Frank Gaillard
Diagnosis certain



Patient Data

Age: Adult

Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

Note: The diagnostic criteria reflect practice at the time and do not necessarily match the current WHO classification of CNS tumors

A right frontal lobe mass with central hemorrhagic component is present (intrinsic high T1, low T2) with a peripheral region of enhancement and high T2 signal. Some of the enhancement may be in reaction to the hemorrhage, depending on the time course. 

Although the tumor is not hypervascular, it does displace vessels; a feature used prior to cross-sectional imaging to localize tumors. 

Case Discussion

The patient went on to have a biopsy and subtotal resection. 


Microscopic Description: 

All sections show a diffusely infiltrating glial neoplasm. The majority of the tumor is composed of cells with uniform small round nuclei surrounded by a clear perinuclear halo. These areas are associated with delicate branching capillary vasculature, microcalcification, and focal microcystic architecture. Where the tumor diffusely infiltrates into the neocortex, there are prominent Sherer's secondary structures in the form of perineuronal, perivascular, and subpial aggregation of cells. In addition, there are focal nodular areas of marked hypercellularity where the cells have greater variation in nuclear size and shape and much more mitotic activity (up to 5 mitoses in a single high power field). Some of these cells have visible cytoplasm with either short delicate processes or micro-gemistocytic morphology. The hypercellular regions are also associated with and at least some endothelial proliferation and focal tumor necrosis. There are much larger confluent areas of acute necrosis associated with hemorrhage that more likely represents acute hemorrhagic infarction of part of the tumor. GFAP immunohistochemistry stains the mini gemistocytes as well as reactive astrocytes in the cortex. MIB-1 labeling in significantly higher in the hypercellular nodules.

Final Diagnosis:  Anaplastic oligodendroglioma NOS (WHO grade III).

Note: This case predates the recent (2016) revision WHO classification of CNS tumors, and thus molecular markers (IDH mutation and 1p19q co-deletion) are not available. As such, this tumor would now be classified as an anaplastic oligodendroglioma NOS.


How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.