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Oligodendroglioma
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Oligodendroglioma

Overview
  • Diffusely infiltrative glioma that comprises cells, which resemble mature oligodendrocytes, have a predilection for the gray/white junction of the frontal and temporal lobes, and are slow-growing.
  • Typical age of onset: 40's
  • Often present with seizures or focal deficits (eg, aphasia) secondary to their infiltrative nature of frontal and temporal lobes.
Histopathology
  • Fried egg cell appearance
    • Round nucleus
    • Perinuclear halo (clear zone)
This is an artifact of formalin fixation
  • “Chicken-wire” capillary pattern of vasculature
    • Delicate capillary network
  • GFAP negative
    • Whereas GFAP does typically stain astrocytic neoplasms, GFAP does not stain classic oligodendrogliomas (except for their minigemistocytes).
  • Minigemistocytes
    • Eccentric nucleus
    • Small, eosiniphilic cytoplasmic cell body
  • Resemble mature oligodendroctytes
  • Microcalcifications are more common in oligodendrogliomas than astrocytomas
  • Mixed oligoastrocytomas have a worse prognosis than pure oligodendrogliomas (but better prognosis than pure astrocytomas).
Favorable Molecular Markers
  • 1p/19q co-deletion
    • Patients with 1p/19q co-deletion: deletion of the short arm of chromosome 1 (1p) and the long arm of chromosome 19 (19q) (1p/19q co-deletion) had longer survival than those without 1p/19q co-deletion.
  • IDH mutation
    • Patients with mutation of either IDH1 or IDH2 had longer survival than those without an IDH mutation.
Radiographic Appearance
  • T2-weighted MRI: Hyperintense
  • T1-weighted MRI: Hypointense
  • T1-weighted MRI with contrast: Poor enhancement (typically)
Note that these tumors are often calcified.*
Treatment
  • Surgery
    • Note that younger patients and those with better performance status have a better prognosis than older patients with worse presurgical performance status.
  • Radiation
  • Chemotherapy in anaplastic oligodendroglioma.
Possible regimens:
    • Temozolomide
    • Procarbazine, lomustine (CCNU), and vincristine
References
  • Adesina, Adekunle M., Tarik Tihan, Christine E. Fuller, and Tina Young Poussaint. Atlas of Pediatric Brain Tumors. Springer, 2016.
  • Cheng, Liang, and David G. Bostwick. Essentials of Anatomic Pathology. Springer, 2016.
  • Gray, Frangoise, Charles Duyckaerts, and Umberto De Girolami. Escourolle and Poirier’s Manual of Basic Neuropathology. OUP USA, 2013.
  • Louis, David N., Arie Perry, Guido Reifenberger, Andreas von Deimling, Dominique Figarella-Branger, Webster K. Cavenee, Hiroko Ohgaki, Otmar D. Wiestler, Paul Kleihues, and David W. Ellison. “The 2016 World Health Organization Classification of Tumors of the Central Nervous System: A Summary.” Acta Neuropathologica 131, no. 6 (June 1, 2016): 803–20. https://doi.org/10.1007/s00401-016-1545-1.
  • Lysiak, M., K. Radke, A. Malmström, O. Jönsson, A. L. Hallbeck, C. Bratthäll, M. Strandeus, P. Milos, M. Hallbeck, and P. Söderkvist. “P03.15 Detection of 1p19q Co-Deletion in Oligodendrogliomas with Droplet Digital PCR.” Neuro-Oncology 19, no. suppl_3 (May 1, 2017): iii36–iii36. https://doi.org/10.1093/neuonc/nox036.130.
  • Molavi, Diana Weedman. The Practice of Surgical Pathology: A Beginner’s Guide to the Diagnostic Process. Springer Science & Business Media, 2008.
  • Newton, Herbert B. Handbook of Brain Tumor Chemotherapy, Molecular Therapeutics, and Immunotherapy. Academic Press, 2018.
Orkin, Stuart H., David E. Fisher, A. Thomas Look, Samuel Lux, David Ginsburg, and David G. Nathan. Oncology of Infancy and Childhood E-Book. Elsevier Health Sciences, 2009.
  • Perry, Arie. “WHO’s Arrived in 2016! An Updated Weather Forecast for Integrated Brain Tumor Diagnosis.” Brain Tumor Pathology 33, no. 3 (July 1, 2016): 157–60. https://doi.org/10.1007/s10014-016-0266-4.
  • Reni, Michele, Elena Mazza, Silvia Zanon, Gemma Gatta, and Charles J. Vecht. “Central Nervous System Gliomas.” Critical Reviews in Oncology/Hematology 113 (May 2017): 213–34. https://doi.org/10.1016/j.critrevonc.2017.03.021.
  • Reyaz, Nadeem, Muhammad Tayyab, Saeed Akhtar Khan, and Tehseen Siddique. “Correlation of Glial Fibrillary Acidic Protein (GFAP) with Grading of the Neuroglial Tumours.” Journal of the College of Physicians and Surgeons--Pakistan: JCPSP 15, no. 8 (August 2005): 472–75. https://doi.org/08.2005/JCPSP.472475.
  • Ryall, Scott, Uri Tabori, and Cynthia Hawkins. “A Comprehensive Review of Paediatric Low-Grade Diffuse Glioma: Pathology, Molecular Genetics and Treatment.” Brain Tumor Pathology 34, no. 2 (April 1, 2017): 51–61. https://doi.org/10.1007/s10014-017-0282-z.
  • Sharma, Suash, and Prabal Deb. “Intraoperative Neurocytology of Primary Central Nervous System Neoplasia: A Simplified and Practical Diagnostic Approach.” Journal of Cytology / Indian Academy of Cytologists 28, no. 4 (2011): 147–58. https://doi.org/10.4103/0970-9371.86339.
Image References
  • “Anaplastic_oligodendroglioma_(1).Jpg”. Hematoxylin & Eosin Stain. January 17, 2006. No machine-readable source provided. Own work assumed (based on copyright claims). https://commons.wikimedia.org/wiki/File:Anaplastic_oligodendroglioma_(5)_minigemistocytes.jpg.
  • Jensflorian. English: Histopathology of Anaplastic Oligodendroglioma (HE Stain) Showing Minigemistocytes and Mitoses among Tumor Cells with Perinuclear Halo. June 15, 2015. Own work. https://commons.wikimedia.org/wiki/File:Anaplastic_oligodendroglioma_minigemistocytes.jpg.
  • Nephron. English: Low Magnification Micrograph of an Oligodendroglioma. Brain Biopsy. H&E Stain. [object HTMLTableCellElement]. Own work. https://commons.wikimedia.org/wiki/File:Oligodendroglioma1_low_mag.jpg.

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