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)
- “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)
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.
- 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.