case of the oligo dr. vinh.16.12

8/6/2019 Case of the Oligo Dr. Vinh.16.12

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Case of the day

Dao Danh Vinh

Bach Mai HospitalRadiology Department



� M, 46Y

� Chronic headache (> 3 months)

� No seizure, no fever

� No local neurodeficiency

� Blood test: no abnormality.

Case of the day



.

� .



Diagnosis

� Oligodendroglioma

� Astrocytoma

� GBM

� «..



Oligodendroglioma

Well-differentiated Anaplastic

Anne Osborn 2004; 2 nd Ed: 1642-1645



Introduction

� 1900: Robertson recognized the oligodendrocyte, the partof the neuroglial family of cells and is found predominantlyin the white matter of the central nervous system

� 1926: Bailey and Cushing were the first to recognize this tumor.

� 1929: Bailey and Bucy descripted of 13 cases of the tumor

� Oligodendroglioma is the third most common glialneoplasm, most commonly arises in the frontal lobe.

� Two main type of pathologic classification: ± Well-differenciated oligodendroglioma

± Anaplastic variant

� Oligoastrocytoma: less common ± Mixutres of both oligodendroglial and astrocytic component

± Both well-differenciated and anaplastic form

K elly K. K oeller . RadioGraphics 2005; 25: 1669-1688



Introduction

� US: Annual incidence of 0.3 /100,000

� The third most common glioma overall:

± 2% ±5% of primary brain tumors

± 5% ±18% of all glial neoplasms

± < 1% of pediatric central nervous system neoplasms

� M>F

� Age: 5th ± 6th decades

� Clinical presentation is often of several year duration

� WHO: grade II (well differentiation), grade III (anaplastic)




Histology

� .


Anaplastic oligodendroglioma.

Florid microvascular proliferation (arrows) withina typical oligodendroglial morphology.

Well-differentiated oligodendroglioma.Uniform round cells

Oligoastrocytoma. Astrocytic (a) and oligodendroglialcomponents combined in this field.

Arrowheads representativeoligodendrocytes with the typical ³fried-egg´ appearance.



Imagings

� Typically manifest as a round or oval sharply marginatedmass involving the cortex or subcortical white matter atcross-sectional neuroimaging.

� Occasionally, the tumor margins are not well-defined, as itappears to blend imperceptibly into the normal adjacent

brain parenchyma.� CT:

± About 60% are hypoattenuating

± While 23% are isoattenuating

± About 6% are hyperattenuating

± Calcification: 70

-90%

± Cystic denengeration: 20%

± Vasogenic edema

± Heamorrhage

± Enhancement




Imagings

� MRI

± T1W: usually hypointense compared to GM

± T2W: hyperintense compared to GM

± Heterogeneity of this signal intensity is the rule

± Less commonly, a large cystlike pattern may be seen.

± Surrounding vasogenic edema is not common ± Maybe extend through the corpus callosum to produce a ³butterfly

glioma´ pattern (frontal lobe tumors).

± ADC: shows a characteristic but not pathognomonic differencebetween lowgrade and high-grade glial neoplasms.

� Contrast MRI:

± CT ~ MRI

± ³Dot-like´ lacy enhancement is commonly seen

± Many tumors may not enhance at all.



.

� .


Well-differentiatedoligodendroglioma



.

� .


Extension through thecorpus callosum withinvolvement of both frontallobes is seen





This appearance mimics that of a glioblastoma multiforme.




� .

Oligoastrocytoma




Different diagnosis

� Astrocytoma

� GBM

� Ganglioglioma

� DNET (dysembryoplastic neuroepithelial tumor)� Pleomorphic xanthoastrocytoma

� Cerebritis

� Ischemia

Anne Osborn 2004; 2 nd Ed: 1642-1645



Different diagnosis

� Astrocytoma

Anne Osborn 2004; 2 nd Ed: 1642-1645



Different diagnosis

� GBM

Anne Osborn 2004; 2 nd Ed: 1642-1645



Different diagnosis

� Ganglioglioma

Anne Osborn 2004; 2 nd Ed: 1642-1645



Different diagnosis

�D

NE

T

Anne Osborn 2004; 2 nd Ed: 1642-1645



Different diagnosis

� Pleomorphic xanthoastrocytoma

Anne Osborn 2004; 2 nd Ed: 1642-1645



T hanks for your attention!

case of the oligo dr. vinh.16.12

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