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Difference between revisions of "Oligodendroglioma"
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'''Oligodendroglioma''' is [[CNS tumour]] that is typically in the fourth ventricle or intramedullary spinal cord. | |||
==General== | |||
*Do ''not'' arise from oligodendrocytes. | |||
**Arise from ''glial precursor cells''. | |||
Usual location: | |||
*Fourth ventricle. | |||
*Intramedullary spinal cord. | |||
Prognosis by flavours (average survival):<ref name=Ref_PSNP98>{{Ref PSNP|98}}</ref> | |||
*WHO grade II: 10-15 years. | |||
*WHO grade III: 3-5 years. | |||
==Microscopic== | |||
Features: | |||
*Highly cellular lesion composed of: | |||
**Cells resembling ''fried eggs'' (oligodendrocytes) with: | |||
***Round nucleus - '''key feature'''. | |||
***Distinct cell borders. | |||
***Moderate-to-marked nuclear atypia. | |||
***Clear cytoplasm - useful feature (if present). | |||
****Some oligodendrogliomas have eosinophilic cytoplasm with focal perinuclear clearing. | |||
**Acutely branched capillary sized vessels - "chicken-wire" like appearance. | |||
***Abundant, delicate appearing; may vaguely resemble a paraganglioma at low power. | |||
*Calcifications - important feature.<ref>URL: [http://www.emedicine.com/radio/topic481.htm http://www.emedicine.com/radio/topic481.htm].</ref> | |||
Note: | |||
*Tumour cells may be plasmacytoid, i.e. have a [[plasma cell]]-like appearance.<ref name=pmid17284109>{{Cite journal | last1 = Aldape | first1 = K. | last2 = Burger | first2 = PC. | last3 = Perry | first3 = A. | title = Clinicopathologic aspects of 1p/19q loss and the diagnosis of oligodendroglioma. | journal = Arch Pathol Lab Med | volume = 131 | issue = 2 | pages = 242-51 | month = Feb | year = 2007 | doi = 10.1043/1543-2165(2007)131[242:CAOQLA]2.0.CO;2 | PMID = 17284109 | URL = http://www.archivesofpathology.org/doi/full/10.1043/1543-2165(2007)131%5B242:CAOQLA%5D2.0.CO;2 }}</ref> | |||
DDx: | |||
*[[Neurocytoma]] also have perinuclear clearing and well-defined cellular borders. | |||
**Pineocytomatous/neurocytic rosettes = (irregular) rosette with a large meshwork of fibers (neuropil) at the centre. | |||
Notes: | |||
*Few neural tumours have round nuclei - DDx: | |||
**[[Oligodendroglioma]]. | |||
**[[Lymphoma]]. | |||
**Clear cell variant of [[ependymoma]]. | |||
**[[Germ cell tumour]] (germinoma/dysgerminoma/seminoma). | |||
===Images=== | |||
*[[WC]]: | |||
**[http://commons.wikimedia.org/wiki/File:Oligodendroglioma1_high_mag.jpg Oligodendroglioma high mag. (WC)]. | |||
**[http://commons.wikimedia.org/wiki/File:Oligodendroglioma1_low_mag.jpg Oligodendroglioma low mag. (WC)]. | |||
www: | |||
*[http://path.upmc.edu/cases/case713.html Oligodendroglioma - several images (upmc.edu)]. | |||
*[http://frontalcortex.com/?page=oll&topic=24&qid=864 Oligodendroglioma with plasmacytoid cells (frontalcortex.com)]. | |||
===Histologic grading=== | |||
Come in two flavours: | |||
# WHO grade II. | |||
#*This is most oligodendrogliomas. | |||
# WHO grade III. | |||
#*Features for calling high grade:<ref name=Ref_PSNP98>{{Ref PSNP|98}}</ref> | |||
#**Endothelial hypertrophy. | |||
#***Plump/large endothelial cells. | |||
#**Necrosis. | |||
#**High mitotic rate (6 mitoses/10 HPF for whatever "HPF" means, see [[HPFitis]]). | |||
==IHC== | |||
Features: | |||
*MAP-2 +ve.<reF name=pmid12025943>{{cite journal |author=Suzuki SO, Kitai R, Llena J, Lee SC, Goldman JE, Shafit-Zagardo B |title=MAP-2e, a novel MAP-2 isoform, is expressed in gliomas and delineates tumor architecture and patterns of infiltration |journal=J. Neuropathol. Exp. Neurol. |volume=61 |issue=5 |pages=403–12 |year=2002 |month=May |pmid=12025943 |doi= |url=}}</ref> | |||
*GFAP -ve. | |||
**Some subtypes +ve - should not be used to distinguish.<ref name=Ref_PSNP>{{Ref PSNP|98}}</ref> | |||
*EMA +ve. | |||
*IDH-1 -ve. (???). | |||
*p53 -ve. | |||
**Useful for differentiating ''astrocytoma'' vs. ''oligodendroglioma''. | |||
*Ki-67. | |||
==Molecular pathology== | |||
Losses of 1p and 19q both helps with diagnosis and is prognostic:<ref name=pmid18565359>{{cite journal |author=Fontaine D, Vandenbos F, Lebrun C, Paquis V, Frenay M |title=[Diagnostic and prognostic values of 1p and 19q deletions in adult gliomas: critical review of the literature and implications in daily clinical practice] |language=French |journal=Rev. Neurol. (Paris) |volume=164 |issue=6-7 |pages=595–604 |year=2008 |pmid=18565359 |doi=10.1016/j.neurol.2008.04.002 |url=}}</ref> | |||
*Greater chemosensitivity | |||
*Better prognosis. | |||
==See also== | |||
*[[Neuropathology tumours]]. | |||
*[[Neuropathology]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Neuropathology tumours]] | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||