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Difference between revisions of "Oligodendroglioma"
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==General== | ==General== | ||
*Do ''not'' arise from oligodendrocytes. | *Do ''not'' arise from oligodendrocytes, although tumor cells look very similiar.<ref>{{Cite journal | last1 = Hartmann | first1 = C. | last2 = von Deimling | first2 = A. | title = Molecular pathology of oligodendroglial tumors. | journal = Recent Results Cancer Res | volume = 171 | issue = | pages = 25-49 | month = | year = 2009 | doi = 10.1007/978-3-540-31206-2_2 | PMID = 19322536 }}</ref> | ||
**Arise from ''glial precursor cells''. | **Arise from ''glial precursor cells''. | ||
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*WHO grade II: 10-15 years. | *WHO grade II: 10-15 years. | ||
*WHO grade III: 3-5 years. | *WHO grade III: 3-5 years. | ||
Oligodendrogliomas account for approx 5% of all [[glioma]]s. | |||
* Numbers may be higher when stringent classifiation criteria are not applied. | |||
* Peak incidence: 40-45 years. | |||
* First description of the tumor in 1926. | |||
*WHO Grade II: ICD-O: 9450/3. | |||
*WHO Grade III: ICD-O: 9451/3. | |||
==Gross/radiologic== | ==Gross/radiologic== | ||
Location: | Location: | ||
*Cerebral hemispheres - most often frontal lobe, followed by parietal and temporal lobes.<ref name=Ref_PSNP94>{{Ref PSNP|94}}</ref> | *Cerebral hemispheres - most often (50-60%) frontal lobe, followed by parietal and temporal lobes.<ref name=Ref_PSNP94>{{Ref PSNP|94}}</ref> | ||
*Posterior fossa (rare). | *Posterior fossa (rare). | ||
*Intramedullary spinal cord (very rare). | *Intramedullary spinal cord (very rare). | ||
| Line 51: | Line 59: | ||
*Nonenhancing or enhancing. | *Nonenhancing or enhancing. | ||
*Occasionally well-circumscribed. | *Occasionally well-circumscribed. | ||
Clinical symptoms: | |||
*Seizures. | |||
*Intracranial pressure. | |||
*Focal neurologic decifits. | |||
*Cognitive changes. | |||
==Microscopic== | ==Microscopic== | ||
Features: | Features: | ||
*Diffusely growing tumor. | |||
*Highly cellular lesion composed of: | *Highly cellular lesion composed of: | ||
**Cells resembling ''fried eggs'' (oligodendrocytes) with: | **Cells resembling ''fried eggs'' (oligodendrocytes) with: | ||
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***Abundant, delicate appearing; may vaguely resemble a paraganglioma at low power. | ***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> | *Calcifications - important feature.<ref>URL: [http://www.emedicine.com/radio/topic481.htm http://www.emedicine.com/radio/topic481.htm].</ref> | ||
*Perifocal edema uncommon. | |||
*Few tumors may exhibit [[eosinophilic granular bodies]]. | |||
*Some tumors may show a [[Spongioblastoma]]-like growth pattern. | |||
Anaplastic (grade III) criteria:<ref>{{Cite journal | last1 = Giannini | first1 = C. | last2 = Scheithauer | first2 = BW. | last3 = Weaver | first3 = AL. | last4 = Burger | first4 = PC. | last5 = Kros | first5 = JM. | last6 = Mork | first6 = S. | last7 = Graeber | first7 = MB. | last8 = Bauserman | first8 = S. | last9 = Buckner | first9 = JC. | title = Oligodendrogliomas: reproducibility and prognostic value of histologic diagnosis and grading. | journal = J Neuropathol Exp Neurol | volume = 60 | issue = 3 | pages = 248-62 | month = Mar | year = 2001 | doi = | PMID = 11245209 }}</ref> | |||
*"Significant" or "brisk" mitotic activity. | |||
**That means for most neuropathologists >= 6 mitoses per 10 HPF. | |||
*Microvacular proliferation. | |||
*Necrosis. | |||
Note: | 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> | * 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> | ||
**Also called minigemistocytes. | |||
**The are usually strong GFAP+ve. | |||
DDx: | DDx: | ||
*[[Neurocytoma]] also have perinuclear clearing and well-defined cellular borders. | *[[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. | **Pineocytomatous/neurocytic rosettes = (irregular) rosette with a large meshwork of fibers (neuropil) at the centre. | ||
*Clear cell [[ependymoma]]. | |||
*[[Dysembryoplastic neuroepithelial tumor]]. | |||
*Oligodendroglial-like cells in [[Pilocytic astrocytoma]]. | |||
*Clear cell [[meningioma]]. | |||
*Demyelinisation. | |||
Notes: | Notes: | ||
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Image:Oligodendroglioma1_high_mag.jpg | Oligodendroglioma high mag. (WC) | Image:Oligodendroglioma1_high_mag.jpg | Oligodendroglioma high mag. (WC) | ||
Image:Oligodendroglioma1_low_mag.jpg | Oligodendroglioma low mag. (WC) | Image:Oligodendroglioma1_low_mag.jpg | Oligodendroglioma low mag. (WC) | ||
File:Oligodendroglioma_discrete_invasion_HE.jpg | Discrete invasion in a oligodendroglioma. (WC/jensflorian). | |||
</gallery> | </gallery> | ||
www: | www: | ||
*[http://path.upmc.edu/cases/case713.html Oligodendroglioma - several images (upmc.edu)]. | *[http://path.upmc.edu/cases/case713.html Oligodendroglioma - several images (upmc.edu)]. | ||
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**Some subtypes +ve - should not be used to distinguish.<ref name=Ref_PSNP>{{Ref PSNP|98}}</ref> | **Some subtypes +ve - should not be used to distinguish.<ref name=Ref_PSNP>{{Ref PSNP|98}}</ref> | ||
*EMA +ve. | *EMA +ve. | ||
*IDH-1 | *IDH-1 (R132H) +ve (approx 85%). | ||
**18% +ve in one series of children,<ref name=pmid24805856>{{Cite journal | last1 = Rodriguez | first1 = FJ. | last2 = Tihan | first2 = T. | last3 = Lin | first3 = D. | last4 = McDonald | first4 = W. | last5 = Nigro | first5 = J. | last6 = Feuerstein | first6 = B. | last7 = Jackson | first7 = S. | last8 = Cohen | first8 = K. | last9 = Burger | first9 = PC. | title = Clinicopathologic features of pediatric oligodendrogliomas: a series of 50 patients. | journal = Am J Surg Pathol | volume = 38 | issue = 8 | pages = 1058-70 | month = Aug | year = 2014 | doi = 10.1097/PAS.0000000000000221 | PMID = 24805856 }}</ref> 23% +ve in another series.<ref name=pmid23361281>{{Cite journal | last1 = Sipayya | first1 = V. | last2 = Sharma | first2 = I. | last3 = Sharma | first3 = KC. | last4 = Singh | first4 = A. | title = Immunohistochemical expression of IDH1 in gliomas: a tissue microarray-based approach. | journal = J Cancer Res Ther | volume = 8 | issue = 4 | pages = 598-601 | month = | year = | doi = 10.4103/0973-1482.106567 | PMID = 23361281 }}</ref> | **18% +ve in one series of children,<ref name=pmid24805856>{{Cite journal | last1 = Rodriguez | first1 = FJ. | last2 = Tihan | first2 = T. | last3 = Lin | first3 = D. | last4 = McDonald | first4 = W. | last5 = Nigro | first5 = J. | last6 = Feuerstein | first6 = B. | last7 = Jackson | first7 = S. | last8 = Cohen | first8 = K. | last9 = Burger | first9 = PC. | title = Clinicopathologic features of pediatric oligodendrogliomas: a series of 50 patients. | journal = Am J Surg Pathol | volume = 38 | issue = 8 | pages = 1058-70 | month = Aug | year = 2014 | doi = 10.1097/PAS.0000000000000221 | PMID = 24805856 }}</ref> 23% +ve in another series.<ref name=pmid23361281>{{Cite journal | last1 = Sipayya | first1 = V. | last2 = Sharma | first2 = I. | last3 = Sharma | first3 = KC. | last4 = Singh | first4 = A. | title = Immunohistochemical expression of IDH1 in gliomas: a tissue microarray-based approach. | journal = J Cancer Res Ther | volume = 8 | issue = 4 | pages = 598-601 | month = | year = | doi = 10.4103/0973-1482.106567 | PMID = 23361281 }}</ref> | ||
*ATRX +ve. | |||
**Useful for differentiating ''astrocytoma'' vs. ''oligodendroglioma''.<ref>{{Cite journal | last1 = Reuss | first1 = DE. | last2 = Sahm | first2 = F. | last3 = Schrimpf | first3 = D. | last4 = Wiestler | first4 = B. | last5 = Capper | first5 = D. | last6 = Koelsche | first6 = C. | last7 = Schweizer | first7 = L. | last8 = Korshunov | first8 = A. | last9 = Jones | first9 = DT. | title = ATRX and IDH1-R132H immunohistochemistry with subsequent copy number analysis and IDH sequencing as a basis for an "integrated" diagnostic approach for adult astrocytoma, oligodendroglioma and glioblastoma. | journal = Acta Neuropathol | volume = 129 | issue = 1 | pages = 133-46 | month = Jan | year = 2015 | doi = 10.1007/s00401-014-1370-3 | PMID = 25427834 }}</ref> | |||
*p53 -ve. | *p53 -ve. | ||
* | *Ki-67 (usu. >5% in grade II). | ||
* | *May have neuronal "islands" (Synapto +ve, NeuN +ve). | ||
==Molecular pathology== | ==Molecular pathology== | ||
Combined losses of 1p and 19q both helps with diagnosis and is prognostic and therapeutic relevant:<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><ref>{{Cite journal | last1 = Wiestler | first1 = B. | last2 = Capper | first2 = D. | last3 = Hovestadt | first3 = V. | last4 = Sill | first4 = M. | last5 = Jones | first5 = DT. | last6 = Hartmann | first6 = C. | last7 = Felsberg | first7 = J. | last8 = Platten | first8 = M. | last9 = Feiden | first9 = W. | title = Assessing CpG island methylator phenotype, 1p/19q codeletion, and MGMT promoter methylation from epigenome-wide data in the biomarker cohort of the NOA-04 trial. | journal = Neuro Oncol | volume = 16 | issue = 12 | pages = 1630-8 | month = Dec | year = 2014 | doi = 10.1093/neuonc/nou138 | PMID = 25028501 }}</ref><ref>{{Cite journal | last1 = Cairncross | first1 = G. | last2 = Wang | first2 = M. | last3 = Shaw | first3 = E. | last4 = Jenkins | first4 = R. | last5 = Brachman | first5 = D. | last6 = Buckner | first6 = J. | last7 = Fink | first7 = K. | last8 = Souhami | first8 = L. | last9 = Laperriere | first9 = N. | title = Phase III trial of chemoradiotherapy for anaplastic oligodendroglioma: long-term results of RTOG 9402. | journal = J Clin Oncol | volume = 31 | issue = 3 | pages = 337-43 | month = Jan | year = 2013 | doi = 10.1200/JCO.2012.43.2674 | PMID = 23071247 }}</ref> | |||
*Greater chemosensitivity | *Greater chemosensitivity | ||
*Better prognosis. | *Better prognosis. | ||
Note: | |||
*Consider underdiagnosed Glioblastoma, when tumor is IDH1/2 wildtype and has no LOH 1p/19q and/or ATRX loss. | |||
**It is very likely in the future, that non-codeleted tumors are no longer classified as oligodendrogliomas on molecular basis. | |||
==See also== | ==See also== | ||