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{{ Infobox diagnosis
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:'''Not''' to be confused with ''[[ganglioneuroma]]''.
Ganglioglioma is a epilepsy-associated glioneuronal tumour with benign course. '''Not''' to be confused with ''[[ganglioneuroma]]''.
 
====General====
====General====
*Gangliolioma: Grade I WHO mixed neuronal-glial tumour (ICD-O code: 9505/1).
*Gangliolioma: Grade I WHO mixed neuronal-glial tumour (ICD-O code: 9505/1).
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*Recognized as a cause of [[epilepsy]].<ref name=pmid12125968>{{Cite journal  | last1 = Im | first1 = SH. | last2 = Chung | first2 = CK. | last3 = Cho | first3 = BK. | last4 = Lee | first4 = SK. | title = Supratentorial ganglioglioma and epilepsy: postoperative seizure outcome. | journal = J Neurooncol | volume = 57 | issue = 1 | pages = 59-66 | month = Mar | year = 2002 | doi =  | PMID = 12125968 }}</ref>
*Recognized as a cause of [[epilepsy]].<ref name=pmid12125968>{{Cite journal  | last1 = Im | first1 = SH. | last2 = Chung | first2 = CK. | last3 = Cho | first3 = BK. | last4 = Lee | first4 = SK. | title = Supratentorial ganglioglioma and epilepsy: postoperative seizure outcome. | journal = J Neurooncol | volume = 57 | issue = 1 | pages = 59-66 | month = Mar | year = 2002 | doi =  | PMID = 12125968 }}</ref>
*Favourable prognosis (survival rates up to 97%)
*Favourable prognosis (survival rates up to 97%)
**Insufficient data für anaplastic ganglioglioma.
**Anaplastic ganglioglioma have a recurrence risk of 69%-100% and median OS: 27months<ref>{{Cite journal  | last1 = Terrier | first1 = LM. | last2 = Bauchet | first2 = L. | last3 = Rigau | first3 = V. | last4 = Amelot | first4 = A. | last5 = Zouaoui | first5 = S. | last6 = Filipiak | first6 = I. | last7 = Caille | first7 = A. | last8 = Almairac | first8 = F. | last9 = Aubriot-Lorton | first9 = MH. | title = Natural course and prognosis of anaplastic gangliogliomas: a multicenter retrospective study of 43 cases from the French Brain Tumor Database. | journal = Neuro Oncol | volume = 19 | issue = 5 | pages = 678-688 | month = 05 | year = 2017 | doi = 10.1093/neuonc/now186 | PMID = 28453747 }}</ref><ref>{{Cite journal  | last1 = Zanello | first1 = M. | last2 = Pages | first2 = M. | last3 = Tauziède-Espariat | first3 = A. | last4 = Saffroy | first4 = R. | last5 = Puget | first5 = S. | last6 = Lacroix | first6 = L. | last7 = Dezamis | first7 = E. | last8 = Devaux | first8 = B. | last9 = Chrétien | first9 = F. | title = Clinical, Imaging, Histopathological and Molecular Characterization of Anaplastic Ganglioglioma. | journal = J Neuropathol Exp Neurol | volume = 75 | issue = 10 | pages = 971-980 | month = Oct | year = 2016 | doi = 10.1093/jnen/nlw074 | PMID = 27539475 }}</ref>
 
 


==Imaging==
==Imaging==
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*Strong CM enhancement.
*Strong CM enhancement.
*May contain cysts.
*May contain cysts.
*Associated with midline structures.
*Associated with temporal lobe.


==Gross==
==Gross==
Features:<ref name=Ref_PSNP82>{{Ref PSNP|82}}</ref>
*Circumscribed lesion.
*Usually well-circumscribed, soft.
*Usu. contrast enhancing.
*Can be cystic with mural nodule.
*Solid, but intracortical cysts may be present.
*Optic gliomas may present as fusiform mass.
*Little mass effect.
*Occ. calcium deposits and hemosiderin.


==Microscopic==
==Microscopic==
Features:<ref name=Ref_PSNP82-4>{{Ref PSNP|82-4}}</ref>
*Classically biphasic (though either may be absent):
*#Fibrillar.
*#Microcystic/loose.
*Hair-like fibres ~ 1 micrometer; ''pilo-'' = hair.<ref>URL: [http://dictionary.reference.com/browse/pilo- http://dictionary.reference.com/browse/pilo-]. Accessed on: 24 November 2010.</ref>
**Best seen on smear or with GFAP [[IHC]].
*Rosenthal fibres - '''key feature'''.
**May be rare.  Not pathognomonic (see below).
*Eosinophilic granular bodies.
*Low cellularity - when compared to medulloblastoma and ependymoma.


Notes:  
====Microscopic====
*+/-Microvascular proliferation.
Features:
*+/-Focal necrosis.
*Dysplastic neurons.
**Necrosis with pseudopalisading more likely glioblastoma.
**Out of regular architecture / heterotopic location.
*+/-Mitoses - not significant in the context of the Dx.
**Cytomegaly
**Abnormal clustering
**Binucleated (very occassionally).
**Perimembranous Nissl aggreation.
*Atypical glia (ie neoplastic).
*Eosinophilic granular bodies (more common than rosenthal fibers).
*Dystrophic calcification.
*Prominent capillary network.
*Lymphocytic cuffing.
*May contain some reticulin.  
*Glial component may resemble:
**Fibrillary astrocytoma.
**Oligodendroglioma.
**Pilocytic astrocytoma.


DDx (of Rosenthal fibers):<ref>Munoz D. 9 Mar 2009.</ref>
Anaplastic ganglioglioma:
*Chronic reactive gliosis.
*Brisk mitotic activity
*Subependymoma.
*Necrosis
*Pilocytic astrocytoma.
*Ganglioglioma.


DDx of pilocystic astrocytoma (brief):
====IHC====
*Piloid gliosis (esp. in sellar lesions).
*Neurons:
*[[Oligodendroglioma]].
**[[MAP2]] +ve
*[[Glioblastoma]] (uncommon - but important).
**Synaptophysin +ve
*Tanycytic [[Ependymoma]]
***Perikaryal surface immunoreactivity for synaptophysin.<ref name="pmid8246055">{{cite journal |authors=Lang FF, Epstein FJ, Ransohoff J, Allen JC, Wisoff J, Abbott IR, Miller DC |title=Central nervous system gangliogliomas. Part 2: Clinical outcome |journal=J. Neurosurg. |volume=79 |issue=6 |pages=867–73 |date=December 1993 |pmid=8246055 |doi=10.3171/jns.1993.79.6.0867 |url=}}</ref>
*Pilocytic tumor components may be found in [[Ganglioglioma]], [[DNET]], [[RGNT]]
***This is however also seen in reactive changes.<ref name="pmid9591724">{{cite journal |authors=Quinn B |title=Synaptophysin staining in normal brain: importance for diagnosis of ganglioglioma |journal=Am. J. Surg. Pathol. |volume=22 |issue=5 |pages=550–6 |date=May 1998 |pmid=9591724 |doi=10.1097/00000478-199805000-00005 |url=}}</ref>
** Neurofilament +ve
** Chromogranin +ve
*Glia:
**CD34+/-ve
*BRAF V600E +ve (approx. 25%, mainly ganglion cells).
*MAP2: usu. absent.
*MIB-1 (low, but resembles proliferative tumor component).
 
====Molecular====
*BRAF V600E-mutated(approx. 25%).<ref>{{Cite journal  | last1 = Schindler | first1 = G. | last2 = Capper | first2 = D. | last3 = Meyer | first3 = J. | last4 = Janzarik | first4 = W. | last5 = Omran | first5 = H. | last6 = Herold-Mende | first6 = C. | last7 = Schmieder | first7 = K. | last8 = Wesseling | first8 = P. | last9 = Mawrin | first9 = C. | title = Analysis of BRAF V600E mutation in 1,320 nervous system tumors reveals high mutation frequencies in pleomorphic xanthoastrocytoma, ganglioglioma and extra-cerebellar pilocytic astrocytoma. | journal = Acta Neuropathol | volume = 121 | issue = 3 | pages = 397-405 | month = Mar | year = 2011 | doi = 10.1007/s00401-011-0802-6 | PMID = 21274720 }}</ref>
**BRAF V600E antibody stains especially neuronal cells.<ref>{{Cite journal  | last1 = Koelsche | first1 = C. | last2 = Wöhrer | first2 = A. | last3 = Jeibmann | first3 = A. | last4 = Schittenhelm | first4 = J. | last5 = Schindler | first5 = G. | last6 = Preusser | first6 = M. | last7 = Lasitschka | first7 = F. | last8 = von Deimling | first8 = A. | last9 = Capper | first9 = D. | title = Mutant BRAF V600E protein in ganglioglioma is predominantly expressed by neuronal tumor cells. | journal = Acta Neuropathol | volume = 125 | issue = 6 | pages = 891-900 | month = Jun | year = 2013 | doi = 10.1007/s00401-013-1100-2 | PMID = 23435618 }}</ref>
*IDH1/2 wt.
*No 1p/19q codeletion.
*Usu. Chr. 7 gain.
*Rare cases with KIAA1459-BRAF fusion.<ref>{{Cite journal  | last1 = Pekmezci | first1 = M. | last2 = Villanueva-Meyer | first2 = JE. | last3 = Goode | first3 = B. | last4 = Van Ziffle | first4 = J. | last5 = Onodera | first5 = C. | last6 = Grenert | first6 = JP. | last7 = Bastian | first7 = BC. | last8 = Chamyan | first8 = G. | last9 = Maher | first9 = OM. | title = The genetic landscape of ganglioglioma. | journal = Acta Neuropathol Commun | volume = 6 | issue = 1 | pages = 47 | month = 06 | year = 2018 | doi = 10.1186/s40478-018-0551-z | PMID = 29880043 }}</ref>
** DDx: consider pilocytic astrocytoma with ganglioglioma component. <ref>{{Cite journal  | last1 = Mesturoux | first1 = L. | last2 = Durand | first2 = K. | last3 = Pommepuy | first3 = I. | last4 = Robert | first4 = S. | last5 = Caire | first5 = F. | last6 = Labrousse | first6 = F. | title = Molecular Analysis of Tumor Cell Components in Pilocytic Astrocytomas, Gangliogliomas, and Oligodendrogliomas. | journal = Appl Immunohistochem Mol Morphol | volume = 24 | issue = 7 | pages = 496-500 | month = Aug | year = 2016 | doi = 10.1097/PAI.0000000000000288 | PMID = 27389560 }}</ref>
*CDKN2A deletions, ATRX loss and TERT promotor mutations in anaplastic ganglioglioma.<ref>{{Cite journal  | last1 = Zanello | first1 = M. | last2 = Pages | first2 = M. | last3 = Tauziède-Espariat | first3 = A. | last4 = Saffroy | first4 = R. | last5 = Puget | first5 = S. | last6 = Lacroix | first6 = L. | last7 = Dezamis | first7 = E. | last8 = Devaux | first8 = B. | last9 = Chrétien | first9 = F. | title = Clinical, Imaging, Histopathological and Molecular Characterization of Anaplastic Ganglioglioma. | journal = J Neuropathol Exp Neurol | volume = 75 | issue = 10 | pages = 971-980 | month = Oct | year = 2016 | doi = 10.1093/jnen/nlw074 | PMID = 27539475 }}</ref>
**DD: consider anaplastic astrocytoma with piloid features (similiar molecular profile).<ref>{{Cite journal  | last1 = Reinhardt | first1 = A. | last2 = Stichel | first2 = D. | last3 = Schrimpf | first3 = D. | last4 = Sahm | first4 = F. | last5 = Korshunov | first5 = A. | last6 = Reuss | first6 = DE. | last7 = Koelsche | first7 = C. | last8 = Huang | first8 = K. | last9 = Wefers | first9 = AK. | title = Anaplastic astrocytoma with piloid features, a novel molecular class of IDH wildtype glioma with recurrent MAPK pathway, CDKN2A/B and ATRX alterations. | journal = Acta Neuropathol | volume = 136 | issue = 2 | pages = 273-291 | month = Aug | year = 2018 | doi = 10.1007/s00401-018-1837-8 | PMID = 29564591 }}
</ref>
*H3F3A wildtype.
**DDx: consider [[Diffuse hemispheric glioma, H3 G34-mutant]] (rare cases may contain dysplastic ganglion cells).<ref>{{Cite journal  | last1 = Andreiuolo | first1 = F. | last2 = Lisner | first2 = T. | last3 = Zlocha | first3 = J. | last4 = Kramm | first4 = C. | last5 = Koch | first5 = A. | last6 = Bison | first6 = B. | last7 = Gareton | first7 = A. | last8 = Zanello | first8 = M. | last9 = Waha | first9 = A. | title = H3F3A-G34R mutant high grade neuroepithelial neoplasms with glial and dysplastic ganglion cell components. | journal = Acta Neuropathol Commun | volume = 7 | issue = 1 | pages = 78 | month = May | year = 2019 | doi = 10.1186/s40478-019-0731-5 | PMID = 31109382 }}</ref>
*Rare cases with co-occurrence of K27M mutation.<ref>{{Cite journal  | last1 = Pagès | first1 = M. | last2 = Beccaria | first2 = K. | last3 = Boddaert | first3 = N. | last4 = Saffroy | first4 = R. | last5 = Besnard | first5 = A. | last6 = Castel | first6 = D. | last7 = Fina | first7 = F. | last8 = Barets | first8 = D. | last9 = Barret | first9 = E. | title = Co-occurrence of histone H3 K27M and BRAF V600E mutations in paediatric midline grade I ganglioglioma. | journal = Brain Pathol | volume =  | issue =  | pages =  | month = Dec | year = 2016 | doi = 10.1111/bpa.12473 | PMID = 27984673 }}</ref>


===Images===  
===Images===  
====Smears====
 
<gallery>
<gallery>
File:Ganglioglioma lymphocytic cuffing PAS.jpg | Lymphocytic cuffing in ganglioglioma (WC/jensflorian)
File:Ganglioglioma lymphocytic cuffing PAS.jpg | Lymphocytic cuffing in ganglioglioma (WC/jensflorian)
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File:Anaplastic ganglioglioma HE.jpg | Pleomorphic ganglion cells in ganglioglioma (WC/jensflorian)
File:Anaplastic ganglioglioma HE.jpg | Pleomorphic ganglion cells in ganglioglioma (WC/jensflorian)
</gallery>
</gallery>
====Sections====
<gallery>
Image:Rosenthal_HE_40x.jpg | Rosenthal fibres. (WC)
Image:Pilocytic astrocytoma cell pleomorphism.jpg | Occasional pleomorphism. (WC)
Image:Pilocytic astrocytoma endothelial proliferations.jpg | Microvascular proliferation. (WC)
</gallery>
www:
*[http://moon.ouhsc.edu/kfung/jty1/neurotest/Q19-Ans.htm Rosenthal fibre (ouhsc.edu)].
*[http://path.upmc.edu/cases/case162.html Pilocytic astrocytoma (upmc.edu)].
*[http://path.upmc.edu/cases/case90.html Pilocytic astrocytoma - another case (upmc.edu)].
*[http://path.upmc.edu/cases/case195/images/figure3b.jpg Pilocytic astrocytoma - pennies on a plate (upmc.edu)].<ref>URL: [http://path.upmc.edu/cases/case195.html http://path.upmc.edu/cases/case195.html]. Accessed on: 8 January 2012.</ref>
*[http://path.upmc.edu/cases/case397.html Pilocytic astrocytoma (upmc.edu)].


==Stains==
==Prognosis==
*PAS-D: eosinophilic granular bodies +ve.
*Very good (10-year OS: 97%)
*Primary treatment: surgery.
**Seizure free outcome: 81%.
**Incomplete resection as major factor for persisting epilepsia.<ref>{{Cite journal  | last1 = Devaux | first1 = B. | last2 = Chassoux | first2 = F. | last3 = Landré | first3 = E. | last4 = Turak | first4 = B. | last5 = Laurent | first5 = A. | last6 = Zanello | first6 = M. | last7 = Mellerio | first7 = C. | last8 = Varlet | first8 = P. | title = Surgery for dysembryoplastic neuroepithelial tumors and gangliogliomas in eloquent areas. Functional results and seizure control. | journal = Neurochirurgie | volume = 63 | issue = 3 | pages = 227-234 | month = Jun | year = 2017 | doi = 10.1016/j.neuchi.2016.10.009 | PMID = 28506485 }}</ref>


==IHC==
====DDx:====
Features:<ref name=Ref_PSNP84>{{Ref PSNP|84}}</ref>
*[[DNT]].
*GFAP +ve (fibres).
*[[Oligodendroglioma]].
*CD68: may have a significant macrophage component.
*[[PXA]].
*KI-67: may be "high" (~20% ???).
*Desmoplastic infantile astrocytoma and ganglioglioma.
*Olig 2: Usually strongly present.<ref name=pmid21193945>{{Cite journal  | last1 = Otero | first1 = JJ. | last2 = Rowitch | first2 = D. | last3 = Vandenberg | first3 = S. | title = OLIG2 is differentially expressed in pediatric astrocytic and in ependymal neoplasms. | journal = J Neurooncol | volume = 104 | issue = 2 | pages = 423-38 | month = Sep | year = 2011 | doi = 10.1007/s11060-010-0509-x | PMID = 21193945 }}</ref>
*Cortical tuber.
*[[IDH1]] (R132H) -ve.
*Trapped cortical neurons in diffuse astrocytoma.
*[[H3F3A]] (K27M) -ve.
*Papillary glioneuronal tumor.
 
==Molecular==
* Almost all alteration associated with the MAPK pathway.<ref>{{Cite journal  | last1 = Collins | first1 = VP. | last2 = Jones | first2 = DT. | last3 = Giannini | first3 = C. | title = Pilocytic astrocytoma: pathology, molecular mechanisms and markers. | journal = Acta Neuropathol | volume = 129 | issue = 6 | pages = 775-88 | month = Jun | year = 2015 | doi = 10.1007/s00401-015-1410-7 | PMID = 25792358 }}</ref>
* KIAA1549-BRAF fusion transcripts most common in sporadic PA (up to 2/3 of all cases).
**DDx: Fusion reported in rare Diffuse Leptomeingeal Glioneuronal Tumors and Oligodendroglioma.
* Rarely BRAF, KRAS or FGFR1 mutations, NTRK2, SRGAP3-RAF1 or FAM131B-BRAF fusions.<ref>{{Cite journal  | last1 = Jones | first1 = DT. | last2 = Hutter | first2 = B. | last3 = Jäger | first3 = N. | last4 = Korshunov | first4 = A. | last5 = Kool | first5 = M. | last6 = Warnatz | first6 = HJ. | last7 = Zichner | first7 = T. | last8 = Lambert | first8 = SR. | last9 = Ryzhova | first9 = M. | title = Recurrent somatic alterations of FGFR1 and NTRK2 in pilocytic astrocytoma. | journal = Nat Genet | volume = 45 | issue = 8 | pages = 927-32 | month = Aug | year = 2013 | doi = 10.1038/ng.2682 | PMID = 23817572 }}</ref><ref>{{Cite journal  | last1 = Cin | first1 = H. | last2 = Meyer | first2 = C. | last3 = Herr | first3 = R. | last4 = Janzarik | first4 = WG. | last5 = Lambert | first5 = S. | last6 = Jones | first6 = DT. | last7 = Jacob | first7 = K. | last8 = Benner | first8 = A. | last9 = Witt | first9 = H. | title = Oncogenic FAM131B-BRAF fusion resulting from 7q34 deletion comprises an alternative mechanism of MAPK pathway activation in pilocytic astrocytoma. | journal = Acta Neuropathol | volume = 121 | issue = 6 | pages = 763-74 | month = Jun | year = 2011 | doi = 10.1007/s00401-011-0817-z | PMID = 21424530 }}</ref>
*Up to 15% of all [[NF1]] patients develop a PA ("optic glioma" as predilection).<ref>{{Cite journal  | last1 = Friedrich | first1 = RE. | last2 = Nuding | first2 = MA. | title = Optic Pathway Glioma and Cerebral Focal Abnormal Signal Intensity in Patients with Neurofibromatosis Type 1: Characteristics, Treatment Choices and Follow-up in 134 Affected Individuals and a Brief Review of the Literature. | journal = Anticancer Res | volume = 36 | issue = 8 | pages = 4095-121 | month = Aug | year = 2016 | doi =  | PMID = 27466519 }}</ref>
*Rare reports of PA in Noonan-Syndrome (PTPN11 mutation).<ref>{{Cite journal  | last1 = Jones | first1 = DT. | last2 = Hutter | first2 = B. | last3 = Jäger | first3 = N. | last4 = Korshunov | first4 = A. | last5 = Kool | first5 = M. | last6 = Warnatz | first6 = HJ. | last7 = Zichner | first7 = T. | last8 = Lambert | first8 = SR. | last9 = Ryzhova | first9 = M. | title = Recurrent somatic alterations of FGFR1 and NTRK2 in pilocytic astrocytoma. | journal = Nat Genet | volume = 45 | issue = 8 | pages = 927-32 | month = Aug | year = 2013 | doi = 10.1038/ng.2682 | PMID = 23817572 }}</ref>
 
==Prognosis==
*Excellent (10-year OS: 90%)
*In thalamic/chiasmatic region not so good (incomplete resection, often [[Pilomyxoid astrocytoma]]).
*Primary treatment: surgery. Incomplete resection: RT has to be considered.
**Chx is given in rare cases that are still progredient<ref>{{Cite journal  | last1 = Metts | first1 = RD. | last2 = Bartynski | first2 = W. | last3 = Welsh | first3 = CT. | last4 = Kinsman | first4 = S. | last5 = Bredlau | first5 = AL. | title = Bevacizumab Therapy for Pilomyxoid Astrocytoma. | journal = J Pediatr Hematol Oncol | volume =  | issue =  | pages =  | month = Mar | year = 2017 | doi = 10.1097/MPH.0000000000000824 | PMID = 28338567 }}</ref>


==See also==
==See also==
Jensflorian
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