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2010 년 10 월 가을학술대회 신경병리 연구회. Case 3. 울산대학교 의과대학 서울아산병원 병리과 김선아. Clinical history. 65/M Personality change, headache, gait disturbance for one month Admitted for seizure with loss of consciousness. Summary of histology. Oligodendroglioma , anaplastic Suspicious astrocytoma component

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case 3

2010년 10월 가을학술대회 신경병리 연구회

Case 3

울산대학교 의과대학

서울아산병원 병리과

김선아

clinical history
Clinical history
  • 65/M
  • Personality change, headache, gait disturbance for one month
  • Admitted for seizure with loss of consciousness
summary of histology
Summary of histology
  • Oligodendroglioma, anaplastic
  • Suspicious astrocytoma component
  • Dysplastic ganglion cells
slide21

Synaptophysin

  • Anaplasticoligoastrocytoma
  • Ganlgioglioma
slide23

Synaptophysin

Anaplasticoligoastrocytoma

Ganlgioglioma

slide24

Neu N

Anaplasticoligoastrocytoma

Ganlgioglioma

Adjacent normal brain

slide25

Ki-67

Anaplasticoligoastrocytoma

Ganlgioglioma

slide26

GFAP

Analplasticoligoastrocytoma

Ganlgioglioma

1p19q deletion
1p19q deletion

- Chromosome 1p/19q is stable: 1p (0/2) & 19q (0/2)

D1S508 D19S412 D1S186 D1S2734 D19S219

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No NoNo N/A No

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The LOH patterns were identical between oligoastrocytoma component and ganglioglioma component

slide28

Oral mucosa

Ganglioglioma

Anaplasticoligoastro-cytoma

Oral mucosa

Ganglioglioma

Anaplasticoligoastro-cytoma

what do we call this tumor
What do we call this tumor?
  • Anaplasticoligoastrocytoma with ganglioglioma-like maturation
  • Ganglioglioma with anaplasticoligoastrocytic component
  • Composite tumor of anaplasticoligoastocytoma and ganglioglioma
oligodendroglioma with neurocytic differentiation
Oligodendroglioma with neurocytic differentiation
  • Oligodendroglioma may contain neoplastic cells that express synaptophysin and/or neurofilatments

(Vajtai et al. Oligodendroglioma with neurocytic differentiation and characteristic loss of heterozygosity on chromosomes 1p and 19q, Acta Neuropathol (2005) 110: 520–522)

  • Neurocytic differentiation has also been demonstrated by ultrastructural level

(Vyberg et al. Neuronal features of oligodendrogliomas—an ultrastructural and immunohistochemical study, Histopathology 2007, 50, 887–896)

  • The neuronal phenotype is usually not evident by routine histology alone
anaplastic ganglioglioma
Anaplasticganglioglioma
  • Glioal component of ganglioglioma may resemble fibrillaryastrocytoma, oligodendroglioma or pilocyticastrocytoma
  • Malignant change almost invariably involves the glial component
slide35

Synaptophysin

Neurofilament

differences from ganglioglioma
Differences from ganglioglioma
  • No eosinophilic granular body
  • No CD34-positive cells
  • Less prominent perivascular lymphocytic infiltration
  • Older age (median 44y)
  • No history of chronic seizure disorder
  • Neuroimaging : characteristic findings of diffuse gliomas in three cases (infiltrative growth, significant mass effect, involvement of corpus callosum)
deletion of 1p and or 19q
Deletion of 1p and/or 19q
  • 80~90% of oligodendroglioma
  • Less frequently in anaplasticoligodendroglioma
  • 30~40% of oligoastrocytoma