Case 3

1. Case 3 Neuropathology Please direct any questions regarding this case to Dr. Syed A. Jaffar Kazmi, M.D.

2. University of Nebraska Medical Center History of Present Illness 68 yr old female presented to ED after having seizure and found to have a new left frontal mass. Hx of Grade IV follicular lymphoma. MRI shows a left frontal lobe non-enhancing tumor with associated edema and small focus of calcification. Patient underwent surgery for resection of tumor.

3. University of Nebraska Medical Center Histology Perineuronal Satellitosis Microcysts Microcalcifications Chicken wire vasculature Perinuclear halos (fried egg) Round nuclei and uniform cell density Nuclei have delicate chromatin, and small nucleoli Low proliferation index

4. University of Nebraska Medical Center Diagnosis OligodendrogliomaWHO Grade II

5. University of Nebraska Medical Center Oligodendroglioma, WHO Grade II ODG accounts for 10%-15% of all gliomas Mainly affecting adults Commonly presented by seizures Cerebral hemispheres are most common site Radiology MRI: T2 – bright with variable mass effect w or w/o calcification Histology Perinuclear halos, Minigemistocyte, Microcysts, Calcification, Prominent vasculature (chicken wire), Secondary structure of Scher (Perineuronal Satellitosis, Perivascular & Subpial accumulation) Uniform cell density with round nuclei with delicate chromatin, and small nucleoli Few mitoses, no necrosis or vascular endothelial proliferation

6. University of Nebraska Medical Center Oligodendroglioma, WHO Grade II • Mol • 1p36 and 19q13 co-deletions, IDH1 mutation • Treatment • Surgical resection with observation, radiation, • and chemotherapy, depending upon clinical • status

7. University of Nebraska Medical Center University of Nebraska Medical Center