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Case 3

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

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  1. 2010년 10월 가을학술대회 신경병리 연구회 Case 3 울산대학교 의과대학 서울아산병원 병리과 김선아

  2. Clinical history • 65/M • Personality change, headache, gait disturbance for one month • Admitted for seizure with loss of consciousness

  3. Summary of histology • Oligodendroglioma, anaplastic • Suspicious astrocytoma component • Dysplastic ganglion cells

  4. Synaptophysin • Anaplasticoligoastrocytoma • Ganlgioglioma

  5. Synaptophysin

  6. Synaptophysin Anaplasticoligoastrocytoma Ganlgioglioma

  7. Neu N Anaplasticoligoastrocytoma Ganlgioglioma Adjacent normal brain

  8. Ki-67 Anaplasticoligoastrocytoma Ganlgioglioma

  9. GFAP Analplasticoligoastrocytoma Ganlgioglioma

  10. 1p19q deletion - Chromosome 1p/19q is stable: 1p (0/2) & 19q (0/2) D1S508 D19S412 D1S186 D1S2734 D19S219 ----------------------------------------------------------- No NoNo N/A No ----------------------------------------------------------- The LOH patterns were identical between oligoastrocytoma component and ganglioglioma component

  11. Oral mucosa Ganglioglioma Anaplasticoligoastro-cytoma Oral mucosa Ganglioglioma Anaplasticoligoastro-cytoma

  12. What do we call this tumor? • Anaplasticoligoastrocytoma with ganglioglioma-like maturation • Ganglioglioma with anaplasticoligoastrocytic component • Composite tumor of anaplasticoligoastocytoma and ganglioglioma

  13. 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

  14. Anaplasticganglioglioma • Glioal component of ganglioglioma may resemble fibrillaryastrocytoma, oligodendroglioma or pilocyticastrocytoma • Malignant change almost invariably involves the glial component

  15. Synaptophysin Neurofilament

  16. 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)

  17. Deletion of 1p and/or 19q • 80~90% of oligodendroglioma • Less frequently in anaplasticoligodendroglioma • 30~40% of oligoastrocytoma

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