Oligodendroglioma anaplásico quístico: reporte de caso / Anaplastic cystic oligodendroglioma: case report

Resumen: Los oligodendrogliomas anaplásicos son gliomas infiltrantes grado III de la organización mundial de la salud (OMS). Son tumores poco frecuentes y representan el 5-10% de todas las neoplasias intracraneales primarias. Su incidencia es de 0.3 por 100.000 habitantes por año en Estados Unidos. Con frecuencia se presentan en adultos entre los 40-60 años de edad. Los síntomas principales pueden ser déficit motor, déficit cognitivos y síntomas de aumento de la presión intracraneal. Su comportamiento en resonancia magnética muestra un aspecto heterogéneo con necrosis, degeneración quística y hemorragia intratumoral. Las presentaciones quísticas extensas son poco frecuentes. Reportamos el caso de un oligodendroglioma anaplásico de aspecto predominantemente quístico en una mujer joven.

Abstract: Anaplastic oligodendrogliomas are grade III infiltrating gliomas of the World Health Organization (WHO). They are rare tumors and represent 5-10% of all primary intracranial neoplasms. Its incidence is 0.3 per 100.000 inhabitants per year in the United States. They often occur in adults between 40-60 years of age. The main symptoms may be motor deficit, cognitive deficits and symptoms of increased intracranial pressure. Its behavior in MRI shows a heterogeneous appearance with necrosis, cystic degeneration and intratumoral hemorrhagic. Extensive cystic presentations are rare. We report the case of an anaplastic oligodendroglioma of predominantly cystic appearance in a young woman.

Superior Sagittal Sinus Invasion by Malignant Glioma: Case Report and Literature Review

Anaplastic oligodendrogliomas (AOs) correspond to 23% of all oligodendrogliomas. They correspond to a tumor with malignant histological characteristics, focal or diffuse, associated with a worse prognosis. In the present case report, we describe the case of a 30-year-old female submitted to resection of a right parietal lesion whose histology showed to be an AO. She underwent complementary treatment with chemotherapy and radiotherapy according to the Roger Stupp protocol. Four years after the initial diagnosis, there was tumor recurrence within the superior sagittal sinus, with no evidence of recurrence elsewhere. In the literature, we have found no similar published case reinforcing the rarity of this condition.

Temozolomide Salvage Chemotherapy for Recurrent Anaplastic Oligodendroglioma and Oligo-Astrocytoma

OBJECTIVE: To evaluate the efficacy of temozolomide (TMZ) chemotherapy for recurrent anaplastic oligodendroglioma (AO) and anaplastic oligoastrocytoma (AOA). METHODS: A multi-center retrospective trial enrolled seventy-two patients with histologically proven AO/AOA who underwent TMZ chemotherapy for their recurrent tumors from 2006 to 2010. TMZ was administered orally (150 to 200 mg/m2/day) for 5 days per 28 days until unacceptable toxicity occurred or tumor progression was observed. RESULTS: TMZ chemotherapy cycles administered was median 5.3 (range, 1-41). The objective response rate was 24% including 8 cases (11%) of complete response and another 23 patients (32%) were remained as stable disease. Severe side effects (> or =grade 3) occurred only in 9 patients (13%). Progression-free survival (PFS) of all patients was a median 8.0 months (95% confidence interval, 6.0-10.0). The time to recurrence of a year or after was a favorable prognostic factor for PFS (p<0.05). Overall survival (OS) was apparently differed by the patient's histology, as AOA patients survived a median OS of 18.0 months while AO patients did not reach median OS at median follow-up of 11.5 months (range 2.7-65 months). Good performance status of Eastern Cooperative Oncology Group 0 and 1 showed prolonged OS (p<0.01). CONCLUSION: For recurrent AO/AOA after surgery followed by radiation therapy, TMZ could be recommended as a salvage therapy at the estimated efficacy equal to procarbazine, lomustine, and vincristine (PCV) chemotherapy at first relapse. For patients previously treated with PCV, TMZ is a favorable therapeutic option as 2nd line salvage chemotherapy with an acceptable toxicity rate.

Gliosarcoma with Components of Anaplastic Oligodendroglioma and Unclassifiable Spindle Cells: A Case Report

Gliosarcoma is a distinct disease entity that is characterized by a biphasic tissue pattern with alternating areas displaying glial and mesenchymal differentiation. The tumor in our case was a rare morphologic variant of gliosarcoma with components of anaplastic oligodendroglioma and unclassifiable spindle cells. Spindle cells showed CD34 and S-100 protein immunoreactivity, which was possibly related to peripheral nerve sheath differentiation. This unique feature has not been described previously and so this case expands the spectrum of possible divergent mesenchymal differentiation, and it lends support to pluripotential stem cells being the origin of this tumor.

Cerebellar Anaplastic Oligodendroglioma Presenting with Hemorrhage

The authors describe an anaplastic oligodendroglioma of the cerebellum which is distinctly uncommon. The patient presented with sudden onset of decreased consciousness associated with hemorrhage in the cerebellum, which appeared to origin from a vascular malformation or a tumor on a initial computed tomography (CT) scan. Subsequent magnetic resonance (MR) imaging suggested a high grade glioma with abundant vascularity in the right cerebellum. The histological examination revealed the findings compatible with those of an anaplastic oligodendroglioma. A complicated clinical course had led him to a poor outcome.

A Clinical Analysis of Anaplastic Oligodendroglioma

OBJECTIVE: The author evaluate the efficacy of surgery, radiation therapy and chemotherapy as a treatment methods for anaplastic oligodendroglioma patients to provide the standardized treatment option. METHODS: A retrospective analysis of ten pathologically proven cases of anaplastic oligodendroglioma was performed. RESULTS: The ten patients comprised four males and six females. The mean age at diagnosis was 34.4 year (8-70). The mean follow-up was 40.5 months, and two patients died of tumor progression during the follow-up (70, 86 months, respectively). All patients had craniotomy and the tumors were removed as much as possible. The tumos were resected totally in five cases, only subtotally in the rest. Radiation therapy was applied to seven patients, and PCV (procarbazine-CCNU-vincristine) based chemotherapeutic agent was administered to five patients. In the group with PCV therapy, complete remission was observed in two, partial remission was in one, stable disease in one, and disease progression in one who were died of tumor extension. During the follow-up, tumor recurrences were observed in four patients, and they were treated with additional operation and/or chemotherapy. CONCLUSION: Anaplastic oligodendrogliomas respond to the surgical and radiological treatment and especially to the chemotherapy, and have a relatively good prognosis. PCV is an effective and safe regimen for suppressing tumor growth, and is feasible for recurrent cases. PCV chemotherapy should be considered for primary treatment method for anaplastic oligodendroglioma patients.

A Rupture of Distal Anterior Cerebral Artery Aneurysm Invaded by Anaplastic Oligodendroglioma

The authors report a very unusual case of ruptured aneurysm by direct vessel invasion of anaplastic oligodendroglioma (WHO grade III) confirmed by histopathological examinations. As local invasion is the hallmark of malignant gliomas, malignant glial tumors invade neighboring structure and often cause microscopic endothelial proliferation, telangiectasias in small arteriols, but direct arterial invasion by glioma is very rare. Possible mechanisms of intracranial aneurysm development by glioma are thought to be related to the close proximity to the tumor, perivascular basement membrane breakage due to high tumor pressure and increased regional blood flow through the feeding artery of tumor. The aneurysm and tumor were treated in a single operation simultaneously.

The Effect of Intraventricular Methotrexate in a Patient of Disseminated Anaplastic Oligodendroglioma: Case Report

Oligodendrogiomas account for about 4 per cent of intracranial gliomas and surgery is known to be an essential first step to establish an accurate diagnosis and when oligodendrogliomas recur with or without anaplastic features after initial resection, radiation and chemotherapy consisting of the administration of procarbazine, lomustine, and vincristine are usually indicated. We report our experience of an excellent result with intraventricular methotrexate chemotherapy for a patient with disseminated anaplastic oligodendroglioma. A 29-year-old male patient presented with diplopia and headache for two months. MRI showed a irregular, faintly enhanced mass in the posterior fossa. The hisotological diagnosis was an anaplaplastic oligodendroglioma and he was treated with chemotherapy of PCV regimen and radiotherapy followed by surgery. CSF dissemination was revealed by a follow-up MRI during the period. Intraventricular methotrexate(0.175mg/kg) was given twice a week for 4 weeks through ommaya reservoir and the size of the multiple tumors was decreased significantly on follow-up MRI. This case report suggests that an aggressive treatment involving intravent-ricular chemotherapy may be helpful even when anaplastic oligodendrogliomas disseminates to leptomeninges.