ABSTRACT
Oligodendrogliomas are infiltrative tumors of the central nervous systemconsidered to be morphologically stable and to offer a better prognosis. Here, we describe the case of a 36- year-old man with an initial diagnosis of oligodendroglioma, World Health Organization (WHO) grade II, who presented transformation to a sarcomatous form, while maintaining the oligodendroglial component as well as the genetic characteristics of the initial tumor without having undergone any complementary treatments previously. Despite the favorable genetic characteristics, the tumor presented poor response to complementary treatments, and rapid progression, including spinal metastasis.
Subject(s)
Humans , Male , Adult , Oligodendroglioma/pathology , Oligodendroglioma/therapy , Oligodendroglioma/diagnostic imaging , Astrocytoma/rehabilitation , Sarcoma/complications , Prognosis , Brain Neoplasms/complications , Neoplasm Metastasis/diagnostic imagingABSTRACT
Many aspects of the management of low-grade gliomas have been controversial. Warren Mason reviews the new evidence addressing some of them in the article Advances in the management of low-grade gliomas, published in Can J. Neurol. Sci. 2005. This information should be specially useful for tailoring therapies to each particular situation. The presence of an oligodendroglial component and 1p and 19q deletions confers a better prognosis and better response rates to chemotherapy and radiotherapy. Delaying interventions in stable, asymptomatic patients does not seem to affect overall survival. More extensive resections are associated to longer and better quality survival. Early radiotherapy prolongs time to progression, but not overall survival as compared to delayed radiotherapy. The optimal dose is in the range between 45Gy and less than 59.4 Gy. Chemotherapy produces responses in most of these patients.
Subject(s)
Humans , Glioma/diagnosis , Glioma/therapy , Brain Neoplasms/therapy , Astrocytoma/therapy , Dacarbazine/therapeutic use , Oligodendroglioma/therapy , Radiotherapy/methodsABSTRACT
El estudio de los oligodendrogliomas ha generado gran interés en los últimos 15años, debido que se trata de tumores primarios del cerebro, que son quimiosensibles, a diferencia del resto de los gliomas característicamente quiimioresistentes. Los rápidos avances tecnológicos, permiten el estudio y una mejor comprensión de los cambioscromosómicos y las mutaciones de los ácidos desoxiribonucleicos, que llevan a la activación de los proto-oncógenos y a la perdida de la función de los genes supresores de tumor. Algunos cambioscomo las deleciones del brazo corto p del cromosoma 1 y del brazo largo q del cromosoma 19, y especialmente cuando se dan en forma simultanea, son considerados prácticamente específicospara el diagnóstico de oligodendroglioma. Esto ha permitido demostrar, que estos tumores son muchomas frecuentes que lo que se estimaba hace unos 10 años atrás, y que por lo tanto, el estudio genético molecular es un complemento diagnóstico fundamental al estudio histológico ehistoquimico convencional de este tipo de tumor, que como sabemos muchas veces no permite distinguirlode otros gliomas. Esta caracterización molecular de los gliomas, adquiere gran relevancia ya que permite diagnosticar un mayor número de oligodendrogliomas u otros gliomas con componente oligodendroglial que pueden ser tratados con quimioterapia.
The study of oligodendrogliomas has generated great interest in the last fifteen years, because it refers about primary tumors of the brain, that are quimiosensitive, opposed to the rest of the gliomas, that are characteristicaly quimiorresistent. The rapid advances in technology, allows the study and a better understanding of the chromosomalchanges and the deoxyribonucleic acid mutations, that lead to the activation of proto-oncogenes and loss of function of tumor suppresor genes. Some changes, like deletions in the short arm (p) of the chromosome 1, and the long arm (q) of the chromosome 19, specially when specially when they are simultaneous, are considered practicaly specific for thediagnosis of oligodendroglioma. This fact has lead us to demostrate, that this tumors are much more frequent,than considered 10 years ago, and that is why the genetic molecular study is an essencial complement to the conventional hystologycal and hystochemichal study of this kind of tumors, that as we know, many times, it not allow us to distinguish from othergliomas. This molecular characterization of gliomas, acquieres great relevance allowing to diagnose a greater numberof oligodendrogliomas or other gliomas with oligodendroglial component that can be treated whith quimiotherapy.
Subject(s)
Humans , Male , Female , Brain Neoplasms/genetics , Brain Neoplasms/therapy , Oligodendroglioma/genetics , Oligodendroglioma/therapyABSTRACT
Oligodendrogliomas correspondem a 4-5 por cento dos tumores primários do sistema nervoso central apresentando crescimento infiltrativo e lento. Relatamos os achados anatomopatológicos e clínicos de 15 casos de oligodendrogliomas. Oito pacientes eram do sexo masculino e 7 do feminino. As idade oscilaram entre 17 e 66 anos, apresentando média de 39,73 anos. A sintomatologia apresentada correspondeu ao crescimento expansivo, sendo cefaléia (60 por cento) e crises convulsivas (60 por cento) os sintomas mais frequentes. O lobo frontal (n=6) foi o sítio anatômico mais acometido, seguido pelo parietal (n=2), temporal (n=1) e occipital (n=1). Cinco pacientes foram submetidos a ressecção total do tumor e 10 pacientes a exerese parcial; dentre estes, 3 foram submetidos a radioterapia adjuvante, 1 a quimioterapia e 1 a quimio e radioterapia. Evidenciou-se taxa de recidiva tumoral total de 60 por cento em período médio de 32 meses de acompanhamento. Cinco recidivas tumorais ocorreram nos pacientes submetidos apenas ao tratamento cirúrgico e quatro nos pacientes submetidos a quimio ou radioterapia adjuvante. Estes achados aproximam-se dos encontrados na literatura, auxiliando na compreensão do comportamento biológico deste raro tumor cerebral.
Subject(s)
Adult , Middle Aged , Female , Humans , Adolescent , Brain Neoplasms/pathology , Oligodendroglioma/pathology , Age Distribution , Brain Neoplasms/epidemiology , Brain Neoplasms/therapy , Brazil/epidemiology , Central Nervous System Neoplasms/epidemiology , Central Nervous System Neoplasms/pathology , Neoplasm Recurrence, Local , Oligodendroglioma/epidemiology , Oligodendroglioma/therapyABSTRACT
Los oligodendrogliomas constituyen el 4.2% de los tumores cerebrales primarios y el 1-2% de los tumores intracraneanos en ninos. Se presenta un caso de oligodendroglioma del angulo pontocerebeloso derecho, que consulto por ataxia aguda y que posteriormente presento hipertension endocraneana. La poca frecuencia de estas lesiones y la localizacion inusual en la fosa posterior, motivo la revision de la bibliografia nacional e internacional referente al tema