Oligodendroglioma: imaging findings, radio-pathological correlation and evolution

Transcription

1 Oligodendroglioma: imaging findings, radio-pathological correlation and evolution Poster No.: C-2104 Congress: ECR 2013 Type: Authors: Keywords: DOI: Scientific Exhibit A. Hernandez Castro, M. D. Monedero Picazo, M. Escribano Talaya, D. Caldevilla Bernardo, R. Vera Berón, E. Lozano Setién; Albacete/ES Head and neck, CT, MR /ecr2013/C-2104 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 12

2 Purpose Analyze all the oligodendrogliomas diagnosed in our hospital since 2006 to 2010 and correlate with histologic findings and radiological images. Methods and Materials Oligodendrogliomas are brain tumors of glial origin involving around 7% of intracranial gliomas. Predominantly affect men with a ratio 2:1. Occurs around the sixth decade of life. The most common site of presentation is the frontal lobe followed the temporal lobe. the first clinical manifestations are seizures because in most instances the cortex is involved, headaches being the second most common manifestation. The histopathological classification distinguishes two degrees, well differentiated oligodendrogliomas (grade II) that are less aggressive and anaplastic oligodendrogliomas (grade III). There is also a less common variety of mixed tumors containing oligodendroglial and astrocytic elements are oligoastrocytomas. In TC oligodendrogliomas usually hypo or isodense in relation to the gray matter, while in the MRI appear as hypointense mass on T1 and hyperintense on T2. Frequently affect corticosubcortical region and sometimes have ill-defined margins. The presence of calcification is common (80-90%). may be cystic and hemorrhagic areas (20%) (Fig. 1). About 15 to 20% of the oligodendrogliomas have contrast enhancement and this uptake has been associated with high grade tumors (Figure 2), but high-grade tumors can be seen without contrast enhancement. Oligodendrogliomas must be treated by surgery, and chemo-radiotherapy could be added depending of the histological grade and the surgery success. they have a better prognosis than other tumors with the same histological grade, with an average survival of 17 to 20 years in low-grade tumors and 1 to 4 year in anaplastic tumors, who have also a higher risk of recurrence. This study reviewed all primary CNS neoplasms from 2004 to 2010 (226 cases), eleven cases were oligodendrogliomas with different histological grade. We analyzed: age at diagnosis, sex, location, clinical and imaging findings, in this case using CT and MRI. the presence of calcifications, intratumoral hemorrhage, cystic Page 2 of 12

3 degeneration, necrosis and postcontrast enhancement. All these data were correlated with the histological findings and the patients evolution (recurrence) from 2004 until now. Images for this section: Page 3 of 12

4 Page 4 of 12

5 Fig. 1: Figure 1. DIFFERENT STYLES of oligodendrogliomas in TC: A and B: CT with and without contrast of the same patient with an ill-defined hypodense mass left frontal cortico-subcortical without contrast capación or calcifications (it was a grade II oligodendroglioma). C and D: CT with and without contrast of the same patient with a hypodense mass with coarse calcifications affecting the right frontal subcortical white matter without contrast enhancement (it was a grade II oligodendroglioma). E and F: CT with and without contrast of an intraventricular tumor with gross calcifications and cystic areas important associated conditions contrast enhancement and obstructive hydrocephalus. We can also see that there is a small level bloody in occipital horn of the left lateral ventricle (it was a grade III oligodendroglioma). Page 5 of 12

6 Page 6 of 12

7 Fig. 2: FIGURE 2: RADIO-PATHOLOGYCAL DIFFERENCES BETWEEN LOW AND HIGH GRADE ODENDROGLIOMAS A: TC of a low-grade oligodendroglioma shown as an isodense and poorly defined mass in the left frontal lobe. B and C: MR images of the same patient with gadolinium T1 (without identifying contrast enhancement) and FLAIR shows us more clearly than in the TC the extent of injury to the cortex. D: T1 MRI a high-grade oligodendroglioma front left lateral ventricle which compresses and displaces the midline, this mass has hypointense areas in the sequence T2 gradient echo (E) produces a magnetic susceptibility artifact, so it was intratumoral bleeding. F: MRI with gadolinium of a high-grade oligodendroglioma right anterior temporal presenting significant contrast enhancement. G and H: histopathologic differences between lowgrade oligodendroglioma (G) and a high (H), the latter is identified neovascularization much higher than in the low-grade. Page 7 of 12

8 Results The most common tumor was Glioblastoma with 43%, followed by meningioma (11%), low grade astrocytoma (11%) high-grade astrocytoma (9%), and oligodendroglioma with 4.8%. Other tumors such as medulloblastoma and brainstem gliomas accounted for 5% while the other 16% were a heterogeneous group of rare tumors (Figure 3). 63% of oligodendrogliomas were located in frontal lobe, 18% in the temporal lobe, one of the oligodendrogliomas was located in the right lateral ventricle, this location is unusual in other series. The median age at diagnosis was 47.6 years and the most frequent clinical debut were the seizures appeared in 63% of patients, the second most common symptom was headache holocraneal found which appeared in 18%, other symptoms were motor and sensory disturbances. Gender distribution showed a moderate male predominance being men, 64% of patients (Figure 4). In the histological distribution 63% of tumours were histologically well differentiated (grade II) while only three patients (37%) had an anaplastic oligodendroglioma. The most common findings in the images (Figure 5) were calcifications (72%), followed by contrast enhancement (63%), the presence of cysts / necrosis (45%) and bleeding (36%). There were significant differences between low-grade oligodendrogliomas and high grade, presence of bleeding and contrast enhancement was present in 100% of anaplastic oligodendrogliomas, whereas low-grade tumours showed contrast enhancement only 50 % and 13% bleeding. These data are consistent with increased vascularization in high-grade tumours. Finally it should be noted that there were also important differences between the two grades of tumor recurrence rate, being the high level group and 66% in the low grade of 38%. Images for this section: Page 8 of 12

9 Fig. 3 Page 9 of 12

10 Fig. 4 Page 10 of 12

11 Fig. 5 Page 11 of 12

12 Conclusion Oligodendroglioma is a rare neoplasm with frontal cortico-subcortical involvement, may have calcifications, cystic degeneration, contrast enhancement and bleeding (more common in aggressive tumors). Anaplastic tumors have more recurrence. And finely imaging findings may suggest the diagnosis of these tumors and their histological grade. References - Kelly K. Koeller, CAPT, MC, USN # Elisabeth J. Rushing, COL, MC, USA. From the Archives of the AFIP: Oligodendroglioma and Its Variants: Radiologic-Pathologic Correlation. - Matthew L. White, Yan Zhang, Patricia Kirby, and Timothy C. Ryken. Can Tumor Contrast Enhancement Be Used as a Criterion for Differentiating Tumor Grades of Oligodendrogliomas? AJNR Am J Neuroradiol 26: , April 2005 Personal Information Page 12 of 12