Oligodendroglial neoplasms with ganglioglioma-like maturation: a diagnostic pitfall.
Although oligodendroglial neoplasms are traditionally considered purely glial, increasing evidence suggests that they are capable of neuronal or neurocytic differentiation. Nevertheless, ganglioglioma-like foci (GGLF) have not been previously described. Herein, we report seven examples where the primary differential diagnosis was a ganglioglioma with an oligodendroglial component. These five male and two female patients ranged in age from 29 to 63 (median 44) years at initial presentation and neuroimaging features were those of diffuse gliomas in general. At presentation, the glial component was oligodendroglioma in six and oligoastrocytoma in one; one was low-grade and six were anaplastic. A sharp demarcation from adjacent GGLF was common, although some intermingling was always present. The GGLF included enlarged dysmorphic and occasionally binucleate ganglion cells, Nissl substance, expression of neuronal antigens, GFAP-positive astrocytic elements, and low Ki-67 labeling indices. In contrast to classic ganglioglioma, however, cases lacked eosinophilic granular bodies and CD34-positive tumor cells. Scattered bizarre astrocytes were also common and one case had focal neurocytic differentiation. By FISH analysis, five cases showed 1p/19q codeletion. In the four cases with deletions and ample dysmorphic ganglion cells for analysis, the deletions were found in both components. At last follow-up, two patients suffered recurrences, one developed radiation necrosis mimicking recurrence, and one died of disease 7.5 years after initial surgery. We conclude that GGLF represents yet another form of neuronal differentiation in oligodendroglial neoplasms. Recognition of this pattern will prevent a misdiagnosis of ganglioglioma with its potential for under-treatment.
Perry
Arie
A
Washington University School of Medicine, St. Louis, MO 63110-1093, USA. aperry@wustl.edu
Burton
Stephanie S
SS
Fuller
Gregory N
GN
Robinson
Christopher A
CA
Palmer
Cheryl A
CA
Resch
Lothar
L
Bigio
Eileen H
EH
Gujrati
Meena
M
Rosenblum
Marc K
MK
D000328:Adult; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000378:metabolism; D002872:Chromosome Deletion; D002878:Chromosomes, Human, Pair 1; D002888:Chromosomes, Human, Pair 19; D005260:Female; D018303:Ganglioglioma / Q000175:diagnosis* / Q000235:genetics / Q000378:metabolism; D005904:Glial Fibrillary Acidic Protein / Q000378:metabolism; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D016900:Neurofilament Proteins / Q000378:metabolism; D009837:Oligodendroglioma / Q000175:diagnosis* / Q000235:genetics / Q000378:metabolism; D012189:Retrospective Studies
D005904:Glial Fibrillary Acidic Protein; D016900:Neurofilament Proteins
Acta Neuropathol. 2004 Aug;108(2):89-96
15146346
J Neuropathol Exp Neurol. 2002 May;61(5):403-12
12025943
Hum Pathol. 2004 Sep;35(9):1156-9
15343519
Neuroscience. 1996 Mar;71(2):601-11
9053811
Acta Neuropathol. 2005 Nov;110(5):520-2
16222523
J Neuropathol Exp Neurol. 2002 Jul;61(7):575-84
12125736
Glia. 2000 Feb 1;29(3):233-45
10642750
Brain Pathol. 2004 Jan;14(1):34-42
14997935
Cancer. 2008 Dec 15;113(12):3355-63
18988291
J Clin Oncol. 2006 Dec 1;24(34):5419-26
17135643
Acta Neuropathol. 1999 May;97(5):481-90
10334485
J Clin Oncol. 2006 Jun 20;24(18):2715-22
16782911
Semin Ultrasound CT MR. 2008 Feb;29(1):40-6
18383906
J Neurooncol. 2007 Apr;82(2):199-205
17039400
J Neuropathol Exp Neurol. 2001 Oct;60(10):984-93
11589429
J Clin Oncol. 2006 Jun 20;24(18):2707-14
16782910
Mol Cancer. 2008 May 20;7:41
18492260
Histopathology. 2007 Jun;50(7):887-96
17543079
J Neurooncol. 2009 Dec;95(3):343-354
19597701
Brain Pathol. 2008 Jul;18(3):360-9
18371182
J Neuropathol Exp Neurol. 2002 Nov;61(11):947-55
12430711
Neuropathol Appl Neurobiol. 2006 Oct;32(5):461-8
16972880
Cancer Genet Cytogenet. 2002 Apr 1;134(1):71-6
11996800
Arch Pathol Lab Med. 2007 Feb;131(2):242-51
17284109
J Natl Cancer Inst. 1998 Oct 7;90(19):1473-9
9776413
Pediatr Neurosurg. 2001 Jun;34(6):301-5
11455230
Histopathology. 1990 Nov;17(5):439-41
1706300
Front Biosci. 2003 Jan 01;8:a1-9
12456321
Cancer. 1997 Jan 1;79(1):127-31
8988736
Am J Pathol. 1994 Nov;145(5):1175-90
7977648
Brain Pathol. 2008 Jul;18(3):326-37
18371186
Clin Neuropathol. 2005 Sep-Oct;24(5):225-9
16167546
J Clin Oncol. 2000 Feb;18(3):636-45
10653879
J Neuropathol Exp Neurol. 2004 Apr;63(4):314-22
15099021
Neuro Oncol. 2007 Apr;9(2):124-34
17259542
Neuro Oncol. 2009 Dec;11(6):737-46
19224764
Acta Neuropathol. 1997 Nov;94(5):436-43
9386775
Neuropathol Appl Neurobiol. 1998 Aug;24(4):302-8
9775396