|Year : 2018 | Volume
| Issue : 4 | Page : 209-211
Intraventricular anaplastic oligodendroglioma
Amit Agrawal1, Vissa Shanthi2, V Umamaheswara Reddy3
1 Department of Neurosurgery, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India
2 Department of Pathology, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India
3 Department of Radiology, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India
|Date of Web Publication||16-Apr-2019|
Dr. Amit Agrawal
Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore - 524 003, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Oligodendrogliomas arising primarily in the ventricle are quite rare. A 27-year-old male patient presented with features of raised intracranial pressure, forgetfulness, diplopia, and blurring of vision. Axial computed tomography scan brain showed heterogeneous mass with calcifications in the third and lateral ventricles involving the septum with dilatation of the frontal and occipital horns of the lateral ventricle. The tumor was resected an interhemispheric transcallosal approach. Histopathology showed tumor cells in sheets and small clusters with intervening thin blood vessels. Tumor cells had round-to-oval nuclei with clear cytoplasm. There were many foci showed calcifications and psammoma bodies. Neuropathological examination supported the diagnosis of anaplastic intraventricular oligodendroglioma. Although intraventricular oligodendrogliomas are slow-growing tumors, their deep location makes the complete removal difficult.
Keywords: Anaplastic oligodendroglioma, brain tumor, intraventricular, oligodendroglioma, treatment
|How to cite this article:|
Agrawal A, Shanthi V, Reddy V U. Intraventricular anaplastic oligodendroglioma. J Datta Meghe Inst Med Sci Univ 2018;13:209-11
| Introduction|| |
Oligodendrogliomas arising primarily in the ventricle are quite rare with only few published cases in literature.,,,,,,,,,, In the present article, we describe clinicopathological and imaging findings of an intraventricular oligodendroglioma young male and review the relevant literature.
| Case Report|| |
A 27-year-old male patient presented with severe headache 1 year increased by 4–5 months, vomiting, and hydrocephalic attacks. There was a history of forgetfulness, diplopia, and blurring of vision. He also had difficulty in walking. Cranial nerve examination was normal. Fundus examination showed bilateral papilledema. He was moving all four limbs equally. Deep tendon reflexes were normal. Planters were flexor. All the blood investigations were normal. Axial computed tomography (CT) scan brain showed heterogeneous mass with calcifications in the third and lateral ventricles involving the septum with dilatation of the frontal and occipital horns of the lateral ventricle. There was no perilesional edema [Figure 1]. The lesion showed minimal heterogeneous enhancement after contrast administration [Figure 2]. Coronal and sagittal reconstruction images showed the involvement of foramen of Monro and extension of the mass into the third ventricle [Figure 3]. The tumor was resected an interhemispheric transcallosal approach. The tumor could be identified just after opening corpus callosum and could be partially resected. A ventricular catheter was placed in the left lateral ventricle for external ventricular drainage. The patient was conscious and alert but had right-sided weakness following surgery. Postoperative CT scan showed large tumor bed hematoma associated with intraventricular hemorrhage [Figure 4]. The patient was managed with external intraventricular drainage and antiedema measures. Follow-up CT scan images showed resolution of the hemorrhages, but dilation of the ventricles was persisting [Figure 5]. A right ventriculoperitoneal shunt was placed. Multiple sections showed tumor cells in sheets and small clusters with intervening thin blood vessels. Tumor cells had round-to-oval nuclei with clear cytoplasm. Some of the tumor cells had eosinophilic cytoplasm. Many foci showed calcifications and psammoma bodies. Occasional foci showed arrangement of tumor cells. Normal glial tissue was also noted [Figure 6]. Neuropathological examination supported the diagnosis of anaplastic oligodendroglioma.
|Figure 1: Plain axial computed tomography scan brain images (a, b and c) showing heterogeneous mass with calcifications in the third and lateral ventricles |
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|Figure 2: Axial postcontrast images (a and b) showing minimal heterogeneous enhancement of the mass |
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|Figure 3: Coronal (a) and sagittal (b) images showing involvement of foramen of monro and extension of the mass into the third ventricle|
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|Figure 4: Postoperative image showing reduction in the size of the tumor, also note the peritumoral and intraventricular hemorrhage|
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|Figure 5: Follow-up computed tomography scan images showing resolution of the hemorrhages but dilation of the ventricles was persisting|
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|Figure 6: (a) Tumor cells having rounded nuclei, clear cytoplasm, and rich network of capillaries. Microcalcification at the left top (H and E, ×100), (b) tumor cells having rounded nuclei, clear cytoplasm, and rich network of capillaries (H and E, ×400), (c) upper half showing calcifications and lower half showing tumor (H and E, ×100), and (d) tumor cells having rounded nuclei, clear cytoplasm, and rich network of capillaries. Microcalcification at the top (H and E, ×400)|
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| Discussion|| |
Oligodendrogliomas comprise 2%–5% of primary brain tumors and 4%–15% of gliomas. Oligodendrogliomas commonly arise from the cortex and/or subcortical white matter and may secondarily invade the adjacent ventricular system., Most commonly intraventricular oligodendrogliomas arise the anterior parts of the lateral ventricles and rarely involve the occipital horn and atrium of the lateral ventricle. Intraventricular oligodendrogliomas are rare and have the same histological features as their parenchymal counterpart but have different clinical and imaging characteristics.,, In contrast to the hemispheric oligodendrogliomas (where seizure is the most common presenting symptom), the intraventricular oligodendrogliomas commonly present with signs of raised intracranial pressure (obstruction of the cerebrospinal fluid pathways).,,, Based on their specific CT characteristics (but not pathognomonic), intraventricular oligodendrogliomas can be distinguished from other intraventricular lesions. Typically oligodendrogliomas appear hypodense or isodense on CT scan and intraventricular oligodendrogliomas appear as hyperdense lesions on CT scan with clumped calcifications.,, Contrast enhancement (which can be mild to moderate) in the intraventricular oligodendrogliomas heralds a poor prognosis. Most of the patients have hydrocephalus as there is CSF outflow obstruction. A number of lesions need to be considered in the differential diagnosis of intraventricular oligodendrogliomas including subependymoma, ependymomas, gangliogliomas, astrocytomas, choroid plexus papillomas, central neurocytoma, intraventricular meningiomas, epidermoid, and dermoid tumors.,,, Based on imaging findings and histological features, definitive diagnosis can be made., Intraventricular oligodendrogliomas are slow-growing tumors and can have prolonged survival but their deep location makes the complete removal difficult and these patients frequently need CSF diversion procedure.,,
| Conclusion|| |
Intraventricular oligodendroglioma is a relatively rare tumor among the many tumors arising in the ventricles and may have overlapping imaging features. Considering patient's age, gender and tumor location may help in narrowing the differential diagnosis. Histopathology plays a key role in confirming the diagnosis and along with cross sectional imaging helps in planning the management.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
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