Oligodendroglioma

FACTS

  • represent 10% gliomas
  • age 35-40 years, M = F
  • WHO Grade II or III
  • diffusely infiltrating
  • arise in white matter of hemispheres

HPI

universal ROS
  • emphasis on seizures, a frequent presentation
  • KPS

PHYSICAL EXAM

universal exam
  • vision

IMAGING

  • will notice they grow from white matter and infiltrate cortex
  • higher hemorrhage risk compared other glial tumors
A/P
  • Standard of care: GTR + radiation + chemotherapy (RTOG 9802)
  • Chemo: PCV (procarbazine, carmustine, vincristine)
    • 1p/19q heterozygosity loss associated w/ better response
  • Counsel:
    • prognosis highly depends on grade (low grade 74% 5 year survival, high grade 41% 5 year)
    • poor prognostic factors
      • pseudo-palisading necrosis, TERT mutation, IDH WT
    • favorable prognostic factors
      • low-grade, combined loss of 1p19q, younger age, good KPS

Pathology

  • sheets of similar cells with “perinuclear halos”
  • Round nuclei with scant cytoplasm “chicken-wire vasculature”: occasional serpentine configuration, fried egg yolk appearing cells
  • IHC: GFAP+/S100+
notion image

References

  • Buckner, J. C. et al. Radiation plus Procarbazine, CCNU, and Vincristine in Low-Grade Glioma. New England Journal of Medicine 374, 1344–1355 (2016)
  • Jhaveri J, et al. Is less more? Comparing chemotherapy alone with chemotherapy and radiation for high-risk grade 2 glioma: an analysis of the National Cancer Data Base