Case 3 울산대학교 의과대학 서울아산병원 병리과 김선아 2010 년 10 월 가을학술대회 신경병리 연구회.

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Case 3 울산대학교 의과대학 서울아산병원 병리과 김선아 2010 년 10 월 가을학술대회 신경병리 연구회

Clinical history 65/M Personality change, headache, gait disturbance for one month Admitted for seizure with loss of consciousness

Summary of histology Oligodendroglioma, anaplastic Suspicious astrocytoma component Dysplastic ganglion cells

Anaplastic oligoastrocytoma Ganlgioglioma Synaptophysin

Ganlgioglioma Synaptophysin Anaplastic oligoastrocytoma

Ganlgioglioma Neu N Adjacent normal brain

Ki-67 Anaplastic oligoastrocytomaGanlgioglioma

Analplastic oligoastrocytoma Ganlgioglioma GFAP

1p19q deletion - Chromosome 1p/19q is stable: 1p (0/2) & 19q (0/2) D1S508 D19S412 D1S186 D1S2734 D19S No No No N/A No The LOH patterns were identical between oligoastrocytoma component and ganglioglioma component

Oral mucosa Ganglioglioma Anaplastic oligoastrocytoma Oral mucosa Ganglioglioma Anaplastic oligoastrocytoma

What do we call this tumor? Anaplastic oligoastrocytoma with ganglioglioma-like maturation Ganglioglioma with anaplastic oligoastrocytic component Composite tumor of anaplastic oligoastocytoma and ganglioglioma

Oligodendroglioma with neurocytic differentiation Oligodendroglioma may contain neoplastic cells that express synaptophysin and/or neurofilatments (Vajtai et al. Oligodendroglioma with neurocytic differentiation and characteristic loss of heterozygosity on chromosomes 1p and 19q, Acta Neuropathol (2005) 110: 520–522) Neurocytic differentiation has also been demonstrated by ultrastructural level (Vyberg et al. Neuronal features of oligodendrogliomas—an ultrastructural and immunohistochemical study, Histopathology 2007, 50, 887–896) The neuronal phenotype is usually not evident by routine histology alone

Anaplastic ganglioglioma Glioal component of ganglioglioma may resemble fibrillary astrocytoma, oligodendroglioma or pilocytic astrocytoma Malignant change almost invariably involves the glial component

CaseAge/sexSiteWHO grade O-GG interface 144/MRt frontalIIISharp 258/MLt temporalIIISharp 340/MRt frontotemporalIIISharp and diffuse 429/FLt frontalIIIDiffuse 555/MRt frontalIISharp 663/FLt frontalIIIDiffuse 742/MRt frontalIIISharp and diffuse

Synaptophysin Neurofilament

Differences from ganglioglioma No eosinophilic granular body No CD34-positive cells Less prominent perivascular lymphocytic infiltration Older age (median 44y) No history of chronic seizure disorder Neuroimaging : characteristic findings of diffuse gliomas in three cases (infiltrative growth, significant mass effect, involvement of corpus callosum)

Deletion of 1p and/or 19q 80~90% of oligodendroglioma Less frequently in anaplastic oligodendroglioma 30~40% of oligoastrocytoma