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      Low-Grade Oligodendroglioma of the Pineal Region: Case Report

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          Abstract

          Background Although germ cell tumors and pineal cell tumors account for most of the histologic tumor subtypes, > 17 different tumors can arise in this location. We report a rare case of a low-grade oligodendroglioma that arose in the pineal region.

          Clinical Presentation A young woman complaining of a headache underwent magnetic resonance imaging that showed a mass in the pineal region and mild hydrocephalus. A ventriculoperitoneal shunt was performed followed by a near-total tumor removal, due to tumor invasion of the tectal plate and thalamus. The histologic examination confirmed the diagnosis of a low-grade oligodendroglioma. The patient then underwent chemotherapy and radiotherapy as adjuvant therapies.

          Conclusion Although the pineal region is a common place for a large number of tumoral lesions, low-grade oligodendrogliomas are extremely rare in this location. This case is only the second account of a benign oligodendroglioma of the pineal region reported in the literature.

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          The effect of extent of resection on recurrence in patients with low grade cerebral hemisphere gliomas.

          Stefan Berger, A V Deliganis, G. Evren Keles … (1994)
          To evaluate the role of radical resection for low grade cerebral hemisphere gliomas, the authors analyzed the preoperative and postoperative radiographic tumor volumes (computed tomography hypodensity, magnetic resonance imaging-T2 signal hyperintensity) in 53 patients. Using a previously described method of computerized image analysis, the authors evaluated whether the percent of resection and volume of residual disease, postoperatively, influenced the incidence of recurrence, time to tumor progression, and histology of the recurrent tumor. Survival was not analyzed in this study. No recurrence was detected, regardless of percent of resection and volume of residual disease, in patients with preoperative tumor volumes less than 10 cm2 (mean follow-up, 41.7 months). Patients with tumors measuring 10-30 cm3 had an incidence of recurrence and time to tumor progression of 13.6% and 58 months, respectively, compared with tumors measuring greater than 30 cm3, which had an incidence of recurrence and time to tumor progression of 41.2% and 30 months, respectively (P = 0.016). All patients (n = 13) who underwent a 100% resection had a recurrence-free follow-up period (mean, 54 months). In the remaining patients (n = 40), as the percent of resection decreased, the incidence of recurrence increased along with a shorter time to tumor progression (P = 0.03). Patients with a volume of residual disease of greater than 10 cm3 had a higher incidence of recurrence (46.2%) and a shorter time to tumor progression (30 months) compared with patients with a tumor volume of residual disease of less than 10 cm3 (incidence of recurrence, 14.8% and time to tumor progression, 50 months) (P = 0.002). Forty-six percent of patients with a tumor volume of residual disease of more than 10 cm3 had a recurrence of higher histologic grade, and this was significantly more frequent than patients with a volume of residual disease less than 10 cm3 (3.7%) (P = 0.0009). Age, radiotherapy, and histologic subtype had no influence on recurrence patterns. For tumors greater than 10 cm3, the authors' data suggest that a greater percent of resection and a smaller volume of residual disease conveys a significant advantage, that is, terms of incidence of recurrence and the recurrent tumor phenotype, for patients with low grade cerebral hemisphere gliomas, compared with those who have a less aggressive resection or biopsy. While this may also be the case with tumors less than 10 cm3, further follow-up is necessary to determine the effect of surgery on recurrence patterns for this subset of patients.
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            Pineal region tumors and the role of stereotactic biopsy: review of the mortality, morbidity, and diagnostic rates in 370 cases.

            J. Regis, P Bouillot, F Rouby-Volot … (1996)
            It is classically considered that the morbidity and mortality rates are greater for stereotactic biopsies of pineal region tumors, compared with tumors in other regions. However, to date, the number of cases studied in the literature has been insufficient to evaluate these parameters and compare them with the morbidity and mortality rates for stereotactic biopsies of tumors located elsewhere.
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              Oligodendroglioma: pathology and molecular biology.

              Herbert H Engelhard, Ana Stelea, Elizabeth Cochran (2002)
              Recently, important new information has become available concerning the histologic recognition and molecular biology of oligodendrogliomas. This information, in turn, impacts the way neurosurgeons diagnose and treat patients with these tumors. The purpose of this paper is to review the pathology and basic science of oligodendroglioma, highlighting these developments. Information for this review was obtained by a Medline search using the term "oligodendroglioma," and limiting the results to articles dealing with pathology. Chapters from standard textbooks were also used, and bibliographies were checked for additional key articles contributing to the understanding of the pathobiology of this disease. On histologic examination, oligodendrogliomas must be differentiated from tumors including the fibrillary astrocytoma, clear cell ependymoma, central neurocytoma, and dysembryoplastic neuroepithelial tumor (DNT). There is no specific immunocytochemical marker allowing for the recognition of human oligodendroglial tumor cells. A current simplified grading scheme separates these tumors into low grade (WHO grade II) and anaplastic (WHO grade III) oligodendrogliomas. New molecular and genetic markers may aid in grading oligodendrogliomas and identifying patients with a better prognosis or response to chemotherapy. Markers studied include Ki-67, PCNA, EGFr, VEGF, platelet-derived growth factor, p16, p18, p53, bcl-2, COX-1, and chromosomal deletions. The combination of allelic losses on chromosomes 1p and 19q has been statistically associated with a longer recurrence-free survival after chemotherapy. A patient with an oligodendroglioma may at times still present a diagnostic challenge for the neuropathologist. Yet making an accurate diagnosis is essential, since the clinical course and optimal therapeutic approach differs from that of other gliomas. In the near future, molecular characterization of oligodendrogliomas is expected to play an even greater clinical role.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Neurol Surg Rep
                Journal ID (iso-abbrev): J Neurol Surg Rep
                Journal ID (doi): 10.1055/s-00000182
                Title: Journal of Neurological Surgery Reports
                Publisher: Georg Thieme Verlag KG (Stuttgart · New York )
                ISSN (Print): 2193-6358
                ISSN (Electronic): 2193-6366
                Publication date (Electronic): 05 February 2015
                Publication date (Print): July 2015
                Volume: 76
                Issue: 1
                Pages: e55-e58
                Affiliations
                [1 ]Department of Neurosurgery, Federal University of São Paulo, São Paulo, Brazil
                [2 ]Department of Pathology, Federal University of São Paulo, São Paulo, Brazil
                [* ]Both authors contributed equally to this work
                Author notes
                Address for correspondence Manoel Antonio de Paiva Neto, MD Department of Neurosurgery, Federal University of São Paulo São PauloBrazil mapnpaiva@ 123456ig.com.br
                Article
                Publisher ID: 140036
                DOI: 10.1055/s-0034-1396653
                PMC ID: 4520971
                SO-VID: 876cd3e7-f4a9-4c3c-a5f9-6220155f95df
                Copyright © © Thieme Medical Publishers
                History
                Date received : 13 May 2014
                Date accepted : 19 October 2014
                Categories
                Subject: Article

                Keywords: oligodendroglioma,pineal region,tectal plate,pineal gland
                Data availability:
                Keywords: oligodendroglioma, pineal region, tectal plate, pineal gland

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