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Al-Hajri A, Al-Mughairi S, Somani A, An S, Liu J, Miserocchi A, McEvoy AW, Yousry T, Hoskote C, Thom M. Pathology-MRI Correlations in Diffuse Low-Grade Epilepsy Associated Tumors. J Neuropathol Exp Neurol 2017; 76:1023-1033. [PMID: 29040640 PMCID: PMC5939705 DOI: 10.1093/jnen/nlx090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 09/19/2017] [Indexed: 11/14/2022] Open
Abstract
It is recognized that IDH mutation negative, low-grade epilepsy associated tumors (LEAT) can show diffuse growth patterns and lack the diagnostic hallmarks of either classical dysembryoplastic neuroepithelial tumors (DNT) or typical ganglioglioma. “Nonspecific or diffuse DNT” and more recently “polymorphous low-grade neuroepithelial tumor of the young” have been terms used for these entities. There are few reports on the MRI recognition of these diffuse glioneuronal tumors (dGNT), which is important in planning the extent of surgical resection. In 27 LEATs T1, T2, FLAIR, and postcontrast T1 MRI were evaluated and the pathology reviewed, including immunostaining for NeuN, CD34, MAP2, and IDH1. Each case was then independently classified by pathology or MRI as simple DNT, complex DNT, or dGNT. There was agreement in 23/27 (85%; Kappa score 0.62; p < 0.01). In 4 cases, there was discrepancy in the diagnosis of simple versus complex DNT but 100% agreement achieved for dGNT. DNT showed significantly more expansion of the cortex, cystic change and ventricle extension than dGNT. dGNT showed significantly more subcortical T2w hyperintensity and focal cortical atrophy which correlated on pathology with CD34 expression, cortical neuronal loss and white matter rarefaction. There was no distinct cortical dysplasia component identified by MRI or pathology in any case. This study highlights that dGNT can be reliably discriminated on MRI from DNT.
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Affiliation(s)
- Aliya Al-Hajri
- From The Lysholm Department of Neuroradiology in National Hospital for Neurology and Neurosurgery, London, UK (AA-H, SAM, TY, CH); Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK (AS, SA, JL, MT); Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK (AS, JL, AME, MT); and Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK (AM, AME)
| | - Salim Al-Mughairi
- From The Lysholm Department of Neuroradiology in National Hospital for Neurology and Neurosurgery, London, UK (AA-H, SAM, TY, CH); Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK (AS, SA, JL, MT); Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK (AS, JL, AME, MT); and Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK (AM, AME)
| | - Alyma Somani
- From The Lysholm Department of Neuroradiology in National Hospital for Neurology and Neurosurgery, London, UK (AA-H, SAM, TY, CH); Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK (AS, SA, JL, MT); Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK (AS, JL, AME, MT); and Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK (AM, AME)
| | - Shu An
- From The Lysholm Department of Neuroradiology in National Hospital for Neurology and Neurosurgery, London, UK (AA-H, SAM, TY, CH); Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK (AS, SA, JL, MT); Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK (AS, JL, AME, MT); and Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK (AM, AME)
| | - Joan Liu
- From The Lysholm Department of Neuroradiology in National Hospital for Neurology and Neurosurgery, London, UK (AA-H, SAM, TY, CH); Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK (AS, SA, JL, MT); Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK (AS, JL, AME, MT); and Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK (AM, AME)
| | - Anna Miserocchi
- From The Lysholm Department of Neuroradiology in National Hospital for Neurology and Neurosurgery, London, UK (AA-H, SAM, TY, CH); Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK (AS, SA, JL, MT); Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK (AS, JL, AME, MT); and Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK (AM, AME)
| | - Andrew W. McEvoy
- From The Lysholm Department of Neuroradiology in National Hospital for Neurology and Neurosurgery, London, UK (AA-H, SAM, TY, CH); Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK (AS, SA, JL, MT); Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK (AS, JL, AME, MT); and Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK (AM, AME)
| | - Tarek Yousry
- From The Lysholm Department of Neuroradiology in National Hospital for Neurology and Neurosurgery, London, UK (AA-H, SAM, TY, CH); Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK (AS, SA, JL, MT); Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK (AS, JL, AME, MT); and Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK (AM, AME)
| | - Chandrashekar Hoskote
- From The Lysholm Department of Neuroradiology in National Hospital for Neurology and Neurosurgery, London, UK (AA-H, SAM, TY, CH); Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK (AS, SA, JL, MT); Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK (AS, JL, AME, MT); and Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK (AM, AME)
| | - Maria Thom
- From The Lysholm Department of Neuroradiology in National Hospital for Neurology and Neurosurgery, London, UK (AA-H, SAM, TY, CH); Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK (AS, SA, JL, MT); Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK (AS, JL, AME, MT); and Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK (AM, AME)
- Send correspondence to: Maria Thom, MRCPath, FRCPath Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK; E-mail:
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