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Pinto SN, Chiang J, Qaddoumi I, Livingston D, Bag A. Pediatric diencephalic tumors: a constellation of entities and management modalities. Front Oncol 2023; 13:1180267. [PMID: 37519792 PMCID: PMC10374860 DOI: 10.3389/fonc.2023.1180267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
The diencephalon is a complex midline structure consisting of the hypothalamus, neurohypophysis, subthalamus, thalamus, epithalamus, and pineal body. Tumors arising from each of these diencephalic components differ significantly in terms of biology and prognosis. The aim of this comprehensive review is to describe the epidemiology, clinical symptoms, imaging, histology, and molecular markers in the context of the 2021 WHO classification of central nervous system neoplasms. We will also discuss the current management of each of these tumors.
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Affiliation(s)
- Soniya N. Pinto
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Jason Chiang
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Ibrahim Qaddoumi
- Departments of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - David Livingston
- Department of Radiology, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Asim Bag
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN, United States
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2
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Zhang M, Xu B, Li C, Liu Z, Gao Y, Song Y, Liu R. Occurrence of Chordoid Glioma With Sodium Ion Metabolism Disorder 5 Years After Meningioma Surgery and Whole-Exome Sequencing: A Case Report and Literature Review. Front Genet 2021; 12:617575. [PMID: 34040630 PMCID: PMC8143433 DOI: 10.3389/fgene.2021.617575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/31/2021] [Indexed: 11/13/2022] Open
Abstract
Chordoid glioma (CG), a rare slow-growing brain tumor, mainly occurs in the region of the third ventricle. Although its degree of malignancy is relatively low, its clinical prognosis is poor due to obscure clinical manifestations and the particular growing position. Currently, gross total resection is the best available method for treatment of CG. However, the tumor is located in the deep structure of the brain and close to neurovascular structure so it is difficult to remove completely. This study reported a case of CG of the third ventricle 5 years after surgery of right frontal parietal fibrous meningioma, accompanied with peri and post-operative sodium ion metabolism disorder. Whole-exome sequencing (WES) revealed 25 gene mutations shared by meningioma and CG. In addition, the PRKCA D463H CG marker gene mutation also existed in this patient. We reviewed the latest literature on this rare brain tumor, summarized its clinical manifestations, imaging and pathological characteristics, and discussed the mechanism related to its occurrence and the reasons for sodium ion disorder.
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Affiliation(s)
- Mei Zhang
- Department of VIP Unit, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Baofeng Xu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Chang Li
- Department of VIP Unit, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Ziwei Liu
- Department of Endocrinology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yuanyuan Gao
- Department of Endocrinology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yuming Song
- Department of VIP Unit, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Rui Liu
- Department of VIP Unit, China-Japan Union Hospital of Jilin University, Changchun, China
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Huang C, Gan D, Huang B, Luo J, Zhou X, Wang W, Wang Y. Chordoid glioma in the thalamus of a child: Rare location and atypical imaging findings. BJR Case Rep 2021; 7:20200108. [PMID: 34131491 PMCID: PMC8171145 DOI: 10.1259/bjrcr.20200108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 12/07/2020] [Accepted: 12/17/2020] [Indexed: 11/29/2022] Open
Abstract
Chordoid glioma is a rare intracranial tumour, which usually occurs in middle-aged female patients, mainly in the third ventricle, hypothalamus and suprasellar region. It can reportedly occur in the temporal–parietal lobe, occipital horn of the lateral ventricle and left thalamus. Here, we report a case of chordoid glioma in the thalamic region of a female child, which is different from the previously reported chordoid glioma in the left thalamus. Given its atypical location and imaging findings, it is often misdiagnosed as low-grade glioma before operation. Through the study of this case, we recognized the atypical imaging manifestations of chordoid glioma in a rare location.
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Affiliation(s)
- Cong Huang
- Department of Radiology, No. 926 Hospital, Joint Logistics Support Force of PLA, Kaiyuan, Yunnan, China
| | - Dengwei Gan
- Department of Radiology, No. 926 Hospital, Joint Logistics Support Force of PLA, Kaiyuan, Yunnan, China
| | - Botao Huang
- Department of Radiology, The Affiliated Dongguan Houjie Hospital of Guangdong Medical University, Dongguan, Guangzhou, China
| | - Junde Luo
- Department of Radiology, No. 926 Hospital, Joint Logistics Support Force of PLA, Kaiyuan, Yunnan, China
| | - Xingshun Zhou
- Department of Radiology, No. 926 Hospital, Joint Logistics Support Force of PLA, Kaiyuan, Yunnan, China
| | - Wensheng Wang
- Department of Imaging Center, Guangdong 999 Brain Hospital, Guangzhou, Guang Dong, China
| | - Yujun Wang
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
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Lee YS, Yeung TW, Leung OC. One of a kind-chordoid glioma in the fourth ventricle: a case report and literature review. Acta Radiol Open 2020; 9:2058460120980143. [PMID: 33403125 PMCID: PMC7739103 DOI: 10.1177/2058460120980143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/21/2020] [Indexed: 11/16/2022] Open
Abstract
Chordoid glioma (CG) is a rare brain tumor that is known for its characteristic location in the third ventricle. A wide spectrum of radiological presentations has been described, with few common features among them. Its radiological diagnosis is mainly suggested by location. However, several cases of CG with atypical locations have been described, illustrating that CG is not limited to the third ventricle, and should be considered in the list of radiological differential diagnosis for intraventricular masses. We present here a case of CG that was found in the fourth ventricle.
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Zhang GB, Huang HW, Li HY, Zhang XK, Wang YG, Lin S. Intracranial chordoid glioma: A clinical, radiological and pathological study of 14 cases. J Clin Neurosci 2020; 80:267-273. [PMID: 33099359 DOI: 10.1016/j.jocn.2020.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Chordoid gliomas (CGs) are rare neuroepithelial tumors, which commonly arise from the anterior part of the third ventricle. Most studies on CGs included only one or two cases. To better understand the disease, we report 14 patients with pathologically confirmed CGs. METHOD The clinical characteristics, including radiological and histological examination, operative records, and prognoses were analyzed and reviewed. RESULT The case series included six male and eight female patients with an average age of 44.4 years. The most common preoperative symptom was headache (64.3%) and visual deterioration (57.1%). Radiological results showed that the third ventricle (12/14) was the most common site of the brain involved, and the lesions presented with solid (n = 9, 64.3%) or cystic-solid (n = 5, 35.7%) appearance. All patients were misdiagnosed as non-CG tumors. The operation approach was mainly determined by tumor location, thus trans-callosal approach (9/14) and trans-laminar terminalis approach were commonly used. Gross total resection (GTR) was achieved in all cases and none of them received any adjuvant therapy postoperatively. The most frequent postoperative complications were diabetes insipidus, electrolyte disturbance, hypopituitarism, cognitive dysfunction, and obstructive hydrocephalus. During an average follow-up period of 40.1 months, 2 cases (14.3%) were died of refractory hypopituitarism and pulmonary embolism, respectively. The preoperative symptoms and postoperative complications were all significantly improved in other 12 patients, and MRI showed no tumor recurrence. CONCLUSION According to our experience, we recommend GTR as the primary goal, which is associated with improved rates of tumor control and without increasing rates of postoperative complications.
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Affiliation(s)
- Guo-Bin Zhang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases (NCRC-ND), Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brian Tumor, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, PR China
| | - Hua-Wei Huang
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, PR China
| | - Hao-Yi Li
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases (NCRC-ND), Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brian Tumor, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, PR China
| | - Xiao-Kang Zhang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases (NCRC-ND), Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brian Tumor, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, PR China
| | - Yong-Gang Wang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases (NCRC-ND), Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brian Tumor, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, PR China
| | - Song Lin
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases (NCRC-ND), Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brian Tumor, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, PR China.
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Chordoid glioma of the third ventricle: A systematic review and single-center experience. INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2019.100515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Yang B, Yang C, Du J, Fang J, Li G, Wang S, Xu Y. Chordoid glioma: an entity occurring not exclusively in the third ventricle. Neurosurg Rev 2019; 43:1315-1322. [PMID: 31422571 DOI: 10.1007/s10143-019-01161-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 07/11/2019] [Accepted: 08/06/2019] [Indexed: 11/25/2022]
Abstract
Chordoid gliomas are extremely rare entities, which are generally considered occurring exclusively in the third ventricle. Despite the low-grade histological grade, aggressive behaviors have been reported in literatures. Due to the low morbidity, the origins, clinical, and radiological features, management and prognosis are still yet to be well elucidated. We retrospectively reviewed the clinical profiles from a series of 6 patients with chordoid gliomas. All patients underwent surgical treatment, and the diagnoses were based on histopathological examinations. Magnetic resonance imaging (MRI) was performed perioperatively. Follow-up outcomes were presented. This case series consisted of three male and three female patients (age range 27-67 years; mean age 43.3 years). MRI results showed tumors in the third ventricle (4/6), temporal-parietal-occipital lobe involving the lateral ventricle (1/6), and cerebellar hemisphere (1/6). Three tumors were solid, and the others were cystic-solid. Hydrocephalus was present in one patient. The T1-weighted imaging showed hypo- to isointensity, and T2-weighted imaging showed iso- to hyperintensity; enhancement was homogeneous (4/6) or heterogeneous (2/6). Diffusion-weighted imaging showed no evidence of restricted diffusion. Magnetic resonance spectrum showed an elevated choline value and reduced N-acetylaspartate value. Gross total resection was achieved in all patients, and during an average follow-up period of 35.8 months, no recurrence was noted. Chordoid gliomas can occur outside the third ventricle with a great diagnostic challenge. The MRI characteristics suggest a low-grade tumor, and the accurate diagnosis depends on pathological criteria. Complete surgical resection is associated with a favorable outcome.
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Affiliation(s)
- Bao Yang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, 100050, China
| | - Chenlong Yang
- Department of Orthopedics, Peking University Third Hospital, Haidian District, Beijing, 100191, China
| | - Jiang Du
- Department of Neuro-Pathology, Beijing Neurosurgical Institute, Capital Medical University, Fengtai District, Beijing, 100050, China
| | - Jingyi Fang
- Department of Neuro-Pathology, Beijing Neurosurgical Institute, Capital Medical University, Fengtai District, Beijing, 100050, China
| | - Guang Li
- Department of Pathology, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, 100050, China
| | - Shuo Wang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, 100050, China.
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Dongcheng District, Beijing, 100050, China.
| | - Yulun Xu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, 100050, China.
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Dongcheng District, Beijing, 100050, China.
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Danilowicz K, Abbati SG, Sosa S, Witis FL, Sevlever G. Suprasellar chordoid glioma: a report of two cases. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2019; 62:648-654. [PMID: 30624507 PMCID: PMC10118663 DOI: 10.20945/2359-3997000000092] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 12/14/2016] [Indexed: 11/23/2022]
Abstract
Chordoid glioma (CG) is considered a slow growing glial neoplasm. We report two new cases with endocrinological presentation, management and outcome. Case reports: 1) An 18 year-old female patient was admitted due to headaches, nausea and vomiting and visual abnormalities. She was in amenorrhea. A brain magnetic resonance imaging (MRI) demonstrated a 35 mm-diameter sellar and suprasellar mass. An emergency ventricular peritoneal valve was placed due to obstructive hydrocephalus. Transcraneal surgery was performed. The patient developed central hypothyroidism, adrenal insufficiency and transient diabetes insipidus; she never recovered spontaneous menstrual cycles. Histopathologic study showed cells in cords, inside a mucinous stroma, positive for glial fibrillary acidic protein (GFAP). Due to residual tumor gamma knife radiosurgery was performed. Three years after surgery, the patient is lucid, with hypopituitarism under replacement. 2) A 46 year-old woman complained about a three year-history of amenorrhea, galactorrhea and headache. An MRI showed a solid-cystic sellar mass 40 mm-diameter that extended to the suprasellar cistern. She had hypogonatropic hypogonadism and mild hyperprolactinemia. The tumor mass was removed via nasal endoscopic approach. Histopathological study reported cellular proliferation of glial lineage positive for GFAP. The patient evolved with central hypothyroidism and diabetes insipidus. She was re-operated for fistula and again under the diagnosis of extradural abscess. She evolved with cardiorespiratory descompensation and death, suspected to be due to a thromboembolism. In conclusion, the first case confirms that best treatment for CG is surgery considering radiotherapy as an adjuvant therapy. The other case, on the contrary, illustrates the potentially fatal evolution due to surgical complications.
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Affiliation(s)
- Karina Danilowicz
- Hospital de Clínicas, Universidad de Buenos Aires, Endocrinology, Buenos Aires, Argentina
| | | | - Soledad Sosa
- Hospital de Clínicas, Universidad de Buenos Aires, Endocrinology, Buenos Aires, Argentina
| | - Florencia Lustig Witis
- Hospital de Clínicas, Universidad de Buenos Aires, Endocrinology, Buenos Aires, Argentina
| | - Gustavo Sevlever
- Instituto de Investigaciones Neurológicas "Dr. Raúl Carrea", FLENI, Pathology, Buenos Aires, Argentina
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Garcia-Garcia S, Aldecoa I, Caral LA, Ferrer E, Ribalta T, González-Sánchez JJ. Management in chordoid glioma: Avoiding the pitfalls in this rare and challenging entity. Neurol India 2017; 65:808-813. [PMID: 28681757 DOI: 10.4103/neuroindia.ni_1008_15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Chordoid glioma (CG) of the third ventricle is an unusual neoplasm of glial nature, which is almost exclusively located in the anterior wall of the third ventricle, in close relation with the hypothalamus. Magnetic resonance images show CG as a suprasellar, hypo- to isointense mass, homogeneously enhancing after the administration of gadolinium. Since its description in 1998 by Brat et al., approximately 85 cases have been reported. Some of its pathological features are under discussion and its histological origin still remains unclear. In this study, we present a patient having this rare entity. We review the management of CG reported in literature. We also studied its pathological features, the postoperative mortality and morbidity related to radical surgical resection, and the implemented adjuvant therapies. Due to its classical clinical features and its close resemblance to other lesions in the region, it is an entity unlikely to be suspected prior to its histological diagnosis. Despite the benign nature of this tumor, the clinical outcome might be poor. Its treatment may represent a real challenge because it involves critical anatomical areas, leading to high postoperative morbidity and mortality rates. An initial minimally invasive management and adjuvant therapies, such as radiosurgery, in case of symptomatic recurrences, can be effective handling strategies.
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Affiliation(s)
| | - Iban Aldecoa
- Department of Pathology, Hospital Clínic i Provincial, Barcelona, Spain
| | - Luis Alberto Caral
- Department of Neurosurgery, Hospital Clínic i Provincial, Barcelona, Spain
| | - Enrique Ferrer
- Department of Neurosurgery, Hospital Clínic i Provincial; Department of Neurosurgery, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Teresa Ribalta
- Department of Pathology, Hospital Clínic i Provincial; Department of Pathology, Hospital Sant Joan de Deu, Barcelona, Spain
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Qixing F, Peiyi G, Kai W, Xuzhu C, Xiangde M, Jianping D. The radiological findings of chordoid glioma: report of two cases, one case with MR spectroscopy. Clin Imaging 2015; 39:1086-9. [DOI: 10.1016/j.clinimag.2015.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 05/28/2015] [Accepted: 06/15/2015] [Indexed: 10/23/2022]
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Ampie L, Choy W, Lamano JB, Kesavabhotla K, Mao Q, Parsa AT, Bloch O. Prognostic factors for recurrence and complications in the surgical management of primary chordoid gliomas: A systematic review of literature. Clin Neurol Neurosurg 2015; 138:129-36. [PMID: 26342205 DOI: 10.1016/j.clineuro.2015.08.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 08/05/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Chordoid gliomas (CG) are rare neoplasms which frequently arise within the third ventricle. Surgery remains the mainstay treatment for CG. The present study comprehensively reviews all reported cases of CG within the literature in order to identify risk factors for surgical complications and tumor recurrence. METHODS A comprehensive search on MEDLINE (OVID and PubMed), Scopus, Embase, and Web of Science was conducted following PRISMA guidelines to identify all reported cases of CG. RESULTS A total of 81 patients met the study criteria which comprised of 33 males and 48 females. Median age at diagnosis was 48 years with a range from 5 to 72 years, and mean tumor size was 3.1cm. Biopsy, subtotal resection (STR), and gross total resection (GTR) were achieved in 8, 34, and 33 patients, respectively, with six cases not reporting extent of resection (EOR). Thirteen patients underwent adjuvant radiotherapy. Postoperative complications were noted in 30 cases (37%), with new onset diabetes insipidus being the most common. Postoperative morbidity was not associated with age, tumor size, or extent of resection. A trans-lamina terminalis approach demonstrated a strong trend towards decreased overall rates of postoperative morbidity compared to other approaches (p=0.051). GTR was associated with improved progression-free survival (PFS; p=0.028), while adjuvant radiotherapy, age, tumor size and proliferative index were not predictive of patient outcomes. CONCLUSION GTR should be the primary goal for the management of CG, as it is associated with improved rates of tumor control without an increased rate of postoperative complications. Surgical approach was a stronger predictor of complication rates than extent of resection. Morbidity remains high, and future studies to further elaborate on factors predictive of postoperative complications are critical.
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Affiliation(s)
- Leonel Ampie
- Department of Neurological Surgery Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Winward Choy
- Department of Neurological Surgery Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Jonathan B Lamano
- Department of Neurological Surgery Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Kartik Kesavabhotla
- Department of Neurological Surgery Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Qinwen Mao
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Andrew T Parsa
- Department of Neurological Surgery Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Orin Bloch
- Department of Neurological Surgery Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
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Bongetta D, Risso A, Morbini P, Butti G, Gaetani P. Chordoid glioma: a rare radiologically, histologically, and clinically mystifying lesion. World J Surg Oncol 2015; 13:188. [PMID: 26018908 PMCID: PMC4453048 DOI: 10.1186/s12957-015-0603-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 05/12/2015] [Indexed: 11/10/2022] Open
Abstract
Chordoid glioma (CG) is a rare central nervous system neoplasm (WHO grade II) of uncertain origin whose typical localization is in the anterior part of the third ventricle. Its clinical, radiological, and histological features may vary and furthermore mimic other kind of benign lesions usually associated with a better outcome. We report a case of a 43-year-old female who underwent gross total removal of a lesion of the third ventricle causing hydrocephalus. The imaging studies and the intraoperative examination led at first to a hypothesis of meningioma. Early surgical and neurological outcomes were good. The patient underwent multiple complications related to hypothalamic dysfunctions and thrombohemorragic issues and eventually died because of systemic infections. Definitive examination was of chordoid glioma of the third ventricle. Reviewing literature, we evaluated possible pitfalls in radiological and histological diagnosis as well as in surgical and medical treatment of CGs. Despite their benign presentation, a high incidence of multiple possible severe complications is reported. Early alertness and combined treatment strategies could improve overall CGs treatment strategies.
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Affiliation(s)
- Daniele Bongetta
- Neurosurgery, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Università degli Studi di Pavia, Piazzale Golgi 19, 27100, Pavia, Italy.
| | - Andrea Risso
- Neurosurgery, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Università degli Studi di Pavia, Piazzale Golgi 19, 27100, Pavia, Italy.
| | - Patrizia Morbini
- Unit of Pathology, Department of Molecular Medicine, University of Pavia and Fondazione IRCCS Policlinico S. Matteo, Piazzale Golgi 19, 27100, Pavia, Italy.
| | - Giorgio Butti
- Neurosurgery Unit, Fondazione IRCCS Policlinico S. Matteo, Piazzale Golgi 19, 27100, Pavia, Italy.
| | - Paolo Gaetani
- Neurosurgery Unit, Fondazione IRCCS Policlinico S. Matteo, Piazzale Golgi 19, 27100, Pavia, Italy.
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Smith AB, Smirniotopoulos JG, Horkanyne-Szakaly I. From the radiologic pathology archives: intraventricular neoplasms: radiologic-pathologic correlation. Radiographics 2013; 33:21-43. [PMID: 23322825 DOI: 10.1148/rg.331125192] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A variety of neoplasms may arise in the ventricular system. Intraventricular neoplasms may be discovered as an incidental finding at cross-sectional imaging or may manifest with varied symptoms depending on their location, including symptoms of increased intracranial pressure. These lesions may arise from various ventricular structures, including the ependymal lining (eg, ependymoma), subependymal layer (eg, subependymoma), or choroid plexus (eg, choroid plexus neoplasms), or they may have a cell of origin that has yet to be determined (eg, chordoid glioma). Other neoplasms involving the ventricular system include central neurocytoma, subependymal giant cell tumor, meningioma, rosette-forming glioneuronal tumor, and metastases. The differential diagnosis for intraventricular neoplasms can be broad, and many of them have similar patterns of signal intensity and contrast enhancement at imaging. However, the location of the lesion in the ventricular system-along with knowledge of the patient's age, gender, and underlying conditions-will help narrow the differential diagnosis.
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Affiliation(s)
- Alice Boyd Smith
- Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814-4799, USA.
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KOBAYASHI T, TSUGAWA T, HASHIZUME C, ARITA N, HATANO H, IWAMI K, NAKAZATO Y, MORI Y. Therapeutic Approach to Chordoid Glioma of the Third Ventricle. Neurol Med Chir (Tokyo) 2013; 53:249-55. [DOI: 10.2176/nmc.53.249] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Norio ARITA
- Department of Neurosurgery, Hyogo Medical College
| | - Hisashi HATANO
- Department of Neurosurgery, Nagoya 1st Redcross Hospital
| | - Kenichiro IWAMI
- Department of Neurosurgery, Nagoya University School of Medicine
| | - Yoichi NAKAZATO
- Department of Human Pathology, Gunma University Graduate School of Medicine
| | - Yoshimasa MORI
- Department of Radiology and Radiation Oncology, Nagoya City University Graduate School of Medical Sciences
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15
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Ni HC, Piao YS, Lu DH, Fu YJ, Ma XL, Zhang XJ. Chordoid glioma of the third ventricle: four cases including one case with papillary features. Neuropathology 2012; 33:134-9. [PMID: 22716306 DOI: 10.1111/j.1440-1789.2012.01333.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Chordoid glioma is a rare, slowly growing tumor of the CNS, which is always located in the third ventricle of adults. Chordoid glioma has classic histological features consisting of clusters and cords of epithelioid tumor cells embedded within a mucinous stroma with rich lymphoplasmacytic infiltrate. The important distinctive immunohistochemical feature of this neoplasm is strong and diffuse reactivity for GFAP. Here, we report four cases of chordoid glioma that occupied the anterior portion of the third ventricle or suprasellar region. These four cases were all adult females with almost typical clinical, radiological, histologic and immunohistochemical characteristics of chordoid glioma. However, in one case there was an unusual histologic finding with regard to the papillary region. In this region, elongated tumor cells were observed radiating toward a central vessel to form characteristic papillary structures. Immunohistochemically, three cases showed strong reactivity for GFAP, and one exhibited weak reactivity. All cases were focally positive for epithelial membrane antigen, CD34 and D2-40, but negative for neurofilament protein (NFP). Several ultrastructural investigations have supported the ependymal origin of chordoid glioma. In some cases of immunoreactivity for NFP, some authors have supposed that chordoid glioma originates from a multipotential stem cell with glial and neuronal cell differentiation. With regard to the present four cases with immunoreactivity for D2-40 (an ependymal marker) and CD34 (undifferentiated neural precursors) and based on previously published data, we considered that the majority of chordoid gliomas had an ependymal origin, and that a small minority might have originated from a multipotential stem cell having ependymal and neuronal cell differentiation.
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Affiliation(s)
- Hai-Chun Ni
- Department of Neuropathology, Xuanwu Hospital, Capital Medical University, Beijing, China
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Ghosal N, Thakar S, Kumaran SP, Hegde AS. Chordoid glioma in suprasellar location with extension into the third ventricle: smear preparation morphology of a rare tumor. Diagn Cytopathol 2012; 40:155-8. [PMID: 22246933 DOI: 10.1002/dc.21606] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 10/21/2010] [Indexed: 11/10/2022]
Abstract
We report a rare case of recurrent chordoid glioma in suprasellar region with extension into the third ventricle diagnosed peroperatively. On MRI, a brilliantly contrast enhancing lesion in the suprasellar region extending superiorly into the third ventricle and measuring 2.5 × 3 × 3.5 cm was identified. Patient had a previous history of subtotal removal of the tumor 8 months back and had received 56 Gy of postoperative radiotherapy. On smear preparation the tumor was composed of cells arranged in chords and rows in a myxoid background with sprinkling of lymphocytes. The individual cells were polygonal with moderate amount of faintly eosinophilic cytoplasm with cytoplasmic vacoules in few cells. The nuclei showed fine chromatin with small prominent nucleoli. Paraffin sections confirmed the diagnosis and on immunohistochemistry the tumor cells showed strong positivity for GFAP and focal weak positivity for EMA with low MIB-1 labeling index (<1%). To the best of our knowledge this is the first documented case of chordoid glioma described on crush cytology.
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Affiliation(s)
- Nandita Ghosal
- Department of Pathology and Transfusion Medicine, SSSIHMS, Bangalore, India.
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CD99 is expressed in chordoid glioma and suggests ependymal origin. Virchows Arch 2011; 460:119-22. [PMID: 22102064 DOI: 10.1007/s00428-011-1170-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 10/24/2011] [Accepted: 11/03/2011] [Indexed: 10/15/2022]
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Desouza RM, Bodi I, Thomas N, Marsh H, Crocker M. Chordoid glioma: ten years of a low-grade tumor with high morbidity. Skull Base 2011; 20:125-38. [PMID: 20808539 DOI: 10.1055/s-0029-1246223] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We report two new cases of chordoid glioma of the third ventricle and review all previously published cases of this rare tumor with regard to presentation, optimum management, and outcome. Two new cases are reported with the radiological and histopathologic findings. We searched and cross-referenced PubMed and published reports of this tumor to retrieve an additional 51 cases of this tumor, which were then analyzed according to a proforma. Chordoid glioma has consistent radiological features, although some atypical elements including a cystic component are well described. The insidious presentation and morbidity of attempted surgical resection combine to give high overall morbidity. There is a high incidence of postoperative thromboembolic disturbance. Adjuvant radiosurgery has a promising role. The morbidity of this condition is likely to remain high but may be minimized by a less aggressive surgical approach together with surveillance and early use of radiosurgery.
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Affiliation(s)
- Ruth-Mary Desouza
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
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Al Hinai QS, Petrecca K. Rarest of the rare: Chordoid glioma infiltrating the optic chiasm. Surg Neurol Int 2011; 2:53. [PMID: 21697970 PMCID: PMC3114368 DOI: 10.4103/2152-7806.80118] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 04/08/2011] [Indexed: 11/17/2022] Open
Abstract
Background: Chordoid glioma is a rare brain tumor typically located within the anterior third ventricle. It is a well-circumscribed, non-infiltrative tumor that grows as a mass within the ventricle. Case Description: We present the case of a 50-year-old woman with a chordoid glioma located in the anterior third ventricle. Unusually, MRI revealed an enlarged optic chiasm. Histological sampling of the chiasm revealed tumor invasion. Conclusion: Involvement of the optic apparatus is generally thought to be an imaging feature that can be used to distinguish chordoid gliomas from optic/hypothalamic gliomas. This case provides the first reported exception to this dogma.
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Affiliation(s)
- Qasim S Al Hinai
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
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Kim JW, Kim JH, Choe G, Kim CY. Chordoid glioma : a case report of unusual location and neuroradiological characteristics. J Korean Neurosurg Soc 2010; 48:62-5. [PMID: 20717514 DOI: 10.3340/jkns.2010.48.1.62] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 12/21/2009] [Accepted: 06/10/2010] [Indexed: 11/27/2022] Open
Abstract
Since the World Health Organization (WHO) classification for central nervous system neoplasms was declared in 2000, chordoid glioma of the third ventricle has been noted as a newly recognized tumor for central nervous system neoplasms. Although there is not enough universal experience to know the nature of this tumor due to its rarity, the origin of chordoid glioma was guardedly proposed to be the ependymal cells of the third ventricle. Such an idea has been primarily based on the specific location of the tumor, that is, third ventricle, suprasellae, and hypothalamus. However, we report a rare case of histologically confirmed chordoid glioma located in the left thalamus, not attached to any of the midline structures having unusual neuroradiological characteristics.
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Affiliation(s)
- Jin Wook Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Vanhauwaert DJ, Clement F, Van Dorpe J, Deruytter MJ. Chordoid glioma of the third ventricle. Acta Neurochir (Wien) 2008; 150:1183-91. [PMID: 18936876 DOI: 10.1007/s00701-008-0014-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Accepted: 07/08/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Chordoid glioma is a rare tumour (World Health Organisation grade II) originating from the third ventricle with both glial and chordoid features. It was first described by Brat in 1998. Since there is no detailed information available on the outcome after surgery and adjuvant treatment, we reviewed the literature. METHODS A literature search through PUBMED revealed 50 cases of chordoid glioma. Most reports were found in pathology journals. Information on the postoperative course was sometimes very limited. We reviewed the available literature and studied in detail the presenting symptoms, mortality and postoperative complications in relation to the extent of resective surgery, as well as the importance of adjuvant treatment. CONCLUSIONS Mortality in the immediate postoperative period is 32% and is higher after gross total resection as compared to subtotal resection. Non-fatal postoperative complications are hypothalamic disorders and mental alterations. Gross total resection is the treatment of choice since no recurrence has been reported after macroscopically complete resection, but this is often difficult because of the location and adherence to the hypothalamus. The role of postoperative radiotherapy is uncertain. There is some indication that radiosurgery with or without conventional irradiation is superior to conventional radiation alone. Planned subtotal resection followed by stereotactic radiosurgery can be a safe and effective alternative in a patient in whom gross total resection is considered to be too risky. There is no report on the use of chemotherapy in the treatment of chordoid gliomas. More information about the optimal treatment strategy is needed, and more reports are also needed.
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Horbinski C, Dacic S, McLendon RE, Cieply K, Datto M, Brat DJ, Chu CT. Chordoid glioma: a case report and molecular characterization of five cases. Brain Pathol 2008; 19:439-48. [PMID: 18652591 DOI: 10.1111/j.1750-3639.2008.00196.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Chordoid gliomas are rare, slow-growing neoplasms of the anterior third ventricle. We reported a case of chordoid glioma in a 41-year-old man with obstructive hydrocephalus. Histologically, the tumor consisted of polygonal epithelioid cells admixed with elongated cells in a myxoid stroma. A prominent lymphoplasmacytic infiltrate was present. The tumor cells expressed glial fibrillary acidic protein (GFAP), epithelial membrane antigen (EMA), vimentin, CD31, CD34, epidermal growth factor receptor (EGFR) and S100 but were negative for pankeratin and E-cadherin. The percentage of Ki67 positive cells was approximately 3%. Weak p53 immunoreactivity was seen in less than 10% of the cells. Array comparative genomic hybridization performed on this case, as well as on four other archived cases, showed losses at several loci. Fluorescence in situ hybridization (FISH) confirmed consistent genetic alterations at 9p21 and 11q13. These are the fifth through ninth reported cases of chordoid gliomas with molecular characterization suggesting a distinct genetic origin from other gliomas.
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Affiliation(s)
- Craig Horbinski
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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