Extraneural metastases of anaplastic oligodendroglioma

Case report: Spinal drop metastasis of IDH-mutant, 1p/19q-codeleted oligodendroglioma

Background

Symptomatic spinal metastases of oligodendroglioma are rare. Moreover, none of the previously published cases demonstrated the typical IDH mutation and 1p/19q-codeletion for this glial tumor. This case presents an IDH mutant, 1p/19q-codeleted oligodendroglioma with multiple spinal drop metastases.

Case description

We report a case of a 55-year-old woman with left frontal grade 3 oligodendroglioma diagnosed 3 years ago. No tumor recurrence was observed in post-operative follow-up MRI examinations. However, she was admitted to our institution again with severe low back pain. Gadolinium enhanced MRI of the spine revealed an intradural, extramedullary metastatic lesion between T11-L1 levels and multiple enhancing metastatic tumor deposits around cauda equine roots between L4-S1. T11-T12 midline laminectomy was performed and gross total resection of metastatic lesions was achieved. Final histological diagnosis of the spinal lesions was WHO Grade 3 Oligodendroglioma, IDH-mutant, 1p/19q-codeleted.

Conclusion

This case is the first molecularly-defined spinal metastatic oligodendroglioma. The possibility of drop metastasis should be kept in mind in oligodendroglioma patients with spinal cord-related symptoms. There is no standard approach for the diagnosis and treatment of spinal metastases of this type of glial tumor.

Bone metastases from a 1p/19q codeleted and IDH1-mutant anaplastic oligodendroglioma: a case report

BACKGROUND

Oligodendroglioma is a rare type of primary brain tumor which, like other malignant gliomas, metastasizes very rarely even when in high-grade form.

CASE REPORT

A 36-year-old white man diagnosed 29 months previously as having 1p/19q codeleted anaplastic oligodendroglioma presented bilateral cruralgia and lower limb motor deficits. A computed tomography scan showed multiple osteoblastic bone lesions. The presence of oligodendroglial cells was revealed by bone marrow biopsy and confirmed by immunohistochemical analyses. A positon emission tomography-computed tomography scan confirmed the exclusive involvement of bones.

CONCLUSION

This case joins less than 20 other reported cases of oligodendroglioma bone marrow metastasis, and is one of only a handful of cases of diffuse bone metastases beyond the axial skeleton. To the best of our knowledge, the early relapse of 1p/19q codeleted anaplastic oligodendroglioma with this distribution of metastases has never been described in the literature.

Widely metastatic IDH1-mutant glioblastoma with oligodendroglial features and atypical molecular findings: a case report and review of current challenges in molecular diagnostics

Background

Gliomas with 1p/19q-codeletion as well as mutation of isocitrate dehydrogenase (IDH) 1 are typically characterized as oligodendrogliomas with comparatively good response to treatment with radiation and chemotherapy.

Case presentation

We present the case of a 28-year-old man with an IDH1 and TP53 mutant high grade glioma with abnormalities in chromosomes 1 and 19 suggestive of anaplastic oligodendroglioma that rapidly progressed to widespread metastatic disease. Biopsy of a liver lesion confirmed metastasis of the patient’s known brain primary and chemotherapy with temozolomide was initiated. The patient’s rapidly growing tumor burden with fulminant liver failure and tumor lysis led to multisystem failure of which the patient died. Further molecular testing illustrated features more consistent with glioblastoma: multiple large chromosomal aberrations including loss of whole chromosome 1 and 2q; gain/amplification of MYCN, MET, and CDK4; loss of CDKN2A/B; and an ATRX mutation.

Conclusion

This case illustrates the importance of higher level molecular diagnostic testing for patients with particularly aggressive disease progression that is not concordant with standard prognoses. Additional data on cases with atypical alterations of 1p and 19q are needed to better understand the distinct biology of these cancers so that appropriate therapies can be developed.

Electronic supplementary material

The online version of this article (10.1186/s13000-019-0793-5) contains supplementary material, which is available to authorized users.

Anaplastic oligodendroglioma metastasizing to the bone marrow: a unique case report and literature review

Oligodendrogliomas are a rare type of primary brain tumor. They are genetically defined as diffuse gliomas carrying mutation in isocitrate dehydrogenase type 1 (IDH1) or type 2 (IDH2) and codeletion of chromosomes 1p and 19q. The WHO grading system distinguishes two histopathologic grades of ODs: grade II (low-grade) and grade III (anaplastic oligodendroglioma or AO). These tumors rarely metastasize outside of central nervous system with only few cases reported in the literature. Here we present a case of an AO, which metastasized to the bone marrow and other sites within a year of diagnosis despite aggressive treatment measures. Our patient eventually succumbed to his disease, raising many questions about this rare condition, its natural course and optimal management strategy.

Extracranial metastasis of anaplastic oligoastrocytoma

Extracranial metastasis (ECM) of glioma is a rare condition that occurs in the internal nervous axis. A 23-year-old woman presented with anaplastic oligoastrocytoma (WHO III) in a left temporal tumor. The patient received chemoradiotherapy after surgery in our center. Three years after treatment, the patient experienced multiple ECMs in the right lung, left iliac bone, and multiple swollen subcutaneous nodules including the right clavicle, back of the neck, left forearm, right upper arm, and right clavicle. The patient died of cerebral herniation at the age of 27 due to recurrent intracranial glioma. Treatment of ECM of glioma remains very challenging, and further investigations are needed.

Postoperative extracranial metastasis from glioblastoma: a case report and review of the literature

Background

Glioblastoma is the most common primary malignant brain tumor. Extraneural metastases are rarely reported in the literature.

Case presentation

We report a case of a 38-year-old patient who was diagnosed with glioblastoma in 2015. Four months after surgery, local relapse was found and the patient received a second surgery. After another 4 months, we found a hard mass in the right posterior neck when she admitted to our department for fourth cycle of adjuvant chemotherapy. Immunohistochemical investigation supported the diagnosis of glioblastoma metastases to the neck after resection of the right neck mass. A few days later, spinal vertebral magnetic resonance imaging (MRI) confirmed multiple metastases in the thoracic, lumbar, sacral, and bilateral iliac bones.

Conclusions

Glioblastoma is the most common primary malignant brain tumor. Whole tumor resection and early radiotherapy and chemotherapy can delay recurrence and prolong survival. Extracranial metastases are extremely rare. We report this case with the aim of bringing attention to extracranial metastasis of brain glioma.

Spinal metastases of two different grade oligodendrogliomas: a case report and review of literature

Oligodendrogliomas (OGD) are glial tumors, together with mixed oligoastrocytoma constituting 5-20% of all gliomas, which occur predominantly in younger populations and are managed with surgery and chemotherapy with good long-term prognosis after treatment and additionally present with low rates of metastases. We present the case of a 46-year-old patient with intracranial right frontal subcortical OGD [World Health Organisation (WHO) grade II] managed at the Neurosurgery Department in Foscal Clinic, Floridablanca, Colombia. Two years after brain surgery the patient presents with neurological symptomatology suggestive of spinal cord compression and is found to have a neoplastic lesion with extra medullary compressive strength on the conus medullary and wrapping all of the roots with the final report of pathology and immunohistochemistry indicating: OGD (WHO grade III), this lesion was the only one found, the brain studies shows any residual tumor or recurrence in the primary tumor site.

Occipital anaplastic oligodendroglioma with multiple organ metastases after a short clinical course: a case report and literature review

Background

It is generally believed that malignant gliomas never metastasize outside the central nervous system (CNS). However, the notion that oligodendrogliomas (OGDs) cells cannot spread outside CNS is being challenged.

Methods

We described in detail the clinical story of one patient with anaplastic OGD, which metastasized to lymph nodes, bone marrowand bones Genetic analyses included detection of 1p and 19q chromosomal arms, methylation status of MGMT promoter, and PTEN exon mutations. A search of worldwide literature was conducted for reports of metastatic OGDs using NCBI-PubMed, with the keywords “extracranial”, “extraneural”, “oligodendroglioma”, “oligodendrogliomas”, “metastatic”, “metastasis”, and “metastases”, in different combinations.

Results

An open biopsy of the infiltrated bones in our patient revealed that malignant cells had replaced the patient’s marrow. Moreover, the diagnosis of multiple-organ metastases of anaplastic OGD was confirmed based on immunohistochemical staining. Genetic analyses showed that the tumors originated from previously resected brain lesions. None of the lesions had 1p and 19q deletions, but hypermethylation of MGMT promoter, and the G → A transversion at codon 234 of PTEN exon 2 were detected. Literatures review yielded 60 reports of metastatic OGDs from 1951 to the present, which with our patient makes 61 cases. Concerning these 61 patients, there were 110 infiltrated sites correlated closely with primary OGDs. The most frequent metastatic sites were bone and bone marrow (n = 47; 42.7%), lymph nodes (n = 22; 20.0%), liver (n = 7; 6.4%), scalp (n = 6; 5.5%), lung (n = 6; 5.5%), pleura (n = 4; 3.6%), chest wall (n = 3; 2.7%), iliopsoas muscle (n = 2; 1.8%), soft tissue (n = 2; 1.8%), and parotid gland (n = 2; 1.8%).

Conclusions

Extracranial metastases in anaplastic OGD are very rare but they do occur; bone and bone marrow may be the most common sites. Detection of certain molecular markers such as deletion of 1p and 19q chromosomal arms, hypermethylation of MGMT promoter, and characteristic PTEN exon mutations may help differentiate subtypes which are more prone to extracranial metastases.

Virtual slides

The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/8749838611478560.

Unusual intracranial spread of anaplastic oligodendroglioma

Oligodendrogliomas are the third most common type of glioma. Oligodendrogliomas are typically indolent tumours, yet the majority of them are incurable and most patients will ultimately die. Anaplastic oligodendrogliomas are important to recognise from other primary brain tumours, since they have unique molecular, histological and clinical features. Oligodendroglioma, especially the anaplastic type, has a tendency to intracranial and extracranial metastasis. In this paper, we present an unusual manifestation of anaplastic oligodendroglioma.

Interventricular low-grade oligodendroglioma with multiple parenchymal relapse

Oligodendrogliomas can be found anywhere oligodendrocytes exist; however, they mostly occur in frontal lobes. Although intra- and extra central nervous system dissemination of anaplastic oligodendroglioma is a well-known property of this tumour, low-grade oligodendroglioma with intracranial relapse is a very uncommon finding. In this case report, a 37-year-old man with grade II oligodendroglioma relapsed after 18 months with multiple parenchymal masses is presented.

Extracranial skeletal metastasis in anaplastic oligodendroglioma: case report and review of the literature

A case of anaplastic oligodendroglioma with femoral metastasis is presented in a 37-year old male with a 2-year history of progressive headaches and dizziness associated with a 2-month history of epilepsy and right hemiparesis. Magnetic resonance imaging (MRI) demonstrated a solid temporoparietal tumour and the patient underwent a left temporal craniotomy and subtotal resection followed by limited-field radiation therapy. The pathological diagnosis was anaplastic oligodendroglioma. The patient presented with left hip pain 3 years later. Radiography and computed tomography demonstrated osteosclerosis of the left proximal femur, and MRI revealed an intramedullary metastatic lesion. Total body (99m)Tc-methylene diphosphonate bone scan showed hyperactivity in the lesion and open biopsy confirmed it was a metastasis from the cerebral oligodendroglioma. The patient was treated with temozolomide and, to date, there is no sign of recurrence or progression in either the brain or the femur. Seven previously reported cases of extracranial skeletal metastasis from anaplastic oligodendroglioma are reviewed. Co-deletion of chromosome arms 1p and 19q and O(6)-methylguanine DNA methyltransferase status remain the most important prognostic and predictive markers.

Extra-neural metastases of malignant gliomas: myth or reality?

Malignant gliomas account for approximately 60% of all primary brain tumors in adults. Prognosis for these patients has not significantly changed in recent years-despite debulking surgery, radiotherapy and cytotoxic chemotherapy-with a median survival of 9-12 months. Virtually no patients are cured of their illness. Malignant gliomas are usually locally invasive tumors, though extra-neural metastases can sometimes occur late in the course of the disease (median of two years). They generally appear after craniotomy although spontaneous metastases have also been reported. The incidence of these metastases from primary intra-cranial malignant gliomas is low; it is estimated at less than 2% of all cases. Extra-neural metastases from gliomas frequently occur late in the course of the disease (median of two years), and generally appear after craniotomy, but spontaneous metastases have also been reported. Malignant glioma metastases usually involve the regional lymph nodes, lungs and pleural cavity, and occasionally the bone and liver. In this review, we present three cases of extra-neural metastasis of malignant gliomas from our department, summarize the main reported cases in literature, and try to understand the mechanisms underlying these systemic metastases.