[1638] Unusual Histological Findings in a Cohort of Gliomas with High Grade Features: A Clinicopathological Study of 5 Cases at a Single Institution.

Ying Sun, Xianyuan Song, Inam Kureshi, Thomas Ciesielski, Srinivas Mandavilli. Hartford Hospital, CT

Background: Rosenthal fibers (RF) and eosinophilic granular bodies (EGB) are commonly encountered in pilocytic astrocytoma (PA), pleomorphic xanthoastrocytoma (PXA) and ganglioglioma, and usually associated with long standing processes. There is limited literature addressing the clinical significance of RF and EGB in gliomas with high grade features (HGF). The aim of this study is to evaluate the clinical, radiologic and pathologic findings in such cases.
Design: The pathology database for the time period 2003-2010 was queried for Gliomas with HGF and there were 5 cases in which RF and/ or EGB were described as a prominent finding. The pathologic diagnoses were: 2 PXA, 2 grade III gliomas, and 1 mixed tumor with glial and neurocytic features. The clinical follow-up ranged from 1 month to over 20 years (see Table 1).
Results: All patients underwent tumor resection. Histologically, all tumors showed high grade features including high cellularity, pseudopalisading necrosis, vascular proliferation and variable mitotic activity. Two cases (#1 and #2) had EGB and RF. Two (#3 and #5) had RF and one (#4) had EGB.

Table 1. Summary of cases of glioma with HGF and RF/EGB
CaseDiagnosisGradeAge/SexPresentationImagingFollow-up
1PXAII-III16MAcute; 1 weekLeft frontal lobe enhancing mass9mo; stable
2Mixed tumor with glial and neurocytic featuresUncertain61FIncreasing headache 1 month4th ventricle complex cystic mass with peripheral enhancement1 mo; stable
3Glioma with pilocytic featuresIII33FRecent headache, seizureRight frontal lobe mass with decreased attenuation13 mo; stable
4*PXA*II-III*31M *Headache *Right frontal lobe enhancing mass *14 years; alive *
5AstrocytomaIII-IV29MMental status changesLeft frontal lobe mass6 years; recent status unknown
* indicates patient's age, presentation and follow-up from the 1st recurrence as grade III glioma (9 years after initial diagnosis of PA); mo: month


Conclusions: This study is a collection of gliomas with HGF showing the somewhat rare finding of numerous RF and EGB. While it is difficult to draw definitive conclusions from this small patient sample, 4 of the 5 patients were less than 35 years of age at diagnosis. This is at least 10 years younger than the mean for high grade gliomas. Additionally, most patients had stable follow-up, with the longest being more than 14 years after initial diagnosis. Such gliomas with HGF and RF/EGB could be a unique set of tumors that present acutely yet behave more indolently compared to the usual high grade gliomas.
Category: Neuropathology

Tuesday, March 1, 2011 1:00 PM

Poster Session IV # 232, Tuesday Afternoon

 

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