Comparison of Cytologic Features of Gangliogliomas on Crush Preparations.
Leonidas D Arvanitis, Richard L Cantley, Lisa Pitelka, Vijaya Reddy, Pincas Bitterman, Paolo Gattuso. Rush University Medical Center, Chicago, IL
Background: Gangliogliomas (GG) are well-differentiated, slowly growing neuroepithelial tumors composed of neoplastic, mature ganglion cells in combination with neoplastic glial cells. The histopathologic features of GG have been well described. However, the cytopathologic features have been sporadically reported in the literature mainly as single case reports. Because of the rarity of this lesion and the confusion with other low-grade astrocytic lesions on cytologic material we undertook a retrospectic study to investigate the cytologic features of this tumor on crush preparations.
Design: A retrospective search of the archives from our institution for a fourteen year period of time revealed a total of 15 cases of GG, all of which underwent frozen section examination with concomitant crush preparations, however cytologic material was available for eleven patients for review, which forms the basis of this study. The clinical and cytologic findings were reviewed.
Results: There were eleven males and four females (M:F, 3:1), ranging in age from 7 to 48 years with a mean age of 25.3 years. The anatomic locations were; temporal lobe (9), amygdala (2), cerebellum (1), hippocampus (1), parietal lobe (1) and frontal lobe (1). The most common clinical presentation was an incidental mass and intractable seizures. The initial frozen section interpretations were; low-grade glioma (4), GG (3), reactive astrocytosis (3), pleomorphic xanthomatous astrocytoma (3) and pilocytic astrocytoma (1), while one case was interpreted as negative. The majority of the tumors show hypercellular smears, predominantly fibrillary background, fine complex capillary background and scattered neuronal cells with eccentrically located nuclei with fine chromatin pattern, prominent nucleoli and indistinct cytoplasmic borders. Non-consistent cytologic features included microcalcifications, intranuclear cytoplasmic inclusions, eosinophillic bodies, binucleation and pilocytic appearance mimicking a pilocytic astrocytoma. Immunostaining was done on paraffin material in all cases using GFAP, Neu-N and synaptophysin and displayed expected results. Clinical outcome was available in all cases and patients are all alive without disease.
Conclusions: The intraoperative cytologic diagnosis of GG is possible. However, due to its rarity and highly variegated cytomorphologic appearance, it could often lead to a more generic diagnosis of “low-grade glioma, NOS”. The presence of dispersed neuronal cells with eccentrically located nuclei should raise the possibility of a GG. The main differential diagnosis includes pilocytic astrocytoma and other low-grade gliomas.
Wednesday, March 2, 2011 1:00 PM
Poster Session VI # 96, Wednesday Afternoon