Email updates

Keep up to date with the latest news and content from Diagnostic Pathology and BioMed Central.

Open Access Case Report

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

Gang Li1, Zhiguo Zhang1, Jianghong Zhang1, Tianbo Jin2, Hongjuan Liang1, Li Gong3, Guangbin Cui4, Haixia Yang1, Shiming He1, Yongsheng Zhang5* and Guodong Gao1*

Author Affiliations

1 Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi’an 710038, P.R China

2 National Engineering Research Center for Miniaturized Detection Systems, School of Life Sciences, Northwest University, Xi’an 710069, P.R China

3 Department of Pathology, Tangdu Hospital, Fourth Military Medical University, Xi’an 710038, P.R China

4 Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi’an 710038, P.R China

5 Department of Administrative, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, P.R. China

For all author emails, please log on.

Diagnostic Pathology 2014, 9:17  doi:10.1186/1746-1596-9-17

Published: 21 January 2014

Abstract

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 webcite.

Keywords:
Oligodendroglioma; Extracranial metastasis; Autopsy; 1p/19q; Chromosome deletions; Genetic analysis