Anaplastic Oligodendroglioma Metastasized to Extraneural Sites
Extraneural metastases of malignant gliomas are rare. According to literature they tend to appear in glioblastoma patients. The rarity of metastases is attributed to the presence of blood brain barrier, absence of lymphatic vessels and short survival of the patients. Craniotomy, irradiation and ventriculoperitoneal shunting are supposed to enable the tumor cells access to extracranial sites. Metastatic dissemination in oligodendroglioma, a relatively uncommon primary brain tumor, is similarly rare and mostly occurs in patients with anaplastic oligodendroglioma. Patterns of metastatic spread in oligodendroglioma patients include lympho- and/or hematogenic pathways and dissemination via cerebrospinal fluid. Preferential sites of involvement are neck lymph nodes and spinal bones/bone marrow. The diagnosis of metastatic oligodendroglioma requires adequate clinical information and use of appropriate immunohistochemical markers with special regard to interpretation of both, positive and negative reactions.
New therapeutic approaches, prologing the already long overall survival of oligodendroglioma patients, could increase the risk of extracranial dissemination. In particular in patients with characteristic 1p19q loss of heterozygosity (LOH), present in most oligodendrogliomas, which is associated with response to chemotherapy and prolonged survival. However, regardless of histological grade and time to progression or characteristic LOH, the prognosis of metastatic oligodendroglioma remains poor. Although rare now, extraneural spread of anaplastic oligodendroglioma might in future become a less unusual complication, so it should be kept in mind. Particularly in cases with a clinical history of primary brain tumor, craniotomy and/or irradiation. Without this information the diagnosis is almost impossible.
KeywordsGlial Fibrillary Acid Protein Malignant Glioma Primary Brain Tumor Neck Lymph Node Bone Marrow Involvement
- Bailey P, Cushing P (1926) A classification of the tumors of the glioma group on histogenetic basis with correlated study of prognosis. J.B. Lippincott, PhiladelphiaGoogle Scholar
- Cairncross JG, Ueki K, Zlatescu MC, Lisle DK, Finkelstein DM, Hammond RR, Silver JS, Stark PC, Macdonald DR, Ino Y, Ramsay DA, Louis DN (1998) Specific genetic predictors of chemotherapeutic response and survival in patients with anaplastic oligodendrogliomas. J Natl Cancer Inst 90:1473–1479PubMedCrossRefGoogle Scholar
- Fecteau AH, Penn I, Hanto DW (1998) Peritoneal metastasis of intracranial glioblastoma via a ventriculoperitoneal shunt preventing organ retrieval. Case report and review of the literature. Clin Transpl 12:348–350Google Scholar
- Reifenberger G, Kros JM, Louis DN, Collins VP, von Deimling A (2007) Oligodendroglial tumors. In: Louis DN, Ohgaki H, Wiestler OD, Cavenee WK (eds) WHO classification of tumours of the central nervous system. World Health Organization Classification of Tumors, 4th edn. IARC Press, Lyon, pp 53–67Google Scholar
- Willis RA (1952) The spread of tumors in the human body, 2nd edn. Butterworth, LondonGoogle Scholar