Sanjeeb Kumar Sarma ( Down Town Hospital/ Guwahati/ India)  

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6 Years  

Female  

Head-Brain and brain nerves  

neoplastic  

Six year old female child presenting with on and off headache since last 6 to 7 months. Parents also observed a few episodes of seizures in last two months.  

Oligodendrogliomas are uncommon gliomas. They arise from a specific type of glial cells, the oligodendrocytes, that make and maintain the CNS myelin. They are typically white matter tumors that may extend into the cortex and leptomeninges. Oligodendrogliomas comprise 2 - 5% of all primary brain tumors and 5 - 10% of gliomas. Adults are more affected than children (8:1), peak age being 35-45 years. Although they can be found anywhere, the most common site being the frontal lobes.
On plain X-ray of skull calcifications may be seen if the tumor is densely calcified. Angiographycally this tumor is avascular or faintly vascular that shows focal stretching and draping of cortical vessels around the lesion in low grade type, whereas the malignant ones may have significant vascularity. Oligodendrogliomas are the most common intracranial tumors to calcify. Non-contrast CT scans show a partially calcified (70-90% of all cases show calcification) mixed density hemispheric mass that extends peripherally to the cortex. Scalloped erosion of the inner table is seen in some larger masses. Cystic degeneration is common but frank intra-tumoral hemorrhage and edema is distinctly uncommon. Mild to moderate enhancement after intravenous contrast is seen in two third of cases. MR scans show mixed hypo- and isointense areas on T1W1 and hyperintense foci on T2 weighted sequences. Enhancement is typically patchy and moderate.
Treatment is surgical removal of the mass.
 

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CT 1: CT scannogram showing tumoral calcifications (white arrow) and pressure effect over inner calvarial table (black arrow) of right parietal bone.




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CT 2: Axial non-contrast CT section showing iso to slightly hyperdense mass with both solid (white arrow) and cystic (black arrow) components. The tumor measures 65x55x40 mm in its widest diameters.





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CT 3: Axial non-contrast CT section showing multiple cystic components within the tumor (black arrows).No intra tumoral hemorrhage seen





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CT 4: Axial non-contrast CT section showing tumoral calcifications ( black arrow).





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CT 5: Axial contrast CT section showing mild to moderate non-homogenous enhancement of solid component of the tumor.





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CT 6: Axial contrast CT section showing the same mass at a higher level in the right parietal lobe.





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CT 7: Axial CT section in bone window showing clearly the erosion (black arrow) of inner table of right parietal bone and tumoral calcifications (white arrow).




 

Surgery / Histo  

Astrocytoma  

Most oligodendrogliomas are slow growing neoplasms; only a minority cases are anaplastic. Tumor grade is the single most important prognostic factor. Patients with low grade lesions have 5 and 10 year survival rates of 74% and 46% respectively, whereas these rates reduced to 41% and 20% for grade 3 and grade 4 tumors.  

Though oligodendroglioma is not uncommon in adults, however it is distinctly rare in pediatric age group. This is a biopsy proven case and is of low grade type. Patient was clinically well postoperatively and was advised to come for follow up.  

N/A  

Diagnostic Neuroradiology by Anne G. Osborn (Mosby)- chapter 13- Astrocytomas and other glial neoplasms P- 563-566.  

Oligodendroglioma, glioma, supratentorial mass, calcified cerebral mass, child, childhood, pediatric radiology  

Sanjeeb Kumar. Oligodendroglioma:presenting as supratentorial cerebral mass in a child. PedRad [serial online] vol 9, no. 5.
URL: www.PedRad.info/?search=20090528153613