MULTIFOCAL COMPLEX GLIONEURONAL TUMOR IN AN ELDERLY MAN: AN ... : Neurosurgery (original) (raw)

CASE REPORTS

AN AUTOPSY STUDY

CASE REPORT

Lu, Jian-Qiang M.D.; Scheithauer, Bernd W. M.D.; Sharma, Pranshu M.D.; Scott, James N. M.D.; Parney, Ian F. M.D.; Hader, Walter M.D.; Burger, Peter C. M.D.; Clark, Arthur W. M.D.

Department of Pathology, Foothills Medical Centre, University of Calgary, Calgary, Canada (Lu) (Clark)

Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Scheithauer)

Department of Radiology, Foothills Medical Centre, University of Calgary, Calgary, Canada (Sharma) (Scott)

Department of Clinical Neurosciences, Foothills Medical Centre, University of Calgary, Calgary, Canada (Parney) (Hader)

Department of Pathology, Johns Hopkins University, Baltimore, Maryland (Burger)

Reprint requests: Arthur W. Clark, M.D., Department of Pathology, Foothills Medical Centre, University of Calgary, 1403 - 29th Street, NW, Calgary, Alberta, T2N 2T9, Canada. Email: [email protected]

Received, June 26, 2008.

Accepted, December 19, 2008.

Abstract

OBJECTIVE

The clinicopathological spectra of a dysembryoplastic neuroepithelial tumor (DNT) and a rosette-forming glioneuronal tumor (RGNT) are expanding. We report here the autopsy findings of a case of complex glioneuronal tumor with combined histological features of both a DNT and an RGNT.

CLINICAL PRESENTATION

A 79-year-old man presented with a 1-month history of confusion and gait difficulties. A magnetic resonance imaging scan revealed obstructive hydrocephalus attributed to a mass in the posterior third ventricle.

INTERVENTION

A third ventriculostomy was performed. Postoperatively, the mass remained unchanged in size for more than 14 months. Thirty-eight months after his initial manifestations, he experienced minor head trauma and was then hospitalized. Despite placement of an external ventricular drain and other supportive treatment, he deteriorated and died. A full autopsy was performed, with emphasis on the brain. The mass lesion and a few independent microfoci situated primarily around the third ventricle showed histological features of pilocytic astrocytoma with recurrent hemorrhage. Far more numerous were microfoci with histological features of a DNT, including floating neurons, as well as typical RGNT-associated, synaptophysin-positive rosettes and perivascular pseudorosettes.

CONCLUSION

The advanced age of the patient, the coexisting histological features of the DNT and RGNT, and the distinctive anatomic distribution of the lesions, being centered on the third ventricle, may lend insight into the histogenetic relationship of a DNT, an RGNT, and mixed glioneuronal tumors.