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Primary spinal cord anaplastic oligoastrocytoma presenting with paraplegia
23 Jeng-Hung Guo, MDa,c, Hsiang-Ming Huang, MDa,c, Yung-Chih Hsu, MDb,c, Der-Yang Cho, MD, PhDa,d 4
5 aDepartment of Neurosurgery, China Medical University Hospital, Taichung, Taiwan 6 bDepartment of Pathology, China Medical University Hospital, Taichung, Taiwan 7 cChina Medical University, Taichung, Taiwan
8 dGraduate Institute of Immunology, China Medical University, Taichung, Taiwan 9
10 11
12 Correspondence author: Hsiang-Ming Huang, MD
13 Department of Neurosurgery, China Medical University Hospital, No.2, Yude Rd., North Dist., Taichung 14 City 40447, Taiwan (R.O.C)
15 E-mail: [email protected] 16 Tel.: +886-937-891626
17 Fax.:+886-4-22052121 18
19 Keywords: spine; intramedullary; anaplastic oligoastrocytoma; paraplegia
20 21
22 A 43-year-old man presented with progressive bilateral leg weakness since 2 weeks. He had no 23 trauma history. Neurological examination revealed a muscle power of grade 3/5 in his lower limbs. His 24 lateral spinal radiograph showed no abnormality. Furthermore, spinal magnetic resonance imaging 25 revealed an intramedullary lesion at the T10-12 level. It appeared isointense on T1-weighted images (Fig. 26 1A) and mild hyperintense on T2-weighted images (Fig. 1B), and showed heterogeneous enhancement 27 after gadolinium administration (Fig. 1C). A T10-T12 laminectomy with intraoperative neuromonitoring 28 was performed. A soft, grey infiltrative tumor with indistinct margins was found (Fig. 2). A
29 histopathological examination confirmed the diagnosis of anaplastic oligoastrocytoma (Fig. 3A, 3B). 30 Postoperative adjuvant radiotherapy was administered. The magnetic resonance imaging of his brain 31 revealed no intracranial lesion. The strength of his lower limbs improved moderately at the 6-month 32 follow-up.
1 Oligoastrocytoma is a mixed glioma with distinct oligodendroglial and astrocytic components. It 2 arises preferentially in the cerebral hemispheres [1] and may disseminate through local, hematogenous, or 3 cerebrospinal fluid spread [2, 3, 4]. Primary spinal cord oligoastrocytoma is extremely rare, and few cases 4 have been reported [1, 5]. The codeletion of the chromosomal arms 1p and 19q in oligoastrocytoma is a 5 favorable genetic marker that predicts better response to treatment, and results in a significant survival 6 benefit [6, 7].
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8 References
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6 Figure legends
7 Fig. 1 Spinal magnetic resonance images demonstrating the intramedullary mass with isointensity on
8 T1-weighted images (A), mild hyperintensity on T2-weighted images (B), and heterogeneous 9 enhancement on T1-weighted images taken after contrast agent administration (C).
10 Fig. 2 A soft, grey infiltrative tumor with indistinct margins found intraoperatively.
11 Fig. 3 (A) An image of the tumor specimen showing a diffusely infiltrating glioma composed of
12 neoplastic oligodendrocytes intermingled with astrocytes in the fibrillary background. The
13 oligodendroglial component consists of round and uniform cells with characteristic perinuclear halos 14 (black arrows). The astrocytic component consists of star-shaped cells with indistinct cell borders and 15 small nuclei with changes indicating mild atypia (white arrows). (B) Focal area of the anaplastic change 16 showing high cellularity, nuclear atypia, and cellular pleomorphism. These findings are indicative of 17 anaplastic, high-grade glioma (WHO grade 3/4) (H&E, 400×).
