Chordoid Glioma : A Case Report of Unusual Location and Neuroradiological Characteristics

Kim, Jin Wook; Kim, Jae Hyoung; Choe, Gheeyoung; Kim, Chae-Yong

doi:10.3340/jkns.2010.48.1.62

Cited by 18 publications

(29 citation statements)

References 24 publications

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“…Ring enhancement was noted in 1 patient. [22] On T2 weighted MRI, CG frequently appeared as hyperintense or isointense lesions that were homogenously enhancing. Mixed signal intensity was noted in 3 patients.…”

Section: Resultsmentioning

confidence: 99%

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Prognostic factors for recurrence and complications in the surgical management of primary chordoid gliomas: A systematic review of literature

Ampie

Choy

Lamano

et al. 2015

Clinical Neurology and Neurosurgery

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Introduction Chordoid Gliomas (CG) are rare neoplasms which frequently arise within the third ventricle. Surgery remains the mainstay treatment for CG. The present study comprehensively reviews all reported cases of CG within the literature in order to identify risk factors for surgical complications and tumor recurrence. Methods A comprehensive search on MEDLINE (OVID and Pubmed), Scopus, Embase, and Web of Science was conducted following PRISMA guidelines to identify all reported cases of CG. Results A total of 81 patients met the study criteria, comprised of 33 males and 48 females. Median age at diagnosis was 48 years with a range from 5 to 72 years, and mean tumor size was 3.1 cm. Biopsy, subtotal resection (STR), and gross total resection (GTR) was achieved in 8, 34, and 33 patients, respectively, with 6 cases not reporting extent of eresection (EOR). Thirteen patients underwent adjuvant radiotherapy. Postoperative complications were noted in 30 cases (37%), with new onset diabetes insipidus being the most common. Postoperative morbidity was not associated with age, tumor size, or extent of resection. A trans-lamina terminalis approach demonstrated a strong trend towards decreased overall rates of postoperative morbidity compared to other approaches (p=0.051). GTR was associated with improved progression-free survival (PFS; p=0.028), while adjuvant radiotherapy, age, tumor size and MIB-I were not predictive of patient outcomes. Conclusion GTR should be the primary goal for the management of CG, as it is associated with improved rates of tumor control without an increased rate of postoperative complications. Surgical approach was a stronger predictor of complication rates than extent of resection. Morbidity remains high, and future studies to further elaborate on factors predictive of postoperative complications are critical.

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Section: Resultsmentioning

confidence: 99%

“…The most common surgical approaches described to resect CG include transcallosal in 7 [12, 29, 37, 43, 44, 50], transcortical in 5 [22, 31, 51, 52], and trans-lamina terminalis in 17 [4, 11, 13, 17, 20, 23, 42, 43, 46, 47, 53–55]. Surgical approach was not specified in 52 patients.…”

Section: Resultsmentioning

confidence: 99%

Prognostic factors for recurrence and complications in the surgical management of primary chordoid gliomas: A systematic review of literature

Ampie

Choy

Lamano

et al. 2015

Clinical Neurology and Neurosurgery

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“…Chordoid glioma is mainly located in the third ventricle or nearby structures, hence the name "Chordoid glioma of the third ventricle". Unusual locations without third ventricular association that have been reported are parieto-temporal region (3) and thalamic pulvinar area (5). The tumors arising in or involving the third ventricle, especially at the anterior part, are considered in the differential diagnosis for chordoid glioma (4).…”

Section: Discussionmentioning

confidence: 99%

A 29‐Year‐Old Man with Progressive Short Term Memory Loss

2013

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A 29-year-old man presented with a 1 year history of memory impairment. He had become somnolent and lethargic for 8 months before seeking medical attention. He needed to sleep over 20 hours per day. The physical examination and neurological examination were unremarkable. RADIOLOGYBrain MRI revealed a 5.7x4.3x4.2 cm in the third ventricle with isosignal intensity on T1W, heterogeneous signal on T2W and FLAIR (not shown). The mass showed intense heterogeneous enhancement on T1W after gadolinium injection. Extension to the suprasellar cistern was demonstrated on sagittal T1W after gadolinium injection ( Figure 1a). There was also thickening and enhancement of the pituitary stalk, suggestive of involvement or origin of hypothalamus. The coronal T1W after gadolinium injection showed separation of the mass from lateral ventricle ( Figure 1b). The inferior wall of the lateral ventricle was displaced upward as well as the septum pellucidum. SURGICAL TREATMENT AND POST OPERATIVE OUTCOMEThe patient underwent biopsy and later bifrontal craniotomy for tumor removal. Intraoperatively, the tumor appeared white and had rubbery to hard consistency. It was located in the third ventricle adhering to lamina terminalis and both thalami. There was low tumor vascularization. The tumor was totally resected. Postoperatively, the patient developed transient diabetes insipidus. There was no evidence of tumor recurrence on follow up MRI after 9 months of surgery. MICROSCOPIC PATHOLOGYIntraoperative squash preparation showed hypercellular smear with epithelioid tumor nests, non-cohesive tumor cells, and 3D papillary-like fragments (Figure 2a). The epithelioid tumor cells contained moderate amount of eosinophilic cytoplasm. They were relatively uniform and possessed round to oval, central or eccentric nuclei, with open chromatin and small nucleoli (Figure 2b). The non-cohesive tumor cells had delicate cytoplasmic process and show similar nuclear features (Figure 2c). Permanent section revealed a well demarcated mass composed of clusters and cords of epithelioid cells in a myxoid stroma with scattered lymphoplasmacytic infiltration (Figure 2d, Figure 2e). Rosenthal fibers are observed in adjacent brain parenchyma. Mitotic figure, necrosis, and vascular proliferation were not present. Higher magnification showed uniform to mildly variate (Figure 2f) epithelioid tumor cells with moderate to ample amount of eosinophilic cytoplasm in a myxoid stroma. Findings on nuclear detail were similar to those present in squash cytology. Immunohistochemically, the tumor cells were diffusely positive to GFAP (Figure 3a), and vimentin (not shown). Focal positivity to CD34 was noted (Figure 3b). Staining for S-100 protein and EMA were negative (not shown). Ultrastructural study on specimen retrieved from paraffinembedded tissue revealed microvilli (Figure 3c) at the luminal surface, and intermediate junctions (not shown). The cytoplasm contained mitochondria, ribosome, lysosome, and dilated rER. Intermediate filaments (Figure 3d) are noted in the cytoplasm of m...

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“…However, several recent ultrastructural studies have proposed an ependymal origin for these tumors (3,5,8). In the 3 cases studied by Cenacchi et al (8), the authors suggest that CGs may be an ependymoma subtype, based on the ultrastructural similarities between CGs and the specialized ependymal cells of the subcommissural organ, which is prominent during embryologic life but undergoes a progressive involution.…”

Section: Discussionmentioning

confidence: 99%

“…CG exclusively involves areas of the anterior portion of the third ventricle near the hypothalamus (2). The tumor is termed as "CG of the third ventricle" because of this stereotypical location, and only a few cases of extraventricular CG have been reported (3,4). To the best of our knowledge, 23 cases of suprasellar CG have been reported to date, including the current case.…”

Section: Introductionmentioning

confidence: 87%

Chordoid Glioma Originating in the Intrasellar and Suprasellar Regions: Case Report

Hwang

Lee

Chang

et al. 2015

Investig Magn Reson Imaging

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Chordoid glioma is a rare, low-grade brain neoplasm typically located in the third ventricle. Herein, we report an unusual case of histologically confirmed chordoid glioma located in the pituitary fossa and suprasellar region, not attached to the third ventricle. A 57-year-old woman presented with a 2-month history of headache and visual disturbance. Magnetic resonance imaging revealed an ovoid mass in the pituitary fossa and suprasellar region, compressing the optic chiasm without involvement of the third ventricle. The tumor showed low signal intensity on T1-weighted images and iso-to high signal intensity on T2-weighted images, with strong and homogenous contrast enhancement. Subtotal resection was performed via the transcranial approach, and the patient subsequently received adjuvant gamma knife radiosurgery. However, the residual mass showed disease progression 5 months after the initial surgery.

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Chordoid Glioma : A Case Report of Unusual Location and Neuroradiological Characteristics

Cited by 18 publications

References 24 publications

Prognostic factors for recurrence and complications in the surgical management of primary chordoid gliomas: A systematic review of literature

Prognostic factors for recurrence and complications in the surgical management of primary chordoid gliomas: A systematic review of literature

A 29‐Year‐Old Man with Progressive Short Term Memory Loss

Chordoid Glioma Originating in the Intrasellar and Suprasellar Regions: Case Report

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