Glioblastoma with Oligodendroglioma Component (GBMO) in an adolescent: a case report
Background:Glioblastoma with oligodendroglioma component (GBMO) is a recently classified subtype of glioblastoma, which carries different clinical and prognostic outcomes, being frequently misdiagnosed. Both glioblastoma and GBMO are mainly seen in older ages, such as the 5th and 6th decades of life, being an extremely rare occurrence in children or adolescents and more frequent in male patients.
Case report: A 15-year-old girl, presented with history of daily headache, not relieved by painkillers, vomiting, blurred vision and strabismus. Magnetic resonance imaging of the brain revealed expansive tumour on left temporo-occipital lobe. Patient was submitted to intracranial exeresis, along with histopathological examination: glial neoplasm with areas of pleomorphism, hyperchromatism, anaplasia, foci of oligodendroglial component, perinuclear halo and ramified capillaries, resembling oligodendroglioma, necrosis and intense mitotic activity. The immunohistochemical analysis revealed positive Glial Fibrillary Acidic Protein (GFAP), synaptophysin, Ki-67 (MindBomb E3 ubiquitin protein ligase 1 – MIB-1)and hyperexpression of Epidermal Growth Factor Receptor (EGFR), indicating GBMO. Subsequently, Fluorescence in situ Hybridization (FISH) showed 1p/19q codeletion and Isocitrate Dehydrogenase 1 (IDH 1) mutation, suggesting an oligodendroglioma component. Tumour resection was total and symptoms disappeared. Afterwards, she started adjuvant oral chemotherapy with temozolomide. Treatment was completed nine months after the diagnosis, with no greater symptoms or complications and complete remission.
Conclusion: GBMO must be considered as a possible diagnosis when confronted with a malignant glioma with oligodendroglial tumour component, independent of age or genre. Necrosis upon histopathological examination has a strong relation to shorter median overall survival. IDH mutation and 1p/19q codeletion should be analyzed by immunohistochemistry. Total tumour resection, with adjuvant treatment (chemotherapy with temozolomide and radiotherapy), increases benefits and improves prognosis.
2. Louis DN, Perry A, Reifenberger G, Deimling AV, Figarella-Branger D, Cavenee WK, et al. The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol. 2016; doi:10.1007/s00401-016-1545-1.
3. Myung JK, Cho HJ, Kim H, Park CK, Lee SH, Choi SH, et al. Prognosis of Glioblastoma with oligodendroglioma component is associated with the IDH1 Mutation and MGMT Methylation Status. Transl Oncol. 2014; doi: 10.1016/j.tranon.2014.10.002.
4. Appin CL, Gao J, Chisolm C, Torian M, Alexis D, Vincentelli C, et al. Glioblastoma with oligodendroglioma component (GBM-O): molecular genetics and clinical characteristics. Brain Pathol. 2013; doi: 10.1111/bpa.12018.
5. Elmahdi A, Frary AJ, Scotton WJ, O'Donovan DG, Price SJ. Glioblastomas with oligodendroglial component have the same clinical phenotype as classical glioblastomas. Br J Neurosurg. 2013; doi: 10.3109/02688697.2013.767315.
6. Karsy M, Gelbman M, Shah P, Balumbu O, Moy F, Arsian E. Established And Emerging Variants Of Glioblastoma Multiforme: Review Of Morphological And Molecular Features. Folia Neuropathol. 2012; doi: 10.5114/fn.2012.32361.
7. Lobão CAF., Barbosa AS, Nogueira J, Aversa A. Cerebellar glioblastoma mutiforme in an adult. Arq Neuro-Psiquiatr. 2008;66(4):879-80.
8. Borgo MCM, Pereira JLB, Lima FBF, Brandão RACS, Carvalho GTC, Costa BS. Glioblastoma multiforme in childhood: a case report. Clinics. 2010;65(9):923-5.
9. Salvati M, Formichella AI, D’Elia A, Brogna C, Frati A, Giangaspero F, et al. Cerebral glioblastoma with oligodendrogliomal component: analysis of 36 cases. J Neurooncol. 2009;94:129-134.
10. Miller CR, Perry A. Glioblastoma. Arch Pathol Lab Med. 2007;131(3):397-406
11. Pinto LW, Araujo MB, Vettore AL, Wernersbach L, Leite AC, Chimelli LM, et al. Glioblastomas: correlation between oligodendroglial components, genetic abnormalities, and prognosis. Virchows Arch. 2008; doi: 10.1007/s00428-007-0562-9.
12. Klink B, Schlingelhof B, Klink M, Stout-Weider K, Patt S, Schrock E. Glioblastomas with oligodendroglial component - common origin of the different histological parts and genetic subclassification. Anal Cell Pathol (Amst). 2010; doi: 10.3233/ACP-CLO-2010-0530.
13. Sathornsumetee S, Reardon DA, Desjardins A, Quinn JA, Vredenburgh JJ, Rich JN. Molecularly targeted therapy for malignant glioma. Cancer. 2007; doi: 10.1002/cncr.22741.
14. Furnari FB, Fenton T, Bachoo RM, Mukasa A, Stommel JM, Stegh A, et al. Malignant astrocytic glioma: genetics, biology and paths to treatment. Genes Dev. 2007; doi: 10.1101/gad.1596707.
15. Quick A, Patel D, Hadziahmetovic M, Chakravarti A; Mehta M. Current therapeutic paradigms in glioblastoma. Rev Recent Clin Trials. 2010; doi: 10.2174/157488710790820544.
16. Olson JJ, Nayak L, Ormond DR, Wen PY, Kalkanis SN, AANS/CNS Joint Guidelines Committee. The role of cytotoxic chemotherapy in the management of progressive glioblastoma: a systematic review and evidence based clinical practice guideline. J Neurooncol. 2014; doi: 10.1007/s11060-013-1338-5.
17. Stupp R, Mason WP, Van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005; doi: 10.1056/NEJMoa043330.
18. Stupp R, Hegi ME, Mason WP, Van den Bent MJ, Taphoorn MJ, Janzer RC, et al. Effects of radiotherapy with concomitant and adjuvant temozoloide versus radiotherapy alone on survival in glioblastoma in a randomized phase III study: 5 years analysis of the EORTC-NCIC trial. Lancet Oncol. 2009; doi: 10.1016/S1470-2045(09)70025-7.
19. Wang Y, Li S, Chen L, You G, Boa Z, Yan W, et al. Glioblastoma with an oligodendroglioma component: distinct clinical behavior, genetic alterations, and outcome. Neuro Oncol. 2012; doi: 10.1093/neuonc/nor232.
20. Aldape K, Burger PC, Perry A. Clinicopathologic aspects of 1p/19q loss and the diagnosis of oligodendroglioma. Arch Pathol Lab Med. 2007;131(2):242-51.
21. Kouwenhoven MC, Gorlia T, Kros JM, Brandes AA, Bromberg JE, Mokhtari K, et al. Molecular analysis of anaplastic oligodendroglial tumors in a prospective randomized study: A report from EORTC study 26951. Neuro Oncol. 2009; doi: 10.1215/15228517-2009-011.
22. Scoccianti S, Magrini SM, Ricardi U, Detti B, Buglione M, Sotti G, et al. Patterns of care and survival in a retrospective analysis of 1059 patients with glioblastoma multiforme treated between 2002 and 2007: a multicenter study by the Central Nervous System Study Group of Airo (italian Association of Radiation Oncology). Neurosurgery. 2010; doi: 10.1227/01.NEU.0000371990.86656.E8.
23. He J, Mokhtari K, Sanson M, Marie Y, Kujas M, Huguet S, et al. Glioblastomas with an oligodendroglial component: a pathological and molecular study. J Neuropathol Exp Neurol. 2001;60(9):863-71.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright policies & self-archiving
We are a RoMEO green journal.
Author's Pre-print: author can archive pre-print (ie pre-refereeing)
Author's Post-print: author can archive post-print (ie final draft post-refereeing)
Publisher's Version/PDF: author can archive publisher's version/PDF
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access and Benefits of Publishing Open Access).
This journal provides immediate open access to its content on the principle that making research freely available to the public supports a greater global exchange of knowledge.
Articles are published Under License of Creative Commons Attribution 4.0 License ©