Case 034

History/Physical

History/Physical:

47-year-old right-handed female.

Fatigue and nausea over the past three months. First seizure on the day of presentation.

There is asymmetric fullness of the right temporal pole (*).

There is no abnormal enhancement.

There is uncal herniation (arrow).

The lesion is hypointense on T1 (*).

The lesion extends posteriorly to the occipital lobe (arrows).

The lesion is much more conspicuous on FLAIR and T2 than on T1 (*).

On T2, CSF has high signal (arrows). Edema in the tumor is also hyperintense (*), though not quite as bright as CSF.

Diagnosis: Oligodendroglioma, IDH mutant, 1p/19q codeleted

Microcystic, fibrillary lesion with tendency for rounded nuclei.

Rounded tumour cell nuclei with moderate pleomorphism and occasional perinuclear halos.

Background reactive astroglia and select tumour minigemistocytes express glial fibrillary acidic protein (GFAP).
Additional studies reveal ATRX expression, IDH-1 (R132H) mutation and 1p/19q codeletion (not shown).