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Updated: Dec 26 2021


  • Snapshot
    • A 47-year-old man presents to the emergency department complaining of a headache. His symptoms have been progressively worsening over the course of week. He does not have a past medical history of headaches and has noticed some weakness in his left upper extremity. Physical examination is notable for 4/5 power throughout the left upper extremity. MRI brain with gadolinium demonstrates a white matter mass lesion with patchy enhancement. Neurosurgery is consulted for surgical resection.
  • Introduction
    • Definition
      • malignant tumor arise from oligodendrocytes
        • most commonly affects the frontal and temporal lobe and is slow growing
    • Pathophysiology
      • genetic mutations lead to dysregulated and abnormal cellular proliferation
  • Epidemiology
    • Demographics
      • typically 25-45 years of age
  • Presentation
    • Symptoms/physical exam
      • clinical manifestations depend on where the tumor arises from
      • seizure
      • headaches
      • personality changes
  • Imaging
    • MRI brain with and without contrast
      • indication
        • imaging study of choice
      • findings
        • enhancing mass
          • calcifications are characteristic
          • absence of contrast enhancement does not exclude the diagnosis
  • Studies
    • Histopathology and molecular testing
      • indication
        • confirms the diagnosis
      • findings
        • histopathology
          • "fried egg" cellular appearance
            • round nuclei within a clear cytoplasm
        • molecular testing
          • IDH1 or IDH2 mutation and 1p/19q co-deletion
  • Differential
    • Other malignant brain neoplasm
      • differentiating factors
        • based on histological findings
          • e.g., glioblastomas will have pleomorphic tumor cells surrounding a central area of necrosis
  • Treatment
    • Surgical
      • resection
        • indication
          • initial step in management
            • obtain tissue for histopathology and molecular testing
            • radiation therapy and chemotherapy is typically given as well
  • Complications
    • Seizures
    • Neurological deficits
  • Prognosis
    • Poor
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