ODG; Another brain tumor, mostly on frontal area but presumably the low grade as well as high grade in nature.

1. Start with the great name of ALLAH, the most
beneficial and the most Merciful

2. 45 year male presented with behavioral changes and Seizures.

3.  2-4 % of all primary brain tumor
 25-33% of glial tumors
 M:F ; 3: 2
 Average 40 years (peak B/w 26-46 year) with smallest
early childhood peak (b/w 6 -12 years)
 CSF metastasis; 10 %
 Spinal ODG; 2.6 % intra-medullary tumor
Oligodendroglial Tumor

4. Oligodendroglial Tumor
Presentation
 Seizures ; 50 – 80 %
 Headache; 22 %
 Mental status change; 10 %
 Vertigo/ nausea; 9 %
Location
 Supra-tentorial ; 90 %
 Frontal lobe; 45 %
 Hemisphere (except front); 40
%
 With in 3rd and lateral ventricle;
15%
 Infra-tentorial and spine; <10%

5.  Calcification; 90 % on CT scan
 T2 - weighted well circumscribed, homogeneously
hyper-intense
 T1 weighted, contrast enhanced, heterogenously hypo-
intense with no significant enhancement
 70 % calcified; hypo intense on T1 and T2, but micro
calcification can demonstrate hyperintense on T1
weighted
Radiological Presentation

7.  73% micro-calcification; 16 % cystic; 33- 41 % have
component of ependymal or neoplastic astrocytoma
 Penetrate intact parenchyma
 Fried egg appearance
 Chicken wire vascular pattern
 Round monotonous nuclei surrounding eccentric rim
of eosinophilic cytoplasm with lacked cell process
 GFAP staining; mostly for astrocyte component
Pathology

9.  WHO class II (low grade)
 WHO class III (High Grade)
 Smith grading System; compose of five variables
o N/c ratio
o Maximal cell density
o Pleomorphism; related to Survival
o Endothelial proliferation
o Necrosis
Grading System

11.  1p or 19 q or both allelic loss responses on
chemotherapy
 PVC; Procarbazine 60 mg/m2 IV, CCNU aka lomustine
110 mg/ m2 PO, Vincristine 1.4 mg/m2 all given on 29
days cycle repeated every 6 weeks.
Chemotherapy

12. Indication of surgery
 Significant mass effect regardless of grade
Without mass effect;
 low grade: gross total resection; improve survival
 High grade: no improvement in survival, either with
gross total or partial de bulking or biopsy
 Pink to red friable mass, can have false plane of
demarcation between tumor and normal brain
parenchyma
Surgery

13.  Controversial
 Survival is better with > 45 Gy
 No improvement in 5 year survival with or with out
XRT
Post operative Radiation

14.  Pure ODG have better outcome from astrocyte
component
 Median survival; grade A; 94 months, grade B; 51
months, grade C; 45 months and grade D; 17 months
 10 year survival; surgically treated mean 52 months
 Calcified; 108 months vs Non- calcified 58 month
 Frontal lobe; 37 months vs temporal lobe; 28 months
 Chromosome 1 p loss have longer survival
Prognosis

15. Thank you
Dr Muzammil