Atormac
brintellex
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 2457  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  » Next article
  » Previous article 
  » Table of Contents
  
 Resource Links
  »  Similar in PUBMED
 »  Search Pubmed for
 »  Search in Google Scholar for
 »Related articles
  »  Article in PDF (146 KB)
  »  Citation Manager
  »  Access Statistics
  »  Reader Comments
  »  Email Alert *
  »  Add to My List *
* Registration required (free)  

 
  In this Article
 »  Abstract
 »  Case Report
 »  Discussion
 »  References
 »  Article Figures

 Article Access Statistics
    Viewed5600    
    Printed92    
    Emailed7    
    PDF Downloaded217    
    Comments [Add]    
    Cited by others 22    

Recommend this journal

 


 
CASE REPORT
Year : 2007  |  Volume : 55  |  Issue : 4  |  Page : 406-407

An incidentally detected third ventricle chordoid glioma


Department of Neurosurgery and Human Pathology, University of Florence, Florence, Italy

Date of Acceptance12-Feb-2007

Correspondence Address:
Pasquale Gallina
Department of Neurosurgery, University of Florence, CTO Hospital, 1, Largo P. Palagi, 50139 - Florence
Italy
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.33301

Rights and Permissions

 » Abstract 

Chordoid glioma is a rare low-grade tumor located in the third ventricle-hypothalamic region. Since its first report, 37 cases have been described in the literature. We report on an additional case that we considered significant because of its incidental detection and its uneventful surgical removal.


Keywords: Brain surgery, chordoid glioma, immunohistochemistry, third ventricle


How to cite this article:
Gallina P, Pansini G, Mouchaty H, Mura R, Buccoliero AM, Lorenzo ND. An incidentally detected third ventricle chordoid glioma. Neurol India 2007;55:406-7

How to cite this URL:
Gallina P, Pansini G, Mouchaty H, Mura R, Buccoliero AM, Lorenzo ND. An incidentally detected third ventricle chordoid glioma. Neurol India [serial online] 2007 [cited 2020 Jul 12];55:406-7. Available from: http://www.neurologyindia.com/text.asp?2007/55/4/406/33301


Chordoid glioma (CG) of the third ventricle is a rare low-grade tumor described for the first time by Brat in 1998 as a distinct clinical-pathological entity. [1] The histopathological features of CG are consistent with a slowly growing neoplasm, thus successfully curable by surgery. However, due to its anatomical neighborhood, its prognosis is comparatively poor.


 » Case Report Top


A previously healthy 56-year-old woman was admitted after a head injury due to a road accident. Physical and neurological examination was unremarkable. Routine computerized tomography (CT) scans revealed a circumscribed, round, hypodense suprasellar mass. No hydrocephalus was detected. On contrast-enhanced magnetic resonance (MR) imaging, the lesion appeared well-circumscribed, solid and homogeneously enhanced without signs of mass effect [Figure - 1]. Despite the little size of the lesion and the absence of neurological signs or symptoms and considering the advantage of obtaining histopathological diagnosis, surgical removal was proposed. A right fronto-temporal craniotomy was performed, the Sylvian fissure was split to expose the chiasmatic region and then the suprasellar cistern was widely opened. The nodule, located between the optic nerves, was first gently dissected from the chiasm and the right optic nerve. Once isolated from the antero-superior wall of the third ventricle, it was removed "en bloc". The postoperative course was totally uneventful. Particularly, no signs of hypothalamic dysfunctions were observed. Postoperative MR imaging confirmed complete removal of the lesion and no further therapy was recommended. At the 48-month follow-up, the patient remained asymptomatic and MR imaging showed complete anatomical normalization of the area [Figure - 2].

Histopathological findings

The lesion presented a fibrous capsule, sharply demarcating it from the parenchyma. It consisted of clusters and cords of epithelioid cells with abundant eosinophilic cytoplasm and isomorphous nuclei. Abundant lymphoplasmacytic infiltration was appreciable, particularly at the tumor-parenchyma interface. The lesion did not show necrosis and the mitoses were exceptional. Immunohistochemically, the tumor cells showed diffuse expression of glial fibrillary acidic protein (GFAP), neurofilaments (NF), vimentin (VIM), CD34 and a weaker expression of neuron specific enolase (NSE) [Figure - 3].


 » Discussion Top


In the last revised edition of the WHO classification of the nervous system tumors (2000), CG has been incorporated under the category of glial tumors of uncertain origin. [2] It typically shows chordoma-like histological features and glial fibrillary acid immunoreactivity; it mainly occurs in middle-aged women and is usually found in the hypothalamic-suprasellar-third ventricle region. Chordoid glioma is usually revealed by signs of obstructive hydrocephalus, visual field loss, endocrine abnormalities and/or personality changes. Due to its small size and thus absence of compression on the neighboring structures, the lesion in the described case represents the only reported CG of incidental detection.

The precise anatomic origin of the lesion remains unclear but according to other authors the chordoid glioma seems to rise from the vicinity of the lamina terminalis and infundibular recess and such a hypothesis has been confirmed in our case by the anatomical exposure at the surgical time. [3]

Three cases described in the literature underwent a biopsy (open surgery, stereotaxy, endoscopy). All the CG lesions described in the literature were surgically treated through different approaches: pterional, interemispheric (trans lamina terminalis) and less frequently transcallosal or transphenoidal (in the latter case the lesion was initially taken for a pitituary adenoma). From the reports in which treatment and follow-up are available, in only 17 cases (including ours) complete removal was achieved. [4],[5] Eight of these cases presented postoperative complications including severe hypothalamic disturbances that were transitory in five and lethal in three. In this group, within a 6-68 month follow-up, no cases of recurrence were observed and no adjuvant therapy was followed. Of 17 patients who underwent only partial surgical removal of the lesion seven presented complications that were lethal in two cases and transitory in five. In four of these cases the remnant was treated with external radiotherapy, with radiosurgery in three cases and in one case, the patient underwent re-surgery, external radiotherapy and radiosurgery. Within this group of partially removed lesions, six patients are well after a 9-42 month follow-up, while two died independently from the CG.

The CG radical removal that represents the recommended treatment is not easily reachable because of the strict closeness of critical structures. Moreover, surgery, also in cases of subtotal removal, often presents complications, even death. External radiotherapy does not seem to give benefits while the role of radiosurgery cannot be evaluated as it was practiced only in one case on the residue after surgery. Our case represents a relatively small asymptomatic tumor, and should support the early removal of lesions of the third ventricle needing diagnostic confirmation.

 
 » References Top

1.Brat DJ, Scheithauer BW, Staugaitis SM, Cortez SC, Brecher K, Burger PC. Third ventricular chordoid glioma: A distinct clinicopathologic entity. J Neuropathol Exp Neurol 1998;57:283-90.  Back to cited text no. 1  [PUBMED]  
2.Brat DJ, Scheithauer BW, Cortez SC, Reifenberger G. Chordoid glioma of the third ventricle. In : Kleihuis P, Cavenee WK, editors. Pathology and genetics: Tumours of the Nervous System. World Health Organization Classification. International Agency for Research on Cancer Press: Lyon; 2000. p. 90-1.  Back to cited text no. 2    
3.Leeds NE, Lang FF, Ribalta T, Sawaya R, Fuller GN. Origin of chordoid glioma of the third ventricle. Arch Pathol Lab Med 2006;130:460-4.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Raizer JJ, Shetty T, Gutin PH, Obbens EA, Holodny AI, Antonescu CR, et al . Chordoid glioma: Report of a case with unusual histologic features, ultrastructural study and review of the literature. J Neurooncol 2003;63:39-47.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Nakajima M, Nakasu S, Hatsuda N, Takeichi Y, Watanabe K, Matsuda M. Third ventricular chordoid glioma: Case report and review of the literature. Surg Neurol 2003;59:424-8.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]

This article has been cited by
1 Freiburg Neuropathology Case Conference
C. A. Taschner,P. Süß,M. Hohenhaus,H. Urbach,N. Lützen,M. Prinz
Clinical Neuroradiology. 2018; 28(1): 139
[Pubmed] | [DOI]
2 Chordoid glioma of the third ventricle: a patient presenting with SIADH and a review of this rare tumor
Matilde Calanchini,Simon Cudlip,Monika Hofer,James Byrne,Andrea Fabbri,Ashley Grossman
Pituitary. 2016;
[Pubmed] | [DOI]
3 Prognostic factors for recurrence and complications in the surgical management of primary chordoid gliomas: A systematic review of literature
Leonel Ampie,Winward Choy,Jonathan B. Lamano,Kartik Kesavabhotla,Qinwen Mao,Andrew T. Parsa,Orin Bloch
Clinical Neurology and Neurosurgery. 2015; 138: 129
[Pubmed] | [DOI]
4 Therapeutic approach to chordoid glioma of the third ventricle
Kobayashi, T. and Tsugawa, T. and Hashizume, C. and Arita, N. and Hatano, H. and Iwami, K. and Nakazato, Y. and Mori, Y.
Neurologia Medico-Chirurgica. 2013; 53(4): 249-255
[Pubmed]
5 Chordoid glioma of the third ventricle: Four cases including one case with papillary features
Ni, H.-C. and Piao, Y.-S. and Lu, D.-H. and Fu, Y.-J. and Ma, X.-L. and Zhang, X.-J.
Neuropathology. 2013; 33(2): 134-139
[Pubmed]
6 Chordoid glioma of the third ventricle: Four cases including one case with papillary features
Hai-Chun Ni,Yue-Shan Piao,De-Hong Lu,Yong-Juan Fu,Xiao-Li Ma,Xiao-Juan Zhang
Neuropathology. 2013; 33(2): 134
[Pubmed] | [DOI]
7 Chordoid glioma of the third ventricle: A case report with review of literature
Vij, M. and Jaiswal, S. and Jaiswal, A. and Jain, M. and Behari, S.
Neurology India. 2011; 59(3): 469-471
[Pubmed]
8 CD99 is expressed in chordoid glioma and suggests ependymal origin
Alfredo E. Romero-Rojas, Julio A. Díaz-Pérez, Lina M. Ariza-Serrano
Virchows Archiv. 2011;
[VIEW] | [DOI]
9 Chordoid glioma: A case report and literature review
Liu, W.-P., Cheng, J.-X., Yi, X.-C., Zhen, H.-N., Fei, Z., Li, Q., Zhang, X.
Neurologist. 2011; 17(1): 52-56
[Pubmed]
10 Chordoid glioma: A case report of unusual location and neuroradiological characteristics
Kim, J.W. and Kim, J.H. and Choe, G. and Kim, C.
Journal of Korean Neurosurgical Society. 2010; 48(1): 62-65
[Pubmed]
11 Chordoid glioma: Ten years of a low-grade tumor with high morbidity
DeSouza, R.-M., Bodi, I., Thomas, N., Marsh, H., Crocker, M.
Skull Base. 2010; 20(2): 125-138
[Pubmed]
12 Chordoid Glioma : A Case Report of Unusual Location and Neuroradiological Characteristics
Jin Wook Kim,Jae Hyoung Kim,Gheeyoung Choe,Chae-Yong Kim
Journal of Korean Neurosurgical Society. 2010; 48(1): 62
[Pubmed] | [DOI]
13 Chordoid glioma with calcification and neurofilament expression: case report and review of the literature (Iwami et al. Surg Neurol 2008;10.1016/j.surneu.2007.07.032)
Kim, C.H.
Surgical Neurology. 2009; 72(5): 554-555
[Pubmed]
14 Chordoid glioma: A case report and molecular characterization of five cases
Abstract + Refs Full Text (opens in new window) Show Abstract Horbinski, C., Dacic, S., McLendon, R.E., Cieply, K., Datto, M., Brat, D.J., Chu, C.T.
Brain Pathology. 2009; 19(3): 439-448
[Pubmed]
15 Chordoid glioma with calcification and neurofilament expression: case report and review of the literature (Iwami et al. Surg Neurol 2008;10.1016/j.surneu.2007.07.032)
Choong Hyun Kim
Surgical Neurology. 2009; 72(5): 554
[Pubmed] | [DOI]
16 Glioma cordoide del III ventrículo: descripción de un nuevo caso y revisión de la literatura
Belén Ferri-Ñíguez,M. Amparo Torroba-Carón,Joaquín Sola-Pérez,Claudio Piqueras-Pérez
Revista Española de Patología. 2009; 42(3): 214
[Pubmed] | [DOI]
17 Radiologic features of the chordoid glioma: A report of three cases
Jia, C.-H. and Lu, G.-M. and Zhu, Z.-M. and Xu, Y. and Bai, Z.-J. and Huang, Q.-L. and Zhang, Z.-J. and Zhang, F.
Chinese Journal of Radiology. 2009; 43(11): 1139-1141
[Pubmed]
18 Chordoid glioma of the third ventricle: Case report and literature review [Glioma cordoide del III ventrículo: Descripción de un nuevo caso y revisión de la literatura]
Ferri-íguez, B. and Amparo Torroba-Carón, M. and Sola-Pérez, J. and Piqueras-Pérez, C.
Revista Espanola de Patologia. 2009; 42(3): 214-220
[Pubmed]
19 Chordoid Glioma: A Case Report and Molecular Characterization of Five Cases
Craig Horbinski,Sanja Dacic,Roger E. McLendon,Kathy Cieply,Michael Datto,Daniel J. Brat,Charleen T. Chu
Brain Pathology. 2009; 19(3): 439
[Pubmed] | [DOI]
20 Chordoid glioma of the third ventricle attached to the optic chiasm. Successful removal through a trans-lamina terminalis approach
Carrasco, R., Pascual, J.M., Reina, T., Nieto, S., Linera, J., Sola, R.G.
Clinical Neurology and Neurosurgery. 2008; 110(8): 828-833
[Pubmed]
21 Chordoid glioma of the third ventricle
D. J. Vanhauwaert, F. Clement, J. Dorpe, M. J. Deruytter
Acta Neurochirurgica. 2008; 150(11): 1183-1191
[Pubmed] | [DOI]
22 Chordoid glioma of the third ventricle attached to the optic chiasm
Rodrigo Carrasco,Jose M. Pascual,Teresa Reina,Santiago Nieto,Juan Linera,Rafael G. Sola
Clinical Neurology and Neurosurgery. 2008; 110(8): 828
[Pubmed] | [DOI]



 

Top
Print this article  Email this article
Previous article Next article
Online since 20th March '04
Published by Wolters Kluwer - Medknow