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Table of Contents    
LETTER TO EDITOR
Year : 2022  |  Volume : 70  |  Issue : 8  |  Page : 340-342

Symptomatic Spinal Intramedullary Metastasis (SIM) in a Postoperative Case of Low-Grade Intracranial Oligodendroglioma after Nine Years


1 Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
2 Department of Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Date of Submission24-Apr-2020
Date of Decision12-Jul-2020
Date of Acceptance26-Jul-2020
Date of Web Publication11-Nov-2022

Correspondence Address:
Kamlesh S Bhaisora
Assistant Professor, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.360919

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How to cite this article:
Attri G, Singh S, Kumar G K, Joseph J, Bhaisora KS, Srivastava AK, Jaiswal S, Behari S. Symptomatic Spinal Intramedullary Metastasis (SIM) in a Postoperative Case of Low-Grade Intracranial Oligodendroglioma after Nine Years. Neurol India 2022;70, Suppl S2:340-2

How to cite this URL:
Attri G, Singh S, Kumar G K, Joseph J, Bhaisora KS, Srivastava AK, Jaiswal S, Behari S. Symptomatic Spinal Intramedullary Metastasis (SIM) in a Postoperative Case of Low-Grade Intracranial Oligodendroglioma after Nine Years. Neurol India [serial online] 2022 [cited 2022 Dec 3];70, Suppl S2:340-2. Available from: https://www.neurologyindia.com/text.asp?2022/70/8/340/360919




Sir,

Spinal drop metastasis is common sequelae in high-grade like glioblastoma. However drop metastasis in a grade 2 oligodendroglioma (ODG) has been rarely reported. In literatureso far three cases have been reported on symptomatic spinal intramedullary metastasis (SIM) from low grade oilgodendroglioma.[1] We report an unusual case of a low-grade ODG, developed symptomatic intramedullary spinal cord metastasis after years.

A year-old male presented in 2010 with seizures and CT scan revealed a right frontal intracranial lesion [Figure 1]a he underwent resection, and histopathology was grade 2 oligodendroglioma [Figure 2]a, [Figure 2]b, [Figure 2]c, [Figure 2]d). Postoperatively 30 fractions of 54 Gy radiotherapy given but lost followup for chemotherapy.
Figure 1: (a) Pre operaperativenoncontrast CT head showing right frontal mass lesion and perilesional edema leading tosubfalcine herniation. (b) Postoperaperative CT head showing right frontal surgical cavity is communicating with right frontal horn with ventriculomegaly (c) the T2-weighted saggital section images showing lesion at C6 and D8-D9 vertebral level showing heterogenous contrast enhancement and cord edema. (d) T2-weighted axial section MRI at D8 vertebral level showing dorsally exophytic intramedullary contrast enhancing mass lesion. (e) T1-weighted axial contrast MRI brain showing pachymeningeal enhancement

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Figure 2: Photomicrograph showing section from frontal lobe lesion showing (×200; H&E) tumor disposed in sheets displaying round to oval nuclei, evenly distributed chromatin, indistinct nucleoli, and perinuclear clearing (a).On immunohistochemistry, tumor cells show Ki-67 < 1% (b; ×200), cytoplasmic isocitratedehydrogenease positivity (c; ×400) and retained nuclear ATRX expression (d; ×400).

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In 2018, he presented with features of raised intracranial pressure. CT head revealed communicating hydrocephalus, and ventriculoperitoneal shunt was done [Figure 1]b. MRI brain was planned, but lost follow up.

In 2019, he presented with progressive spastic paraparesis and MRI dorsal spine revealed a contrast enhancing dorsally exophytic intramedullary mass lesion at D8D9 vertebral body level [Figure 1]c and [Figure 1]d. Another lesion at C6 vetebral level, which was asymptomatic. Contrast-enhanced MRI brain showed pachymeningeal enhancement without evidence of local recurrence [Figure 1]e.He underwent D8-D9 laminectomy and decompression of tumor followed by radiotherapy and systemic chemotherapy. Histopathology showed anaplastic oligodendroglioma [Figure 3]a, [Figure 3]b, [Figure 3]c, [Figure 3]d and presently doing well at 1 year follow up.
Figure 3: Photomicrograph showing a section from spinal lesion showing (×200; H&E) tumor disposed in sheets displaying, monomorphous round to oval nuclei, evenly distributed chromatin, indistinct nucleoli, and perinuclear clearing (a). On immunohistochemistry (X200), tumor cells show Ki-67 < 1% (b), cytoplasmic isocitratedehydrogenease positivity (c) and retained nuclear ATRX expression (d).

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Incidence of CSF dissemination of oligodendroglioma is around 8.5-14%. Symptomatic spinal metastasis with macroscopic deposits has been reported in about 25 cases, with only seven of them being intramedullary [Table 1], and most of them were anaplastic.[1],[2]
Table 1: Reported cases of intramedullary spinal cord metastasis from intracranial oligodendroglioma

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The mechanism of intramedullary dissemination is unclear, and two theories have been postulated. One being spread through perivascular spaces, and the other direct invasion across leptomeningeal metastasis across pia. The second mechanism is more common, as leptomeningeal and intramedullary dissemination coexist in 27% of reported cases.[2],[3],[5],[6]

In our case, the initial surgical cavity was communicating with the lateral ventricle, which might have led to drop metastasis. The communicating hydrocephalus may be due to the leptomeningeal dissemination.

1p/19q and a lower rate of GFAP expression contribute to a higher tendency to spread into the CSF.[4] The SIM has poor overall survival, requiring adjuvant chemo-radiotherapy (cranio-spinal) and rehabilitation. In literature, none of them survived more than 2 years.[1],[2],[7],[8]

Spinal cord metastasis from low-grade oligodendroglioma is a rarity. Early detection and prompt treatment of spinal metastasis may prolong survival. Oligodendroglioma with ventricular extension, high proliferation index (Ki-67), and lower rate of GFAP expression should be evaluated thoroughly.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Natale M, Spennato P, Savarese L, Bocchetti A, Esposito S, Barbato R. Anaplastic oligodendroglioma presenting with drop metastases in the caudaequina. Clin Neurol Neurosurg 2005;107:417-20.  Back to cited text no. 1
    
2.
Elefante A, Peca C, Del Basso De Caro ML. Symptomatic spinal cord metastasis from cerebral oligodendroglioma.Neurol Sci 2012;33:609-13.  Back to cited text no. 2
    
3.
Godard J, Viennet G, Raul JS. Intramedullary spread of a cerebral oligodendroglioma. Two case reports.Neuro-Chirurgie 2000;46:558-562.  Back to cited text no. 3
    
4.
Onda K, Tanaka R, Takahashi H, Takeda N, Ikuta F. Cerebral glioblastoma with cerebrospinal fluid dissemination: Aclinicopathological study of 14 cases examined by complete autopsy. Neurosurgery 1989;25:533-40.  Back to cited text no. 4
    
5.
Singla R, Singh PK, Khanna G, et al. An institutional review of 10 cases of spinal hemangiopericytoma/solitary fibrous tumor. Neurol India 2020;68:448-453.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Gupta D, Shetty N, Shivaprasad A, et al. Rash Decisions in Neurology: A Case Report of Brachioradial Pruritus Secondary to Cervical Intramedullary Lesion. Neurol India 2021;69:1034-1036.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Dandpat SK, Tripathi M, Kaur G, Radotra BD, Joshi A, Mohindra S. Cervico Medullary Junction “Intramedullary Schwannoma” Masquerading As Glioma: A Surprise During Surgery. Neurol India 2021;69:1747-1752.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Singh AK, Sheikh AI, Pandey TK, Chabbra DK. Congenital Mobile Atlantoaxial Dislocation with Cervicomedullary Astrocytoma in Pediatric Patient. Neurol India 2021;69:194-197.  Back to cited text no. 8
[PUBMED]  [Full text]  


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