Case 2 History

Presented by:  Dr. Daryl Fourney, Neurosurgeon, Saskatoon

Age:  23   Sex: Female

History:

• Epilepsy for 10 years. 

• Presented with headache/meningism in April 1998. 

• Progressively drowsy after LP.

Pre-op CT head

April 10, 1998

Diagnosis:  Oligodendroglioma  

Treatment:

•  Craniotomy and resection of tumor

•  Radiotherapy (5400 cGy 30 fractions) May 1988

Histology:  WHO grade III Oligodendroglioma

Histology Slides

Fried egg 1998	Anaplasia 1998

Post-op CT head

April 11, 1998.  Some residual tumor

July 2000:  She presented with increased headaches over a 3 month period.  CT showed progression of disease.

Pre-op CT head

July 6, 2000

Treatment:

• Repeat craniotomy and excision of tumor Aug, 2000
•  PCV chemotherapy.  She completed 5 cycles, but developed neutropenia.
  
  

Histology Slides

high cellularity 2000	anaplasia 2000

Pathology essentially unchanged.  No deletions of 1p or 19q.

Post-op CT head

August 10, 2000.  Some residual tumor

Pre-op CT head

October 29, 2002

December 2002:  Progression of disease on MRI, evidence of new involvement of the frontal lobe, and questionable areas of enhancement.  Some slurred speech, word-finding difficulties, and memory problems.

Treatment:
 Awake craniotomy and resection with speech mapping.

Histology Slides

Diagnosis:  Pathology WHO grade II oligodendroglioma.

Jan 23, 2003

Questions:

• Surviving clone actually a less anaplastic oligodendroglioma?  
• Repeat genetic analysis has been requested.
• Try further chemotherapy (Temodar)?