Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, P,R China.
Diagn Pathol. 2014 Jan 21;9:17. doi: 10.1186/1746-1596-9-17.
It is generally believed that malignant gliomas never metastasize outside the central nervous system (CNS). However, the notion that oligodendrogliomas (OGDs) cells cannot spread outside CNS is being challenged.
We described in detail the clinical story of one patient with anaplastic OGD, which metastasized to lymph nodes, bone marrowand bones Genetic analyses included detection of 1p and 19q chromosomal arms, methylation status of MGMT promoter, and PTEN exon mutations. A search of worldwide literature was conducted for reports of metastatic OGDs using NCBI-PubMed, with the keywords "extracranial", "extraneural", "oligodendroglioma", "oligodendrogliomas", "metastatic", "metastasis", and "metastases", in different combinations.
An open biopsy of the infiltrated bones in our patient revealed that malignant cells had replaced the patient's marrow. Moreover, the diagnosis of multiple-organ metastases of anaplastic OGD was confirmed based on immunohistochemical staining. Genetic analyses showed that the tumors originated from previously resected brain lesions. None of the lesions had 1p and 19q deletions, but hypermethylation of MGMT promoter, and the G → A transversion at codon 234 of PTEN exon 2 were detected. Literatures review yielded 60 reports of metastatic OGDs from 1951 to the present, which with our patient makes 61 cases. Concerning these 61 patients, there were 110 infiltrated sites correlated closely with primary OGDs. The most frequent metastatic sites were bone and bone marrow (n = 47; 42.7%), lymph nodes (n = 22; 20.0%), liver (n = 7; 6.4%), scalp (n = 6; 5.5%), lung (n = 6; 5.5%), pleura (n = 4; 3.6%), chest wall (n = 3; 2.7%), iliopsoas muscle (n = 2; 1.8%), soft tissue (n = 2; 1.8%), and parotid gland (n = 2; 1.8%).
Extracranial metastases in anaplastic OGD are very rare but they do occur; bone and bone marrow may be the most common sites. Detection of certain molecular markers such as deletion of 1p and 19q chromosomal arms, hypermethylation of MGMT promoter, and characteristic PTEN exon mutations may help differentiate subtypes which are more prone to extracranial metastases.
The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/8749838611478560.
人们普遍认为恶性神经胶质瘤不会在中枢神经系统（CNS）以外转移。然而，少突胶质细胞瘤（OGDs）细胞不能在 CNS 外扩散的观点正受到挑战。
我们详细描述了一例间变性 OGD 患者的临床病史，该患者发生了淋巴结、骨髓和骨骼转移。遗传分析包括检测 1p 和 19q 染色体臂、MGMT 启动子的甲基化状态和 PTEN 外显子突变。使用 NCBI-PubMed 对全球文献进行了以“颅外”、“神经外”、“少突胶质细胞瘤”、“少突胶质细胞瘤”、“转移性”、“转移”和“转移”为关键词的检索，以不同的组合搜索转移性 OGDs 的报告。
对患者浸润骨骼的开放性活组织检查显示，恶性细胞已取代了患者的骨髓。此外，根据免疫组织化学染色，诊断为间变性 OGD 的多器官转移。遗传分析表明肿瘤起源于先前切除的脑部病变。没有一个病变有 1p 和 19q 缺失，但检测到 MGMT 启动子的高度甲基化和 PTEN 外显子 2 中 234 密码子的 G→A 颠换。文献综述从 1951 年至今共发现 60 例转移性 OGDs 的报告，加上我们的患者共 61 例。关于这 61 例患者，有 110 个浸润部位与原发性 OGDs 密切相关。最常见的转移部位是骨骼和骨髓（n=47；42.7%）、淋巴结（n=22；20.0%）、肝脏（n=7；6.4%）、头皮（n=6；5.5%）、肺（n=6；5.5%）、胸膜（n=4；3.6%）、胸壁（n=3；2.7%）、髂腰肌（n=2；1.8%）、软组织（n=2；1.8%）和腮腺（n=2；1.8%）。
间变性 OGD 颅外转移非常罕见，但确实会发生；骨骼和骨髓可能是最常见的部位。检测某些分子标志物，如 1p 和 19q 染色体臂缺失、MGMT 启动子的高度甲基化和特征性的 PTEN 外显子突变，可能有助于区分更易发生颅外转移的亚型。
