Chordoid Glioma of the Third Ventricle

Takei, Hiroyuki; Bhattacharjee, Meenakshi B.; Adesina, Adekunle M.

doi:10.1159/000326044

Cited by 31 publications

(8 citation statements)

References 20 publications

(14 reference statements)

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“…A widespread knowledge of this newly defined third ventricle pathological entity in the radiologists’ community appears to be mandatory. As for histological examination, recent publications report that intraoperative smear cytology could reveal distinctive cytological features, identifying the unique histological pattern of chordoid gliomas [ 14 , 20 ]. In literature, we found that the main problem lied in telling a chordoid glioma from a chordoid meningioma.…”

Section: Discussionmentioning

confidence: 99%

“…Contrast enhancement is vivid; there may be cystic changes and rare calcifications [ 10 – 12 ]. Chordoid glioma histologic features show clusters and cords of epithelioid cells with eosinophilic cytoplasm embedded in a mucinous matrix rich in lymphoplasmacellular infiltrates and Russell bodies; mitotic activity, vascular proliferation, nuclear atypia, and necrosis are rare or absent [ 13 , 14 ]. Immunohistochemical analysis is characterized by strong and diffuse reaction to glial fibrillary acidic protein (GFAP) and Vimentin; epithelial membrane antigen (EMA), CD34, S-100, and cytokeratin are expressed in more than 2/3 of samples [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Chordoid glioma: a rare radiologically, histologically, and clinically mystifying lesion

et al. 2015

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Chordoid glioma (CG) is a rare central nervous system neoplasm (WHO grade II) of uncertain origin whose typical localization is in the anterior part of the third ventricle. Its clinical, radiological, and histological features may vary and furthermore mimic other kind of benign lesions usually associated with a better outcome. We report a case of a 43-year-old female who underwent gross total removal of a lesion of the third ventricle causing hydrocephalus. The imaging studies and the intraoperative examination led at first to a hypothesis of meningioma. Early surgical and neurological outcomes were good. The patient underwent multiple complications related to hypothalamic dysfunctions and thrombohemorragic issues and eventually died because of systemic infections. Definitive examination was of chordoid glioma of the third ventricle. Reviewing literature, we evaluated possible pitfalls in radiological and histological diagnosis as well as in surgical and medical treatment of CGs. Despite their benign presentation, a high incidence of multiple possible severe complications is reported. Early alertness and combined treatment strategies could improve overall CGs treatment strategies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Chordoid glioma: a rare radiologically, histologically, and clinically mystifying lesion

et al. 2015

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“…45,61 Although progesterone receptor expression is not well characterized in enchondromas or chondrosarcomas, expression in chordomas and chordoid gliomas have shown unreliable, mixed results with uncertain diagnostic significance. 9,26,79 As such, this marker was also excluded from our study.…”

Section: Discussionmentioning

confidence: 99%

Distinguishing Chordoid Meningiomas From Their Histologic Mimics

Sangoi

Dulai²,

Beck

et al. 2009

American Journal of Surgical Pathology

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Chordoid meningioma, World Health Organization grade II, is an uncommon variant of meningioma with a propensity for aggressive behavior and increased likelihood of recurrence. As such, recognition of this entity is important in cases that show similar morphologic overlap with other chondroid/myxoid neoplasms that can arise within or near the central nervous system. A formal comparison of the immunohistochemical features of chordoid meningioma versus tumors with significant histologic overlap has not been previously reported. In this study, immunohistochemical staining was performed with antibodies against D2-40, S100, pankeratin, epithelial membrane antigen (EMA), brachyury, and glial fibrillary acidic protein (GFAP) in 4 cases of chordoid glioma, 6 skeletal myxoid chondrosarcomas, 10 chordoid meningiomas, 16 extraskeletal myxoid chondrosarcoma, 18 chordomas, 22 low-grade chondrosarcomas, and 27 enchondromas. Staining extent and intensity were evaluated semiquantitatively and mean values for each parameter were calculated. Immunostaining with D2-40 showed positivity in 100% of skeletal myxoid chondrosarcomas, 96% of enchondromas, 95% of low-grade chondrosarcomas, 80% of chordoid meningiomas, and 75% of chordoid gliomas. Staining with S100 demonstrated diffuse, strong positivity in all (100%) chordoid gliomas, skeletal myxoid chondrosarcomas, low-grade chondrosarcomas, and enchondromas, 94% of chordomas, and 81% of extraskeletal myxoid chondrosarcomas, with focal, moderate staining in 40% of chordoid meningiomas. Pankeratin highlighted 100% of chordoid gliomas and chordomas, 38% of extraskeletal myxoid chondrosarcomas, and 20% of chordoid meningiomas. EMA staining was positive in 100% of chordoid gliomas, 94% of chordomas, 90% of chordoid meningiomas, and 25% of extraskeletal myxoid chondrosarcomas. Brachyury was positive only in the chordomas (100%), whereas GFAP was positive only in the chordoid gliomas (100%). EMA was the most effective antibody for differentiating chordoid meningioma from skeletal myxoid chondrosarcoma, low-grade chondrosarcoma, and enchondroma, whereas D2-40 was the most effective antibody for differentiating chordoid meningioma from extraskeletal myxoid chondrosarcoma and chordoma. Our findings demonstrate that in conjunction with clinical and radiographic findings, immunohistochemical evaluation with a panel of D2-40, EMA, brachyury, and GFAP is most useful in distinguishing chordoid meningioma from chordoid glioma, skeletal myxoid chondrosarcoma, extraskeletal myxoid chondrosarcoma, chordoma, low-grade chondrosarcoma, and enchondroma. A lack of strong, diffuse S100 reactivity may also be useful in excluding chordoid meningioma. Among the neoplasms evaluated, brachyury and GFAP proved to be both sensitive and specific markers for chordoma and chordoid glioma, respectively. Of note, this study is the first to characterize the D2-40 immunoprofile in extraskeletal myxoid chondrosarcoma, results that could be of utility in differential diagnostic assessment.

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“…Differentiation from other tumors mimicking secretory globules is important. Russell bodies seen in lymphoplasmacyte-rich meningioma or chordoid meningioma should be distinguished from eosinophilic globules seen in secretory meningioma [ 10 ]. Russell bodies also have eosinophilic, large, homogeneous refractile immunoglobulin-containing inclusions found in plasmacytic cells resulting from excessive synthesis of immunoglobulin; these Russell bodies correspond to the distended endoplasmic reticulums [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Pseudopsammoma bodies are secretory materials located in intracellular lumina lined by microvilli or scattered secretory materials outside within the extracellular spaces [ 12 ]. Lymphoplasmacytic infiltrates may also be observed with secretory meningioma, but uncommonly show a mucinous background, which is a characteristic cytologic finding of chordoid meningioma [ 10 ]. Histologically, these pseudopsammoma bodies show staining with both PAS and epithelial and secretory markers such as pancytokeratin, CEA, IgA, IgG, or IgM [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Crush Cytology of Secretory Meningioma: A Case Report

Kim

Yee

Cho

2015

Brain Tumor Res Treat

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Secretory meningioma, a histologic subtype of meningioma of World Health Organization grade 1, is clinically significant because it is frequently accompanied by peritumoral brain edema. The patient was a 53-year-old woman suffering from dysarthria and motor weakness of the right arm. Enhanced magnetic resonance images showed an enhancing mass measuring 2.5 cm in size located in the right parietal convexity. Intraoperative squash cytology showed moderately cellular smears composed mainly of clusters of ovoid cells with scattered whorl formations. The cells had round nuclei and a moderate amount of eosinophilic cytoplasm with ill-defined cell borders. Neither atypia nor mitosis was observed. Some scattered round shaped eosinophilic refractile hyaline globules, measuring from 5 to 25 µm, were observed, and a periglobular halo was occasionally observed. The diagnosis of secretory meningioma should be made as early as possible so that neurosurgeons can prevent postoperative aggravation of peritumoral edema. We emphasize that cytologic findings including eosinophilic, non-fibrillary cytoplasm with eosinophilic refractile hyaline globules are helpful in differentiating secretory meningioma from other subtypes of meningioma, primary and metastatic brain tumors.

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Chordoid Glioma of the Third Ventricle

Cited by 31 publications

References 20 publications

Chordoid glioma: a rare radiologically, histologically, and clinically mystifying lesion

Chordoid glioma: a rare radiologically, histologically, and clinically mystifying lesion

Distinguishing Chordoid Meningiomas From Their Histologic Mimics

Crush Cytology of Secretory Meningioma: A Case Report

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