Oligodendroglioma metastatic to bone marrow

Abstract

We report on a patient with oligodendroglioma metastatic to bone, presenting with pancytopenia and fever 10 years after initial tumor resection. Our review of the literature showed a total of 30 reported extraneural metastases, with only 19 of these being similar cases of bone metastases. These bony lesions have increased signal intensity in T2-weighted and low signal intensity on T1-weighted images, with intense homogeneous enhancement. However, on MR imaging, we were unable to find necrosis or compression deformity of the vertebrae, despite extensive metastatic disease.

Fig 1.

The figures show a small well-delineated nonenhancing right temporal lobe mass with predominately low signal intensity in T1-weighted (A) and predominately increased signal intensity in T2-weighted (B) images, involving white and gray marrow consistent with oligodendroglioma.

Fig 2.

The neoplasm is of moderate cellularity and composed of relatively uniform cells with round nuclei. Mitotic figures or pleomorphism is not identified.

Fig 3.

Four years later, interval tumor recurrence is seen in the posterior aspect of the surgical cavity with a homogeneous increased signal intensity seen in the T2-weighted (A) image and low signal intensity in the T1-weighted (B) image without enhancement.

Fig 4.

A second tumor recurrence is seen 8 years after initial diagnosis. A large homogenous mass is present, abutting the right lateral ventricle with low signal intensity on T1-weighted (A) and increased signal intensity on T2-weighted (B) images. No evidence of abnormal enhancement and of either subependymal or leptomeningeal spread is seen on the coronal T1-weighted postgadolinium (C) image.

Fig 5.

Histologic image shows anaplastic oligodendroglioma with increased cellularity, with mitotic activity and increased nuclear pleomorphism.

Fig 6.

There are numerous areas of signal-intensity abnormality throughout the vertebral body with abnormal low signal intensity in T1-weighted (A) images corresponding to increased signal intensity on T2-weighted (B) images and diffuse abnormal enhancement after gadolinium administration (C). Note the absence of a compression deformity despite the presence of diffuse bony metastases.

Fig 7.

Metastatic poorly differentiated neoplasm in the bone marrow with scant cytoplasm and large hyperchromatic nuclei (A). The same specimen shows cytoplasmic staining for glial fibrillary acidic protein in tumor cells in the bone marrow (B).

Fig 8.

The sagittal T1-weighted (A) image demonstrates abnormal diffuse low signal intensity of the vertebral body consistent with replacement of the normal fatty marrow by tumor cells as well as interval development of a posterior epidural mass compressing the cord. Sagittal T1-weighted postgadolinium with fat saturation (B) image demonstrates intense enhancement of the epidural mass with a dural tail sign as well as diffuse enhancement of the vertebral bodies. Sagittal T2-weighted with fat saturation (C) image demonstrates the epidural mass having homogeneous increased signal intensity with subtle but diffuse increased signal intensity of the vertebral body.