Acute Hydrocephalus due to Secondary Leptomeningeal Dissemination of an Anaplastic Oligodendroglioma

Abstract

Secondary leptomeningeal dissemination of oligodendroglioma is very rare. We report the case of a 38-year-old Caucasian male who presented with acute hydrocephalus. 8 months before, the patient had undergone craniotomy for right frontal anaplastic oligodendroglioma, WHO grade III. By that time, there was no evidence of tumor dissemination. MRI now ruled out local tumor progression but revealed meningeal contrast enhancement along the medulla, the myelon, and the cauda equina. Repeated lumbar puncture revealed increased cerebro-spinal fluid (CSF) pressure and protein content. Malignant cells were not detectable. Surgical treatment consisted in (1) placement of an ommaya reservoir for daily CSF puncture, (2) Spinal dural biopsy confirming leptomeningeal oligodendroglioma metastasis, and (3) ventriculo-peritoneal shunt placement after CSF protein has decreased to 1500-2000 mg/l.

Figure 1

(a)–(d) Cranial MRI at initial presentation before surgical treatment of right frontal anaplastic oligodendroglioma. (a): axial T1-weighted contrast-enhanced MRI, (b) axial fluid-attenuated inversion recovery (FLAIR), and (c) sagittal T1-weighted contrast-enhanced MRI revealed a hyperintense lesion on the right cingulate gyrus with slight local mass effect (arrows). (d): T2-weighted axial MRI showing regular ventricular size. (e)-(f): MRI at second presentation 8 months after initial surgery. (e): sagittal T1-weighted contrast-enhanced MRI showing meningeal enhancement in the craniocervical junction (arrows). (f): Axial T2-weighted MRI showed marked ventricular enlargement.

Figure 2

(a) Sagittal and (b) transversal T1-weighted contrast-enhanced magnetic resonance imaging (MRI) of the spine demonstrates meningeal enhancement along the lumbar spinal canal (arrows). Additional enhancement was seen in the cauda equine nerve roots. The biopsy was performed on level L 2/3 (long arrow in (a), level of (b)).

Figure 3

(a) Histopathological image of the primary tumor showing moderate cellularity and a rounded, clear cytoplasm. Histological examination of the dura and the nerve roots revealed infiltration by cells of the anaplastic astrocytoma: (b) Hematoxylin-Eosin staining, magnification 250-fold. (c) Elastica-van-Gieson staining showed tumor cells within dural collagen fibers, magnification 500-fold.