Mismatch Between Imaging and Histopathology Diagnosis in High and Low-Grade Gliomas: A Case Report

TL;DR

A case report shows how brain tumor imaging can be misleading, highlighting the need for tissue diagnosis in glioma classification.

Contribution

Highlights a rare case of radiologic-histopathologic discordance in oligodendroglioma diagnosis.

Findings

Neuroimaging suggested a high-grade glioma, but histopathology revealed a WHO Grade 2 oligodendroglioma.

The case emphasizes the importance of molecular profiling and tissue diagnosis for accurate glioma classification.

Abstract

Oligodendrogliomas aie diffusely infiltrating gliomas classified as WHO grade 2 or 3 tumors. While typically presenting with chronic seizures, they may rarely demonstrate imaging features suggestive of high-grade malignancy. A 40-year-old lady with untreated seizures for one year presented with acute loss of consciousness and recurrent generalized tonic-clonic seizures. Neuroimaging (CT/MRI) revealed a left temporoparietal lesion with cystic changes and hemorrhage, suggesting high-grade glioma. Histopathological analysis following craniotomy unexpectedly demonstrated WHO Grade 2 oligodendroglioma. This case highlights significant radiologic-histopathologic discordance in glioma diagnosis, emphasizing that radiologic features of high-grade malignancy may occur in low-grade oligodendrogliomas. Tissue diagnosis with molecular profiling remains essential for accurate classification and management.

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