EXTRACRANIAL METASTASIS OF PRIMARY LOW-GRADE OLIGODENDROGLIOMA 10 YEARS AFTER DIAGNOSIS - RESPONSE ON CHEMOTHERAPY - A CASUISTIC CONTRIBUTION

Background: Oligodendrogliomas occur in 4-15% of cerebral gliomas. Loc al recurrence is not uncommon while systemic extracranial metastatic d isease is a rare event. Case Report: A 55-year-old male patient was ad mitted in 1994 for further evaluation of diffuse pain and weight loss. Case history revealed a right-sided frontoparietal oligodendroglioma treated by iodine-125 interstitial irradiation in 1984, 1989 and 1990, followed by gross tumor resection and adjuvant radiotherapy in 1992 b ecause of a third recurrence, Clinical examination and laboratory work -up on admission were indicative of a hemolytic anemia with leukoeryth roblastic blood smear. Further investigation including bone scan and i liac crest biopsy disclosed diffuse bone marrow metastases of cerebral secondary anaplastic oligodendroglioma with secondary myelosclerosis, After 4 cycles of a palliative chemotherapy with Procarbacine 60 mg/m (2) day 8-21, CCNU 110 mg/m(2) day 1, and Vincristine 1.4 mg/m(2) day 1 and 29, every 4 weeks - the 'PCV'-regimen as described by Levin - fr ank regression of the metastases and pain alleviation was noted. The p resented case is discussed against the background of a literature revi ew of rare cases of cerebral oligodendrogliomas with extracranial meta stases and a short discussion of the treatment strategy in such cases, Conclusion: In the rare subgroup of patients with an extracranial met astasizing oligodendroglioma a pattern of diffuse bone metastases is n ot uncommon. Including the presented case this pattern was found in 19 of 27 (70%) cases. Chemotherapy with the 'PCV' regimen offers an effe ctive palliative approach even in secondary anaplastic tumors.