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

Oligodendrogliomas are 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 unconsciousness 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.