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Diffuse Astrocytic and Oligodendroglial Tumors

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Neuropathology of Brain Tumors with Radiologic Correlates

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Abstract

The 2016 WHO Classification of CNS tumors categorizes diffuse gliomas (astrocytic and oligodendroglial) that infiltrate the CNS parenchyma and are further classified as astrocytic, oligodendroglial, and rare mixed oligodendroglial-astrocytic. The diffuse glioma grades are: Grade II (low grade), Grade III (anaplastic) and Grade IV (glioblastoma). Astrocytic tumors demonstrate IDH mutations (IDH1 > IDH2), are associated with TP53 and ATRX mutation, do not exhibit loss of chromosomes 1p and 19q.These have a definite effect on prognosis and may be predictive of response to radiation and /or alkylating chemotherapy. IDH-mutant, diffuse astrocytomas have an intrinsic capacity for malignant progression to IDH-mutant, anaplastic astrocytoma grade III and ultimately progressing to IDH-mutant, glioblastoma grade IV. (Juratli et al. J Neurooncol 108(3):403–10, 2012) All oligodendrogliomas demonstrate IDH1 mutation along with the characteristic 1p and 19q co-deletion, rarely demonstrate p53 mutation and ATRX mutation. (Watanabe et al. Am J Pathol 174(4):1149–53, 2009). The third pathway includes tumors which do not exhibit IDH-mutation are IDH-wildtype gliomas. Such gliomas appear to rapidly acquire multiple complex genetic alterations, to become glioblastomas very early in their development due to amplification or mutation of EGFR, and loss of the PTEN gene (Yan et al. N Engl J Med 360(8):765–73, 2009). The cell of origin for some tumors remains unknown, such tumors are classified according to their pure or mixed histology (oligoastrocytoma), the grade and molecular basis. Main molecular makers in gliomas are IDH 1/2, 1p/19q codeletion, MGMT, TERT, ATRX and p53, EGFR, PDGF, PDGFR and H3 K27M-mutation, which are of diagnostic significance. Details have been discussed in the following chapters.

Reinforcing the latest WHO classification (2016) which integrates the phenotypic and genotypic status based on the IDH status, gliomas have been classified as follows:

Table 1
Full size table

The chapter illustrates multiple MR images and findings, intraoperative cytology, histopathology, IHC pictures, and their features along with differential diagnosis for each of the above, genetic profile, prognosis, and case studies.

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  1. Shanti Pathology Laboratory, Kolhapur, Maharashtra, India

    Meghana Chougule

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Chougule, M. (2020). Diffuse Astrocytic and Oligodendroglial Tumors. In: Neuropathology of Brain Tumors with Radiologic Correlates. Springer, Singapore. https://doi.org/10.1007/978-981-15-7126-8_4

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