Brain Tumor Pathology: Current Diagnostic Hotspots and by Davide Schiffer

By Davide Schiffer

Since Bailey and Cushing (1926), all mind tumor classifications were referred to as histogenetic. The nosographic place that the tumor kinds steadily bought within the class structures derived from the resemblance of tumor cells to these of the cytogenesis, converted at any time when new details turned to be had from assorted organic learn fields and particularly from molecular genetics. Classically, at the foundation of the tough correspondence among the mature/immature point of tumor cells and the benign/malignant organic habit of the tumors, the histological labels contained a prognostic importance. The meant foundation of the tumors was once therefore an element for diagnosis. afterward, with the idea that of anaplasia (Cox, 1933; Kernohan et al., 1949) new standards have been brought for developing the malignancy grades of tumors. Immunohistochemistry and later molecular genetics extra sophisticated the prognostic diagnoses, considerably expanding the possibilities to acknowledge the mobile beginning of tumors, beside revealing the pathogenetic mechanisms. Prognoses turned extra exact, as required by means of the higher and extra specific chances of therapy.

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2004). , 2005). PTEN mutations and EGFR amplification, on the contrary, turned out to be important prognostic factors in anaplastic astrocytomas. , 2001). , 2001). In a large series of tumors, TP53 mutations emerged as favorable and PTEN LOH as poor prognostic factors, independently of the tumor type, whereas LOH of 1p and 19q were not associated with better survival, unless they were in combination, even with no oligodendroglial morphology. Interestingly, the combination of TP53 mutations and EGFR amplification was not found to be as rare as usually believed and EGFR amplification did not prove to be prognostic.

Astrocytic Tumors I A B Figure 19. Astrocytoma Grade III: nuclear pleomorphism and mitoses, H&E, x 400; B. Astrocytoma grade III, MIB-1 LI > 10%, DAB x 400 46 Chapter 4 Figure 20. Anaplastic astrocytoma. Two mitoses and pleomorphic nuclei. H&E, x 400 The observation that statistically high-grade astrocytomas show contrast enhancement and more mitoses than low-grade gliomas does not help to exclude in single cases an ominous evolution when the mentioned features are not present. The evaluation of the malignancy grade cannot be based on the occurrence of factors identified as prognostic after multivariate analysis.

3% glioblastomas showed positive immunohistochemistry for vIII and that all the positive tumors expressed vIII and amplified EGFR. 4% showed this alteration. Interestingly in glioblastomas, vIII was not associated with a reduced survival, whereas in anaplastic astrocytomas the association was very high. , 2004). , 2005). PTEN mutations and EGFR amplification, on the contrary, turned out to be important prognostic factors in anaplastic astrocytomas. , 2001). , 2001). In a large series of tumors, TP53 mutations emerged as favorable and PTEN LOH as poor prognostic factors, independently of the tumor type, whereas LOH of 1p and 19q were not associated with better survival, unless they were in combination, even with no oligodendroglial morphology.

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