Diffuse astrocytoma - Revision history

Jensflorian: /* Molecular */ CDKN2AB

2019-05-27T08:12:14Z

Molecular: CDKN2AB

← Older revision		Revision as of 08:12, 27 May 2019
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	==Molecular==		==Molecular==
	*IDH1 R132- or IDH2 R172-~~point~~ mutations classify the tumors as Diffuse astrocytoma, IDH-mutant.		*IDH1 R132- or IDH2 R172-hotsopt mutations classify the tumors as Diffuse astrocytoma, IDH-mutant.
	*Absence of LOH 1p/19q.		*Absence of LOH 1p/19q (otherwise classify tumor as oligodendroglioma).
	*Tp53 mutations in approx. 60% (80-90% in gemistocytic, 50% in fibrillary types).		*Tp53 mutations in approx. 60% (80-90% in gemistocytic, 50% in fibrillary types).
	*MGMT promotor methylated in approx. 50%.		*MGMT promotor methylated in approx. 50%.
			*CDKN2A/B homozygous deletion in IDH mutant diffuse astrocytoma has unfavourable prognosis.<ref>{{Cite journal \| last1 = Shirahata \| first1 = M. \| last2 = Ono \| first2 = T. \| last3 = Stichel \| first3 = D. \| last4 = Schrimpf \| first4 = D. \| last5 = Reuss \| first5 = DE. \| last6 = Sahm \| first6 = F. \| last7 = Koelsche \| first7 = C. \| last8 = Wefers \| first8 = A. \| last9 = Reinhardt \| first9 = A. \| title = Novel, improved grading system(s) for IDH-mutant astrocytic gliomas. \| journal = Acta Neuropathol \| volume = 136 \| issue = 1 \| pages = 153-166 \| month = Jul \| year = 2018 \| doi = 10.1007/s00401-018-1849-4 \| PMID = 29687258 }}</ref><ref>{{Cite journal \| last1 = Aoki \| first1 = K. \| last2 = Nakamura \| first2 = H. \| last3 = Suzuki \| first3 = H. \| last4 = Matsuo \| first4 = K. \| last5 = Kataoka \| first5 = K. \| last6 = Shimamura \| first6 = T. \| last7 = Motomura \| first7 = K. \| last8 = Ohka \| first8 = F. \| last9 = Shiina \| first9 = S. \| title = Prognostic relevance of genetic alterations in diffuse lower-grade gliomas. \| journal = Neuro Oncol \| volume = 20 \| issue = 1 \| pages = 66-77 \| month = 01 \| year = 2018 \| doi = 10.1093/neuonc/nox132 \| PMID = 29016839 }}</ref>
			Note:
	*The existence of diffuse astrocytoma, IDH wildtype is challenged.<ref>{{Cite journal \| last1 = Reuss \| first1 = DE. \| last2 = Kratz \| first2 = A. \| last3 = Sahm \| first3 = F. \| last4 = Capper \| first4 = D. \| last5 = Schrimpf \| first5 = D. \| last6 = Koelsche \| first6 = C. \| last7 = Hovestadt \| first7 = V. \| last8 = Bewerunge-Hudler \| first8 = M. \| last9 = Jones \| first9 = DT. \| title = Adult IDH wild type astrocytomas biologically and clinically resolve into other tumor entities. \| journal = Acta Neuropathol \| volume = 130 \| issue = 3 \| pages = 407-17 \| month = Sep \| year = 2015 \| doi = 10.1007/s00401-015-1454-8 \| PMID = 26087904 }}</ref>		*The existence of diffuse astrocytoma, IDH wildtype is challenged.<ref>{{Cite journal \| last1 = Reuss \| first1 = DE. \| last2 = Kratz \| first2 = A. \| last3 = Sahm \| first3 = F. \| last4 = Capper \| first4 = D. \| last5 = Schrimpf \| first5 = D. \| last6 = Koelsche \| first6 = C. \| last7 = Hovestadt \| first7 = V. \| last8 = Bewerunge-Hudler \| first8 = M. \| last9 = Jones \| first9 = DT. \| title = Adult IDH wild type astrocytomas biologically and clinically resolve into other tumor entities. \| journal = Acta Neuropathol \| volume = 130 \| issue = 3 \| pages = 407-17 \| month = Sep \| year = 2015 \| doi = 10.1007/s00401-015-1454-8 \| PMID = 26087904 }}</ref>
	**Most adult cases show genetic alterations compatible with glioblastoma.<ref>{{Cite journal \| last1 = Hasselblatt \| first1 = M. \| last2 = Jaber \| first2 = M. \| last3 = Reuss \| first3 = D. \| last4 = Grauer \| first4 = O. \| last5 = Bibo \| first5 = A. \| last6 = Terwey \| first6 = S. \| last7 = Schick \| first7 = U. \| last8 = Ebel \| first8 = H. \| last9 = Niederstadt \| first9 = T. \| title = Diffuse Astrocytoma, IDH-Wildtype: A Dissolving Diagnosis. \| journal = J Neuropathol Exp Neurol \| volume = \| issue = \| pages = \| month = Feb \| year = 2018 \| doi = 10.1093/jnen/nly012 \| PMID = 29444314 }}</ref>		**Most adult cases show genetic alterations compatible with glioblastoma.<ref>{{Cite journal \| last1 = Hasselblatt \| first1 = M. \| last2 = Jaber \| first2 = M. \| last3 = Reuss \| first3 = D. \| last4 = Grauer \| first4 = O. \| last5 = Bibo \| first5 = A. \| last6 = Terwey \| first6 = S. \| last7 = Schick \| first7 = U. \| last8 = Ebel \| first8 = H. \| last9 = Niederstadt \| first9 = T. \| title = Diffuse Astrocytoma, IDH-Wildtype: A Dissolving Diagnosis. \| journal = J Neuropathol Exp Neurol \| volume = \| issue = \| pages = \| month = Feb \| year = 2018 \| doi = 10.1093/jnen/nly012 \| PMID = 29444314 }}</ref>

Jensflorian: /* Molecular */ cIMPACT 4 update

2019-04-01T08:27:30Z

Molecular: cIMPACT 4 update

← Older revision		Revision as of 08:27, 1 April 2019
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	**Suggested Sign-out: <pre> Diffuse astrocytic glioma, IDH-wildtype, with molecular features of glioblastoma, WHO grade IV</pre>		**Suggested Sign-out: <pre> Diffuse astrocytic glioma, IDH-wildtype, with molecular features of glioblastoma, WHO grade IV</pre>
	**WHO grade II diffuse gliomas IDH-wt/H3-wt in children and adolescents have an indolent clinical behavior and rare anaplastic progression.		**WHO grade II diffuse gliomas IDH-wt/H3-wt in children and adolescents have an indolent clinical behavior and rare anaplastic progression.
	***Most tumors show a BRAFV600E mutation, an FGFR alteration, or a MYB or MYBL1 rearrangement.		***Most tumors show a BRAFV600E mutation, an FGFR alteration, or a MYB or MYBL1 rearrangement.<ref>{{Cite journal \| last1 = Ellison \| first1 = DW. \| last2 = Hawkins \| first2 = C. \| last3 = Jones \| first3 = DTW. \| last4 = Onar-Thomas \| first4 = A. \| last5 = Pfister \| first5 = SM. \| last6 = Reifenberger \| first6 = G. \| last7 = Louis \| first7 = DN. \| title = cIMPACT-NOW update 4: diffuse gliomas characterized by MYB, MYBL1, or FGFR1 alterations or BRAF \| journal = Acta Neuropathol \| volume = 137 \| issue = 4 \| pages = 683-687 \| month = Apr \| year = 2019 \| doi = 10.1007/s00401-019-01987-0 \| PMID = 30848347 }}</ref>
			***Glial morphology can be astrocytic or oligodendrocytic.
			**Suggested sign-out:
			<pre>
			Diffuse glioma, MYB-altered.
			Diffuse glioma, MYBL1-altered.
			Diffuse glioma, FGFR1 TKD-duplicated.
			Diffuse glioma, FGFR1-mutant.
			Diffuse glioma, BRAF V600E-mutant.
			Diffuse glioma, other MAPK pathway alteration.
			</pre>

	==DDx==		==DDx==

Jensflorian: /* Molecular */ update

2019-04-01T08:23:26Z

Molecular: update

← Older revision		Revision as of 08:23, 1 April 2019
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	*The existence of diffuse astrocytoma, IDH wildtype is challenged.<ref>{{Cite journal \| last1 = Reuss \| first1 = DE. \| last2 = Kratz \| first2 = A. \| last3 = Sahm \| first3 = F. \| last4 = Capper \| first4 = D. \| last5 = Schrimpf \| first5 = D. \| last6 = Koelsche \| first6 = C. \| last7 = Hovestadt \| first7 = V. \| last8 = Bewerunge-Hudler \| first8 = M. \| last9 = Jones \| first9 = DT. \| title = Adult IDH wild type astrocytomas biologically and clinically resolve into other tumor entities. \| journal = Acta Neuropathol \| volume = 130 \| issue = 3 \| pages = 407-17 \| month = Sep \| year = 2015 \| doi = 10.1007/s00401-015-1454-8 \| PMID = 26087904 }}</ref>		*The existence of diffuse astrocytoma, IDH wildtype is challenged.<ref>{{Cite journal \| last1 = Reuss \| first1 = DE. \| last2 = Kratz \| first2 = A. \| last3 = Sahm \| first3 = F. \| last4 = Capper \| first4 = D. \| last5 = Schrimpf \| first5 = D. \| last6 = Koelsche \| first6 = C. \| last7 = Hovestadt \| first7 = V. \| last8 = Bewerunge-Hudler \| first8 = M. \| last9 = Jones \| first9 = DT. \| title = Adult IDH wild type astrocytomas biologically and clinically resolve into other tumor entities. \| journal = Acta Neuropathol \| volume = 130 \| issue = 3 \| pages = 407-17 \| month = Sep \| year = 2015 \| doi = 10.1007/s00401-015-1454-8 \| PMID = 26087904 }}</ref>
	**Most cases show genetic alterations compatible with glioblastoma.<ref>{{Cite journal \| last1 = Hasselblatt \| first1 = M. \| last2 = Jaber \| first2 = M. \| last3 = Reuss \| first3 = D. \| last4 = Grauer \| first4 = O. \| last5 = Bibo \| first5 = A. \| last6 = Terwey \| first6 = S. \| last7 = Schick \| first7 = U. \| last8 = Ebel \| first8 = H. \| last9 = Niederstadt \| first9 = T. \| title = Diffuse Astrocytoma, IDH-Wildtype: A Dissolving Diagnosis. \| journal = J Neuropathol Exp Neurol \| volume = \| issue = \| pages = \| month = Feb \| year = 2018 \| doi = 10.1093/jnen/nly012 \| PMID = 29444314 }}</ref>		**Most adult cases show genetic alterations compatible with glioblastoma.<ref>{{Cite journal \| last1 = Hasselblatt \| first1 = M. \| last2 = Jaber \| first2 = M. \| last3 = Reuss \| first3 = D. \| last4 = Grauer \| first4 = O. \| last5 = Bibo \| first5 = A. \| last6 = Terwey \| first6 = S. \| last7 = Schick \| first7 = U. \| last8 = Ebel \| first8 = H. \| last9 = Niederstadt \| first9 = T. \| title = Diffuse Astrocytoma, IDH-Wildtype: A Dissolving Diagnosis. \| journal = J Neuropathol Exp Neurol \| volume = \| issue = \| pages = \| month = Feb \| year = 2018 \| doi = 10.1093/jnen/nly012 \| PMID = 29444314 }}</ref>
	**Molecular upgrade according to cIMPACT-NOW Update 3 consensus (one of these is sufficient):<ref>{{Cite journal \| last1 = Brat \| first1 = DJ. \| last2 = Aldape \| first2 = K. \| last3 = Colman \| first3 = H. \| last4 = Holland \| first4 = EC. \| last5 = Louis \| first5 = DN. \| last6 = Jenkins \| first6 = RB. \| last7 = Kleinschmidt-DeMasters \| first7 = BK. \| last8 = Perry \| first8 = A. \| last9 = Reifenberger \| first9 = G. \| title = cIMPACT-NOW update 3: recommended diagnostic criteria for "Diffuse astrocytic glioma, IDH-wildtype, with molecular features of glioblastoma, WHO grade IV". \| journal = Acta Neuropathol \| volume = 136 \| issue = 5 \| pages = 805-810 \| month = Nov \| year = 2018 \| doi = 10.1007/s00401-018-1913-0 \| PMID = 30259105 }}</ref>		**Molecular upgrade according to cIMPACT-NOW Update 3 consensus (one of these is sufficient):<ref>{{Cite journal \| last1 = Brat \| first1 = DJ. \| last2 = Aldape \| first2 = K. \| last3 = Colman \| first3 = H. \| last4 = Holland \| first4 = EC. \| last5 = Louis \| first5 = DN. \| last6 = Jenkins \| first6 = RB. \| last7 = Kleinschmidt-DeMasters \| first7 = BK. \| last8 = Perry \| first8 = A. \| last9 = Reifenberger \| first9 = G. \| title = cIMPACT-NOW update 3: recommended diagnostic criteria for "Diffuse astrocytic glioma, IDH-wildtype, with molecular features of glioblastoma, WHO grade IV". \| journal = Acta Neuropathol \| volume = 136 \| issue = 5 \| pages = 805-810 \| month = Nov \| year = 2018 \| doi = 10.1007/s00401-018-1913-0 \| PMID = 30259105 }}</ref>
	***EGFR amplification		***EGFR amplification
	***Combined whole chromosome 7 gain and whole chromosome 10 loss (+ 7/− 10)		***Combined whole chromosome 7 gain and whole chromosome 10 loss (+ 7/− 10)
	***TERT promoter mutation		***TERT promoter mutation
	**Suggested Sign-out:		**Suggested Sign-out: <pre> Diffuse astrocytic glioma, IDH-wildtype, with molecular features of glioblastoma, WHO grade IV</pre>
	<pre>		**WHO grade II diffuse gliomas IDH-wt/H3-wt in children and adolescents have an indolent clinical behavior and rare anaplastic progression.
	Diffuse astrocytic glioma, IDH-wildtype, with molecular features of glioblastoma, WHO grade IV		***Most tumors show a BRAFV600E mutation, an FGFR alteration, or a MYB or MYBL1 rearrangement.
	</pre>

	==DDx==		==DDx==

Jensflorian: /* Molecular */ sign-out

2019-01-16T11:11:57Z

Molecular: sign-out

← Older revision		Revision as of 11:11, 16 January 2019
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	***Combined whole chromosome 7 gain and whole chromosome 10 loss (+ 7/− 10)		***Combined whole chromosome 7 gain and whole chromosome 10 loss (+ 7/− 10)
	***TERT promoter mutation		***TERT promoter mutation
	**Suggested Sign-out: Diffuse astrocytic glioma, IDH-wildtype, with molecular features of glioblastoma, WHO grade IV		**Suggested Sign-out:
			<pre>
			Diffuse astrocytic glioma, IDH-wildtype, with molecular features of glioblastoma, WHO grade IV
			</pre>

	==DDx==		==DDx==

Jensflorian: /* Molecular */ +ref

2019-01-16T11:09:28Z

Molecular: +ref

← Older revision		Revision as of 11:09, 16 January 2019
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	*The existence of diffuse astrocytoma, IDH wildtype is challenged.<ref>{{Cite journal \| last1 = Reuss \| first1 = DE. \| last2 = Kratz \| first2 = A. \| last3 = Sahm \| first3 = F. \| last4 = Capper \| first4 = D. \| last5 = Schrimpf \| first5 = D. \| last6 = Koelsche \| first6 = C. \| last7 = Hovestadt \| first7 = V. \| last8 = Bewerunge-Hudler \| first8 = M. \| last9 = Jones \| first9 = DT. \| title = Adult IDH wild type astrocytomas biologically and clinically resolve into other tumor entities. \| journal = Acta Neuropathol \| volume = 130 \| issue = 3 \| pages = 407-17 \| month = Sep \| year = 2015 \| doi = 10.1007/s00401-015-1454-8 \| PMID = 26087904 }}</ref>		*The existence of diffuse astrocytoma, IDH wildtype is challenged.<ref>{{Cite journal \| last1 = Reuss \| first1 = DE. \| last2 = Kratz \| first2 = A. \| last3 = Sahm \| first3 = F. \| last4 = Capper \| first4 = D. \| last5 = Schrimpf \| first5 = D. \| last6 = Koelsche \| first6 = C. \| last7 = Hovestadt \| first7 = V. \| last8 = Bewerunge-Hudler \| first8 = M. \| last9 = Jones \| first9 = DT. \| title = Adult IDH wild type astrocytomas biologically and clinically resolve into other tumor entities. \| journal = Acta Neuropathol \| volume = 130 \| issue = 3 \| pages = 407-17 \| month = Sep \| year = 2015 \| doi = 10.1007/s00401-015-1454-8 \| PMID = 26087904 }}</ref>
	**Most cases show genetic alterations compatible with glioblastoma.<ref>{{Cite journal \| last1 = Hasselblatt \| first1 = M. \| last2 = Jaber \| first2 = M. \| last3 = Reuss \| first3 = D. \| last4 = Grauer \| first4 = O. \| last5 = Bibo \| first5 = A. \| last6 = Terwey \| first6 = S. \| last7 = Schick \| first7 = U. \| last8 = Ebel \| first8 = H. \| last9 = Niederstadt \| first9 = T. \| title = Diffuse Astrocytoma, IDH-Wildtype: A Dissolving Diagnosis. \| journal = J Neuropathol Exp Neurol \| volume = \| issue = \| pages = \| month = Feb \| year = 2018 \| doi = 10.1093/jnen/nly012 \| PMID = 29444314 }}</ref>		**Most cases show genetic alterations compatible with glioblastoma.<ref>{{Cite journal \| last1 = Hasselblatt \| first1 = M. \| last2 = Jaber \| first2 = M. \| last3 = Reuss \| first3 = D. \| last4 = Grauer \| first4 = O. \| last5 = Bibo \| first5 = A. \| last6 = Terwey \| first6 = S. \| last7 = Schick \| first7 = U. \| last8 = Ebel \| first8 = H. \| last9 = Niederstadt \| first9 = T. \| title = Diffuse Astrocytoma, IDH-Wildtype: A Dissolving Diagnosis. \| journal = J Neuropathol Exp Neurol \| volume = \| issue = \| pages = \| month = Feb \| year = 2018 \| doi = 10.1093/jnen/nly012 \| PMID = 29444314 }}</ref>
	**Molecular upgrade according to cIMPACT-NOW Update 3 consensus (one of these is sufficient):		**Molecular upgrade according to cIMPACT-NOW Update 3 consensus (one of these is sufficient):<ref>{{Cite journal \| last1 = Brat \| first1 = DJ. \| last2 = Aldape \| first2 = K. \| last3 = Colman \| first3 = H. \| last4 = Holland \| first4 = EC. \| last5 = Louis \| first5 = DN. \| last6 = Jenkins \| first6 = RB. \| last7 = Kleinschmidt-DeMasters \| first7 = BK. \| last8 = Perry \| first8 = A. \| last9 = Reifenberger \| first9 = G. \| title = cIMPACT-NOW update 3: recommended diagnostic criteria for "Diffuse astrocytic glioma, IDH-wildtype, with molecular features of glioblastoma, WHO grade IV". \| journal = Acta Neuropathol \| volume = 136 \| issue = 5 \| pages = 805-810 \| month = Nov \| year = 2018 \| doi = 10.1007/s00401-018-1913-0 \| PMID = 30259105 }}</ref>
	***EGFR amplification		***EGFR amplification
	***Combined whole chromosome 7 gain and whole chromosome 10 loss (+ 7/− 10)		***Combined whole chromosome 7 gain and whole chromosome 10 loss (+ 7/− 10)

Jensflorian: /* Molecular */

2019-01-16T11:07:11Z

Molecular

← Older revision		Revision as of 11:07, 16 January 2019
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	*The existence of diffuse astrocytoma, IDH wildtype is challenged.<ref>{{Cite journal \| last1 = Reuss \| first1 = DE. \| last2 = Kratz \| first2 = A. \| last3 = Sahm \| first3 = F. \| last4 = Capper \| first4 = D. \| last5 = Schrimpf \| first5 = D. \| last6 = Koelsche \| first6 = C. \| last7 = Hovestadt \| first7 = V. \| last8 = Bewerunge-Hudler \| first8 = M. \| last9 = Jones \| first9 = DT. \| title = Adult IDH wild type astrocytomas biologically and clinically resolve into other tumor entities. \| journal = Acta Neuropathol \| volume = 130 \| issue = 3 \| pages = 407-17 \| month = Sep \| year = 2015 \| doi = 10.1007/s00401-015-1454-8 \| PMID = 26087904 }}</ref>		*The existence of diffuse astrocytoma, IDH wildtype is challenged.<ref>{{Cite journal \| last1 = Reuss \| first1 = DE. \| last2 = Kratz \| first2 = A. \| last3 = Sahm \| first3 = F. \| last4 = Capper \| first4 = D. \| last5 = Schrimpf \| first5 = D. \| last6 = Koelsche \| first6 = C. \| last7 = Hovestadt \| first7 = V. \| last8 = Bewerunge-Hudler \| first8 = M. \| last9 = Jones \| first9 = DT. \| title = Adult IDH wild type astrocytomas biologically and clinically resolve into other tumor entities. \| journal = Acta Neuropathol \| volume = 130 \| issue = 3 \| pages = 407-17 \| month = Sep \| year = 2015 \| doi = 10.1007/s00401-015-1454-8 \| PMID = 26087904 }}</ref>
	**Most cases show genetic alterations compatible with glioblastoma.<ref>{{Cite journal \| last1 = Hasselblatt \| first1 = M. \| last2 = Jaber \| first2 = M. \| last3 = Reuss \| first3 = D. \| last4 = Grauer \| first4 = O. \| last5 = Bibo \| first5 = A. \| last6 = Terwey \| first6 = S. \| last7 = Schick \| first7 = U. \| last8 = Ebel \| first8 = H. \| last9 = Niederstadt \| first9 = T. \| title = Diffuse Astrocytoma, IDH-Wildtype: A Dissolving Diagnosis. \| journal = J Neuropathol Exp Neurol \| volume = \| issue = \| pages = \| month = Feb \| year = 2018 \| doi = 10.1093/jnen/nly012 \| PMID = 29444314 }}</ref>		**Most cases show genetic alterations compatible with glioblastoma.<ref>{{Cite journal \| last1 = Hasselblatt \| first1 = M. \| last2 = Jaber \| first2 = M. \| last3 = Reuss \| first3 = D. \| last4 = Grauer \| first4 = O. \| last5 = Bibo \| first5 = A. \| last6 = Terwey \| first6 = S. \| last7 = Schick \| first7 = U. \| last8 = Ebel \| first8 = H. \| last9 = Niederstadt \| first9 = T. \| title = Diffuse Astrocytoma, IDH-Wildtype: A Dissolving Diagnosis. \| journal = J Neuropathol Exp Neurol \| volume = \| issue = \| pages = \| month = Feb \| year = 2018 \| doi = 10.1093/jnen/nly012 \| PMID = 29444314 }}</ref>
			**Molecular upgrade according to cIMPACT-NOW Update 3 consensus (one of these is sufficient):
			***EGFR amplification
			***Combined whole chromosome 7 gain and whole chromosome 10 loss (+ 7/− 10)
			***TERT promoter mutation
			**Suggested Sign-out: Diffuse astrocytic glioma, IDH-wildtype, with molecular features of glioblastoma, WHO grade IV

	==DDx==		==DDx==

Jensflorian: /* Molecular */ update on idh-wildtype astrocytoma

2018-03-19T09:11:36Z

Molecular: update on idh-wildtype astrocytoma

← Older revision		Revision as of 09:11, 19 March 2018
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	*Tp53 mutations in approx. 60% (80-90% in gemistocytic, 50% in fibrillary types).		*Tp53 mutations in approx. 60% (80-90% in gemistocytic, 50% in fibrillary types).
	*MGMT promotor methylated in approx. 50%.		*MGMT promotor methylated in approx. 50%.

			*The existence of diffuse astrocytoma, IDH wildtype is challenged.<ref>{{Cite journal \| last1 = Reuss \| first1 = DE. \| last2 = Kratz \| first2 = A. \| last3 = Sahm \| first3 = F. \| last4 = Capper \| first4 = D. \| last5 = Schrimpf \| first5 = D. \| last6 = Koelsche \| first6 = C. \| last7 = Hovestadt \| first7 = V. \| last8 = Bewerunge-Hudler \| first8 = M. \| last9 = Jones \| first9 = DT. \| title = Adult IDH wild type astrocytomas biologically and clinically resolve into other tumor entities. \| journal = Acta Neuropathol \| volume = 130 \| issue = 3 \| pages = 407-17 \| month = Sep \| year = 2015 \| doi = 10.1007/s00401-015-1454-8 \| PMID = 26087904 }}</ref>
			**Most cases show genetic alterations compatible with glioblastoma.<ref>{{Cite journal \| last1 = Hasselblatt \| first1 = M. \| last2 = Jaber \| first2 = M. \| last3 = Reuss \| first3 = D. \| last4 = Grauer \| first4 = O. \| last5 = Bibo \| first5 = A. \| last6 = Terwey \| first6 = S. \| last7 = Schick \| first7 = U. \| last8 = Ebel \| first8 = H. \| last9 = Niederstadt \| first9 = T. \| title = Diffuse Astrocytoma, IDH-Wildtype: A Dissolving Diagnosis. \| journal = J Neuropathol Exp Neurol \| volume = \| issue = \| pages = \| month = Feb \| year = 2018 \| doi = 10.1093/jnen/nly012 \| PMID = 29444314 }}</ref>

	==DDx==		==DDx==

Jensflorian: WHO 2016 update

2016-05-19T08:14:20Z

WHO 2016 update

← Older revision		Revision as of 08:14, 19 May 2016
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	* Usually shows progression to [[glioblastoma]] sooner or later.		* Usually shows progression to [[glioblastoma]] sooner or later.

	~~Previously categorized as follows~~:<ref ~~name=WHOCNS~~>{{~~Ref WHOCNS~~\|25}}</ref>		WHO 2016 categorization combines morphology and genetics into following groups:<ref>{{Cite journal \| last1 = Louis \| first1 = DN. \| last2 = Perry \| first2 = A. \| last3 = Reifenberger \| first3 = G. \| last4 = von Deimling \| first4 = A. \| last5 = Figarella-Branger \| first5 = D. \| last6 = Cavenee \| first6 = WK. \| last7 = Ohgaki \| first7 = H. \| last8 = Wiestler \| first8 = OD. \| last9 = Kleihues \| first9 = P. \| title = The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. \| journal = Acta Neuropathol \| volume = 131 \| issue = 6 \| pages = 803-20 \| month = Jun \| year = 2016 \| doi = 10.1007/s00401-016-1545-1 \| PMID = 27157931 }}</ref>
	*Diffuse astrocytoma ICD-O: 9400/3		*Diffuse astrocytoma, IDH-mutant ICD-O: 9400/3 - most frequent.
	**~~Fibrillary~~ astrocytoma ICD-O: ~~9420~~/3 ~~- most frequent~~		**Gemistocytic astrocytoma, IDH-mutant ICD-O:9411/3
	**Gemistocytic astrocytoma ICD-O:~~9411~~/3		*Diffuse astrocytoma, IDH-wildtype ICD-O: 9400/3
	**Protoplasmatic astrocytoma ICD-O:~~9410~~/3 - ~~rare~~		*Diffuse astrocytoma,NOS ICD-O: 9400/3 - genetic data missing.
	Note: This subtyping is no longer in use!
			''Note:'' Older terminologies included Fibrillary astrocytoma (ICD-O: 9420/3) and Protoplasmatic astrocytoma (ICD-O:9410/3)<ref name=WHOCNS>{{Ref WHOCNS\|25}}</ref> This subtyping is no longer in use. These tumors are now classified according their IDH mutation status.

	==Radiology/Clinic==		==Radiology/Clinic==
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	File:Astrocytoma whoII HE.jpg \| Astrocytoma, fibrillary type (WC/jensflorian)		File:Astrocytoma whoII HE.jpg \| Astrocytoma, fibrillary type (WC/jensflorian)
	File:Neuropathology case II 02.jpg \| Astrocytoma, protoplasmatic type (WC/jensflorian)		File:Neuropathology case II 02.jpg \| Astrocytoma, protoplasmatic type (WC/jensflorian)
			File:Gemistocytic astrocytoma.jpg \| Gemistocytic astrocytoma (WC/jensflorian)
	</gallery>		</gallery>

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	*MIB-1: 0-5% (mean: 2%).		*MIB-1: 0-5% (mean: 2%).
	*[[IDH-1]] (R132H)+ve in 60-70%.		*[[IDH-1]] (R132H)+ve in 60-70%.
	*[[ATRX]] loss in 70%.		**'Note:'' This antibody does not detect other rare IDH1/2 mutations.
			*[[ATRX]] nuclear loss in 70%.

	<gallery>		<gallery>
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	==Molecular==		==Molecular==
			*IDH1 R132- or IDH2 R172-point mutations classify the tumors as Diffuse astrocytoma, IDH-mutant.
	*Absence of LOH 1p/19q.		*Absence of LOH 1p/19q.
	*Tp53 mutations in approx. 60% (80-90% in gemistocytic, 50% in fibrillary types).		*Tp53 mutations in approx. 60% (80-90% in gemistocytic, 50% in fibrillary types).
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	*Reactive astrocytosis.		*Reactive astrocytosis.
	*Demyelinisation.		*Demyelinisation.
	*[[Anaplastic astrocytoma]]		*[[Anaplastic astrocytoma]] - increased mitotic activity.
	*[[Oligoastrocytoma]]		*[[Oligoastrocytoma]], NOS - esp. when genetic data on IDH and LOH 1p/19q are lacking.
	*[[Oligodendroglioma]] - esp. protoplasmatic forms.		*[[Oligodendroglioma]] - esp. protoplasmatic forms. LOH 1p/19q testing required.
	*[[SEGA]] - esp. gemistocytic forms.		*[[SEGA]] - esp. gemistocytic forms.

Jensflorian: update

2015-10-22T10:16:50Z

update

← Older revision		Revision as of 10:16, 22 October 2015
Line 5:		Line 5:
	* Usually shows progression to [[glioblastoma]] sooner or later.		* Usually shows progression to [[glioblastoma]] sooner or later.

	Previously categorized as follows:{{Ref WHOCNS\|25}}		Previously categorized as follows:<ref name=WHOCNS>{{Ref WHOCNS\|25}}</ref>
	*Diffuse astrocytoma ICD-O: 9400/3		*Diffuse astrocytoma ICD-O: 9400/3
	**Fibrillary astrocytoma ICD-O: 9420/3 - most frequent		**Fibrillary astrocytoma ICD-O: 9420/3 - most frequent
Line 11:		Line 11:
	**Protoplasmatic astrocytoma ICD-O:9410/3 - rare		**Protoplasmatic astrocytoma ICD-O:9410/3 - rare
	Note: This subtyping is no longer in use!		Note: This subtyping is no longer in use!

			==Radiology/Clinic==
			*Mass effect.
			*Seizures.
			*Neurologic decifit.
			*Usually not contrast-enhanching, T2 bright.

			==Macroscopy==
			*No clear demarcation from white matter
			*May contain larger cysts
			*No necrosis

	==Histology==		==Histology==
			Features: <ref name=AFIP2007>{{Ref AFIP2007\|34}}</ref>
	*Cell density higher than normal brain.		*Cell density higher than normal brain.
	*Mild to moderate nuclear pleomorphism.		*Mild to moderate nuclear pleomorphism.
	**Monotony of atypical nuclei ~~hints at~~ neoplasm.		**Monotony of atypical nuclei and irregular distribution indicates neoplasm.
			**"naked nuclei" without recognizeable processes.
			**No prominent nucleolus.
	*Cytoplasm highly variable (even within the same tumour).		*Cytoplasm highly variable (even within the same tumour).
	**In normal CNS the cytoplasm blends within the neuropil.		**In normal CNS the cytoplasm blends within the neuropil.
	*Mitoses absent or very rare.		*Mitoses absent or very rare.
	*Microcystic ~~changes~~ of the background (none to extensive).		*Microcystic spaces of the background (none to extensive).
	*No necrosis, no vascular proliferations.		*No necrosis, no vascular proliferations.
			**Except radiation necrosis.
			*Lymphocytic cuffing (mostly in gemistocytic type)
			*Abent to few rosenthal fibers.

			<gallery>
			File:Diffuse_astrocytoma_HE_stain.jpg \| Diffuse astrocytoma, [[H&E]] (WC/jensflorian)
			File:Image NP T2a 0002.JPG \| Diffuse astrocytoma, [[H&E]] (WC/jensflorian)
			File:Astrocytoma whoII HE.jpg \| Astrocytoma, fibrillary type (WC/jensflorian)
			File:Neuropathology case II 02.jpg \| Astrocytoma, protoplasmatic type (WC/jensflorian)
			</gallery>


	==IHC==		==IHC==
Line 27:		Line 52:
	*Vimentin+ve (often perinuclear).		*Vimentin+ve (often perinuclear).
	*S-100+ve.		*S-100+ve.
			*p53: Nuclear staining in 30% of the tumours (usually few cells).
	*MIB-1: 0-5% (mean: 2%).		*MIB-1: 0-5% (mean: 2%).
	*[[IDH-1]] (R132H)+ve in 60-70%.		*[[IDH-1]] (R132H)+ve in 60-70%.
	*[[ATRX]] loss in 70%.		*[[ATRX]] loss in 70%.

			<gallery>
			File:GFAP astrocytoma.jpg\| GFAP in astrocytoma (WC/jensflorian)
			File:Neuropathology case II 04.jpg \| ATRX loss in astrocytoma (WC/jensflorian)
			</gallery>

	==Molecular==		==Molecular==
Line 44:		Line 75:
	*[[SEGA]] - esp. gemistocytic forms.		*[[SEGA]] - esp. gemistocytic forms.

	~~<gallery>~~
	~~File:Diffuse_astrocytoma_HE_stain.jpg \| DIffuse astrocytoma, [[H&E]] (WC/jensflorian)~~
	~~File:Astrocytoma whoII HE.jpg \| Astrocytoma, fibrillary type (WC/jensflorian)~~
	~~File:Neuropathology case II 02.jpg \| Astrocytoma, protoplasmatic type (WC/jensflorian)~~
	~~</gallery>~~

	=See also=		=See also=

Jensflorian: +pic

2015-10-22T06:26:32Z

+pic

← Older revision		Revision as of 06:26, 22 October 2015
Line 22:		Line 22:
	*No necrosis, no vascular proliferations.		*No necrosis, no vascular proliferations.

	===IHC===		==IHC==
	*[[GFAP]]+ve.		*[[GFAP]]+ve.
	*[[MAP2]]+ve (especially in cell processes).		*[[MAP2]]+ve (especially in cell processes).
Line 31:		Line 31:
	*[[ATRX]] loss in 70%.		*[[ATRX]] loss in 70%.

	===Molecular===		==Molecular==
	*Absence of LOH 1p/19q.		*Absence of LOH 1p/19q.
	*Tp53 mutations in approx. 60% (80-90% in gemistocytic, 50% in fibrillary types).		*Tp53 mutations in approx. 60% (80-90% in gemistocytic, 50% in fibrillary types).
Line 39:		Line 39:
	*Reactive astrocytosis.		*Reactive astrocytosis.
	*Demyelinisation.		*Demyelinisation.
			*[[Anaplastic astrocytoma]]
			*[[Oligoastrocytoma]]
			*[[Oligodendroglioma]] - esp. protoplasmatic forms.
			*[[SEGA]] - esp. gemistocytic forms.

	<gallery>		<gallery>
			File:Diffuse_astrocytoma_HE_stain.jpg \| DIffuse astrocytoma, [[H&E]] (WC/jensflorian)
	File:Astrocytoma whoII HE.jpg \| Astrocytoma, fibrillary type (WC/jensflorian)		File:Astrocytoma whoII HE.jpg \| Astrocytoma, fibrillary type (WC/jensflorian)
	File:Neuropathology case II 02.jpg \| Astrocytoma, protoplasmatic type (WC/jensflorian)		File:Neuropathology case II 02.jpg \| Astrocytoma, protoplasmatic type (WC/jensflorian)