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Malignant MCA Infarct – DESTINY II Over-60s — SCE Neurology MCQ

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HardCerebrovascular DiseaseMalignant MCA Infarct – DESTINY II Over-60sSCE Neurology

A diffusely infiltrating thalamic glioma has bland histology, low mitotic activity and no necrosis. It is IDH-wildtype and shows loss of H3K27 trimethylation with an H3 K27 alteration. What is the correct integrated classification?

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Correct answer: C — Diffuse midline glioma, H3 K27-altered, grade 4

Explanation lettering: D = shown as B · E = shown as C · C = shown as D · B = shown as E

A does not fit a diffuse infiltrating midline glioma with the defining H3 pathway abnormality. B requires an IDH mutation. C requires both IDH mutation and whole-arm 1p/19q codeletion. D is a biologically and anatomically distinct ependymoma. E is correct: an H3 K27-altered diffuse midline glioma is assigned CNS WHO grade 4 even when histology appears bland and lacks necrosis.

Reference: EANO guideline on diffuse gliomas of adulthood: https://pmc.ncbi.nlm.nih.gov/articles/PMC7904519/