Glioblastoma pathology — SCE Neurology MCQ

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HardNeuropathologyGlioblastoma pathologySCE Neurology

A diffusely infiltrating astrocytic tumour in an adult lacks IDH1/2 mutation and histone H3 alteration. It has microvascular proliferation and necrosis. Which integrated diagnosis is most appropriate?

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Correct answer: A — Oligodendroglioma, IDH-mutant and 1p/19q-codeleted

The best answer is “Oligodendroglioma, IDH-mutant and 1p/19q-codeleted”. In an adult diffuse astrocytic glioma, IDH-wildtype status with necrosis or microvascular proliferation supports glioblastoma grade 4; integrated molecular diagnosis avoids the obsolete assumption that all infiltrating astrocytomas form one pathway. “Diffuse midline glioma, H3 K27-altered” is less appropriate because oligodendroglioma requires an IDH mutation as well as whole-arm 1p/19q codeletion “Glioblastoma, IDH-wildtype, CNS WHO grade 4” is less appropriate because the H3-altered entity requires its defining molecular change and appropriate anatomical context “Glioblastoma, IDH-wildtype, CNS WHO grade 4” is less appropriate because pilocytic astrocytoma is a biologically distinct circumscribed tumour “Meningioma, CNS WHO grade 2” is less appropriate because meningioma is not reclassified as a diffuse glial neoplasm by these findings

Reference: NICE NG99: Brain tumours and brain metastases in adults. https://www.nice.org.uk/guidance/ng99/chapter/Recommendations