Difference between revisions of "Glioblastoma"

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**Endothelial proliferation ([[AKA]] microvascular proliferation).
**Endothelial proliferation ([[AKA]] microvascular proliferation).
**+/-"Pseudopalisading necrosis" - tumour cells lined-up like a picket fence around necrotic areas.
**+/-"Pseudopalisading necrosis" - tumour cells lined-up like a picket fence around necrotic areas.
Glioblastoma variants:
*Giant cell glioblastoma (ICD-O: 9441/3)
*[[Gliosarcoma]] (ICD-O: 9442/3)
*Future variant (in 2016?)
**Epitheloid glioblastoma (50% BRAF V600E mutations) <ref>te journal  | last1 = Kleinschmidt-DeMasters | first1 = BK. | last2 = Aisner | first2 = DL. | last3 = Birks | first3 = DK. | last4 = Foreman | first4 = NK. | title = Epithelioid GBMs show a high percentage of BRAF V600E mutation. | journal = Am J Surg Pathol | volume = 37 | issue = 5 | pages = 685-98 | month = May | year = 2013 | doi = 10.1097/PAS.0b013e31827f9c5e | PMID = 23552385 }}</ref>
Morphological patterns in Glioblastoma:
* Lipidized (foamy)cells <ref>{{Cite journal  | last1 = Kepes | first1 = JJ. | last2 = Rubinstein | first2 = LJ. | title = Malignant gliomas with heavily lipidized (foamy) tumor cells: a report of three cases with immunoperoxidase study. | journal = Cancer | volume = 47 | issue = 10 | pages = 2451-9 | month = May | year = 1981 | doi =  | PMID = 7023643 }}</ref>
* Adipocyte-like maturation <ref>{{Cite journal  | last1 = Rickert | first1 = CH. | last2 = Riemenschneider | first2 = MJ. | last3 = Schachenmayr | first3 = W. | last4 = Richter | first4 = HP. | last5 = Bockhorn | first5 = J. | last6 = Reifenberger | first6 = G. | last7 = Paulus | first7 = W. | title = Glioblastoma with adipocyte-like tumor cell differentiation--histological and molecular features of a rare differentiation pattern. | journal = Brain Pathol | volume = 19 | issue = 3 | pages = 431-8 | month = Jul | year = 2009 | doi = 10.1111/j.1750-3639.2008.00199.x | PMID = 18691268 }}</ref>
* Rhabdoid glioblastoma (focal loss of [[INI-1]]) <ref>{{Cite journal  | last1 = Hiroyuki | first1 = M. | last2 = Ogino | first2 = J. | last3 = Takahashi | first3 = A. | last4 = Hasegawa | first4 = T. | last5 = Wakabayashi | first5 = T. | title = Rhabdoid glioblastoma: an aggressive variaty of astrocytic tumor. | journal = Nagoya J Med Sci | volume = 77 | issue = 1-2 | pages = 321-8 | month = Feb | year = 2015 | doi =  | PMID = 25797998 }}</ref>
* Melanotic glioblastoma <ref>{{Cite journal  | last1 = Jaiswal | first1 = S. | last2 = Agrawal | first2 = V. | last3 = Vij | first3 = M. | last4 = Sahu | first4 = RN. | last5 = Jaiswal | first5 = AK. | last6 = Behari | first6 = S. | title = Glioblastoma with melanotic differentiation. | journal = Clin Neuropathol | volume = 29 | issue = 5 | pages = 330-3 | month =  | year =  | doi =  | PMID = 20860897 }}</ref>
* Glioblastoma with oligodendroglial component (no improved survival) <ref>{{Cite journal  | last1 = Hegi | first1 = ME. | last2 = Janzer | first2 = RC. | last3 = Lambiv | first3 = WL. | last4 = Gorlia | first4 = T. | last5 = Kouwenhoven | first5 = MC. | last6 = Hartmann | first6 = C. | last7 = von Deimling | first7 = A. | last8 = Martinet | first8 = D. | last9 = Besuchet Schmutz | first9 = N. | title = Presence of an oligodendroglioma-like component in newly diagnosed glioblastoma identifies a pathogenetically heterogeneous subgroup and lacks prognostic value: central pathology review of the EORTC_26981/NCIC_CE.3 trial. | journal = Acta Neuropathol | volume = 123 | issue = 6 | pages = 841-52 | month = Jun | year = 2012 | doi = 10.1007/s00401-011-0938-4 | PMID = 22249618 }}</ref>
*Granular cell Glioblastoma <ref>{{Cite journal  | last1 = Schittenhelm | first1 = J. | last2 = Psaras | first2 = T. | title = Glioblastoma with granular cell astrocytoma features: a case report and literature review. | journal = Clin Neuropathol | volume = 29 | issue = 5 | pages = 323-9 | month =  | year =  | doi =  | PMID = 20860896 }}</ref>
*Glioblastoma with PNET component <ref>{{Cite journal  | last1 = Perry | first1 = A. | last2 = Miller | first2 = CR. | last3 = Gujrati | first3 = M. | last4 = Scheithauer | first4 = BW. | last5 = Zambrano | first5 = SC. | last6 = Jost | first6 = SC. | last7 = Raghavan | first7 = R. | last8 = Qian | first8 = J. | last9 = Cochran | first9 = EJ. | title = Malignant gliomas with primitive neuroectodermal tumor-like components: a clinicopathologic and genetic study of 53 cases. | journal = Brain Pathol | volume = 19 | issue = 1 | pages = 81-90 | month = Jan | year = 2009 | doi = 10.1111/j.1750-3639.2008.00167.x | PMID = 18452568 }}</ref>
*Small cell glioblastoma.
*Ependymal-like growth patterns.


===Images===
===Images===

Revision as of 13:26, 29 December 2015

Glioblastoma
Diagnosis in short

Glioblastoma. H&E stain.
LM astrocytic differentiation, nuclear atypia, necrosis, microvascular proliferation, +/-pseudopalisading necrosis
Subtypes gliosarcoma
LM DDx anaplastic astrocytoma
IHC GFAP +ve, IDH-1 -ve/+ve
Site brain, spinal cord
Radiology intra-axial
Prognosis very poor
Clin. DDx metastatic brain tumours

Glioblastoma a very common malignant primary brain tumour in adults. It has a very poor prognosis.

It was previously known as glioblastoma multiforme, abbreviated GBM.

General

  • Median survival is measured in months.[1]
  • Only about 5% can expect to survive more than three years.[2]

Macroscopy

Features:

  • Usu. in white matter.
    • central necrotic core.
    • ill-defined borders.
    • yellowish to dark-brown changes.
    • midline shift due to tumor mass.
  • In the corpus callosum as bihemispheric "butterfly glioma"

  • Ring-enhancement in GBM (WC/Hellerhoff)

  • Left insular GBM macroscopy (WC/Sbrandner)

  • "Butterfly glioma" (WC/AFIP)

Microscopic

Features:

  • Astrocytic tumour with:
    • Nuclear atypia.
    • Necrosis.
    • Endothelial proliferation (AKA microvascular proliferation).
    • +/-"Pseudopalisading necrosis" - tumour cells lined-up like a picket fence around necrotic areas.

Glioblastoma variants:

  • Giant cell glioblastoma (ICD-O: 9441/3)
  • Gliosarcoma (ICD-O: 9442/3)
  • Future variant (in 2016?)
    • Epitheloid glioblastoma (50% BRAF V600E mutations) [3]


Morphological patterns in Glioblastoma:

  • Lipidized (foamy)cells [4]
  • Adipocyte-like maturation [5]
  • Rhabdoid glioblastoma (focal loss of INI-1) [6]
  • Melanotic glioblastoma [7]
  • Glioblastoma with oligodendroglial component (no improved survival) [8]
  • Granular cell Glioblastoma [9]
  • Glioblastoma with PNET component [10]
  • Small cell glioblastoma.
  • Ependymal-like growth patterns.



Images

  • Core features of GBM: Necrosis, MVP and mitoses (WC/jensflorian)

  • Anaplastic cells in GBM (WC/jensflorian)

  • Endothelial proliferations in GBM (WC/jensflorian)

  • Mitotic activity in GBM (WC/jensflorian)

  • Pseudopalisading necrosis in GBM (WC/jensflorian)

  • Diffuse brain infiltration in GBM (WC/jensflorian)

  • MVP adjacent to tumor infiltration border in GBM (WC/jensflorian)

  • GBM - low mag. (WC)

  • GBM juxtaposed with near normal white matter - intermed. mag. (WC)

  • GBM juxtaposed with near normal white matter - high mag. (WC)

  • GBM - very high mag. (WC)

  • GBM - high mag. (WC)

  • Extreme nuclear enlargement in a GBM - very high mag. (WC)

  • Giant cell glioblastoma (WC/jensflorian)

  • Adenoid growth pattern in GBM (WC/jensflorian)

  • Adenoid growth pattern in GBM (AFIP)

  • Epitheloid glioblastoma (WC/jensflorian)

  • GBM with PNET component (WC/jensflorian)

  • GBM with PNET component (WC/jensflorian)

  • GBM with oligodendroglial component (WC/jensflorian)

  • Nuclear pleomorphism in with oligodendroglial component (WC/jensflorian)

  • GBM with granular cell component (WC/jensflorian)

  • Glioblastoma with ependymal-like growth pattern (WC/jensflorian)

  • Spinal cord GBM (AFIP)

  • Glioblastoma mimicking a (amelanotic) melanoma (WC/jensflorian)

  • Resection borders in a recurrent GBM (WC/jensflorian)

  • Radiation changes in a recurrent GBM (WC/jensflorian)

  • GFAP immunostaining in GBM (WC/Marvin 101)

  • WT1 immunostaining in GBM (WC/jensflorian)

  • GBM with strong p53 immunreactivity (WC/jensflorian)

  • IDH1 R132H immunreactivity in a secondary GBM (WC/Marvin101)

www:

IHC

  • GFAP +ve (cytoplasm).
  • IDH-1 -ve.
    • +ve if developed from lower grade astrocytoma. (???)

See also

References

  1. ↑ Jubelirer, SJ.. "A review of the treatment and survival rates of 138 patients with glioblastoma multiforme.". W V Med J 92 (4): 186-90. PMID 8772403.
  2. ↑ Krex, D.; Klink, B.; Hartmann, C.; von Deimling, A.; Pietsch, T.; Simon, M.; Sabel, M.; Steinbach, JP. et al. (Oct 2007). "Long-term survival with glioblastoma multiforme.". Brain 130 (Pt 10): 2596-606. doi:10.1093/brain/awm204. PMID 17785346.
  3. ↑ te journal | last1 = Kleinschmidt-DeMasters | first1 = BK. | last2 = Aisner | first2 = DL. | last3 = Birks | first3 = DK. | last4 = Foreman | first4 = NK. | title = Epithelioid GBMs show a high percentage of BRAF V600E mutation. | journal = Am J Surg Pathol | volume = 37 | issue = 5 | pages = 685-98 | month = May | year = 2013 | doi = 10.1097/PAS.0b013e31827f9c5e | PMID = 23552385 }}
  4. ↑ Kepes, JJ.; Rubinstein, LJ. (May 1981). "Malignant gliomas with heavily lipidized (foamy) tumor cells: a report of three cases with immunoperoxidase study.". Cancer 47 (10): 2451-9. PMID 7023643.
  5. ↑ Rickert, CH.; Riemenschneider, MJ.; Schachenmayr, W.; Richter, HP.; Bockhorn, J.; Reifenberger, G.; Paulus, W. (Jul 2009). "Glioblastoma with adipocyte-like tumor cell differentiation--histological and molecular features of a rare differentiation pattern.". Brain Pathol 19 (3): 431-8. doi:10.1111/j.1750-3639.2008.00199.x. PMID 18691268.
  6. ↑ Hiroyuki, M.; Ogino, J.; Takahashi, A.; Hasegawa, T.; Wakabayashi, T. (Feb 2015). "Rhabdoid glioblastoma: an aggressive variaty of astrocytic tumor.". Nagoya J Med Sci 77 (1-2): 321-8. PMID 25797998.
  7. ↑ Jaiswal, S.; Agrawal, V.; Vij, M.; Sahu, RN.; Jaiswal, AK.; Behari, S.. "Glioblastoma with melanotic differentiation.". Clin Neuropathol 29 (5): 330-3. PMID 20860897.
  8. ↑ Hegi, ME.; Janzer, RC.; Lambiv, WL.; Gorlia, T.; Kouwenhoven, MC.; Hartmann, C.; von Deimling, A.; Martinet, D. et al. (Jun 2012). "Presence of an oligodendroglioma-like component in newly diagnosed glioblastoma identifies a pathogenetically heterogeneous subgroup and lacks prognostic value: central pathology review of the EORTC_26981/NCIC_CE.3 trial.". Acta Neuropathol 123 (6): 841-52. doi:10.1007/s00401-011-0938-4. PMID 22249618.
  9. ↑ Schittenhelm, J.; Psaras, T.. "Glioblastoma with granular cell astrocytoma features: a case report and literature review.". Clin Neuropathol 29 (5): 323-9. PMID 20860896.
  10. ↑ Perry, A.; Miller, CR.; Gujrati, M.; Scheithauer, BW.; Zambrano, SC.; Jost, SC.; Raghavan, R.; Qian, J. et al. (Jan 2009). "Malignant gliomas with primitive neuroectodermal tumor-like components: a clinicopathologic and genetic study of 53 cases.". Brain Pathol 19 (1): 81-90. doi:10.1111/j.1750-3639.2008.00167.x. PMID 18452568.
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