Highlights & Basics
- Gliomas may be described as circumscribed or diffuse.
- Circumscribed gliomas (e.g., pleomorphic xanthoastrocytoma, subependymal giant cell astrocytoma, pilocytic/pilomyxoid astrocytoma) have well-defined margins, and are generally considered benign. Maximal safe resection is the mainstay of treatment.
- Diffuse astrocytomas (grade 2-4) represent a spectrum of the same highly infiltrative disease, with lower grades inevitably progressing to higher-grade lesions. They can be characterized on the basis of the isocitrate dehydrogenase (IDH) and histone 3 (H3) mutation status.
- IDH-wildtype diffuse glioma (glioblastoma) is an aggressive primary brain tumor that presents in patients in the sixth or seventh decade of life. It is the most common type of glioma.
- IDH-mutant gliomas (including oligodendroglioma, IDH-mutant, 1p/19q codeleted, grades 2-3; and astrocytoma, IDH-mutant, grades 2-4) tend to occur in young or middle-age patients.
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Simplified classification of diffuse gliomas based on the 2021 WHO classification of CNS tumors. *Astrocytoma, IDH-mutant, can be diagnosed as grade 2, 3, or 4 based on histopathologic grading criteria and cyclin-dependent kinase inhibitor 2A/cyclin-dependent kinase inhibitor 2B (CDKN2A/B) status. ***Oligodendroglioma, IDH-mutant with codeletion of the short arm of chromosome 1 and the long arm of chromosome 19 (1p19q), can be diagnosed as grade 2 or 3 based on histopathologic features
T2-weighted MRI without (A) and with (B) contrast demonstrating a pontine glioma
MRI: T2 and T1 post-contrast, demonstrating a tectal glioma (grade 2)
MRI demonstrating a right temporal glioblastoma (grade 4)
MRI demonstrating a right frontal grade 2 diffuse astrocytoma
MRI demonstrating a cerebellar pilocytic astrocytoma (grade 1)
Important molecular tests to establish the diagnosis and prognosis of glioblastoma
Citations
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