The New WHO Classification and the Role of Integrated Molecular Profiling in the Diagnosis of Malignant Gliomas

Size: px
Start display at page:

Download "The New WHO Classification and the Role of Integrated Molecular Profiling in the Diagnosis of Malignant Gliomas"

Transcription

1 The New WHO Classification and the Role of Integrated Molecular Profiling in the Diagnosis of Malignant Gliomas Stefan Prokop, MD Neuropathology Fellow Hospital of the University of Pennsylvania

2 Background Updated WHO in 2016 Incorporates Layered Diagnoses Histology Immunohistochemical markers Molecular WHO grade Re-classifies certain tumors and tumor groups

3 Glial neoplasms: Infiltrating Gliomas then (2007 WHO classification) Astrocytic tumors Diffuse astrocytoma Anaplastic astrocytoma Glioblastoma Giant cell glioblastoma Gliosarcoma Oligoastrocytic tumors Oligoastrocytoma Anaplastic oligoastrocytoma Oligodendroglial tumors Oligodendroglioma Anaplastic oligodendroglioma

4 Photo courtesy of Dr. Edward B. Lee Oligodendrogliomas Fried egg appearance Chicken wire capillaries Micro-califications Microcystic Gemistocytic tumor cells

5 Photo courtesy of Aivi T. Nguyen Astrocytomas Hypercellularity Nuclear atypia +/- Mitotic activity No necrosis No microvascular proliferation

6 Photo courtesy of Aivi T. Nguyen Astrocytomas: Glioblastoma Atypia Necrosis Pseuodpalisading Geographic Microvascular proliferation Vessel thromboses

7 Photo courtesy of Aivi T. Nguyen Astrocytomas: Glioblastoma Atypia Necrosis Pseuodpalisading Geographic Microvascular proliferation Vessel thromboses

8 Molecular Landscape of Gliomas

9 Isocitrate dehydrogenase (IDH) mutations in gliomas Yan et al., NEJM 2009

10 IDH: Isocitrate Dehydrogenase mutations in tumors Presner et al., Nature Med, 2011

11 Prognostic impact of IDH mutation status IDH1-mutation specific antibody Hartmann et al., Acta Neuropathologica 2010

12 Concurent 1p and 19q chromosome loss in Oligodendrogliomas lost Whole-arm translocation Weller et al., Neuro-Oncology Initially shown to be associated with better prognosis in diffuse gliomas Griffin et al., Journal of Neuropathology and Experimental Neurology Co-occurrence of 1p/19q deletion and IDH mutation defines Oligodendrogliomas

13 Glial neoplasms: Infiltrating Gliomas now (2016 WHO classification) Astrocytic tumors Diffuse astrocytoma Anaplastic astrocytoma Glioblastoma Giant cell glioblastoma Gliosarcoma Oligodendroglial tumors Oligodendroglioma Anaplastic oligodendroglioma Oligoastrocytic tumors Oligoastrocytoma Anaplastic oligoastrocytoma Integrated diagnosis incorporating histology, immunohistochemistry and molecular findings to define tumor entities

14 Glial neoplasms: Infiltrating Gliomas now (2016 WHO classification) Astrocytic tumors Diffuse astrocytoma Anaplastic astrocytoma Glioblastoma Giant cell glioblastoma Gliosarcoma IDH wild type or IDH mutant 1p/19q non co-deleted Oligodendroglial tumors Oligodendroglioma Anaplastic oligodendroglioma IDH mutant and 1p/19q co-deleted (entity defining genetic alterations)

15 Louis et al., Acta Neuropathologica 2016

16 Mutations of Selected Genes in Glioma Subtypes Glioblastoma Astrocytoma Oligodendroglioma Oligoastrocytoma Killela et al., PNAS 2013

17 The New WHO Classification in Action

18 WHO 2016: Layered Diagnosis Integrated Diagnosis Incorporating all aspects of tissue diagnosis Histological Classification WHO Grade reflects natural history, based on histology Molecular information Louis et al., Brain Pathology 2014

19 Workflow Histology H&E sections Tissue is processed (formalin fixation) and put on slides Review slides and immunostains, write pathology report Molecular Molecular tests ordered CPD, EGFRvIII, MGMT promoter methylation tests ordered after sign out of case Integrated Diagnosis Molecular results Results returned ~2 weeks Integrated diagnosis in addendum (no longer pending )

20 Example: Histology Photos courtesy of Dr. Edward B. Lee

21 Example: Initial Diagnosis Integrated diagnosis: Pending Histologic diagnosis: Infiltrating high grade glioma Histologic grade: At least WHO grade III Molecular information: Pending

22 Example: Final Diagnosis Integrated diagnosis: Pending Histologic diagnosis: Infiltrating high grade glioma Histologic grade: At least WHO grade III Molecular information: Pending Integrated diagnosis: Glioblastoma, IDH-wildtype, WHO grade IV Histologic diagnosis: Glioblastoma Histologic grade: WHO grade IV Molecular information: IDH negative, 1p/19q-intact

23 Example: Final Diagnosis Integrated diagnosis: Pending Histologic diagnosis: Infiltrating high grade glioma Histologic grade: At least WHO grade III Molecular information: Pending Integrated diagnosis: Glioblastoma, IDH-mutant, WHO grade IV Histologic diagnosis: Glioblastoma Histologic grade: WHO grade IV Molecular information: IDH p.r132h positive, 1p/19q-intact

24 Example: Final Diagnosis Integrated diagnosis: Pending Histologic diagnosis: Infiltrating high grade glioma Histologic grade: At least WHO grade III Molecular information: Pending Integrated diagnosis: Anaplastic Oligodendroglioma, IDH-mutant, 1p/19qcodeleted, WHO grade III Histologic diagnosis: Oligodendroglioma Histologic grade: WHO grade III Molecular information: IDH p.r132h, 1p/19q-codeleted

25 Three different diagnoses Glioblastoma - 1 IDH-wildtype IDH1 (R132H) negative CPD negative 1p/19q-intact Glioblastoma - 2 IDH-mutant IDH1 (R132H) positive IDH1 p.r132h 1p/19q-intact Anaplastic Oligo. IDH-mutant IDH1 (R132H) positive IDH1 p.r132h 1p/19q-codeleted

26 Do we need a microscope? Yes! Must make histological diagnosis of glioma first WHO grade is based mainly on histology Some gliomas do not have these diagnostic genetic changes

27 Simplified algorithm for classification of diffuse gliomas based on histology and genetics More genetic changes will be found. Louis et al., Acta Neuropathologica

28 Summary Integration of molecular and histologic findings improves the definition of tumor entities Molecular profiling of gliomas and glioma subtypes will guide targeted and personalized therapeutic approaches

29 Neuro-Oncology Molecular testing workflow

30 Neuro-Oncology Molecular testing workflow

31 Neuro-Oncology Molecular testing workflow

32 Neuro-Oncology Molecular testing workflow

33 Neuro-Oncology Molecular testing workflow

34 Neuro-Oncology Molecular testing workflow

35 Neuro-Oncology Molecular testing workflow

MOLECULAR DIAGNOSTICS OF GLIOMAS

MOLECULAR DIAGNOSTICS OF GLIOMAS MOLECULAR DIAGNOSTICS OF GLIOMAS Arie Perry, M.D. Director, Neuropathology Division DIFFUSE GLIOMAS Cell types Astrocytomas (A) Oligodendrogliomas (O) Mixed oligoastrocytoma (MOA) Three WHO grades: II,

More information

Classification of Diffuse Gliomas: Progress, Pearls and Pitfalls. Rob Macaulay Neuropathologist, MCC October 21, 2017

Classification of Diffuse Gliomas: Progress, Pearls and Pitfalls. Rob Macaulay Neuropathologist, MCC October 21, 2017 Classification of Diffuse Gliomas: Progress, Pearls and Pitfalls Rob Macaulay Neuropathologist, MCC October 21, 2017 Objectives Explain why the designation high grade glioma is preferable to GBM for intraoperative

More information

Morphological features and genetic alterations

Morphological features and genetic alterations Morphological features and genetic alterations Tutor : Audrey Rousseau Caget Lise: Université d Angers Iorio Vittoria: Seconda Università degli studi di Napoli Manaila Roxana: Iuliu Hatieganu University

More information

Gliomas in the 2016 WHO Classification of CNS Tumors

Gliomas in the 2016 WHO Classification of CNS Tumors Gliomas in the 2016 WHO Classification of CNS Tumors Hindi N Al-Hindi, MD, FCAP Consultant Neuropathologist and Head Section of Anatomic Pathology Department of Pathology and Laboratory Medicine King Faisal

More information

CNS pathology Third year medical students. Dr Heyam Awad 2018 Lecture 12: CNS tumours 2/3

CNS pathology Third year medical students. Dr Heyam Awad 2018 Lecture 12: CNS tumours 2/3 CNS pathology Third year medical students Dr Heyam Awad 2018 Lecture 12: CNS tumours 2/3 Pilocytic astrocytoma Relatively benign ( WHO grade 1) Occurs in children and young adults Mostly: in the cerebellum

More information

Clinically Useful Next Generation Sequencing and Molecular Testing in Gliomas MacLean P. Nasrallah, MD PhD

Clinically Useful Next Generation Sequencing and Molecular Testing in Gliomas MacLean P. Nasrallah, MD PhD Clinically Useful Next Generation Sequencing and Molecular Testing in Gliomas MacLean P. Nasrallah, MD PhD Neuropathology Fellow Division of Neuropathology Center for Personalized Diagnosis (CPD) Glial

More information

WHO 2016 CNS Tumor Classification Update. DISCLOSURES (Arie Perry, MD) PATTERN RECOGNITION. Arie Perry, M.D. Director, Neuropathology

WHO 2016 CNS Tumor Classification Update. DISCLOSURES (Arie Perry, MD) PATTERN RECOGNITION. Arie Perry, M.D. Director, Neuropathology WHO 2016 CNS Tumor Classification Update Arie Perry, M.D. Director, Neuropathology DISCLOSURES (Arie Perry, MD) I have no financial relationships to disclose. - and - I will not discuss off label use or

More information

Case Presentation: USCAP Jason T. Huse, MD, PhD Assistant Member Department of Pathology Memorial Sloan Kettering Cancer Center

Case Presentation: USCAP Jason T. Huse, MD, PhD Assistant Member Department of Pathology Memorial Sloan Kettering Cancer Center Case Presentation: USCAP 2016 Jason T. Huse, MD, PhD Assistant Member Department of Pathology Memorial Sloan Kettering Cancer Center Case History 53 year old female with a long standing history of migraines

More information

Disclaimers. Molecular pathology of brain tumors. Some aspects only. Some details are inevitably personal opinions

Disclaimers. Molecular pathology of brain tumors. Some aspects only. Some details are inevitably personal opinions Molecular pathology of brain tumors Disclaimers Some aspects only H.K. Ng The Chinese University of Hong Kong Some details are inevitably personal opinions Free ppt : http://www.acp.cuhk.edu.hk/hkng Why

More information

Examining large groups of cancer patients to identify ways of predicting which therapies cancers might respond to.

Examining large groups of cancer patients to identify ways of predicting which therapies cancers might respond to. Stratified Medicine Examining large groups of cancer patients to identify ways of predicting which therapies cancers might respond to. Looking in detail at cancer cells and their genetic make up. Permit

More information

Pr D.Figarella-Branger Service d Anatomie Pathologique et de Neuropathologie, La Timone, Marseille UMR 911 Inserm, Université d Aix-Marseille

Pr D.Figarella-Branger Service d Anatomie Pathologique et de Neuropathologie, La Timone, Marseille UMR 911 Inserm, Université d Aix-Marseille Novelties in the WHO 2016 classification of brain tumours Pr D.Figarella-Branger Service d Anatomie Pathologique et de Neuropathologie, La Timone, Marseille UMR 911 Inserm, Université d Aix-Marseille The

More information

21/03/2017. Disclosure. Practice Changing Articles in Neuro Oncology for 2016/17. Gliomas. Objectives. Gliomas. No conflicts to declare

21/03/2017. Disclosure. Practice Changing Articles in Neuro Oncology for 2016/17. Gliomas. Objectives. Gliomas. No conflicts to declare Practice Changing Articles in Neuro Oncology for 2016/17 Disclosure No conflicts to declare Frances Cusano, BScPharm, ACPR April 21, 2017 Objectives Gliomas To describe the patient selection, methodology

More information

IDH1 R132H/ATRX Immunohistochemical validation

IDH1 R132H/ATRX Immunohistochemical validation IDH1 R132H/ATRX Immunohistochemical validation CIQC/DSM 2016 12 June 2016 0835-0905 Stephen Yip, M.D., Ph.D., FRCPC University of British Columbia Disclosure Statement I have nothing to disclose I will

More information

Applications of molecular neuro-oncology - a review of diffuse glioma integrated diagnosis and emerging molecular entities

Applications of molecular neuro-oncology - a review of diffuse glioma integrated diagnosis and emerging molecular entities Wood et al. Diagnostic Pathology (2019) 14:29 https://doi.org/10.1186/s13000-019-0802-8 REVIEW Applications of molecular neuro-oncology - a review of diffuse glioma integrated diagnosis and emerging molecular

More information

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES CENTRAL NERVOUS SYSTEM ANAPLASTIC GLIOMAS CNS Site Group Anaplastic Gliomas Author: Dr. Norm Laperriere Date: February 20, 2018 1. INTRODUCTION

More information

Diagnostic implications of IDH1-R132H and OLIG2 expression patterns in rare and challenging glioblastoma variants

Diagnostic implications of IDH1-R132H and OLIG2 expression patterns in rare and challenging glioblastoma variants & 2012 USCAP, Inc. All rights reserved 0893-3952/12 $32.00 1 Diagnostic implications of IDH1-R132H and OLIG2 expression patterns in rare and challenging glioblastoma variants Nancy M Joseph 1, Joanna Phillips

More information

Neuropathology Evening Session: Case 3

Neuropathology Evening Session: Case 3 Neuropathology Evening Session: Case 3 Christine E. Fuller, MD Cincinnati Children s Hospital Medical Center Disclosure of Relevant Financial Relationships USCAP requires that all faculty in a position

More information

5-hydroxymethylcytosine loss is associated with poor prognosis for

5-hydroxymethylcytosine loss is associated with poor prognosis for 5-hydroxymethylcytosine loss is associated with poor prognosis for patients with WHO grade II diffuse astrocytomas Feng Zhang 1,*, Yifan Liu 2, Zhiwen Zhang 1, Jie Li 1, Yi Wan 3, Liying Zhang 1, Yangmei

More information

A clinical perspective on neuropathology and molecular genetics in brain tumors

A clinical perspective on neuropathology and molecular genetics in brain tumors A clinical perspective on neuropathology and molecular genetics in brain tumors M.J. van den Bent Erasmus MC Cancer Institute Rotterdam, the Netherlands Disclosures Member speakersbureau: MSD Consultancy:

More information

Diagnostic application of SNParrays to brain cancers

Diagnostic application of SNParrays to brain cancers Diagnostic application of SNParrays to brain cancers Adriana Olar 4/17/2018 No disclosures 55 yo M, focal motor seizure T2 T1-post C DIAGNOSIS BRAIN, LEFT FRONTAL LOBE, BIOPSY: - DIFFUSE GLIOMA, OLIGODENDROGLIAL

More information

Clinical significance of genetic analysis in glioblastoma treatment

Clinical significance of genetic analysis in glioblastoma treatment Clinical significance of genetic analysis in glioblastoma treatment Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan Koji Yoshimoto Can we get prognostic

More information

The 2016 WHO classification of central nervous system tumors: what neurologists need to know

The 2016 WHO classification of central nervous system tumors: what neurologists need to know REVIEW C URRENT OPINION The 2016 WHO classification of central nervous system tumors: what neurologists need to know John C. DeWitt a,, Andreas Mock a,b,c,, and David N. Louis a Purpose of review The 2016

More information

Dual-Genotype Diffuse Low-Grade Glioma: Is It Really Time to Abandon Oligoastrocytoma As a Distinct Entity?

Dual-Genotype Diffuse Low-Grade Glioma: Is It Really Time to Abandon Oligoastrocytoma As a Distinct Entity? Journal of Neuropatholgy & Experimental Neurology Vol. 0, No. 0, 2017, pp. 1 5 doi: 10.1093/jnen/nlx024 BRIEF REPORT Dual-Genotype Diffuse Low-Grade Glioma: Is It Really Time to Abandon Oligoastrocytoma

More information

General: Brain tumors are lesions that have mass effect distorting the normal tissue and often result in increased intracranial pressure.

General: Brain tumors are lesions that have mass effect distorting the normal tissue and often result in increased intracranial pressure. 1 Lecture Objectives Know the histologic features of the most common tumors of the CNS. Know the differences in behavior of the different tumor types. Be aware of the treatment modalities in the various

More information

Detection of IDH1 mutation in human gliomas: comparison of immunohistochemistry and sequencing

Detection of IDH1 mutation in human gliomas: comparison of immunohistochemistry and sequencing DOI.7/s4--3-7 ORIGINAL ARTICLE Detection of IDH mutation in human gliomas: comparison of immunohistochemistry and sequencing Shingo Takano Wei Tian Masahide Matsuda Tetsuya Yamamoto Eiichi Ishikawa Mika

More information

Precision medicine for gliomas

Precision medicine for gliomas Precision medicine for YAZMIN ODIA, MD MS LEAD PHYSICIAN OF MEDICAL NEURO-ONCOLOGY DISCLOSURES Novocure: Advisory Board for Optune in No other financial conflicts of interest Glioma OVERVIEW INFILTRATIVE,

More information

Beyond the World Health Organization grading of infiltrating gliomas: advances in the molecular genetics of glioma classification

Beyond the World Health Organization grading of infiltrating gliomas: advances in the molecular genetics of glioma classification Beyond the World Health Organization grading of infiltrating gliomas: advances in the molecular genetics of glioma classification Krishanthan Vigneswaran, Emory University Stewart Neill, Emory University

More information

Anaplastic Pilocytic Astrocytoma: The fusion of good and bad

Anaplastic Pilocytic Astrocytoma: The fusion of good and bad Anaplastic Pilocytic Astrocytoma: The fusion of good and bad Alexandrina Nikova 1, Charalampos-Chrysovalantis Chytoudis-Peroudis 2, Penelope Korkolopoulou 3 and Dimitrios Kanakis 4 Abstract 5 Pilocytic

More information

성균관대학교삼성창원병원신경외과학교실신경종양학 김영준. KNS-MT-03 (April 15, 2015)

성균관대학교삼성창원병원신경외과학교실신경종양학 김영준. KNS-MT-03 (April 15, 2015) 성균관대학교삼성창원병원신경외과학교실신경종양학 김영준 INTRODUCTIONS Low grade gliomas (LGG) - heterogeneous group of tumors with astrocytic, oligodendroglial, ependymal, or mixed cellular histology - In adults diffuse, infiltrating

More information

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES CENTRAL NERVOUS SYSTEM LOW GRADE GLIOMAS CNS Site Group Low Grade Gliomas Author: Dr. Norm Laperriere 1. INTRODUCTION 3 2. PREVENTION 3 3. SCREENING

More information

Oligodendrogliomas & Oligoastrocytomas

Oligodendrogliomas & Oligoastrocytomas Oligodendrogliomas & Oligoastrocytomas ABOUT THE AMERICAN BRAIN TUMOR ASSOCIATION Founded in 1973, the American Brain Tumor Association (ABTA) was the first national nonprofit organization dedicated solely

More information

Molecular diagnostics of gliomas: state of the art

Molecular diagnostics of gliomas: state of the art Acta Neuropathol (2010) 120:567 584 DOI 10.1007/s00401-010-0736-4 REVIEW Molecular diagnostics of gliomas: state of the art Markus J. Riemenschneider Judith W. M. Jeuken Pieter Wesseling Guido Reifenberger

More information

Molecular characteristics of malignant gliomas and their future perspectives a review

Molecular characteristics of malignant gliomas and their future perspectives a review Molecular characteristics of malignant gliomas and their future perspectives a review Markus Mieskolainen 1 Malignant glial tumours are the most common primary brain tumours and the most aggressive and

More information

Biology, genetics and imaging of glial cell tumours

Biology, genetics and imaging of glial cell tumours The British Journal of Radiology, 84 (2011), S90 S106 Biology, genetics and imaging of glial cell tumours 1,2 C WALKER, BSc, PhD, 1 A BABORIE, FRCPath, 1 D CROOKS, FRCPath, 2 S WILKINS, MRCPCH and 1,2

More information

R1601 Essential Immunohistochemical and Molecular Markers for General CNS Glial Tumors

R1601 Essential Immunohistochemical and Molecular Markers for General CNS Glial Tumors October 22, 2018 12:00-1:00 PM Background The World Health Organization Classification of tumors of the Central Nervous System has recently been revised. There is now greater emphasis on molecular phenotype

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy Analysis of MGMT Promoter Methylation in Malignant Gliomas File Name: Origination: Last CAP Review: Next CAP Review: Last Review: analysis_of_mgmt_promoter_methylation_in_malignant_gliomas

More information

DNA methylation signatures for 2016 WHO classification subtypes of diffuse gliomas

DNA methylation signatures for 2016 WHO classification subtypes of diffuse gliomas Paul et al. Clinical Epigenetics (2017) 9:32 DOI 10.1186/s13148-017-0331-9 RESEARCH Open Access DNA methylation signatures for 2016 WHO classification subtypes of diffuse gliomas Yashna Paul, Baisakhi

More information

Tumors of the Central Nervous System

Tumors of the Central Nervous System Tumors of the Central Nervous System 1 Financial Disclosures I have NO SIGNIFICANT FINANCIAL, GENERAL, OR OBLIGATION INTERESTS TO REPORT Introduction General: Brain tumors are lesions that have mass effect

More information

Radioterapia no Tratamento dos Gliomas de Baixo Grau

Radioterapia no Tratamento dos Gliomas de Baixo Grau Radioterapia no Tratamento dos Gliomas de Baixo Grau Dr. Luis Souhami University Montreal - Canada Low Grade Gliomas Relatively rare Heterogeneous, slow growing tumors WHO Classification Grade I Pilocytic

More information

Review: Diagnostic, prognostic and predictive relevance of molecular markers in gliomas

Review: Diagnostic, prognostic and predictive relevance of molecular markers in gliomas Review: Diagnostic, prognostic and predictive relevance of molecular markers in gliomas Sebastian Brandner MD FRCPath 1 and Andreas von Deimling 2 MD 1) Division of Neuropathology, The National Hospital

More information

SUPPLEMENTARY INFORMATION

SUPPLEMENTARY INFORMATION VOLUME: 1 ARTICLE NUMBER: 0027 In the format provided by the authors and unedited. Rapid intraoperative histology of unprocessed surgical specimens via fibre-laser-based stimulated Raman scattering microscopy

More information

Predicting cancer outcomes from histology and genomics using convolutional networks

Predicting cancer outcomes from histology and genomics using convolutional networks Predicting cancer outcomes from histology and genomics using convolutional networks Pooya Mobadersany a, Safoora Yousefi a, Mohamed Amgad a, David A. Gutman b, Jill S. Barnholtz-Sloan c, José E. Velázquez

More information

European Association for Neuro-Oncology (EANO) guideline on the diagnosis and treatment of adult astrocytic and oligodendroglial gliomas

European Association for Neuro-Oncology (EANO) guideline on the diagnosis and treatment of adult astrocytic and oligodendroglial gliomas European Association for Neuro-Oncology (EANO) guideline on the diagnosis and treatment of adult astrocytic and oligodendroglial gliomas Michael Weller, Martin van den Bent, Jörg C Tonn, Roger Stupp, Matthias

More information

2017 Diagnostic Slide Session Case 3

2017 Diagnostic Slide Session Case 3 2017 Diagnostic Slide Session Case 3 Andrew Gao, MD Lili-Naz Hazrati, MD, PhD Cynthia Hawkins, MD, PhD Hospital for Sick Children and University of Toronto, Toronto, Canada Disclosures: none Clinical History

More information

Contemporary Management of Glioblastoma

Contemporary Management of Glioblastoma Contemporary Management of Glioblastoma Incidence Rates of Primary Brain Tumors Central Brain Tumor Registry of the United States, 1992-1997 100 Number of Cases per 100,000 Population 10 1 0.1 x I x I

More information

WHO 2016 CNS TUMOR CLASSIFICATION UPDATE. Arie Perry, M.D. Director, Neuropathology

WHO 2016 CNS TUMOR CLASSIFICATION UPDATE. Arie Perry, M.D. Director, Neuropathology WHO 2016 CNS TUMOR CLASSIFICATION UPDATE Arie Perry, M.D. Director, Neuropathology DISCLOSURES (Arie Perry, MD) I have no financial relationships to disclose. - and - I will not discuss off label use or

More information

CNS SESSION 3/8/ th Multidisciplinary Management of Cancers: A Case based Approach

CNS SESSION 3/8/ th Multidisciplinary Management of Cancers: A Case based Approach CNS SESSION Chair: Ruben Fragoso, MD/PhD UC Davis Fellow: Michael Cardenas, MD UC Davis Panel: Gordon Li, MD Stanford Seema Nagpal, MD Stanford Jennie Taylor, MD UCSF HPI: 46 yo right handed woman who

More information

MALIGNANT GLIOMAS: TREATMENT AND CHALLENGES

MALIGNANT GLIOMAS: TREATMENT AND CHALLENGES MALIGNANT GLIOMAS: TREATMENT AND CHALLENGES DISCLOSURE No conflicts of interest to disclose Patricia Bruns APRN, CNS Givens Brain Tumor Center Abbott Northwestern Hospital October 12, 2018 OBJECTIVES THEN

More information

Research Article Isocitrate Dehydrogenase-1 Mutations as Prognostic Biomarker in Glioblastoma Multiforme Patients in West Bohemia

Research Article Isocitrate Dehydrogenase-1 Mutations as Prognostic Biomarker in Glioblastoma Multiforme Patients in West Bohemia BioMed Research International, Article ID 735659, 5 pages http://dx.doi.org/10.1155/2014/735659 Research Article Isocitrate Dehydrogenase-1 Mutations as Prognostic Biomarker in Glioblastoma Multiforme

More information

Understanding general brain tumor pathology, Part I: The basics. Craig Horbinski, M.D., Ph.D. Department of Pathology University of Kentucky

Understanding general brain tumor pathology, Part I: The basics. Craig Horbinski, M.D., Ph.D. Department of Pathology University of Kentucky Understanding general brain tumor pathology, Part I: The basics Craig Horbinski, M.D., Ph.D. Department of Pathology University of Kentucky plan of attack what IS a pathologist, anyway? what s so special

More information

Integrating molecular markers into the World Health Organization classification of CNS tumors: a survey of the neuro-oncology community

Integrating molecular markers into the World Health Organization classification of CNS tumors: a survey of the neuro-oncology community Integrating molecular markers into the World Health Organization classification of CNS tumors: a survey of the neuro-oncology community The Harvard community has made this article openly available. Please

More information

LETTER INTENT

LETTER INTENT 2016-2017 LETTER INTENT Using CRISPR Induced Deletions on Chromosome 1p and 19q of human tissue models to Determine the Effectiveness of Temozolomide Chemotherapy Treatment on Grade II Oligodendroglioma

More information

Tumors of the Nervous System

Tumors of the Nervous System Tumors of the Nervous System Peter Canoll MD. PhD. What I want to cover What are the most common types of brain tumors? Who gets them? How do they present? What do they look like? How do they behave? 1

More information

Genomic analysis of childhood High grade glial (HGG) brain tumors

Genomic analysis of childhood High grade glial (HGG) brain tumors Genomic analysis of childhood High grade glial (HGG) brain tumors Linda D Cooley Children s Mercy, Kansas City The Children s Mercy Hospital, 2017 Genomic analysis of childhood High grade glial (HGG) brain

More information

UPDATES ON CHEMOTHERAPY FOR LOW GRADE GLIOMAS

UPDATES ON CHEMOTHERAPY FOR LOW GRADE GLIOMAS UPDATES ON CHEMOTHERAPY FOR LOW GRADE GLIOMAS Antonio M. Omuro Department of Neurology Memorial Sloan-Kettering Cancer Center II International Neuro-Oncology Congress Sao Paulo, 08/17/12 CHALLENGES IN

More information

Pathological spectrum in recurrences of glioblastoma multiforme

Pathological spectrum in recurrences of glioblastoma multiforme pathologica 2015;107:1-8 Original article Pathological spectrum in recurrences of glioblastoma multiforme G. MARUCCI 1, P.V. FABBRI 1, L. MORANDI 1, D. DE BIASE 2, E. DI OTO 1, G. TALLINI 2, C. STURIALE

More information

Immunohistochemical Classification of Primary and Secondary Glioblastomas

Immunohistochemical Classification of Primary and Secondary Glioblastomas The Korean Journal of Pathology 2013; 47: 541-548 ORIGINAL ARTICLE Immunohistochemical Classification of Primary and Secondary Glioblastomas Kyu Sang Lee Gheeyoung Choe 1 Kyung Han Nam 1 An Na Seo 1 Sumi

More information

ATRX loss refines the classification of anaplastic gliomas and identifies a. subgroup of IDH mutant astrocytic tumors with better prognosis

ATRX loss refines the classification of anaplastic gliomas and identifies a. subgroup of IDH mutant astrocytic tumors with better prognosis Wiestler et al. 1 ATRX loss refines the classification of anaplastic gliomas and identifies a subgroup of IDH mutant astrocytic tumors with better prognosis Benedikt Wiestler 1,4, David Capper 2,5, Tim

More information

Chapter 1 Introduction

Chapter 1 Introduction Chapter 1 Introduction Men think epilepsy divine, merely because they do not understand it. But if they called everything divine which they do not understand, why, there would be no end to divine things.

More information

Glioblastoma with Oligodendroglioma Component (GBM-O): Molecular Genetic and Clinical Characteristics

Glioblastoma with Oligodendroglioma Component (GBM-O): Molecular Genetic and Clinical Characteristics Glioblastoma with Oligodendroglioma Component (GBM-O): Molecular Genetic and Clinical Characteristics Christina L. Appin, Emory University Jingjing Gao, Emory University Candace Chisolm, Emory University

More information

Systemic Treatment. Third International Neuro-Oncology Course. 23 May 2014

Systemic Treatment. Third International Neuro-Oncology Course. 23 May 2014 Low-Grade Astrocytoma of the CNS: Systemic Treatment Third International Neuro-Oncology Course São Paulo, Brazil 23 May 2014 John de Groot, MD Associate Professor, Neuro-Oncology UT MD Anderson Cancer

More information

Oligodendroglioma: Toward Molecular Definitions in Diagnostic Neuro-Oncology

Oligodendroglioma: Toward Molecular Definitions in Diagnostic Neuro-Oncology Journal of Neuropathology and Experimental Neurology Vol. 62, No. 2 Copyright 2003 by the American Association of Neuropathologists February, 2003 pp. 111 126 Oligodendroglioma: Toward Molecular Definitions

More information

AMERICAN BRAIN TUMOR ASSOCIATION. Oligodendroglioma and Oligoastrocytoma

AMERICAN BRAIN TUMOR ASSOCIATION. Oligodendroglioma and Oligoastrocytoma AMERICAN BRAIN TUMOR ASSOCIATION Oligodendroglioma and Oligoastrocytoma ACKNOWLEDGEMENTS ABOUT THE AMERICAN BRAIN TUMOR ASSOCIATION Founded in 1973, the American Brain Tumor Association (ABTA) was the

More information

Neuro-Oncology. Martin J. van den Bent. Department of Neuro-oncology/Neurology, Erasmus M.C. Cancer Institute, Rotterdam, Netherlands

Neuro-Oncology. Martin J. van den Bent. Department of Neuro-oncology/Neurology, Erasmus M.C. Cancer Institute, Rotterdam, Netherlands Neuro-Oncology Neuro-Oncology 16(12), 1570 1574, 2014 doi:10.1093/neuonc/nou297 Advance Access date 29 October 2014 Practice changing mature results of RTOG study 9802: another positive PCV trial makes

More information

Characterizing invading glioma cells based on IDH1-R132H and Ki-67 immunofluorescence

Characterizing invading glioma cells based on IDH1-R132H and Ki-67 immunofluorescence DOI 10.1007/s10014-013-0172-y ORIGINAL ARTICLE Characterizing invading glioma cells based on IDH1-R132H and Ki-67 immunofluorescence Hemragul Sabit Mitsutoshi Nakada Takuya Furuta Takuya Watanabe Yutaka

More information

CNS TUMORS. D r. Ali Eltayb ( U. of Omdurman. I ). M. Path (U. of Alexandria)

CNS TUMORS. D r. Ali Eltayb ( U. of Omdurman. I ). M. Path (U. of Alexandria) CNS TUMORS D r. Ali Eltayb ( U. of Omdurman. I ). M. Path (U. of Alexandria) CNS TUMORS The annual incidence of intracranial tumors of the CNS ISmore than intraspinal tumors May be Primary or Secondary

More information

What yield in the last decade about Molecular Diagnostics in Neuro

What yield in the last decade about Molecular Diagnostics in Neuro What yield in the last decade about Molecular Diagnostics in Neuro Oncology? Raphael Salles S.Medeiros Neuropathologist at HC FMUSP Clinical Research Project Manager at Oncology department at Hospital

More information

BAH1 - Primary Glioblastoma

BAH1 - Primary Glioblastoma BAH1 - Primary Glioblastoma R frontal tumour for frozen section. No known primary. Contrast enhancing lesion. Cholecystectomy. FROZEN SECTION REPORT Right frontal tumour: The specimen consists of multiple

More information

Jennie W Taylor, MD 02/15/2019. Patient 1 Presentation

Jennie W Taylor, MD 02/15/2019. Patient 1 Presentation Patient 1 Presentation Jennie W Taylor, MD 02/15/2019 A 34 year old right handed woman presents in 07/2015 with 9 years of stereotyped spells of olfactory change, nausea, and altered awareness. Imaging

More information

Data Mining for Research and Diagnostics

Data Mining for Research and Diagnostics UCL DEPARTMENT OF GEOGRAPHY UCL INSTITUTE OF NEUROLOGY Data Mining for Research and Diagnostics Sebastian Brandner, UCL Institute of Neurology, London Data mining for Research and Diagnostics Our setup

More information

Assessment performed on Friday, September 18, 2015, at Vancouver General Hospital

Assessment performed on Friday, September 18, 2015, at Vancouver General Hospital Assessors report for ciqc Run 49: ATRX (June 2015) Assessors: S Yip and J Won (recorder) Assessment performed on Friday, September 18, 2015, at Vancouver General Hospital Background The combined application

More information

Imaging for suspected glioma

Imaging for suspected glioma Imaging for suspected glioma 1.1.1 Offer standard structural MRI (defined as T2 weighted, FLAIR, DWI series and T1 pre- and post-contrast volume) as the initial diagnostic test for suspected glioma, unless

More information

Primary Brain Tumors: Characteristics, Practical Diagnostic and Treatment Approaches

Primary Brain Tumors: Characteristics, Practical Diagnostic and Treatment Approaches Primary Brain Tumors: Characteristics, Practical Diagnostic and Treatment Approaches Kraig Moore and Lyndon Kim Abstract Primary brain tumors are classified according to the tissue of phylogenic origin.

More information

Enterprise Interest None

Enterprise Interest None Enterprise Interest None Heterogeneous chromosomal profiles in a unique series of DIPG in children and young adults European Congress of Pathology Amsterdam, 6 th September 2017 Charlotte Dufour, Romain

More information

SPECIAL SLIDE SEMINAR CASE 3

SPECIAL SLIDE SEMINAR CASE 3 SPECIAL SLIDE SEMINAR CASE 3 Tihana Džombeta, MD Leo Pažanin, MD, PhD Department of Pathology, School of Medicine, University of Zagreb Department of Pathology, Clinical Hospital Centre Sestre milosrdnice

More information

Karl Kashofer, Phd Institut für Pathologie Medizinische Universität Graz

Karl Kashofer, Phd Institut für Pathologie Medizinische Universität Graz Expanding on WHO guideline compliant molecular testing of central nervous system tumors by low density whole genome sequencing. Karl Kashofer, Phd Institut für Pathologie Medizinische Universität Graz

More information

Advances in Brain Tumor Research: Leveraging BIG data for BIG discoveries

Advances in Brain Tumor Research: Leveraging BIG data for BIG discoveries Advances in Brain Tumor Research: Leveraging BIG data for BIG discoveries Jill Barnholtz-Sloan, PhD Associate Professor & Associate Director for Bioinformatics and Translational Informatics jsb42@case.edu

More information

MolDX: Chromosome 1p/19q deletion analysis

MolDX: Chromosome 1p/19q deletion analysis MolDX: Chromosome 1p/19q deletion analysis CGS Administrators, LLC Jump to Section... Please Note: This is a Proposed LCD. Proposed LCDs are works in progress and not necessarily a reflection of the current

More information

Brain and CNS Cancer. Measurability of Quality Performance Indicators Version 3.0

Brain and CNS Cancer. Measurability of Quality Performance Indicators Version 3.0 Brain and CNS Cancer Measurability of Quality Permance Indicators Version 3.0 To be read in conjunction with: Brain and Central Nervous System Cancer Clinical Quality Permance Indicators Brain and Central

More information

Concepts for a personalized neurosurgical oncology. XXIV Annual Conference Pietro Paoletti 27. November 2015

Concepts for a personalized neurosurgical oncology. XXIV Annual Conference Pietro Paoletti 27. November 2015 Concepts for a personalized neurosurgical oncology Jörg-Christian Tonn Dept. of Neurosurgery Ludwig-Maximilian University München Großhadern Germany XXIV Annual Conference Pietro Paoletti 27. November

More information

Low grade glioma: a journey towards a cure

Low grade glioma: a journey towards a cure Editorial Page 1 of 5 Low grade glioma: a journey towards a cure Ali K. Choucair SIU School of Medicine, Springfield, IL, USA Correspondence to: Ali K. Choucair, MD. Professor of Neurology, Director of

More information

Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich

Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH8057 Zurich www.zora.uzh.ch Year: 2015 Molecular classification of diffuse cerebral WHO grade II/III gliomas using

More information

Histopathological Study and Categorisation of Brain Tumors

Histopathological Study and Categorisation of Brain Tumors Histopathological Study and Categorisation of Brain Tumors Ruchira Wadhwa 1*, Purvi Patel 2, Hansa Goswami 3 1 Third Year Resident, 2 Assistant Professor, 3 Professor and Head, Department of Pathology,

More information

Five Most Common Problems in Surgical Neuropathology

Five Most Common Problems in Surgical Neuropathology Five Most Common Problems in Surgical Neuropathology If the brain were so simple that we could understand it, we would be so simple that we couldn t Emerson Pugh What is your greatest difficulty in neuropathology?

More information

Pathologic Analysis of CNS Surgical Specimens

Pathologic Analysis of CNS Surgical Specimens 2015 Kenneth M. Earle Memorial Neuropathology Review Pathologic Analysis of CNS Surgical Specimens Peter C. Burger, MD Interdisciplinary Quality Control Familiarity with entities Use of diagnostic algorithm

More information

Modeling origin and natural evolution of low-grade gliomas

Modeling origin and natural evolution of low-grade gliomas Modeling origin and natural evolution of low-grade gliomas Mathilde Badoual Paris Diderot University, IMNC lab 2nd HTE workshop: Mathematical & Computer Modeling to study tumors heterogeneity in its ecosystem,

More information

Molecular Classification Defines 4 Prognostically Distinct Glioma Groups Irrespective of Diagnosis and Grade

Molecular Classification Defines 4 Prognostically Distinct Glioma Groups Irrespective of Diagnosis and Grade J Neuropathol Exp Neurol Copyright Ó 2015 by the American Association of Neuropathologists, Inc. Vol. 74, No. 3 March 2015 pp. 241Y249 ORIGINAL ARTICLE Molecular Classification Defines 4 Prognostically

More information

I have no conflicts of interest in relation to this presentation. Vogel FS & Burger PC 3/28/2016

I have no conflicts of interest in relation to this presentation. Vogel FS & Burger PC 3/28/2016 IF THIS IS NOT GLIOBLASTOMA, THEN WHAT IS IT? Murat Gokden, MD Department of Pathology/Neuropathology University of Arkansas for Medical Sciences Little Rock, AR mgokden@uams.edu I have no conflicts of

More information

Peter Canoll MD. PhD.

Peter Canoll MD. PhD. Tumors of the Nervous System Peter Canoll MD. PhD. What I want to cover What are the most common types of brain tumors? Who gets them? How do they ypresent? What do they look like? How do they behave?

More information

Brain Tumors: Radiologic Perspective

Brain Tumors: Radiologic Perspective Brain Tumors: Radiologic Perspective Alberto Bizzi, M.D. Neuroradiology Humanitas Research Hospital Milan, Italy The job of the neuroradiologist in the work-up of brain tumors has quite changed in the

More information

We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors

We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 4,100 116,000 120M Open access books available International authors and editors Downloads Our

More information

Prognostic or predictive value of MGMT promoter methylation in gliomas depends on IDH1 mutation

Prognostic or predictive value of MGMT promoter methylation in gliomas depends on IDH1 mutation Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2013 Prognostic or predictive value of MGMT promoter methylation in gliomas

More information

A case of multicentric gliomas in both supra- and infratentorial regions with different histology: a case report

A case of multicentric gliomas in both supra- and infratentorial regions with different histology: a case report Inoue et al. World Journal of Surgical Oncology (2016) 14:152 DOI 10.1186/s12957-016-0907-4 CASE REPORT Open Access A case of multicentric gliomas in both supra- and infratentorial regions with different

More information

AMERICAN BRAIN TUMOR ASSOCIATION. Oligodendroglioma and Oligoastrocytoma

AMERICAN BRAIN TUMOR ASSOCIATION. Oligodendroglioma and Oligoastrocytoma AMERICAN BRAIN TUMOR ASSOCIATION Oligodendroglioma and Oligoastrocytoma ACKNOWLEDGEMENTS ABOUT THE AMERICAN BRAIN TUMOR ASSOCIATION Founded in 1973, the American Brain Tumor Association (ABTA) was the

More information

BRAIN TUMOURS: SUCCESSES AND CHALLENGES ON THE OTHER SIDE OF THE BLOOD-BRAIN BARRIER

BRAIN TUMOURS: SUCCESSES AND CHALLENGES ON THE OTHER SIDE OF THE BLOOD-BRAIN BARRIER BRAIN TUMOURS: SUCCESSES AND CHALLENGES ON THE OTHER SIDE OF THE BLOOD-BRAIN BARRIER Kathryn M Field and Mark A Rosenthal Department of Medical Oncology, Royal Melbourne Hospital, Victoria, Australia.

More information

Predictive Biomarkers in GBM

Predictive Biomarkers in GBM Predictive Biomarkers in GBM C. David James, Ph.D. Professor & Associate Director, Brain Tumor Research Center Dept. Neurological Surgery and Helen Diller Comprehensive Cancer Center, University of California

More information

Tumours of the Central Nervous System (CNS) Molecular Information Reporting Guide

Tumours of the Central Nervous System (CNS) Molecular Information Reporting Guide Sponsored by Tumours of the Central Nervous System (CNS) Molecular Information Reporting Guide Family/Last name Given name(s) Date of birth DD MM YYYY Patient identifiers Date of request Accession/Laboratory

More information

Advancements in Neuro- Oncology

Advancements in Neuro- Oncology Advancements in Neuro- Oncology Ricky Chen, MD Director, Neuro-Oncology Providence St Vincent Medical Center November 30 th, 2018 No disclosures Recognizing a brain tumor New and *Persistent Headaches*

More information

UNDERSTANDING MOLECULAR TESTING IN BRAIN TUMORS: HOW CLINICALLY USEFUL IS IT?

UNDERSTANDING MOLECULAR TESTING IN BRAIN TUMORS: HOW CLINICALLY USEFUL IS IT? UNDERSTANDING MOLECULAR TESTING IN BRAIN TUMORS: HOW CLINICALLY USEFUL IS IT? Seema Nagpal, MD Stanford University Stanford, CA Goals: 1. Describe the most commonly used tests in glioma, including MGMT,

More information

Gliomatosis cerebri: no evidence for a separate brain tumor entity

Gliomatosis cerebri: no evidence for a separate brain tumor entity Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2016 Gliomatosis cerebri: no evidence for a separate brain tumor entity Herrlinger,

More information