Brain Tumor Pathology: Current Diagnostic Hotspots and by Davide Schiffer

By Davide Schiffer

Since Bailey and Cushing (1926), all mind tumor classifications were known as histogenetic. The nosographic place that the tumor varieties steadily obtained within the category platforms derived from the resemblance of tumor cells to these of the cytogenesis, transformed each time new details turned to be had from diversified organic examine fields and particularly from molecular genetics. Classically, at the foundation of the tough correspondence among the mature/immature point of tumor cells and the benign/malignant organic habit of the tumors, the histological labels contained a prognostic importance. The intended beginning of the tumors was once therefore an element for diagnosis. in a while, with the concept that of anaplasia (Cox, 1933; Kernohan et al., 1949) new standards have been brought for constructing the malignancy grades of tumors. Immunohistochemistry and later molecular genetics extra subtle the prognostic diagnoses, considerably expanding the possibilities to acknowledge the cellphone foundation of tumors, beside revealing the pathogenetic mechanisms. Prognoses grew to become extra actual, as required by way of the higher and extra exact chances of therapy.

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They are interchangeable. The cell cycle can be deregulated by the alteration of one or more of the oncogenes/ proteins involved. e. nuclear pleomorphism, mitoses, circumscribed necroses and microvascular proliferations, is present in diffuse astrocytomas. In these cases, MRI shows circumscribed areas 42 Chapter 4 Figure 16. GFAP- positive cells, uncertain between GFOC and tumor or reactive astrocytes, DAB, x 400 hypo-intense in T1 and hyper-intense in T2 weighted images; but when it shows non homogeneous aspects and, especially, contrast enhancement, most probably the suspicion of a sampling error is legitimate, because the histological picture should be of greater malignancy.

1997), but they are not easily applicable, especially when the diagnosis must be given without delay. The old procedures with acetic carmin could be of help and are more practicable (Schiffer and Fabiani, 1971), but they are today obsolete. , 2003) (See chapter VI). In some cases, not only for the reduced dimensions of the specimen, but also because of the diffuse hypo-intensity at MRI that shows nothing characteristic for one tumor or the other, the distinction is really difficult and a diagnostic compromise is chosen with the diagnosis of oligoastrocytoma.

Since the presence of necrosis is mandatory for the diagnosis of glioblastoma, if it is lacking in the sample, the diagnosis should be that of grade III astrocytoma, even though it has been proposed, for practical purposes, to consider as glioblastomas all astrocytomas grade III on biopsy, just to avoid the undergrading of glioblastomas (Chandrasoma and Apuzzo, 1989). 50 Chapter 4 The problems discussed till now reverberate on the management of patients. Following strict criteria for the indication of radiotherapy, based on a correct diagnosis of tumor type and grade, its application to grade II astrocytomas is still debated and mostly not performed, because of the lacking of a biological rationale.

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