GLIOMAS

DR NILOFAR
GLIOMAS
Gliomas are brain tumors of brain parenchyma arising
from neuroglia and classified as
astrocytoma,oligodendroglioma and ependymomas
Most common of primary CNS tumor
Account for 40% of all intracranial tumors
Genetics and pathogenesis
Mutation in IDH genes are commonly observed in
grade 2 astrocytoma and oligodendrogliomas leads to
increased production of 2-hydroxyglutarate which
interferes with activity of several enzymes that
regulate gene expression
Mutation in promoter of telomerase which result in
immortalization of tumor cells
Genetic and pathogenesis
Seen in glioblastoma and other astrocytic tumor
Co deletion of 1p and 19 q in oligodendrogliomas
Mutations that lead to overgrowth of EGF receptor or
other receptor tyrosine kinases
Disable p53 or RB gene
1 :Astrocytomas
Most common type of adult gliomas (80%)
Most frequent in fourth through sixth decade decades
of life
Most common site cerebral hemisphere and
occassionally in spinal cord
In children and yound adults pilocytic astrocytomas
arise in cerebellum ,optic nerve and brain stem
Presenting sign and symptoms are seizures,headache
and focal neurolo
Astrocytomas
Presenting sign and symptoms are seizures, headache
and focal neurological deficits related to anatomical
sites of involvment
Astrocytomas
WHO CLASSIFICATION
1. Grade 1:pilocytic astrocytoma
2. Grade 2 :low grade (diffuse) astrocytoma
3. Grade 3 :high grade anaplastic astrocytoma
4. Grade 4 :glioblastoma multiforme (high grade )
1:pilocytic astrocytoma
Effect children and young adults
Most commonly located in cerebellum
May also involve third ventricle ,optic pathways ,spinal
cord and occasionally cerebral hemisphere
Morphology
 Gross: Often cystic e mural nodule in wall of cyst
 Microscopic :If solid ,it is usually well circumscribed
Bipolar cells e long thin hair like processes that are
GAFP positive
Rosenthal fibers (eosinophilic granular inclusions)
Micro cyst are often present
Morphology
Morphology
2:grade 2 diffuse astrocytoma
They are low grade
Gross features :
Poorly defined ,grey white tumor of variable in size
Infiltrative tumor
Expand and distort the invaded brain without forming
discrete mass
Cut surface is either firm ,soft or gelatinous
Cystic degeneration may be present
Grade 2 astrocytoma
Microscopic features
Mild to moderate increase in glial cells nuclei
Variable nuclear pleomorphism
Fibrillary appearance of background due to fine ,glial
GFAP positive astrocytic cell processes
Morphology
grade 3 anaplastic astrocytoma
Gross features
It may not be distinguishable from grade 2
Microscopic features
More densely cellular
Greater nuclear pleomorphism
Mitotic figures are present
Morphology
Grade 4 glioblastoma
Gross features
Variation in gross appearance of tumor from region to
region is characteristic
Some areas are firm and white ,others are soft and
yellow
Still other shows region of cystic degeneration and
hemorrhage
Grade 4 glioblastoma
Microscopic features
Same as anaplastic astrocytoma
Microvascular proliferation
Areas of tumor necrosis around which tumor cells
form pseudopalisading
Morphology
Morphology
Morphology
Morphology
Oligodendroglioma
Accounts for 5 -15% of gliomas
Occur most commonly in fourth and 5th decade of life
Slow growing
Site is mostly cerebral hemisphere mainly in frontal
and temporal lobes
Classification
Well differentiated grade 2
Anaplastic grade 3
Morphology
Grossly
form gelatinous ,grey masses
May show cysts ,focal hemorrhage and calcification
Morphology
Morphology
Morphology
Microscopic features
Grade 2
Sheets of regular cells with spherical nuclei containing
finely granular chromatin surrounded by clear halo of
cytoplasm
Delicate network of anastomosing capillaries
Calcification present in 90% of cases
Mitotic activity is usually low
Morphology
Grade 3 anaplastic
Higher cell density
Nuclear anaplasia
Increased mitotic activity
Often microvascular invasion
Ependymoma
Often arise next to ependyma lined ventricular system
including central canal of spinal cord
In first two decades of life they typically occur near the
fourth ventricle and accounts for 5 -10 %of primary
brain tumors in this age group
In adults spinal cord is their common site
Morphology
Grossly
Grey or red color
Solid or papillary masses
May contain cysts
Morphology
Microscopical features
Cells contain regular round to oval nuclei and
abundant granular chromatin
Dense fibrillary background
Tumor cells may form
Rounded structure or rosette
Elongated structures or canals
More frequently perivascular pseudo rosette are
present
Morphology
In anaplastic ependymomas there is
Increased cell density
High mitotic rates
Necrosis
Microvascular proliferation
Less evident ependymal differentiation
Morphology
Morphology