Patterns of Epithelial Metaplasia in Malignant Gliomas II. Squamous Differentiation of Epithelial-like Formations in Gliosarcomas and Glioblastomas

Mörk, Sverre; Rubinstein, Lucien J.; Kepes, John J.; Perentes, Elias; Uphoff, Dean F.

doi:10.1097/00005072-198803000-00003

Cited by 64 publications

(43 citation statements)

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“…Distinct from WHO grade II fibrillary astrocytoma (ICD-O 9420/3), fibrillary/epithelial differentiation in GBM shows malignant features along with the formation of squamous nests and glands [73,106]. This pattern must often be distinguished from closely mimicking metastatic carcinomas, through the use of GFAP and CAM 5.2 immunostains among others [113].…”

Section: Fibrillary/epithelial Glioblastoma Multiformementioning

confidence: 99%

“…This pattern must often be distinguished from closely mimicking metastatic carcinomas, through the use of GFAP and CAM 5.2 immunostains among others [113]. Some studies have also suggested that fibrillary/epithelial differentiation in GBM may be due to primitive neuroepithelial cells, mechanical compression, or the histological response of host cells to tumour [73,106]. Fibrillary differentiation is a rare event suggested as a potential characteristic of GBM but not a distinct fib-rillary GBM variant.…”

Section: Fibrillary/epithelial Glioblastoma Multiformementioning

confidence: 99%

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Established and emerging variants of glioblastoma multiforme: review of morphological and molecular features

Karsy¹,

Gelbman²,

Shah³

et al. 2012

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A b s t r a c t Since the recent publication of the World Health Organization brain tumour classification guidelines in 2007, a significant expansion in the molecular understanding of glioblastoma multiforme (GBM) and its pathological as well as genomic variants has been evident. The purpose of this review article is to evaluate the histopathological, molecular and clinical features surrounding emerging and currently established GBM variants. The tumours discussed include classic glioblastoma multiforme and its four genomic variants, proneural, neural, mesenchymal, classical, as well as gliosarcoma (GS), and giant cell GBM (gcGBM). Furthermore, the emerging variants include fibrillary/epithelial GBM, small cell astrocytoma (SCA), GBM with oligodendroglial component (GBMO), GBM with primitive neuroectodermal features (GBM-PNET), gemistocytic astrocytoma (GA), granular cell astrocytoma (GCA), and paediatric high-grade glioma (HGG) as well as diffuse intrinsic pontine glioma (DIPG

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Section: Fibrillary/epithelial Glioblastoma Multiformementioning

confidence: 99%

Section: Fibrillary/epithelial Glioblastoma Multiformementioning

confidence: 99%

Established and emerging variants of glioblastoma multiforme: review of morphological and molecular features

Karsy¹,

Gelbman²,

Shah³

et al. 2012

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“…True epithelial differentiation can assume the form of either squamous cell nests or glandular nests 11,15 . Pseudoepithelial differentiation has two different forms: adenoid, with cohesive cell clusters arranged in cords, nests and/or a cribriform pattern, and epithelioid, in which the tumor cells are relatively large, round, have copious amounts of eosinophilic cytoplasm, generally lack cytoplasmic processes or are very process-poor, and often display large nuclei with single prominent nucleoli 1,4,5,8,12,15 .…”

Section: Discussionmentioning

confidence: 99%

Multifocal epithelioid glioblastoma mimicking cerebral metastasis: case report

et al. 2009

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Objective. Epithelioid glioblastoma is a rare morphologic subtype of glioblastoma that closely mimics metastatic carcinoma or metastatic melanoma histologically. All previous case reports of this unusual glioblastoma variant have been solitary lesions. We report here the first case to our knowledge of multifocal epithelioid glioblastoma mimicking cerebral metastasis.Clinical presentation. A 67-year-old man with a prior history of mycosis fungoides, a common form of cutaneous T-cell lymphoma, presented with memory loss and impaired peripheral vision. Two discrete brain lesions highly suspicious for metastases were identified by magnetic resonance imaging (MRI).Intervention. The patient underwent two separate craniotomies; both lesions were successfully resected in toto with an excellent post-surgical outcome.Conclusion. Epithelioid glioblastoma is one of the rarest morphologic subtypes of glioblastoma. Here we describe the first case to our knowledge of multifocal epithelioid glioblastoma that convincingly mimicked a secondary metastatic process. Multifocal epithelioid glioblastoma should be included in the differential diagnosis of patients who present with multiple discrete brain lesions. An attempt at gross total resection is recommended when anatomically feasible for definitive histopathological diagnosis and to improve progression free survival of patients who present with similarly ambiguous and potentially misleading multiple lesions.

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“…4,9,11 In a number of cases in which metaplastic changes were reported, the initial diagnosis had been metastasis. 10,11 To determine whether the two specimens in our case represented tumor originating from a single clone, we screened the DNA sequence of the two specimens and the white blood cells of the patient, representing the nontumor-derived DNA, in loci where genetic alterations are expected in glioblastoma. Loss of heterozygosity on chromosomal area 10q, in the region of the 10q23 locus of the PTEN gene, is the most common genetic alteration, found in 60%-85% of patients.…”

Section: Histopathological Findingsmentioning

confidence: 99%

Conflicting pathology reports: a diagnostic dilemma

Shahar¹,

Rozovski²,

Shapira³

et al. 2015

JNS

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Short tandem repeat (STR) analysis is a polymerase chain reaction (PCR)-based technology that is based on typing highly polymorphic repeats of 2-6 base pairs of DNA. Typically these repeats are inherited in codominant mode, so that the number of repeats in each allele is independently determined. Such analysis enables the identification of loss of heterozygosity (LOH) or a shift in a genetic region, and reveals whether two cell populations are genetically "similar" or different.2 Emerging first as a DNA identity tool in the forensic setting, several clinical diagnostic uses for STR typing have already been established: for example, follow-up of engraftment after bone marrow transplantation; identification of uniparental disomy pattern of inheritance; and assessment of maternal cell contamination in prenatal specimens. 13 The authors report a case in which STR typing was used to resolve a diagnostic dilemma involving two discrepant specimens from a patient with a brain tumor. case report History and ExaminationA 47-year-old, right-handed man presented to the emergency center with a 2-day history of progressive right leg weakness. His medical history was significant for heavy smoking of 40 pack-years. His physical examination findings were remarkable for right lower-extremity weakness and mild upper-limb dysmetria. However, findings on chest radiographs were unremarkable, and brain MRI studies obtained with contrast revealed two separate ring-enhancing lesions localized to the left frontal lobe (Fig. 1). The radiological differential diagnosis included multiple brain metastases, multicentric glioblastoma, lymphoma, or, less likely, brain abscesses. A stereotactic biopsy sample taken from the left frontal anterior lesion was most compatible with metastatic small cell carcinoma with neuroendocrine features ( Fig. 2A and B). At that time the working diagnosis, based on the history of heavy smoking, multiple brain lesions on MRI studies, and the pathology report was that of metastatic small cell lung carcinoma. Ten days after his initial presentation, the patient presented to the emergency center complaining of worsening right leg weakness, headaches, and blurred vision, and was admitted for urgent radiation treatment. Radiation Treatment and Subsequent OperationA chest CT scan performed at the time of admission abbreviatioNs LOH = loss of heterozygosity; PCR = polymerase chain reaction; STR = short tandem repeat. The differential diagnosis of a brain lesion with two discordant pathology reports includes the presence of collision tumor, metaplastic changes, and labeling errors that occurred during the processing of the specimen. The authors present a case in which the first brain biopsy from a 47-year-old patient with a history of heavy smoking was compatible with metastatic small cell carcinoma, and the second biopsy taken during decompression craniotomy 3 weeks later was compatible with WHO Grade IV glioblastoma. Using short tandem repeat (STR) analysis of the two specimens and nontumorderived patient DNA, the autho...

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Patterns of Epithelial Metaplasia in Malignant Gliomas II. Squamous Differentiation of Epithelial-like Formations in Gliosarcomas and Glioblastomas

Cited by 64 publications

References 0 publications

Established and emerging variants of glioblastoma multiforme: review of morphological and molecular features

Established and emerging variants of glioblastoma multiforme: review of morphological and molecular features

Multifocal epithelioid glioblastoma mimicking cerebral metastasis: case report

Conflicting pathology reports: a diagnostic dilemma

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