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The histological representativeness of glioblastoma tissue samples. Acta Neurochir (Wien) 2021; 163:1911-1920. [PMID: 33085022 PMCID: PMC8195928 DOI: 10.1007/s00701-020-04608-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/05/2020] [Indexed: 02/08/2023]
Abstract
Background Glioblastomas (GBMs) are known for having a vastly heterogenous histopathology. Several studies have shown that GBMs can be histologically undergraded due to sampling errors of small tissue samples. We sought to explore to what extent histological features in GBMs are dependent on the amount of viable tissue on routine slides from both biopsied and resected tumors. Methods In 106 newly diagnosed GBM patients, we investigated associations between the presence or degree of 24 histopathological and two immunohistochemical features and the tissue amount on hematoxylin-eosin (HE) slides. The amount of viable tissue was semiquantitatively categorized as “sparse,” “medium,” or “substantial” for each case. Tissue amount was also assessed for associations with MRI volumetrics and the type of surgical procedure. Results About half (46%) of the assessed histological and immunohistochemical features were significantly associated with tissue amount. The significant features were less present or of a lesser degree when the tissue amount was smaller. Among the significant features were most of the features relevant for diffuse astrocytic tumor grading, i.e., small necroses, palisades, microvascular proliferation, atypia, mitotic count, and Ki-67/MIB-1 proliferative index (PI). Conclusion A substantial proportion of the assessed histological features were at risk of being underrepresented when the amount of viable tissue on HE slides was limited. Most of the grading features were dependent on tissue amount, which underlines the importance of considering sampling errors in diffuse astrocytic tumor grading. Our findings also highlight the importance of adequate tissue collection to increase the quality of diagnostics and histological research.
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Mikkelsen VE, Dai HY, Stensjøen AL, Berntsen EM, Salvesen Ø, Solheim O, Torp SH. MGMT Promoter Methylation Status Is Not Related to Histological or Radiological Features in IDH Wild-type Glioblastomas. J Neuropathol Exp Neurol 2021; 79:855-862. [PMID: 32688383 DOI: 10.1093/jnen/nlaa060] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/25/2020] [Accepted: 06/03/2020] [Indexed: 11/15/2022] Open
Abstract
O6-methylguanine DNA methyltransferase (MGMT) promoter methylation is an important favorable predictive marker in patients with glioblastoma (GBM). We hypothesized that MGMT status could be a surrogate marker of pretreatment tumor biology observed as histopathological and radiological features. Apart from some radiological studies aiming to noninvasively predict the MGMT status, few studies have investigated relationships between MGMT status and phenotypical tumor biology. We have therefore aimed to investigate such relationships in 85 isocitrate dehydrogenase (IDH) wild-type GBMs. MGMT status was determined by methylation-specific PCR and was assessed for associations with 22 histopathological features, immunohistochemical proliferative index and microvessel density measurements, conventional magnetic resonance imaging characteristics, preoperative speed of tumor growth, and overall survival. None of the investigated histological or radiological features were significantly associated with MGMT status. Methylated MGMT status was a significant independent predictor of improved overall survival. In conclusion, our results suggest that MGMT status is not related to the pretreatment phenotypical biology in IDH wild-type GBMs. Furthermore, our findings suggest the survival benefit of MGMT methylated GBMs is not due to an inherently less aggressive tumor biology, and that conventional magnetic resonance imaging features cannot be used to noninvasively predict the MGMT status.
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Affiliation(s)
- Vilde Elisabeth Mikkelsen
- From the Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology
| | - Hong Yan Dai
- Department of Pathology, St Olav's University Hospital
| | - Anne Line Stensjøen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology
| | - Erik Magnus Berntsen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology.,Department of Radiology and Nuclear Medicine, St. Olav's University Hospital
| | | | - Ole Solheim
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology.,Department of Neurosurgery, St. Olav's University Hospital, Trondheim, Norway
| | - Sverre Helge Torp
- From the Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology.,Department of Pathology, St Olav's University Hospital
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Pham DT, Skaland I, Winther TL, Salvesen Ø, Torp SH. Correlation Between Digital and Manual Determinations of Ki-67/MIB-1 Proliferative Indices in Human Meningiomas. Int J Surg Pathol 2019; 28:273-279. [PMID: 31771372 DOI: 10.1177/1066896919889148] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objective. Proliferative activity in tumor tissues is assessed as the percentage of Ki-67/MIB-1-positive cells, or the proliferative index (PI). The PI is routinely assessed manually. However, the subjectivity of manual assessments might result in poor reproducibility. We hypothesized that digital assessments might reduce the error. Method. In our study, we assessed Ki-67/MIB-1 PIs, both manually and digitally, with tissue microarrays constructed from 141 human meningioma samples. Spearman-rank correlation and κ statistics were applied for correlation and agreement analyses, respectively. Mann-Whitney U tests were used to compare MIB-1 PIs between groups. Prognostic ability was assessed with Kaplan-Meier and Cox regression analyses. Results. We found a significant, high correlation (Spearman ρ = 0.832, P < .01) and moderate agreement (κ coefficient = 0.617, observed agreement = 80.9%) between the 2 methods. Both methods found significantly different Ki-67/MIB-1 PIs for different World Health Organization grades (P < .05). Neither method showed significant prognostic value. Conclusion. Digital determinations of Ki-67/MIB-1 PIs in human meningiomas are feasible for the daily routine.
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Affiliation(s)
- Duc-Tien Pham
- NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Ivar Skaland
- Stavanger University Hospital, Stavanger, Norway
| | - Theo L Winther
- NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Øyvind Salvesen
- NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Sverre H Torp
- NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,St. Olavs University Hospital, Trondheim, Norway
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Varughese RK, Lind-Landström T, Habberstad AH, Salvesen Ø, Haug CS, Sundstrøm S, Torp SH. Mitosin and pHH3 predict poorer survival in astrocytomas WHO grades II and III. J Clin Pathol 2015; 69:26-34. [DOI: 10.1136/jclinpath-2015-202983] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 06/28/2015] [Indexed: 01/02/2023]
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Brat DJ, Ryken TC, Kalkanis SN, Olson JJ. The role of neuropathology in the management of progressive glioblastoma : a systematic review and evidence-based clinical practice guideline. J Neurooncol 2014; 118:461-78. [PMID: 24733643 DOI: 10.1007/s11060-013-1331-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 12/28/2013] [Indexed: 11/27/2022]
Abstract
QUESTION 1. What are the most important diagnostic considerations in reporting progressive glioblastoma? TARGET POPULATION These recommendations apply to adults with progressive glioblastoma RECOMMENDATIONS LEVEL III For patients who undergo biopsy or neurosurgical resection at the time of radiologic or clinical progression, it is recommended that the pathologist report the presence and extent of progressive neoplasm as well as the presence and extent of necrosis within the pathologic material examined. Furthermore, to ensure the proper interpretation of progressive glioblastoma, it is recommended that the pathologist take into account the patient's previous diagnosis and treatment, as well as the current clinical and neuroimaging features that have led to a second biopsy or resection. QUESTION 2. What techniques and ancillary studies are most useful in separating malignant progression from treatment effect? TARGET POPULATION These recommendations apply to adults with progressive glioblastoma RECOMMENDATIONS LEVEL III In the setting of prior radiation and chemotherapy, it is recommended to adhere to strict histologic criteria for microvascular proliferation and necrosis in order to establish a diagnosis of a glioblastoma. Immunohistochemistry and genetic studies are selectively recommended for distinguishing neoplastic cells from atypical reactive cells in progressive glioblastoma.
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Affiliation(s)
- Daniel J Brat
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA,
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Alexiou GA, Vartholomatos E, Goussia A, Dova L, Karamoutsios A, Fotakopoulos G, Kyritsis AP, Voulgaris S. DNA content is associated with malignancy of intracranial neoplasms. Clin Neurol Neurosurg 2013; 115:1784-7. [DOI: 10.1016/j.clineuro.2013.04.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Revised: 04/08/2013] [Accepted: 04/20/2013] [Indexed: 11/15/2022]
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Lind-Landström T, Varughese RK, Sundstrøm S, Torp SH. Expression and clinical significance of the proliferation marker minichromosome maintenance protein 2 (Mcm2) in diffuse astrocytomas WHO grade II. Diagn Pathol 2013; 8:67. [PMID: 23618321 PMCID: PMC3648352 DOI: 10.1186/1746-1596-8-67] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 04/19/2013] [Indexed: 12/20/2022] Open
Abstract
Background The WHO classification system for astrocytomas is not considered optimal, mainly because of the subjective assessment of the histopathological features. Few prognostic variables have been found that stratify the risk of clinical progression in patients with grade II astrocytoma. For that reason there is a continuous search for biomarkers that can improve the histopathological diagnosis and prognostication of these tumours. Aim This study was designed to investigate the prognostic significance of the proliferative marker Mcm2 (minichromosome maintenance protein 2) in diffuse astrocytomas WHO grade II and correlate the findings with histopathology, mitoses, and Ki67/MIB-1 immunostaining. Method 61 patients with histologically verified grade II astrocytoma (WHO 2007) were investigated. Paraffin sections were immunostained with anti-Mcm2, and the Mcm2 proliferative index (PI) was determined as the percentage of immunoreactive tumour cell nuclei. Results Mcm2 PI was not associated with any histopathological features but correlated significantly with mitotic count and Ki67/MIB-1 PI (p<0.05). In the survival analyses Mcm2 showed trends to poorer survival, however, statistical significance was not achieved in the univariate analyses (p>0.05). Conclusions In our hands Mcm2 immunostaining has no advantage over Ki67/MIB-1 in the evaluation of grade II astrocytomas. Larger studies are needed to fully clarify the prognostic role of this biomarker. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1715002791944037
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Affiliation(s)
- Tove Lind-Landström
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
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Management of newly diagnosed glioblastoma: guidelines development, value and application. J Neurooncol 2009; 93:1-23. [DOI: 10.1007/s11060-009-9838-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Accepted: 02/23/2009] [Indexed: 11/25/2022]
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Diagnosis of malignant glioma: role of neuropathology. J Neurooncol 2008; 89:287-311. [PMID: 18712282 DOI: 10.1007/s11060-008-9618-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Accepted: 05/19/2008] [Indexed: 01/08/2023]
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Esposito F, Kelly DF, Vinters HV, DeSalles AAF, Sercarz J, Gorgulhos AA. Primary sphenoid sinus neoplasms: a report of four cases with common clinical presentation treated with transsphenoidal surgery and adjuvant therapies. J Neurooncol 2006; 76:299-306. [PMID: 16163447 DOI: 10.1007/s11060-005-7285-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Primary neoplasms of the sphenoid sinus are a rare occurrence, accounting for approximately 1-2% of all paranasal sinus tumors. Here we report a series of four such patients. METHODS Four patients with sphenoid sinus neoplasms were identified (1%), all treated during the year 2003. RESULTS The four patients included two women and two men (mean age 61 years, range 44-70 years). Two patients presented with unilateral abducens cranial nerve (CN) palsies; one had trigeminal facial numbness and dizziness; another had headache, epistaxis, and partial third and fourth CN palsies. MRIs in all patients demonstrated large sphenoid sinus masses with partial clival and sellar bone erosion but with clear visualization of the pituitary gland above the mass. Cavernous sinus invasion was present in all four cases, including one patient with tumor in the ethmoid sinus and intra-tumoral hemorrhage. No patients had endocrinopathy. All patients underwent subtotal tumor removal via an endonasal transsphenoidal route. Tumor histology included neuroendocrine carcinoma, sinonasal undifferentiated carcinoma, mucoepidermoid carcinoma, and giant cell tumor. Post-operatively, all four patients had improved symptoms with complete resolution of diplopia in 3 of 3 patients. Metastatic work-ups were negative in all patients, and all received fractionated stereotactic radiotherapy; three received chemotherapy. One patient required a second endonasal tumor debulking 15 months after the first for new visual loss that then resolved. At a median follow-up of 21 months, all patients are alive and functional. CONCLUSIONS Intra-sphenoidal tumors are locally invasive tumors that include a wide pathological spectrum. In this small series, they presented with cavernous sinus symptoms and headache but not endocrinopathy. Recognizing their distinctive clinical presentation and MRI features is helpful in differentiating them from primary sellar tumors. Their aggressive nature warrants a multimodality treatment plan including surgical debulking, radiotherapy, and chemotherapy in some cases.
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Affiliation(s)
- Felice Esposito
- Department of Surgery, Division of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles (UCLA) Medical Center, Los Angeles, California 90095-7182, USA
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Colodner KJ, Montana RA, Anthony DC, Folkerth RD, De Girolami U, Feany MB. Proliferative Potential of Human Astrocytes. J Neuropathol Exp Neurol 2005; 64:163-9. [PMID: 15751231 DOI: 10.1093/jnen/64.2.163] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although a number of studies have demonstrated proliferation of nonneoplastic astrocytes in experimental animal models, the proliferative potential of human astrocytes has not been well defined. Using double-label immunohistochemistry, we identified proliferating cells with the proliferation marker MIB-1 and astrocytes with glial fibrillary acidic protein staining in human biopsy and autopsy tissue. MIB-1 labeling of astrocytes was monitored in a variety of conditions containing significant numbers of reactive astrocytes, including infections, arteriovenous malformations, demyelinating lesions, metastatic tumors, and long-standing gliosis. Twenty-nine of a total of 54 cases showed no evidence of astrocyte-specific MIB-1 labeling despite prominent reactive changes. An average proliferation rate of 0.9% was present in the remaining 25 cases. Labeling indices were highest in infectious conditions and acute demyelinating lesions. We also examined astrocyte proliferation in 5 cases of progressive multifocal leukoencephalopathy. Astrocytic labeling indices were notably elevated in these cases, with an average labeling index of 5.8%. We conclude that low, but appreciable, astrocytic proliferation may occur in nonneoplastic human astrocytes. These findings have implications for astrocyte function in the normal and disease states and for the diagnostic distinction between reactive lesions and low-grade astrocytic neoplasms.
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Affiliation(s)
- Kenneth J Colodner
- Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
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Abstract
In this review, the results of previous histomorphometric studies of brain tumours are summarized and discussed with respect to their potential value for diagnostic purposes and for tumour research. In the majority of these studies, human gliomas were investigated. In a few studies, human meningiomas and other human or experimental tumour types were investigated. A computerized image analysis system was used for the morphometric analyses in most studies. The three main histologic structures examined were tumour cell nuclei, nucleolar organizer regions and tumour vessels. The current state of knowledge provides evidence that a diagnostic benefit could be provided by histomorphometric investigations of brain tumours, especially for grading of gliomas and with respect to independent prognostic information. Additional studies are necessary to delineate the spectrum of histomorphometric parameters and the investigation of their prognostic significance for cases with the same tumour type and tumour grade. Together with many recently published observations in this field, this review shows that histomorphometry is an important approach towards the investigation of brain tumour biology.
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Affiliation(s)
- R Nafe
- Department of Neuroradiology, Clinics of Johann Wolfgang Goethe University, Frankfurt am Main, Germany.
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McManamy CS, Lamont JM, Taylor RE, Cole M, Pearson ADJ, Clifford SC, Ellison DW. Morphophenotypic variation predicts clinical behavior in childhood non-desmoplastic medulloblastomas. J Neuropathol Exp Neurol 2003; 62:627-32. [PMID: 12834107 DOI: 10.1093/jnen/62.6.627] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Histopathologic assessment of 273 non-desmoplastic medulloblastomas (MBs) from children aged 3 to 16 years and entered into the SIOP/UKCCSG (International Society of Pediatric Oncology/United Kingdom Children's Cancer Study Group) PNET3 trial revealed that 47 (17%) fulfilled criteria for the recently proposed anaplastic variant. In addition, an anaplastic phenotype was focally present in all 5 (2%) large cell MBs from this series. Children with large cell MBs had the worst outcome, but there was also a significant difference between the event-free and overall survivals of children with classic MBs and those with anaplastic MBs. While objective morphometric analysis confirmed that subjective evaluation of nuclear size and variability contributed to the separation of MBs into classic, anaplastic, and large cell variants, these cytologic measures were not themselves prognostic indicators. However, anaplastic and classic MBs also possessed significantly different mitotic counts/indices, and these measures of proliferation were related to survival. Significant prognostic indicators in a multivariate survival analysis were histologic variant, metastases at presentation, and subtotal surgical excision of tumor. Our study supports the concept of an anaplastic variant among MBs, demonstrating that it has clinical utility.
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Affiliation(s)
- Charles S McManamy
- Northern Institute for Cancer Research, University of Newcastle, Newcastle-upon-Tyne, UK
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