Glioblastoma Pathology [Neurosurgery Wiki]

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====== Glioblastoma Pathology ======

Histological features of [[Glioblastoma]] include marked [[hypercellularity]], [[nuclear atypia]], [[microvascular proliferation]], and [[necrosis]]. The tumor shows palisading of tumor cells around necrotic foci; in addition, Glioblastoma harbors [[cancer stem cell]]s (CSCs). Although histological analysis remains essential in the diagnosis of gliomas, recent discoveries especially in the field of genetics strongly improved our understanding of these tumors. In addition to the mutational status of IDH1/2 and enzymes involved in a variety of metabolic processes, such as the production of redox species and epigenetic mechanisms, and DNA repair 
((Lu C., Ward P.S., Kapoor G.S., Rohle D., Turcan S., Abdel-Wahab O., Edwards C.R., Khanin R., Figueroa M.E., Melnick A., et al. IDH mutation impairs histone demethylation and results in a block to cell differentiation. Nature. 2012;483:474–478. doi: 10.1038/nature10860.))
((Molenaar R.J., Maciejewski J.P., Wilmink J.W., van Noorden C.J.F. Wild-type and mutated IDH1/2 enzymes and therapy responses. Oncogene. 2018;37:1949–1960. doi: 10.1038/s41388-017-0077-z.))
((Turcan S., Rohle D., Goenka A., Walsh L.A., Fang F., Yilmaz E., Campos C., Fabius A.W., Lu C., Ward P.S., et al. IDH1 mutation is sufficient to establish the glioma hypermethylator phenotype. Nature. 2012;483:479–483. doi: 10.1038/nature10866.))
((Wesseling P., Capper D. WHO 2016 Classification of gliomas. Neuropathol. Appl. Neurobiol. 2018;44:139–150. doi: 10.1111/nan.12432.)).

===== Abnormal vascularity =====

Glioblastoma is characterized by heterogeneous and abnormal vascularity. Subtypes of vascular habitats within the [[tumor]] and [[edema]] can be distinguished: high [[angiogenic]] tumor (HAT), low angiogenic tumor (LAT), infiltrated peripheral [[edema]] (IPE), and peripheral [[vasogenic edema]] (VPE).