‘Glioblastoma in the making’. Genetic tests predict brain tumor prognosis. Clinical case. 8
This was a special clinical brain tumor case that was referred to us from another hospital. They operated on a 55-year-old gentleman. Dr. Sebastian Brandner, MD. He had a few weeks of history of seizures. The neurosurgeon went straight into the brain tumor biopsy. The pathologists at the referring hospital saw a benign tumor under the microscope. But that didn’t really fit clinical situation. Because all the markers of benign brain glioma were not present there. These markers are IDH mutation and 1p / 19q chromosomal co- deletion. Dr. Anton Titov, MD. What could that brain tumor be? So they sent it to us. “Prof. Brandner, could you help us with the gene array to diagnose this brain tumor?” We did exactly that. Gene array diagnostic brain tumor test came back with the diagnosis of glioblastoma. Dr. Anton Titov, MD. How does that fit? Because the tumor looks benign. Dr. Sebastian Brandner, MD. But we know that glioblastoma is a malignant tumor. There we need to think back on the biology of brain tumors. It is increasingly clear is glioblastomas do not just come out of the blue as a fully malignant tumor. Now that we have all these advanced brain scanning technologies. Patients come and get early diagnosis. They have a seizure. patients go to the general physician. GP thinks that seizure in a 55-year-old otherwise healthy person could be a brain tumor. Dr. Sebastian Brandner, MD. General practitioner sends a patient to an MRI. MRI shows a brain tumor with enhancement. It could be even a diffusely infiltrating brain tumor. It is increasingly understood that these are “early GBMs” [glioblastoma multiforme]. I call them “early GBMs”. Other pathologists call them “IDH wild-type astrocytomas”. I prefer the term “early GBM (glioblastoma multiforme)” because that reflects that this brain tumor is a growing GBM (glioblastoma multiforme). It is GBM (glioblastoma multiforme) in the making. The term signifies evolution of brain tumor. Yes! So the molecular profile of the brain tumor has already a profile of glioblastoma. But the pathology is that of a more benign tumor. But we would wait another half-year. Then this brain tumor would then histologically show the hallmarks of a malignant glioma. Dr. Sebastian Brandner, MD. This is why these molecular diagnostics can help us so tremendously. This is why I think this is the future. It’s also very reassuring that pathologists use latest brain tumor diagnostic technology. Many colleagues ask. Dr. Anton Titov, MD. With all this automated algorithmic diagnosis, will we all be made redundant?” My answer is “No”. You still need to put this findings in clinical and pathologic context. Because no bioinformatician can tell a neurosurgeon how this tumor looks under the microscope. How to read and put those things together. So the integrated brain tumor diagnosis will become a very important feature. It is a very important element of the glioma clinical treatment. We develop new diagnostic technologies for brain tumors. We keep track with all the developments. It is better for the patient. But it is also better for the development and future of pathology. Dr. Sebastian Brandner, MD. The new glioblastoma case that you described is also very important. It is interaction between the patient’s and physician. Because new brain cancer diagnosis is a difficult situation. A newly diagnosed brain tumor. Dr. Anton Titov, MD. Physician and neurosurgeon cannot rely only on their clinical experience to develop and discuss the treatment strategy. How aggressively treat malignant brain tumor. Whether to use adjuvant chemotherapy, radiotherapy. How to estimate prognosis. But they can rely on quantitative data that you can provide to establish very precise diagnosis of brain tumor. Yes. 55-year-old man had seizures. He was found to have a small brain tumor. It looked benign under the microscope. But its molecular genetic profile on gene expression array suggested aggressive glioblastoma multiforme (GBM).It was “early GBM” or glioblastoma-in-the-making. Leading brain tumor diagnosis expert explains importance of molecular genetic diagnosis of brain tumors.
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