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The ISN-Haarlem consensus guidelines proposed that pathology reports should display multiple types of data and be composed of four lines [10, 79]:

•First, an “integrated diagnosis” reflecting all tissue-based information, including category of the neoplasm and profiles of major genes, should be presented.

Fig. 6. Possible pathological report on gliomas according to the ISN-Haarlem consensus guidelines. Note that both tumors are given the same histopathological name (“anaplastic astrocytoma”), but different WHO grades depending on molecular profile. From Louis [79]. Such a scheme is not suitable for current clinical practice, since it was not included in the updated WHO classification of CNS tumors (2016) [11.]

•Second, the histopathological name of the tumor should be given, according to the standard microscopic evaluation of hematoxylin and eosin (H&E) stained tissue sections with optional addition of histochemical, IHC, and electron microscopy data.

•Third, the WHO histopathological grade should be designated reflecting the natural history of the neoplasm treated with surgery alone. In difference with the current WHO classification of CNS tumors (2016) [11], it was suggested that the grade of the neoplasm may not be fixed to its type, but may depend on specific molecular alterations. For example, AA with IDH1 mutation may be assigned WHO grade III, whereas without that mutation it becomes WHO grade IV (Fig. 6) [5, 11, 79]. In some specific situations when molecular profiling or effects of adjuvant therapy provide a different prognosis from that suggested by the histopathological tumor grade, the difference may be reflected in special comment [6]. Finally, it was assumed that sometimes WHO grading may be not possible (e.g., in cases of small tissue sampling of mixed glioma, or if histology and molecular pattern are vastly discordant).

•Fourth, the molecular characteristics should be listed and include the particular set of alterations determined for each tumor entity and undergoing regular updating. It is expected that for each group of neoplasms the recommended tests and their order, in cases of sequential use, will be given.

•Inclusion of clinical and radiological information is not required for such reports, but may be of clear utility in particular cases.

It is important to underline that these proposals were not included in the updated WHO classification of CNS tumors (2016) [11], thus are not suitable for current clinical practice!