Expert: Claes-Gustaf Nordquist, M.D. - 11/18/2009

Question
A.  Brain, right frontal lobe, excision:
Anaplastic astrocytoma (World Health Organization grade III) with
focal         oligodendroglial component.  See comment.
B.  Brain, right frontal lobe, excision:
Anaplastic astrocytoma (World Health Organization grade III) with
focal         oligodendroglial component.  See comment.
 Comment:
Cory T. Bernadt, M.D., R2             Patricia A. Kirby, M.D.
Date reported: 12/17/07               Pathologist (Electronic Signature)
 COMMENT:  
 This tumor is predominantly astrocytic with nuclear pleomorphism with a
minor oligodendroglial component.  Mitoses are rare but their presence,
together with the nuclear features, compel one to grade this as World
Health Organization Classification III.  1p and 19q deletions are not
identified on FISH.
 HISTORY:  
 36 year old male right frontal tumor.
 TISSUE SUBMITTED:  
 A.  R frontal brain lesion
B.  R frontal brain lesion
 FROZEN SECTION:  
 FS:
A.  Right frontal brain lesion: TP1: Probably anaplastic
oligodendroglioma. May have astrocytic component which could upgrade to
GBM.  OR called.  PK Patricia A. Kirby, M.D.
 GROSS:  
 A.  Received fresh for frozen section are eight white to tan pink soft
tissue fragments 0.3 to 0.5 cm in greatest dimension, wrapped and
submitted in A1-A2. B.  Received in formalin are five white-tan soft
tissue fragments ranging from 0.2 to 0.4 cm in greatest dimension.
Wrapped in B1-B2. LCTB
 MICROSCOPIC:  
 A,B.  Sections show hypercellular tissue composed of several different
cell types including cells that have round nuclei with vesicular chromatin
and small nucleoli, a population of cells that have hyperchromatic
angulated, pleomorphic nuclei and numerous micro gemistocytes.  Rare
mitoses are identified.  No vascular proliferation or necrosis is
identified. Immunohistochemistry shows the tumor cells to be GFAP positive
with a second, smaller component of tumor cells being negative.  P53 is
negative and the MIB1 shows a low proliferation index.

What can you tell me from this pathology results??????

Answer
I assume that all is from the same patient. The patient has been surgically operated for a malignant brain tumor in his right frontal lobe. The tumor is a malignant astrocytoma (mostly though there is also a small oligodendroglioma (more benign) component. The astrocytoma component - the major part of the tumor - (which most probably therefore will mostly decide the prognosis of the tumor) is evaluated as a grade III (3). Prognosis is mainly determined by grade for a given tumor diagnosis. Grade I (1) is almost benign and patients can survive for many years after treatment (surgery & radiation therapy, maybe also chemotherapy). Grade II (2) usually has a somewhat shorter survival time after treatment but it can still be measured in several years. These two grades can be called the "good grades". Grade III (3) survives only for a couple or at most a few years after treatment while grade IV (4) is the worst with a survival time of 1 to 2 years or so regardless of treatment. So these can be called the "bad grades". Survival times without any treatment are shorter. However it is rather often difficult to determine grade and to do it correctly. In this case there seems to be some uncertainty with regards to grade. I would therefore recommend a second opinion on that point by for example The Armed Forces' Institute of Pathology. Good luck!

You can also reach me on: http://www.lifestylerescue.com/expert/health-fitness-advice/dr-claes-gustaf/128