Glioma Classification and MD Note Generation Guide

Gliomas are heterogeneous. They change and adapt in response to the composition of their microenvironment and response to therapy. Therefore, developing molecular classifiers that provide meaningful ways to stratify patients remains a significant challenge for the field.

The latest WHO CNS5 2021 (Louis 2021) suggests a seven-layer integrated diagnosis comprising eight genomic and five protein signatures. The seven molecular layers for an integrated gliomas diagnosis are:

1.  Isocitrate dehydrogenase (IDH1) mutations.

2.  α-thalassemia/mental-retardation-syndrome-X-linked gene (ATRX) expression.

3.  1p/19q co-deletion.

4.  CDKN2A/B homozygous deletion on 9p21.

5.  TERT promoter mutation/EGFR gene amplification and/or chromosomes 7 gain and 10 loss (+7/–10).

6.  Histone H3 G34R/V mutations.

7.  Histone H3 K27M/ mutations.

For the first time, molecular features have been explicitly added to the grading schema. For example, an IDH-wildtype astrocytoma with low-grade histologic features can be considered grade 4 (glioblastoma) in the presence of nuclear ATRX, EGFR amplification, TERT promoter mutation, or the combined gain of chromosome 7 and loss of chromosome 10 [+7/-10]. 

Pathology and Prognosticators

Pathology: Grading and Classification dependent on markers, enter manually or generate from markers. Select a pathology Astrocytoma Grade I Astrocytoma Grade II Astrocytoma Grade III Astrocytoma Grade IV Oligodendroglioma Grade II Oligodendroglioma Grade III

Necrosis/MVP present? Necrosis /Microvascular Proliferation Present Absent

Age: years.

KPS: Select a KPS 100 - Normal, no complaints, no evidence of disease 90 - Able to carry on normal activity, minor symptoms 80 - Normal activity with effort, some symptoms 70 - Cares for self, unable to carry on normal activity 60 - Requires occasional assistance, cares for most needs 50 - Requires considerable assistance and frequent medical care 40 - Disabled, requires special care and assistance 30 - Severely disabled, hospitalization is indicated

Extent of Resection: Select an extent of resection Biopsy only Subtotal Gross Total

Ki-67: Enter as percentage.

Integrated Diagnosis:
Recommendations:

References:

Biblio: