Histopathologic grading of anaplasia in retinoblastoma.

PURPOSE: To determine whether the degree of tumor anaplasia has prognostic value by evaluating its correlation with high-risk histopathologic features and clinical outcomes in a series of retinoblastoma patients. DESIGN: Retrospective clinicopathologic study. METHODS: The clinical and pathologic findings in 266 patients who underwent primary enucleation for retinoblastoma were reviewed. The histologic degree of anaplasia was graded as retinocytoma, mild, moderate, or severe as defined by increasing cellular pleomorphism, number of mitoses, nuclear size, and nuclear hyperchromatism. Nuclear morphometric characteristics were measured. The clinical and pathologic data of 125 patients were compared using Kaplan-Meier estimates of survival. Fisher exact test and multivariate regression were used to analyze the association between anaplasia grade and high-risk histologic features. RESULTS: Increasing grade of anaplasia was associated with decreased overall survival (P = .003) and increased risk of metastasis (P = .0007). Histopathologic features that were associated with anaplasia included optic nerve invasion (P < .0001), choroidal invasion (P < .0001), and anterior segment invasion (P = .04). Multivariate analysis considering high-risk histopathology and anaplasia grading as predictors of distant metastasis and death showed that high-risk histopathology was statistically significant as an independent predictor (P = .01 for metastasis, P = .03 for death) but anaplasia was not (P = .63 for metastasis, P = .30 for death). In the absence of high-risk features, however, severe anaplasia identified an additional risk for metastasis (P = .0004) and death (P = .01). CONCLUSION: Grading of anaplasia may be a useful adjunct to standard histopathologic criteria in identifying retinoblastoma patients who do not have high-risk histologic features but still have an increased risk of metastasis and may need adjuvant therapy.

Classification and biology of astrocytic gliomas.

The presented classification of astrocytic gliomas follows the system adopted by the WHO which was last published in 1993. The nosographic position of each tumour type is discussed in relation to previous positions and the rationale of changes is provided. The biology and pathology of anaplasia, leading from astrocytoma to glioblastoma, are discussed briefly. The increasing genotypic and phenotypic heterogeneity is described in its progressive stages. A series of genetic changes are associated with the main histologic features of malignancy , such as TP53 mutations, EGFR amplification, CDKN2 deletion, etc. The genetic differences between primary and secondary glioblastomas are emphasised. Tumour-associated biological events are presented: cell invasion and spread, necrosis and apoptosis and angiogenesis are all discussed in some detail. Of each event a short survey on the principal phenotypic and molecular features is given with emphasis on their significance to pathogenesis. Each tumour type is briefly summarised from epidemiological, clinical and pathological standpoints.

Malignant glioma. Results of combined modality therapy.

Multimodal treatment of malignant gliomas is routinely used at New York University Medical Center. Overall, our treatment program has resulted in survival rates of 78% at six months, 51% at one year, and 7% at five years for these high-grade brain tumors. However, various subgroups (based on tumor or host factors, or both) fared significantly better or worse than others. Particularly limited survival rates were found in patients who experienced paresis/paralysis or impaired mental function, who had tumors that were markedly anaplastic, who were elderly, or who for a variety of reasons did not receive the multimodal treatment we consider optimal.