Figarella-Branger D, Bouvier C, Moroch J, Michalak S
Inserm U911, 13000 Marseille France.
Neurochirurgie. 2010 Dec;56(6):459-63. doi: 10.1016/j.neuchi.2010.07.014.
In the 2007 WHO classification, glioblastomas are classified among the group of astrocytic tumors. They are highly malignant (grade IV). This group of tumors is morphologically heterogeneous. The WHO distinguishes between clinico-pathological entities, variants of entities and histological pattern. Variants are defined as being reliably indentified histologically and having some relevance for clinical outcome but as still being part of a previously defined overarching entity. Patterns of differentiation are identifiable by histological appearances but without clinical or pathological significance.
The description of the histological and immunohistochemical features is based on the 2007 WHO classification.
In addition to the classic form of glioblastoma, two variants exist: the giant cell GBM and the gliosarcoma. The first but not the second would have a better outcome than the classic glioblastoma. The WHO classification also distinguishes several patterns of differentiation: small cells glioblastoma; glioblastoma with lipidized cells; glioblastoma with oligodendroglioma component; glioblastoma with heterologous differentiation. These patterns have to be recognized because they represent sometimes a diagnostic challenge. GFAP, Olig2 and Mib1/Ki67 are the most relevant immunohistochemical markers. Diagnostic value of neuronal markers is still controversial. EGFR or p53 expression can be detected and their prognosis value is discussed in this chapter. A systematic analysis of some markers in routine, for example IDH1 or internexin-a, could help to define more homogeneous groups of patients.
在2007年世界卫生组织（WHO）分类中，胶质母细胞瘤被归类于星形细胞瘤组。它们具有高度恶性（IV级）。这类肿瘤在形态上具有异质性。WHO区分临床病理实体、实体变体和组织学模式。变体被定义为在组织学上可可靠识别且与临床结果有一定相关性，但仍属于先前定义的总体实体的一部分。分化模式可通过组织学表现识别，但无临床或病理意义。
组织学和免疫组化特征的描述基于2007年WHO分类。
除了胶质母细胞瘤的经典形式外，还存在两种变体：巨细胞胶质母细胞瘤和胶质肉瘤。第一种变体（而非第二种）的预后可能优于经典胶质母细胞瘤。WHO分类还区分了几种分化模式：小细胞胶质母细胞瘤；含脂质化细胞的胶质母细胞瘤；含少突胶质细胞瘤成分的胶质母细胞瘤；具有异源性分化的胶质母细胞瘤。必须识别这些模式，因为它们有时代表诊断挑战。GFAP、Olig2和Mib1/Ki67是最相关的免疫组化标记物。神经元标记物的诊断价值仍存在争议。可检测EGFR或p53表达，本章将讨论它们的预后价值。对常规检查中的一些标记物（例如IDH1或internexin-α）进行系统分析，可能有助于定义更具同质性的患者群体。
