Geramizadeh Bita, Kohandel-Shirazi Mahsa, Soltani Ahmad
Department of Pathology, Medical School of Shiraz University, Shiraz University of Medical Sciences, Shiraz, Iran.
Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Clin Pathol. 2021 Feb 11;14:2632010X20986168. doi: 10.1177/2632010X20986168. eCollection 2021 Jan-Dec.
Reactive gliosis is a response of glial tissue to different types of injury such as brain abscess, trauma, hemorrhage, or even neoplastic process. In some circumstances, especially when the tissue biopsy is small, there may be difficulty to discriminate this reactive condition with low-grade diffuse astrocytoma (World Health Organization [WHO] grade II) by conventional hematoxylin and eosin (H&E) slides, so some immunohistochemical and molecular markers have been introduced for this differential diagnosis. One of the important aspects of updated WHO classification in 2016 has been dividing some of the glial tumor according to IDH1 (isocitrate dehydrogenase 1) mutation.
In this study, we tried to evaluate IDH1 and P53 mutation by immunohistochemistry as a simple and highly specific and sensitive method to differentiate low-grade astrocytoma and reactive gliosis.
For 5 years (2013-2018), 50 cases of clinically documented reactive gliosis and 50 cases of low-grade astrocytoma were evaluated for the presence or absence of IDH1 and P53 mutation by immunohistochemistry.
Isocitrate dehydrogenase 1 was positive in 92% and 4% of the astrocytoma and reactive gliosis cases and P53 was positive in 90% and 4% of the cases with the final diagnosis of astrocytoma and reactive gliosis, respectively.
Combination of P53 and IDH1 as an immunohistochemical panel showed specificity of 96% and sensitivity of 91% for differential diagnosis of reactive gliosis and low-grade astrocytoma. These 2 markers can be extremely helpful for this differential diagnosis.
反应性胶质增生是胶质组织对不同类型损伤的一种反应，如脑脓肿、创伤、出血，甚至肿瘤形成过程。在某些情况下，尤其是当组织活检样本较小时，通过传统苏木精和伊红（H&E）染色切片，可能难以将这种反应性病变与低级别弥漫性星形细胞瘤（世界卫生组织[WHO]二级）区分开来，因此引入了一些免疫组化和分子标志物用于鉴别诊断。2016年WHO更新分类的一个重要方面是根据异柠檬酸脱氢酶1（IDH1）突变对一些胶质肿瘤进行分类。
在本研究中，我们试图通过免疫组化评估IDH1和P53突变，作为一种简单且具有高度特异性和敏感性的方法来区分低级别星形细胞瘤和反应性胶质增生。
在5年（2013 - 2018年）期间，通过免疫组化对50例临床诊断为反应性胶质增生的病例和50例低级别星形细胞瘤病例进行IDH1和P53突变情况评估。
在星形细胞瘤病例中，异柠檬酸脱氢酶1阳性率为92%，在反应性胶质增生病例中为4%；P53在最终诊断为星形细胞瘤和反应性胶质增生的病例中的阳性率分别为90%和4%。
P53和IDH1作为免疫组化组合在鉴别反应性胶质增生和低级别星形细胞瘤时，特异性为96%，敏感性为91%。这两种标志物对该鉴别诊断非常有帮助。
