Qasim Hussein, Khattab Karees, Abu Shugaer Mohammad, Varrassi Giustino
Department of Pathology and Laboratory Medicine, Jordan University of Science and Technology, Irbid, JOR.
Faculty of Medicine, Jordan University of Science and Technology, Irbid, JOR.
Cureus. 2025 Aug 11;17(8):e89806. doi: 10.7759/cureus.89806. eCollection 2025 Aug.
Oligodendrogliomas and diffuse midline gliomas (DMGs) are distinct subtypes of central nervous system (CNS) tumors with differing prognoses and treatment responses. Accurate differentiation between these tumors is critical yet often challenging, particularly when comprehensive molecular testing is unavailable. This review explores the diagnostic value of immunohistochemical surrogate markers, vimentin, synaptophysin, and histone H3 lysine 27 methylation (H3K27me), in distinguishing these tumor types. A narrative review methodology was employed following the Scale for the Assessment of Narrative Review Articles (SANRA) guidelines. Relevant peer-reviewed studies were identified through comprehensive database searches of PubMed, Embase, Scopus, Web of Science (WoS), and Google Scholar using targeted keywords and Medical Subject Headings (MeSH) terms. Articles were included based on their focus on the immunohistochemical and molecular characterization of oligodendrogliomas and DMGs. Vimentin, typically associated with mesenchymal transition, is highly expressed in DMGs and high-grade gliomas, reflecting aggressive behavior and invasiveness. In contrast, oligodendrogliomas usually lack vimentin expression. Synaptophysin, a neuronal differentiation marker, is frequently expressed in oligodendrogliomas but largely absent in DMGs, offering discriminatory value. The loss of H3K27 trimethylation (H3K27me3) expression is a defining feature of H3K27M-mutant DMGs and serves as a highly specific diagnostic marker. Together, these markers improve diagnostic precision, particularly in resource-limited settings or where molecular assays are not readily available. Vimentin, synaptophysin, and H3K27me expression patterns offer practical, cost-effective surrogate tools to enhance diagnostic accuracy in glioma classification. Their integration into routine neuropathological assessment can support timely and appropriate therapeutic decision-making, especially in settings lacking full molecular testing capabilities. Further research is needed to explore their potential roles in guiding targeted therapies and prognostication.
少突胶质细胞瘤和弥漫性中线胶质瘤（DMG）是中枢神经系统（CNS）肿瘤的不同亚型，具有不同的预后和治疗反应。准确区分这些肿瘤至关重要，但往往具有挑战性，尤其是在无法进行全面分子检测的情况下。本综述探讨了免疫组化替代标志物波形蛋白、突触素和组蛋白H3赖氨酸27甲基化（H3K27me）在区分这些肿瘤类型中的诊断价值。按照叙事性综述文章评估量表（SANRA）指南采用叙事性综述方法。通过使用目标关键词和医学主题词（MeSH）对PubMed、Embase、Scopus、科学网（WoS）和谷歌学术进行全面数据库检索，确定了相关的同行评审研究。纳入的文章基于其对少突胶质细胞瘤和DMG的免疫组化及分子特征的关注。波形蛋白通常与间充质转化相关，在DMG和高级别胶质瘤中高表达，反映出侵袭性行为和侵袭性。相比之下，少突胶质细胞瘤通常缺乏波形蛋白表达。突触素是一种神经元分化标志物，在少突胶质细胞瘤中经常表达，但在DMG中大多不存在，具有鉴别价值。H3K27三甲基化（H3K27me3）表达缺失是H3K27M突变型DMG的一个决定性特征，可作为高度特异性的诊断标志物。这些标志物共同提高了诊断准确性，特别是在资源有限的环境或分子检测不易获得的情况下。波形蛋白、突触素和H3K27me的表达模式提供了实用、经济有效的替代工具，可提高胶质瘤分类的诊断准确性。将它们纳入常规神经病理学评估可以支持及时和适当的治疗决策，特别是在缺乏完整分子检测能力的情况下。需要进一步研究以探索它们在指导靶向治疗和预后评估中的潜在作用。
