Download PDF
Radiologie up2date 2023; 23(04): 301-316
DOI: 10.1055/a-2067-1148
Neuroradiologie

Wichtige Neuerungen in der WHO-Klassifikation der ZNS-Tumoren mit neuroradiologischer Relevanz

Important Innovations in the WHO Classification of CNS Tumors with Neuroradiological Relevance
Reinhold Nafe
,
Patrick Felix Samp
,
Elke Hattingen
› Further Information
Also available at
    Permissions and Reprints All articles of this category

Die 5. Edition der WHO-Klassifikation der ZNS-Tumoren beinhaltet viele neue Aspekte, vor allem zu den molekularen Kriterien der Diagnostik. Einige Neuerungen muss auch der Neuroradiologe im Rahmen der Routinediagnostik kennen, z. B. die geänderten Kriterien der Tumorgraduierung oder auch die Tatsache, dass bei bestimmten Tumoren mit molekular bestätigtem Tumorgrad 4 die bildgebenden Merkmale eines hochgradigen Tumors im Einzelfall fehlen können.

Abstract

The 5th edition of the WHO classification of CNS tumors contains many new aspects, especially with regard to the molecular diagnostic criteria. Even neuroradiologists must be familiar with some innovations in the context of routine diagnostics, such as new molecular criteria for tumor grading or the fact that in certain tumors with molecularly confirmed tumor grade 4, the imaging features of a high-grade tumor may be absent in individual cases.

Kernaussagen

  • Die molekulare Analyse der Tumoren des Zentralnervensystems gehört mittlerweile neben Bildgebung und Histopathologie zu den 3 wichtigsten diagnostischen Verfahren bei der Differenzierung der einzelnen Entitäten.

  • Auch im Rahmen der bildgebenden Diagnostik, etwa bei der Nachuntersuchung mit vorliegendem neuropathologischem Befund, kann die Kenntnis der Bedeutung der genannten molekularen Veränderungen zur gesamtklinischen und prognostischen Einschätzung im individuellen Fall beitragen.

  • Bei einzelnen Entitäten sind in der aktuellen Edition der WHO-Klassifikation neue molekulare Kriterien im Rahmen der Graduierung hinzugetreten, insbesondere bei den diffusen Astrozytomen, IDH-mutiert, Tumorgrad 4, den Glioblastomen, IDH-Wildtyp, Tumorgrad 4 und bei den Meningeomen Tumorgrad 3.

  • Bildmorphologische Zeichen eines höheren Tumorgrades können in einzelnen Fällen von hochgradigen Tumoren fehlen, insbesondere bei den folgenden 4 Tumorarten: Astrozytom, IDH-mutiert, Tumorgrad 4; Glioblastom, IDH-Wildtyp, Tumorgrad 4; diffuses Gliom der Mittellinie, H3K27M-alteriert; hemisphärisches Gliom, H3G34-mutiert.

Schlüsselwörter

diffuse Gliome - High-Grade-Astrozytom mit piloiden Merkmalen - Ependymome - embryonale Tumoren - Tumoren der Glandula pinealis

Key words

diffuse gliomas - high-grade astrocytoma with piloid features - ependymomas - embryonal tumors - tumors of the pineal gland


Publication History

Article published online:
08 December 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Brat DJ, Ellison DW, Figarella-Branger D. et al. Eds. WHO Classification of Tumours Editorial Board. Central nervous System Tumours. Lyon (France): International Agency for Research on Cancer; 2021. (WHO classification of tumours series, 5th ed.; vol. 6). Im Internet: https://publications.iarc.fr/601
    Google Scholar
  • 2 Brat DJ, Ellison DW, Figarella-Branger D. et al. Gliomas, glioneuronal Tumours, and neuronal Tumours. In: Central nervous System Tumours. Lyon (France): International Agency for Research on Cancer; 2021. WHO classification of tumours series, 5th ed.; vol. 6). Im Internet: https://publications.iarc.fr/601
    Google Scholar
  • 3 Nafe R, Porto L, Samp PF. et al. Adult-type and pediatric-type diffuse gliomas – what the neuroradiologist should know. Clin Neuroradiol 2023; DOI: 10.1007/s00062-023-01277-z.
    CrossrefPubMedGoogle Scholar
  • 4 Sabin ND, Hwang SN, Klimo P. et al. Anatomic neuroimaging characteristics of posterior fossa type A ependymoma subgroups. Am J Neuroradiol 2021; 42: 2245-2250 DOI: 10.3174/ajnr.A7322.
    CrossrefPubMedGoogle Scholar
  • 5 Bender K, Perez E, Chirica M. et al. High-grade astrocytoma with piloid features (HGAP): the Charité experience with a new central nervous system tumor entity. J Neurooncol 2021; 153: 109-120 DOI: 10.1007/s11060-021-03749-z.
    CrossrefPubMedGoogle Scholar
  • 6 Chen W, Soon YY, Pratiseyo PD. et al. Central nervous system neuroepithelial tumors with MN1-alteration: an individual patient data meta-analysis of 73 cases. Brain Tumor Pathol 2020; 37: 145-153 DOI: 10.1007/s10014-020-00372-0.
    CrossrefPubMedGoogle Scholar
  • 7 Solomon DA, Blümcke I, Gessi M. et al. Myxoid glioneuronal Tumour. In: Central nervous System Tumours. Lyon (France): International Agency for Research on Cancer; 2021. (WHO classification of tumours series, 5th ed.; vol. 6). Im Internet: https://publications.iarc.fr/601
    Google Scholar
  • 8 Jarzembowski JA, De Kock L, Mete O. et al. Pituitary Blastoma. In: Central nervous System Tumours. Lyon (France): International Agency for Research on Cancer; 2021. (WHO classification of tumours series, 5th ed.; vol. 6). Im Internet: https://publications.iarc.fr/601
    Google Scholar
  • 9 Singh R, Wesseling P. Melanocytic Tumours. In: Central nervous system tumours. Lyon (France): International Agency for Research on Cancer; 2021. (WHO classification of tumours series, 5th ed.; vol. 6). Im Internet: https://publications.iarc.fr/601
    Google Scholar
  • 10 Griewank KG, Koelsche C, Van de Nes J. et al. Integrated genomic classification of melanocytic tumors of the central nervous system using mutation analysis, copy number alterations, and DNA methylation profiling. Clin Cancer Res 2018; 24: 4494-4504 DOI: 10.1158/1078-0432.CCR-18-0763.
    CrossrefPubMedGoogle Scholar
  • 11 Asa SL, Mete O. Immunohistochemical biomarkers in pituitary pathology. Endocr Pathol 2018; 29: 130-136 DOI: 10.1007/s12022-018-9521-z.
    CrossrefPubMedGoogle Scholar
  • 12 Ellison DW, Figarella-Branger D, Pfister SM. et al. Embryonal tumours. In: Central nervous system tumours. Lyon (France): International Agency for Research on Cancer; 2021. (WHO classification of tumours series, 5th ed.; vol. 6) https://publications.iarc.fr/601
    Google Scholar
  • 13 Sharma T, Schwalbe EC, Williamson D. et al. Second-generation molecular subgrouping of medulloblastoma: an international meta-analysis of Group 3 and Group 4 subtypes. Acta Neuropathol 2019; 138: 309-326 DOI: 10.1007/s00401-019-02020-0.
    CrossrefPubMedGoogle Scholar
  • 14 Lastowska M, Trubicka J, Sobocinska A. et al. Molecular identification of CNS NB-FOXR2, CNS EFT-CIC, CNS HGNET-MN1 and CNS HGNET-BCOR pediatric brain tumors using tumor-specific signature genes. Acta Neuropathol Commun 2020; 8: 105 DOI: 10.1186/s40478-020-00984-9.
    CrossrefPubMedGoogle Scholar
  • 15 Ferris SP, Vega JV, Aboian M. et al. High-grade neuroepithelial tumor with BCOR exon 15 internal tandem duplication–a comprehensive clinical, radiographic, pathologic, and genomic analysis. Brain Pathol 2020; 30: 46-62 DOI: 10.1111/bpa.12747.
    CrossrefPubMedGoogle Scholar
  • 16 Lazar AJ, Ng HK. Mesenchymal, non-meningothelial Tumours involving the CNS. In: Central nervous System Tumours. Lyon (France): International Agency for Research on Cancer; 2021. (WHO classification of tumours series, 5th ed.; vol. 6). Im Internet: https://publications.iarc.fr/601
    Google Scholar
  • 17 Yang MJ, Whelan R, Madden J. et al. Intracranial Ewing sarcoma: four pediatric examples. Childs Nerv Syst 2018; 34: 441-448 DOI: 10.1007/s00381-017-3684-7.
    CrossrefPubMedGoogle Scholar
  • 18 Louis DN. Meningioma. In: Central nervous System Tumours. Lyon (France): International Agency for Research on Cancer; 2021. (WHO classification of tumours series, 5th ed.; vol. 6). Im Internet: https://publications.iarc.fr/601
    Google Scholar
  • 19 Jiang J, Yu J, Liu X. et al. The efficacy of preoperative MRI features in the diagnosis of meningioma WHO grade and brain invasion. Front Oncol 2023; 12: 1100350 DOI: 10.3389/fonc.2022.1100350.
    CrossrefPubMedGoogle Scholar
  • 20 Hasselblatt M, Huang A, Jones DTW. et al. Pineocytoma. In: Central nervous System Tumours. Lyon (France): International Agency for Research on Cancer; 2021. (WHO classification of tumours series, 5th ed.; vol. 6). Im Internet: https://publications.iarc.fr/601
    Google Scholar
  • 21 Liu APY, Bryan KL, Pfaff E. et al. Clinical and molecular heterogeneity of pineal parenchymal tumors: a consensus study. Acta Neuropathol 2021; 141: 771-785 DOI: 10.1007/s00401-021-02284-5.
    CrossrefPubMedGoogle Scholar
  • 22 Vasiljevic A. Histopathology and molecular pathology of pediatric pineal parenchymal tumors. Childs Nerv Syst 2022; PubMed:35972537 DOI: 10.1007/s00381-022-05637-x.
    CrossrefPubMedGoogle Scholar
  • 23 Komakula S, Warmuth-Metz M, Hildenbrand P. et al. Pineal parenchymal tumor of intermediate differentiation: Imaging spectrum of an unusual tumor in 11 cases. Neuroradiology 2011; 53: 577-584 DOI: 10.1007/s00234-010-0794-2.
    CrossrefPubMedGoogle Scholar