WHO

Grading & Diagnostic

Imaging for Brain Tumor
YUYUN YUENIWATI
Departemen Radiologi
FK Universitas Brawijaya/ RSU dr. Saiful Anwar
Malang

Dibawakan pada PKB Neuroradiologi

Surabaya, 19-20 Desember 2015
 Overview

2
26. mars, 2021 :: Yuyun Yueniwati
 Introduction

3
March 26, 2021 :: Yuyun Yueniwati
 Brain tumors

4
March 26, 2021 :: Yuyun Yueniwati
5
26. mars, 2021 :: Yuyun Yueniwati
 Tumor-Specific Statistics

6
March 26, 2021 :: Yuyun Yueniwati
 Brain tumors

Grading

7
26. mars, 2021 :: Yuyun Yueniwati
 Brain tumors

Staging

8
26. mars, 2021 :: Yuyun Yueniwati
 Tumor grade
 communicate better
 plan treatment
 predict outcomes & prognosis

9
March 26, 2021 :: Yuyun Yueniwati
10
March 26, 2021 :: Yuyun Yueniwati
 2016 Updates to the WHO Brain Tumor
Classification System
• Some tumors are defined by a
combination of microscopic morphologic
and molecular and genetic factors,
whereas others continue to be defined by
morphology alone

11
March 26, 2021 :: Yuyun Yueniwati
 Layered diagnosis

12
March 26, 2021 :: Yuyun Yueniwati
 2016 five key updates
1. Gliomatosis cerebri no longer a
distinct entity
2. Revised classification of Embryonal
tumors
3. GBM & IDH mutation
4. Addition of new tumours
5. Gr II/III infiltrating gliomas defined
by IDH & 1p 19q status

13
March 26, 2021 :: Yuyun Yueniwati
 • Gliomatosis is a pattern
of growth that can be
displayed by any
infiltrating glioma

14
March 26, 2021 :: Yuyun Yueniwati
 • Primitive Neuroectodermal Tumor (PNET)
• No longer a part of the diagnostic lexicon

15
March 26, 2021 :: Yuyun Yueniwati
 Diagnostic schema for
WHO grades II and III
infiltrating gliomas in
adults

16
March 26, 2021 :: Yuyun Yueniwati
 Diagnostic schema
for GBM (WHO grade IV
astrocytoma), with key features
of primary and secondary
tumors

17
March 26, 2021 :: Yuyun Yueniwati
 New Tumor
• Multinodular and
vacuolating neuronal tumor
• Diffuse Midline Glioma, H3-
K27M mutant (DIPG variant)
• Diffuse Leptomeningeal
Glioneuronal Tumor

18
March 26, 2021 :: Yuyun Yueniwati
19
March 26, 2021 :: Yuyun Yueniwati
20
:: Yuyun Yueniwati
21
26. mars, 2021 :: Yuyun Yueniwati
 Astrocytoma

22
March 26, 2021 :: Yuyun Yueniwati
 WHO grading

23
March 26, 2021 :: Yuyun Yueniwati
 Pilocytic Astrocytoma

WHO grade I

24
March 26, 2021 :: Yuyun Yueniwati
 Pilocytic Astrocytoma

25
26. mars, 2021 :: Yuyun Yueniwati
 Radiographic features

Variable enhancement
Calcification
Hemorrhage
26
March 26, 2021 :: Yuyun Yueniwati
 Pilocytic Astrocytoma

27
March 26, 2021 :: Yuyun Yueniwati
 Diffuse astrocytoma

WHO grade II • Low-grade astrocytoma

• Fibrillary;
Protoplasmic;
Gemistocytic; mixed
tumours

28
:: Yuyun Yueniwati
 Diffuse Astrocytoma
• tumour matrix
rich
with neuroglial
fibrils

29
26. mars, 2021 :: Yuyun Yueniwati
 Radiographic features

CT Scan

30
26. mars, 2021 :: Yuyun Yueniwati
 Radiographic features

MRI

31
26. mars, 2021 :: Yuyun Yueniwati
 Low grade Astrocytoma

32
March 26, 2021 :: Yuyun Yueniwati
 Anaplastic Astrocytoma

WHO grade
III

33
:: Yuyun Yueniwati
 Anaplastic Astrocytoma
• Pathological features
intermediate WHO
grade II – IV
• mitotic activity and
cellular
pleomorphism

34
26. mars, 2021 :: Yuyun Yueniwati
 Radiographic features

CT Scan

35
March 26, 2021 :: Yuyun Yueniwati
 Radiographic features

MRI

36
26. mars, 2021 :: Yuyun Yueniwati
37
March 26, 2021 :: Yuyun Yueniwati
 Glioblastoma

WHO grade
IV

38
26. mars, 2021 :: Yuyun Yueniwati
 • Pleomorphic
astrocytes with
marked atypia and
numerous mitoses
• Necrosis and
microvascular
proliferation are
hallmarks of
glioblastomas
39
26. mars, 2021 :: Yuyun Yueniwati
 Radiographic features
CT Scan

40
March 26, 2021 :: Yuyun Yueniwati
 Radiographic features

MRI

41
26. mars, 2021 :: Yuyun Yueniwati
 MR spectroscopy

42
26. mars, 2021 :: Yuyun Yueniwati
43
:: Yuyun Yueniwati
44
March 26, 2021 :: Yuyun Yueniwati
 Meningioma

45
March 26, 2021 :: Yuyun Yueniwati
 WHO grading

46
March 26, 2021 :: Yuyun Yueniwati
 Plain radiography

47
:: Yuyun Yueniwati
 CT Scan

48
:: Yuyun Yueniwati
 MRI

49
March 26, 2021 :: Yuyun Yueniwati
50
March 26, 2021 :: Yuyun Yueniwati
 Helpful sign

51
March 26, 2021 :: Yuyun Yueniwati
 Meningioma

WHO grade I

Transitional Psammomatous Angiomatous

52
March 26, 2021 :: Yuyun Yueniwati Meningothelial
53
:: Yuyun Yueniwati
 Atypical Meningioma
WHO grade II

54
March 26, 2021 :: Yuyun Yueniwati
 Malignant Meningioma
WHO grade III

55
March 26, 2021 :: Yuyun Yueniwati
 Meningioma with sarcomatous
degeneration WHO grade IV

56
March 26, 2021 :: Yuyun Yueniwati
57
March 26, 2021 :: Yuyun Yueniwati
 Metastatic Brain Tumor

58
March 26, 2021 :: Yuyun Yueniwati
 Location
Metastasis lession

85%
15%
59
March 26, 2021 :: Yuyun Yueniwati
 • Meningeal
carcinomatoses

60
March 26, 2021 :: Yuyun Yueniwati
 Radiographic features
• Contrast enhanced
CT was previously
thought to be
equivalent to MRI for
the detection of
metastases

61
March 26, 2021 :: Yuyun Yueniwati
 • Current MRI
technology has been
shown to be more
sensitive than CT
and is the preferred
imaging of choice

62
March 26, 2021 :: Yuyun Yueniwati
 Take home messages

63
March 26, 2021 :: Yuyun Yueniwati
64
:: Yuyun Yueniwati
65
March 26, 2021 :: Yuyun Yueniwati