0:00

So molecular glioblastoma.

0:02

Before I talk about molecular,

0:04

let me tell you the classic glioblastomas.

0:06

Here are eight patients that I've known in the past

0:09

have the classic central necrosis, very aggressive,

0:13

irregular remen of enhancement.

0:15

These are all glioblastomas.

0:18

And the classic GBM now have all these extra

0:23

molecular genetic diagnosis

0:25

that our pathologist is testing for.

0:28

And some of them will be MGM TM methylated

0:31

and most, some of you know the implication of MGMT,

0:34

hypermethylated GBM.

0:35

These are actually the ones that respond quite well to

0:40

temozolomide chemotherapy.

0:42

But there's all these other things that they test for.

0:45

But the unifying one is

0:48

that all glioblastomas are IDH one wild type.

0:53

So there's no more what's called the glioblastoma

0:56

IDH mutant does not exist anymore.

1:00

All glioblastomas are IDH wild type.

1:04

Now what is molecular glioblastoma?

1:08

These have a genetic mutation.

1:10

The three component here, TER promoter mutation, EGFR,

1:14

gene amplification, trisomy seven and monosomy 10.

1:18

And on imaging they do not look like the classic

1:21

glioblastoma I just showed you.

1:24

Uh, this is the 19-year-old who was originally, uh,

1:28

misdiagnosed as a stroke.

1:29

If you look at her post con imaging,

1:31

it does not enhance at all.

1:34

And on DWI, it has really

1:38

hyper intense DWI signal intensity and very low A DC.

1:43

This is a path proven molecular glioblastoma

1:48

with these three molecular alterations.

1:50

Third promoter, EGFR, trisomy seven

1:54

and monosomy 10.

1:56

And this is new.

1:58

This is a separate tumor, but

2:00

nonetheless, molecular glioblastoma are just as aggressive

2:05

as classic glioblastoma.

2:08

And this young lady who, uh,

2:12

received TPA and cerebral angiogram looking for a source

2:15

of stroke elsewhere came to us.

2:18

This was resected.

2:19

This is a molecular glioblastoma,

2:22

but if you look down, patient has a second focus

2:26

of additional tumor.

2:28

And this is really bad news, additional lesion.

2:32

And that is the lesion

2:33

that turns five months later into a frank glioblastoma.

2:37

And this is a terrible prognostic, uh, situation.

Adult Brain Tumors Based on Molecular Genetics: Glioblastomas

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Pro Tip: Click on a word in the transcript to jump to that point in the video

0:00

So molecular glioblastoma.

0:02

Before I talk about molecular,

0:04

let me tell you the classic glioblastomas.

0:06

Here are eight patients that I've known in the past

0:09

have the classic central necrosis, very aggressive,

0:13

irregular remen of enhancement.

0:15

These are all glioblastomas.

0:18

And the classic GBM now have all these extra

0:23

molecular genetic diagnosis

0:25

that our pathologist is testing for.

0:28

And some of them will be MGM TM methylated

0:31

and most, some of you know the implication of MGMT,

0:34

hypermethylated GBM.

0:35

These are actually the ones that respond quite well to

0:40

temozolomide chemotherapy.

0:42

But there's all these other things that they test for.

0:45

But the unifying one is

0:48

that all glioblastomas are IDH one wild type.

0:53

So there's no more what's called the glioblastoma

0:56

IDH mutant does not exist anymore.

1:00

All glioblastomas are IDH wild type.

1:04

Now what is molecular glioblastoma?

1:08

These have a genetic mutation.

1:10

The three component here, TER promoter mutation, EGFR,

1:14

gene amplification, trisomy seven and monosomy 10.

1:18

And on imaging they do not look like the classic

1:21

glioblastoma I just showed you.

1:24

Uh, this is the 19-year-old who was originally, uh,

1:28

misdiagnosed as a stroke.

1:29

If you look at her post con imaging,

1:31

it does not enhance at all.

1:34

And on DWI, it has really

1:38

hyper intense DWI signal intensity and very low A DC.

1:43

This is a path proven molecular glioblastoma

1:48

with these three molecular alterations.

1:50

Third promoter, EGFR, trisomy seven

1:54

and monosomy 10.

1:56

And this is new.

1:58

This is a separate tumor, but

2:00

nonetheless, molecular glioblastoma are just as aggressive

2:05

as classic glioblastoma.

2:08

And this young lady who, uh,

2:12

received TPA and cerebral angiogram looking for a source

2:15

of stroke elsewhere came to us.

2:18

This was resected.

2:19

This is a molecular glioblastoma,

2:22

but if you look down, patient has a second focus

2:26

of additional tumor.

2:28

And this is really bad news, additional lesion.

2:32

And that is the lesion

2:33

that turns five months later into a frank glioblastoma.

2:37

And this is a terrible prognostic, uh, situation.

Report

Faculty

Soonmee Cha, MD

Program Director, Vice Chair of Education

University of California San Francisco Medical Center

Lesson

Introduction

Lesson

Meningiomas

Lesson

Non-glial Tumors

Lesson

2021 WHO CNS Tumor Classification

Lesson

Gliomas

Lesson

Pediatric Brain Tumor Cases

Adult Brain Tumors Based on Molecular Genetics: Glioblastomas