Abstract
Gangliogliomas are central nervous system tumors located in the temporal lobe of young patients, frequently associated with epilepsy. In this paper, we propose a grading system based solely on histopathological criteria. We reevaluated all cases of ganglioglioma, atypical ganglioglioma, and anaplastic ganglioglioma diagnosed between 2011 and 2020 in the Pathology Department of the Emergency Clinical Hospital Bagdasar-Arseni, based on the type of glial mitoses, the number of neuronal and glial mitoses, presence of necrosis, microvascular proliferation, eosinophilic granular bodies, hypercellularity, presence and disposition of inflammatory infiltrate and atypical pleomorphism. Based on the proposed grading system, a score of 0–4 corresponded to a benign ganglioglioma, 5–9 to an atypical ganglioglioma, and 10–18 to an anaplastic ganglioglioma. The survival rates were 90% for benign ganglioglioma, 71.43% for atypical ganglioglioma, and 62.54% for anaplastic ganglioglioma. One case of benign ganglioglioma underwent a malignant transformation into anaplastic ganglioglioma, and recurrences were noticed in 28.57% of atypical ganglioglioma cases and 30.7% of all anaplastic gangliogliomas. The presence of rare glial mitoses and hypercellularity was correlated with mortality in cases of atypical ganglioglioma. We believe this histopathological scoring system could be used as a three-tier system to identify atypical ganglioglioma cases that are bound to have an aggressive course of evolution and require close follow-up. The other option would be to convert it to a two-tier grading system that can separate low-grade gangliogliomas from high-grade ones. The latter category can encompass both atypical and anaplastic ganglioglioma due to the high mortality of both entities.
Highlights
Gangliogliomas are tumors of the central nervous system composed of a dual neoplastic population and showing a predilection for the temporal lobe [1, 2]
The latter frequently imparts an aspect of pilocytic astrocytoma, but an infiltrative glioma can rarely be part of the neoplastic proliferation, making anaplastic ganglioglioma the correct diagnosis [1, 4, 5]
We propose a novel histopathological grading system for gangliogliomas, which includes a grade II ganglioglioma
Summary
Gangliogliomas are tumors of the central nervous system composed of a dual neoplastic population and showing a predilection for the temporal lobe [1, 2]. Neoplastic proliferation is constituted of both dysplastic neurons and neoplastic glial cells [3] The latter frequently imparts an aspect of pilocytic astrocytoma, but an infiltrative glioma can rarely be part of the neoplastic proliferation, making anaplastic ganglioglioma the correct diagnosis [1, 4, 5]. The latest edition of the World Health Organization (WHO) classification of central nervous system tumors only recognizes a benign (grade I) ganglioglioma and a malignant variant, called anaplastic ganglioglioma (grade III). A number of 50 patients have been included in this study, which aims to correlate the histopathological features of gangliogliomas with the overall survival rates. There are no scientific studies in the literature encompassing benign, atypical, and anaplastic gangliogliomas aiming to implement a histological grading system. A recent publication has evaluated low-grade gangliogliomas in the adult population, focusing on epidemiological and clinical data, but less emphasis was given to histology [7]
Sign-in/Register to view highlights & summary 
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call