The aim of this study was to validate the modified Pignatti scoring system as a predictor of survival in patients with World Health Organization (WHO) grade II diffuse fibrillary astrocytomas (DFAs). In this retrospective cohort study, data were collected from 135 consecutive patients who underwent excision/biopsy of WHO grade II DFAs from January 2000 to December 2015. The effect of the following prognostic variables on overall survival (OS) and progression-free survival (PFS) was studied: Pignatti score (PS = 1–4, low versus high risk), location of tumor (lobar versus nonlobar), extent of resection (subtotal resection [STR] versus <STR), and presence of enhancement (yes versus no). The median age was 42 years (range = 13–81 years) with male to female ratio of 1.8. A total of 99 patients had taken radiation therapy and had a follow-up >1 year (median follow-up = 5.2 years, range = 1–16 years). In all, 80 patients (81%, PS = 1–2) were in the low-risk group. The median PFS in the low-risk group (PS = 1 and 2) was 120 months (95% confidence interval [CI] = 72, 128). The median PFS in the high-risk group (PS = 3 and 4) was 72 months (95% CI = 18, not applicable [NA]). The median OS in the low-risk group was significantly higher at 128 months (95% CI = 72, NA) as compared to 72 months (95% CI = 18, NA) in the high-risk group (P = .005). The modified PS can be used to prognosticate survival in patients with WHO grade II DFAs, with patients of the low-risk category having a better OS but not PFS.

Glioblastoma (GBM), World Health Organization grade IV, is the most lethal and aggressive primary brain tumor. Despite maximal surgical resection, genotoxic treatment with ionizing radiation, and alkylating agent temozolomide, the median survival of the patients remains less than 12 months. Resistance and recurrence in GBM have been majorly attributed to altered DNA repair mechanisms. The DNA repair in a cell is mediated by many repair genes and proteins whose expression and recruitment are controlled epigenetically by DNA methylation and histone modifications. Understanding the mechanistic details of the interplay between DNA damage response (DDR) and epigenetics to identify potential targets has emerged as an essential therapeutic strategy for GBM. This review will summarize our current knowledge of how epigenetics modulate DDR in GBM and our understanding as to how these modifications impact therapy regimens. Finally, we will discuss the recent advances in epigenetic drugs and the scope of such drugs for future applications in treating brain tumors.

Background: Molecular testing has now been incorporated into the mainstream of neuropathological diagnosis, especially in gliomas. There are multiple molecular markers that determine prognosis, and a few are of therapeutic importance. Currently, a number laboratory techniques are being used to test these molecular markers, with an ever increasing number making the transition from being a research tool to use in day-to-day clinical practice.Objective: The objective of this article is to inform the practicing clinicians of the various molecular markers that may be used in neuropathological practice and to highlight the various laboratory methods that are used and the strengths and drawbacks of each test.Materials and Methods: Using intracranial gliomas as an example of the recent changes, this article highlights the different laboratory methods used for the testing of the most popular molecular markers that are used in clinical practice, namely, 1p19q, IDH, P53, H3K27M, EGFR, ATRX, and TERT and details the strengths and pitfalls of each one of them when compared with the current gold standard.Results: The results of traditional immunohistochemistry are compared to the modern molecular biology techniques, and the differences in interpreting the results are discussed.Conclusion: This article highlights the different ways of molecular testing in neuropathology and their differing interpretations. This knowledge is vital in clinical practice.

Tumors involving sellar and parasellar regions can present with headache, visual disturbances, cranial nerve deficits, and other neurological symptoms. Patients with such tumors can also present with endocrine dysfunction due to a hormone excess or deficient state. As many lesions in this critical area are slow growing in nature, they may evade early clinical detection and may present after a long period of time. Pituitary adenomas represent an overwhelming majority of sellar masses, whereas various nonpituitary tumors or metastases can also present with similar findings. Differentiation between pituitary and nonpituitary pathology is critical, as management strategies for the disorders mentioned earlier differ significantly. In such cases, radiological and histopathological evaluations are pivotal for arriving at a correct diagnosis. We describe an interesting case of sellar mass that presented with cranial nerve deficits and endocrine dysfunction, which was subsequently attributed to the myelomatous involvement of sella due to a relapse of multiple myeloma.

Primary central nervous system vasculitis (PCNSV) is a rare disorder usually presenting with nonspecific complaints. Its incidence is estimated to be 2.4 per million population per year. Very few reported cases have developed into large tumor-like lesions mimicking glioma. It is a diagnosis of exclusion when systemic vasculitis is ruled out. High-dose steroids with or without the combination of cyclophosphamide (CYP) help in remission. Biopsy with histopathology helps in forming a definitive diagnosis. Excision of the mass lesion is required in some cases.

Background: Multicentric gliomas are an uncommon entity and are mostly of astrocytic lineage and rarely oligodendrogliomas (ODGs). Multicentric ODGs are very rare, mostly comprising of two to three lesions. Here, we describe a case of multicentric ODG, with varying histological grades with at least six distinct lesions involving six different regions of the brain.Case Report: A 33-year-old gentleman presented with features of raised intracranial pressure and acute onset altered sensorium. Magnetic resonance imaging (MRI) of the brain revealed multiple lesions involving both cerebral (bilateral frontal and temporal lobes) and cerebellar hemispheres. The patient underwent surgical decompression of two of the lesions which were causing significant mass effect, after which his symptoms improved. Interestingly, both lesions demonstrated ODG histology but with different grades, with one being Grade II and the other being a Grade III lesion. Following surgery, he received adjuvant radiotherapy and chemotherapy with temozolomide. His follow-up MRI brain performed 5 months after surgery showed no recurrence at the operated sites and no increase in size of the remaining lesions.Conclusion: Surgical management of multicentric glioma needs individualized strategy with multidisciplinary care and involves maximal safe resection of large tumors with consideration of biopsy from smaller lesions for histomolecular diagnosis and adjuvant therapy.