4/29/2021 1 WHO classification 2021 H.K. Ng Chinese University of Hong Kong Full ppt at http://www.acp.cuhk.edu.hk/hkng/ Sorry this is going to be a boring talk 45 minutes are not enough for the CNS classification as We have many more entities than other systems So there is only enough time to read through the entire Classificatiion Parts of the classification which do not have many changes will not be dealt with.
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Transcript
4/29/2021
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WHO classification 2021
H.K. Ng
Chinese University of Hong Kong
Full ppt at http://www.acp.cuhk.edu.hk/hkng/
Sorry this is going to be a boring talk
45 minutes are not enough for the CNS classification asWe have many more entities than other systemsSo there is only enough time to read through the entireClassificatiionParts of the classification which do not havemany changes will not be dealt with.
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Just too many entities
WHO also includes a section on hereditary brain tumor syndromes
Some entities I have not seen myself
Sorry cannot illustrate everything
WHO Classification 2021
Imminently in print and latest June
Look out for summary in Neuro‐oncology soon
Louis DN et al.
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Disclaimer : Just don’t shoot the messenger
WHO 2021 – led by IARC
Ten neuropathologists
‐ Brat, Dan
‐ Ellison, David
‐ Figarella‐Branger, Dominique
‐ Hawkins, Cynthia
‐ Louis, David
‐ Perry, Arie
‐ Ng, H K
‐ Von Deimling, Andreas
‐ Reifenberger, Guido
‐ Wesseling, Pieter
Two clinicians
‐ Pfister, Stefan
‐ Soffietti, Riccardo
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Some general changes
• Pediatric and adult gliomas separate
• Grading changed to Arabic numerals, e.g. 1, 2,3, 4 and not I, II, III,IV
• Grading is WITHIN each tumor group
• Methylomes a desirable criteria in
• Many of the new and rare lesions diagnosable by methylation profiles
• Appreciate that some tumors are Not Elsewhere Classified (NEC)
• Integrated diagnosis as per Haarlem (2014) recommendation
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Whole genome methylation profiling
BinaryIDAT files(1 for red, 1 for green)
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Typical report from DKFZ Molecular Classifier
Capper D et al. Nature 2018
Methylation profiling listed as DESIRABLE criteria in WHO 2021for many entities
Figure 1. Unsupervised clustering of reference cohort samples and 85 IDH mutant glioblastomas using t-SNE dimensionality reduction. The reference cohort of the DKFZCNS tumor classifier includes 82 tumour and 9 non-tumour classes and they are shown as circles of different colors. The 85 primary IDH mutant glioblastomas of ourcohort clustered mainly to the (I) IDH mutant high grade astrocytomas; (2) glioblastoma, IDH wildtype, subclass RTK II and (3) subclass mesenchymal (green triangles).Mutations of IDH in our samples were tested and confirmed by independent PCR and sanger sequencing.
Wong, NgModern Pathology 2021
Methylomes also give you the complete cytogenetic picture of copy number variation of genes
Wong, Ng. Modern Pathology 2021
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Other information obtainable from methylomes
• MGMT
• 1p19q status
• G‐CIMP status (have to workOut yourself)
Pediatric gliomas
2.1.2: Pediatric-type diffuse low-grade gliomas2.1.2.1: Diffuse astrocytoma, MYB- or MYBL1-altered2.1.2.2: Angiocentric glioma 2.1.2.3: Diffuse low-grade glioma, MAPK-altered2.1.2.4: Polymorphous low-grade neuroepithelial tumour of the young