Q. What could a brain biopsy show in case of seizures, balance, and memory issues?
Hello doctor,
I have had balance and memory issues for about a year, and my seizures started two months back. I had a brain biopsy done, for which the results have come, and I would like to have some information about what it means. Currently, I am taking anti-seizure, gout, and cholesterol medications. Please help me understand my biopsy report.
Hello,
Welcome to icliniq.com.
I read your query and can understand your concern.
Your report (attachment removed to protect the patient's identity) shows a large brain tumor (glioma), one of the most common brain tumors in this age group. The tumor is associated with some bleeding foci, which impacts the prognosis. The tumor is also IDH (isocitrate dehydrogenase) wild type which means no mutation in the IDH gene, a little worse than the mutant type. But the full molecular report is still pending. Kindly send the molecular test of biopsy, pathology, and MRI (magnetic resonance imaging) reports. The rest of your investigations are normal. If this tumor is surgically removed, then the prognosis is better. If not possible, then maximum debulking, followed by radiotherapy and some oral medicine, also prolongs life.
Hope this helps.
Thank you and take care.
Hello doctor,
Thank you for your reply.
The pathology information is in the report. According to the neurosurgeon, this is the full report. I would like to know what stage of glioma it is. I have attached the MRI reports below.
History of previous tumor or familial syndrome: None.
Specimen type or procedure: Biopsy.
Specimen handling: Smear, frozen section, and permanent section.
Tumor site or laterality: Right corpus callosum, basal ganglia, and frontal and parietal lobes.
Histologic type and grade: Infiltrating glioma, pending further molecular characterization.
Atypical features:
Cellularity: High.
Degree of cytologic atypia or pleomorphism: Moderate.
Tumor necrosis: Not identified.
Vascular or endothelial proliferation: Not identified.
Mitotic activity: The MIB-1 proliferation index is about 5 %.
Ancillary studies: The tumor cells are positive for *GFAP, shows weak immunoreactivity for *IDH1 R132H immunostain (IDH mutation to be confirmed on molecular testing), and show retained nuclear expression of *ATRX by immunohistochemistry. Immunostain for *P53 shows no aberrant staining. Molecular studies for IDH1/2 mutations will be performed and reported in an addendum, and the tissue will be sent for MGMT methylation analysis.
Tumor block for additional studies (if needed): B1.
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern.
1. Gliomas have no staging system. Rather it has a grading system from 1 to 4. Your report shows the grading between 2 to 3, with grade 1 being less aggressive and grade 4 very aggressive.
2. Ki 67 or MiB 1 is 5 %, which is better than above 10. The higher the score, the worse the tumor. It can act as a cellular factor for tumor development.
3. Your tumor MGMT methylation is not detected. So it is unmethylated, meaning it may respond to the oral anti-tumor medicine Temozolomide.
4. Atypia is moderate, which is better than severe atypia.
5, 5GFAP positive is an astrocyte marker and helps diagnose.
Treatment is based on radical or maximum debulking surgery followed by radiotherapy and oral anti-tumor medicine.
Hope this helps.
Thank you and take care.
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