PATHOLOGY MCQs

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Gliosis is often confusing and challenging to differentiate from glioma. Adding to the trouble, is the fact that gliomas often accompany gliosis. Therefore it is essential to differentiate gliosis and gliomas.

Gliosis is also seen in demyelinaying diseases and infections

Ideally ‘gliosis with glioma’ and ‘gliosis without glioma’ shoud be differentiated, but to keep things simple let’s look at a few clues to tell the two apart.

GLIOMAS Vs GLIOSIS

1. MITOSIS

Mitosis naturally is characteristic of multiplying cells. Hence mitosis is lower in gliosis when compared to glioma. As a general rule the Ki67 proliferation index does not exceed > 5% in gliosis.

This isn’t entirely useful, because low grade gliomas do not show mitosis. Ki-67 stains may be useful to quantify mitosis by immunohistochemistry.

2. MARGINS

This is probably the most important differentiating fearure.

GLIOMAS- EXPAND

GLIOSIS- CONTRACTS

However important this finding is, it is difficult to confirm without serial radiographs.

3. CELLULAR DENSITY

Gliosis- cellular density is even

Glioma- cellular density is uneven

4. NUCLEUS

Gliosis- nuclei of cells don’t touch each other.

Glioma- nuclei of cells often touch each other.

5. IMMUNOHISTOCHEMICAL MARKERS

Gliosis- negative for markers such as IDH and p53.

Glioma- positive for markers such as IDH and p53.

IDH and p53 are not positive in many gliomas but, when they are positive they can be diagnostic.

In this context it would be fitting to discuss quickly about a condition which often mimicks brain tumor- GLIOMATOSIS CEREBRI

Gliomatosis cerebri is a rare primary brain tumor. It is commonly characterized by diffuse infiltration of the brain with neoplastic glial cells that affect various areas of the cerebral lobes. Gliomatosis cerebri behaves like a malignant tumor that is very similar to Glioblastoma.

Though it is not an easy task to differentiate gliomas and gliomas, hope these tips would be of some use.

Thank you!

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