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patient_id
string
age_at_diagnosis
float64
gender
string
race
string
ethnicity
string
primary_diagnosis
string
tumor_grade
string
ajcc_m
string
ajcc_n
string
classification_of_tumor
string
morphology
string
tissue_origin
string
laterality
string
prior_malignancy
string
synchronous_malignancy
string
vital_status
string
overall_survival_days
float64
overall_survival_event
int64
days_to_death
float64
days_to_last_followup
float64
cause_of_death
string
days_to_progression
float64
days_to_recurrence
float64
progression_or_recurrence
string
disease_response
string
treatment_types
string
therapeutic_agents
string
days_to_treatment
float64
treatment_outcome
string
pathology_report
string
P0202
59
male
not reported
not reported
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Dead
30
1
30
30
null
null
null
null
WT-With Tumor
Hormone Therapy|Radiation, External Beam
Dexamethasone
0
null
Document Date: Accession Number: Date Collected: Date Received: PT: DIAGNOSIS: 1. RIGHT FRONTAL BRAIN LESION, BIOPSY, FS1A: - GLIOBLASTOMA MULTIFORME (WHO GRADE IV). 2. RIGHT FRONTAL BRAIN LESION, EXCISION: - GLIOBLASTOMA MULTIFORME (WHO GRADE IV). - SEE COMMENT. (Electronic Signature). COMMENT: This primary glioma shows the following features for the diagnosis of. glioblastoma: high cellularity, mitotic activity, vascular proliferation, and. necrosis. SPECIMEN: 1. Right frontal brain lesion. 2. Right frontal brain lesion. CLINICAL HISTORY/OPERATIVE FINDINGS: Frontal craniotomy for brain tumor resection. Right frontal mass. GROSS DESCRIPTION: Two specimens-arereceived each labeled with the patient 's name and medical. record number. Specimen #1 is received fresh for intraoperative consultation, labeled "right. frontal brain lesion" and consists of three pieces of soft tan tissue. measuring 2.5 x 1. 5 x 0.4 cm in aggregate. A touch preparation is. performed. A representative section is submitted for frozen tissue diagnosis,. and the contents of the cryoblock are submitted in cassette "FS1A." The. remainder of the specimen is submitted in cassette "1B. ". Specimen #2 is received in formalin, labeled "right frontal brain lesion" and. consists of multiple pieces of hemorrhagic tan tissue measuring 9.0 x 3.7 x. 0.1 cm in aggregate. Representative sections are submitted in cassettes "2A". and "2B.". INTRAOPERATIVE CONSULTATION: FS1A, TP1A: RIGHT FRONTAL BRAIN LESION, BIOPSY (FROZEN SECTION, TOUCH. PREPARATION): GLIOBLASTOMA MULTIFORME. MICROSCOPIC DESCRIPTION: Microscopic examination performed.
P0203
66
male
white
not reported
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Dead
60
1
60
60
null
null
null
null
WT-With Tumor
Hormone Therapy|Radiation Therapy, NOS|Chemotherapy
Dexamethasone|Carmustine Implant
0
null
Document Date: Date Collected: Date Received: PT: DIAGNOSIS: 1. BRAIN, LEFT FRONTAL, BIOPSY, FS1A, TP1A: - GLIOBLASTOMA MULTIFORME. 2. BRAIN, LEFT FRONTAL, EXCISION: - GLIOBLASTOMA MULTIFORME. (nlectronic Signature). SPECIMEN: 1. Left frontal brain lesion. 2. Left frontal brain lesion. CLINICAL HISTORY/OPERATIVE FINDINGS: Left frontal brain lesion. Left frontal craniotomy for tumor resection. GROSS DESCRIPTION: Two specimens are received, the first fresh for intraoperative consultation, and the second in formalin, each labeled with the patient's name and hospital number. Specimen #1 is labeled as "left frontal brain lesion. " The specimen consists. of three pieces of soft pink tissue measuring in aggregate 1.0 x 0.8 X 0.4. A portionis-submitted for touch prep-evaluation. A representative. section is submitted for intraoperative consultation and frozen section. diagnosis, and the remainder of the cryoblock is submitted in cassette. "FS1A. " The remainder of the tissue is entirely submitted in cassette "1B.". Specimen #2 is labeled as "left frontal brain lesion." The specimen consists. of multiple pieces of hemorrhagic brain tissue, the largest measuring 3.0 x. 2. X 1.5 cm, and the remaining pieces measuring 2.2 X 0.7 X 0.5 cm in. aggregate. Serial sectioning of the largest piece shows an irregular, poorly. circumscribed, yellow soft mass extending to the margins of resection. The. largest piece is inked blue prior to sectioning. The specimen is entirely. submitted in cassettes "2A" through "2F.". INTRAOPERATIVE CONSULTATION: FS1A, TP1A: BRAIN, LEFT FRONTAL, BIOPSY (FROZEN SECTION, TOUCH PREPARATION): GLIOBLASTOMA MULTIFORME. MICROSCOPIC DESCRIPTION: Microscopic examination performed.
P0207
51
male
white
not reported
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Dead
179
1
179
179
null
null
null
null
null
Chemotherapy|Hormone Therapy|Radiation Therapy, NOS
Cisplatin|Carmustine|Dexamethasone
42
null
Specimen #: Clinic #: Department: Neurosurgery. TISSUE SOURCE: Part 1: Right occipital brain lesion,. Part 2: Right occipital brain lesion. CLINICAL DIAGNOSIS & HISTORY: Name of operation: Craniotomy. Pre-Operative Diagnosis: Brain tumor. Post-Operative Diagnosis: Same. INTRAOPERATIVE CONSULTATION:: RIGHT OCCIPITAL BRAIN LESION (FROZEN SECTION AND TOUCH. PREP): INTERMEDIATE GRADE GLIAL NEOPLASM. The pathologist has reviewed and interpreted the case with the. fellow/resident. GROSS DESCRIPTION: Received are two specimens. Each is labeled with the patient's. name and hospital number. Specimen #1 is received fresh for intraoperative consultation. labeled "right occipital brain lesion". The specimen consists. of multiple, red-brown, hemorrhagic fragments of tissue. measuring in aggregate 1 x 1 x 0.3 cm. The remainder of the. cryoblock is submitted in a single cassette labeled "FS1A". Specimen #2 is received in formalin labeled "right occipital. brain lesion". The specimen consists of multiple, soft,. brown-tan fragments of tissue measuring in aggregate 1.5 x 1.5 x. 0.5 cm. The specimen is submitted in its entirety in a single. cassette labeled "2A". Specimen #: Hospital #: Clinic #: MICROSCOPIC DESCRIPTION: Section one shows cells with astrocytic features with moderate. atypia. No neovascularization or necrosis is noted. Although. mitoses are not conspicuous, MIB-1 stain is approximately 25%. positive. Section two shows astroglial lesion with marked atypia, numerous. mitoses, vascular changes and marked necrosis. DIAGNOSIS. BRAIN, RIGHT OCCIPITAL (BIOPSY, FS): GLIOBLASTOMA MULTIFORME. BRAIN, RIGHT OCCIPITAL (BIOPSY): GLIOBLASTOMA MULTIFORME. Tissue Committee Code: 1.
P0209
52
female
white
not reported
Glioblastoma
null
null
null
recurrence
9440/3
Not Reported
null
not reported
Not Reported
Dead
532
1
532
532
null
null
null
Yes
WT-With Tumor
Surgery, NOS|Radiation Therapy, NOS|Hormone Therapy|Radiation, Radioisotope|Pharmaceutical Therapy, NOS
Dexamethasone
29
null
Document Date: Date Collected: Date Received: PT: DIAGNOSIS: 1. BRAIN, RIGHT PARIETO-OCCIPITAL LESION, BIOPSY, FS1A: - GLIOBLASTOMA MULTIFORME (WHO GRADE IV). 2. BRAIN, RIGHT ARIETO-OCCIPITAL, EXCISION, FS2A: - GLIOBLASTOMA MULTIFORME (WHO GRADE IV). 3. BRAIN, RIGHT PARIETO-OCCIPITAL, EXCISION: - GLIOBLASTOMA MULTIFORME (WHO GRADE IV). SPECIMEN: 1. Right, brain, parieto-occipital lesion,. 2. Right, brain, parieto-occipital lesion,. 3. Right, brain, parieto-occipital lesion. CLINICAL HISTORY/OPERATIVE FINDINGS: NAME OF OPERATION: Craniotomy for brain lesion. PREOPERATIVE DIAGNOSIS: Right parieto-occipital brain lesion. POSTOPERATIVE DIAGNOSIS: Right parieto-occipital brain lesion. GROSS DESCRIPTION: Received are three specimens. Each is labeled with the patient's name and. hospital number. Specimen #1 is received fresh for intraoperative consultation and is labeled. "right parieto-occipital lesion". The specimen consists of multiple pieces of. tan tissue which measure 1 X 0.3 X 0.2 cm in aggregate. The specimen is. entirely frozen and the remainder of the cryoblock is submitted in cassettes. "FS1A" and "1B". Specimen #2 is received fresh for intraoperative consultation and is labeled. "right parieto-occipital lesion". The specimen consists of multiple fragments. of tan tissue which measure 5.5 x 2 X 0.5 cm in aggregate. A representative. portion is frozen and the remainder of the cryoblock is submitted in cassette. "FS2A". The remainder of the tissue is submitted in cassettes "2B" and "2C". Specimen #3 is received in formalin and is labeled "right parieto-occipital. lesion". The specimen consists of multiple fragments of hemorrhagic tan. tissue ranging in size from 0.5 X 0.5 X 0.5 to 5 x 3 X 1 cm which measure 6. x. 6 X 1 cm in aggregate. Representative sections are taken and submitted in. cassettes "3A" through "3D". INTRAOPERATIVE CONSULTATION: FS1A, TP1A: LEFT PARIETO-OCCIPITAL LESION (FROZEN SECTION, TOUCH PREPARATION): NECROSIS. FS2A: RIGHT PARIETO-OCCIPITAL LESION (FROZEN SECTION): GLIOBLASTOMA. MULTIFORME. TISSUE COMMITTEE CODE: 1. 1. (Continued.
P0211
74
male
white
not reported
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Dead
12
1
12
12
null
9
null
Yes
null
Hormone Therapy|Pharmaceutical Therapy, NOS|Radiation Therapy, NOS
Dexamethasone
0
null
Document Date: Modified. SUPPLEMENTAL REPORT. SUPPLEMENTAL DIAGNOSIS: Previous diagnosis remains unchanged. See. Molecular Diagnostics. Reprot. results for Block 1A. COMMENT : This test was not requested, performed or reported at. The test was requested by. The test was performed and. reported by Center for. Results are included with this Surgical Pathology report so that. all available. information on this tumor may be accessed at one site. MGMT GENE AMPLIFICATION. DNA was isolated from a paraffin embedded block of the brain tumor. biopsy. DNA methylation patterns in the CpG island of the. MGMT gene. was determined. by chemical. (bisulfite) modification of unmethylated, but not methylated,. cytosines to. uracil and subsequent PCR using primers specific for either. methylated or the. modified unmethylated DNA. The. PCR products were analyzed in duplicate parallel runs by capillary. gel. electrophoresis. The sensitivity of the assay based on DNA. dilution studies. is at least 1:1000. The analyzed region of the MGMT promoter is UNMETHYLATED. INTERPRETATION: MGMT (06 methylguaine DNA nethyltransferase) is a DNA repair gene. Methylation. of the promotor leads to gene silencing and loss of MGMT. expression. a recent. study that tested the methylation status of the same region of the. MGMT. promoter in glioblastomas found that MGMT promoter methylation was. an. independent favorable prognostic factor and was associated with a. survival. benefit in patients treated with temozolamide and radiotherapy. and Benefit from. Temozolomide. in Glioblastomas. DIAGNOSIS: 1. RIGHT FRONTAL BRAIN LESION, RESECTION, FS1A, TP1A: - GLIOBLASTOMA WITH OLIGODENDROGLIOMA COMPONENT, WHO GRADE IV. - SEE COMMENT. 2. RIGHT FRONTAL BRAIN LESION, RESECTION: - GLIOBLASTOMA WITH OLIGODENDROGLIOMA COMPONENT, WHO GRADE IV. - SEE COMMENT. COMMENT: This glioblastoma has an element of oligodendroglioma within it,. comprising. approximately 20% of neoplastic cells. Perhaps more. morphologically. impressive is the high degree of angiogenesis and the extensive. reactive. stromal component associated with it. In the majority of this. stromal. reaction, the matrix has a myxoid appearance whereas in others of. the stroma. has a more highly spindled and collagen-rich. These stromal. elements are. interpreted as a reactive process associated with the angiogenesis. because of. the geographic association of these two processes. FISH analysis. of EGFR and. 1p/19q have been ordered and the results will be issued in a. separate. report. Tissue has been sent for MGMT analysis and the results. will be issued. in a separate report. SPECIMEN: 1. Right frontal brain lesion. 2. Right frontal brain lesion. CLINICAL HISTORY/OPERATIVE FINDINGS: Right craniotomy. Brain tumor. GROSS DESCRIPTION. Two specimens are received, each labeled with the patient's name. and medical. record number. Specimen #1 is received fresh for intraoperative consultation and. is labeled. as "right frontal brain lesion." The specimen consists of multiple. fragments. of pink-tan, soft tissue measuring in aggregate, 0.8 x 0.8 x 0.6. cm. Representative sections are submitted for frozen section diagnosis. and the. contents of the cryoblock are transferred to cassette "FS1A. " A. touch prep is. also performed. The remainder of the specimen is submitted in. cassette. "1B.'. Specimen #2 is received in formalin and is labeled as "right. frontal brain. lesion. " It consists of multiple fragments of brain with adherent. hemorrhage. measuring 4.0 X 3.8 X 2.3 cm in aggregate. The entire specimen is. submitted. in cassettes "2A" through "2G." Dictated by. INTRAOPERATIVE CONSULTATION: FS1A, TP1A: RIGHT FRONTAL BRAIN LESION, BIOPSY (FROZEN SECTION,. TOUCH. PREPARATION) : GLIOBLASTOMA. Frozen Section results were communicated to the surgical. team and. were repeated back by. MICROSCOPIC DESCRIPTION: Microscopic examination performed. SPECIAL STAINS: FISH. DONE. FISH. DONE. FISH. DONE. FISH. DONE. FISH. DONE. FISH. DONE. FLUORESCENCE IN SITU HYBRIDIZATION. SPECIMEN : Brain, right frontal lesion. CLINICAL HISTORY/REFERRING DIAGNOSIS: Glioblastoma with oligodendroglioma component, WHO grade IV. GROSS DESCRIPTION: Paraffin block 1B. TEST PERFORMED/PROBES USED: EGFR gene locus specific probe (7p12). Chromosome 7 alpha satellite DNA specific probe (7p11.1-7q11.1). Probe for chromosome 1p36. Probe for chromosome 1q25. Probe for chromosome 19p13. Probe for chromosome 19q13. NEGATIVE for EGFR gene amplification. nuc ish 7cen (D7Z1x2-10), 7p12 (EGFRx2-10) [200/200]. NEGATIVE for chromosome 1p36 deletion. nuc ish (TP73 x 2), (ANGPTL X 2) [170/200]. NEGATIVE for chromosome 19q13 deletion. nuc ish (ZNF443 X 2), (GLTSCR x 2) [166/200]. INTERPRETATION: Flourescence in situ hybridization was performed using the above. listed DNA. probes. The probes were simultaneously. hybridized to a. section of the formalin-fixed paraffin-embedded tissue submitted. for. evaluation.
P0212
38
female
black or african american
not hispanic or latino
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Alive
115
0
null
115
null
null
null
null
WT-With Tumor
Radiation, External Beam|Chemotherapy|Targeted Molecular Therapy|Hormone Therapy
Temozolomide|Bevacizumab|Dexamethasone
35
null
Document Date: Modified. DIAGNOSIS: 1. RIGHT TEMPORAL BRAIN LESION, RESECTION, FS1A, TP1A: - GLIOBLASTOMA, WHO GRADE IV. - SEE COMMENT. 2. RIGHT TEMPORAL BRAIN LESION, RESECTION: - GLIOBLASTOMA, WHO GRADE IV. - SEE COMMENT. COMMENT: This high grade astrocytoma shows abundant pseudopalisading type. necrosis. FISH studies for EGFR will be performed and the results will be. issued in a. separate report. Tissue will be sent for MGMT analysis and the. results will. be issued in a separate report. SPECIMEN: 1. Right temporal brain lesion. 2. Right temporal brain lesion. CLINICAL HISTORY/OPERATIVE FINDINGS: Right craniotomy for tumor resection. Right brain tumor. GROSS DESCRIPTION: Two specimens are received, each labeled with the patient's name. and medical. record number. Specimen #1 is received fresh for intraoperative consultation and. is labeled. as "temporal brain lesion." The specimen consists of multiple. fragments of. soft tan tissue measuring in aggregate 2.0 x 1.5 x 0.3 cm. The. specimen is. submitted entirely for frozen section diagnosis and the contents of. the. cryoblock are transferred to cassette "FS1A. " A touch prep is also. performed. Specimen #2 is received in formalin and is labeled as "right. temporal brain. lesion. " The specimen consists of multiple fragments of pink-tan. soft tissue. measuring in aggregate 2.5 x 1.5 x 0.3 cm. The specimen is. submitted entirely. in cassette "2A. ". INTRAOPERATIVE CONSULTATION: FS1A, TP1A: RIGHT TEMPORAL BRAIN LESION, BIOPSY (FROZEN SECTION,. TOUCH. PREPARATION): GLIOBLASTOMA. Frozen Section results were communicated to the. surgical team. and were repeated back by. MICROSCOPIC DESCRIPTION: Microscopic examination performed. SPECIAL STAINS: CD4. DONE. CD8. DONE. SV40. DONE. FISH. DONE. FISH. DONE. FISH. DONE. FISH. DONE. FLUORESCENCE IN SITU HYBRIDIZATION. SPECIMEN: Brain, right temporal lesion. CLINICAL HISTORY/REFERRING DIAGNOSIS: Glioblastoma, WHO Grade IV. GROSS DESCRIPTION: Paraffin block 2A. TEST PERFORMED/PROBES USED: EGFR gene locus specific probe (7p12). Chromosome 7 alpha satellite DNA specific probe (7p11. 1- - -7q11.1). PTEN gene locus specific probe 10q23. Chromosome 10 alpha satellite DNA specific probe (10p11.1-q11.1). NEGATIVE for EGFR gene amplification. nuc ish 7cen (D7Z1x2-10), 7p12 (EGFRx2-10) [198/200]. NEGATIVE for chromosome 10q23 deletion. nuc ish (PTEN x 2-4), (D10Z1 X 2-4) [187/200]. INTERPRETATION: Flourescence in situ hybridization was performed using the above. listed DNA. probes. ). The probes were simultaneously. hybridized to a. section of the formalin-fixed paraffin-embedded tissue submitted. for. evaluation. Of 200 interphase nuclei analyzed, 99% of cells were NEGATIVE for. EGFR gene amplification. Positive and negative controls were appropriate. Correlation. with clinical and other laboratory parameters is suggested. Fluorescence in situ hybridization was performed using the above. listed DNA. probes. ). The probes were simultaneously. hybridized to. a section of the formalin-fixed paraffin-embedded tissue submitted. for. evaluation. Of 200 interphase nuclei analyzed, 93% demonstrated a normal number. of signals. for the PTEN probe which indicates the absence of deletion for. chromosome. 10q23. Correlation with clinical and other laboratory parameters is. suggested. COMMENT: The results of this test should not be used alone as the sole basis. for. diagnosis and/or treatment. These results may, however, prove. useful when. used in conjunction with other diagnostic procedures and clinical. evaluations. Use of these results, in this manner, can be considered to fall. within the. scope of practice of medicine. This test was developed and its. performance. characteristics determined by the. It. has not been. FLUORESCENCE IN SITU HYBRIDIZATION. COMMENT. cleared or approved by the U.S. Food and Drug Administration. Medical Records. 3.
P0214
65
male
white
not hispanic or latino
Glioblastoma
null
null
null
Progression
9440/3
Not Reported
null
not reported
Not Reported
Dead
419
1
419
419
null
232
null
Yes
null
Radiation Therapy, NOS|Radiation, External Beam|Targeted Molecular Therapy|Chemotherapy|Pharmaceutical Therapy, NOS
Vorinostat|Temozolomide
259
null
Brain, left parieto-occipital mass, biopsy: Grade 4 (of 4) fibrillary astrocytoma (WHO, glioblastoma). Preliminary Frozen Section Consultation: Brain, left parieto-occipital mass, biopsy: Astrocytoma, favor small cell type, at least intermediate grade.
P0215
21
male
white
not hispanic or latino
Glioblastoma
null
null
null
Progression
9440/3
Not Reported
null
not reported
Not Reported
Dead
1,537
1
1,537
1,550
null
1,550
1,550
Yes
WT-With Tumor
Chemotherapy|Radiation, External Beam
Carmustine|Irinotecan Hydrochloride
38
Unknown
Brain, right frontal lobe, resection: Grade 4 (of 4) fibrillary astrocytoma (glioblastoma multiforme).
P0216
55
male
white
not reported
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Alive
581
0
null
581
null
null
443
Yes
WT-With Tumor
Chemotherapy|Radiation, External Beam|Surgery, NOS|Radiation Therapy, NOS
Temozolomide
68
null
Astrocytoma, grade 4 (of 4), WHO grade 4 (of 4). with fibrillary, gemistocytic, and small cell features. Glioma with astrocytic features.
P0218
65
male
white
not reported
Glioblastoma
null
null
null
recurrence
9440/3
Not Reported
null
yes
Not Reported
Dead
404
1
404
404
null
null
74
Yes
WT-With Tumor
Pharmaceutical Therapy, NOS|Radiation Therapy, NOS|Radiation, External Beam|Chemotherapy
Temozolomide
32
null
Brain, right frontal lobe-1,2,3, mass resection: grade 4 (of 4) fibrillary astrocytoma (WHO grade IV, glioblastoma multiforme). High grade glioma.
P0224
36
female
white
not hispanic or latino
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
yes
Not Reported
Alive
195
0
null
195
null
null
null
null
null
Radiation Therapy, NOS|Pharmaceutical Therapy, NOS
null
null
Not Reported
Visit #: Resulted: Gender: F. Facility: SPECIMEN (S) RECEIVED. 1. Brain tumour. 2. Brain tumour for quick section. DIAGNOSIS. 1. and 2. Brain, left brain tumor: - Glioblastoma, WHO grade IV (see microscopic description). SYNOPTIC DATA. MACROSCOPIC. Specimen Type: Subtotal/partial resection. Specimen Size: Greatest dimension: 2.3 cm. Tumor Site: Cerebrum (specify lobe(s), if. known): left frontal. Tumor Size: Largest dimension: 5 cm. MICROSCOPIC. Histologic Type: Glioblastoma. Histologic Grade: WHO Grade IV. Margins: Not applicable. Additional Studies: None performed. CLINICAL HISTORY. who presented with. and. CT performed in. at that time showed a Targe calcifled. Page: 1 of 2. S. Copath #: Visit #: Resulted: Facility: SPECIMEN (S) RECEIVED. Specimen Type: Subtotal/partial resection. Specimen Size: Greatest dimension: 2.3 cm. Tumor Site: Cerebrum (specify lobe(s), if. known): left frontal. Tumor Size: Largest dimension: 5 cm. MICROSCOPIC. Histologic Type: Glioblastoma. Histologic Grade: WHO Grade IV. Margins: Not applicable. Additional Studies: None performed. CLINICAL HISTORY. who presented with. and. CT performed in. at that time showed a Targe calcifled. Page: 1 of 2. S. Copath #: Visit #: Resulted: Facility: SPECIMEN (S) RECEIVED. Specimen Type: Subtotal/partial resection. Specimen Size: Greatest dimension: 2.3 cm. Tumor Site: Cerebrum (specify lobe(s), if. known): left frontal. Tumor Size: Largest dimension: 5 cm. MICROSCOPIC. Histologic Type: Glioblastoma. Histologic Grade: WHO Grade IV. Margins: Not applicable. Additional Studies: None performed. CLINICAL HISTORY. who presented with. and. CT performed in. at that time showed a Targe calcifled. Page: 1 of 2.
P0278
57
male
white
not hispanic or latino
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Dead
154
1
154
154
null
null
124
Yes
WT-With Tumor
Chemotherapy|Pharmaceutical Therapy, NOS|Radiation Therapy, NOS|Hormone Therapy|Radiation, External Beam
Cisplatin|Dexamethasone|Temozolomide
8
null
Glioblastoma multiforme
P0280
59
female
white
not hispanic or latino
Glioblastoma
null
null
null
Progression
9440/3
Not Reported
null
not reported
Not Reported
Dead
300
1
300
300
null
176
null
Yes
WT-With Tumor
Radiation Therapy, NOS|Chemotherapy|Hormone Therapy|Radiation, External Beam|Pharmaceutical Therapy, NOS
Temozolomide|Dexamethasone
207
null
Glioblastoma multiforme
P0281
67
female
white
not hispanic or latino
Glioblastoma
null
null
null
recurrence
9440/3
Not Reported
null
not reported
Not Reported
Dead
737
1
737
737
null
null
469
Yes
WT-With Tumor
Radiation Therapy, NOS|Pharmaceutical Therapy, NOS|Chemotherapy|Radiation, External Beam|Hormone Therapy
Cisplatin|Procarbazine|Dexamethasone|Fotemustine|Temozolomide
171
null
Glioblastoma multiforme
P0282
56
male
white
not hispanic or latino
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Dead
1,233
1
1,233
1,233
null
null
335
Yes
WT-With Tumor
Chemotherapy|Hormone Therapy|Radiation, External Beam|Radiation Therapy, NOS|Pharmaceutical Therapy, NOS
Fotemustine|Cisplatin|Dexamethasone|Temozolomide|Procarbazine
352
Treatment Ongoing
Glioblastoma multiforme
P0283
53
female
white
not hispanic or latino
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Dead
648
1
648
648
null
157
null
Yes
WT-With Tumor
Chemotherapy|Hormone Therapy|Radiation Therapy, NOS|Pharmaceutical Therapy, NOS|Radiation, External Beam
Carmustine|Tegafur|Not Reported|Dexamethasone|Levetiracetam|Cisplatin|Temozolomide
270
null
Glioblastoma multiforme
P0285
36
male
white
not hispanic or latino
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Dead
427
1
427
427
null
136
null
Yes
WT-With Tumor
Chemotherapy|Pharmaceutical Therapy, NOS|Hormone Therapy|Radiation, External Beam|Radiation Therapy, NOS
Doxorubicin|Temozolomide|Cisplatin|Dexamethasone
35
null
Glioblastoma multiforme
P0286
59
female
white
not hispanic or latino
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Dead
350
1
350
350
null
119
null
Yes
WT-With Tumor
Radiation, External Beam|Chemotherapy|Hormone Therapy|Pharmaceutical Therapy, NOS|Radiation Therapy, NOS
Temozolomide|Dexamethasone|Oxcarbazepine|Cisplatin
71
null
Glioblastoma multiforme
P0295
76
male
white
not hispanic or latino
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Alive
345
0
null
345
null
317
null
Yes
WT-With Tumor
Radiation, Stereotactic/Gamma Knife/SRS|Pharmaceutical Therapy, NOS|Radiation, External Beam|Radiation Therapy, NOS|Chemotherapy
Temozolomide
78
null
Addendum - Please See End of Report. Reason for Addendum #1: Additional studies/stains/opinion(s). DIAGNOSIS: A, G. BRAIN, LEFT TEMPORAL, EXCISIONAL BIOPSY: Glioblastoma multiforme, WHO grade IV. B. BRAIN, LEFT TEMPORAL, EXCISIONAL BIOPSY: Glioblastoma multiforme, WHO grade IV. Necrosis - 30% of the tumor. Proportion of the tumor - 100%. C. BRAIN, LEFT TEMPORAL, EXCISIONAL BIOPSY: Glioblastoma multiforme, WHO grade IV. Proportion of the tumor - 100%. Necrosis - 30%. D. BRAIN, LEFT TEMPORAL, EXCISIONAL BIOPSY: Glioblastoma multiforme, WHO grade IV. Proportion of the tumor - 100%. Proportion of necrosis - 45%. E. BRAIN, LEFT TEMPORAL, EXCISIONAL BIOPSY: Glioblastoma multiforme, WHO grade IV. Proportion of the tumor - 100%. Proportion of necrosis - 50%. F. BRAIN, LEFT TEMPORA, EXCISIONAL BIOPSY: Glioblastoma multiforme, WHO grade IV. Proportion of the tumor 100%. Proportion of necrosis 50%. COMMENT: A high percentage of tumor cells (greater than 20%) immunostainino for MGMT has been reported to be associated. with a relatively diminished response to Temodar. Hence, the low 15% result in. this case suggests a likelihood of this tumor being responsive to Temodar. Recent studies have shown that co-expression of EGFRvIII and PTEN as detected by immunostaining was. significantly correlated with a clinical response of glioblastomas to EGFR kinase inhibitors (. Hence the loss of PTEN in this case suggests a diminished probability of response to. EGFR-kinase inhibitors. PATIENT NOTIFIED OF RESULTS. DR: NURSE: Addendum - Please See End of Report. Recent studies indicated an adverse prognostic significance of increased expression of laminin beta 1 and decreased. expression of laminin beta 2 predicting a worse survival of patients with gliomas. (. between laminin-8 and glial tumor grade, recurrence, and patient survival. Accordingly, low expression of BI and 82 in this tumor suggests a more favorable prognosis. Retained expression of PTEN was found to he associated with a more favioratile. grade gliomas. Molecular subclasses of high-grade glioma. predict prognosis, delineate a pattern of disease progression, and resemble stages in neurogenesis. Cancer Cell. Presence of activated (phosphorylated) p42/44 Mitogen-Activated Protein Kinase (pMAPK) has been shown to be. associated with a relative resistance of glioblastoma multiforme to radiation therapy. rognostic Associations of Activated Mitogen-Activated Protein Kinase and Akt Pathways in. Glioblastoma. Correspondingly, presence of a large fraction of cells immunonegative to pMAPK antibody in this case suggests a. likelihood of this tumor being responsive to radiation therapy. The use of these tests in guiding therapy has limitations. Review of the relevant literature and clinical correlation is. advised. These test results do not obligate or preclude use of the relevant therapeutic agents. IDC2a: Selected slides were reviewed in consultation with. HISTORY: History of left temporal glioma and PS gliadel wafer placement. MICROSCOPIC: This necrotizing glioma features microvascular proliferation, elongate, mitotically active nuclei and striking. perivascular lymphocytic infiltrates,. IMMUNOSTAINS: MGMT (A2): Weak staining in up to 15% of tumor nuclei. PTEN (A2): Loss (0+ stain). pMAPK (A2): 0% of tumor nuclei and 0% of tumor cell cytoplasm is positive. Laminin beta-1 (8/411) (A2): Upregulated (2+ in endothelial cells). Laminin beta-2 (9/421) (A2): Upregulated (2+ in endothelial cells). GROSS: A. LEFT TEMPORAL FS. Labeled with the patient's name, labeled "left temporal FS", and received fresh in the Operating Room for frozen. section consultation and subsequently fixed in formalin is a 1.1 x 0.9 x 0.8 cm tan-gray soft tissue fragment with. focal areas of hemorrhage on the outer surface. Entirely submitted. Slide key: A1. Frozen section remnant - I. A2. Remaining tissue - 3. B. LEFT TEMPORAL. Labeled with the patient's name, labeled "left temporal", and received fresh in the Operating Room and. subsequently fixed in formalin is a 0.5 X 0.4 X 0.4 cm gray-tan soft tissue fragment. Entirely submitted. Addendum - Please See End of Report. B1. (Study) - 1. C. LEFT TEMPORAL. Labeled with the patient's name, labeled "left temporal", and received fresh in the Operating Room and. subsequently fixed in formalin is an aggregate of multiple gray-tan soft tissue fragments ranging from 0.2 to 0.4 cm. in greatest dimension and aggregating to a measurement of 0.6 x 0.3 x 0.2 cm. Entirely submitted. C1. (Study) - 3. D. LEFT TEMPORAL. Labeled with the patient's name, labeled "left temporal", and received fresh in the Operating Room and. subsequently fixed in formalin is a 0.9 x 0.6 x 0.3 cm aggregate of multiple gray-tan soft tissue fragments ranging. from 0.2 to 0.5 cm in greatest dimension. Entirely submitted. D1. (Study) 3. E. LEFT TEMPORAL. Labeled with the patient's name, labeled "left temporal", and received fresh in the Operating Room and. subsequently fixed in formalin is a 1.0 x 0.4 x 0.3 cm aggregate of multiple gray-tan soft tissue fragments ranging. from 0.2 to 0.5 cm in greatest dimension. Entirely submitted. Slide key: E1. (Study) - 3. F. LEFT TEMPORAL. Labeled with the patient's name, labeled II left temporal and received fresh in the Operating Room and. subsequently fixed in formalin are two gray-tan soft tissue fragments measuring 1.0 x 0.4 x 0.2 cm and 0.6 x 0.4 x. 0.2 cm. Entirely submitted. Slide key: F1. (Study) - 2. G. LEFT TEMPORAL (PERMANENT). Labeled with the patient's name, labeled "left temporal tumor", and received in formalin is a 0.9 x 0.7 x 0.6 cm gray-. tan soft tissue fragment with focal areas of hemorrhage on the outer surface. Entirely submitted. G1. 2. OPERATIVE CALL. OPERATIVE CONSULT (FROZEN): PART A. LEFT TEMPORAL FS: Glioblastoma. If this report includes imnunohistochemicul test results, please note the following: Numerous imnmmohistochemical tests were developed and their performance characteristics determined by. athology and Laboratory Medicine. Those immunohistochemical tests have not been cleared or approved by the. U.S. Food and Drug Administration (FDA), and FDA approval is not required. I have personally. examined the specimen. interpreted the results, reviewed the report and signed it electronically. Addendum - Please See End of Report. FISH (FLUORESCENCE IN SITU HYBRIDIZATION) for EGFR. Number of cells analyzed: 40. Ratio of EGFR/CEP: 1.0. Percentage of cells with >4 copies of EGFR: 5%. Amplification: NO. High Level of Polysomy: NO. INTERPRETATION: Samples are interpreted as Positive if : a. EGFR to CEP 7 signal ratio is > 2.0 in > 10% of analyzed cells. b. When high level of polysomy (> four copies of EGFR in > 40% of cells) is present. 2. Samples are interpreted as Negative if EGFR to CEP 7 signal ratio is < 2.0 or in the absence of high. level of polysomy (> four copies of EGFR). 3. Samples are considered inconclusive, requiring consult with the pathologist, when EGFR to CEP 7. signal ratio is 2.0 in < 10% of analyzed cells or when high level of polysomy (> four copies of. EGFR) is present in < 40% of cells. These cases also need to be co-read. REFERENCES. I have-nersonally examined the specimen. interpreted the results. reviewed the report and signed it electronically.
P0297
44
male
white
not hispanic or latino
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Dead
77
1
77
77
null
null
null
null
null
Chemotherapy|Radiation, External Beam
Temozolomide
25
null
DIAGNOSIS: Glioblastoma multiforme, WHO grade IV. COMMENT: Recent studies indicated an adverse prognostic significance of increased expression of laminin beta 1 and decreased expression of laminin beta 2 predicting a worse survival of patients with gliomas. between laminin-8 and glial tumor grade, recurrence, and patient survival. Accordingly, elevated expression of beta 1 and suppressed expression of beta 2 in this tumor predict more aggressive behavior. The use of these tests in guiding therapy has limitations. Review of the relevant literature and clinical correlation is advised. These test results do not obligate or preclude use of the relevant therapeutic agents.
P0298
73
male
white
not hispanic or latino
Glioblastoma
null
null
null
Progression
9440/3
Not Reported
null
not reported
Not Reported
Alive
280
0
null
280
null
280
null
Yes
WT-With Tumor
Pharmaceutical Therapy, NOS|Chemotherapy|Radiation Therapy, NOS|Radiation, External Beam
Temozolomide
19
null
Glioblastoma multiforme, WHO grade IV. Glioblastoma multiforme. Glioblastoma multiforme, WHO grade IV. Glioblastoma multiforme, WHO grade IV. Glioblastoma multiforme, WHO grade IV. Glioblastoma multiforme, WHO grade IV. Glioblastoma multiforme, WHO grade IV. Glioblastoma multiforme, WHO grade IV. MGMT (): 5%. PTEN (): Loss (I+). pMAPK (GI): 20% of tumor nuclei are positive and 60% of tumor cell cytoplasm positive. Laminin beta-1 (8/411) (): Upregulated (3+ in endothelial cells). Laminin beta-2 (9/421) (): Upregulated (2-3+ in endothelial cells). EGFR amplification by FISH is pending. High-grade glioma. Necrotizing malignant neoplasm featuring hyperchromatic elongate enlarged nuclei with numerous mitotic figures, associated with florid microvascular proliferation. MGMT (): 5%. PTEN (): Loss (I+). pMAPK (GI): 20% of tumor nuclei are positive and 60% of tumor cell cytoplasm positive. Laminin beta-1 (8/411) (): Upregulated (3+ in endothelial cells). Laminin beta-2 (9/421) (): Upregulated (2-3+ in endothelial cells). EGFR amplification by FISH is pending. High-grade glioma. Necrotizing malignant neoplasm featuring hyperchromatic elongate enlarged nuclei with numerous mitotic figures, associated with florid microvascular proliferation. MGMT (): 5%. PTEN (): Loss (I+). pMAPK (GI): 20% of tumor nuclei are positive and 60% of tumor cell cytoplasm positive. Laminin beta-1 (8/411) (): Upregulated (3+ in endothelial cells). Laminin beta-2 (9/421) (): Upregulated (2-3+ in endothelial cells). EGFR amplification by FISH is pending. High-grade glioma. Necrotizing malignant neoplasm featuring hyperchromatic elongate enlarged nuclei with numerous mitotic figures, associated with florid microvascular proliferation. MGMT (): 5%. PTEN (): Loss (I+). pMAPK (GI): 20% of tumor nuclei are positive and 60% of tumor cell cytoplasm positive. Laminin beta-1 (8/411) (): Upregulated (3+ in endothelial cells). Laminin beta-2 (9/421) (): Upregulated (2-3+ in endothelial cells). EGFR amplification by FISH is pending. High-grade glioma. Necrotizing malignant neoplasm featuring hyperchromatic elongate enlarged nuclei with numerous mitotic figures, associated with florid microvascular proliferation. MGMT (): 5%. PTEN (): Loss (I+). pMAPK (GI): 20% of tumor nuclei are positive and 60% of tumor cell cytoplasm positive. Laminin beta-1 (8/411) (): Upregulated (3+ in endothelial cells). Laminin beta-2 (9/421) (): Upregulated (2-3+ in endothelial cells). EGFR amplification by FISH is pending. High-grade glioma. Necrotizing malignant neoplasm featuring hyperchromatic elongate enlarged nuclei with numerous mitotic figures, associated with florid microvascular proliferation. MGMT (): 5%. PTEN (): Loss (I+). pMAPK (GI): 20% of tumor nuclei are positive and 60% of tumor cell cytoplasm positive. Laminin beta-1 (8/411) (): Upregulated (3+ in endothelial cells). Laminin beta-2 (9/421) (): Upregulated (2-3+ in endothelial cells). EGFR amplification by FISH is pending. High-grade glioma. Necrotizing malignant neoplasm featuring hyperchromatic elongate enlarged nuclei with numerous mitotic figures, associated with florid microvascular proliferation. MGMT (): 5%. PTEN (): Loss (I+). pMAPK (GI): 20% of tumor nuclei are positive and 60% of tumor cell cytoplasm positive. Laminin beta-1 (8/411) (): Upregulated (3+ in endothelial cells). Laminin beta-2 (9/421) (): Upregulated (2-3+ in endothelial cells). EGFR amplification by FISH is pending. High-grade glioma. Necrotizing malignant neoplasm featuring hyperchromatic elongate enlarged nuclei with numerous mitotic figures, associated with florid microvascular proliferation. MGMT (): 5%. PTEN (): Loss (I+). pMAPK (GI): 20% of tumor nuclei are positive and 60% of tumor cell cytoplasm positive. Laminin beta-1 (8/411) (): Upregulated (3+ in endothelial cells). Laminin beta-2 (9/421) (): Upregulated (2-3+ in endothelial cells). EGFR amplification by FISH is pending. High-grade glioma. Necrotizing malignant neoplasm featuring hyperchromatic elongate enlarged nuclei with numerous mitotic figures, associated with florid microvascular proliferation. MGMT (): 5%. PTEN (): Loss (I+). pMAPK (GI): 20% of tumor nuclei are positive and 60% of tumor cell cytoplasm positive. Laminin beta-1 (8/411) (): Upregulated (3+ in endothelial cells). Laminin beta-2 (9/421) (): Upregulated (2-3+ in endothelial cells). EGFR amplification by FISH is pending. High-grade glioma. Necrotizing malignant neoplasm featuring hyperchromatic elongate enlarged nuclei with numerous mitotic figures, associated with florid microvascular proliferation. MGMT (): 5%. PTEN (): Loss (I+). pMAPK (GI): 20% of tumor nuclei are positive and 60% of tumor cell cytoplasm positive. Laminin beta-1 (8/411) (): Upregulated (3+ in endothelial cells). Laminin beta-2 (9/421) (): Upregulated (2-3+ in endothelial cells). EGFR amplification by FISH is pending. High-grade glioma. Necrotizing malignant neoplasm featuring hyperchromatic elongate enlarged nuclei with numerous mitotic figures, associated with florid microvascular proliferation. MGMT (): 5%. PTEN (): Loss (I+). pMAPK (GI): 20% of tumor nuclei are positive and 60% of tumor cell cytoplasm positive. Laminin beta-1 (8/411) (): Upregulated (3+ in endothelial cells). Laminin beta-2 (9/421) (): Upregulated (2-3+ in endothelial cells). EGFR amplification by FISH is pending. High-grade glioma. Necrotizing malignant neoplasm featuring hyperchromatic elongate enlarged nuclei with numerous mitotic figures, associated with florid microvascular proliferation. MGMT (): 5%. PTEN (): Loss (I+). pMAPK (GI): 20% of tumor nuclei are positive and 60% of tumor cell cytoplasm positive. Laminin beta-1 (8/411) (): Upregulated (3+ in endothelial cells). Laminin beta-2 (9/421) (): Upregulated (2-3+ in endothelial cells). EGFR amplification by FISH is pending. High-grade glioma. Necrotizing malignant neoplasm featuring hyperchromatic elongate enlarged nuclei with numerous mitotic figures, associated with florid microvascular proliferation. MGMT (): 5%. PTEN (): Loss (I+). pMAPK (GI): 20% of tumor nuclei are positive and 60% of tumor cell cytoplasm positive. Laminin beta-1 (8/411) (): Upregulated (3+ in endothelial cells). Laminin beta-2 (9/421) (): Upregulated (2-3+ in endothelial cells). EGFR amplification by FISH is pending. High-grade glioma. Necrotizing malignant neoplasm featuring hyperchromatic elongate enlarged nuclei with numerous mitotic figures,
P0300
61
female
white
not hispanic or latino
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Alive
232
0
null
232
null
219
null
Yes
WT-With Tumor
Immunotherapy (Including Vaccines)|Chemotherapy|Radiation, External Beam
Dendritic Cell Vaccine|Temozolomide
114
null
Department of Pathology & Laboratory Medicine. DIAGNOSIS: A. BRAIN, LEFT FRONTAL, EXCISIONAL BIOPSY: Glioblastoma multiforme, WHO grade IV. B. BRAIN, LEFT OCCIPITAL, EXCISIONAL BIOPSY, NCI #1: Glioblastoma multiforme, WHO grade IV. Up to 5% of tumor necrosis. Up to 90% of tumor cellularity. C. BRAIN, LEFT OCCIPITAL, EXCISIONAL BIOPSY, NCI #2: Glioblastoma multiforme, WHO grade IV. Up to 70% of tumor necrosis. Up to 90% of viable tumor cellularity. D. BRAIN, LEFT OCCIPITAL, EXCISIONAL BIOPSY, NCI #3: Glioblastoma multiforme, WHO grade IV. Up to 30% of tumor necrosis. Up to 90% of viable tumor cellularity. E. BRAIN, LEFT OCCIPITAL EXCISIONAL BIOPSY, NCI #4: Glioblastoma multiforme, WHO grade IV. Up to 30% of tumor necrosis. Up to 90% of viable tumor cellularity. F. BRAIN, LEFT OCCIPITAL, EXCISIONAL BIOPSY, NCI #5: Glioblastoma multiforme, WHO grade IV. Up to 1% of tumor necrosis. Up to 90% of tumor cellularity. G, H. BRAIN, LEFT OCCIPITAL, EXCISIONAL BIOPSY: Glioblastoma multiforme, WHO grade IV. COMMENT: A high percentage of tumor cells (greater than 20%) immunostaining for MGMT has been reported. to be associated with a relatively diminished response to Temodar (. Hence, the. low 5% result in this case suggests a likelihood of this tumor being responsive to Temodar. Recent studies indicated an adverse prognostic significance of increased expression of laminin beta 1 and decreased. expression of laminin beta 2 predicting a worse survival of patients with gliomas. between laminin-8 and glial tumor grade, recurrence, and patient survival. Patient Case(s). Page I or -. PATIENT RESULIS. DR. Accordingly, elevated expression of beta 1 and focally suppressed expression of beta 2 in this tumor predict more. aggressive behavior. Recent studies have shown that co-expression of EGFRvIII and PTEN as detected by immunostaining was. significantly correlated with a clinical response of glioblastomas to EGFR kinase inhibitors. Hence the preserved expression of PTEN in this case, when combined with EGFRvIII. mutation, permits a possibility of this tumor being responsive to EGFR-kinase inhibitors. Retained expression of PTEN was found to be associated with a more favorable prograncie in national with high. grade gliomas (. Molecular subclasses of high-grade glioma. predict prognosis, delineate a pattern of disease progression, and resemble stages in neurogenesis. Cancer Cell. Presence of activated (phosphorylated) p42/44 Mitogen-Activated Protein Kinase (pMAPK) has been shown to be. associated with a relative resistance of glioblastoma multiforme to radiation therapy. Prognostic Associations of Activated Mitogen-Activated Protein Kinase and Akt Pathways in. Glioblastoma. Correspondingly, a high percentage of tumor cells immunoreactive to pMAPK antibody in this case predicts a. relative resistance to radiation therapy. The use of these tests in guiding therapy has limitations. Review of the relevant literature and clinical correlation is. advised. These test results do not obligate or preclude use of the relevant therapeutic agents. IDC2a: Selected slides were reviewed in consultation with. HISTORY: Neurologic symptoms multiple. MICROSCOPIC: Sections disclose high-grade infiltrating astrocytic neoplasm composed of pleomorphic hyperchromatic nuclei. featuring numerous mitotic figures and associated with florid microvascular proliferation and extensive foci of. neutrophil and macrophage-rich abscess-like necrosis with focal palisading. IMMUNOSTAINS: MGMT (G1): Up to 5%. PTEN (G1): Retained (2-3+). pMAPK (G1): Up to 10% of tumor nuclei are positive and up to 60% of tumor cytoplasm is positive. Laminin beta-1 (8/411) (G1): Upregulated (3+ in endothelial cells). Laminin beta-2 (9/421) (G1): Focal down-regulated (1-2+ in endothelial cells). EGFR by FISH is pending. GROSS: A. LEFT FRONTAL. Labeled with the patient's name, labeled "left frontal", and received fresh in the Operating Room for intraoperative. frozen consultation and subsequently fixed in formalin is a 2.2 x 1.4 x 0.3 cm aggregate of multiple tan-red soft. tissue fragments. Representative portion of tissue was submitted for frozen section analysis. Entirely embedded. A1. FSA remnant - multiple. A2. Remaining tissue - I. B. LEFT OCCIPITAL NCI #1. Labeled with the patient's name, labeled "left occipital NCI #1", and received in a cassette in formalin is a 2.1 x 1.4. x 0.2 cm aggregate of tan-red soft tissue fragments. Entirely embedded. 81. Multiple. C. LEFT OCCIPITAL NCI #2. Labeled with the patient's name, labeled "left occipital NCI #2", and received fresh and subsequently fixed in. formalin in a cassette is a 2.3 x 1.4 x 0.2 cm aggregate of multiple tan-red soft tissue fragments. Entirely embedded. CI. Multiple. D. LEFT OCCIPITAL NCI #3. Labeled with the patient's name, labeled "left occipital", and received in a cassette labeled "D" are two tan-red soft. tissue fragments amounting to 2.1 x 1.2 x 0.2 cm in aggregate. Entirely embedded. D1. 2. E. LEFT OCCIPITAL NCI #4. Labeled with the patient's name, labeled "B-F left occipital", and received fresh and subsequently fixed in formalin. in cassette labeled "E" is a 2.0 x 1.2 x 0.2 cm aggregate of multiple tan-red soft tissue fragments. Entirely. embedded. E1. Multiple. F. LEFT OCCIPITAL NCI #5. Labeled with the patient's name, labeled "D-F left occipital", and received fresh and subsequently fixed in formalin. in a cassette labeled "F" are two tan-red soft tissue fragments amounting to 1.5 x 1.1 X 0.3 cm in aggregate. Entirely. embedded. F1. 2. G. LEFT OCCIPITAL PERMANENT. Labeled with the patient's name, labeled "left occipital", and received in formalin is a 6.1 x 3.5 x 1.5 cm aggregate. of multiple tan-red friable soft tissue fragments. Entirely embedded. Slide key: GI. 3. G2. 5. G3. I. G4. Multiple. G5. 1. G6. 1. H. LEFT OCCIPITAL. Labeled with the patient's name, labeled "left occipital", and received in formalin are two friable tan-red soft tissue. fragments amounting to 3.0 X 2.5 x 1.0 cm in aggregate. The portions of tissue are serially sectioned and entirely. embedded. Slide key: HI-H3. 2,2,2. Gross dictated by. OPERATIVE CALL. OPERATIVE CONSULT (FROZEN): OCCIPITAL FS AND TP: High-grade glioma. If this report includes immunohistochemical test results, please note the following: Numerous immunoltistochomicnl tests were developed and their performance characteristics determined by (. and Laboratory Medicine. Those immunohistochemical tests have not been cleared or approved by the. U.S. Food and Drug Administration (FDd), and FDA approval is not required. I have personally examined the specimen. interpreted the results. reviewed the report and signed it electronically.
P0301
42
female
white
not hispanic or latino
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Alive
258
0
null
258
null
null
null
null
WT-With Tumor
Chemotherapy|Immunotherapy (Including Vaccines)|Radiation, External Beam
Temozolomide|Dendritic Cell Vaccine
11
null
Department of Pathology & Laboratory. Medicine. Addendum - Please See End of Report. Reason for Addendum #1: Additional studies/stains/opinion(s). DIAGNOSIS: A. BRAIN, LEFT FRONTAL, BIOPSY: Glioblastoma multiforme, WHO grade IV. B. BRAIN, LEFT FRONTAL, BIOPSY, NCI#: Glioblastoma multiforme, WHO grade IV. Tumor necrosis: 0%. Tumor attributable cellularity: 70%. C. BRAIN, LEFT FRONTAL, NCI #: Glioblastoma multiforme, WHO grade IV. Tumor necrosis: 1%. Tumor attributable cellularity: 90%. D. BRAIN, LEFT FRONTAL, NCI #: Glioblastoma multiforme, WHO grade IV. Tumor necrosis: 1%. Tumor attributable cellularity: 90%. E. BRAIN, LEFT FRONTAL, NCI#: Glioblastoma multiforme, WHO grade IV. Tumor necrosis: 1%. Tumor attributable cellularity: 90%. F. BRAIN, LEFT FRONTAL, NCI #: Glioblastoma multiforme, WHO grade IV. Tumor necrosis: 5%. Tumor attributable cellularity: 90%. G. BRAIN, LEFT FRONTAL, EXCISIONAL BIOPSY: Glioblastoma multiforme, WHO grade IV. COMMENT: A high percentage of tumor cells (greater than 20%) immunostaining for MGMT has been reported to be associated with a relatively diminished response to Temodar. Tence, the low 2% result in. this case suggests a likelihood of this tumor being responsive to Temodar. Patient Case(s):: Page of 5. Addendum - Please See End of Report. Recent studies have shown that co-expression of EGFRvIII and PTEN as detected by immunostaining was. significantly correlated with a clinical response of glioblastomas to EGFR kinase inhibitors. ence the loss of PTEN in this case suggests a diminished probability of response to. EGFR-Kinase inhibitors. Retained expression of PTEN was found to be associated with a more favorable prognosis in patients with high. grade gliomas. Molecular subclasses of high-grade glioma. predict prognosis, delineate a pattern of disease progression, and resemble stages in neurogenesis. Cancer Cell. Recent studies indicated an adverse prognostic significance of increased expression of laminin beta 1 and decreased. expression of laminin beta 2 predicting a worse survival of patients with gliomas. between Jaminin-8 and glial tumor grade, recurrence, and patient survival. Accordingly, elevated expression of beta 1 and suppressed expression of beta 2 in this tumor predict more. aggressive behavior. Presence of activated (phosphorylated) p42/44 Mitogen-Activated Protein Kinase (pMAPK) has been shown to be. associated with a relative resistance of glioblastoma multiforme to radiation therapy. Pelloski et al. 2006. Prognostic Associations of Activated Mitogen-Activated Protein Kinase and Akt Pathways in. Glioblastoma. Correspondingly, a high percentage of tumor cells immunoreactive to pMAPK antibody in this case predicts. a. relative resistance to radiation therapy. The use of these tests in guiding therapy has limitations. Review of the relevant literature and clinical correlation is. advised. These test results do not obligate or preclude use of the relevant therapeutic agents. IDC2a: Selected slides were reviewed in consultation with. HISTORY: Left frontal brain tumor. MICROSCOPIC: Sections disclose necrotizing predominantly well circumscribed but focally diffusely infiltrating astrocytoma. featuring striking ependymal-like differentiation with palisading of nuclei and presence of perinuclear pseudo-. rosettes. The tumor is predominantly composed of elongate hyperchromatic nuclei, associated with numerous. mitotic figures and showing readily discernible eosinophilic cytoplasm. In addition to ependymal differentiation. there is a presence of gemistocytic cells infiltrating brain parenchyma. Additionally, areas of highly cellular tumor. with neuroblastic-like differentiation are also discerned (PNET-like component). A focally conspicuous. microvascular proliferation is detected. Abundant tumor necrosis, some of which showing palisading, is also seen. IMMUNOSTAINS: p53 (G9): majority of tumor nuclei are positive in more aggressive appearing foci. Synaptophysin (G9): focal weak positivity in more aggressive appearing foci. MGMT (GI): positive in up to 2% of tumor nuclei. PTEN (G1): loss (I+). pMAPK (GI): 10% of tumor nuclei are positive and 30% of tumor cell cytoplasm is positive. Laminin beta 1 (8/411) (G1): up-regulated (2+ in endothelial cells). Laminin beta 2 (9/421) (G1): down regulated (focal perinuclear dot-like staining in endothelial cells (1-. Neurofilament (G2): discloses trapped axons. GROSS: Addendum - Please See End of Report. PATIENT: €. A. LEFT FRONTAL. Labeled with the patient's name, labeled "left frontal., and received fresh for intraoperative consultation and. subsequently fixed in formalin is a piece of light tan tissue measuring approximately 0.3 x 0.3 x 0.2 cm. Entirely. submitted. Slide key: A1. Frozen section remnant - I. A2. Remainder of specimen - 1. A3. B. LEFT FRONTAL NCI #1. Labeled with the patient's name, labeled "left frontal NCI #1", and received fresh and subsequently fixed in formalin. are two irregular pieces of soft gray-tan tissue measuring 1.5 x 0.9 x,0,5 cm in aggregate. Entirely submitted. B1. 2. C. LEFT FRONTAL NCI #2. Labeled with the patient's name, labeled "left frontal NCI #2", and received in formalin is a piece of soft white-tan. tissue measuring 1.4 x 1.2 x 0.4 cm. Entirely submitted. C1. I. D. LEFT FRONTAL NCI #3. Labeled with the patient's name, labeled "left frontal NCI #3", and received in formalin is a single piece of. hemorrhagic yellow to tan tissue measuring about 1.1 x 1.2 x 0.5 cm. Entirely submitted. D1. 1. E. LEFT FRONTAL NCI #4. Labeled with the patient's name, labeled "left frontal NCI #4", and received in formalin is a piece of piece of soft tan. to yellowish hemorrhagic tissue measuring 1.5 x 1.0 x 0.4 cm. Entirely submitted. E1. 1. F. LEFT FRONTAL NCI #5. Labeled with the patient's name, labeled "left frontal NCI #5", and received in formalin is a single piece of soft. yellow-tan tissue measuring 1.7 x 1.1 x 0.5 cm. Entirely submitted. F1. 1. G. LEFT FRONTAL PERMANENT. Labeled with the patient's name, labeled "left frontal permanent", and received in formalin are multiple fragments of. necrotic and hemorrhagic soft tan tissue measuring an aggregate 4.5 x 4.5 x 4.0 cm. Entirely submitted. GI-G14. 1. Gross dictated by. OPERATIVE CALL. OPERATIVE CONSULTATION. SPECIMEN A. LEFT FRONTAL FS AND TP: - Glinhlastoma. If this report includes immunolistochemical test results, please note the following: Numerous imntunohistochemical lests were developed and their performance characteristics determined by. nem of Pathology and Laboratory Medicine. Those imminohistochemical tests have not been cleared or approveu oy the. U.S. Food and Drug Administration (FDA), and FDA approval is not required. Addendum - Please See End of Report. I have personally examined the specimen. interpreted the results, reviewed the report and signed it electronically. M.D. Electronically signed. ADDENDUM. 1. FISH (FLUORESCENCE IN SITU HYBRIDIZATION) for EGFR. Number of cells analyzed: 40. Ratio of EGFR/CEP: 41.0. Percentage of cells with >4 copies of EGFR: 100%. Amplification: YES. High Level of Polysomy: YES. INTERPRETATION: 1. Samples are interpreted as Positive if: a. EGFR to CEP 7 signal ratio is > 2.0 in 10% of analyzed cells. b. When high level of polysomy (> four copies of EGFR) is present. 2. Samples are interpreted as Negative if EGFR to CEP 7 signal ratio is < 2.0 or in the absence of high. level of polysomy (> four copies of EGFR). 3. Samples are considered inconclusive, requiring consult with the pathologist, when EGFR to CEP 7. signal ratio is > 2.0 in < 10% of analyzed cells or when high level of polysomy (> four copies of. EGFR) is present in < 40% of cells. These cases also need to be co-read. REFERENCES.
P0304
78
male
white
not hispanic or latino
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Alive
86
0
null
86
null
null
null
null
TF-Tumor Free
Chemotherapy|Radiation, Stereotactic/Gamma Knife/SRS|Radiation, External Beam
Temozolomide
21
null
Addendum - Please See End of Report. Reason for Addendum #1: Additional studies/stains/opinion(s). DIAGNOSIS: A. BRAIN, RIGHT TEMPORAL, BIOPSY: Glioblastoma multiforme, WHO grade IV. B. BRAIN, RIGHT TEMPORAL, EXCISIONAL BIOPSY: Glioblastoma multiforme, WHO grade IV. C. BRAIN, RIGHT TEMPORAL, EXCISIONAL BIOPSY, NCI #: Glioblastoma multiforme, WHO grade IV. 0% of necrosis. 80% of tumor cellularity. D. BRAIN, RIGHT TEMPORAL, EXCISIONAL BIOPSY, NCI #: Glioblastoma multiforme, WHO grade IV. 0% of necrosis. 70% of tumor cellularity. E. BRAIN, RIGHT TEMPORAL, EXCISIONAL BIOPSY, NCI #: Glioblastoma multiforme, WHO grade IV. 0% of tumor necrosis. 70% of tumor cellularity. F. BRAIN, RIGHT TEMPORAL, EXCISIONAL BIOPSY, NCI #: Glioblastoma multiforme, WHO grade IV. 0% of tumor necrosis. 60% of tumor cellularity. G. BRAIN, RIGHT TEMPORAL, EXCISIONAL BIOPSY, NCI #: Glioblastoma multiforme, WHO grade IV. 0% of necrosis. 90% of tumor cellularity. H. BRAIN, RIGHT TEMPORAL, EXCISIONAL BIOPSY: Glioblastoma multiforme, WHO grade IV. I. BRAIN, RIGHT TEMPORAL, EXCISIONAL BIOPSY, NCI #: Glioblastoma multiforme, WHO grade IV. 0% of tumor necrosis. Patient Case(s): PATIENT NOTIFIED OF RESULTS. COMMENT: A high percentage of tumor cells (greater than 20%) immunostaining for MGMT has been reported to be associated with a relatively diminished response to Temodar. Hence, the low 5% result in this case suggests a likelihood of this tumor being responsive to Temodar. Recent studies have shown that co-expression of EGFRvIII and PTEN as detected by immunostaining was significantly correlated with a clinical response of glioblastomas to EGFR kinase inhibitors. Hence the loss of PTEN in this case suggests a diminished probability of response to EGFR-kinase inhibitors. Retained expression of PTEN was found to be associated with a more favorable prognosis in patients with high-grade gliomas. Molecular subclasses of high-grade glioma predict prognosis, delineate a pattern of disease progression, and resemble stages in neurogenesis. Cancer Cell. Recent studies indicated an adverse prognostic significance of increased expression of laminin beta 1 and decreased expression of laminin beta 2 predicting a worse survival of patients with gliomas. between laminin-8 and glial tumor grade, recurrence, and patient survival. Accordingly, elevated expression of ß1 and ß2 in this tumor suggest the tumor aggressiveness intermediate between the Bill (or normal)/ß2 normal (or 11) (the most favorable prognosis) and BIRT B2U (least favorable prognosis). Presence of activated (phosphorylated) p42/44 Mitogen-Activated Protein Kinase (pMAPK) has been shown to be associated with a relative resistance of glioblastoma multiforme to radiation therapy. Prognostic Associations of Activated Mitogen-Activated Protein Kinase and Akt Pathways in Glioblastoma. Clin Cancer Res. Correspondingly, presence of a large fraction of cells immunonegative to pMAPK antibody in this case suggests a likelihood of this tumor being responsive to radiation therapy. Addendum - Please See End of Report. The use of these tests in guiding therapy has limitations. Review of the relevant literature and clinical correlation is advised. These test results do not obligate or preclude use of the relevant therapeutic agents. IDC2a: Selected slides were reviewed in consultation with HISTORY: None given. MICROSCOPIC: Sections disclose predominantly cortex and underlying white matter with moderately cellular proliferation of highly pleomorphic hyperchromatic elongate nuclei often containing multinucleated/cleft forms. Scattered mitotic figures are seen. Incipient endothelial proliferation is present on multiple slides but there is no necrosis. The tumor has features of secondary GBM given the strong p53 expression, low mitotic and Ki-67 count, only incipient endothelial proliferation and only minimal up-regulation of laminin beta 1. IMMUNOSTAINS: P53 (M1): Strong diffuse positivity in up to 100% of tumor nuclei. Ki-67 (M1): Up to 8%. MGMT (M1): Up to 5%. PTEN (M1): Loss (1+ in 70% of tumor cells). pMAPK (M1): Up to 20% of tumor nuclei are positive and up to 25% of tumor cell cytoplasm is positive. Laminin beta-1 (8/411) (M1): Minimal upregulation (2+ in endothelial cells). Laminin beta-2 (9/421) (M1): Slight upregulation (1-2+ in endothelial cells). GROSS: A. RIGHT TEMPORAL. Labeled with the patient's name, labeled "right temporal mass", and received fresh for intraoperative consultation and subsequently submitted in formalin are two portions of soft pale tan cortical tissue with adherent blood clot measuring 1.6 and 1.7 cm in greatest dimension and amounting in aggregate to 2.1 x 1.7 x 0,4 cm. Entirely submitted. Slide key: A1. Frozen remnant - 1. A2. Remaining tissue - 2. B. RIGHT TEMPORAL. Labeled with the patient's name, labeled "right temporal", and received fresh for intraoperative consultation and subsequently submitted in formalin is a 1.1 x 0.7 x 0.2 cm aggregate of soft pale tan cortical tissue ranging from 0.2 to 0.7 cm in greatest dimension. Entirely submitted. Slide key: B1. Frozen remnant - 2. B2. Remaining tissue - multiple. C. RIGHT TEMPORAL NCI #1. Labeled with the patient's name, labeled "right temporal C", and received fresh and subsequently submitted in formalin is a 1.1 x 0.5 x 0.2 cm portion of soft pale tan cortical tissue with areas of hemorrhage. Entirely submitted. Slide key: Addendum - Please See End of Report. C1. 1. D. RIGHT TEMPORAL NCI #2. Labeled with the patient's name, labeled "right temporal D", and received fresh and subsequently submitted in formalin is a 1.0 x 0.9 x 0.2 portion of soft pale tan cortical tissue with areas of hemorrhage. Entirely submitted. D1. 1. E. RIGHT TEMPORAL NCI #3. Labeled with the patient's name, labeled "right temporal E", and received fresh and subsequently submitted in formalin is a 0.6 x 0.4 x 0.2 cm portion of soft pale tan cortical tissue with areas of hemorrhage. Entirely submitted. E1. 1. F. RIGHT TEMPORAL NCI #4. Labeled with the patient's name, labeled "right temporal F", and received fresh and subsequently submitted in formalin is a 1.1 x 0,6 X 0.2 cm soft pale tan portion of cortical tissue with areas of hemorrhage. Entirely submitted. F1. 1. G. RIGHT TEMPORAL NCI #5. Labeled with the patient's name, labeled "right temporal G", and received fresh and subsequently submitted in formalin is a 1.0 x 0.9 x 0.3 cm portion of soft pale tan cortical tissue with areas of hemorrhage. Entirely submitted. G1. 1. H. RIGHT TEMPORAL/PERMANENT. Labeled with the patient's name, labeled "right temporal", and received in formalin is a 1.1 X 0.7 x 0.5 cm portion of soft pale tan cortical tissue with adherent blood clot. Entirely submitted. H1. 4. I. RIGHT TEMPORAL NCI #6. Labeled with the patient's name, labeled "right temporal NCI #6", and received fresh and subsequently submitted in formalin is a 0.6 x 0.4 x 0.2 cm portion of soft cortical tissue with areas of hemorrhage. Entirely submitted. II. 1. J. RIGHT TEMPORAL NCI #7. Labeled with the patient's name, labeled "right temporal #7 J", and received fresh and subsequently submitted in formalin is a 0.6 x 0.4 x 0.2 cm portion of soft pale tan cortical tissue with areas of hemorrhage. Entirely submitted. J1. 1. K. RIGHT TEMPORAL NCI #8. Labeled with the patient's name, labeled "right temporal NCI #8 K", and received fresh and subsequently submitted. in formalin is a 1.5 x 1.1 x 0.2 cm portion of soft pale tan cortical tissue with areas of hemorrhage. Entirely submitted. K1. 1. L. RIGHT TEMPORAL NCI #9. Labeled with the patient's name, labeled "right temporal NCI #9 L", and received fresh and subsequently submitted in formalin is a 0,9 x 0.6 x 0,2 cm portion of soft pale tan cortical tissue with areas of hemorrhage. Entirely submitted. L1. 1. M. RIGHT TEMPORAL NCI #10. Labeled with the patient's name, labeled "right temporal NCI #10 M", and received fresh and subsequently submitted in formalin is a 1.6 x 1.2 x 0.3 cm aggregate of soft pale tan cortical tissue with areas of hemorrhage. Addendum - Please See End of Report. M1. Multiple. N. TEMPORAL LOBE. Labeled with the patient's name, labeled "temporal lobe", and received in formalin is a 3.1 x 2.2 x 0.6 cm aggregate of soft, tan-gray cortical tissue with areas of hemorrhage. Serially sectioned to reveal soft, gray-brown hemorrhagic tissues. Entirely submitted. N1, N2. 4 each. OPERATIVE CALL. OPERATIVE CONSULT (FROZEN): A. RIGHT TEMPORAL FS: Glioma, low cellularity. B. RIGHT TEMPORAL FS. Astrocytoma, at least anaplastic. If this report includes immunohistochemical test results, please note the following: Numerous immunohistochemical tests were developed and their performance characteristics determined by Center Department of Pathology and Laboratory Medicine. Those immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required. I have personally examined the specimen interpreted the results reviewed the report and signed it electronically. Addendum - Please See End of Report. FISH (FLUORESCENCE IN SITU HYBRIDIZATION) for EGFR. Number of cells analyzed: 40. Ratio of EGFR/CEP: 1.3. Percentage of cells with >4 copies of EGFR: 62.5%. Amplification: YES. High Level of Polysomy: YES. INTERPRETATION: 1. Samples are interpreted as Positive if a. EGFR to CEP 7 signal ratio is > 2.0 in > 10% of analyzed cells. b. When high level of polysomy (> four copies of EGFR in > 40% of cells) is present. 2. Samples are interpreted as Negative if EGFR to CEP 7 signal ratio is < 2.0 or in the absence of high level of polysomy (> four copies of EGFR in > 40% of cells). 3. Samples are considered inconclusive, requiring consult with the pathologist, when EGFR to CEP 7 signal ratio is 2.0 in < 10% of analyzed cells or when high level of polysomy (> four copies of EGFR) is present in < 40% of cells. 4. These cases also need to be co-read.
P0305
71
male
white
not hispanic or latino
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Alive
4
0
null
4
null
null
null
null
null
null
null
null
null
A. BRAIN, RIGHT TEMPORAL, BIOPSY: Glioblastoma multiforme, WHO grade IV. B. BRAIN, RIGHT TEMPORAL, BIOPSY, NCI #1: Glioblastoma multiforme, WHO grade IV. 30% of tumor necrosis. 80% of tumor cellularity. C. BRAIN, RIGHT TEMPORAL, BIOPSY NCI #2: Glioblastoma multiforme, WHO grade IV. 70% of tumor necrosis. 90% of viable tumor cellularity. D. BRAIN, RIGHT TEMPORAL, BIOPSY NCI #3: Glioblastoma multiforme, WHO grade IV. 80% of tumor necrosis. 10% of viable tumor cellularity. E. BRAIN, RIGHT TEMPORAL, BIOPSY NCI #4: Glioblastoma multiforme, WHO grade IV. 90% of tumor necrosis. 5% of viable tumor cellularity. F. BRAIN, RIGHT TEMPORAL, BIOPSY NCI #5: Glioblastoma multiforme, WHO grade IV. 30% of tumor cellularity. 90% of tumor necrosis. G. BRAIN, RIGHT TEMPORAL, EXCISION: Glioblastoma multiforme, WHO grade IV. H. BRAIN, RIGHT TEMPORAL, EXCISIONAL BIOPSY: Glioblastoma multiforme, WHO grade IV. COMMENT: Patient Case(s). A high percentage of tumor cells (greater than 20%) immunostainino for MGMT has been reported to be associated with a relatively diminished response to Temodar. Hence, the low 5% result in this case suggests a likelihood of this tumor being responsive to Temodar. Recent studies have shown that co-expression of EGFRvIII and PTEN as detected by immunostaining was significantly correlated with a clinical response of glioblastomas to EGFR kinase inhibitors. Hence the preserved expression of PTEN in this case, when combined with EGFRvIII mutation, permits a possibility of this tumor being responsive to EGFR-kinase inhibitors. Retained expression of PTEN was found in be associated with. grade aliomas). n. Molecular subclasses of high-grade glioma. predict prognosis, delineate a pattern of disease progression, and resemble stages in neurogenesis. Cancer Cell,. Recent studies indicated an adverse prognostic significance of increased expression of laminin heta 1 and decreased expression of laminin beta 2 predicting a worse survival of patients with gliomas. between laminin-8 and glial tumor grade, recurrence, and patient survival. Accordingly, elevated expression of B1 and 32 in this tumor suggest the tumor aggressΓ­veness intermediate between the Bill (or normal)/22 normal (or ii) (the most favorable prognosis) and Bill/ (least favorable prognosis). Presence of activated (phosphorylated) p42/44 Mitogen-Activated Protein Kinase (pMAPK) has been shown to be associated with a relative resistance of glioblastoma multiforme to radiation therapy. Prognostic Associations of Activated Mitogen-Activated Protein Kinase and Akt Pathways in Glioblastoma. Clin Cancer Res. Correspondingly, a high percentage of tumor cells immunoreactive to pMAPK antibody in this case predicts a relative resistance to radiation therapy. The use of these tests in guiding therapy has limitations. Review of the relevant literature and clinical correlation is advised. These test results do not obligate or preclude use of the relevant therapeutic agents. IDC2a: Selected slides were reviewed in consultation with HISTORY: Tumor brain. MICROSCOPIC: This extensively necrotizing malignant infiltrating glioma features nuclear pleomorphism, scattered mitotic activity, focal microvascular endothelial proliferation. IMMUNOSTAINS: MGMT (G1): Up to 5% of tumor nuclei are positive. PTEN (G1): Retained (1-2+ in 80% of tumor cells). pMAPK (G1): 40% of tumor nuclei are positive and 70% of tumor cytoplasm is positive. Laminin beta-1 (8/411) (G1): Upregulated (3+ in endothelial cells). Laminin beta-2 (9/421) (G1): Upregulated (2+ in endothelial cells). GROSS: A. RIGHT TEMPORAL BRAIN TUMOR FS 1. Labeled with patient's name, labeled right temporal brain tumor FS 1", is a 0.6 x 0.5 x 0.2 cm piece of soft tan tissue. Specimen is entirely submitted for frozen section diagnosis. Entirely submitted. A1. Frozen section control for FS #1 (specimen A) - 1. Addendum - Please See End of Report. PATIENT: &. B. RIGHT TEMPORAL NCI #1. Labeled with patient's name, labeled "right temporal #1 NCI", and received fresh in the Operating Room for research tissue procurement is a 1.7 x 1.2 x 0.4 cm portion of pink-tan, focally hemorrhagic tissue. Specimen is entirely submitted. B1, 1. C. RIGHT TEMPORAL NCI #2. Labeled with patient's name, labeled "right temporal NCI #2", and received fresh in the Operating Room for research tissue procurement and is subsequently fixed in formalin and is a 2.0 x 1.5 X 0.5 cm light tan focally hemorrhagic tissue fragment. Specimen is entirely submitted. CI. 1. D. RIGHT TEMPORAL NCI #3. Labeled with patient's name, labeled "right temporal NCI #3", and received fresh in the Operating Room for research tissue procurement and is subsequently fixed in formalin and is a 1.5 x 1.0 x 0.5 cm light tan tissue fragment. Specimen is entirely submitted. D1. 1. E. RIGHT TEMPORAL NCI #4. Labeled with patient's name, labeled "right temporal NCI #4", and received fresh in the Operating Room for research tissue procurement and is subsequently fixed in formalin and is a 1.7 x 1.0 x 0.5 cm light tan focally hemorrhagic tissue fragment. Specimen is entirely submitted. E1. 1. F. RIGHT TEMPORAL NCI #5. Labeled with patient's name, labeled "right NCI #5", and received fresh in the Operating Room for research tissue procurement and is subsequently fixed in formalin and is a 2.0 x 1.0 x 0.5 cm portion of hemorrhagic light tan tissue. Specimen is entirely submitted. F1. I. G. RIGHT TEMPORAL FOR PERMANENTS. Labeled with patient's name, labeled "right temporal", and received in formalin are two portions of light tan hemorrhagic somewhat friable tissue. Tissues serially sectioned and entirely submitted. G1, G2. 2 each. H. RIGHT TEMPORAL. Labeled with patient's name, labeled "right temporal", and received in formalin are three pieces of semi-firm friable pink-white soft tissue ranging in size from 0.7 up to 1.0 cm in greatest dimension. Tissues are entirely submitted. H1, H2. 4, 3. OPERATIVE CALL. OPERATIVE CONSULT (FROZEN): A. RIGHT TEMPORAL FS: Glioma. If this report includes immunohistochemical test results, please note the following: Addendum - Please See End of Report. Numavone. ?mical tests were developed and their performance characteristics determined by and Laboratory Medicine. Those immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA) and FDA approval is not required. I have personally examined the specimen, interpreted the results, reviewed the report and signed it electronically. ADDENDUM. FISH (FLUORESCENCE IN SITU HYBRIDIZATION) for EGFR. Number of cells analyzed: 40. Ratio of EGFR/CEP: 8.3. Percentage of cells with >4 copies of EGFR: 10%. Amplification: YES. High Level of Polysomy: NO. INTERPRETATION: 1. Samples are interpreted as Positive if a. EGFR to CEP 7 signal ratio is > 2.0 in > 10% of analyzed cells. b. When high level of polysomy (> four copies of EGFR in 40% of cells) is present. 2. Samples are interpreted as Negative if EGFR to CEP 7 signal ratio is < 2.0 or in the absence of high level of polysomy (> four copies of EGFR). 3. Samples are considered inconclusive, requiring consult with the pathologist, when EGFR to CEP 7 signal ratio is 2.0 in < 10% of analyzed cells or when high level of polysomy (> four copies of EGFR) is present in < 40% of cells. These cases also need to be co-read. REFERENCES. Addendum - Please See End of Report. I have personally examined the specimen, interpreted the results, reviewed the report and signed it electronically.
P0306
48
male
white
not hispanic or latino
Glioblastoma
null
null
null
Progression
9440/3
Not Reported
null
not reported
Not Reported
Alive
143
0
null
143
null
105
null
Yes
WT-With Tumor
Pharmaceutical Therapy, NOS|Chemotherapy|Radiation, External Beam|Radiation Therapy, NOS
Bevacizumab|Erlotinib Hydrochloride|Temozolomide
105
null
DEPARTMENT OF PATHOLOGY & LABORATORY MEDICINE. DIAGNOSIS: A. SITE #1 (RIGHT OCCIPITAL CRANIOTOMY): Unremarkable gray and white matter. B. SITE #2 (RIGHT OCCIPITAL CRANIOTOMY): Glioblastoma multiforme, WHO grade IV. C. NCI RESEARCH PROTOCOL: Glioblastoma multiforme with approximate 10% necrosis. D. NCI RESEARCH PROTOCOL: Glioblastoma multiforme without apparent necrosis. (One piece showing gray matter with few infiltrating tumor cells). E. NCI RESEARCH PROTOCOL: Glioblastoma multiforme without apparent necrosis. (One piece showing gray matter with few infiltrating tumor cells). F. NCI RESEARCH PROTOCOL: Glioblastoma multiforme without apparent necrosis. G. NCI RESEARCH PROTOCOL: Glioblastoma multiforme with approximate 5% necrosis. H. NCI RESEARCH PROTOCOL: Glioblastoma multiforme with less than 5% necrosis. I. BRAIN TUMOR (RIGHT OCCIPITAL CRANIOTOMY): Glioblastoma multiforme, WHO grade IV. J. SITE #3 (RIGHT OCCIPITAL CRANIOTOMY): Glioblastoma multiforme, WHO grade IV. K. BRAIN TUMOR (RIGHT OCCIPITAL CRANIOTOMY): Glioblastoma multiforme, WHO grade IV. COMMENT: Immunostain for MGMT is considered to be positive (30% of tumor cells positive). The majority of tumor cells are immunoreactive for PTEN and MAPK. Both laminin beta 1 and laminin beta 2 are moderately up-regulated (see note). Presence of activated (phosphorylated) p42/44 mitogen-activated protein kinase (pMAPK) in glioblastoma multiforme has been shown to be associated with a relative resistance to radiation therapy. Elevated expression of laminin B1 and (32 in this tumor may suggest the tumor aggressiveness intermediate between the IBI (or normaly102 (or normal) (the most favorable prognosis) and 101/182 (the least favorable prognosis). The use of these tests in guiding therapy has limitations. Review of the relevant literature and clinical correlation is advised. These test results do not obligate or preclude use of the relevant therapeutic agents. HISTORY: Right occipital brain tumor. MICROSCOPIC: See diagnosis. IMMUNOSTAINS: MGMT, PTEN, MAPK, laminin beta 1 and laminin beta 2 (K1). GROSS: A. SITE #1. Labeled with the patient's name, labeled "site #1", and received in formalin is a 0.4 x 0.3 x 0.3 cm soft pink-tan tissue fragment. The specimen is entirely submitted. A1. 1. B. SITE #2 FS. Labeled with the patient's name, labeled "site #2 FS", and received fresh in the Operating Room for intraoperative frozen consultation and subsequently fixed in formalin is a 0.4 x 0.3 x 0.2 cm portion of soft tan tissue. The specimen is entirely submitted for frozen section diagnosis. Entirely submitted. B1. Frozen section control for FS1 (specimen B) -. I. C. NCI RESEARCH PROTOCOL. Labeled with the patient's name, labeled "NCI research protocol", and received in a cassette labeled "C" is a 1.0 x 0.5 x 0.5 cm gray-tan soft tissue fragment. Entirely submitted. C1. 2. D. NCI RESEARCH PROTOCOL. Labeled with the patient's name, labeled "NCI research protocol", and received in a cassette labeled "D" are two portions of soft pink-tan tissues measuring 0.7 and 0.5 cm, respectively, in greatest dimension. Entirely submitted. D1. 2. E. NCI RESEARCH PROTOCOL. Labeled with the patient's name, labeled "NCI research protocol", and received in a cassette labeled "E" are two portions of soft pink-tan tissues ranging in size from 0.8 up to 1.0 cm in greatest dimension. Entirely submitted. E1. 2. F. NCI RESEARCH PROTOCOL. PATIENT: a. Labeled with the patient's name, labeled "NCI research protocol", and received in a cassette labeled "F" are two portions of soft pink-tan tissues measuring 0.9 and 0.7 cm, respectively, in greatest dimension. Entirely submitted. F1. 2. G. NCI RESEARCH PROTOCOL. Labeled with the patient's name, labeled "NCI research protocol", and received in a cassette labeled "G" are two fragments of soft pink-tan tissues each measuring 0.5 cm greatest dimension. Entirely submitted. GI. 2. H. NCI RESEARCH PROTOCOL. Labeled with the patient's name, labeled "NCI research protocol", and received in a cassette labeled "H" are two portions of soft pink-tan tissues measuring 0.6 and 0.5 cm, respectively, in greatest dimension. Entirely submitted. HI. 2. I. BRAIN TUMOR. Labeled with the patient's name, labeled "brain tumor", and received in formalin are multiple fragmented pieces of pink-tan soft somewhat friable tissues together measuring 1.0 x 1.0 x 0.5 cm in total aggregate. Entirely submitted. 11. Multiple. J. SITE #3. Labeled with the patient's name, labeled "site #3", and received in formalin is a 0.4 x 0.3 x 0.2 cm soft tan tissue fragment. Entirely submitted. J1. 1. K. BRAIN TUMOR. Labeled with the patient's name, labeled "brain tumor", and received in formalin are two portions of friable, gray-tan soft focally hemorrhagic brain tissue. Tissues are serially sectioned and entirely submitted. K1. 6. OPERATIVE CALL. OPERATIVE CONSULTATION (FROZEN): B. SITE #2, FSA AND TPA: High grade glioma, favor glioblastoma multiforme.
P0307
59
male
white
not reported
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Not Reported
95
0
null
95
null
null
null
null
null
null
null
null
null
Addendum - Please See End of Report. DIAGNOSIS: A, B. BRAIN, LEFT PARIETAL, EXCISIONAL BIOPSY: Glioblastoma multiforme, WHO grade IV. C. BRAIN, LEFT PARIETAL, CORE BIOPSY,: Glioblastoma, WHO grade IV. 95% of tumor cellularity. Less than 2% of tumor necrosis. D. BRAIN, LEFT PARIETAL, CORE BIOPSY,: Glioblastoma multiforme, WHO grade IV. 95% of tumor cellularity. Less than 5% of tumor necrosis. E. BRAIN, LEFT PARIETAL, CORE BIOPSY,: Glioblastoma multiforme, WHO grade IV. 95% of tumor cellularity. 7% of tumor necrosis. F. BRAIN, LEFT PARIETAL, CORE BIOPSY,: Glioblastoma multiforme, WHO grade IV. 95% of tumor cellularity. 12% of tumor necrosis. G. BRAIN, LEFT PARIETAL, CORE BIOPSY,: Glioblastoma multiforme, WHO grade IV. 95% of tumor cellularity. 8% of tumor necrosis. COMMENT: A high percentage of tumor cells (greater than 20%) immunostaining for MGMT has been reported to. be. associated with a relatively diminished response to Temodar. Hence,. the low 3% result in this case suggests a likelihood of this tumor being responsive to Temodar. Recent studies have shown that co-expression of EGFRvIII and PTEN as detected by immunostaining. was significantly correlated with a clinical response of glioblastomas to EGFR kinase inhibitors (. Hence the loss of PTEN in this case suggests a diminished probability of. response to EGFR-kinase inhibitors.
P0309
63
female
white
not hispanic or latino
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Alive
205
0
null
205
null
84
null
Yes
WT-With Tumor
Immunotherapy (Including Vaccines)|Pharmaceutical Therapy, NOS|Radiation Therapy, NOS|Surgery, NOS|Radiation, External Beam|Targeted Molecular Therapy|Chemotherapy
Antineoplastic Vaccine|Afatinib Dimaleate|Temozolomide
107
Treatment Ongoing
Addendum - Please See End of Report. Reason for Addendum #1: Additional studies/stains/opinion(s). DIAGNOSIS: Glioblastoma multiforme, WHO grade IV. 0% of tumor necrosis. 80% of tumor cellularity. 0% of tumor necrosis. 90% of tumor cellularity. 0% of tumor necrosis. 80% of tumor cellularity. 3% of tumor necrosis. 90% of tumor cellularity. 5% of tumor necrosis. 95% of tumor cellularity. A high percentage of tumor cells (greater than 20%) immunostaining for MGMT has been reported to be associated with a relatively diminished response to Temodar. Recent studies have shown that co-expression of EGFRvIII and PTEN as detected by immunostaining was significantly correlated with a clinical response of glioblastomas to EGFR kinase inhibitors.
P0310
77
female
white
not hispanic or latino
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Alive
145
0
null
145
null
null
null
null
null
Radiation, External Beam|Chemotherapy|Targeted Molecular Therapy
Temozolomide|Cilengitide
33
Treatment Ongoing
Glioblastoma multiforme, giant cell variant, WHO grade IV. Cellular tumor with approximately 30% tumor necrosis. Cellular tumor with less than 5% tumor necrosis in one piece. Cellular tumor, no tumor necrosis identified. Cellular tumor with approximately 20% tumor necrosis in one piece. Cellular tumor with approximately 5% tumor necrosis in one piece. Immunostain for MGMT is considered to be negative (less than 1% tumor cells positive). Tumor cells are diffusely and strongly positive for PTEN and MAPK. Laminin beta-1 is markedly increased while laminin beta 2 is moderately increased. A low percentage of tumor cells (20% and less) immunostaining for MGMT has been reported to be associated with a relative response to Temodar. Presence of activated (phosphorylated) p42/44 mitogen-activated protein kinase (pMAPK) in glioblastoma multiforme has been shown to be associated with a relative resistance to radiation therapy. Retained expression of PTEN was found to be associated with a more favorable prognosis in patients with high grade gliomas. Elevated expression of laminin 31 (laminin-8) and decreased laminin ß2 (laminin-9) expression predicting a worse survival of patients with high grade gliomas.
P0311
37
male
white
not reported
Glioblastoma
null
null
null
Progression
9440/3
Not Reported
null
not reported
Not Reported
Dead
343
1
343
343
null
193
null
Yes
WT-With Tumor
Radiation Therapy, NOS|Radiation, Stereotactic/Gamma Knife/SRS|Pharmaceutical Therapy, NOS|Chemotherapy
Etoposide|Bevacizumab
150
null
SGA-28-2512 - -. Addendum - Please See End of Report. Reason for Addendum #1: Additional studies/stains/opinion(s). Reason for Addendum #2: Additional studies/stains/opinion(s). DIAGNOSIS: A. BRAIN, RIGHT TEMPORAL, BIOPSY: Giant cell glioblastoma, WHO grade IV. B. BRAIN, RIGHT TEMPORAL, BIOPSY, NCI#: Giant cell glioblastoma, WHO grade IV. Tumor cellularity is 95%. Tumor necrosis is 3%. C. BRAIN, RIGHT TEMPORAL, BIOPSY, NCI#: Giant cell glioblastoma, WHO grade IV. Tumor cellularity is 95%. Tumor necrosis is 1%. D. BRAIN, RIGHT TEMPORAL, BIOPSY, NCI#: Giant cell glioblastoma, WHO grade IV. Tumor cellularity is 95%. Tumor necrosis is 10%. E. BRAIN, RIGHT TEMPORAL, BIOPSY, NCI#: Giant cell glioblastoma, WHO grade IV. Tumor cellularity is 95%. Tumor necrosis is 1%. F. BRAIN, RIGHT TEMPORAL, BIOPSY, NCI#: Giant cell glioblastoma, WHO grade IV. Tumor cellularity is 95%. Tumor necrosis is 0%. G. BRAIN, RIGHT TEMPORAL, EXCISIONAL BIOPSY: Giant cell glioblastoma, WHO grade IV. IDC2a: Selected slides were reviewed in consultation with Dr. COMMENT: A high percentage of tumor cells (greater than 20%) immunostaining for MGMT has been reported to be associated with a relatively diminished response to Temodar. Hence, the 95% result in this case suggests the possibility of a relatively diminished response to Temodar.
P0312
69
female
white
not hispanic or latino
Glioblastoma
null
null
null
Progression
9440/3
Not Reported
null
not reported
Not Reported
Alive
222
0
null
222
null
75
null
Yes
WT-With Tumor
Radiation Therapy, NOS|Radiation, Stereotactic/Gamma Knife/SRS|Targeted Molecular Therapy|Chemotherapy|Radiation, External Beam|Pharmaceutical Therapy, NOS
Bevacizumab|Temozolomide
85
Treatment Ongoing
Meningioma, WHO grade I. Glioblastoma multiforme, WHO grade IV. Cellular tumor tissue with less than 5% of tumor necrosis. Cellular tumor tissue without tumor necrosis. Cellular tumor tissue with approximately 20% tumor necrosis. Cellular tumor tissue without tumor necrosis. Cellular tumor tissue with 5% of tumor necrosis. Immunostain for MGMT is considered to be negative (10% tumor cells. positive). Presence of activated (phosphorylated) p42/44 mitogen-activated protein kinase (pMAPK) in glioblastoma multiforme has been shown to be associated with a relative resistance to radiation therapy.
P0313
45
male
asian
not hispanic or latino
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Alive
160
0
null
160
null
null
null
null
null
Chemotherapy|Radiation, External Beam
Temozolomide
29
Treatment Ongoing
DIAGNOSIS: Glioblastoma multiforme (WHO grade IV). Cellular tumor without necrosis. Cellular tumor with approximately 15% tumor necrosis. Cellular tumor with approximately 10% necrosis. Cellular tumor with approximately 5% tumor necrosis in one core. Immunostain for MGMT is considered to be negative (less than 5% tumor cell positive). Immunostain for PTEN and MAPK are positive. Presence of activated (phosphorylated) p42/44 mitogen-activated protein kinase (pMAPK) in glioblastoma multiforme has been shown to be associated with a relative resistance to radiation therapy. Retained expression of PTEN was found to be associated with a more favorable prognosis in patients with high grade gliomas. Elevated expression of laminin beta-1 and laminin beta-2 may suggest the tumor aggressiveness intermediate between the normal/normal and the least favorable prognosis.
P0314
72
male
white
not reported
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Dead
454
1
454
454
null
null
null
null
WT-With Tumor
Radiation, External Beam|Chemotherapy
Temozolomide
9
null
Glioblastoma multiforme, WHO grade IV. Glioblastoma multiforme, WHO grade IV. Glioblastoma multiforme, WHO grade IV. Glioblastoma multiforme, WHO grade IV. Glioblastoma multiforme, WHO grade IV. Glioblastoma multiforme, WHO grade IV. Glioblastoma multiforme, WHO grade IV. Glioblastoma multiforme, WHO grade IV. Glioblastoma multiforme, WHO grade IV. Glioblastoma multiforme, WHO grade IV. Glioblastoma multiforme, WHO grade IV. Glioblastoma multiforme, WHO grade IV. A high percentage of tumor cells (greater than 20%) immunostaining for MGMT has been reported to be associated with a relatively diminished response to Temodar. Hence, the 20% result in this case suggests the possibility of a relatively diminished response to Temodar. Recent studies have shown that co-expression of EGFRvIII and PTEN as detected by immunostalining was significantly correlated with a clinical response of glioblastomas to EGFR kinase inhibitors. Hence the preserved expression of PTEN in this case, when combined with EGFRvIII mutation, permits a possibility of this tumor being responsive to EGFR-kinase inhibitors. Retained expression of PTEN was found to be associated with a more favorable prognosis in patients with high grade gliomas. Molecular subclasses of high-grade glioma predict prognosis, delineate a pattern of disease progression, and resemble stages in neurogenesis. Cancer Cell. Recent studies indicated an adverse prognostic significance of increased expression of laminin beta 1 and decreased expression of laminin beta 2 predicting a worse survival of patients with gliomas. Association between laminin-8 and glial tumor grade, recurrence, and patient survival. Accordingly, elevated expression of ß1 and ß2 in this tumor suggest the tumor aggressiveness, intermediate between the Bill (or normal)/22 normal (or ii) (the most favorable prognosis) and Bill/ B2V (least favorable prognosis). Presence of activated (phosphorylated) p42/44 Mitogen-Activated Protein Kinase (pMAPK) often is indicative of an upregulation of receptor tyrosine kinase signaling. It has been shown to be associated with a relative resistance to radiation therapy in glioblastoma multiforme. Prognostic Associations of Activated Mitogen-Activated Protein Kinase and Akt Pathways in Glioblastoma. Correspondingly, a high percentage of tumor cells immunoreactive to pMAPK antibody in this case may predict a relative resistance to radiation therapy. Numerous immunohistochemical tests were developed and their performance characteristics determined by CSMC. Cytogenetics Laboratory as required by the. They have not been cleared or approved for specific uses by the U.S. Food and Drug Administration. ation. Fluorescence in situ hybridization (FISH) for EGFR in BRAIN. EGFR Amplification (See note below). Number of cells evaluated: 40. Interpretation: Fluorescence in situ hybridization (FISH) analysis on a brain tumor sample from this patient with Abbott. Molecular probes specific for the centromere of chromosome 7 (control probe) and the short arm (EGFR-. 7p12) of chromosome 7 was performed. These studies showed amplification of the EGFR gene with a 11.8 ratio of EGFR signals to the centromere signals in 80% of the nuclei examined. Note: Samples are considered positive in brain if the EGFR to CEP 7 signal ratio is 2.0 in 10% of analyzed cells or tumors with four or more copies of the EGFR gene in > 40% of the cells (high polysomy). Samples are considered inconclusive, requiring consult with the pathologist, in brain if the EGFR to CEP 7 signal ratio is 2.0 in <10% of analyzed cells or when four or more copies of the EGFR gene in <40% of the cells. A left temporal FS. A left temporal possible clinical trial study. A left temporal permanent. A left temporal NCI #1. A left temporal NCI #2. A left temporal NCI #3. A left temporal NCI #4. A left temporal NCI #5. A left temporal NCI #6. A left temporal NCI #7. A left temporal permanent. A left temporal tumor. A left temporal FS + TP.
P0315
71
male
white
not reported
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Dead
343
1
343
343
null
null
null
null
WT-With Tumor
Chemotherapy|Radiation Therapy, NOS
Temozolomide
null
null
A. SKIN, LEFT FRONTAL, EXCISION: Seborrheic keratosis. This benign skin lesion extends to the right excisional margin. B. BRAIN, LEFT FRONTAL-TEMPORAL, EXCISIONAL BIOPSY: Glioblastoma multiforme, WHO grade IV. C. BRAIN, LEFT TEMPORAL, EXCISION, NCI #1: Glioblastoma multiforme, WHO grade IV. 0% of tumor necrosis. 90% of tumor cellularity. D. BRAIN, LEFT TEMPORAL, EXCISION, NCI #2: Glioblastoma multiforme, WHO grade IV. 0% of tumor necrosis. 90% of tumor cellularity. E. BRAIN, LEFT TEMPORAL, EXCISION, NCI #3: Glioblastoma multiforme, WHO grade IV. 40% of tumor necrosis. 95% of tumor cellularity. F. BRAIN, LEFT TEMPORAL, EXCISION, NCI #4: Glioblastoma multiforme, WHO grade IV. 70% of tumor necrosis. 95% of tumor cellularity. G. BRAIN, LEFT TEMPORAL, EXCISION, NCI #5: Glioblastoma multiforme, WHO grade IV. 30% of tumor necrosis. 95% of tumor cellularity. H-J. BRAIN, LEFT TEMPORAL, EXCISIONAL BIOPSY: Glioblastoma multiforme, WHO grade IV. COMMENT: A high percentage of tumor cells (greater than 20%) immunostaining for has been reported to be associated with a relatively diminished response to the 60% result in this case suggests the possibility of a relatively diminished response to. Recent studies have shown that co-expression of EGFRvIII and PTEN as detected by immunostaining was significantly correlated with a clinical response of glioblastomas to EGFR kinase inhibitors. Hence the preserved expression of PTEN in this case, when combined with EGFRvIII mutation, permits a possibility of this tumor being responsive to EGFR-kinase inhibitors. Retained expression of PTEN was found to be associated with a more favorable prognosis in patients with high grade gliomas. Subclasses of high-grade glioma predict prognosis, delineate a pattern of disease progression, and resemble stages in neurogenesis. Cancer Cell. Recent studies indicated an adverse prognostic significance of increased expression of laminin beta 1 and decreased expression of laminin beta 2 predicting a worse survival of patients with gliomas. Association between laminin-8 and glial tumor grade, recurrence, and patient survival. Accordingly, elevated expression of beta 1 and suppressed expression of beta 2 in this tumor predict more aggressive behavior. Presence of activated (phosphorylated) p42/44 Mitogen-Activated Protein Kinase (pMAPK) often is indicative of an upregulation of receptor tyrosine kinase signaling. It has been shown to be associated with a relative resistance to radiation therapy in glioblastoma multiforme. The use of these tests in guiding therapy has limitations. Review of the relevant literature and clinical correlation is advised. These test results do not obligate or preclude use of the relevant therapeutic agents. HISTORY: Pre-operative diagnosis: left frontal tumor. MICROSCOPIC FINDINGS: These focally necrotic infiltrating high-grade astrocytoma shows enlarged hyperchromatic pleomorphic nuclei showing numerous mitotic figures and associated with florid endothelial proliferation. IMMUNOHISTOCHEMISTRY: Study/Antibody. Block. MGMT. J8. Up to 60%. PTEN. J8. Retained (3+). pMAPK. J8. Up to 80% of tumor nuclei and 90% of cytoplasm is positive. Laminin beta-1 (8/411). J8. Upregulated (2+) with some glial cells positive. Laminin beta-2 (9/421). J8. Focal paranuclear retention (1+). EGFR by FISH. J8. Pending. GROSS: A. LEFT FRONTAL SKIN LESION. Labeled with the patient's name, labeled "left frontal skin lesion" and received fresh for intraoperative consultation and subsequently submitted in formalin is an oriented hair-bearing pale tan skin ellipse with attached subcutaneous tissue measuring 2.3 x 0.7 cm and excised to a depth of 0.7 cm. ddendum - Please See End of Report. Along the skin surface there is a centrally located flesh colored papule measuring 0.6 x 0.4 cm and comes within 1.0 cm of the front tip, abuts the right margin, 0.3 cm away from the back tip and 0.1 cm away from the left margin. Entirely submitted. Slide key: A1. Frozen remnant - 1. A2. Front tip, bisected - 2. A3. Back tip, bisected - 2. A4, A5. Remaining sections - 3 each. B. LEFT FRONTAL TEMPORAL FS. Labeled with the patient's name, labeled "left temporal FS" and received fresh for intraoperative consultation and subsequently submitted in formalin is a 1.4 x 0.5 X 0.3 cm aggregate of multiple soft pale tan slightly hemorrhagic tissue fragments. Entirely submitted. Slide key: B1. Frozen remnant - multiple. B2. Remaining tissue - multiple. C. LEFT TEMPORAL NCI #1. Labeled with the patient's name, labeled "left temporal NCI #1" and received in formalin is a 1.2 X 0.7 X 0.3 cm aggregate of multiple soft pale tan-pink slightly hemorrhagic tissue fragments. Entirely submitted. C1. Multiple. D. LEFT TEMPORAL NCI #2. Labeled with the patient's name, labeled "left temporal NCI #2" and received in formalin is a 1.1 x 0.5 X 0.3 cm irregular portion of soft pink-tan slightly hemorrhagic tissue. Entirely submitted. D1. 2. E. LEFT TEMPORAL NCI #3. Labeled with the patient's name, labeled "left temporal NCI #3" and received in formalin is a 0.9 X 0.7 X 0.4 cm irregular portion of soft pink-tan slightly hemorrhagic tissue. Entirely submitted. E1. 2. F. LEFT TEMPORAL NCI #4. Labeled with the patient's name, labeled "left temporal NCI #4" and received in formalin is a 0.8 X 0.6 x 0.4 cm irregular portion of soft pink-tan slightly hemorrhagic tissue. Entirely submitted. F1. 2. G. LEFT TEMPORAL NCI #5. Labeled with the patient's name, labeled "left temporal NCI #5" and received in formalin is a 1.0 X 0.8 x 0.3 cm irregular portion of soft pink-tan slightly hemorrhagic tissue. Entirely submitted. G1. 2. H. LEFT TEMPORAL PERMANENT. Labeled with the patient's name, labeled "left temporal permanent" and received in formalin is a 1.6 x 1.1 X 0.3 cm aggregate of soft pale tan slightly hemorrhagic tissue. Entirely submitted. Addendum - Please See End of Report. H1. Multiple. I. LEFT TEMPORAL, CLINICAL TRIAL. Labeled with the patient's name, labeled "left temporal clinical trial" and received in formalin is a 1.4 X 0.5 X 0.4 cm irregular portion of soft pale tan hemorrhagic tissue. Entirely submitted. 11. 1. J. LEFT TEMPORAL MASS. Labeled with the patient's name, labeled "left temporal mass" and received in formalin is an unoriented portion of the temporal lobe measuring 4.3 x 3.7 X 2.9 cm. The gyri are slightly dilated. The cut surface reveals diffusely necrotic slightly friable pale tan tissue. Entirely submitted. Slide key: J1-J14. 1, 2, 1, 1, 2, 3, 1, 3, 1, 1, 1, 1, 1,1. Gross dictated by INTRAOPERATIVE CONSULTATION: OPERATIVE CALL. OPERATIVE CONSULT (FROZEN AND TP): A) LEFT FRONTAL SKIN FS: Seborrheic keratosis, extending to the right excisional margin. B) LEFT TEMPORAL FS + TP: Glioblastoma. I have personally examined the specimen, interpreted the results, reviewed the report and signed it electronically. Addendum - Please See End of Report. FLUORESCENCE IN SITU HYBRIDIZATION (FISH) for EGFR in BRAIN. Tissue Block: J8. POSITIVE for EGFR Amplification (See note below). Number of cells evaluated: 40. INTERPRETATION: Fluorescence in situ hybridization (FISH) analysis on a brain tumor sample from this patient with Abbott Molecular probes specific for the centromere of chromosome 7 (control probe) and the short arm (EGFR-. 7p12) of chromosome 7 was performed. The control sample gave expected results. These studies showed amplification of the EGFR gene with a 8.1 ratio of EGFR signals to the centromere signals in 72.5% of the nuclei examined. NOTE: 1. Samples are considered positive in brain if the EGFR to CEP 7 signal ratio is 2.0 in 10% of analyzed cells or tumors with four or more copies of the EGFR gene in 40% of the cells (high polysomy). 2. Samples are considered inconclusive, requiring consult with the pathologist, in brain if the EGFR to CEP 7 signal ratio is 2.0 in <10% of analyzed cells or when four or more copies of the EGFR gene in <40% of the cells. References: These FISH tests were developed and their performance characteristics determined by as required by the CLIA regulations. They have not been cleared or approved for specific uses by the U.S. Food and Drug Administration. I have personally examined the specimen, interpreted the results, reviewed the report and signed it electronically.
P0316
52
male
white
not reported
Glioblastoma
null
null
null
Progression
9440/3
Not Reported
null
not reported
Not Reported
Dead
544
1
544
544
null
148
null
Yes
Unknown
Radiation Therapy, NOS|Pharmaceutical Therapy, NOS|Chemotherapy|Radiation, Stereotactic/Gamma Knife/SRS|Radiation, External Beam
Temozolomide|Bevacizumab|Irinotecan Hydrochloride
149
null
A. BRAIN, RIGHT FRONTAL, EXCISIONAL BIOPSY: Glioblastoma multiforme, WHO grade IV. 10% of tumor necrosis. 95% of tumor cellularity. B. BRAIN, RIGHT FRONTAL, EXCISIONAL BIOPSY, NCI #1: Glioblastoma multiforme, WHO grade IV. 10% of tumor necrosis. 95% of tumor cellularity. C. BRAIN, RIGHT FRONTAL, EXCISIONAL BIOPSY, NCI #2: Glioblastoma multiforme, WHO grade IV. 10% of tumor necrosis. 95% of tumor cellularity. D. BRAIN, RIGHT FRONTAL, EXCISIONAL BIOPSY, NCI #3: Glioblastoma multiforme, WHO grade IV. 10% of tumor necrosis. 95% of tumor cellularity. E. BRAIN, RIGHT FRONTAL, EXCISIONAL BIOPSY, NCI #4: Glioblastoma multiforme, WHO grade IV. 2% of tumor necrosis. 95% of tumor cellularity. F. BRAIN, RIGHT FRONTAL, EXCISIONAL BIOPSY, NCI #5: Glioblastoma multiforme, WHO grade IV. 0% of tumor necrosis. 90% of tumor cellularity. G. BRAIN, RIGHT FRONTAL, EXCISIONAL BIOPSY, NCI #6: Glioblastoma multiforme, WHO grade IV. 0% of tumor necrosis. 95% of tumor cellularity. H. BRAIN, RIGHT FRONTAL, EXCISIONAL BIOPSY, NCI #7: Glioblastoma multiforme, WHO grade IV. 0% of tumor necrosis. 95% of tumor cellularity. I. BRAIN, RIGHT FRONTAL, EXCISIONAL BIOPSY, NCI #8: Glioblastoma multiforme, WHO grade IV. 0% of tumor necrosis. 95% of tumor cellularity. J. BRAIN, RIGHT FRONTAL, EXCISIONAL BIOPSY, NCI #9: Glioblastoma multiforme, WHO grade IV. 0% of tumor necrosis. 95% of tumor cellularity. K. BRAIN, RIGHT FRONTAL, EXCISIONAL BIOPSY, NCI #10: Glioblastoma multiforme, WHO grade IV. 0% of tumor necrosis. 95% of tumor cellularity. L. BRAIN, RIGHT FRONTAL, EXCISIONAL BIOPSY: Glioblastoma multiforme, WHO grade IV. M. BRAIN, RIGHT FRONTAL, EXCISIONAL BIOPSY, CLINICAL TRIAL: Glioblastoma multiforme, WHO grade IV. 2% of tumor necrosis. N. BRAIN, RIGHT FRONTAL, EXCISIONAL BIOPSY: Glioblastoma multiforme, WHO grade IV. Comment: A high percentage of tumor cells (greater than 20%) immunostaining for MGMT has been reported to be. associated with a relatively diminished response to. Hence,. the low 5% result in this case suggests a likelihood of this tumor being responsive to. Recent studies have shown that co-expression of EGFRvIII and PTEN as detected by immunostaining. was significantly correlated with a clinical response of glioblastomas to EGFR kinase inhibitors. Hence the preserved expression of PTEN in this case, when combined. with EGFRvIII mutation, permits a possibility of this tumor being responsive to EGFR-kinase inhibitors. Retained expression of PTEN was found to be associated with a more favorable prognosis in patients. with high grade gliomas. subclasses of high-grade glioma predict prognosis, delineate a pattern of disease progression, and. resemble stages in neurogenesis. Cancer Cell. Recent studies indicated an adverse prognostic significance of increased expression of laminin beta 1. and decreased expression of laminin beta 2 predicting a worse survival of patients with gliomas. Association between laminin-8 and glial tumor grade, recurrence, and patient survival. Accordingly, elevated expression of beta 1 and suppressed expression of beta 2 in this tumor predict. more aggressive behavior. Presence of activated (phosphorylated) p42/44 Mitogen-Activated Protein Kinase (pMAPK) often is. indicative of an upregulation of receptor tyrosine kinase signaling. It has been shown to be associated. with a relative resistance to radiation therapy in glioblastoma multiforme. Correspondingly, a high percentage of tumor cells immunoreactive to pMAPK antibody in this case may. predict a relative resistance to radiation therapy. The use of these tests in guiding therapy has limitations. Review of the relevant literature and clinical. correlation is advised. These test results do not obligate or preclude use of the relevant therapeutic. agents. GROSS: A. RIGHT FRONTAL FS #1. Labeled with the patient's name, labeled "right frontal" and received fresh for intraoperative consultation. and subsequently fixed in formalin is three portions of brown-tan tissue ranging in size from 0.3 to 0.7 cm. in greatest dimension. Entirely submitted.. FSA1 - 2.. Remaining unfrozen tissue - 2. B. RIGHT FRONTAL NCI #1. Labeled with the patient's name, labeled "right frontal NCI #1" and received fresh and subsequently fixed. in formalin is a 1.6 X 1.0 x 0.3 cm portion of pink-tan tissue. Entirely submitted.. 1. C. RIGHT FRONTAL NCI #2. Labeled with the patient's name, labeled "right frontal NCI #2" and received fresh and subsequently fixed. in formalin is a 1.5 x 0.5 X 0.5 cm portion of tan tissue. Entirely submitted.. 1. D. RIGHT FRONTAL NCI #3. Labeled with the patient's name, labeled "right frontal NCI #3" and received fresh and subsequently fixed. in formalin is a 1.0 X 0.5 X 0.5 cm portion of tan tissue. Entirely submitted.. 1. E. RIGHT FRONTAL NCI #4. Labeled with the patient's name, labeled "right frontal NCI #4" and received fresh and subsequently fixed. in formalin is a 1.3 x 0.5 X 0.4 cm portion of tan tissue. Entirely submitted.. 1. F. RIGHT FRONTAL NCI #5. Labeled with the patient's name, labeled "right frontal NCI #5" and received fresh and subsequently fixed. in formalin are two portions of tan tissue measuring 1.0 x 0.7 x 0.3 cm and 1.0 X 0.4 x 0.3 cm. Entirely. submitted.. 2. G. RIGHT FRONTAL NCI #6. Labeled with the patient's name, labeled "right frontal NCI #6" and received fresh is a 1.5 X 0.7 X 0.3 cm. portion of tan tissue. Entirely submitted.. 1. H. RIGHT FRONTAL NCI #7. Labeled with the patient's name, labeled "right frontal NCI #7" and received fresh is a 1.4 X 0.7 x 0.5 cm. portion of tan tissue. Entirely submitted.. 1. I. RIGHT FRONTAL NCI #8. Labeled with the patient's name, labeled "right frontal NCI #8" and received fresh are three portions of tan. tissue measuring 0.5 to 1.2 cm in greatest dimension. Entirely submitted. 11. 3. J. RIGHT FRONTAL NCI #9. Labeled with the patient's name, labeled "right frontal NCI #9" and received fresh is a 1.4 X 0.7 x 0.4 cm. portion of tan tissue. Entirely submitted.. 1. K. RIGHT FRONTAL NCI #10. Labeled with the patient's name, labeled "right frontal NCI #10" and received fresh is a 0.8 X 0.8 x 0.5 cm. fragment of tan-gray tissue. Entirely submitted.. 1. L. RIGHT FRONTAL PERMANENT. Labeled with the patient's name, labeled "right frontal clinical trial study" and received in formalin are two. portions of tan tissue, measuring 1.2 and 1.3 cm in greatest dimension. Entirely submitted.. 2. Gross dictated by. INTRAOPERATIVE CONSULTATION: OPERATIVE CALL. OPERATIVE CONSULT (FROZEN AND TP): A. RIGHT FRONTAL FS AND TP: High-grade glioma. I have personally examined the specimen, interpreted the results, reviewed the report and signed it electronically. If this report includes immunohistochemical test results, please note the following: Numerous immunohistochemical tests were developed and their. performance characteristics determined by. Those. immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required.
P0318
42
male
black or african american
not reported
Glioblastoma
null
null
null
Progression
9440/3
Not Reported
null
not reported
Not Reported
Alive
358
0
null
358
null
225
null
Yes
WT-With Tumor
Pharmaceutical Therapy, NOS|Chemotherapy|Radiation Therapy, NOS|Radiation, External Beam
Temozolomide|Irinotecan Hydrochloride|Bevacizumab
-1
null
Here's the deidentified and cleaned text, removing all the specified elements: A. BRAIN, RIGHT PARIETAL, EXCISIONAL BIOPSY: Glioblastoma multiforme, WHO grade IV. B. BRAIN, RIGHT PARIETAL, EXCISIONAL BIOPSY: Glioblastoma multiforme, WHO grade IV. C. BRAIN, RIGHT PARIETAL, NCI #1: Glioblastoma multiforme, WHO grade IV. 80% of tumor necrosis. 90% of tumor cellularity. D. BRAIN, RIGHT PARIETAL, NCI #2: Glioblastoma multiforme, WHO grade IV. 90% of tumor necrosis. 90% of tumor cellularity. E. BRAIN, RIGHT PARIETAL, EXCISIONAL BIOPSY, NCI #3: Glioblastoma multiforme, WHO grade IV. 50% of tumor necrosis. 90% of tumor cellularity. F. BRAIN, RIGHT PARIETAL, EXCISIONAL BIOPSY, NCI #4: Glioblastoma multiforme, WHO grade IV. 60% of tumor necrosis. 90% of tumor cellularity. G. BRAIN, RIGHT PARIETAL, EXCISIONAL BIOPSY, NCI #5: Glioblastoma multiforme, WHO grade IV. 60% of tumor necrosis. 90% of tumor cellularity. H. BRAIN, RIGHT PARIETAL, EXCISIONAL BIOPSY, NCI #6: Glioblastoma multiforme, WHO grade IV. 30% of tumor necrosis. 90% of tumor cellularity. I. BRAIN, RIGHT PARIETAL, EXCISIONAL BIOPSY: Glioblastoma multiforme, WHO grade IV. J. BRAIN, RIGHT PARIETAL, EXCISIONAL BIOPSY: Patient Case(s): Copy For. Page TOTO. PATIENT NOTIFIED OF RESULTS. Glioblastoma multiforme, WHO grade IV. COMMENT: A high percentage of tumor cells (greater than 20%) immunostaining for MGMT has been reported to be. associated with a relatively diminished response to. Hence,. the 20% result in this case suggests the possibility of a relatively diminished response to. Recent studies have shown that co-expression of EGFRvIII and PTEN as detected by immunostaining. was significantly correlated with a clinical response of glioblastomas to EGFR kinase inhibitors. Hence the preserved expression of PTEN in this case, when combined. with EGFRvIII mutation, permits a possibility of this tumor being responsive to EGFR-kinase inhibitors. Retained expression of PTEN was found to be associated with a more favorable prognosis in patients. with high grade gliomas. subclasses of high-grade glioma predict prognosis, delineate a pattern of disease progression, and. resemble stages in neurogenesis. Cancer Cell. Recent studies indicated an adverse prognostic significance of increased expression of laminin beta 1. and decreased expression of laminin beta 2 predicting a worse survival of patients with gliomas. Association between laminin-8 and glial tumor grade, recurrence, and patient survival. Accordingly, elevated expression of beta 1 and suppressed expression of beta 2 in this tumor predict. more aggressive behavior. Presence of activated (phosphorylated) p42/44 Mitogen-Activated Protein Kinase (pMAPK) often is. indicative of an upregulation of receptor tyrosine kinase signaling. It has been shown to be associated. with a relative resistance to radiation therapy in glioblastoma multiforme. Correspondingly, a high percentage of tumor cells immunoreactive to pMAPK antibody in this case may. predict a relative resistance to radiation therapy. The use of these tests in guiding therapy has limitations. Review of the relevant literature and clinical. correlation is advised. These test results do not obligate or preclude use of the relevant therapeutic. agents. HISTORY: Brain tumor. MICROSCOPIC FINDINGS: As best revealed on part B and J the tumor is composed of a hypercellular proliferation of pleomorphic. nuclei associated with mitotic figures. The tumor is extensively necrotic and contains blood vessels with. endothelial proliferation. Some gemistocytic element is detected and there are also cells with perinuclear. clearing, but those are rare. Sections on part I predominantly demonstrate cortex and white matter with. minimal tumor load. IMMUNOHISTOCHEMISTRY: Study/Antibody. Block. MGMT.. Up to 20%. PTEN.. Retained (1-2+). pMAPK.. Up to 95% of tumor nuclei and cytoplasm is positive. Laminin beta 1 (8/411).. Up-regulated (2-3+). Laminin beta 2 (9/421).. Focal down-regulation with paranuclear retention. Addendum - Please See End of Report... Up to 5% of tumor nuclei are weakly positive (1+). GROSS: A. RIGHT PARIETAL FROZEN SECTION. Labeled with the patient's name, labeled "right parietal FS", and received fresh in the Operating Room for. frozen section consultation and subsequently fixed in formalin is one portion of tan soft tissue that has. previously been submitted for frozen section consultation that measures 0.5 X 0.3 x 0.1 cm. Entirely. submitted.. FSA remnant - 1. B. RIGHT PARIETAL. Labeled with the patient's name, labeled "right parietal", and received in formalin are two portions of tan. soft tissues that measure in aggregate to 0.7 x 0.5 x 0.4 cm. The individual fragments range in size from. 0.2 to 0.7 cm in greatest dimension. There are focal areas of hemorrhage on the cut surface. No other. lesions are grossly identified. Entirely submitted.. 3. C. RIGHT PARIETAL NCI #1 - STUDY. Labeled with the patient's name, labeled "right parietal NCI #1 - study", and received in formalin is a. single portion of tan soft tissue that measures 0.3 x 0.3 x 0.1 cm. No lesions are grossly identified. Entirely submitted.. 1. D. RIGHT PARIETAL NCI #2 - STUDY. Labeled with the patient's name, labeled "right parietal NCI #2 - study", and received in formalin are two. portions of tan soft tissue that measure in aggregate to 0.5 x 0.3 x 0.1 cm. No lesions are grossly. identified. Entirely submitted.. 2. E. RIGHT PARIETAL NCI #3 - STUDY. Labeled with the patient's name, labeled "right parietal NCI #3 - study", and received in formalin is a. single portion of tan soft tissue that measures 0.3 x 0.3 x 0.1 cm. No lesions are grossly identified. Entirely submitted.. 1. F. RIGHT PARIETAL NCI #4 - STUDY. Labeled with the patient's name, labeled "right parietal NCI #4 - study", and received in formalin is a. single portion of tan soft tissue that measures 0.3 x 0.3 x 0.1 cm. No lesions are grossly identified. Entirely submitted.. 1. G. RIGHT PARIETAL NCI #5 - STUDY. Labeled with the patient's name, labeled "right parietal NCI #5 - study", and received in formalin is a. single portion of tan soft tissue that measures 0.3 x 0.3 x 0.1 cm. No lesions are grossly identified. Entirely submitted.. 1. H. RIGHT PARIETAL, EXCISIONAL BIOPSY: Glioblastoma multiforme, WHO grade IV. I. BRAIN, RIGHT PARIETAL, EXCISIONAL BIOPSY: Glioblastoma multiforme, WHO grade IV. J. BRAIN, RIGHT PARIETAL, EXCISIONAL BIOPSY: Patient Case(s): Copy For. Page TOTO. PATIENT NOTIFIED OF RESULTS. Addendum - Please See End of Report. FLUORESCENCE IN SITU HYBRIDIZATION (FISH) for EGFR in BRAIN. Tissue Block:. POSITIVE for EGFR Amplification (See note below). Number of cells evaluated: 40. INTERPRETATION: Fluorescence in situ hybridization (FISH) analysis on a brain tumor sample from this patient with Abbott. Molecular probes specific for the centromere of chromosome 7 (control probe) and the short arm (EGFR-. 7p12) of chromosome 7 was performed. The control sample gave expected results. These studies showed amplification of the EGFR gene with a 4.4 ratio of EGFR signals to the centromere. signals in 85.0% of the nuclei examined. NOTE: 1. Samples are considered positive in brain if the EGFR to CEP 7 signal ratio is 2.0 in > 10% of analyzed cells or tumors with four. or more copies of the EGFR gene in 40% of the cells (high polysomy). 2. Samples are considered inconclusive, requiring consult with the pathologist, in brain if the EGFR to CEP
P0319
72
male
white
not reported
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Alive
951
0
null
951
null
null
null
null
WT-With Tumor
Chemotherapy|Radiation, External Beam
Temozolomide
11
Treatment Ongoing
Glioblastoma multiforme, WHO grade IV. 20% of tumor necrosis. 80% of tumor cellularity. Glioblastoma multiforme, WHO grade IV. 20% of tumor necrosis. 70% of tumor cellularity. Glioblastoma multiforme, WHO grade IV. 10% of tumor necrosis. 50% of tumor cellularity. Glioblastoma multiforme, WHO grade IV. 10% of tumor necrosis. 80% of tumor cellularity. Glioblastoma multiforme, WHO grade IV. 50% of tumor necrosis. 50% of tumor cellularity. Glioblastoma multiforme, WHO grade IV. 0% of tumor necrosis. 60% of tumor cellularity. Glioblastoma multiforme, WHO grade IV. 5% of tumor necrosis. 90% of tumor cellularity. Glioblastoma multiforme, WHO grade IV... Up to 1% (3+). MGMT.. Up to 90%. PTEN.. Retained (1-2+). pMAPK.. Up to 40% of nuclei and 60% of cytoplasm is positive. Laminin beta 1 (8/411).. Up-regulated (3+). Laminin beta 2 (9/421).. Focally down-regulated (1+). EGFR by FISH.. Pending. Glioblastoma multiforme, WHO grade IV. Numerous immunohistochemical tests were developed and their. performance characteristics determined by. Those. immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required. Glioblastoma multiforme, WHO grade IV. Numerous immunohistochemical tests were developed and their. performance characteristics determined by. Those. immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required. Glioblastoma multiforme, WHO grade IV. Numerous immunohistochemical tests were developed and their. performance characteristics determined by. Those. immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required. Glioblastoma multiforme, WHO grade IV. Numerous immunohistochemical tests were developed and their. performance characteristics determined by. Those. immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required. Glioblastoma multiforme, WHO grade IV. Numerous immunohistochemical tests were developed and their. performance characteristics determined by. Those. immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required. Glioblastoma multiforme, WHO grade IV. Numerous immunohistochemical tests were developed and their. performance characteristics determined by. Those. immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required. Glioblastoma multiforme, WHO grade IV. Numerous immunohistochemical tests were developed and their. performance characteristics determined by. Those. immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required. Glioblastoma multiforme, WHO grade IV. Numerous immunohistochemical tests were developed and their. performance characteristics determined by. Those. immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required. Glioblastoma multiforme, WHO grade IV. Numerous immunohistochemical tests were developed and their. performance characteristics determined by. Those. immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required. Glioblastoma multiforme, WHO grade IV. Numerous immunohistochemical tests were developed and their. performance characteristics determined by. Those. immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required. Glioblastoma multiforme, WHO grade IV. Numerous immunohistochemical tests were developed and their. performance characteristics determined by. Those. immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required. Glioblastoma multiforme, WHO grade IV. Numerous immunohistochemical tests were developed and their. performance characteristics determined by. Those. immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required. Glioblastoma multiforme, WHO grade IV. Numerous immunohistochemical tests were developed and their. performance characteristics determined by. Those. immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required. Glioblastoma multiforme, WHO grade IV. Numerous immunohistochemical tests were developed and their. performance characteristics determined by. Those. immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required. Glioblastoma multiforme, WHO grade IV. Numerous immunohistochemical tests were developed and their. performance characteristics determined by. Those. immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required. Glioblastoma multiforme, WHO grade IV. Numerous immunohistochemical tests were developed and their. performance characteristics determined by. Those. immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required. Glioblastoma multiforme, WHO grade IV. Numerous immunohistochemical tests were developed and their. performance characteristics determined by. Those. immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required. Glioblastoma multiforme, WHO grade IV. Numerous immunohistochemical tests were developed and their. performance characteristics determined by. Those. immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required. Glioblastoma multiforme, WHO grade IV. Numerous immunohistochemical tests were developed and their. performance characteristics determined by. Those. immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required. Glioblastoma multiforme, WHO grade IV. Numerous immunohistochemical tests were developed and their. performance characteristics determined by. Those. immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required. Glioblastoma multiforme, WHO grade IV. Numerous immunohistochemical tests were developed and their. performance characteristics determined by. Those. immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required. Glioblastoma multiforme, WHO grade IV. Numerous immunohistochemical tests were developed and their. performance characteristics determined by. Those. immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required. Glioblastoma multiforme, WHO grade IV. Numerous immunohistochemical tests were developed and their. performance characteristics determined by. Those. immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required. Glioblastoma multiforme, WHO grade IV. Numerous immunohistochemical tests were developed and their. performance characteristics determined by. Those. immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required. Glioblastoma multiforme, WHO grade IV. Numerous immunohistochemical tests were developed and their. performance characteristics determined by. Those. immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required. Glioblastoma multiforme, WHO grade IV. Numerous immunohistochemical tests were developed and their. performance characteristics determined by. Those. immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required. Glioblastoma multiforme, WHO grade IV. Numerous immunohistochemical tests were developed and their. performance characteristics determined by. Those. immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required. Glioblastoma multiforme, WHO grade IV. Numerous immunohistochemical tests were developed and their. performance characteristics determined by. Those. immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required. Glioblastoma multiforme, WHO grade IV. Numerous immunohistochemical tests were developed and their. performance characteristics determined by. Those. immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required. Glioblastoma multiforme, WHO grade IV. Numerous immunohistochemical tests were
P0320
53
male
white
not reported
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Dead
713
1
713
713
null
247
null
Yes
WT-With Tumor
Chemotherapy|Radiation, Stereotactic/Gamma Knife/SRS|Radiation, External Beam|Radiation Therapy, NOS|Surgery, NOS|Pharmaceutical Therapy, NOS
Bevacizumab|Irinotecan Hydrochloride|Temozolomide
262
Treatment Ongoing
A. BRAIN, LEFT TEMPORAL, BIOPSY: Glioblastoma multiforme, WHO grade IV. B. BRAIN, LEFT TEMPORAL, EXCISIONAL BIOPSY, NCI #: Glioblastoma multiforme, WHO grade IV. 5% of tumor necrosis. 95% of tumor cellularity. C. BRAIN, LEFT TEMPORAL, EXCISIONAL BIOPSY, NCI #: Glioblastoma multiforme, WHO grade IV. 30% of tumor necrosis. 95% of tumor cellularity. D. BRAIN, LEFT TEMPORAL, EXCISIONAL BIOPSY, NCI #: Glioblastoma multiforme, WHO grade IV. 2% of tumor necrosis. 95% of tumor cellularity. E. BRAIN, LEFT TEMPORAL, EXCISIONAL BIOPSY, NCI #: Glioblastoma multiforme, WHO grade IV. 30% of tumor necrosis. 95% of tumor cellularity. F. BRAIN, LEFT TEMPORAL, EXCISIONAL BIOPSY, NCI #: Glioblastoma multiforme, WHO grade IV. 5% of tumor necrosis. 95% of tumor cellularity. G. BRAIN, LEFT TEMPORAL, EXCISIONAL BIOPSY, NCI #: Glioblastoma multiforme, WHO grade IV. 0% of tumor necrosis. 95% of tumor cellularity. H. BRAIN, LEFT TEMPORAL, EXCISIONAL BIOPSY, NCI #: Glioblastoma multiforme, WHO grade IV. 0% of tumor necrosis. 95% of tumor cellularity. I. BRAIN, LEFT TEMPORAL, EXCISIONAL BIOPSY, NCI #: Glioblastoma multiforme, WHO grade IV. 3% of tumor necrosis. 95% of tumor cellularity. J. BRAIN, LEFT TEMPORAL, EXCISIONAL BIOPSY, NCI #: Glioblastoma multiforme, WHO grade IV. 3% of tumor necrosis. 95% of tumor cellularity. K. BRAIN, LEFT TEMPORAL, CLINICAL TRIAL: Glioblastoma multiforme, WHO grade IV. L, M. BRAIN, LEFT TEMPORAL, EXCISIONAL BIOPSY: Glioblastoma multiforme, WHO grade IV. COMMENT: A high percentage of tumor cells (greater than 20%) immunostaining for MGMT has been reported to be associated with a relatively diminished response to. Hence,. the 70% result in this case suggests the possibility of a relatively diminished response to. Recent studies have shown that co-expression of EGFRvIII and PTEN as detected by immunostaining was significantly correlated with a clinical response of glioblastomas to EGFR kinase inhibitors. Hence the loss of PTEN in this case suggests a diminished probability of response to EGFR-Kinase inhibitors. Recent studies indicated an adverse prognostic significance of increased expression of laminin beta 1 and decreased expression of laminin beta 2 predicting a worse survival of patients with gliomas. Association between laminin-8 and glial tumor grade, recurrence, and patient survival. Accordingly, elevated expression of B1 and ß2 in this tumor suggest the tumor aggressiveness, intermediate between the B1U (or normal)/82 normal (or ii) (the most favorable prognosis) and Bill/ B2V (least favorable prognosis). Presence of activated (phosphorylated) p42/44 Mitogen-Activated Protein Kinase (pMAPK) often is indicative of an upregulation of receptor tyrosine kinase signaling. It has been shown to be associated with a relative resistance to radiation therapy in glioblastoma multiforme. Cancer Res. Correspondingly, presence of a large fraction of cells immunonegative to pMAPK antibody in this case suggests a likelihood of this tumor being responsive to radiation therapy. The use of these tests in guiding therapy has limitations. Review of the relevant literature and clinical correlation is advised. These test results do not obligate or preclude use of the relevant therapeutic agents. HISTORY: Pre-operative diagnosis: Frontal glioma. MICROSCOPIC FINDINGS: Sections disclose infiltrating densely cellular proliferation of pleomorphic hyperchromatic angulate nuclei, associated with numerous mitotic figures. The nuclei demonstrate high pleomorphism and multinucleation. Endothelial proliferation and necrosis are conspicuous. IMMUNOHISTOCHEMISTRY: Study/Antibody. Block. Addendum - Please See End of Report. P53. M2. Up to 5% (1-3+). Ki-67. M2. Up to 25%. MGMT. M2. Up to 70% (1-2+). PTEN. M2. Loss (0-1+). pMAPK. M2. Up to 10% of tumor nuclei and 20% of cytoplasm positive. Laminin beta-1 (8/411). M2. Upregulated (2+). Laminin beta-2 (9/421). M2. Upregulated (2-3+). EGFR by FISH. M2. Pending. GROSS: A. LEFT TEMPORAL MASS. Labeled with the patient's name, labeled "left temporal mass", and received fresh for intraoperative consultation and subsequently submitted in formalin is a 1.1 x 0.7 x 0.2 cm aggregate of multiple soft pale tan-brown cortical tissue fragments with adherent blood clot. Entirely submitted. Slide key: A1. Frozen remnant - multiple. A2. Remaining tissue - multiple. B. LEFT TEMPORAL NCI #: 0.9 X 0.8 x 0.3 cm aggregate of multiple soft hemorrhagic pale tan-pink tissue fragments. B1. Multiple. C. LEFT TEMPORAL NCI #: 1.0 x 0.6 X 0.3 cm aggregate of multiple soft hemorrhagic pale tan tissue fragments. C1. Multiple. D. LEFT TEMPORAL NCI #: 3.0% of tumor necrosis. 95% of tumor cellularity. E. LEFT TEMPORAL NCI #: 4.0% of tumor necrosis. 95% of tumor cellularity. F. LEFT TEMPORAL NCI #: 5.0% of tumor necrosis. 95% of tumor cellularity. G. LEFT TEMPORAL NCI #: 6.0% of tumor necrosis. 95% of tumor cellularity. H. LEFT TEMPORAL NCI #: 7.0% of tumor necrosis. 95% of tumor cellularity. I. LEFT TEMPORAL NCI #: 8.0% of tumor necrosis. 95% of tumor cellularity. J. LEFT TEMPORAL NCI #: 9.0% of tumor necrosis. 95% of tumor cellularity. K. LEFT TEMPORAL, CLINICAL TRIAL. L. LEFT TEMPORAL MASS (PERMANENT). FLUORESCENCE IN SITU HYBRIDIZATION (FISH) for EGFR in BRAIN. Addendum - Please See End of Report. Tissue Block: POSITIVE for EGFR Amplification (See note below). Number of cells evaluated: 40. INTERPRETATION: Fluorescence in situ hybridization (FISH) analysis on a brain tumor sample from this patient with Abbott Molecular probes specific for the centromere of chromosome 7 (control probe) and the short arm (EGFR-. 7p12) of chromosome 7 was performed. The control sample gave expected results. These studies showed amplification of the EGFR gene with a 26.4 ratio of EGFR signals to the centromere signals in 87.5% of the nuclei examined. NOTE: 1. Samples are considered positive in brain if the EGFR to CEP 7 signal ratio is 2.0 in 10% of analyzed cells or tumors with four or more copies of the EGFR gene in 40% of the cells (high polysomy). 2. Samples are considered inconclusive, requiring consult with the pathologist, in brain if the EGFR to CEP 7 signal ratio is 2.0 in <10% of analyzed cells or when four or more copies of the EGFR gene in <40% of the cells.
P0321
62
female
white
not reported
Unknown
null
null
null
Unknown
Unknown
Not Reported
null
not reported
Not Reported
Dead
335
1
335
335
null
164
null
Yes
WT-With Tumor
Pharmaceutical Therapy, NOS|Radiation Therapy, NOS|Chemotherapy
Temozolomide|Bevacizumab
null
null
A. BRAIN, RIGHT TEMPORAL, EXCISIONAL BIOPSY; Glioblastoma multiforme, WHO grade IV. B. BRAIN, RIGHT TEMPORAL, EXCISIONAL BIOPSY: Glioblastoma multiforme, WHO grade IV. C. BRAIN, RIGHT TEMPORAL, EXCISIONAL BIOPSY, NCI#: Glioblastoma multiforme, WHO grade IV. 3% of tumor necrosis. 95% of tumor cellularity. D. BRAIN, RIGHT TEMPORAL, EXCISIONAL BIOPSY, NCI#: Glioblastoma multiforme, WHO grade IV. 20% of tumor necrosis. 95% of tumor cellularity. E. BRAIN, RIGHT TEMPORAL, EXCISIONAL BIOPSY, NCI#: Glioblastoma multiforme, WHO grade IV. 0% of tumor necrosis. 95% of tumor cellularity. F. BRAIN, RIGHT TEMPORAL, EXCISIONAL BIOPSY, NCI#: Glioblastoma multiforme, WHO grade IV. 0% of tumor necrosis. 95% of tumor cellularity. G. BRAIN, RIGHT TEMPORAL, EXCISIONAL BIOPSY, NCI#: Glioblastoma multiforme, WHO grade IV. 1% of tumor necrosis. 95% of tumor cellularity. H. BRAIN, RIGHT TEMPORAL, EXCISIONAL BIOPSY, NCI#: Glioblastoma multiforme, WHO grade IV. A high percentage of tumor cells (greater than 20%) immunostaining for MGMT has been reported to be associated with a relatively diminished response to. Hence, the 20% result in this case suggests the possibility of a relatively diminished response to. Patient Case(s). Copy For. PATIENT NOTIFIED OF RESULTS. DR: NURSE: Recent studies have shown that co-expression of EGFRvIII and PTEN as detected by immunostaining was significantly correlated with a clinical response of glioblastomas to EGFR kinase inhibitors. Hence the loss of PTEN in this case suggests a diminished probability of response to EGFR-kinase inhibitors. Recent studies indicated an adverse prognostic significance of increased expression of laminin beta 1 and decreased expression of laminin beta 2 predicting a worse survival of patients with gliomas. Association between laminin-8 and glial tumor grade, recurrence, and patient survival. Accordingly, elevated expression of beta 1 and suppressed expression of beta 2 in this tumor predict more aggressive behavior. Presence of activated (phosphorylated) p42/44 Mitogen-Activated Protein Kinase (pMAPK) often is indicative of an upregulation of receptor tyrosine kinase signaling. It has been shown to be associated with a relative resistance to radiation therapy in glioblastoma multiforme. Cancer Res. Correspondingly, a high percentage of tumor cells immunoreactive to pMAPK antibody in this case may predict a relative resistance to radiation therapy. The use of these tests in guiding therapy has limitations. Review of the relevant literature and clinical correlation is advised. These test results do not obligate or preclude use of the relevant therapeutic agents. HISTORY: Preoperative diagnosis: Right temporal tumor. MICROSCOPIC FINDINGS: This focally necrotizing diffusely infiltrating astrocytoma is composed of pleomorphic hyperchromatic angulate nuclei associated with numerous mitotic figures, and endothelial proliferation. Focally prominent myxoid matrix is also detected. IMMUNOHISTOCHEMISTRY: Study/Antibody. Block. MGMT. B3. 20%. PTEN. B3. Loss (1+). pMAPK. B3. 60% of tumor nuclei and 70% of cytoplasm is positive. Laminin beta 1 (8/411). B3. Up-regulated (3+ in endothelial cells and staining in the large fraction of tumor cells). Laminin beta 2 (9/421). B3. Focal loss of expression (1+ with paranuclear retention). EGFR. B3. Pending. GROSS: A. RIGHT TEMPORAL LOBE. Labeled with the patient's name, labeled "right temporal lobe", and received in formalin is a 6.3 x 3.7 x 1.8 cm irregular portion of the temporal lobe. Along the outer aspect the gyri and sulci are within normal caliber. The cut surface reveals soft gray-brown tissue with pinpoint areas of hemorrhage. Entirely submitted. Slide key: A1-A24. 1 each. Addendum - Please See End of Report. B. RIGHT TEMPORAL TUMOR FSA. Labeled with the patient's name, labeled "right temporal tumor", and received fresh from intraoperative consultation and subsequently submitted in formalin is a 2.8 x 2.4 x 0.4 cm aggregate of soft hemorrhagic pale tan-brown tissue. Entirely submitted. Slide key: B1. B2. B3, B4. Remaining tissue - Multiple each. C. RIGHT TEMPORAL LOBE NCI#: Labeled with the patient's name, labeled "right temporal lobe" and received in formalin are two pieces of soft pale tan-brown tissue measuring 0.3 and 0.5 cm in greatest dimension. Entirely submitted. Slide key: C1. 2. D. RIGHT TEMPORAL LOBE NCI#: Labeled with the patient's name, labeled "right temporal lobe" and received in formalin are two pieces of soft pale tan-brown tissue measuring 0.3 and 0.5 cm in greatest dimension. Entirely submitted. Slide key: D1. 2. E. RIGHT TEMPORAL LOBE NCI#: Labeled with the patient's name, labeled "right temporal lobe" and received in formalin are two pieces of soft pale tan-brown tissue measuring 0.3 and 0.5 cm in greatest dimension. Entirely submitted. Slide key: E1. 2. F. RIGHT TEMPORAL LOBE NCI#: Labeled with the patient's name, labeled "right temporal lobe" and received in formalin are two pieces of soft pale tan-brown tissue measuring 0.3 and 0.5 cm in greatest dimension. Entirely submitted. Slide key: F1. 2. G. RIGHT TEMPORAL LOBE NCI#: Labeled with the patient's name, labeled "right temporal lobe" and received in formalin are two pieces of soft pale tan-brown tissue measuring 0.3 and 0.5 cm in greatest dimension. Entirely submitted. Slide key: G1. 2. H. RIGHT TEMPORAL LOBE NCI#: Labeled with the patient's name, labeled "right temporal lobe" and received in formalin are two pieces of soft pale tan-brown tissue measuring 0.3 and 0.5 cm in greatest dimension. Entirely submitted. Slide key: H1. 2. Gross dictated by. Addendum - Please See End of Report. INTRAOPERATIVE CONSULTATION: OPERATIVE CALL. OPERATIVE CONSULT (FROZEN): A) RIGHT TEMPORAL LOBE TUMOR, FSA + TPA. High grade glioma consistent with glioblastoma multiforme. I have personally examined the specimen, interpreted the results, reviewed the report and signed it electronically. FLUORESCENCE IN SITU HYBRIDIZATION (FISH) for EGFR in BRAIN. Tissue Block: POLYSOMY of chromosome 7 (See note below). Number of cells evaluated: 40. INTERPRETATION: Fluorescence in situ hybridization (FISH) analysis on a brain tumor sample from this patient with Abbott Molecular probes specific for the centromere of chromosome 7 (control probe) and the short arm (EGFR-. 7p12) of chromosome 7 was performed. The control sample gave expected results. These studies showed polysomy of chromosome 7 in 45% of the nuclei examined. In brain tumors this signal pattern correlates with an amplified EGFR signal pattern. NOTE: 1. Samples are considered positive in brain if the EGFR to CEP 7 signal ratio is 2.0 in > 10% of analyzed cells or tumors with four or more copies of the EGFR gene in 40% of the cells (high polysomy). 2. Samples are considered inconclusive, requiring consult with the pathologist, in brain if the EGFR to CEP 7 signal ratio is 2.0 in <10% of analyzed cells or when four or more copies of the EGFR gene in <40% of the cells. References: These FISH tests were developed and their performance characteristics determined by as required by the CLIA regulations. They have not been cleared or approved for specific uses by the U.S. Food and Drug Administration. Addendum - Please See End of Report. I have personally examined the specimen, interpreted the results, reviewed the report and signed it electronically. If this report includes immunohistochemical test results, please note the following: Numerous immunohistochemical tests were developed and their performance characteristics determined by. Those immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required.
P0323
63
male
white
not reported
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Dead
157
1
157
157
null
null
null
null
null
Chemotherapy|Radiation, External Beam
Temozolomide
68
null
NECROTIC AMORPHOUS DEBRIS. MALIGNANT NEOPLASM, MOST CONSISTENT WITH GLIOSARCOMA, WHO GRADE IV, 0% OF TUMOR NECROSIS, 95% OF TUMOR CELLULARITY. MALIGNANT NEOPLASM, MOST CONSISTENT WITH GLIOSARCOMA, WHO GRADE IV, 0% OF TUMOR NECROSIS, 95% OF TUMOR CELLULARITY. MALIGNANT NEOPLASM, MOST CONSISTENT WITH GLIOSARCOMA, WHO GRADE IV, 0% OF TUMOR NECROSIS, 90% OF TUMOR CELLULARITY. MALIGNANT NEOPLASM, MOST CONSISTENT WITH GLIOSARCOMA, WHO GRADE IV, 0% OF TUMOR NECROSIS, 95% OF TUMOR CELLULARITY. MALIGNANT NEOPLASM, MOST CONSISTENT WITH GLIOSARCOMA, WHO GRADE IV, 5% OF TUMOR NECROSIS, 95% OF TUMOR CELLULARITY. MALIGNANT NEOPLASM, MOST CONSISTENT WITH GLIOSARCOMA, WHO GRADE IV. MALIGNANT NEOPLASM, MOST CONSISTENT WITH GLIOSARCOMA, WHO GRADE IV. MALIGNANT NEOPLASM, MOST CONSISTENT WITH GLIOSARCOMA, WHO GRADE IV. MALIGNANT NEOPLASM, MOST CONSISTENT WITH GLIOSARCOMA, WHO GRADE IV. ACellular DEBRIS. MALIGNANT NEOPLASM. FLUORESCENCE IN SITU HYBRIDIZATION (FISH) for EGFR in BRAIN. Tissue Block: POLYSOMY of chromosome 7 (See note below). Number of cells evaluated: 40. INTERPRETATION: Fluorescence in situ hybridization (FISH) analysis on a brain tumor sample from this patient with Abbott. Molecular probes specific for the centromere of chromosome 7 (control probe) and the short arm (EGFR-. 7p12) of chromosome 7 was performed. The control sample gave expected results. These studies showed polysomy of chromosome 7 in 80% of the nuclei examined. In brain tumors this. signal pattern correlates with an amplified EGFR signal pattern. NOTE: 1. Samples are considered positive in brain if the EGFR to CEP 7 signal ratio is 2.0 in N 10% of. analyzed cells or tumors with four or more copies of the EGFR gene in 40% of the cells (high. polysomy). 2. Samples are considered inconclusive, requiring consult with the pathologist, in brain if the EGFR to. CEP 7 signal ratio is 2.0 in <10% of analyzed cells or when four or more copies of the EGFR gene in <. 40% of the cells. FLUORESCENCE IN SITU HYBRIDIZATION (FISH) for EWSR1 Disruption. See Comment. FISH NOMENCLATURE: nuc ish(EWSR1x2)[197/200]. COMMENT: This test is in validation and is intended for research use only. Within this limitation, no. disruption of EWSR1 was identified. FLUORESCENCE IN SITU HYBRIDIZATION (FISH) analysis with a commercially available probe. that serves to identify a disruption of the EWSR1 (Ewings sarcoma region) gene located at 22q12 was. carried out on 200 interphase cells. Numerous immunohistochemical tests were developed and their. performance characteristics determined by. Those. immunohistochemical tests have not been cleared or approved by the U.S. Food and Drug Administration (FDA), and FDA approval is not required.
P0324
47
female
white
not reported
Unknown
null
null
null
Unknown
Unknown
Not Reported
null
not reported
Not Reported
Alive
690
0
null
690
null
258
null
Yes
WT-With Tumor
Chemotherapy|Radiation, External Beam
Temozolomide
null
null
DIAGNOSIS: A. RIGHT TEMPORAL TUMOR FS #1 (CRANIOTOMY FOR RESECTION): Glioblastoma multiforme, WHO grade IV. B. RIGHT TEMPORAL, NCI PROTOCOL: #1: Cellular tumor without tumor necrosis in both pieces. C. RIGHT TEMPORAL, NCI PROTOCOL #2: Cellular tumor without tumor necrosis in one piece. One piece of mildly hypercellular white mater. D. RIGHT TEMPORAL, NCI PROTOCOL #3: Cellular tumor without tumor necrosis in one piece. One piece of unremarkable gray matter. E. RIGHT TEMPORAL, NCI PROTOCOL #4: Cellular tumor without tumor necrosis in both pieces. F. RIGHT TEMPORAL, NCI PROTOCOL #5: Cellular tumor without tumor necrosis in one piece. One piece of moderately cellular tumor without tumor necrosis. G. RIGHT TEMPORAL (CRANIOTOMY FOR RESECTION): Glioblastoma multiforme, WHO grade IV. H. RIGHT TEMPORAL, CLINICAL TRIAL (CRANIOTOMY): Glioblastoma multiforme, WHO grade IV. I. BRAIN TUMOR (CRANIOTOMY FOR RESECTION): Glioblastoma multiforme, WHO grade IV. J. ARTIFICIAL DURA, RESECTION: Dense fibrous tissue with attached brain tissue showing hemorrhage and. reactive change. K. HARDWARE EXPLANT: Explanted hardware (gross only). COMMENT: Immunostain for MGMT is considered to be negative (less than 2% tumor. cells positive). Tumor cells are essentially negative for P53, with some tumor cells. negative for PTEN (partial PTEN loss) and MAPK. There is high MIB-1 labeling index. Tumor cells are essentially negative for P53, with some tumor cells negative for PTEN (partial PTEN loss) and MAPK. There is high MIB-1 labeling index. Presence of activated (phosphorylated) p42/44 mitogen-activated protein kinase (pMAPK) in glioblastoma multiforme has been shown to be associated with a relative resistance to radiation therapy. Hence, a low percentage of tumor cells immunoreactive to pMAPK antibody (although a cut-off point has not been well established. yet at the moment) in this case may suggest the possibility of a relative response to radiation therapy. Recent studies have shown an adverse prognostic significance of increased laminin ß1 (laminin-8) and decreased laminin ß2 (laminin-9) expression predicting a worse survival of patients with high grade gliomas. Association between. laminin-8 and glial tumor grade, recurrence, and patient survival. Hence, elevated expression of. laminin 1 and decreased expression of ß2 in this tumor may suggest a least favorable prognosis. However, the use of these tests in guiding therapy has limitations. Review of the relevant literature and clinical correlation. is. advised. These test results do not obligate or preclude use of the relevant therapeutic agents. HISTORY: Glioblastoma status post previous biopsy/subtotal resection on. MICROSCOPIC FINDINGS: See diagnosis. SPECIAL STUDIES: EGFR amplification (I2). IMMUNOHISTOCHEMISTRY: MGMT, PTEN, P53, MIB-1, MAPK, Laminin beta 1 and laminin beta 2 (block 12). GROSS: A. RIGHT TEMPORAL TUMOR FS #1. Labeled with the patient's name, not otherwise designated, and received fresh for frozen section evaluation and subsequently fixed in formalin is a 0.4 x 0.3 x 0.2 cm soft tan tissue fragment. Entirely submitted. A1. Frozen section control for FSA1 - 1. B. RIGHT TEMPORAL NCI #1. Labeled with the patient's name, "right temporal NCI", received fresh and subsequently fixed in formalin is a 0.9 x 0.7 X 0,2 cm soft tan tissue fragment. Entirely submitted. B1. 1. C. RIGHT TEMPORAL NCI #2. Labeled with the patient's name, labeled "right temporal NCI", received fresh and subsequently fixed in. formalin is a 0.9 x 0.3 x 0.2 cm soft tan tissue fragment. Entirely submitted. C1. 1. D. RIGHT TEMPORAL NCI #3. dum - Please See End of Report. Labeled with the patient's name, labeled "right temporal NCI", received fresh and subsequently fixed in. formalin is a 0.7 x 0.3 x 0,2 cm soft tan tissue fragment. Entirely submitted. D1. 1. E. RIGHT TEMPORAL NCI #4. Labeled with the patient's name, labeled "right temporal NCI", received fresh and subsequently fixed in. formalin is a 0.7 x 0.6 x 0.3 cm soft tan tissue fragment. Entirely submitted. E1. 1. F. RIGHT TEMPORAL NCI #5. Labeled with the patient's name, labeled "right temporal NCI", received fresh and subsequently fixed in. formalin is a 1.6 x 0.6 x 0.2 cm soft tan tissue fragment. Entirely submitted. F1. 1. G. RIGHT TEMPORAL. Labeled with the patient's name, labeled "right temporal", and received in formalin is a 1.1 x 1.0 X 0.9 cm. aggregate of soft tan friable tissue fragments. Entirely submitted. G1. Largest portion of tissue, trisected - 3. G2. Smaller fragments - multiple. H. RIGHT TEMPORAL CLINICAL TRIAL. Labeled with the patient's name, labeled "right temporal clinical trial", and received in formalin are two tan. soft tissue fragments measuring 0.7 X 0,7 X 0.3 and 0.9 x 0.4 x 0.3 cm. Entirely submitted. H1. 2. I. BRAIN TUMOR. Labeled with the patient's name, labeled "brain tumor", and received in formalin are two friable tan tissue. fragments measuring 1.7 X 0.7 x 0.5 and 2.7 x 0.8 x 0.3 cm. Entirely submitted. I1. Larger portion of tissue - 1. 12. Smaller portion of tissue - 1. J. ARTIFICIAL DURA. Labeled with the patient's name, labeled "artificial dura", and received in formalin is a 3.7 X 2.2 x 0.3 cm. portion of thin membranous tissue with one shiny surface. No masses are seen. Representative. sections are submitted. J1. 4. K. HARDWARE/EXPLANT. Labeled with the patient's name, labeled "hardware/explant", and received in formalin are eight pieces of. gray metallic hardware including five fully threaded screws measuring 0.3 to 0.4 cm in length, each 0.2. cm in diameter. Also received are three metallic plates each measuring 1.1 x 0.3 x 0.1 cm. No. manufacturer inscription is seen and no soft tissue is identified. Gross only. Gross dictated by. INTRAOPERATIVE CONSULTATION: OPERATIVE CALL. OPERATIVE CONSULT (FROZEN AND TP): A. RIGHT TEMPORAL FS AND TP: Glioblastoma. Addondum - Please See End of Report.
P0328
65
male
white
not hispanic or latino
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Dead
15
1
15
15
null
null
null
null
null
Radiation Therapy, NOS|Pharmaceutical Therapy, NOS
null
null
null
NEUROPATHOLOGY REPOHT. SPECIMEN SOURCE: Left frontal tumor. Left frontal brain tumor. GBM. Left frontal lobe. CONTROL. CLINICAL DIAGNOSIS: Brain tumor. GROSS DESCRIPTION: Received fresh for frozen section labeled with the patient's name and β€œleft frontal tumor” are multiple red-tan mucoid soft tissue fragments aggregating to 0. 6 x 0.2 x 0.1 cm. A smear is performed with the remainder frozen on one chuck. FROZEN SECTION DIAGNOSIS: GLIOBLASTOMA. The specimen is subsequently entirely resubmitted in one cassette for permanent sections. Received in formalin labeled with the patient's name and β€œleft frontal. brain tumor” are multiple pink-tan hemorrhagic soft tissue fragments measuring in aggregate size 1.5 x 1.5 x 0.2 cm. The specimen is entirely submitted in one cassette. Received in formalin labeled with the patient's name and β€œleft frontal. lobe” is a 4.2 X 3.1 x 1.1 cm portion of pink-tan soft tissue consistent with cortical brain. There are few foci of hemorrhage and possible tan discoloration. The specimen is serially sectioned perpendicular to the cortical surface, with representative sections (approximately 40%) submitted in three cassettes. MICROSCOPIC DESCRIPTION: Sections demonstrate a neoplasm with increased cellularity and pleomorphic nuclei. The mitotic rate is increased up to 15 mitoses per 10 high power fields. Necrosis is readily identified. DIAGNOSIS: (PROVISIONAL). LEFT FRONTAL TUMOR, BIOPSY AND RESECTION: GLIOBLASTOMA (WHO GRADE IV). ADDENDUM NEUROPATHOLOGY REPORT. ADDENDUM DISCUSSION: Approximately 25-50% of the tumor cells express MGMT. ADDENDUM DIAGNOSIS: LEFT FRONTAL TUMOR, BIOPSY AND RESECTION: GLIOBLASTOMA (WHO GRADE IV). - 25-50% EXPRESSION OF MGMT.
P0329
63
female
white
hispanic or latino
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Alive
3
0
null
3
null
null
null
null
WT-With Tumor
null
null
null
null
NEUROPATHOLOGY REPORT. SPECIMEN SOURCE: Right frontal brain tumor. CONTROL. CLINICAL DIAGNOSIS: Right frontal brain tumor. GROSS DESCRIPTION: Received fresh for frozen section labeled with the patient's name and β€˜right frontal brain tumor” are multiple pink-tan soft tissue fragments aggregating to 0.9 x 0.4 x 0.3 cm. A smear is performed with the remainder frozen on one chuck. FROZEN SECTION DIAGNOSIS: GLIOBLASTOMA. The specimen is subsequently entirely resubmitted in one cassette for permanent sections. Received in formalin labeled with the patient's name and β€œright frontal. brain tumor” are multiple white hemorrhagic soft tissue fragments aggregating to 4.0 x 3.0 X 2.0 cm. In addition, there is a separate portion of pink-tan membranous soft tissue consistent with dura measuring 3.5 x 3.0 x 0.1 cm. There is a small 0.5 cm thickened area of the dura. Representative sections (approximately 20%) are submitted as follows: A) Tumor and separate portion of dura. B) Tumor. MICROSCOPIC DESCRIPTION: Sections demonstrate a markedly hypercellular glial neoplasm. The tumor is composed of cells resembling mildly to moderately atypical astrocytes with round to oval nuclei. Scattered mitotic figures are seen. There is a striking pattern of microvascular proliferation and large areas of necrosis, as well as smaller areas of pseudopalisading necrosis are seen. Although the nuclei are round and some demonstrate few processes, definite oligodendroglioma differentiation is not seen. DIAGNOSIS: (PROVISIONAL). RIGHT FRONTAL BRAIN TUMOR, BIOPSY AND RESECTION: GLIOBLASTOMA (ASTROCYTOMA GRADE IV), PENDING ADDITIONAL STUDIES. ADDENDUM NEUROPATHOLOGY REPORT. ADDENDUM DISCUSSION: Overall, <10% of the tumor demonstrate immunoreactivity for MGMT. ADDENDUM DIAGNOSIS: RIGHT FRONTAL BRAIN TUMOR, BIOPSY AND RESECTION: GLIOBLASTOMA (ASTROCYTOMA GRADE IV). - MGMT EXPRESSION <10%.
P0330
57
male
white
not hispanic or latino
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Dead
482
1
482
482
null
null
null
null
WT-With Tumor
null
null
null
null
NEUROPATHOLOGY REP(. SPECIMEN SOURCE: 1. Right brain tumor. 2. Right brain tumor. GBM. 3. Hippocampus. CONTROL. CLINICAL DIAGNOSIS: Brain tumor. GROSS DESCRIPTION: 1. Received fresh for frozen section labeled with the patient's name and. "brain tumor" is a 1.0 x 0.7 x 0.2 cm semi solid red-tan soft tissue fragment. A smear is performed with the remainder frozen on one chuck. FROZEN SECTION DIAGNOSIS: GLIOBLASTOMA. The specimen is subsequently entirely resubmitted in one cassette. 2. Received in formalin labeled with the patient's name and "right brain. tumor" are multiple pink-tan hemorrhagic and necrotic soft tissue fragments. measuring in aggregate size 3.5 x 3.0 x 1.0 cm. Representative sections. (approximately 50%) are submitted in two cassettes. 3. Received in formalin labeled with the patient's name and "hippocampus" is. a 1.4 x 0.6 x 0.5 cm pink-tan portion of soft tissue consistent with brain. The possible cortical surface is identified, with the specimen being serially. sectioned perpendicular to this surface and entirely submitted in one. cassette. MICROSCOPIC DESCRIPTION: 1, 2. Sections demonstrate a markedly hypercellular glial neoplasm, the cells. of which resemble small fibrillary astrocytes. Scattered mitotic figures are. seen. Microvascular proliferation is prominent and there are large areas of. tumor necrosis including pseudopalisading tumor necrosis. The tumor diffusely. infiltrates the parenchyma. 3. Sections of hippocampus demonstrate a limited degree of invasion by. glioblastoma as previously described. Nonspecific reactive changes are also. seen. Ammon's horn sclerosis is not noted. DIAGNOSIS: 1, 2. RIGHT BRAIN TUMOR, BIOPSY AND RESECTION: GLIOBLASTOMA, WHO GRADE IV. 3. HIPPOCAMPUS, RESECTION: HIPPOCAMPUS WITH FOCAL INVASION BY GLIOBLASTOMA. ADDENDUM NEUROPATHOLOGY REPORT. ADDENDUM DISCUSSION: More than 10% of the cells are immunoreactive for MGMT. However, most are. endothelial cells. There are patchy areas with definite nuclear positivity. seen in tumor cells. Overall, this specimen consists of more than 75% cellular. tumor and the tumor is considered positive for MGMT expression. ADDENDUM DIAGNOSIS: 1, 2. RIGHT BRAIN TUMOR, BIOPSY AND RESECTION: GLIOBLASTOMA, WHO GRADE IV. - TUMOR CELLS POSITIVE FOR MGMT EXPRESSION.
P0331
69
female
white
not hispanic or latino
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Dead
593
1
593
593
null
265
null
Yes
WT-With Tumor
Surgery, NOS
null
265
null
NEUROPATHOLOGY REPORT. SPECIMEN SOURCE: 1. Brain tumor. 2. Brain tumor. GBM. CONTROL. CLINICAL DIAGNOSIS: Brain tumor. GROSS DESCRIPTION: 1. Received fresh for frozen section are multiple tan-red soft tissues. aggregating to 1.4 x 1.2 x 0.2 cm. A smear is performed. Entirely frozen on. one chuck. FROZEN SECTION DIAGNOSIS: GLIOBLASTOMA. Tissue submitted for frozen is subsequently submitted for permanent. 2. Received in formalin labeled with the patient's name and "brain tumor" are. multiple portions of tan to brown soft tissue aggregating to 3.0 X 2.0 X 1.0. cm. The largest portion is bivalved. The specimen is entirely submitted in. three cassettes. MICROSCOPIC DESCRIPTION: 1, 2. Sections demonstrate a markedly hypercellular glial neoplasm consisting. of a proliferation of tumor cells which resemble astrocytes. The neoplastic. cells exhibit predominantly elongated nuclei and prominent fibrillary. processes. They demonstrate moderate cytologic atypia. Scattered mitotic. figures are seen. Both pseudopalisading necrosis as well as microvascular. proliferation are readily identified. These histologic features are consistent. with a glioblastoma. DIAGNOSIS: (PROVISIONAL): 1, 2. BRAIN TUMOR, BIOPSY AND RESECTION: DIAGNOSIS: GLIOBLASTOMA (WHO GRADE IV). ADDENDUM NEUROPATHOLOGY REPORT. ADDENDUM DISCUSSION: Less than 10% of the tumor cells express MGMT. ADDENDUM DIAGNOSIS: 1, 2. BRAIN TUMOR, BIOPSY AND RESECTION: GLIOBLASTOMA (WHO GRADE IV). - <10% TUMOR CELLS POSITIVE FOR MGMT.
P0332
72
male
white
not hispanic or latino
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Dead
36
1
36
36
null
null
null
null
WT-With Tumor
Pharmaceutical Therapy, NOS|Radiation Therapy, NOS
null
null
null
NEUROPATHOLOGY REPC. SPECIMEN SOURCE: Right temporal brain tumor. GBM. CONTROL. CLINICAL DIAGNOSIS: Right temporal brain tumor. GROSS DESCRIPTION: Received fresh for frozen section labeled with the patient's name and β€œright. temporal brain tumor” are multiple fragments of tan soft tissue aggregating to. 1.3 x 0.1 x 0.8 cm. A smear is made. Entirely frozen on one chuck. FROZEN SECTION DIAGNOSIS: GLIOBLASTOMA. Tissue submitted for frozen is subsequently submitted for permanent in one. cassette. MICROSCOPIC DESCRIPTION: Permanent sections of the frozen section specimen demonstrates a high grade. glial neoplasm that diffusely infiltrates parenchyma. There are large areas. of tumor necrosis, sometimes with pseudopalisading. The tumor cells resemble. moderately atypical fibrillary and occasionally gemistocytic astrocytes. Microvascular proliferation is also seen. Scattered mitotic figures are. noted. DIAGNOSIS: (PROVISIONAL). RIGHT TEMPORAL BRAIN TUMOR, FROZEN SECTION BIOPSY: GLIOBLASTOMA, PENDING REVIEW OF ADDITIONAL TISSUE. ADDENDUM NEUROPATHOLOGY REPORT. ADDENDUM DISCUSSION: 1. Please see previous report. 2. Right temporal lobe and tumor. 3. Intratumor hematoma. ADDENDUM GROSS DESCRIPTION: 1. Please see previous report. 2. Received in formalin labeled with the patient's name and β€œright temporal. lobe and brain tumor” are multiple portions of tan-gray brain aggregating to. 4.5 x 4.0 x 1.8 cm. Representative sections are submitted in three cassettes. 3. Received in formalin labeled with the patient's name and β€œintratumor. hematoma” is a 2.0 x1.1.8 x 1.0 cm tan-red blood clot. The specimen is entirely. submitted in one cassette. ADDENDUM DIAGNOSIS: 2. Sections, again, demonstrate a high grade glial neoplasm consistent with. glioblastoma. The tumor demonstrates extensive necrosis. At the edges, there. is infiltration into the parenchyma. Microvascular proliferation and mitotic. figures are also seen. 3. Sections consist almost entirely of acute blood clot. A thin rim of tumor. cells and reactive blood vessels is also seen. ADDENDUM #2 NEUROPATHOLOGY REPORT. ADDENDUM DISCUSSION: ADDENDUM #2 NEUROPATHOLOGY REPORT. ADDENDUM DISCUSSION: Fewer than 10% of cells overall demonstrate immunoreactivity for MGMT. Tumor. cells immunoreactivity is limited to perinecrotic areas. ADDENDUM DIAGNOSIS: 1, 2. RIGHT TEMPORAL BRAIN TUMOR, BIOPSY AND RESECTION: GLIOBLASTOMA. - TUMOR CELLS NEGATIVE FOR MGMT EXPRESSION.
P0333
76
female
white
not hispanic or latino
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Dead
142
1
142
142
null
null
null
null
WT-With Tumor
Chemotherapy
Carmustine Implant
null
null
NEUROPATHOLOGY REPORT. SPECIMEN SOURCE: Right parietal tumor. CLINICAL DIAGNOSIS: Brain tumor. GROSS DESCRIPTION: Received fresh for frozen section labeled with the patient's name are two. tan-red soft tissues measuring 1.2 x 0.9 x 0.8 cm and 0. x 0.7 x 0.4 cm. The larger portion is bivalved. Representative sections are submitted as follows: Smaller portion of soft tissue and half of the larger portion. FROZEN SECTION DIAGNOSIS: GLIAL NEOPLASM INTERMEDIATE TO HIGH GRADE. Tissue submitted for frozen is subsequently submitted for permanent. The remainder of the tissue is submitted in cassettes 1B. Also present in the container are multiple small portions of tan-red. shaggy soft tissue aggregating to 2.4 x 1.5 x 0.8 cm. The largest portion is serially sectioned to reveal a tan-yellow homogenous cut surface. Entirely submitted as follows: A-F) Serial sections of largest portion of soft tissue. G) Unattached soft tissues also present in the container. MICROSCOPIC DESCRIPTION: Sections demonstrate a markedly hypercellular glial neoplasm, the cells of which resemble moderately atypical fibrillary astrocytes. Numerous scattered mitotic figures are seen. Microvascular proliferation is focally prominent. Foci of confluent tumor necrosis are seen. DIAGNOSIS: BRAIN TUMOR, BIOPSY AND RESECTION: GLIOBLASTOMA. ADDENDUM DISCUSSION: Approximately 10-25% of cells are immunoreactive for MGMT in a patchy distribution. These include many definite tumor cells. ADDENDUM DIAGNOSIS: BRAIN TUMOR, BIOPSY AND RESECTION: GLIOBLASTOMA. - TUMOR CELLS POSITIVE FOR MGMT EXPRESSION.
P0336
60
male
white
not hispanic or latino
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Dead
515
1
515
515
null
null
345
Yes
WT-With Tumor
Radiation, External Beam|Chemotherapy|Radiation Therapy, NOS|Pharmaceutical Therapy, NOS|Surgery, NOS
Temozolomide|Carmustine Implant|Motexafin Gadolinium
23
null
NEUROPATHOLOGY HEP. SPECIMEN SOURCE: Brain mass. GBM. CONTROL. CLINICAL DIAGNOSIS: Brain mass. GROSS DESCRIPTION: Received fresh for frozen section are two portions of tan-pink soft tissue, measuring 0.5 x 0.4 x 0.2 cm and 0.4 x 0.3 x 0.2 cm. A smear preparation is performed. Entirely frozen on one chuck. FROZEN SECTION DIAGNOSIS: GLIOBLASTOMA. The previously frozen tissue is subsequently submitted for permanent sections. MICROSCOPIC DESCRIPTION: Permanent sections of frozen section specimen confirms the presence of a cellular high grade glial neoplasm. The tumor cells resemble atypical fibrillary astrocytes. Large areas of tumor necrosis are seen. DIAGNOSIS: (PROVISIONAL). BRAIN MASS, FROZEN SECTION BIOPSY: GLIOBLASTOMA, PENDING REVIEW OF ADDITIONAL TISSUE. ADDENDUM NEUROPATHOLOGY REPORT. ADDENDUM DISCUSSION: 1. Please see previous report. 2. Brain mass. ADDENDUM GROSS DESCRIPTION: 1. Please see previous report. 2. Received in formalin labeled with the patient's name and "brain mass" are multiple portions of tan-brown soft tissue aggregating to 2.0 x 2.0 x 0.5 cm. The specimen is entirely submitted in one cassette. MICROSCOPIC EXAMINATION: 2. Sections demonstrate a markedly hypercellular glial neoplasm. It is compose of cells resembling atypical fibrillary and small anaplastic astrocytes. Some perinuclear clearing is seen but well-formed halos or definite oligodendroglioma differentiation is not noted. Microvascular proliferation is present. There are large foci of confluent tumor necrosis. Numerous mitotic figures are seen. ADDENDUM DIAGNOSIS: 1, 2. LEFT FRONTAL BRAIN TUMOR, BIOPSY AND RESECTION: GLIOBLASTOMA (ASTROCYTOMA GRADE IV). ADDENDUM #2 NEUROPATHOLOGY REPORT. ADDENDUM DISCUSSION: Overall, approximately 10-25% of the tumor cells are immunoreactive for MGMT. ADDENDUM DIAGNOSIS: 1, 2. LEFT FRONTAL BRAIN TUMOR, BIOPSY AND RESECTION: GLIOBLASTOMA (ASTROCYTOMA GRADE IV).
P0337
63
male
white
not hispanic or latino
Glioblastoma
null
null
null
recurrence
9440/3
Not Reported
null
not reported
Not Reported
Dead
372
1
372
372
null
null
70
Yes
WT-With Tumor
Pharmaceutical Therapy, NOS|Radiation Therapy, NOS|Chemotherapy|Radiation, External Beam
Temozolomide
18
null
Brain tumor. Markedly hypercellular glial neoplasm, the cells of which resemble moderately to markedly atypical astrocytes. Scattered mitotic figures are seen. Microvascular proliferation is present. Large areas of confluent tumor necrosis are present. Temporal brain tumor.
P0342
67
male
white
not hispanic or latino
Glioblastoma
null
null
null
primary
9440/3
Brain, NOS
null
not reported
Not Reported
Dead
766
1
766
766
null
null
null
null
WT-With Tumor
Targeted Molecular Therapy|Chemotherapy|Radiation, External Beam
Clinical Trial|Temozolomide
49
null
NEUROPATHOLOGY REPORT. SPECIMEN SOURCE: 1. Brain tumor. 2. Right temporal tumor. CLINICAL DIAGNOSIS: Brain tumor, right temporal tumor. GROSS DESCRIPTION: 1. Received fresh for frozen section labeled with the patient's name and. "brain tumor" are three red-tan soft tissue fragments aggregating to 0.5 x 0.3 x 0.2 cm. A smear is performed with the remainder frozen on one chuck. FROZEN SECTION DIAGNOSIS: EDEMATOUS WHITE MATTER WITH REACTIVE VASCULAR CHANGES. The specimen is subsequently re-submitted for permanent sections. 2. Received fresh for frozen section labeled with the patient's name and. "right temporal tumor" are multiple red-tan soft tissue fragments aggregating to 1.0 x 1.0 x 0.2 cm. A smear is performed with the remainder frozen on one chuck. FROZEN SECTION DIAGNOSIS: GLIOBLASTOMA. The specimen is subsequently re-submitted for permanent sections. MICROSCOPIC DESCRIPTION: 1. Microscopic examination reveals cortical gray matter and underlying white matter. The white matter appears edematous and demonstrates scattered reactive astrocytes. The blood vessels appear thickened and many demonstrate hyalinized walls. A definitive neoplastic population is not seen. 2. Microscopic examination reveals an infiltrating glioma. The neoplasm appears hypercellular. The tumor cells diffusely infiltrate the brain parenchyma. They demonstrate moderate cytologic atypia. Morphologically the tumor cells exhibit elongated to oval nuclei with prominent fibrillary processes. Mitotic figures are prevalent. Microvascular proliferation is readily identified. DIAGNOSIS: (PROVISIONAL): 1. BRAIN TUMOR, BIOPSY AND RESECTION: EDEMATOUS WHITE MATTER WITH REACTIVE FEATURES. 2, 3. TEMPORAL TUMOR, RESECTION: DIAGNOSIS: GLIOBLASTOMA (WHO GRADE 4).
End of preview. Expand in Data Studio

2025 Dr. Robert Gillies Machine Learning Workshop in Cancer - Hackathon Dataset

Dataset Description

This dataset is part of the 2025 Dr. Robert Gillies Machine Learning Workshop at Moffitt Cancer Center. It contains de-identified medical imaging, pathology reports, and clinical data for glioblastoma patients, designed for an overall survival prediction challenge.

Dataset Splits

  • Training Set: 250 patients with complete survival outcomes
  • Test Set: 50 patients with withheld survival outcomes

Training Dataset

  • Total Patients: 250
  • Pathology Images: 250 whole-slide tissue images (.tif format, ~512MB each)
  • Clinical Records: 250 patient records with comprehensive clinical and pathology data
  • Total Size: ~128GB

Test Dataset

  • Total Patients: 50
  • Pathology Images: 50 whole-slide tissue images (.tif format, ~280MB each)
  • Clinical Records: 50 patient records with predictive features only (survival outcomes withheld)
  • Total Size: ~14GB
  • Purpose: Final evaluation with ground truth outcomes held by organizers

Dataset Structure

train/
β”œβ”€β”€ train.csv                           # Clinical and pathology data (250 patients, 30 columns)
└── images/                             # Pathology images directory
    β”œβ”€β”€ P0002.tif                       # Patient pathology slide (~512MB)
    β”œβ”€β”€ P0005.tif
    β”œβ”€β”€ P0006.tif
    └── ... (250 total .tif files)

test/
β”œβ”€β”€ test.csv                            # Clinical features only (50 patients, 21 columns)
└── images/                             # Pathology images directory
    β”œβ”€β”€ P0001.tif                       # Patient pathology slide (~280MB)
    β”œβ”€β”€ P0004.tif
    β”œβ”€β”€ P0007.tif
    └── ... (50 total .tif files)

Note: Images are whole-slide tissue scans in TIFF format. Each file is named with the corresponding patient ID (e.g., P0002.tif).

Clinical Data Schema (Training Set)

The train.csv file in the training set contains the following fields:

Demographics:

  • patient_id: Unique de-identified patient identifier
  • age_at_diagnosis: Patient age at diagnosis
  • gender: Patient gender
  • race: Patient race
  • ethnicity: Patient ethnicity

Tumor Characteristics:

  • primary_diagnosis: Primary cancer diagnosis
  • tumor_grade: Tumor grade classification
  • ajcc_m: AJCC M stage (metastasis)
  • ajcc_n: AJCC N stage (lymph nodes)
  • classification_of_tumor: Tumor classification (primary/recurrence/progression)
  • morphology: ICD-O-3 morphology code
  • tissue_origin: Anatomical site of origin
  • laterality: Side of body affected
  • prior_malignancy: History of prior cancer
  • synchronous_malignancy: Concurrent cancer diagnosis

Clinical Outcomes:

  • vital_status: Patient vital status (Alive/Dead)
  • overall_survival_days: Overall survival time in days
  • overall_survival_event: Survival event indicator (0/1)
  • days_to_death: Time to death event
  • days_to_last_followup: Time to last follow-up
  • cause_of_death: Cause of death
  • days_to_progression: Time to disease progression
  • days_to_recurrence: Time to disease recurrence
  • progression_or_recurrence: Indicator of disease progression/recurrence
  • disease_response: Response to treatment

Treatment Information:

  • treatment_types: Types of treatments received
  • therapeutic_agents: Specific drugs/agents used
  • days_to_treatment: Time to treatment initiation
  • treatment_outcome: Outcome of treatment

Pathology:

  • pathology_report: Complete de-identified pathology report text

Test Set Features

The test.csv file in the test set contains 21 predictive features only. The following 9 survival outcome columns have been removed to prevent participants from calculating C-index:

Withheld Columns:

  • vital_status (Alive/Dead status)
  • overall_survival_days (survival time - required for C-index)
  • overall_survival_event (event indicator - required for C-index)
  • days_to_death
  • days_to_last_followup
  • cause_of_death
  • days_to_progression
  • days_to_recurrence
  • progression_or_recurrence

Available Test Features (21 columns):

  • All demographic fields (patient_id, age_at_diagnosis, gender, race, ethnicity)
  • All tumor characteristics (primary_diagnosis, tumor_grade, ajcc_m, ajcc_n, classification_of_tumor, morphology, tissue_origin, laterality, prior_malignancy, synchronous_malignancy)
  • Treatment information (treatment_types, therapeutic_agents, days_to_treatment, treatment_outcome, disease_response)
  • Pathology report (pathology_report)

Submission Format

For the overall survival prediction challenge, submit predictions as a CSV file with the following format:

patient_id,outcome,risk_score
P0001,1,0.742
P0004,0,0.234
P0007,1,0.891

Column Definitions:

  • patient_id: Patient identifier (must match test set IDs)
  • outcome: Predicted binary outcome (0 = censored/alive, 1 = event/death)
  • risk_score: Predicted risk score (higher = higher risk of event)

Evaluation Metrics: C-Index (Concordance Index)

Usage

Quick Start

This is a multimodal dataset combining:

  • Pathology images (TIFF format, individual whole-slide images)
  • Clinical/tabular data (CSV format with patient metadata)

Storage Requirements:

  • Full dataset: ~142GB
  • Training split: ~128GB (250 images + CSV)
  • Test split: ~14GB (50 images + CSV)

Loading Clinical Data

import pandas as pd

# Load clinical data directly
train_data = pd.read_csv("hf://datasets/Lab-Rasool/hackathon/train/train.csv")
test_data = pd.read_csv("hf://datasets/Lab-Rasool/hackathon/test/test.csv")

print(f"Training patients: {len(train_data)}")  # 250
print(f"Test patients: {len(test_data)}")      # 50

Downloading Images

Images can be downloaded individually or in bulk from the HuggingFace Hub:

from huggingface_hub import hf_hub_download
import os

# Download a specific patient's image
image_path = hf_hub_download(
    repo_id="Lab-Rasool/hackathon",
    filename="train/images/P0002.tif",
    repo_type="dataset",
    cache_dir="./hf_cache"
)

print(f"Image downloaded to: {image_path}")

# Or download all images in a split using snapshot_download
from huggingface_hub import snapshot_download

# Download entire train split (CSV + all images)
train_dir = snapshot_download(
    repo_id="Lab-Rasool/hackathon",
    repo_type="dataset",
    allow_patterns="train/*",
    cache_dir="./hf_cache"
)

print(f"Training data downloaded to: {train_dir}")

Loading Individual Images

import tifffile
from huggingface_hub import hf_hub_download

# Download and load a specific patient's image
patient_id = "P0002"
image_path = hf_hub_download(
    repo_id="Lab-Rasool/hackathon",
    filename=f"train/images/{patient_id}.tif",
    repo_type="dataset"
)

# Load the image
patient_image = tifffile.imread(image_path)
print(f"Image shape: {patient_image.shape}")
print(f"Image size: {patient_image.nbytes / (1024**2):.1f} MB")

License

This dataset is released under the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) license.

  • βœ… Academic and research use permitted
  • βœ… Educational use permitted
  • ❌ Commercial use prohibited
  • βœ… Derivative works permitted with attribution

Important Notes

  • Training Set (250 patients): Use for model development. Includes survival outcomes.
  • Test Set (50 patients): Use for predictions. Survival outcomes are withheld.
  • Images: Individual .tif files (~142GB total). Can be downloaded selectively or in bulk.
  • Streaming: Images can be downloaded on-demand during training using HuggingFace's caching.
  • Submissions: Must include all test patients with correct patient IDs.
  • No Self-Evaluation: Test set ground truth is held by organizers only.
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