My mother's biopsy report changed from glioblastoma to anaplastic astrocytoma. Is this common?

Question

Hello doctor,

Recently my mother had a craniotomy for tumor removal. Last year she had a craniotomy as well, and it was diagnosed as glioblastoma. But this time, the biopsy report says it is anaplastic astrocytoma. The oncologist says the report is wrong. I am attaching the report below. Please give your opinion.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern and will help you regarding it. I have assessed the attached histopathology report thoroughly (attachments removed to protect the patient's identity). First of all, I would like to tell you that a pathologist gives the diagnosis based on the fulfillment of certain criteria. And sometimes, the diagnosis is subjective (depending on interobserver variability). Sometimes, the tissue is insufficient to show all the features necessary for a particular diagnosis. Sometimes, the radiation-related changes in tissue mask certain features necessary for diagnosis. I wish to ask if you had provided the previous report to the current pathologist? If you read the report, you will find it is written in the last lines, "No necrosis or microvascular proliferation is seen." The presence of atleast one of either necrosis or microvascular proliferation is necessary for the diagnosis of glioblastoma. As the pathologist could not appreciate any of these features, and anaplastic astrocytoma is the most appropriate diagnosis. Now, what you can do is get issued slides from both the previous and current biopsy and get both the slides reviewed together. This will help to establish the most appropriate diagnosis. I must tell you that the treatment of both entities is very much similar. Both respond to chemoradiation. I hope this was helpful. I wish you and your mother all the best. Take care.