The differential diagnosis of astrocytic neoplasms and its impact on treatment and prognosis.

Abstract

Introduction: The most common cell type in the central nervous system (CNS), astrocytes, is also the cell type most commonly associated with the brain cancer called astrocytoma. Advances in genetic/molecular techniques led to the 2021 CNS tumor reclassifications. In this review, we will simplify the somewhat complex 2021 neuropathological diagnostic algorithm and transition into a discussion on uncommon treatment options and the biochemical basis for their applications.

Areas covered: Herein, the authors review the most common new CNS tumor classifications based on histological and genetic alterations. Treatment and prognosis of these tumors change as the diagnostic capabilities improve. The literature utilized to complete this manuscript was collected through www.pubmed.gov, from the years 1924-2026. The search focused on astrocytomas, neuropathology criteria, molecular/genetics of, and treatment options.

Expert opinion: Neuropathology is crucial for providing guidance to the neurosurgeons operating, oncologists and radiation oncologists treating, and most importantly the patients and families that go through these treatments. Neuropathology ultimately provides the most important first step in determining the treatment flow chart, thus the proper identification/diagnosis with a detailed genetic profile of the tumor enhances insight on the treatment and prognostic expectations. Our ability to better understand the genetic/molecular alterations occurring in CNS tumors leads us to better treatments and hopefully eventual cures.