Glioblastoma: Changing concepts in the WHO CNS5 classification

Glioblastoma is the most common malignant central nervous system (CNS) tumor in adults. Acute common clinical symptoms include headache, seizure, behavior changes, focal neurological deficits, and signs of increased intracranial pressure. The classic MRI finding of glioblastoma is an irregularly shaped, rim-enhancing or ring-enhancing lesion with a central dark area of necrosis. This constellation of features correlates with microscopic findings of tumor necrosis and microvascular proliferation. Besides these common features, several well-recognized histological subtypes include giant cell glioblastoma, granular cell glioblastoma, gliosarcoma, glioblastoma with a primitive neuronal component, small cell glioblastoma, and epithelioid glioblastoma. While glioblastoma was historically classified as isocitrate dehydrogenase (IDH)-wildtype and IDH-mutant groups, the Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy (cIMPACT-NOW) and the fifth edition of the WHO Classification of Tumors of the Central Nervous System clearly updated the nomenclature to reflect glioblastoma to be compatible with wildtype IDH status only. Therefore, glioblastoma is now defined as “a diffuse, astrocytic glioma that is IDH-wildtype and H3-wildtype and has one or more of the following histological or genetic features: microvascular proliferation, necrosis, Telomerase reverse transcriptase promoter mutation, Epidermal growth factor receptor gene amplification, +7/?10 chromosome copy-number changes (CNS WHO grade 4).”

Lymphocyte changes in secondary dengue fever: use of the Technicon H*1 to monitor progress of infection.

Secondary dengue fever as dengue hemorrhagic fever or dengue shock syndrome is a potentially fatal complication of an infection that presents with few clinical signs that help in the diagnosis. Previous workers have reported the value of buffy coat determinations of atypical lymphocytes as an aid to the diagnosis. We report here the use of an automated white blood cell differential counter, the Technicon H*1 in the monitoring of the atypical lymphocyte count as a measure of the progress of the infection in a retrospective study of serial full blood counts in 45 serologically confirmed patients. Technicon H*1 'basophil' and large unstained cell counts and manual atypical lymphocyte counts rose in tandem with the drop in platelets and decreased when the platelets recovered. In a sub-study, the atypical lymphocytes were immunophenotyped and found to be predominantly derived from T lymphocytes. We conclude that the Technicon H*1 is a useful monitor of the activity of the infection in dengue hemorrhagic fever.