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Staging of Glial cell tumors- There is no clinical classification for brain tumour used in day to day practice. There is a proposed AJCC system based on ‘GTM classification’ (G, grade; T, tumor size; M, metastasis). In GTM system following rules are followed - • T stage is divided into supra-tentorial and infra-tentorial.• Separated into five staging group;1) Clinical- diagnostic 2) Surgical- evaluative 3) Post-Surgical – pathologic 4) Retreatment 5) Autopsy. • Grading is the most important prognostic tool. It is divided according to –1) G1 is well differentiated. 2) G2 is moderately differentiated. 3) G3 is poorly differentiated. 4) G4 is features of pleomorphism and necrosis. • M stage is metastasis out side brain; rarely seen in medulloblastoma, germ cell tumor.Grading of glial tumors : As there is no effective staging system for brain tumours, the histology and grade of the disease are the most important factors that determine the prognosis and treatment decision.Grading of Astrocytoma: Depends on - § Nuclear Atypia§ Mitosis§ Endothelial Proliferation§ NecrosisGRADE I – None of the features -- Reserved for special variety, ( Juvenile pilocytic astrocytoma) GRADE II – Only 1 feature – Low Grade Glioma (LGG) GRADE III – 2 features –Anaplastic Astrocytoma (AA) GRADE IV – >=3 features – Glioblastoma Multiforme(GBM) ( Cushing & Bailey (1926), Kernohan(1949), Rubinstein(1972)& the Classification propounded by WHO (1979) and revised in 1990 is widely accepted )
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Brain Tumour Foundation Of India Tata Memorial Hospital,
Ernest Borges Marg, Parel, Mumbai - 400 012, INDIA
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