gliomi

Gliomi, or gliomas (the Italian term gliomi is the plural of glioma), are a group of tumors that arise from glial cells in the brain or spinal cord. They are the most common primary brain tumors in adults and vary widely in aggressiveness. Gliomas are classified by histology into astrocytomas, oligodendrogliomas, and ependymomas, and by the World Health Organization (WHO) grading system from I to IV, with higher grades indicating greater malignancy.

Astrocytomas include pilocytic astrocytoma (grade I), diffuse astrocytoma (grade II), anaplastic astrocytoma (grade III), and glioblastoma (grade IV), the latter being the most aggressive. Oligodendrogliomas are typically grade II or III and commonly exhibit 1p/19q codeletion and IDH mutation, features associated with a relatively better prognosis. Ependymomas arise from ependymal cells and are graded I–III, with behavior that depends on location and molecular characteristics.

Clinical presentation depends on tumor location and may include new or worsening headaches, seizures, cognitive or focal neurological deficits, or signs of increased intracranial pressure. Diagnosis relies on imaging, primarily MRI, followed by histopathological examination and molecular testing to determine type, grade, and prognostic markers.

Treatment usually involves maximal safe surgical resection when feasible, followed by radiotherapy and chemotherapy tailored to histology and molecular features. The Stupp protocol (radiotherapy with concomitant and adjuvant temozolomide) is standard for glioblastoma. Oligodendrogliomas may respond to PCV chemotherapy in addition to radiotherapy. Targeted therapies and clinical trials are active areas of research.

Molecular classification has become central to diagnosis and prognosis, with markers such as IDH mutation status, 1p/19q codeletion, and MGMT promoter methylation guiding prognosis and treatment decisions.