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Classification and pathologic diagnosis of gliomas

David N Louis, MD
David Schiff, MD
Tracy Batchelor, MD, MPH
Section Editors
Jay S Loeffler, MD
Patrick Y Wen, MD
Deputy Editor
April F Eichler, MD, MPH


Gliomas account for the great majority of primary tumors that arise within the brain parenchyma. The term "glioma" refers to tumors that have histologic features similar to normal glial cells (ie, astrocytes, oligodendrocytes, and ependymal cells). For each of these types of gliomas, there are neoplasms that span a broad spectrum of biologic aggressiveness.

Historically, the slower-growing lesions, corresponding to World Health Organization (WHO) grades I and II, have been commonly referred to as low-grade gliomas, while the more rapidly progressive tumors are referred to as high-grade gliomas. The WHO classification recommends avoiding the term "low-grade glioma," however, since it lumps together a heterogenous groups of tumors, many of which have significantly different biologic properties, prognoses, and treatment approaches [1,2]. Among grade I and grade II gliomas, for example, current classification favors a distinction between diffuse gliomas (eg, grade II diffuse astrocytoma and oligodendroglioma) and more circumscribed astrocytic tumors (eg, grade I pilocytic astrocytoma).

The classification and diagnosis of gliomas will be reviewed here. Pathogenesis of diffuse gliomas is reviewed separately. (See "Molecular pathogenesis of diffuse gliomas".)


The classification and grading of gliomas have evolved over time, beginning in 1926 with a system devised by Bailey and Cushing [3] and later revised by Kernohan, Ringertz, and others [4-6]. Modern classification of gliomas is based on the World Health Organization (WHO) Classification of Central Nervous System Tumors, first published in 1979 and revised four times since then, most recently in 2016 [1,2].

As of the 2016 edition of the WHO classification, gliomas are classified based not only on histopathologic appearance but also on well-established molecular parameters [1]. The incorporation of molecular features has most notably impacted the classification of astrocytic and oligodendroglial tumors, which are now grouped together as diffuse gliomas, on the basis of growth pattern, behavior, and shared isocitrate dehydrogenase (IDH) genetic status.

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Literature review current through: Nov 2017. | This topic last updated: Nov 10, 2017.
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