Background. The differential diagnosis between infiltrative glioma (IG) and benign or curable glial lesions, such as gliosis, pilocytic astrocytoma, dysembryoplastic neuroepithelial tumor, ganglioglioma, or demyelinating disease, may be challenging for the pathologist because specific markers are lacking. Recently, we described a strong EGFR immunolabelling pattern in cells with a high nuclear to cytoplasmic ratio that enables the discrimination of low-grade IG from gliosis. The aim of this study was to extend our observation to high-grade glioma to assess whether EGFR expression pattern is of value in the discrimination of all IG from noninfiltrative glial lesions (NIG), including gliosis, benign tumors, and demyelinating disease. Methods. One hundred one IG and 58 NIG were compared for immunohistochemical expression of EGFR with use of an antibody that recognizes an epitope in the extracellular domain of both EGFRwt and EGFRvIII. Highly EGFR-positive cells with a high nuclear to cytoplasmic ratio were isolated and further characterized. Results. Cells with intense EGFR staining and a high nuclear to cytoplasmic ratio were significantly associated with the diagnosis of IG (P , .0001). The sensitivity and specificity of this staining pattern for the diagnosis of IG were 95% and 100%, respectively. EGFR expression was independent of IDH1 mutations and EGFR amplification. Finally, we showed that these particular cells displayed the phenotype and properties of glial progenitors and coexpressed CXCR4, a marker of invasiveness. Conclusions. We demonstrate that cells with intense EGFR staining and a high nuclear to cytoplasmic ratio are specific criteria for the diagnosis of IG, irrespective of grade, histological subtype, and progression pathway, and their identification represents a tool to discriminate IG from benign or curable glial lesions. 5 It is therefore very important for pathologists to develop histological markers to identify infiltrating glioma cells. To date, no ideal marker has been identified for this purpose. In practice, the most useful markers are MIB1/Ki67 6,7 and p53, 8,9 but these lack sensitivity and specificity. 10 More recently, the mutated R132H form of isocitrate dehydrogenase 1 (IDH1), which can be specifically detected by immunohistochemistry, 11,12 has been shown to be a good marker of grade II and grade III gliomas and of secondary glioblastomas.13 -15 However IDH1 (R132H) is rare in primary glioblastomas 16 and is not useful for the diagnosis of this subtype, which represents the most common IG. A marker specific for infiltrating cells, which are characteristic of IG regardless of grade or histological subtype, would be of value.Recently, we showed that the EGFR immunolabelling pattern can discriminate low-grade glioma from gliosis.
17The criterion that characterized low-grade gliomas was strong EGFR immunostaining in cells with a high nuclear to cytoplasmic ratio. EGFR overexpression is frequent in gliomas. In 40% of glioblastomas, EGFR overexpression is secondary to gene amplification...