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Astrocytoma, IDH-mutant

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Central Nervous System Tumours (WHO Classification, 5th ed.)

Primary Author(s)*[edit | edit source]

Meenakshi Mehrotra, PhD, Mount Sinai Health System, New York

WHO Classification of Disease[edit | edit source]

Structure Disease
Book Central Nervous System Tumours (5th ed.)
Category Gliomas, glioneuronal tumours, and neuronal tumours
Family Gliomas, glioneuronal tumours, and neuronal tumours
Type Adult-type diffuse gliomas
Subtype(s) Astrocytoma, IDH-mutant

Related Terminology[edit | edit source]

Acceptable N/A
Not Recommended Diffuse astrocytoma, IDH-mutant; anaplastic astrocytoma, IDH-mutant; glioblastoma, IDH-mutant; low-grade astrocytoma; lower-grade astrocytoma; high-grade astrocytoma; infiltrating astrocytoma; diffuse glioma

Gene Rearrangements[edit | edit source]


Driver Gene Fusion(s) and Common Partner Genes Molecular Pathogenesis Typical Chromosomal Alteration(s) Prevalence -Common >20%, Recurrent 5-20% or Rare <5% (Disease) Diagnostic, Prognostic, and Therapeutic Significance - D, P, T Established Clinical Significance Per Guidelines - Yes or No (Source) Clinical Relevance Details/Other Notes
MET PTPRZ1::MET N/A N/A Rare (~1%) P No MET fusions and splicing variants convergently define a subgroup of glioma sensitive to MET inhibitors[1][2]
NTRK2 GOLGA1::NTRK2 N/A N/A Rare (observed in single case report) P, T No Single case report[3]
NTRK2 CDK5RAP2::NTRK2 N/A N/A Rare (observed in single case report) P, T No Single case report[4]

Individual Region Genomic Gain/Loss/LOH[edit | edit source]


Chr # Gain, Loss, Amp, LOH Minimal Region Cytoband and/or Genomic Coordinates [Genome Build; Size] Relevant Gene(s) Diagnostic, Prognostic, and Therapeutic Significance - D, P, T Established Clinical Significance Per Guidelines - Yes or No (Source) Clinical Relevance Details/Other Notes
9 loss chr9:21,967,752-21,995,324 CDKN2A P Yes  (WHO CNS5) Poorer prognosis[5]
9 loss chr9:22,002,903-22,009,313 CDKN2B P Yes  (WHO CNS5) Poorer prognosis[6]
12 amp chr12:57,747,727-57,756,013 CDK4 P,T No Poorer prognosis[7]
13 loss chr13:48,303,744-48,599,436 RB1 P No [8]
4 amp chr4:54,229,280-54,298,245 PDGFRA P No Poorer prognosis[9]
2 amp chr2:15,940,550-15,947,007 MYCN P No Poorer prognosis[10][11]
7 amp chr7:116,672,196-116,798,377 MET No [12]
10 loss chr10:87863113-87971930 PTEN P No [13]

Characteristic Chromosomal or Other Global Mutational Patterns[edit | edit source]


Chromosomal Pattern Molecular Pathogenesis Prevalence -

Common >20%, Recurrent 5-20% or Rare <5% (Disease)

Diagnostic, Prognostic, and Therapeutic Significance - D, P, T Established Clinical Significance Per Guidelines - Yes or No (Source) Clinical Relevance Details/Other Notes
9p, 10q, 11p, 22q and 13q deletions N/A Rare P No Poor prognosis[14]


19q loss alone N/A Rare P No Better outcome[15]
Gains chr 7 and chr 8q N/A Rare P No Poor prognosis[16]
CNLOH chr17p N/A Rare P No Better prognosis[17]


Gene Mutations (SNV/INDEL)[edit | edit source]


Gene Genetic Alteration Tumor Suppressor Gene, Oncogene, Other Prevalence -

Common >20%, Recurrent 5-20% or Rare <5% (Disease)

Diagnostic, Prognostic, and Therapeutic Significance - D, P, T   Established Clinical Significance Per Guidelines - Yes or No (Source) Clinical Relevance Details/Other Notes
IDH1 Codon 132 activating mutations Oncogene


Common D Yes (WHO CNS5) Essential diagnostic criterion (WHO CNS 5)
IDH2 Codon 172 activating mutations Oncogene


Common D Yes (WHO CNS5) Essential diagnostic criterion (WHO CNS 5)
TP53 Variable LOF mutations TSG


Common D Yes (WHO CNS5) Desirable diagnostic criterion (WHO CNS 5)
ATRX Variable LOF mutations TSG Common D Yes (WHO CNS5) Desirable diagnostic criterion (WHO CNS 5)
TERT Hotspot GOF mutation Oncogene Rare D Yes (WHO CNS5) Mutually exclusive with ATRX mutations[18][19][20]
MET Splicing variant Oncogene Rare P No Poorer prognosis[21]
PIK3R1 Variable LOF mutations TSG Rare P No Poorer prognosis[22][23]
PIK3CA Exon 10, exon 21 activating mutations Oncogene Rare P No Poorer prognosis[24][25]
TTN Activating mutations Oncogene Rare No [26]

Note: A more extensive list of mutations can be found in cBioportal, COSMIC, and/or other databases. When applicable, gene-specific pages within the CCGA site directly link to pertinent external content.

Epigenomic Alterations[edit | edit source]

MGMT promoter methylation (73%)[27] [28]

Genes and Main Pathways Involved[edit | edit source]

Put your text here and fill in the table (Instructions: Please include references throughout the table. Do not delete the table.)

Gene; Genetic Alteration Pathway Pathophysiologic Outcome
Homozygous deletion of CDKN2A, CDKN2B, RB1, and CDK4 RB pathway Increased cell growth and proliferation Negatively correlated with overall survival[29]
Amp of PDGFRA and activating mutations in PI3K genes RTK-PI3K-mTOR Increased activation induces cell cycle progression[30]  

Genetic Diagnostic Testing Methods[edit | edit source]

·      Initial diagnostic workup is performed by using routine immunohistochemical panel which involves IDH1 R132H, p53 and ATRX IHC

·      In case of negative and indeterminate IHC results, sequencing need to be performed for IDH1 codon 132 and IDH2 codon 172, to detect non-canonical (non-R132H) IDH1/2 mutations.

Familial Forms[edit | edit source]

·      Generally sporadic but low frequency SNP at 8q24.21 associated with increased risk[31]

·      Variants at 8q24.21 (CCDC locus), PHLDB1, AKT3, IDH1, D2HGDH[32]

·      Li-Fraumeni syndrome characterized by germline TP53 mutations[33]

·      IDH1R132C mutations in tumors with germline TP53 mutation[34]

·      Patients with inherited Ollier disease[35]

·      Germline mutations in mismatch repair genes (pediatric and adults)[36]

References[edit | edit source]


  1. ↑ Liu, Lingyu; et al. (2024-05). "MET fusions and splicing variants is a strong adverse prognostic factor in astrocytoma, isocitrate dehydrogenase mutant". Brain Pathology (Zurich, Switzerland). 34 (3): e13198. doi:10.1111/bpa.13198. ISSN 1750-3639. PMC 11007006 Check |pmc= value (help). PMID 37530224 Check |pmid= value (help). Check date values in: |date= (help)
  2. ↑ Wong, Queenie Hoi-Wing; et al. (2021-07). "Molecular landscape of IDH-mutant primary astrocytoma Grade IV/glioblastomas". Modern Pathology: An Official Journal of the United States and Canadian Academy of Pathology, Inc. 34 (7): 1245–1260. doi:10.1038/s41379-021-00778-x. ISSN 1530-0285. PMID 33692446 Check |pmid= value (help). Check date values in: |date= (help)
  3. ↑ Kirishima, Mari; et al. (2022-11). "IDH-mutant astrocytoma with an evolutional progression to CDKN2A/B homozygous deletion and NTRK fusion during recurrence: A case report". Pathology, Research and Practice. 239: 154163. doi:10.1016/j.prp.2022.154163. ISSN 1618-0631. PMID 36265224 Check |pmid= value (help). Check date values in: |date= (help)
  4. ↑ Kirishima, Mari; et al. (2022-11). "IDH-mutant astrocytoma with an evolutional progression to CDKN2A/B homozygous deletion and NTRK fusion during recurrence: A case report". Pathology, Research and Practice. 239: 154163. doi:10.1016/j.prp.2022.154163. ISSN 1618-0631. PMID 36265224 Check |pmid= value (help). Check date values in: |date= (help)
  5. ↑ Yang, Rui Ryan; et al. (2020-05). "IDH mutant lower grade (WHO Grades II/III) astrocytomas can be stratified for risk by CDKN2A, CDK4 and PDGFRA copy number alterations". Brain Pathology (Zurich, Switzerland). 30 (3): 541–553. doi:10.1111/bpa.12801. ISSN 1750-3639. PMC 8018138 Check |pmc= value (help). PMID 31733156. Check date values in: |date= (help)
  6. ↑ Lee, Kwanghoon; et al. (2023-04-25). "Genomic profiles of IDH-mutant gliomas: MYCN-amplified IDH-mutant astrocytoma had the worst prognosis". Scientific Reports. 13 (1): 6761. doi:10.1038/s41598-023-32153-y. ISSN 2045-2322. PMC 10130138 Check |pmc= value (help). PMID 37185778 Check |pmid= value (help).
  7. ↑ Yang, Rui Ryan; et al. (2020-05). "IDH mutant lower grade (WHO Grades II/III) astrocytomas can be stratified for risk by CDKN2A, CDK4 and PDGFRA copy number alterations". Brain Pathology (Zurich, Switzerland). 30 (3): 541–553. doi:10.1111/bpa.12801. ISSN 1750-3639. PMC 8018138 Check |pmc= value (help). PMID 31733156. Check date values in: |date= (help)
  8. ↑ Shirahata, Mitsuaki; et al. (2018-07). "Novel, improved grading system(s) for IDH-mutant astrocytic gliomas". Acta Neuropathologica. 136 (1): 153–166. doi:10.1007/s00401-018-1849-4. ISSN 1432-0533. PMID 29687258. Check date values in: |date= (help)
  9. ↑ Yang, Rui Ryan; et al. (2020-05). "IDH mutant lower grade (WHO Grades II/III) astrocytomas can be stratified for risk by CDKN2A, CDK4 and PDGFRA copy number alterations". Brain Pathology (Zurich, Switzerland). 30 (3): 541–553. doi:10.1111/bpa.12801. ISSN 1750-3639. PMC 8018138 Check |pmc= value (help). PMID 31733156. Check date values in: |date= (help)
  10. ↑ Shirahata, Mitsuaki; et al. (2018-07). "Novel, improved grading system(s) for IDH-mutant astrocytic gliomas". Acta Neuropathologica. 136 (1): 153–166. doi:10.1007/s00401-018-1849-4. ISSN 1432-0533. PMID 29687258. Check date values in: |date= (help)
  11. ↑ Lee, Kwanghoon; et al. (2023-04-25). "Genomic profiles of IDH-mutant gliomas: MYCN-amplified IDH-mutant astrocytoma had the worst prognosis". Scientific Reports. 13 (1): 6761. doi:10.1038/s41598-023-32153-y. ISSN 2045-2322. PMC 10130138 Check |pmc= value (help). PMID 37185778 Check |pmid= value (help).
  12. ↑ Li, Kay Ka-Wai; et al. (2019). "Identification of subsets of IDH-mutant glioblastomas with distinct epigenetic and copy number alterations and stratified clinical risks". Neuro-Oncology Advances. 1 (1): vdz015. doi:10.1093/noajnl/vdz015. ISSN 2632-2498. PMC 6798792. PMID 31667475.
  13. ↑ Lee, Kwanghoon; et al. (2023-04-25). "Genomic profiles of IDH-mutant gliomas: MYCN-amplified IDH-mutant astrocytoma had the worst prognosis". Scientific Reports. 13 (1): 6761. doi:10.1038/s41598-023-32153-y. ISSN 2045-2322. PMC 10130138 Check |pmc= value (help). PMID 37185778 Check |pmid= value (help).
  14. ↑ Tesileanu, C. Mircea S.; et al. (2022-11). "Molecular markers related to patient outcome in patients with IDH-mutant astrocytomas grade 2 to 4: A systematic review". European Journal of Cancer (Oxford, England: 1990). 175: 214–223. doi:10.1016/j.ejca.2022.08.016. ISSN 1879-0852. PMID 36152406 Check |pmid= value (help). Check date values in: |date= (help)
  15. ↑ Mirchia, Kanish; et al. (2020-07-06). "Beyond IDH-Mutation: Emerging Molecular Diagnostic and Prognostic Features in Adult Diffuse Gliomas". Cancers. 12 (7): 1817. doi:10.3390/cancers12071817. ISSN 2072-6694. PMC 7408495 Check |pmc= value (help). PMID 32640746 Check |pmid= value (help).
  16. ↑ Tesileanu, C. Mircea S.; et al. (2022-11). "Molecular markers related to patient outcome in patients with IDH-mutant astrocytomas grade 2 to 4: A systematic review". European Journal of Cancer (Oxford, England: 1990). 175: 214–223. doi:10.1016/j.ejca.2022.08.016. ISSN 1879-0852. PMID 36152406 Check |pmid= value (help). Check date values in: |date= (help)
  17. ↑ Tesileanu, C. Mircea S.; et al. (2022-11). "Molecular markers related to patient outcome in patients with IDH-mutant astrocytomas grade 2 to 4: A systematic review". European Journal of Cancer (Oxford, England: 1990). 175: 214–223. doi:10.1016/j.ejca.2022.08.016. ISSN 1879-0852. PMID 36152406 Check |pmid= value (help). Check date values in: |date= (help)
  18. ↑ Cancer Genome Atlas Research Network; et al. (2015-06-25). "Comprehensive, Integrative Genomic Analysis of Diffuse Lower-Grade Gliomas". The New England Journal of Medicine. 372 (26): 2481–2498. doi:10.1056/NEJMoa1402121. ISSN 1533-4406. PMC 4530011. PMID 26061751.
  19. ↑ Eckel-Passow, Jeanette E.; et al. (2015-06-25). "Glioma Groups Based on 1p/19q, IDH, and TERT Promoter Mutations in Tumors". The New England Journal of Medicine. 372 (26): 2499–2508. doi:10.1056/NEJMoa1407279. ISSN 1533-4406. PMC 4489704. PMID 26061753.
  20. ↑ Killela, Patrick J.; et al. (2013-04-09). "TERT promoter mutations occur frequently in gliomas and a subset of tumors derived from cells with low rates of self-renewal". Proceedings of the National Academy of Sciences of the United States of America. 110 (15): 6021–6026. doi:10.1073/pnas.1303607110. ISSN 1091-6490. PMC 3625331. PMID 23530248.
  21. ↑ Liu, Lingyu; et al. (2024-05). "MET fusions and splicing variants is a strong adverse prognostic factor in astrocytoma, isocitrate dehydrogenase mutant". Brain Pathology (Zurich, Switzerland). 34 (3): e13198. doi:10.1111/bpa.13198. ISSN 1750-3639. PMC 11007006 Check |pmc= value (help). PMID 37530224 Check |pmid= value (help). Check date values in: |date= (help)
  22. ↑ Aoki, Kosuke; et al. (2018-01-10). "Prognostic relevance of genetic alterations in diffuse lower-grade gliomas". Neuro-Oncology. 20 (1): 66–77. doi:10.1093/neuonc/nox132. ISSN 1523-5866. PMC 5761527. PMID 29016839.
  23. ↑ Wong, Queenie Hoi-Wing; et al. (2021-07). "Molecular landscape of IDH-mutant primary astrocytoma Grade IV/glioblastomas". Modern Pathology: An Official Journal of the United States and Canadian Academy of Pathology, Inc. 34 (7): 1245–1260. doi:10.1038/s41379-021-00778-x. ISSN 1530-0285. PMID 33692446 Check |pmid= value (help). Check date values in: |date= (help)
  24. ↑ Wong, Queenie Hoi-Wing; et al. (2021-07). "Molecular landscape of IDH-mutant primary astrocytoma Grade IV/glioblastomas". Modern Pathology: An Official Journal of the United States and Canadian Academy of Pathology, Inc. 34 (7): 1245–1260. doi:10.1038/s41379-021-00778-x. ISSN 1530-0285. PMID 33692446 Check |pmid= value (help). Check date values in: |date= (help)
  25. ↑ Aoki, Kosuke; et al. (2018-01-10). "Prognostic relevance of genetic alterations in diffuse lower-grade gliomas". Neuro-Oncology. 20 (1): 66–77. doi:10.1093/neuonc/nox132. ISSN 1523-5866. PMC 5761527. PMID 29016839.
  26. ↑ Zhao, Binghao; et al. (2022-03-14). "Molecular landscape of IDH-mutant astrocytoma and oligodendroglioma grade 2 indicate tumor purity as an underlying genomic factor". Molecular Medicine (Cambridge, Mass.). 28 (1): 34. doi:10.1186/s10020-022-00454-z. ISSN 1528-3658. PMC 8919570 Check |pmc= value (help). PMID 35287567 Check |pmid= value (help).
  27. ↑ Nakamura, M.; et al. (2001-10). "Promoter methylation of the DNA repair gene MGMT in astrocytomas is frequently associated with G:C --> A:T mutations of the TP53 tumor suppressor gene". Carcinogenesis. 22 (10): 1715–1719. doi:10.1093/carcin/22.10.1715. ISSN 0143-3334. PMID 11577014. Check date values in: |date= (help)
  28. ↑ Turcan, Sevin; et al. (2012-02-15). "IDH1 mutation is sufficient to establish the glioma hypermethylator phenotype". Nature. 483 (7390): 479–483. doi:10.1038/nature10866. ISSN 1476-4687. PMC 3351699. PMID 22343889.
  29. ↑ Tesileanu, C. Mircea S.; et al. (2022-11). "Molecular markers related to patient outcome in patients with IDH-mutant astrocytomas grade 2 to 4: A systematic review". European Journal of Cancer (Oxford, England: 1990). 175: 214–223. doi:10.1016/j.ejca.2022.08.016. ISSN 1879-0852. PMID 36152406 Check |pmid= value (help). Check date values in: |date= (help)
  30. ↑ Tesileanu, C. Mircea S.; et al. (2022-11). "Molecular markers related to patient outcome in patients with IDH-mutant astrocytomas grade 2 to 4: A systematic review". European Journal of Cancer (Oxford, England: 1990). 175: 214–223. doi:10.1016/j.ejca.2022.08.016. ISSN 1879-0852. PMID 36152406 Check |pmid= value (help). Check date values in: |date= (help)
  31. ↑ Batchelor, Tracy T.; et al. (2023-04-06). "Understanding the Genetic Risk of IDH-Mutant Glioma". The New England Journal of Medicine. 388 (14): 1332–1334. doi:10.1056/NEJMcibr2213112. ISSN 1533-4406. PMID 37018498 Check |pmid= value (help).
  32. ↑ Batchelor, Tracy T.; et al. (2023-04-06). "Understanding the Genetic Risk of IDH-Mutant Glioma". The New England Journal of Medicine. 388 (14): 1332–1334. doi:10.1056/NEJMcibr2213112. ISSN 1533-4406. PMID 37018498 Check |pmid= value (help).
  33. ↑ Watanabe, Takuya; et al. (2009-06). "Selective acquisition of IDH1 R132C mutations in astrocytomas associated with Li-Fraumeni syndrome". Acta Neuropathologica. 117 (6): 653–656. doi:10.1007/s00401-009-0528-x. ISSN 1432-0533. PMID 19340432. Check date values in: |date= (help)
  34. ↑ Watanabe, Takuya; et al. (2009-06). "Selective acquisition of IDH1 R132C mutations in astrocytomas associated with Li-Fraumeni syndrome". Acta Neuropathologica. 117 (6): 653–656. doi:10.1007/s00401-009-0528-x. ISSN 1432-0533. PMID 19340432. Check date values in: |date= (help)
  35. ↑ Corvino, Sergio; et al. (2022-07-16). "Brain Gliomas and Ollier Disease: Molecular Findings as Predictive Risk Factors?". Cancers. 14 (14): 3464. doi:10.3390/cancers14143464. ISSN 2072-6694. PMC 9324397 Check |pmc= value (help). PMID 35884525 Check |pmid= value (help).
  36. ↑ Richardson, Timothy E.; et al. (2023). "Mismatch repair protein mutations in isocitrate dehydrogenase (IDH)-mutant astrocytoma and IDH-wild-type glioblastoma". Neuro-Oncology Advances. 5 (1): vdad085. doi:10.1093/noajnl/vdad085. ISSN 2632-2498. PMC 10406418 Check |pmc= value (help). PMID 37554222 Check |pmid= value (help).

Notes[edit | edit source]

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Prior Author(s): *Citation of this Page: “Astrocytoma, IDH-mutant”. Compendium of Cancer Genome Aberrations (CCGA), Cancer Genomics Consortium (CGC), updated 09/4/2025, https://ccga.io/index.php/CNS5:Astrocytoma, IDH-mutant.

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