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Introduction: Glioblastoma multiforme (GBM) is one of the deadliest cranial tumors occurring in adults. Various biomarkers have been tested for their significance in diagnosis, prognosis, and treatment of GBM. Some well-studied markers in GBM are Isocitrate dehydrogenase 1 (IDH1), Murine double minute 2 (MDM2), Epidermal Growth Factor Receptor (EGFR), and p53. The aim of this study was to investigate the protein expression of these markers in GBM patients of Pakistan. Methods: A total of 102 surgically resected formalin-fixed paraffin-embedded specimens from patients diagnosed and treated at Aga Khan University Hospital were included in this study. Immunohistochemistry (IHC) for IDH1, MDM2, EGFR, and p53 was performed using Dako EnVision System and respective monoclonal antibodies. Survival analysis was performed to check association of markers protein expression with prognosis in GBM patients. Results: There were 73 males and 29 females in this study, with a median age of 49 years at the time diagnosis. Overexpression of molecular markers was as follows: 52% for EGFR, 26% for p53, 72% for IDH1, and 83% for MDM2. We did observe that EGFR was significantly associated with increased age of our patients and with worse survival. Age > 40 years was a predictor for worse prognosis as well. Conclusion: EGFR overexpression and advanced age were worse prognostic indicators. [ABSTRACT FROM AUTHOR]

Objective: To determine the immune histochemical expression of IDH1, ATRX and p53 in low-grade diffuse gliomas. Study Design: Cross-sectional study. Place and Duration of Study: Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Jan to Jun 2020. Methodology: Forty-two cases of low-grade diffuse glioma were included in the study. The cases were stratified into diffuse astrocytoma and oligodendroglioma based on results of immunohistochemistry expression for IDH1, ATRX and p53. Results: The frontal lobe was the most commonly affected site 14 (33.3%). Based on the results of immunohistochemistry expression, 26 cases (61.9%) were diagnosed as an oligodendroglioma, while 16 cases (38.1%) were diagnosed as diffuse astrocytoma. All cases were assigned who grade II out of IV. In oligodendrogliomas, all cases (100%) were IDH1 mutants with the retained expression of ATRX and wild type expression of p53. Among the 16 cases of diffuse astrocytoma, IDH1 was mutant in 12 cases (75%), ATRX expression was lost in all cases, and p53 was mutant in 6 cases (37.5%). Conclusion: The study showed that low-grade diffuse gliomas could be stratified and sub-classified in accordance with the World Health Organization (WHO) classification of CNS tumours (2016) successfully by application of immunohistochemistry for IDH1, ATRX and p53. [ABSTRACT FROM AUTHOR]