{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T10:45:01Z","timestamp":1789469101319,"version":"build-2803163510"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Diffuse gliomas are the most common malignant primary central nervous system (CNS) tumors, and contemporary World Health Organization (WHO) criteria require molecular markers, mainly isocitrate dehydrogenase (IDH) status and 1p\/19q codeletion, for an integrated diagnosis. Access to these tests remains uneven in low- and middle-income settings. Data describing the glioma spectrum and the practical impact of limited molecular testing in Jordan are scarce.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>We retrospectively retrieved all glioma-related surgical pathology specimens accessioned between 2003 and 2024 at a tertiary academic center in Jordan through a structured text search. Histological category, WHO grade, anatomic site, immunohistochemical (IHC) profile, Ki-67 index, and documented IDH\/1p-19q status were extracted from the free-text reports. After exclusion of non-neoplastic, non-glial, and unclassifiable records, 430 specimens from 332 patients formed the analytic cohort. Ki-67 across grades was compared with the Kruskal-Wallis test and categorical age associations with the chi-square test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The median age was 48 years (IQR 28-63; range 3-98) with a male predominance (male-to-female ratio 1.30). Glioblastoma was the most frequent diagnosis (174\/430; 40.5%), followed by non-pilocytic astrocytoma (17.9%) and unspecified diffuse glioma (12.8%). The Ki-67 index increased significantly across WHO grades (median 3%, 2%, 20%, and 30% for grades I-IV; Kruskal-Wallis p &amp;lt; 0.0001). An actual IDH result was documented for only 10 specimens (2.3% overall; 3.0% of 329 diffuse gliomas), while reports explicitly noted that testing was indicated but unavailable in a further 17.4%. Glioblastoma was almost exclusive to adults and pilocytic astrocytoma to children (both p &amp;lt; 0.0001). Annual case volume rose from approximately 15 to 25 specimens per year, yet documented IDH results appeared only after 2017 and in fewer than 5% of recent specimens.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Over two decades, gliomas at our center were diagnosed predominantly on morphology and a limited IHC panel. The near-absence of molecular results means the large majority of diffuse gliomas cannot be fully classified by current WHO standards, a concrete diagnostic-capacity gap with direct implications for prognostication, treatment stratification, and trial eligibility. The findings support investment in accessible molecular neuropathology, including surrogate IHC and regional referral testing.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1909105","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T09:37:09Z","timestamp":1789465029000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Two-decade clinicopathological spectrum of gliomas at a tertiary center in LMIC: histological profile and the molecular diagnostic gap"],"prefix":"10.3389","volume":"16","author":[{"given":"Suleiman S.","family":"Daoud","sequence":"first","affiliation":[{"name":"Neurosurgery Department, Faculty of Medicine, Jordan University of Science & Technology","place":["Irbid, Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atef F.","family":"Hulliel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brain and Spine, University of South Florida Morsani College of Medicine","place":["Tampa, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sultan","family":"Jarrar","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Faculty of Medicine, Jordan University of Science & Technology","place":["Irbid, Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amer","family":"Jaradat","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Faculty of Medicine, Jordan University of Science & Technology","place":["Irbid, Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lina Ayman","family":"Alababneh","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Faculty of Medicine, Jordan University of Science & Technology","place":["Irbid, Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Abdallah","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Faculty of Medicine, Jordan University of Science & Technology","place":["Irbid, Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"v1","DOI":"10.1093\/neuonc\/noac202","article-title":"CBTRUS statistical report: Primary brain and other central nervous system tumors diagnosed in the United States in 2015-2019","volume":"24","author":"Ostrom","year":"2022","journal-title":"Neuro Oncol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3390\/cancers17010146","article-title":"Glioblastoma: Clinical presentation, multidisciplinary management, and long-term outcomes","volume":"17","author":"Sipos","year":"2025","journal-title":"Cancers (Basel)"},{"key":"B3","article-title":"NICE evidence reviews collection","volume-title":"Evidence reviews for the investigation, management and follow-up of glioma: Brain tumours (primary) and brain metastases in adults: Evidence Report A","author":"National Guideline","year":"2018"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.2176\/nmc.ra.2017-0010","article-title":"The 2016 WHO classification of tumours of the central nervous system: The major points of revision","volume":"57","author":"Komori","year":"2017","journal-title":"Neurol Med Chir (Tokyo)"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/noab106","article-title":"The 2021 WHO classification of tumors of the central nervous system: A summary","volume":"23","author":"Louis","year":"2021","journal-title":"Neuro Oncol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1186\/s12880-025-02080-7","article-title":"Distinguishing IDH-mutant astrocytomas from IDH-wildtype glioblastomas using qualitative and quantitative MRI features: A WHO CNS5 study","volume":"25","author":"Meng","year":"2025","journal-title":"BMC Med Imaging"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1007\/s00234-017-1839-6","article-title":"IDH mutant and 1p\/19q co-deleted oligodendrogliomas: Tumor grade stratification using diffusion-, susceptibility-, and perfusion-weighted MRI","volume":"59","author":"Lin","year":"2017","journal-title":"Neuroradiology"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/noy132","article-title":"MGMT promoter methylation status testing to guide therapy for glioblastoma: Refining the approach based on emerging evidence and current challenges","volume":"21","author":"Mansouri","year":"2019","journal-title":"Neuro Oncol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/noad100","article-title":"Molecular diagnostic tools for the World Health Organization (WHO) 2021 classification of gliomas, glioneuronal and neuronal tumors; an EANO guideline","volume":"25","author":"Sahm","year":"2023","journal-title":"Neuro Oncol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1007\/s11910-023-01314-x","article-title":"Disparities in neuro-oncology","volume":"23","author":"Michaelson","year":"2023","journal-title":"Curr Neurol Neurosci Rep"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1268","DOI":"10.1186\/s40001-025-03511-5","article-title":"Epidemiological trends of burden of brain and CNS cancer at global, regional, and national level: A trend analysis study from 1990 to 2021","volume":"30","author":"Chen","year":"2025","journal-title":"Eur J Med Res"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.7650","article-title":"Detection of ATRX and IDH1-R132H immunohistochemistry in the progression of 211 paired gliomas","volume":"7","author":"Cai","year":"2016","journal-title":"Oncotarget"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/s1470-2045(19)30273-6","article-title":"Global childhood cancer survival estimates and priority-setting: A simulation-based analysis","volume":"20","author":"Ward","year":"2019","journal-title":"Lancet Oncol"},{"key":"B14","doi-asserted-by":"crossref","DOI":"10.15586\/codon.glioblastoma.2017.ch8","article-title":"Epidemiology and outcome of glioblastoma","volume-title":"Glioblastoma","author":"Tamimi","year":"2017"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1093\/noajnl\/vdab125","article-title":"Glioblastoma as an age-related neurological disorder in adults","volume":"3","author":"Kim","year":"2021","journal-title":"Neuro-Oncol Adv"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/1429615","article-title":"The epidemiology of primary central nervous system tumors at the National Neurologic Institute in Saudi Arabia: A ten-year single-institution study","volume":"2020","author":"Almutrafi","year":"2020","journal-title":"J Cancer Epidemiol"},{"key":"B17","article-title":"Epidemiologic patterns of primary brain tumors in Iran","volume":"9","author":"Alimohamadi","year":"2008","journal-title":"Asian Pac J Cancer Prev"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.31557\/apjcp.2020.21.4.1063","article-title":"Association between Ki-67 labeling index and histopathological grading of glioma in Indonesian population","volume":"21","author":"Theresia","year":"2020","journal-title":"Asian Pac J Cancer Prev"},{"key":"B19","doi-asserted-by":"publisher","first-page":"17918","DOI":"10.1038\/s41598-021-95958-9","article-title":"Prognostic role of Ki-67 in glioblastomas excluding contribution from non-neoplastic cells","volume":"11","author":"Dahlrot","year":"2021","journal-title":"Sci Rep"},{"key":"B20","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1186\/s13000-018-0711-2","article-title":"Evaluation of the proliferation marker Ki-67 in gliomas: Interobserver variability and digital quantification","volume":"13","author":"Nielsen","year":"2018","journal-title":"Diagn Pathol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1038\/s41571-020-00447-z","article-title":"EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood","volume":"18","author":"Weller","year":"2021","journal-title":"Nat Rev Clin Oncol"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1111\/nan.12790","article-title":"Diagnostic accuracy of 1p\/19q codeletion tests in oligodendroglioma: A comprehensive meta-analysis based on a Cochrane systematic review","volume":"48","author":"Brandner","year":"2022","journal-title":"Neuropathol Appl Neurobiol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1007\/s11060-025-05368-4","article-title":"Treatment differences in IDH-wildtype glioma - the impact of surgery and adjuvant therapy","volume":"176","author":"Keric","year":"2025","journal-title":"J Neuro-Oncol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2025.1628195","article-title":"Vorasidenib for IDH-mutant grade 2 gliomas: Clinical advances and future directions","volume":"15","author":"Pan","year":"2025","journal-title":"Front Oncol"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.3390\/medsci13040233","article-title":"Incidence and survival of IDH-wildtype glioblastoma and IDH-mutant astrocytoma by treatment and sex: A regional study in Spain (2011-2021)","volume":"13","author":"Encarnacion","year":"2025","journal-title":"Med Sci (Basel)"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.3390\/ijms262412162","article-title":"Glioblastoma-a contemporary overview of epidemiology, classification, pathogenesis, diagnosis, and treatment: A review article","volume":"26","author":"Krolikowska","year":"2025","journal-title":"Int J Mol Sci"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1007\/s00401-014-1370-3","article-title":"ATRX and IDH1-R132H immunohistochemistry with subsequent copy number analysis and IDH sequencing as a basis for an \"integrated\" diagnostic approach for adult astrocytoma, oligodendroglioma and glioblastoma","volume":"129","author":"Reuss","year":"2015","journal-title":"Acta Neuropathol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"iv1","DOI":"10.1093\/neuonc\/noad149","article-title":"CBTRUS statistical report: Primary brain and other central nervous system tumors diagnosed in the United States in 2016-2020","volume":"25","author":"Ostrom","year":"2023","journal-title":"Neuro Oncol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/nox141","article-title":"Pediatric low-grade gliomas: Next biologically driven steps","volume":"20","author":"Jones","year":"2018","journal-title":"Neuro Oncol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1268038","DOI":"10.3389\/fnmol.2024.1268038","article-title":"Pediatric CNS tumors and 2021 WHO classification: What do oncologists need from pathologists","volume":"17","author":"d'Amati","year":"2024","journal-title":"Front Mol Neurosci"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.25122\/jml-2023-0515","article-title":"Recent updates in pediatric diffuse glioma classification: Insights and conclusions from the WHO 5(th) edition","volume":"17","author":"Patel","year":"2024","journal-title":"J Med Life"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1016\/j.neo.2022.100857","article-title":"Pediatric low-grade glioma: Targeted therapeutics and clinical trials in the molecular era","volume":"36","author":"Manoharan","year":"2023","journal-title":"Neoplasia"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2023.1204829","article-title":"Unlocking the power of precision medicine for pediatric low-grade gliomas: Molecular characterization for targeted therapies with enhanced safety and efficacy","volume":"13","author":"Cipri","year":"2023","journal-title":"Front Oncol"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1909105\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T09:37:10Z","timestamp":1789465030000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1909105\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,15]]},"references-count":33,"alternative-id":["10.3389\/fonc.2026.1909105"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1909105","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,15]]},"article-number":"1909105"}}