{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T15:49:50Z","timestamp":1792511390158,"version":"4.5.0"},"reference-count":95,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T00:00:00Z","timestamp":1739232000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Brain tumors pose a significant health threat, leading to high morbidity and mortality rates. Astrocytoma IDH-mutant grade 4 (A4IDHmt) and glioblastoma IDH-wildtype (G4IDHwt) exhibit similar clinical and imaging characteristics. This study aims to highlight the differences in their clinical evolution and histogenetic aspects with the possible therapeutic impact, as well as the adverse prognostic factors in patient survival. Methods: We performed a 10-year retrospective study of grade 4 gliomas, evaluating immunomarkers and FISH tests. We also quantified tumor necrosis and microvascular density. Results: A total of 81 cases were identified; 54.32% were A4IDHmt. We observed that A4IDHmt patients were younger (34.10% under 50) and had a higher survival rate (4.55%). This group also exhibited a more pronounced microvascular density (p = 0.010) and proliferative index (p = 0.026). G4IDHwt was associated with larger tumor volumes (94.84 cm3 vs. 86.14 cm3), lower resectability rates (82.88% vs. 87.67%), and a more significant immature cell population (83.78% vs. 68.18%). In the case of both, the negative risk on survival in the univariate analysis is given by advanced age (A4IDHmt: HR = 1.035, G4IDHwt: HR = 1.045) and p53 immunopositivity (A4IDHmt: HR = 6.962, G4IDHwt: HR = 4.680). Conclusions: The negative risk factors for A4IDHmt include the rapid onset of clinical symptoms (HR = 2.038), diabetes mellitus (HR = 2.311), arterial hypertension (HR = 2.325), residual tumor (HR = 2.662), increased residual tumor volume (HR = 1.060), increased microvascular density (HR = 1.096), and high tumor necrosis (HR = 1.097). For G4IDHwt, the negative risk factors consist of increased residual volume (HR = 1.023), lost PTEN immunoreaction (HR = 33.133), and unmethylated DNA status (HR = 6.765, respectively HR = 20.573). Even if it has more risk factors, A4IDHmt is the lesser evil.<\/jats:p>","DOI":"10.3390\/diagnostics15040438","type":"journal-article","created":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T11:54:06Z","timestamp":1739274846000},"page":"438","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Comparative Clinical-Imaging and Histogenetic Analysis Between Astrocytoma IDH-Mutant Grade 4 and Glioblastoma IDH-Wildtype\u2014Is There Really a Worse One?"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8039-3200","authenticated-orcid":false,"given":"Cristian Ionut","family":"Orasanu","sequence":"first","affiliation":[{"name":"Department of Pathology, Clinical Service of Pathology, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 900591 Constanta, Romania"},{"name":"Faculty of Medicine, \u201cOvidius\u201d University of Constanta, 900470 Constanta, Romania"},{"name":"Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology (CEDMOG), \u201cOvidius\u201d University, 900591 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana","family":"Aschie","sequence":"additional","affiliation":[{"name":"Department of Pathology, Clinical Service of Pathology, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 900591 Constanta, Romania"},{"name":"Faculty of Medicine, \u201cOvidius\u201d University of Constanta, 900470 Constanta, Romania"},{"name":"Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology (CEDMOG), \u201cOvidius\u201d University, 900591 Constanta, Romania"},{"name":"Department of Anatomy, Academy of Medical Sciences of Romania, 030171 Bucharest, Romania"},{"name":"Department VIII\u2014Medical Sciences, The Romanian Academy of Scientists, 030167 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana","family":"Deacu","sequence":"additional","affiliation":[{"name":"Department of Pathology, Clinical Service of Pathology, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 900591 Constanta, Romania"},{"name":"Faculty of Medicine, \u201cOvidius\u201d University of Constanta, 900470 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madalina","family":"Bosoteanu","sequence":"additional","affiliation":[{"name":"Department of Pathology, Clinical Service of Pathology, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 900591 Constanta, Romania"},{"name":"Faculty of Medicine, \u201cOvidius\u201d University of Constanta, 900470 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sorin","family":"Vamesu","sequence":"additional","affiliation":[{"name":"Department of Pathology, Clinical Service of Pathology, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 900591 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuela","family":"Enciu","sequence":"additional","affiliation":[{"name":"Department of Pathology, Clinical Service of Pathology, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 900591 Constanta, Romania"},{"name":"Faculty of Medicine, \u201cOvidius\u201d University of Constanta, 900470 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgeta Camelia","family":"Cozaru","sequence":"additional","affiliation":[{"name":"Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology (CEDMOG), \u201cOvidius\u201d University, 900591 Constanta, Romania"},{"name":"Department of Genetics, Clinical Service of Pathology, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 900591 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anca Florentina","family":"Mitroi","sequence":"additional","affiliation":[{"name":"Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology (CEDMOG), \u201cOvidius\u201d University, 900591 Constanta, Romania"},{"name":"Department of Genetics, Clinical Service of Pathology, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 900591 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sinziana Andra","family":"Ghitoi","sequence":"additional","affiliation":[{"name":"Department of Pathology, Clinical Service of Pathology, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 900591 Constanta, Romania"},{"name":"Faculty of Medicine, \u201cOvidius\u201d University of Constanta, 900470 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Maria","family":"Cretu","sequence":"additional","affiliation":[{"name":"Department of Pathology, Clinical Service of Pathology, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 900591 Constanta, Romania"},{"name":"Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology (CEDMOG), \u201cOvidius\u201d University, 900591 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oana Andreea","family":"Ursica","sequence":"additional","affiliation":[{"name":"Department of Pathology, Clinical Service of Pathology, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 900591 Constanta, Romania"},{"name":"Faculty of Medicine, \u201cOvidius\u201d University of Constanta, 900470 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9396-2350","authenticated-orcid":false,"given":"Raluca Ioana","family":"Voda","sequence":"additional","affiliation":[{"name":"Department of Pathology, Clinical Service of Pathology, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 900591 Constanta, Romania"},{"name":"Faculty of Medicine, \u201cOvidius\u201d University of Constanta, 900470 Constanta, Romania"},{"name":"Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology (CEDMOG), \u201cOvidius\u201d University, 900591 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1038\/s41572-024-00516-y","article-title":"Glioma","volume":"10","author":"Weller","year":"2024","journal-title":"Nat. Rev. Dis. 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