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Creutzfeldt astrocytes may be seen in IDH-wildtype glioblastoma and retain expression of DNA repair and chromatin binding proteins.

  • Ballester, Leomar Y1, 2
  • Boghani, Zain3
  • Baskin, David S3, 4, 5
  • Britz, Gavin W3, 4, 5
  • Olsen, Randall1, 4, 5
  • Fuller, Gregory N6
  • Powell, Suzanne Z1, 4, 5
  • Cykowski, Matthew D1, 4, 5
  • 1 Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX.
  • 2 Department of Pathology and Laboratory Medicine, Department of Neurosurgery, University of Texas Health Science Center, Houston, TX.
  • 3 Department of Neurosurgery, Houston Methodist Hospital, Houston, TX.
  • 4 Weill Cornel Medical College, New York, NY.
  • 5 Houston Methodist Research Institute, Institute of Academic Medicine, Houston, TX.
  • 6 Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX.
Published Article
Brain Pathology
Wiley (Blackwell Publishing)
Publication Date
Nov 01, 2018
DOI: 10.1111/bpa.12604
PMID: 29509313


Astrocytes with multiple micronuclei ("Creutzfeldt cells") in a brain biopsy are classically associated with demyelinating disease. However, glioblastoma may also have prominent Creutzfeldt astrocytes, along with granular mitoses. Therefore, Creutzfeldt cells may raise the diagnostic dilemma of high-grade glioma vs tumefactive demyelination. While cases of glioblastoma (GBM) with Creutzfeldt astrocytes have been reported, their clinicopathologic spectrum and genetic features are not understood. Studies have proposed that micronuclei in Creutzfeldt cells are a consequence of DNA damage, or may be susceptible to DNA damage and chromothripsis, but their biology in the context of glioblastoma remains unclear. Based on a challenging index case of GBM with mild hypercellularity, Creutzfeldt astrocytes, and granular mitoses on biopsy, we searched our archives for additional cases with similar histopathologic features. We identified 13 cases, reviewed their clinico-radiologic and pathologic features, and examined them for recurrent genetic alterations via NGS (9 cases) and for evidence of DNA damage by immunohistochemistry for DNA repair and chromatin remodeling proteins. We found that Creutzfeldt cell-rich GBMs were IDH-wildtype with no recurring genetic alterations. To test our hypothesis that micronuclei demonstrate loss of DNA repair or chromatin remodeling proteins, we examined the expression of various proteins (MDM2, p53, MLH1, MSH2, PMS2, MSH6, ATRX, INI1, SATB2, Ki67, pHH3) in Creutzfeldt cell rich-GBM. There was intact expression of DNA repair and chromatin remodeling proteins, with accumulation of p53 and reduced MDM2 expression within micronuclei. In contrast, granular mitoses showed pHH3 expression, confirming these cells are undergoing mitotic division, with no accumulation of p53 and reduced expression of DNA repair proteins. Our results emphasize that Creutzfeldt cells are part of the morphologic spectrum of IDH-wildtype glioblastoma. We did not find a role for DNA damage in the generation of Creutzfeldt cells, as both DNA repair and chromatin remodeling protein expression was retained in these cells. © 2018 International Society of Neuropathology.

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