Commentary: Radiological Characteristics and Natural History of Adult IDH-Wild-Type Astrocytomas With TERT Promoter Mutations

The authors of this elegant study1 retrospectively reviewed the clinical characteristics of 40 gliomas IDH-wild-type pTERT-mutant astrocytomas (World Health Organization [WHO] grade II [n = 19] and grade III [n = 21]) and compared them to the outcome of 114 IDH-mutant and pTERTwild- type lower grade gliomas (LGG), of 92 IDH-wild-type pTERT-mutant glioblastoma multiforme (GBM), and of 15 IDH-wild-type pTERT-wild-type astrocytomas. The authors showed that IDH-wild-type pTERT-mutant astrocytomas typically present as nonenhancing temporo-insular infiltrative lesions or, in some instances, as gliomatosis cerebri in patients aged >50 yr. Accordingly, although these tumors often display an initial, falsely reassuring, LGG-like appearance, they indeed present a typically aggressive behavior and in the absence of treatment, grow rapidly, and develop GBMlike characteristics.