Despite an improved understanding of the molecular aberrations that occur in glioblastoma, the use of molecularly targeted therapies have so far been disappointing. of the right basal ganglia was performed and the histological exam confirmed a analysis of glioblastoma with regions of both grade II and IV tumour. The patient was treated with standard chemoradiation followed by three cycles of adjuvant temozolomide but his disease progressed.11 The patient died 5 Olaparib months after starting second-line chemotherapy and 10 months from diagnosis. Imaging and histopathology At and missense mutation c.817C>T (p.R273C) (Number 3a) but no mutation of or and (Number 3b), deletion of 15q13.3-22.31 (Number 3c) and LOH of chromosomes 10, 17 and 19. The glioblastoma was characterised by amplification of 4q12 comprising the receptor kinase genes (and (Figure 3d) and gain of (Figure 3e). Figure 2 Model of tumour development based on DNA changes in the three tumours. (Note: chromosome 7 demonstrates gain in the gliosarcoma and astrocytoma and is rearranged in the glioblastoma. Chromosomes 2 and 5 are rearranged in the gliosarcoma). Figure 3 Genetic analysis of the 3 tumours: (i) glioblastoma, (ii) astrocytoma and (iii) gliosarcoma. Panel (a) shows the missense mutation c.817C>T (p.R273C), this was present in all three tumours (astrocytoma shown here). Panel (b) shows the 9p23C21.3 … Discussion The Olaparib most significant advance in the treatment of glioblastoma has been the addition of temozolomide chemotherapy to radiotherapy, but the median survival in treated patients is 14.6 months.11 There has been a focus on determining molecular markers that determine response in individual patients.13, 14, 15, 16, 17 However, in designing trials with molecular targeted agents, tumour heterogeneity has not been addressed. If the target is not present throughout the tumour, how can the tumour respond to the treatment?18 Gliobastomas have been subdivided into primary’ and secondary’ glioblastoma.19 The patients with primary glioblastoma are older with frequent activating mutations in mutation, which have developed from lower grade tumours.12 More recently, this classification has been expanded based on genomic and manifestation changes Olaparib defining four organizations, with classical being defined by aberrations in and and a neural group defined by neural markers.5, 20, 21 The glioblastoma with this full case is thought as a secondary, proneural glioblastoma. This affected person was typical of these with proneural tumours as he was fairly young and got poor success despite intense treatment.20 Gliosarcoma is distinguished from glioblastoma by sarcomatous differentiation from the arteries histologically. This Olaparib diagnosis is manufactured significantly less than glioblastoma as well as the prognosis is worse frequently.22, 23 The shared source of the three tumours was demonstrated by exactly the same p.R273C mutation as well as the patterns of deletions. Deletion of 9p21.3 in tumours is common as this area contains the essential tumour suppressor CTSD gene and amplification from the receptor tyrosine kinase (RTK) Three latest research used FISH to research RTK gene amplification in glioblastoma. They proven different subclones inside the same tumour with differing and mutually special and amplification.26, 27, 28 This scholarly research raises queries over the existing method of analysis, tumour therapies and classification. We suggest that a greater knowledge of hereditary heterogeneity is necessary. This will demand even more delicate recognition of rearrangements and mutations, more complete hereditary assessment from the tumour mass and possibly, evaluation of cell-free DNA where biopsy can be problematic, for instance, from cerebrospinal bloodstream or liquid plasma.29 This will be incorporated right into a new tumour classification system also to guide the usage of therapy ideally to the people lesions present through the entire tumour burden. Alternatively, we will have to identify and target multiple lesions. Materials and methods Ethics approval At the request of the patient and his wife, following the patient’s death, a.