Clinicopathological and prognostic relevance of nestin in low- and high-grade gliomas: An immunohistochemical study

Figure 1 Representative images of morphology and immunohistochemical staining of glioma tumors. A: Low-grade astrocytoma (World Health Organization grade II) on hematoxylin and eosin [hematoxylin-eosin (HE)] staining showing low-grade and uniform nuclei (HE, × 100); B: Cytoplasmic nestin expression on immunohistochemistry (IHC) staining in a low-grade glioma case (IHC for nestin, × 50); C: High-grade glioblastoma (World Health Organization grade IV) on HE staining with high-grade pleomorphic nuclei (HE, × 200); D: Strong cytoplasmic nestin expression on IHC staining in a high-grade glioma case (IHC for nestin, × 200).

Figure 2 Kaplan-Meier survival curves according to nestin expression status, glioma grades. A: It shows that the median survival was 22 months in low expression of nestin, while the median survival was 8 months in high expression of nestin; B: It shows that the median survival in low-grade and low nestin expression was 26 months, while the median survival was 2 months in high-grade tumors with high expression of nestin.

Figure 3 Proposed integration of nestin expression within the 2021 World Health Organization molecular classification framework for gliomas. It illustrates how nestin immunoexpression may complement molecular markers to refine diagnostic accuracy and prognostic assessment. High nestin expression is associated with stem-like, invasive tumor phenotypes and poor outcomes, while low expression correlates with differentiated morphology and improved survival. Incorporating nestin into the World Health Organization 2021 molecular framework may improve patient stratification and guide personalized therapy, particularly in settings with limited molecular testing capabilities. WHO: World Health Organization; IDH: Isocitrate dehydrogenase; IHC: Immunohistochemistry.