Modified Ringertz grading system for diffuse astrocytomas

Changed by Henry Knipe, 12 Apr 2015

Updates to Article Attributes

Body was changed:

The Modified Ringertz grading system is one of the more frequently used grading systems for diffuse astrocytomas, only second to the WHO grading system. Unlike the WHO grading system and St Anne-Mayo grading system (also known as the Dumas-Duport grading sustem) which divide astrocytomas into 4 grades, the Ringertz grading system only has 3 grades, and only applies to diffuse astrocytomas (i.e. not WHO grade 1 tumours such as pilocytic astrocytomas or subependymal giant cell astrocytomas) 1

As such there is a rough equivalence between WHO II - IV and modified Ringertz I - III, although there are some differences in the criteria required to fulfil various grades. 

The modified Ringertz grading system is as follows 2:

  • grade 1 = astrocytoma
    • roughly equivalent to WHO grade II
    • mild hypercellularity
    • mild nuclear atypia (nuclear enlargement, hyperchromasia, pleomorphism) 
    • rare mitotic figures
  • grade 2 = anaplastic astrocytoma 
    • roughly equivalent to WHO grade III
    • more cellular than grade 2
    • more nuclear atypia 
    • more mitotic figures
    • endothelial proliferation (note this is a WHO grade IV feature)
  • grade 3 = glioblastoma multiforme 
    • roughly equivalent to WHO grade IV
    • presence of geographic necrosis +/- surrounding pseduopalisading tumour cells

EtymologyHistory and etymology

Ringertz originally proposed the grading system in 1950 4

  • -<p><strong>The Modified Ringertz grading system</strong> is one of the more frequently used grading systems for <a href="/articles/low-grade-infiltrative-astrocytoma" title="Diffuse astrocytoma">diffuse astrocytomas</a>, only second to the <a href="/articles/who-grading-system-for-diffuse-astrocytomas" title="WHO grading system for diffuse astrocytomas">WHO grading system</a>. Unlike the WHO grading system and <a href="/articles/st-anne-mayo-astrocytoma-grading-system" title="St. Anne-Mayo astrocytoma grading system">St Anne-Mayo grading system</a> (also known as the Dumas-Duport grading sustem) which divide astrocytomas into 4 grades, the Ringertz grading system only has 3 grades, and only applies to diffuse astrocytomas (i.e. not WHO grade 1 tumours such as <a href="/articles/pilocytic_astrocytoma" title="Pilocytic astrocytomas">pilocytic astrocytomas</a> or <a href="/articles/subependymal-giant-cell-astrocytoma" title="Subependymal giant cell astrocytoma">subependymal giant cell astrocytomas</a>) <sup>1</sup>. </p><p>As such there is a rough equivalence between WHO II - IV and modified Ringertz I - III, although there are some differences in the criteria required to fulfil various grades. </p><p>The modified Ringertz grading system is as follows <sup>2</sup>:</p><ul>
  • -<li>grade 1 = <a href="/articles/low-grade-infiltrative-astrocytoma" title="Diffuse astrocytoma">astrocytoma</a><ul>
  • +<p><strong>The Modified Ringertz grading system</strong> is one of the more frequently used grading systems for <a href="/articles/low-grade-infiltrative-astrocytoma">diffuse astrocytomas</a>, only second to the <a href="/articles/who-grading-system-for-diffuse-astrocytomas">WHO grading system</a>. Unlike the WHO grading system and <a href="/articles/st-anne-mayo-astrocytoma-grading-system">St Anne-Mayo grading system</a> (also known as the Dumas-Duport grading sustem) which divide astrocytomas into 4 grades, the Ringertz grading system only has 3 grades, and only applies to diffuse astrocytomas (i.e. not WHO grade 1 tumours such as <a href="/articles/pilocytic-astrocytoma">pilocytic astrocytomas</a> or <a href="/articles/subependymal-giant-cell-astrocytoma">subependymal giant cell astrocytomas</a>) <sup>1</sup>. </p><p>As such there is a rough equivalence between WHO II - IV and modified Ringertz I - III, although there are some differences in the criteria required to fulfil various grades. </p><p>The modified Ringertz grading system is as follows <sup>2</sup>:</p><ul>
  • +<li>grade 1 = <a href="/articles/low-grade-infiltrative-astrocytoma">astrocytoma</a><ul>
  • -<li>grade 2 = <a href="/articles/anaplastic-astrocytoma" title="Anaplastic astrocytoma">anaplastic astrocytoma</a> <ul>
  • +<li>grade 2 = <a href="/articles/anaplastic-astrocytoma">anaplastic astrocytoma</a> <ul>
  • -<li>grade 3 = <a href="/articles/glioblastoma-multiforme" title="Glioblastoma multiforme (GBM)">glioblastoma multiforme</a> <ul>
  • +<li>grade 3 = <a href="/articles/glioblastoma">glioblastoma multiforme</a> <ul>
  • -</ul><h4>Etymology</h4><p>Ringertz originally proposed the grading system in 1950 <sup>4</sup>. </p>
  • +</ul><h4>History and etymology</h4><p>Ringertz originally proposed the grading system in 1950 <sup>4</sup>. </p>

Sections changed:

  • Classifications

ADVERTISEMENT: Supporters see fewer/no ads

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.