TERT and neoplasm: In one retrospective study, 80% of patients with grade II PXAs were still alive after 15 years.6 However, grade III PXAs, which are characterized by ≥5 mitoses/high power field, have a median survival of only 5 years.6 Grade III PXAs usually also contain other genetic alterations associated with worse behavior, like TP53 mutations and TERT promoter mutations.3,7,8 Although the original diagnosis at the outside institution was a GBM, there were no mitoses in the tumor, and the region showing necrosis and microvascular proliferation appeared separate from the main tumor.