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Maher Kurdi,1,2 Nasser Mulla,3 Yousef Katib,4 Taghreed Alsinani,5 Sahar Hakamy,2 Bassam MJ Addas,6 Husam Malibary,7 Taher F Halawa,8 Marwa S Farhan,9 Eyad Faizo,10 Saleh Baeesa6 1Department of Pathology, Faculty of Medicine, King Abdulaziz University, Rabigh, Saudi Arabia; 2Brain Tumour Unit, KFMRC, King Abdulaziz University, Jeddah, Saudi Arabia; 3Department of Internal Medicine, Faculty of Medicine, Taibah University, Medina, Saudi Arabia; 4Department of Radiology, Faculty of Medicine, Taibah University, Madinah, Saudi Arabia; 5Department of Surgery, King Fahad General Hospital, Jeddah, Saudi Arabia; 6Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 7Department of Internal Medicine, Faculty of Medicine, King Abdul Aziz University, Jeddah, Saudi Arabia; 8Pediatric Hematology and Oncology Consultant, Faculty of Medicine, King Abdulaziz University, Rabigh, Saudi Arabia; 9Clinical Pathology Department, Cairo University, Cairo, Egypt; 10Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Tabuk University, Tabuk, Saudi ArabiaCorrespondence: Maher Kurdi, Department of Pathology, Faculty of Medicine, King Abdulaziz University, Rabigh, Saudi Arabia, Tel +966 556655467, Email Ahkurdi@kau.edu.saPurpose: IDH1 and IDH2 are hotspot mutations commonly identified in WHO-grade 4 astrocytomas. Their association with TAMs has never been investigated. We aim to explore the crosstalk between the IDH1/2 mutation metabolic effect and TAMs in tumour microenvironment and how this relationship affects the tumour recurrence.Patients and Methods: The study included 20 samples of patients with WHO-grade 4 astrocytoma. The alteration hotspot in codon IDH1R132 and IDH2R172 was examined using direct sequencing. The protein expression of CD204 on TAM was detected through immunohistochemistry.Results: IDH1R132 and IDH2R172 were symmetrically identified as wildtype in 18/20 tumours (90%) and the remaining 2 tumours (10%) showed synonymou