Endoreduplication and telomeric association in a choroid plexus carcinoma

Tumors of Choroid Plexus and Other Ventricular Tumors

Tumors arising inside the ventricular system are rare but represent a difficult diagnostic and therapeutic challenge. They usually are diagnosed when reaching a big volume and tend to affect young children. There is a wide broad of differential diagnoses with significant variability in anatomical aspects and tumor type. Differential diagnosis in tumor type includes choroid plexus tumors (papillomas and carcinomas), ependymomas, subependymomas, subependymal giant cell astrocytomas (SEGAs), central neurocytomas, meningiomas, and metastases. Choroid plexus tumors, ependymomas of the posterior fossa, and SEGAs are more likely to appear in childhood, whereas subependymomas, central neurocytomas, intraventricular meningiomas, and metastases are more frequent in adults. This chapter is predominantly focused on choroid plexus tumors and radiological and histological differential diagnosis. Treatment is discussed in the light of the modern acquisition in genetics and epigenetics of brain tumors.

The genetic landscape of choroid plexus tumors in children and adults

BACKGROUND

Choroid plexus tumors (CPTs) are intraventricular brain tumors predominantly arising in children but also affecting adults. In most cases, driver mutations have not been identified, although there are reports of frequent chromosome-wide copy-number alterations and TP53 mutations, especially in choroid plexus carcinomas (CPCs).

METHODS

DNA methylation profiling and RNA-sequencing was performed in a series of 47 CPTs. Samples comprised 35 choroid plexus papillomas (CPPs), 6 atypical choroid plexus papillomas (aCPPs) and 6 CPCs plus three recurrences thereof. Targeted TP53 and TERT promotor sequencing was performed in all samples. Whole exome sequencing (WES) and linked-read whole genome sequencing (WGS) was performed in 25 and 4 samples, respectively.

RESULTS

Tumors comprised the molecular subgroups "pediatric A" (N=11), "pediatric B" (N=12) and "adult" (N=27). Copy-number alterations mainly represented whole-chromosomal alterations with subgroup-specific enrichments (gains of Chr1, 2 and 21q in "pediatric B" and gains of Chr5 and 9 and loss of Chr21q in "adult"). RNA sequencing yielded a novel CCDC47-PRKCA fusion transcript in one adult choroid plexus papilloma patient with aggressive clinical course; an underlying Chr17 inversion was demonstrated by linked-read WGS. WES and targeted sequencing showed TP53 mutations in 7/47 CPTs (15%), five of which were children. On the contrary, TERT promoter mutations were encountered in 7/28 adult patients (25%) and associated with shorter progression-free survival (log-rank test, p=0.015).

CONCLUSION

Pediatric CPTs lack recurrent driver alterations except for TP53, whereas CPTs in adults show TERT promoter mutations or a novel CCDC47-PRKCA gene fusion, being associated with a more unfavorable clinical course.

Epigenetics impacts upon prognosis and clinical management of choroid plexus tumors

PURPOSE

Choroid plexus tumors comprise of choroid plexus papilloma (CPP, WHO grade I), atypical choroid plexus papilloma (aCPP, WHO grade II) and choroid plexus carcinoma (CPC, WHO grade III). Molecular events driving the majority of choroid plexus tumors remain poorly understood. Recently, DNA methylation profiling has revealed different epigenetic subgroups.

METHODS

Comprehensive review of epigenetic profiles of choroid plexus tumors in the context of histopathological, genetic, and clinical features. DNA methylation profiling segregates choroid plexus tumors into three distinct epigenetic subgroups: supratentorial pediatric low-risk choroid plexus tumors (CPP and aCPP), infratentorial adult low-risk choroid plexus tumors (CPP and aCPP), and supratentorial pediatric high-risk choroid plexus tumors (CPP and aCPP and CPC). Epigenetic subgrouping provides additional prognostic information in comparison to histopathological grading.

CONCLUSIONS

Epigenetic profiling of choroid plexus tumors can be used for the identification of patients at risk of recurrence and is expected to play a role for treatment stratification and patient management in the context of future clinical trials.

Morphological and biological characterization of cell line developed from bovine Echinococcus granulosus

The taeniid tapeworm Echinococcus granulosus is the causative agent of echinococcal disease, a major zoonosis with worldwide distribution. Several efforts to establish an in vitro model of E. granulosus have been undertaken; however, many of them have been designed for Echinococcus multilocularis. In the present study, we have described and characterized a stable cell line obtained from E. granulosus bovine protoscoleces maintained 3 yr in vitro. Growth characterization, morphology by light, fluorescent and electronic microscopy, and karyotyping were carried out. Cell culture origin was confirmed by immunofluorescent detection of AgB4 antigen and by PCR for the mitochondrial cytochrome c-oxidase subunit 1 (DCO1) gene. Cells seeded in agarose biphasic culture resembled a cystic structure, similar to the one formed in secondary hosts. This cell line could be a useful tool to research equinococcal behavior, allowing additional physiological and pharmacological studies, such as the effect of growth factors, nutrients, and antiparasitic drugs on cell viability and growth and on cyst formation.

Tetraploidy/aneuploidy and stem cells in cancer promotion: The role of chromosome passenger proteins

While polyploidy, a state of having fully duplicated sets of chromosomes per cell, has been described in normally developing bone marrow megakaryocytes or as an adaptive response in other cell types, aneuploidy is never detected in normal cells. Tetraploidy or aneuploidy can be induced by several signals and it is highly prevalent in different forms of cancers, suggesting a role for this cell cycle state in promoting cellular transformation. Investigations suggested that loss of heterozygosity of cancer-related genes in stem cells might contribute to genetic instability in progeny cells and to subsequent cancer development. Deregulated expression of chromosome passenger proteins, such as Aurora kinases or Survivin, is a hallmark of various cancers, and experimentally induced changes in these regulators can promote tetraploidy or aneuploidy and loss of heterozygosity. Our studies described an induction of tetraploidy/aneuploidy by a stable form of Aurora-B, leading to acquisition of transformation properties. It is intriguing to speculate that in some cancers, tetraploidy/aneuploidy induced by deregulated expression of a mitotic regulator represents a primary event that leads to unbalanced expression of a cluster of crucial genes and to cellular transformation.

Molecular cytogenetic analysis in the study of brain tumors: findings and applications

Classic cytogenetics has evolved from black and white to technicolor images of chromosomes as a result of advances in fluorescence in situ hybridization (FISH) techniques, and is now called molecular cytogenetics. Improvements in the quality and diversity of probes suitable for FISH, coupled with advances in computerized image analysis, now permit the genome or tissue of interest to be analyzed in detail on a glass slide. It is evident that the growing list of options for cytogenetic analysis has improved the understanding of chromosomal changes in disease initiation, progression, and response to treatment. The contributions of classic and molecular cytogenetics to the study of brain tumors have provided scientists and clinicians alike with new avenues for investigation. In this review the authors summarize the contributions of molecular cytogenetics to the study of brain tumors, encompassing the findings of classic cytogenetics, interphase- and metaphase-based FISH studies, spectral karyotyping, and metaphase- and array-based comparative genomic hybridization. In addition, this review also details the role of molecular cytogenetic techniques in other aspects of understanding the pathogenesis of brain tumors, including xenograft, cancer stem cell, and telomere length studies.

Chromosomal imbalances in choroid plexus tumors

We studied 49 choroid plexus tumors by comparative genomic hybridization. Chromosomal imbalances were found in 32 of 34 choroid plexus papillomas and 15 of 15 choroid plexus carcinomas. Choroid plexus papillomas frequently showed +7q (65%), +5q (62%), +7p (59%), +5p (56%), +9p (50%), +9q (41%), +12p, +12q (38%), and +8q (35%) as well as -10q (56%), -10p, and -22q (47%); choroid plexus carcinomas mainly showed +12p, +12q, +20p (60%), +1, +4q, +20q (53%), +4p (47%), +8q, +14q (40%), +7q, +9p, +21 (33%) as well as -22q (73%), -5q (40%), -5p, and -18q (33%). Several chromosomal imbalance differences could be found that were characteristic for a tumor entity or age group. In choroid plexus papillomas +5q, +6q, +7q, +9q, +15q, +18q, and -21q were significantly more common whereas choroid plexus carcinomas were characterized by +1, +4q, +10, +14q, +20q, +21q, -5q, -9p, -11, -15q, and -18q. Among choroid plexus papillomas, children more often showed +8q, +14q, +12, and +20q; adults mainly presented with +5q, +6q, +15q, +18q, and -22q. Although the number of aberrations overall as well as of gains and losses on their own bore no significance on survival among choroid plexus tumors, a significantly longer survival among patients with choroid plexus carcinomas was associated with +9p and -10q. Our results show that aberrations differ between choroid plexus papillomas and choroid plexus carcinomas as well as between pediatric and adult choroid plexus papillomas, supporting the notion of different genetic pathways. Furthermore, gain of 9p and loss of 10q seem to be correlated with a more favorable prognosis in choroid plexus carcinomas.

Telomeric associations in cigarette smokers exposed to low levels of X-rays

Telomeric association (TA), i.e. fusion of chromosomes by their telomeres, predisposes a cell to genetic instability. Because of this we investigated the effect of X-rays exposure and cigarette smoking on the frequency of TA in peripheral blood lymphocytes of exposed individuals, in order to determine if TA can be a chromosomal marker in populations exposed to these carcinogens and if there is an synergistic effect between both agents. We found that the exposed groups show a greater percentage of TA when compared with the control group (P<0.001). However, although the percentage of metaphases with TA in the group with combined exposure (12.6%) was greater than in the others exposed groups (P<0.05), this value was less than the sum of the two individual effects (15.1%). Our results suggest that probably there is not an additive or synergistic effect between X-rays and smoking, and that TA may be a useful cytogenetic marker for evaluating populations exposed to mutagens.

Tumors of the choroid plexus

Choroid plexus tumors are rare intraventricular papillary neoplasms derived from choroid plexus epithelium, which account for only between 0.4-0.6% of all intracranial and 2-3% of pediatric neoplasms. Plexus papillomas outnumber choroid plexus carcinomas by a ratio of 5:1 and around 80% of choroid plexus carcinomas arise in children. Plexus tumors are most common in the lateral and fourth ventricles; while 80% of lateral ventricle tumors present in children, fourth ventricle tumors are evenly distributed in all age groups. Clinically, choroid plexus tumors tend to cause hydrocephalus and increased intracranial pressure. Histologically, choroid plexus papillomas correspond to WHO grade I, choroid plexus carcinomas to WHO grade III. Immunohistochemically, cytokeratins and vimentin are expressed by virtually all choroid plexus papillomas and most choroid plexus carcinomas while transthyretin and S-100 protein are present in 80-90% of cases, less frequently, though, in choroid plexus carcinomas. Glial fibrillary acidic protein can be found focally in about 25-55% of choroid plexus papillomas and 20% of choroid plexus carcinomas. The mean Ki67/MIB1 labeling index for choroid plexus papillomas is 1.9%, for choroid plexus carcinomas 13. 8%. Choroid plexus papillomas typically show hyperdiploidy with gains particularly on chromosomes 7, 9, 12, 15, 17, and 18 while one choroid plexus carcinoma showed rearrangements of chromosomes 7p11-12, 9q11-12, 15q22, and 19q13.4. Choroid plexus papillomas can usually be cured by surgery alone with a 5-year survival rate of up to 100% with occasional recurrences while choroid plexus carcinomas grow more rapidly and have a less favorable outcome with a 5-year survival rate of 26-40%.

Pathology of choroid plexus papillomas: a review

Choroid plexus papillomas (CPPs) are rare, usually slow growing neoplasms. Their biological behaviour cannot be predicted in an individual case. Furthermore, the neuropathological diagnosis of these neoplasms is occasionally difficult because light and electron microscopical and immunohistochemical features may overlap with those of other neoplasms localising in the choroid plexus. The aim of this paper is to review the pathological literature (light and electron microscopy (EM) and immunocytochemistry), to provide guidance on current diagnostic tools and criteria and address the identification of 'atypical' CPPs, e.g. those CPPs with histological features indicative of aggressive behaviour, in an attempt to help bridge the diagnostic gap between benign CPPs on the one hand and choroid plexus carcinomas (CPCs) on the other.

Nonrandom pattern of telomeric associations in atypical lipomatous tumors with ring and giant marker chromosomes

Atypical lipomatous tumors (ALTs) are cytogenetically characterized by supernumerary ring and giant marker chromosomes. Another common finding in ALT is that the tumor cells are cytogenetically heterogeneous with a variety of mostly nonclonal numerical and structural chromosome aberrations, including telomeric associations. In a series of 48 cytogenetically investigated ALTs, all chromosomal aberrations, clonal as well as nonclonal, were registered. Clonal ring chromosomes were present in 47 cases and giant markers in 11 cases. In 7 cases, 12 clonal telomeric associations were found and 37 cases showed nonclonal associations involving 344 identified telomeres. The telomere associations were nonrandomly distributed, with the telomeres of 11p, 20p, 20q, 9q, 15p, 19q, and 22q being most frequently (8.7-4.1% of all associations) involved; only Xp and Xq were never affected. The pattern of telomeric associations in ALT was compared with literature data on 47 giant cell tumors (880 telomeres), previously reported to show a nonrandom distribution of associations, and 36 sporadic cases of a variety of other human neoplasms (583 telomeres). The analysis indicated that the telomeres of 11p, 19q, and 20q are preferentially involved in associations in several tumor types. Among other structural aberrations in the ALT series, 221 nonclonal and 52 clonal breakpoints were identified, as well as 342 nonclonal and 14 clonal numerical aberrations. The combined data suggest that telomeric associations may predispose to acquired chromosome aberrations in neoplasia.

Cytogenetic study of pituitary adenomas

We report the results of cytogenetic studies on 23 pituitary adenoma specimens, using both the direct and short-term tissue culture methods. The direct method was applied to all of the specimens and allowed a karyotype to be identified in 15 of the processed samples (65%). Four tumors were shown to have a hypotriploid chromosomal constitution, two of which also presented structural clonal rearrangements: an isochromosome 1q,i(1)(q10) and a der(1)t(1;3)(p22;q21) were observed in two PRL-secreting adenomas, one of which also had a telomeric association involving the short arms of chromosomes 14 and 19. Telomeric associations of the long arms of chromosomes 11, 19, and 22 were observed in a near-diploid, non-secreting tumor showing monosomy 13. One other adenoma showed trisomies 8 and 12, a finding that was confirmed by means of the FISH analysis of chromosome 8 and 12 centromeric probes in the more than 300 scored nuclei. An apparently normal chromosome constitution was observed in the remaining nine cases. Short-term cultures were set up in 21 of the 23 samples, allowing us to obtain a karyotype in 18 specimens (85%). The six tumors that could not be analyzed using the direct method showed a normal karyotype. A diploid chromosome constitution was observed in the four tumors shown to be hypotriploid by the direct method as well as in the tumor with monosomy 13. The trisomies 8 and 12 identified by the direct method in one tumor were still observed, but a clone with a normal karyotype was also found. To the best of our knowledge, this is the only report of the results of cytogenetic studies on pituitary adenomas performed using both direct preparation and short-term culture.

Pigmented choroid plexus carcinoma: a cytogenetic and ultrastructural study

A pigmented choroid plexus carcinoma was studied. The pigment was Fontana-positive, and the neoplastic cells focally expressed melanosomal marker HMB45 and contained probable aberrant melanosomes. The tumor was composed of two pseudodiploid clones, having the karyotypes 46,XY,inv(4)(q12q35),t(6;15)(q21;q22),inv(7)(p11.2q22),t(19; 22) (q13.4;q11.2)[15]/46,XY,t(4;14)(q31.1; p11.2),t(12;13)(p11.1;q34)[6]. The available data seem to indicate that rearrangements of 7p11-12, 9q11-12, 15q22, and 19q13.4 may play a role in the development of choroid plexus carcinomas.