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Sirbu OM, Moreanu MS, Eftimie LG, Socoliuc C, Toma GS, Gorgan RM, Mitrica M. Rosette-Forming Glioneuronal Tumor Mimicking Foramen Monro Colloid Cyst: Case Presentation and Systematic Literature Review. World Neurosurg 2025; 195:123717. [PMID: 39864801 DOI: 10.1016/j.wneu.2025.123717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2025] [Accepted: 01/18/2025] [Indexed: 01/28/2025]
Abstract
BACKGROUND Rosette-forming glioneuronal tumors (RGNTs) are rare indolent and benign tumors, typically associated with the fourth ventricle. Cases in the third ventricle are less common, especially those involving only the anterior part. METHODS A literature review using "rosette-forming glioneuronal tumor" on PubMed yielded 176 articles from 2002 to 2024. Articles excluding third ventricle RGNTs were omitted, with titles and abstracts screened for relevance. We also present our case of an anterior third ventricle RGNT, tracking from initial presentation to follow-up. RESULTS Our patient, a 62-year-old woman, experienced 3 months of recurrent Hakim Triad symptoms-gait instability, urinary incontinence, and cognitive issues. Magnetic resonance imaging revealed a 1.0 × 0.7 cm mass, hypointense on T1-weighted imaging and heterogeneous on T2-weighted imaging, initially suspected as a colloid cyst. Given its high colloid cyst risk score, surgery was performed, but histopathology confirmed an RGNT diagnosis. To date, this is the first case of exclusive anterior third ventricle RGNT microsurgery reported, with 26 months of recurrence-free follow-up. Our literature review identified 20 articles detailing 23 cases of third ventricle RGNT, with only 7 achieving gross total resection, while most underwent biopsy and ventriculostomy. CONCLUSIONS RGNTs in the anterior third ventricle may resemble other tumor types, requiring careful monitoring. This case is significant due to the patient's clinical presentation, imaging, and extended recurrence-free follow-up.
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Affiliation(s)
- Octavian-Mihai Sirbu
- Clinical Neurosciences Department, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Central Military Emergency Hospital "Dr. Carol Davila", Neurosurgical Department, Bucharest, Romania
| | - Mihai-Stelian Moreanu
- Clinical Neurosciences Department, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Central Military Emergency Hospital "Dr. Carol Davila", Neurosurgical Department, Bucharest, Romania.
| | - Lucian-George Eftimie
- Central Military Emergency Hospital "Dr. Carol Davila", Histoptahology Department, Bucharest, Romania; National University of Physical Education and Sports, Bucharest, Romania
| | - Claudiu Socoliuc
- Clinical Neurosciences Department, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Synevo-Histopathology Department, Bucharest, Romania, Bucharest, Romania
| | | | - Radu Mircea Gorgan
- Clinical Neurosciences Department, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; "Bagdasar-Arseni" Clinical Hospital, Neurosurgery Department, Bucharest, Romania
| | - Marian Mitrica
- Clinical Neurosciences Department, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Central Military Emergency Hospital "Dr. Carol Davila", Neurosurgical Department, Bucharest, Romania
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Calandrelli R, Mallio CA, Bernetti C, Pilato F. Multinodular and Vacuolating Neuronal Tumors: Imaging Features, Diagnosis, and Management Challenges. Diagnostics (Basel) 2025; 15:334. [PMID: 39941264 PMCID: PMC11817111 DOI: 10.3390/diagnostics15030334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2024] [Revised: 01/26/2025] [Accepted: 01/27/2025] [Indexed: 02/16/2025] Open
Abstract
Background/Objectives: Multinodular and vacuolating neuronal tumors (MNVTs) are a type of recently identified benign neuroepithelial tumor with debated malformative or neoplastic origins. This review summarizes their neuroanatomical localization, imaging, histopathology, immunohistochemistry, and diagnostic challenges. Methods: A systematic review of PUBMED/MEDLINE was performed in December 2024. Results: Of 118 screened articles, 39 were eligible, covering 299 patients. MNVTs are often asymptomatic "leave me alone" lesions, discovered incidentally, though nonspecific symptoms (59.9%) and seizures (19.7%) are reported. Immunohistochemistry reveals variable profiles, reflecting complex cellular differentiation. The characteristic "bubble-like" MRI pattern along the subcortical ribbon and superficial white matter is a reliable diagnostic feature. Rare cortical involvement and atypical band-like lesions occur. MRI signal intensity varies. Over a mean follow-up of 36 months, lesions were stable or non-recurrent, with only one case of progression. Conclusion: MVNT imaging mimics other glioneuronal lesions, but reliable diagnostic MRI features include a "bubble-clustered" appearance, lack of cortical involvement, absence of enhancement, and temporal lobe predominance. Hemodynamic and metabolic properties support the diagnosis. Most lesions remain stable, requiring no treatment. Surgical resection is reserved for cases with uncontrolled seizures or atypical locations where the diagnosis is unclear.
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Affiliation(s)
- Rosalinda Calandrelli
- Advanced Radiology Center (ARC), Department of Oncological Radiotherapy, and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Carlo Augusto Mallio
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy; (C.A.M.); (C.B.)
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy;
| | - Caterina Bernetti
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy; (C.A.M.); (C.B.)
| | - Fabio Pilato
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy;
- Research Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
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Pereira L, Kitumba D, Fontoura MG, João DA, Mascarenhas L, Resende M. A Rare Lesion in the Anterior Region of the Third Ventricle: Rosette-Forming Glioneuronal Tumor. Cureus 2024; 16:e51971. [PMID: 38333478 PMCID: PMC10853027 DOI: 10.7759/cureus.51971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 02/10/2024] Open
Abstract
Rosette-forming glioneuronal tumor (RGNT) is a rare and indolent mixed glioneuronal tumor involving primarily the fourth ventricular region and occurring predominantly in young adults. We present a case of a 44-year-old woman presented with progressive headaches, vomiting, and a sudden decreasing level of consciousness. The magnetic resonance imaging showed a regular lesion within the anterior portion of the third ventricle and the patient underwent an endoscopic approach to remove the tumor that was exclusively within the anterior portion of the third ventricle. Histopathology showed an RGNT that was totally removed. We also report some unusual complications that are described in the literature and are related to ventricular endoscopy such as seizures and hydroelectrolyte disorders. With two years of follow-up, the patient had no complaints and no tumor progression was observed.
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Affiliation(s)
- Leopoldina Pereira
- Neurosurgery, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Djamel Kitumba
- Neurosurgery, Complexo Hospitalar de Doenças Cardio-Pulmonar Cardial Dom Alexandre do Nascimento, Luanda, AGO
| | - Mário Gil Fontoura
- Internal Medicine, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, PRT
| | - David A João
- Pathology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Lino Mascarenhas
- Neurological Surgery, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Mário Resende
- Neurological Surgery, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
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Capitanio JF, Mortini P. Other Less Prevalent Tumors of the Central Nervous System. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:607-643. [PMID: 37452956 DOI: 10.1007/978-3-031-23705-8_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
The presented tumors in this chapter are somewhat very rare, and their management is still debated due to the scarcity of information about their cell of origin, behavior, and biology. Treatment options are still limited, but we are confident that in the near future by discovering the genetic and biological mechanisms that drive tumor growth we will be able to offer new target therapies that should be flanked by surgery, radiotherapy, and chemotherapeutic agents actually in use. The purpose of this chapter is to highlight the most important known characteristics of these tumors offering the chance to recognize the disease and then offer the best opportunity for treatment to patients. The 5th WHO Classification Central Nervous System features substantial changes by moving further to advance the role of molecular diagnostics in CNS tumor classification, but remaining rooted in other established approaches to tumor characterization, including histology and immunohistochemistry, and probably, the category of many tumors will change. Here, the most important characteristics of each neoplasm are summarized focusing on genetic mechanisms and molecular pathways, their histopathologic footprints, signs and symptoms, radiologic features, therapeutic approaches, and prognosis as well as follow-up protocols. Schematic classifications are also presented to offer a better understanding of the pathology.
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Affiliation(s)
- Jody Filippo Capitanio
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy.
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Dandapath I, Chakraborty R, Kaur K, Mahajan S, Singh J, Sharma MC, Sarkar C, Suri V. Molecular alterations of low-grade gliomas in young patients: Strategies and platforms for routine evaluation. Neurooncol Pract 2021; 8:652-661. [PMID: 34777834 PMCID: PMC8579091 DOI: 10.1093/nop/npab053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In recent years, it has been established that molecular biology of pediatric low-grade gliomas (PLGGs) is entirely distinct from adults. The majority of the circumscribed pediatric gliomas are driven by mitogen-activated protein kinase (MAPK) pathway, which has yielded important diagnostic, prognostic, and therapeutic biomarkers. Further, the Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy (cIMPACT) Steering Committee in their fourth meeting, suggested including a panel of molecular markers for integrated diagnosis in "pediatric-type" diffuse gliomas. However, a designated set of platforms for the evaluation of these alterations has yet not been mentioned for easier implementation in routine molecular diagnostics. Herein, we have reviewed the relevance of analyzing these markers and discussed the strategies and platforms best apposite for clinical laboratories.
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Affiliation(s)
- Iman Dandapath
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Kavneet Kaur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Swati Mahajan
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Jyotsna Singh
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Mehar C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Chitra Sarkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Vaishali Suri
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Prognostic factors in adult brainstem glioma: a tertiary care center analysis and review of the literature. J Neurol 2021; 269:1574-1590. [PMID: 34342680 PMCID: PMC8857120 DOI: 10.1007/s00415-021-10725-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/22/2021] [Accepted: 07/24/2021] [Indexed: 11/24/2022]
Abstract
Introduction Adult brainstem gliomas (BSGs) are rare central nervous system tumours characterized by a highly heterogeneous clinical course. Median survival times range from 11 to 84 months. Beyond surgery, no treatment standard has been established. We investigated clinical and radiological data to assess prognostic features providing support for treatment decisions. Methods 34 BSG patients treated between 2000 and 2019 and aged ≥ 18 years at the time of diagnosis were retrospectively identified from the databases of the two largest Austrian Neuro-Oncology centres. Clinical data including baseline characteristics, clinical disease course, applied therapies, the outcome as well as neuroradiological and neuropathological findings were gathered and analysed. The tumour apparent diffusion coefficient (ADC), volumetry of contrast-enhancing and non-contrast-enhancing lesions were determined on magnetic resonance imaging scans performed at diagnosis. Results The median age at diagnosis was 38.5 years (range 18–71 years). Tumour progression occurred in 26/34 (76.5%) patients after a median follow up time of 19 months (range 0.9–236.2). Median overall survival (OS) and progression-free survival (PFS) was 24.1 months (range 0.9–236.2; 95% CI 18.1–30.1) and 14.5 months (range 0.7–178.5; 95% CI 5.1–23.9), respectively. Low-performance status, high body mass index (BMI) at diagnosis and WHO grading were associated with shorter PFS and OS at univariate analysis (p < 0.05, log rank test, respectively). ADC values below the median were significantly associated with shorter OS (14.9 vs 44.2 months, p = 0.018). Conclusion ECOG, BMI, WHO grade and ADC values were associated with the survival prognosis of BSG patients and should be included in the prognostic assessment.
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Cacchione A, Mastronuzzi A, Carai A, Colafati GS, Diomedi-Camassei F, Marrazzo A, Carboni A, Miele E, Pedace L, Tartaglia M, Amichetti M, Fellin F, Lodi M, Vennarini S. Rosette-Forming Glioneuronal Tumor of the Fourth Ventricle: A Case of Relapse Treated with Proton Beam Therapy. Diagnostics (Basel) 2021; 11:903. [PMID: 34069450 PMCID: PMC8159123 DOI: 10.3390/diagnostics11050903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/07/2021] [Accepted: 05/07/2021] [Indexed: 11/16/2022] Open
Abstract
Rosette-forming glioneuronal tumors (RGNTs) are rare, grade I, central nervous system (CNS) tumors typically localized to the fourth ventricle. We describe a 9-year-old girl with dizziness and occipital headache. A magnetic resonance imaging (MRI) revealed a large hypodense posterior fossa mass lesion in relation to the vermis, with cystic component. Surgical resection of the tumor was performed. A RGNT diagnosis was made at the histopathological examination. During follow-up, the patient experienced a first relapse, which was again surgically removed. Eight months after, MRI documented a second recurrence at the local level. She was a candidate for the proton beam therapy (PBT) program. Three years after the end of PBT, the patient had no evidence of disease recurrence. This report underlines that, although RGNTs are commonly associated with an indolent course, they may have the potential for aggressive behavior, suggesting the need for treatment in addition to surgery. Controversy exists in the literature regarding effective management of RGNTs. Chemotherapy and radiation are used as adjuvant therapy, but their efficacy management has not been adequately described in the literature. This is the first case report published in which PBT was proposed for adjuvant therapy in place of chemotherapy in RGNT relapse.
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Affiliation(s)
- Antonella Cacchione
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy; (A.M.); (E.M.); (L.P.); (M.L.)
| | - Angela Mastronuzzi
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy; (A.M.); (E.M.); (L.P.); (M.L.)
| | - Andrea Carai
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy;
| | - Giovanna Stefania Colafati
- Oncological Neuroradiology Unit, Department of Imaging, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy; (G.S.C.); (A.M.); (A.C.)
| | - Francesca Diomedi-Camassei
- Department of Laboratories, Pathology Unit, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy;
| | - Antonio Marrazzo
- Oncological Neuroradiology Unit, Department of Imaging, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy; (G.S.C.); (A.M.); (A.C.)
| | - Alessia Carboni
- Oncological Neuroradiology Unit, Department of Imaging, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy; (G.S.C.); (A.M.); (A.C.)
| | - Evelina Miele
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy; (A.M.); (E.M.); (L.P.); (M.L.)
| | - Lucia Pedace
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy; (A.M.); (E.M.); (L.P.); (M.L.)
| | - Marco Tartaglia
- Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy;
| | - Maurizio Amichetti
- Proton Therapy Center, Hospital of Trento, Azienda Provinciale per I Servizi Sanitari (APSS), 38123 Trento, Italy; (M.A.); (F.F.); (S.V.)
| | - Francesco Fellin
- Proton Therapy Center, Hospital of Trento, Azienda Provinciale per I Servizi Sanitari (APSS), 38123 Trento, Italy; (M.A.); (F.F.); (S.V.)
| | - Mariachiara Lodi
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy; (A.M.); (E.M.); (L.P.); (M.L.)
| | - Sabina Vennarini
- Proton Therapy Center, Hospital of Trento, Azienda Provinciale per I Servizi Sanitari (APSS), 38123 Trento, Italy; (M.A.); (F.F.); (S.V.)
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Uchiyama T, Gomi A, Nobusawa S, Fukushima N, Matsubara D, Kawai K. A case of a rosette-forming glioneuronal tumor with clinicopathological features of a dysembryoplastic neuroepithelial tumor and fibroblast growth factor receptor 1 internal tandem duplication. Brain Tumor Pathol 2021; 38:250-256. [PMID: 33837479 DOI: 10.1007/s10014-021-00397-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
Rosette-forming glioneuronal tumors (RGNTs) are benign WHO grade 1 tumors that occur in the ventricular system, particularly the fourth ventricle. RGNTs and dysembryoplastic neuroepithelial tumors (DNTs) are both categorized as neuronal and mixed neuronal-glial tumors and may be difficult to distinguish. Coexistence of the two tumor types has been reported. Here, we report a pediatric case of RGNT with DNT-like features showing intraventricular dissemination. The tumor occurred in the medial temporal lobe and presented with specific pathological glioneuronal elements including floating neurons, which are typical in DNTs, but was diagnosed as RGNT because of the presence of neurocytic rosettes. Genetic analysis detected fibroblast growth factor receptor 1 internal tandem duplication (FGFR1-ITD) of the tyrosine kinase domain, which was previously reported to be specific for DNT. RGNTs with FGFR1-ITD may show atypical clinical presentation and pathological features.
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Affiliation(s)
- Taku Uchiyama
- Department of Neurosurgery, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiya-ku Saitama, Saitama, 330-8503, Japan.
| | - Akira Gomi
- Department of Pediatric Neurosurgery, Jichi Children's Medical Center Tochigi, Jichi Medical University, Tochigi, Japan
| | - Sumihito Nobusawa
- Department of Human Pathology, Gunma University Graduate School of Medicine, Gunma, Japan
| | | | | | - Kensuke Kawai
- Department of Neurosurgery, Jichi Medical University, Tochigi, Japan
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Wilson CP, Chakraborty AR, Pelargos PE, Shi HH, Milton CK, Sung S, McCoy T, Peterson JE, Glenn CA. Rosette-forming glioneuronal tumor: an illustrative case and a systematic review. Neurooncol Adv 2020; 2:vdaa116. [PMID: 33134925 PMCID: PMC7586144 DOI: 10.1093/noajnl/vdaa116] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Rosette-forming glioneuronal tumors (RGNTs) are rare, low-grade, primary CNS tumors first described in 2002 by Komori et al. RGNTs were initially characterized as a World Health Organization (WHO) grade I tumors typically localized to the fourth ventricle. Although commonly associated with an indolent course, RGNTs have the potential for aggressive behavior. Methods A comprehensive search of PubMed and Web of Science was performed through November 2019 using the search term “rosette-forming glioneuronal tumor.” Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. English, full-text case reports and series with histopathological confirmation were included. Patient demographics, presentations, MRI features, tumor location, treatment, and follow-up of all 130 cases were extracted. Results A 19-year-old man with a history of epilepsy and autism presented with acute hydrocephalus. MRI scans from 2013 to 2016 demonstrated unchanged abnormal areas of cortex in the left temporal lobe with extension into the deep gray-white matter. On presentation to our clinic in 2019, the lesion demonstrated significant progression. The patient’s tumor was identified as RGNT, WHO grade I. One hundred thirty patients were identified across 80 studies. Conclusion RGNT has potential to transform from an indolent tumor to a tumor with more aggressive behavior. The results of our systematic review provide insight into the natural history and treatment outcomes of these rare tumors.
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Affiliation(s)
- Caleb P Wilson
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Arpan R Chakraborty
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Panayiotis E Pelargos
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Helen H Shi
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Camille K Milton
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Sarah Sung
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Tressie McCoy
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Jo Elle Peterson
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Chad A Glenn
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Joris V, Ribeiro Vaz JG, Lelotte J, Duprez T, Raftopoulos C. Large Epileptogenic Type IIIb Dysplasia: A Radiological and Anatomopathological Challenge. World Neurosurg 2019; 129:330-333. [DOI: 10.1016/j.wneu.2019.06.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 01/12/2023]
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Spena G, Panciani PP, Mattogno PP, Roca E, Poliani PL, Fontanella M. A multimodal staged approach for the resection of a Sylvian aqueduct rosette-forming glioneuronal tumor: A case report and literature review. INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2018.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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12
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Luzzi S, Elia A, Del Maestro M, Elbabaa SK, Carnevale S, Guerrini F, Caulo M, Morbini P, Galzio R. Dysembryoplastic Neuroepithelial Tumors: What You Need to Know. World Neurosurg 2019; 127:255-265. [PMID: 30981794 DOI: 10.1016/j.wneu.2019.04.056] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE An updated and comprehensive review on dysembryoplastic neuroepithelial tumor (DNET) focusing on differential diagnosis, atypical presentation, seizure outcome, and risk of malignant transformation. METHODS A PubMed/MEDLINE-based literature search has been performed using "dysembryoplastic neuroepithelial tumor" as a keyword. Two treated cases characterized by an atypical presentation have been reviewed. RESULTS Of 1162 articles, 200 relevant studies have been selected. DNET is a benign mixed neuronal-glial tumor causing drug-resistant epilepsy primarily in children and young adults. The typical radiological pattern is a magnetic resonance imaging (MRI) T1-hypointense, T2-, and fluid-attenuated inversion-recovery hyperintense multicystic lesion involving the cerebral cortex with no edema. Contrast enhancement may be present and a focal cortical dysplasia is commonly associated with it. MRI diffusion, perfusion, and spectroscopy have a paramount role in the differential diagnosis. The "specific glioneuronal elements" are pathognomonic. They are positive for S100 protein, synaptofisin, neuronal nuclei, oligodendrocyte transcription factor, neurite outgrowth inhibitor, and microtubule-associated protein 2, but negative for glial fibrillary acidic protein. As opposed to v-myb avian myeloblastosis viral oncogene homolog, isocitrate dehydrogenase-1/isocitrate dehydrogenase-2 mutation and codeletion 1p-19q, fibroblast growth factor receptor 1 and BRAF V600E mutations are present. The effectiveness of surgery on seizure outcome has been established. Rare malignant transformations have been reported, especially in extra-temporal and complex forms. CONCLUSIONS Advanced MRI techniques are fundamental in the differential diagnosis for DNET versus other low-grade gliomas. Immuno-phenotype assessment and search for fibroblast growth factor receptor 1 and BRAF V600E mutations limit the risk of misdiagnoses. A gross total tumor removal is generally associated with a seizure-free outcome. Recurrences and malignant transformations may rarely follow, legitimizing MRI surveillance in cases of subtotal tumor resection.
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Affiliation(s)
- Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; D.E.O.T. Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy.
| | - Angela Elia
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Mattia Del Maestro
- PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Samer K Elbabaa
- Pediatric Neurosurgery Department, Pediatric Neuroscience Center of Excellence, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Sergio Carnevale
- Unit of Pathological Anatomy, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Francesco Guerrini
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
| | - Patrizia Morbini
- Unit of Pathological Anatomy, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Renato Galzio
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Multiplex ligation-dependent probe amplification analysis is useful for detecting a copy number gain of the FGFR1 tyrosine kinase domain in dysembryoplastic neuroepithelial tumors. J Neurooncol 2019; 143:27-33. [DOI: 10.1007/s11060-019-03138-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/26/2019] [Indexed: 01/01/2023]
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Al-Hajri A, Al-Mughairi S, Somani A, An S, Liu J, Miserocchi A, McEvoy AW, Yousry T, Hoskote C, Thom M. Pathology-MRI Correlations in Diffuse Low-Grade Epilepsy Associated Tumors. J Neuropathol Exp Neurol 2017; 76:1023-1033. [PMID: 29040640 PMCID: PMC5939705 DOI: 10.1093/jnen/nlx090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 09/19/2017] [Indexed: 11/14/2022] Open
Abstract
It is recognized that IDH mutation negative, low-grade epilepsy associated tumors (LEAT) can show diffuse growth patterns and lack the diagnostic hallmarks of either classical dysembryoplastic neuroepithelial tumors (DNT) or typical ganglioglioma. “Nonspecific or diffuse DNT” and more recently “polymorphous low-grade neuroepithelial tumor of the young” have been terms used for these entities. There are few reports on the MRI recognition of these diffuse glioneuronal tumors (dGNT), which is important in planning the extent of surgical resection. In 27 LEATs T1, T2, FLAIR, and postcontrast T1 MRI were evaluated and the pathology reviewed, including immunostaining for NeuN, CD34, MAP2, and IDH1. Each case was then independently classified by pathology or MRI as simple DNT, complex DNT, or dGNT. There was agreement in 23/27 (85%; Kappa score 0.62; p < 0.01). In 4 cases, there was discrepancy in the diagnosis of simple versus complex DNT but 100% agreement achieved for dGNT. DNT showed significantly more expansion of the cortex, cystic change and ventricle extension than dGNT. dGNT showed significantly more subcortical T2w hyperintensity and focal cortical atrophy which correlated on pathology with CD34 expression, cortical neuronal loss and white matter rarefaction. There was no distinct cortical dysplasia component identified by MRI or pathology in any case. This study highlights that dGNT can be reliably discriminated on MRI from DNT.
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Affiliation(s)
- Aliya Al-Hajri
- From The Lysholm Department of Neuroradiology in National Hospital for Neurology and Neurosurgery, London, UK (AA-H, SAM, TY, CH); Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK (AS, SA, JL, MT); Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK (AS, JL, AME, MT); and Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK (AM, AME)
| | - Salim Al-Mughairi
- From The Lysholm Department of Neuroradiology in National Hospital for Neurology and Neurosurgery, London, UK (AA-H, SAM, TY, CH); Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK (AS, SA, JL, MT); Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK (AS, JL, AME, MT); and Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK (AM, AME)
| | - Alyma Somani
- From The Lysholm Department of Neuroradiology in National Hospital for Neurology and Neurosurgery, London, UK (AA-H, SAM, TY, CH); Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK (AS, SA, JL, MT); Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK (AS, JL, AME, MT); and Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK (AM, AME)
| | - Shu An
- From The Lysholm Department of Neuroradiology in National Hospital for Neurology and Neurosurgery, London, UK (AA-H, SAM, TY, CH); Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK (AS, SA, JL, MT); Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK (AS, JL, AME, MT); and Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK (AM, AME)
| | - Joan Liu
- From The Lysholm Department of Neuroradiology in National Hospital for Neurology and Neurosurgery, London, UK (AA-H, SAM, TY, CH); Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK (AS, SA, JL, MT); Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK (AS, JL, AME, MT); and Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK (AM, AME)
| | - Anna Miserocchi
- From The Lysholm Department of Neuroradiology in National Hospital for Neurology and Neurosurgery, London, UK (AA-H, SAM, TY, CH); Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK (AS, SA, JL, MT); Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK (AS, JL, AME, MT); and Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK (AM, AME)
| | - Andrew W. McEvoy
- From The Lysholm Department of Neuroradiology in National Hospital for Neurology and Neurosurgery, London, UK (AA-H, SAM, TY, CH); Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK (AS, SA, JL, MT); Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK (AS, JL, AME, MT); and Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK (AM, AME)
| | - Tarek Yousry
- From The Lysholm Department of Neuroradiology in National Hospital for Neurology and Neurosurgery, London, UK (AA-H, SAM, TY, CH); Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK (AS, SA, JL, MT); Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK (AS, JL, AME, MT); and Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK (AM, AME)
| | - Chandrashekar Hoskote
- From The Lysholm Department of Neuroradiology in National Hospital for Neurology and Neurosurgery, London, UK (AA-H, SAM, TY, CH); Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK (AS, SA, JL, MT); Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK (AS, JL, AME, MT); and Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK (AM, AME)
| | - Maria Thom
- From The Lysholm Department of Neuroradiology in National Hospital for Neurology and Neurosurgery, London, UK (AA-H, SAM, TY, CH); Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK (AS, SA, JL, MT); Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK (AS, JL, AME, MT); and Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK (AM, AME)
- Send correspondence to: Maria Thom, MRCPath, FRCPath Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK; E-mail:
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Histopathological, molecular, clinical and radiological characterization of rosette-forming glioneuronal tumor in the central nervous system. Oncotarget 2017; 8:109175-109190. [PMID: 29312599 PMCID: PMC5752512 DOI: 10.18632/oncotarget.22646] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 10/29/2017] [Indexed: 12/27/2022] Open
Abstract
Objective A rosette-forming glioneuronal tumor (RGNT) is a rare entity originally described in the fourth ventricle. Recently, RGNTs occurring in extraventricular sites and those with malignant behaviors have been reported. The purpose of this study was to analyze the clinicoradiological and histopathological features, therapeutic strategies, and outcomes of RGNTs. Methods We enrolled 38 patients diagnosed with RGNTs pathologically between August 2009 and June 2016. CT and MRI, including diffusion-weighted imaging and spectroscopy, were performed. The surgical treatment and histopathological and molecular features were assessed. Additionally, we searched the relevant literatures and performed a pooled analysis of individual patient data. The potential risk factors of prognosis were analyzed. Results Our case series included 22 male and 16 female patients, with a mean age of 25.9 years. RGNTs involved the fourth ventricle (26.3%), cerebella (34.2%), supratentorial ventricular system (13.2%), spinal cord (10.5%), temporal lobe (10.5%), thalamus (7.9%), brain stem (7.9%), frontal lobe (5.3%), pineal region (5.3%), suprasellar region (2.6%), and basal ganglia (2.6%). Statistical analyses showed that pediatric age, purely solid appearance of the tumor, and inadequate resection (only partial removal or biopsy) were risk factors associated with progression events. Patients with subtotal resection appeared to do as well as those with gross total resection. Conclusions RGNTs can occur nearly anywhere in the CNS, at both supratentorial and infratentorial sites. Maximal safe surgical resection should be emphasized for treatment; whilst aggressive resection with the goal of complete resection may be unnecessary.
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