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Ge X, Yang Y, Wang W, Tian L, Zhang G, Tian Z, Xue X. Pediatric H3K27M‑mutant diffuse midline glioma with vertebral metastasis: A case report and literature review. Oncol Lett 2024; 27:48. [PMID: 38192660 PMCID: PMC10773191 DOI: 10.3892/ol.2023.14181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 11/07/2023] [Indexed: 01/10/2024] Open
Abstract
H3K27M-mutant diffuse midline glioma (DMG) is a type of high-grade glial tumor, which occurs in the midline structure and develops mostly in children. Extraneural metastases (ENM) are exceedingly rare in patients with H3K27M-mutant DMG. A 9-year-old male patient presented with a headache, nausea and vomiting. Following magnetic resonance imaging and immunohistochemical molecular testing examination, the patient was diagnosed with H3K27M-mutant DMG and received chemoradiotherapy plus five cycles of chemotherapy with temozolomide intermittently as an adjuvant therapy. The treatment resulted in a slight reduction of the tumor volume. However, 2 months later, the patient was admitted to hospital with complaints of drooping of the mouth, and waist and back pain. Magnetic resonance imaging and positron-emission tomography-computed tomography revealed an unusual presentation with multiple vertebral metastases and craniospinal leptomeningeal dissemination. Following discussion between the members of a multidisciplinary medical team, the patient underwent one cycle of chemotherapy with cyclophosphamide, vincristine and cisplatin. However, the condition did not improve and the patient died 4 weeks after the diagnosis of ENM. The mechanisms underlying the development of these rare metastases remain unclear. The present case report provides insights into the clinical characteristics and potential metastasis mechanisms of this aggressive disease and may help to elucidate new pathways for the management of ENM.
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Affiliation(s)
- Xiaohui Ge
- Department of Radiotherapy, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Yu Yang
- Department of Radiotherapy, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Wenyan Wang
- Department of Radiotherapy, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Lei Tian
- Department of Radiotherapy, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Ge Zhang
- Department of Radiotherapy, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Zhesen Tian
- Department of Radiotherapy, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Xiaoying Xue
- Department of Radiotherapy, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
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De Martino L, Picariello S, Russo C, Errico ME, Spennato P, Papa MR, Normanno N, Scimone G, Colafati GS, Cacchione A, Mastronuzzi A, Massimino M, Cinalli G, Quaglietta L. Extra-neural metastases in pediatric diffuse midline gliomas, H3 K27-altered: presentation of two cases and literature review. Front Mol Neurosci 2023; 16:1152430. [PMID: 37547920 PMCID: PMC10398382 DOI: 10.3389/fnmol.2023.1152430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/26/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Pediatric diffuse midline gliomas (DMG), H3 K27- altered, are the most aggressive pediatric central nervous system (CNS) malignancies. Disease outcome is dismal with a median survival of less than one year. Extra-neural metastases are an unusual occurrence in DMG and have been rarely described. Methods and results Here, we report on two pediatric patients affected by DMG with extra-neural dissemination. Their clinical, imaging, and molecular characteristics are reported here. An 11-year-old male 5 months after the diagnosis of diffuse intrinsic pontine glioma (DIPG) developed metastatic osseous lesions confirmed with computed tomography (CT) guided biopsy of the left iliac bone. The patient died one month after the evidence of metastatic progression. Another 11-year-old female was diagnosed with a cerebellar H3K27- altered DMG. After six months, she developed diffuse sclerotic osseous lesions. A CT-guided biopsy of the right iliac bone was non-diagnostic. She further developed multifocal chest and abdominal lymphadenopathy and pleural effusions. Droplet digital polymerase chain reaction (ddPCR) on pleural effusion revealed the presence of H3.3A mutation (c.83A>T, p.K28M). The patient died 24 months after the diagnosis of DMG and 3 months after the evidence of metastatic pleural effusion. Discussion Extra-neural metastasis of DMG is a rare event and no standard therapy exists. An accurate and early diagnosis is necessary in order to develop a personalized plan of treatment. Further research is needed to gain further insights into the molecular pathology of DMG, H3K27- altered and improve the quality of life and the final outcome of patients with this deadly disease.
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Affiliation(s)
- Lucia De Martino
- Neurooncology Unit, Department of Pediatric Oncology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Stefania Picariello
- Neurooncology Unit, Department of Pediatric Oncology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Carmela Russo
- Neuroradiology Unit, Department of Neurosciences, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Maria Elena Errico
- Patology Unit, Department of Pathology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Pietro Spennato
- Pediatric Neurosurgery Unit, Department of Pediatric Neurosciences, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Maria Rosaria Papa
- Department of Paediatric Haematology/Oncology, Cell Therapy, A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | - Nicola Normanno
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori-IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Giuseppe Scimone
- Radiotherapy Unit, AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Giovanna Stefania Colafati
- Oncological Neuroradiology Unit, Department of Imaging, Istituto di Ricovero e Cura a Carattere Scientifico, Bambino Gesù Children's Hospital, Rome, Italy
| | - Antonella Cacchione
- Neurooncology Unit, Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Istituto di Ricovero e Cura a Carattere Scientifico, Bambino Gesù Children's Hospital, Rome, Italy
| | - Angela Mastronuzzi
- Neurooncology Unit, Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Istituto di Ricovero e Cura a Carattere Scientifico, Bambino Gesù Children's Hospital, Rome, Italy
| | - Maura Massimino
- Pediatric Oncology, Fondazione IRCCS-Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuseppe Cinalli
- Pediatric Neurosurgery Unit, Department of Pediatric Neurosciences, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Lucia Quaglietta
- Neurooncology Unit, Department of Pediatric Oncology, Santobono-Pausilipon Children's Hospital, Naples, Italy
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Gubbiotti MA, Dhillon KS, Harris J, Kothari S, Ware JB, Desai A, Shabason J, Miettinen M, Quezado M, Aldape K, Judy K, Wang ZX, Curtis MT, Nasrallah MP. An unusual case of metastatic diffuse midline glioma in an adult. J Neuropathol Exp Neurol 2023; 82:659-663. [PMID: 37075315 PMCID: PMC10501466 DOI: 10.1093/jnen/nlad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Affiliation(s)
- Maria A Gubbiotti
- Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Jaryse Harris
- Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shawn Kothari
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeffrey B Ware
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Arati Desai
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jacob Shabason
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Markku Miettinen
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Martha Quezado
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Kenneth Aldape
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Kevin Judy
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Zi-Xuan Wang
- Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Mark T Curtis
- Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - MacLean P Nasrallah
- Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Lai M, Li S, Li H, Hu Q, Li J, Zhou J, Ai R, Zhen J, Zhou Z, Wang L, Zhang Y, Hu W, Yuan L, Ma X, Zhang X, Song C, Li Z, Cai L. Lorlatinib for
ALK
‐fused, infant‐type hemispheric glioma with lung metastasis: a case report. Ann Clin Transl Neurol 2023; 10:836-841. [PMID: 37000961 DOI: 10.1002/acn3.51766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/24/2023] [Accepted: 03/14/2023] [Indexed: 04/03/2023] Open
Abstract
Infant-type hemispheric glioma, a new subtype of pediatric high-grade glioma, arises in the cerebral hemispheres. Despite better survival outcomes, the treatment of infant-type hemispheric glioma is still facing challenges. Here, we reported a case of QKI-ALK fusion, infant-type hemispheric glioma with lung metastasis who achieved a complete clinical response after lorlatinib treatment. This typical case demonstrated the importance of appropriate molecularly targeted treatments in ALK-fused tumors, and lorlatinib may serve as an effective complement to conventional chemotherapy and radiotherapy in primary glioma harboring ALK fusions and its metastasis.
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Yu N, Lee HS, Raslan OA, Jin LW, Aboud O. H3G34-mutant diffuse hemispheric glioma with osseous metastases: a case report and literature review. CNS Oncol 2023; 12:CNS95. [PMID: 36919796 PMCID: PMC10171036 DOI: 10.2217/cns-2022-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Aim: H3G34 diffuse hemispheric glioma is a CNS tumor that is difficult to diagnose and treat and accompanied with poor prognosis. It is becoming clear that extra CNS metastasis may present in a subset of patients with H3G34 gliomas, further complicating diagnosis and treatment. Materials & methods: We present a case of a 19-year-old female with a H3G34 mutant diffuse hemispheric glioma with osseous metastases. We then provide a literature review of the most recent understanding of H3G34 mutant malignancies. Conclusion: Given the stress that patients with H3G34 can experience and the poor prognosis, it is imperative to expand our knowledge and ascertain accurate diagnostic methodologies and targeted therapeutic approaches.
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Affiliation(s)
- Nina Yu
- University of California, Davis School of Medicine, Sacramento, CA 95817, USA
| | - Han Sung Lee
- Department of Pathology, University of California Davis, Sacramento, CA 95817, USA
| | - Osama A Raslan
- Department of Radiology, Division of Neuroradiology, University of California Davis, Sacramento, CA 95817, USA
| | - Lee-Way Jin
- Department of Pathology, University of California Davis, Sacramento, CA 95817, USA
| | - Orwa Aboud
- Department of Neurology & Neurological Surgery, University of California Davis, Sacramento, CA 95817, USA.,Comprehensive Cancer Center, University of California Davis, Sacramento, CA 95817, USA
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