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Aruta G, Ceraudo M, Truffelli M, Criminelli Rossi D, Zona G, Anania P. Oligodendroglioma with ganglioglioma like differentiation: management and prognostic implications. Is a WHO classification update required? J Neurosurg Sci 2020; 64:581-583. [PMID: 32951414 DOI: 10.23736/s0390-5616.19.04798-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Gelsomina Aruta
- Division of Neurosurgery, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, IRCCS San Martino University Hospital, University of Genoa, Genoa, Italy
| | - Marco Ceraudo
- Division of Neurosurgery, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, IRCCS San Martino University Hospital, University of Genoa, Genoa, Italy -
| | - Monica Truffelli
- Division of Neurosurgery, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, IRCCS San Martino University Hospital, University of Genoa, Genoa, Italy
| | - Diego Criminelli Rossi
- Division of Neurosurgery, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, IRCCS San Martino University Hospital, University of Genoa, Genoa, Italy
| | - Gianluigi Zona
- Division of Neurosurgery, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, IRCCS San Martino University Hospital, University of Genoa, Genoa, Italy
| | - Pasquale Anania
- Division of Neurosurgery, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, IRCCS San Martino University Hospital, University of Genoa, Genoa, Italy
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Meng L, He X, Xiao Y, Zhang J. A Rare Case of Glioneuronal Tumor with Neuropil-like Islands in the Spinal Cord. Clin Neuroradiol 2020; 30:861-864. [PMID: 32382874 DOI: 10.1007/s00062-020-00905-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/14/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Liangliang Meng
- Department of Radiology, PLA General Hospital, Beijing, China.,Department of Radiology, General Hospital, Tianjin Medical University, 154 Anshan Road, Heping District, 300052, Tianjin, China
| | - Xiaoxi He
- Department of Radiology, General Hospital, Tianjin Medical University, 154 Anshan Road, Heping District, 300052, Tianjin, China
| | - Yueyong Xiao
- Department of Radiology, PLA General Hospital, Beijing, China
| | - Jing Zhang
- Department of Radiology, General Hospital, Tianjin Medical University, 154 Anshan Road, Heping District, 300052, Tianjin, China.
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Kakkar A, Nambirajan A, Kaur K, Kumar A, Mallick S, Suri V, Sarkar C, Kale SS, Garg A, Sharma MC. ATRX loss in glioneuronal tumors with neuropil-like islands indicates similarity to diffuse astrocytic tumors. J Neurooncol 2016; 130:63-68. [PMID: 27469217 DOI: 10.1007/s11060-016-2224-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 07/22/2016] [Indexed: 11/27/2022]
Abstract
Glioneuronal tumor with neuropil-like islands (GTNI) is a rare, recently described neoplasm, whose pathogenesis has not been studied extensively. The role of ATRX mutations, a class-defining alteration in diffuse astrocytic neoplasms, has not been assessed in GTNIs previously. We therefore aimed to assess the status of ATRX, along with IDH1, 1p/19q and p53, in cases of GTNI in order to evaluate the molecular profile of these tumors. All cases of GTNI diagnosed at our Institute were retrieved and clinicopathological features were reviewed. Immunohistochemistry for ATRX, IDH1 and p53 was performed. We identified four cases of GTNI, majority of which occurred in young adults. Loss of ATRX immunoexpression, a surrogate marker for ATRX mutation, was seen in all four cases. All cases were immunopositive for p53, while IDH1 positivity was seen in all three cases assessed. 1p/19q codeletion was absent in the three cases analyzed. These results indicate that the molecular pathogenesis of GTNIs similar to that of diffuse astrocytic tumors. Further, the loss of ATRX expression is seen in both the glial as well as neuronal components, indicating that both arise from the same tumor stem/progenitor cell and that the latter may be a metaplastic change. Thus, loss of ATRX immunoexpression, shown for the first time in these tumors, along with immunopositivity for p53 and IDH1, indicates that these tumors are molecular astrocytomas, and their clinical behaviour is likely to recapitulate that of ATRX-mutant and IDH-mutant diffuse astrocytomas of the same grade.
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Affiliation(s)
- Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Aruna Nambirajan
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Kavneet Kaur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Anupam Kumar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Supriya Mallick
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Vaishali Suri
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Chitra Sarkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Shashank Sharad Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Mehar Chand Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India.
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4
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Congenital glioneuronal tumor with neuropil-like islands. J Clin Neurosci 2015; 24:156-7. [PMID: 26455542 DOI: 10.1016/j.jocn.2015.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 07/23/2015] [Indexed: 11/24/2022]
Abstract
The glioneuronal tumor with neuropil-islands is considered a rare variant of an astrocytoma. Congenital cases of glioneuronal tumor with neuropil-islands, which typically arise in adults, have not been reported to our knowledge. We report an autopsy case of an in-utero demise of a 38-week-gestation female fetus in a 29-year-old female. At autopsy, a previously detected supratentorial tectal mass (by fetal MRI) was identified. Histology showed a biphasic neoplasm marked by island of gray matter-like parenchyma rimmed by mature-appearing neuronal cells intermixed with variably cellular areas resembling a low grade astrocytoma. Focally, the tumor was noted to involve the overlying meninges. The neuronal cell components were highlighted with synaptophysin and neuN antibodies and the glioma areas stained with glial fibrillary acidic protein antibody. The tumor did not stain with isocitrate dehydrogenase 1 (R132H) antibody and had a low Ki-67 labeling index (1.4%), in keeping with a low grade tumor. The pathologic findings were interpreted as representing a low grade glioneuronal tumor with neuropil-like islands. There have been few reports of this tumor arising in children, with most of those developing in the spinal cord. To our knowledge, this is the first reported congenital case of this tumor described in the literature.
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Spinal cord glioneuronal tumor with rosetted neuropil-like islands in pediatric age group. Case Rep Pathol 2015; 2014:471645. [PMID: 25574415 PMCID: PMC4276692 DOI: 10.1155/2014/471645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 11/14/2014] [Indexed: 01/28/2023] Open
Abstract
Glioneuronal neoplasms are rare tumors. Recently, an unusual glioneuronal tumor histologically showing neuropil-like islands has been described. Here, we present such a tumor originating from spinal cord of a 14-year-old girl, who has scoliosis and urinary incontinence. Microscopically, the glial component was chiefly fibrillary astrocytic, punctuated by neuropil-like islands. Immunohistochemically, glial tissue was GFAP positive, and neuropil-like areas and big neurons were synaptophysin reactive. For astrocytic component Ki-67 proliferation index was 1% and p53 was immunonegative. This case is unique in that in the literature it is the second reported case in pediatric age group that is located at spinal cord.
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Buccoliero AM, Castiglione F, Degl'innocenti DR, Moncini D, Paglierani M, Sardi I, Giunti L, Giordano F, Sanzo M, Mussa F, Aricò M, Genitori L, Taddei GL. Glioneuronal tumor with neuropil-like islands: clinical, morphologic, immunohistochemical, and molecular features of three pediatric cases. Pediatr Dev Pathol 2012; 15:352-60. [PMID: 22594376 DOI: 10.2350/12-01-1147-oa.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Glioneuronal tumors with neuropil-like islands are rare. The 1st reported cases were localized in the cerebral hemispheres of adults, showed homogeneous histopathologic features (infiltrating astrocytic growth and neuropil-like islands rimmed by neuronal cells), and had an unfavorable behavior. We report 3 pediatric cases (1 boy and 2 girls, ages 4, 6, and 8 years, respectively). The boy had a cerebral tumor, and the girls had a spinal tumor. The younger girl also had multiple posterior fossa lesions. The boy and older girl underwent a gross total resection. The younger girl underwent a subtotal resection of the spinal tumor; posterior fossa lesions were not surgically treated. The boy and younger girl are in complete remission at 33 and 24 months, respectively, after surgery and subsequent high-dose chemoradiotherapy. The older girl had a recurrence that was partially resected. Afterward, she started high-dose chemoradiotherapy and had an optimal radiologic response at 4 months follow up. Microscopically, the common denominator was the presence of synaptophysin-positive neuropil-like islands. One tumor showed ependymal features (pseudorosettes and punctate epithelial membrane antigen immunopositivity). Two tumors had 1p deletion. 19q deletion, MGMT gene promoter methylation, EGFR amplifications or polysomy, and EGFR, IDH1, IDH2, and TP53 genes mutation analyses yielded negative results. In conclusion, glioneuronal tumor with neuropil-like islands can affect children, arise in the spinal cord, and show ependymal features in its glial component. A high-dose chemoradiotherapy program is effective.
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Abstract
The term long-term epilepsy associated tumor (LEAT) encompasses lesions identified in patients investigated for long histories (often 2 years or more) of drug-resistant epilepsy. They are generally slowly growing, low grade, cortically based tumors, more often arising in younger age groups and in many cases exhibit neuronal in addition to glial differentiation. Gangliogliomas and dysembryoplastic neuroepithelial tumors predominate in this group. LEATs are further united by cyto-architectural changes that may be present in the adjacent cortex which have some similarities to developmental focal cortical dysplasias (FCD); these are now grouped as FCD type IIIb in the updated International League Against Epilepsy (ILAE) classification. In the majority of cases, surgical treatments are beneficial from both perspectives of managing the seizures and the tumor. However, in a minority, seizures may recur, tumors may show regrowth or recurrence, and rarely undergo anaplastic progression. Predicting and identifying tumors likely to behave less favorably are key objectives of the neuropathologist. With immunohistochemistry and modern molecular pathology, it is becoming increasingly possible to refine diagnostic groups. Despite this, some LEATs remain difficult to classify, particularly tumors with "non-specific" or diffuse growth patterns. Modification of LEAT classification is inevitable with the goal of unifying terminological criteria applied between centers for accurate clinico-pathological-molecular correlative data to emerge. Finally, establishing the epileptogenic components of LEAT, either within the lesion or perilesional cortex, will elucidate the cellular mechanisms of epileptogenesis, which in turn will guide optimal surgical management of these lesions.
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Affiliation(s)
- Maria Thom
- Department of Clinical and Experimental Epilepsy, UCL, Institute of Neurology, Queen Square, London, UK.
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Fraum TJ, Barak S, Pack S, Lonser RR, Fine HA, Quezado M, Iwamoto FM. Spinal cord glioneuronal tumor with neuropil-like islands with 1p/19q deletion in an adult with low-grade cerebral oligodendroglioma. J Neurooncol 2012; 107:421-6. [PMID: 22083647 PMCID: PMC7446125 DOI: 10.1007/s11060-011-0760-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 11/01/2011] [Indexed: 11/29/2022]
Abstract
Glioneuronal tumor with neuropil-like islands (GTNI) is considered a rare variant of astrocytoma, characterized by discrete aggregates of cells expressing neuronal markers that punctuate a GFAP-positive glial background. Of the 24 published GTNI cases, only two occurred in adult spinal cords; none occurred concurrent with another CNS tumor; and none of those tested exhibited the 1p/19q deletion typical of oligodendroglioma. A 48-year-old man without significant past medical history was diagnosed with a WHO grade II oligodendroglioma by stereotactic biopsy of a lesion discovered after the patient suffered a generalized tonic-clonic seizure. By FISH analysis, this tumor exhibited the 1p/19q deletion present in up to 80% of oligodendrogliomas. The patient received 14 monthly cycles of temozolomide, and his cerebral tumor had a minor response. When the patient subsequently reported progressive paresthesias of his lower extremities, an MRI revealed an enhancing, cystic tumor of the thoracic spinal cord that was diagnosed as GTNI by histological analysis. By FISH analysis, this lesion exhibited the same 1p/19q deletion present in the concurrent cerebral oligodendroglioma. This case of a spinal cord GTNI with 1p/19q deletions constitutes the third report of a spinal cord GTNI in an adult patient; the first report of a GTNI in an individual with a separate CNS neoplasm; and the first report of a GTNI with 1p/19q deletions. This case establishes a potential genetic kinship between GTNI and oligodendroglioma that warrants further investigation.
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Affiliation(s)
- Tyler J Fraum
- Neuro-Oncology Branch, National Institutes of Health, 9030 Old Georgetown Rd., Room 221, Bethesda, MD 20892-8202, USA.
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Xiong J, Liu Y, Chu SG, Chen H, Chen HX, Mao Y, Wang Y. Rosette-forming glioneuronal tumor of the septum pellucidum with extension to the supratentorial ventricles: Rare case with genetic analysis. Neuropathology 2011; 32:301-5. [DOI: 10.1111/j.1440-1789.2011.01261.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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High frequency of IDH-1 mutation links glioneuronal tumors with neuropil-like islands to diffuse astrocytomas. Acta Neuropathol 2011; 122:367-9. [PMID: 21755347 PMCID: PMC3170121 DOI: 10.1007/s00401-011-0855-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 06/30/2011] [Accepted: 06/30/2011] [Indexed: 11/20/2022]
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Glioneuronal tumor with neuropil-like islands of the spinal cord with diffuse leptomeningeal neuraxis dissemination. J Neurooncol 2010; 104:529-33. [PMID: 21188469 DOI: 10.1007/s11060-010-0505-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 12/13/2010] [Indexed: 01/21/2023]
Abstract
A 54-year-old Caucasian female presented with a 1 year history of intermittent numbness of the left leg progressing to bilateral, lower extremity sensory loss that advanced to include impaired vibration and proprioception. The subsequent thoracic spine magnetic resonance imaging (MRI) scan revealed a heterogeneous, avidly enhancing, centrally situated spinal cord mass involving T7 through T10 in association with thick linear enhancement of the anterior and posterior cord surfaces extending both superiorly and inferiorly. Both the cervical and lumbar spine MRI demonstrated diffuse leptomeningeal disease as well. A brain MRI revealed focal leptomeningeal enhancement in the left and right sylvian fissures, the suprasellar cistern, and the posterior fossa; a pattern consistent with metastatic disease. The patient underwent a T6-T10 laminectomy for tumor biopsy and debulking. Histology revealed a WHO grade III glioneuronal tumor with rosetted neuropil-like islands. Synaptophysin and neurofilament (NF) positive staining was noted within the neural appearing component, whereas, glial fibrillary acidic protein (GFAP) immunopositivity was evident in the fibrillary astrocytoma component of the tumor. The Ki-67 labeling index was 7%. This tumor pattern, now included in the 2007 World Health Organization (WHO) classification of central nervous system tumours as a pattern variation of anaplastic astrocytoma (Kleihues et al. In: Louis et al. (eds) WHO classification of tumours of the central nervous system, 2007), was first described in a four-case series by Teo et al. in 1999. The majority of subsequently reported cases described them as primary tumors of the cerebrum. Herein, we report a unique example of a spinal glioneuronal tumor with neuropil-like islands with associated leptomeningeal dissemination involving the entire craniospinal axis.
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Tomasello C, Franceschi E, Tosoni A, Brandes A. Gangliogliomas: recent advances in classification and treatment. FUTURE NEUROLOGY 2010. [DOI: 10.2217/fnl.10.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Gangliogliomas are uncommon neoplasms of the CNS and, as a consequence, few randomized, clinical trials have been performed, thereby limiting treatment guidelines. The best management of newly diagnosed gangliogliomas entails a complete resection, corroborated by postoperative contrast-enhanced MRI. If an incomplete resection is documented, a second attempt at gross total resection should be considered, given the prognostic significance of complete resection. Small-volume residual disease is best managed with involved-field radiotherapy. The role of chemotherapy is uncertain and, in general, would be reserved for patients having previously failed surgery and radiotherapy. This article summarizes the most important available up-to-date information on clinical, prognostic, radiological, pathological and therapeutic findings for gangliogliomas in order to provide valuable guidance for the diagnosis and management of such uncommon tumors. This information may be considered as possible background for future studies designed to clarify the complex management of these tumors.
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Affiliation(s)
- Chiara Tomasello
- Department of Medical Oncology, Azienda USL Bell aria-Maggiore Hospital, Bologna, Italy
| | - Enrico Franceschi
- Department of Medical Oncology, Azienda USL Bell aria-Maggiore Hospital, Bologna, Italy
| | - Alicia Tosoni
- Department of Medical Oncology, Azienda USL Bell aria-Maggiore Hospital, Bologna, Italy
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Min HS, Lee SH, Yoo H, Myung J, Hong EK, Park SH. Cytogenetic study of glioneuronal tumor with neuropil-like islands: a case report. Neuropathology 2009; 30:420-6. [PMID: 19845863 DOI: 10.1111/j.1440-1789.2009.01066.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Glioneuronal tumor with neuropil-like islands (GTNI) is a recently recognized glioneuronal neoplasm but it was classified as an astrocytic tumor by the World Health Organization (WHO) in 2007. We performed a cytogenetic study in a case of GTNI arising in a 55-year-old man and analyzed its genetic alteration. It presented as a heterogeneously enhancing, multi-lobulating solid mass on MRI. Histopathologically, the tumor showed the biphasic feature of the predominating micronodular neuropil-like islands and the diffusely infiltrating glial component. In addition, the prominent blood vessels with perivascular hyalinization were observed. On cytogenetic study, loss of 4q, 5q, 11p and gain of 6p, 7, 8, 11q, 12p, 15q were found. The remaining tumor after subtotal resection progressed 7 months later, despite combined chemo- and radiotherapy. From the results, it seems that GTNI does not share pathologic or genetic features with conventional astrocytoma, suggesting a unique entity with aggressive behavior.
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Affiliation(s)
- Hye Sook Min
- Department of Pathology, National Cancer Center, Goyang, Gyeonggi, South Korea
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Pytel P, Lukas RV. Update on diagnostic practice: tumors of the nervous system. Arch Pathol Lab Med 2009; 133:1062-77. [PMID: 19642733 DOI: 10.5858/133.7.1062] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2008] [Indexed: 11/06/2022]
Abstract
CONTEXT Changes in the practice of diagnosing brain tumors are formally reflected in the evolution of the World Health Organization classification. Beyond this classification, the practice of diagnostic pathology is also changing with the availability of new tests and the introduction of new treatment options. OBJECTIVE Glioblastomas, oligodendrogliomas, glioneuronal tumors, and primitive pediatric tumors are discussed in an exemplary way to illustrate these changes. DATA SOURCES Review of relevant publications through Medline database searches. CONCLUSIONS The example of glioblastomas shows how new predictive markers may help identify subgroups of tumors that respond to certain therapy regimens. The development of new treatment strategies also leads to different questions in the assessment of brain tumors, as seen in the example of pseudoprogression or the changes in tumor growth pattern in patients taking bevacizumab. Oligodendrogliomas illustrate how the identification of 1p/19q loss as a cytogenetic aberration aids our understanding of these tumors and changes diagnostic practice but also introduces new challenges in classification. Glioneuronal tumors are an evolving group of lesions. Besides a growing list of usually low-grade entities with well-defined morphologic features, these also include more poorly defined cases in which a component of infiltrating glioma is often associated with focal neuronal elements. The latter is biologically interesting but of uncertain clinical significance. Oligodendrogliomas and glioneuronal tumors both illustrate the importance of effective communication between the pathologist and the treating oncologist in the discussion of these patients. Finally, the discussion of primitive pediatric tumors stresses the clinical importance of the distinction between different entities, like atypical teratoid rhabdoid tumor, "central" (supratentorial) primitive neuroectodermal tumor, "peripheral" primitive neuroectodermal tumor, and medulloblastoma. In medulloblastomas, the recognition of different variants is emerging as a prognostic factor that may in the future also predict therapy responsiveness.
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Affiliation(s)
- Peter Pytel
- Department of Pathology, University of Chicago Medical Center, Chicago, Illinois 60637, USA.
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Agarwal S, Suri V, Rishi A, Shukla B, Garg A, Sharma MC, Sinha S, Sarkar C. Glioneuronal tumor with neuropil-like islands: A new entity. Neuropathology 2009; 29:96-100. [DOI: 10.1111/j.1440-1789.2008.00933.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Perry A, Miller CR, Gujrati M, Scheithauer BW, Zambrano SC, Jost SC, Raghavan R, Qian J, Cochran EJ, Huse JT, Holland EC, Burger PC, Rosenblum MK. Malignant gliomas with primitive neuroectodermal tumor-like components: a clinicopathologic and genetic study of 53 cases. Brain Pathol 2009; 19:81-90. [PMID: 18452568 PMCID: PMC8094809 DOI: 10.1111/j.1750-3639.2008.00167.x] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Revised: 03/09/2008] [Accepted: 03/11/2008] [Indexed: 12/14/2022] Open
Abstract
Central nervous system neoplasms with combined features of malignant glioma and primitive neuroectodermal tumor (MG-PNET) are rare, poorly characterized, and pose diagnostic as well as treatment dilemmas. We studied 53 MG-PNETs in patients from 12 to 80 years of age (median = 54 years). The PNET-like component consisted of sharply demarcated hypercellular nodules with evidence of neuronal differentiation. Anaplasia, as seen in medulloblastomas, was noted in 70%. Within the primitive element, N-myc or c-myc gene amplifications were seen in 43%. In contrast, glioma-associated alterations involved both components, 10q loss (50%) being most common. Therapy included radiation (78%), temozolomide (63%) and platinum-based chemotherapy (31%). Cerebrospinal fluid (CSF) dissemination developed in eight patients, with response to PNET-like therapy occurring in at least three. At last follow-up, 27 patients died, their median survival being 9.1 months. We conclude that the primitive component of the MG-PNET: (i) arises within a pre-existing MG, most often a secondary glioblastoma; (ii) may represent a metaplastic process or expansion of a tumor stem/progenitor cell clone; (iii) often shows histologic anaplasia and N-myc (or c-myc) amplification; (iv) has the capacity to seed the CSF; and (v) may respond to platinum-based chemotherapy regimens.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents, Alkylating/therapeutic use
- Brain Neoplasms/genetics
- Brain Neoplasms/pathology
- Brain Neoplasms/therapy
- Combined Modality Therapy
- Dacarbazine/analogs & derivatives
- Dacarbazine/therapeutic use
- Female
- Follow-Up Studies
- Genes, myc/genetics
- Glioma/genetics
- Glioma/pathology
- Glioma/therapy
- Humans
- In Situ Hybridization, Fluorescence
- Medulloblastoma/genetics
- Medulloblastoma/pathology
- Medulloblastoma/therapy
- Neoplasm Metastasis
- Neoplasms, Multiple Primary/genetics
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/therapy
- Neuroectodermal Tumors, Primitive/genetics
- Neuroectodermal Tumors, Primitive/pathology
- Neuroectodermal Tumors, Primitive/therapy
- Prognosis
- Proto-Oncogene Proteins/genetics
- Radiotherapy/methods
- Temozolomide
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Arie Perry
- Division of Neuropathology, Washington University School of Medicine, St. Louis, Missouri 63110-1093, USA.
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Abstract
Three new entities have been recently added to the group of glioneuronal tumors in the most recent update of the World Health Organization classification of tumors of the central nervous system: papillary glioneuronal tumor, rosetted glioneuronal tumor with neuropil-like islands, and rosette-forming glioneuronal tumor of the fourth ventricle. These tumors are relatively infrequent lesions, and because of that, they can be challenging to diagnose for the practicing pathologist. In this article, we summarize the clinical and pathologic findings of these new lesions.
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Poliani PL, Sperli D, Valentini S, Armentano A, Bercich L, Bonetti MF, Corriero G, Brisigotti M, Quattrone A, Lanza PL. Spinal glioneuronal tumor with neuropil-like islands and meningeal dissemination: histopathological and radiological study of a pediatric case. Neuropathology 2008; 29:574-8. [PMID: 19077041 DOI: 10.1111/j.1440-1789.2008.00988.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cerebral and spinal location of glioneuronal tumors have been recently described as a novel type of primary CNS neoplasia. A distinctive rare form of glioneuronal tumors with neuropil-like islands (GTNI) have been reported to occur in the adult cerebrum, whereas spinal GTNI localization is extremely rare. In the present report we describe a case of a 15-month-old child with a spinal GTNI of the cervical region and meningeal dissemination. Histologically the tumor was composed of round, small neurocytic-like cells arranged around eosinophilic neuropil cores and embedded in a diffuse fibrillar glial component forming prominent "rosetted" neuropil islands displaying strong immunoreactivity for neuronal markers. Cerebral GTNI shows abundant glial components not rarely exhibiting anaplastic features that justify their inclusion within the group of diffuse astrocytomas. In contrast, including our case, spinal GTNI do not show histological evidence of anaplastic features and exhibits a significant neuronal component that may imply considering these lesions in a separate group. Nevertheless, due to their exceptional rarity, the natural history of these lesions is not yet fully understood, but spinal GTNI seems to have an unfavorable clinical course despite their benign histopathological features, which must be taken into account for appropriate treatment and follow-up of the patient.
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The 2007 WHO classification of tumors of the central nervous system – what has changed? Curr Opin Neurol 2008; 21:720-7. [DOI: 10.1097/wco.0b013e328312c3a7] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
The World Health Organization recently updated its classification of central nervous system tumors, adding 8 entities, as well as defining new variants and morphologic patterns of existing entities. Despite the continued refinement of brain tumor histologic classification and grading, there remain some diagnostic "gray zones" that challenge general surgical pathologists and neuropathologists alike. These include the presence of oligodendroglial features in (mixed) oligoastrocytomas and glioblastomas (GBMs), GBM variants (such as small cell GBM), meningioma classification and grading, medulloblastoma variants, ependymoma grading, the presence of "neuronal features" in otherwise morphologically classic gliomas, and low-grade gliomas with high Ki-67 labeling indices. In the current review, we discuss these issues and offer some practical guidelines for dealing with problematic cases.
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Edgar MA, Rosenblum MK. The Differential Diagnosis of Central Nervous System Tumors: A Critical Examination of Some Recent Immunohistochemical Applications. Arch Pathol Lab Med 2008; 132:500-9. [DOI: 10.5858/2008-132-500-tddocn] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2007] [Indexed: 11/06/2022]
Abstract
Abstract
Context.—As we write, novel antibodies that may well alter the routine practice of surgical neuropathology are in development, characterization, and the early stages of clinical use. These will be used for purposes of tumor subclassification, as prognostic markers, as identifiers of potential therapeutic targets, and as predictors of treatment response.
Objective.—To provide for nonspecialists a critical assessment of the peer-reviewed literature (necessarily colored by our own experience) as it pertains to several immunohistochemical reagents that have been recently forwarded as adjuncts to the histologic typing of central nervous system tumors.
Data Sources.—We address in these pages only antibodies that are commercially available, that have been the subjects of multiple published series, and that we have had occasion to use in the course of everyday problem solving.
Conclusions.—Discussion concentrates on the use of 4 antibodies: BAF47 in the diagnosis of atypical teratoid/ rhabdoid tumor, OCT4 in intracranial germinoma, β-catenin in craniopharyngioma, and NeuN as a marker of neuronal differentiation in neuroepithelial neoplasms.
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Affiliation(s)
- Mark A. Edgar
- From the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Marc K. Rosenblum
- From the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY
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Edgar MA, Rosenblum MK. Mixed glioneuronal tumors: recently described entities. Arch Pathol Lab Med 2007; 131:228-33. [PMID: 17284107 DOI: 10.5858/2007-131-228-mgtrde] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2006] [Indexed: 11/06/2022]
Abstract
CONTEXT Several distinctive mixed glioneuronal tumors that warrant recognition as clinicopathologic entities have been recently described by neuropathologists. OBJECTIVE To summarize important clinical, radiologic, and pathologic findings for 3 novel glioneuronal tumors (papillary glioneuronal tumor, rosetted glioneuronal tumor, and rosette-forming glioneuronal tumor of the fourth ventricle). DATA SOURCES Recent reports in the pathology literature and the authors' experience with mixed glioneuronal tumors at a major cancer center. CONCLUSIONS Histologic features enabling recognition of these recently described glioneuronal tumors are presented along with remarks concerning the classification of mixed neuronal and glial tumors exhibiting unconventional appearances.
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Affiliation(s)
- Mark A Edgar
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA.
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