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Inetas-Yengin G, Bayrak OF. Related mechanisms, current treatments, and new perspectives in meningioma. Genes Chromosomes Cancer 2024; 63:e23248. [PMID: 38801095 DOI: 10.1002/gcc.23248] [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: 04/04/2024] [Revised: 04/18/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024] Open
Abstract
Meningiomas are non-glial tumors that are the most common primary brain tumors in adults. Although meningioma can possibly be cured with surgical excision, variations in atypical/anaplastic meningioma have a high recurrence rate and a poor prognosis. As a result, it is critical to develop novel therapeutic options for high-grade meningiomas. This review highlights the current histology of meningiomas, prevalent genetic and molecular changes, and the most extensively researched signaling pathways and therapies in meningiomas. It also reviews current clinical studies and novel meningioma treatments, including immunotherapy, microRNAs, cancer stem cell methods, and targeted interventions within the glycolysis pathway. Through the examination of the complex landscape of meningioma biology and the highlighting of promising therapeutic pathways, this review opens the way for future research efforts aimed at improving patient outcomes in this prevalent intracranial tumor entity.
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Affiliation(s)
- Gizem Inetas-Yengin
- Department of Medical Genetics, Yeditepe University, Medical School, Istanbul, Turkey
- Department of Genetics and Bioengineering, Yeditepe University, Istanbul, Turkey
| | - Omer Faruk Bayrak
- Department of Medical Genetics, Yeditepe University, Medical School, Istanbul, Turkey
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Taher MM, Ashour KM, Althaqafi BA, Mansouri A, Al-Harbi AA, Filfilan W, Bakhsh GY, Bantan NA, Saeed M, AlQuthami K. Next-Generation DNA Sequencing of Grade 1 Meningioma Tumours: A Case Report of Angiomatous and Psammomatous Meningiomas. Cureus 2024; 16:e54009. [PMID: 38476782 PMCID: PMC10929682 DOI: 10.7759/cureus.54009] [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: 02/11/2024] [Indexed: 03/14/2024] Open
Abstract
We performed the next-generation sequencing (NGS) analysis of a rare grade 1 brain meningioma (angiomatous type) and a common grade 1 spinal meningioma (psammomatous type) and compared their mutation profiling. The data were analysed using the Ion Reporter 5.16 programme (Thermo Fisher Scientific, Waltham, MA). Sequencing analysis identified 10 novel variants and two previously reported variants that were common between these two tumours. Nine variants were missense, which included an insertion in EGFR c.1819_1820insCA, causing frameshifting, and a single nucleotide deletion in HRAS and HNF1A genes, causing frameshifting in these genes. These were common variants identified for both tumours. Also, 10 synonymous variants and 10 intronic variants were common between these two tumours. In intronic variants, two were splice site_5' variants (acceptor site variants). Typical of the angiomatous type tumour, there were 11 novel and six previously reported variants that were not found in the psammomatous tumour; three variants were synonymous, 11 were missense mutations, and three were deletions causing frameshifting. The deletion variants were in the SMARCB1, CDH1, and KDR genes. In contrast, eight novel and five previously reported variants were found in the psammomatous meningioma tumour. In this tumour, two variants were synonymous: a deletion causing a frameshifting in [(c.3920delT; p. (Ile1307fs)], and a two-base pair insertion and deletion (INDEL) [(c.3986_3987delACinsGT; p. (His1329Arg)] both in the APC gene were also found. Among our findings, we have identified that ALK, VHL, CTNNB1, EGFR, ERBB4, PDGFRA, KDR, SMO, ABL1, HRAS, ATM, HNF1A, FLT3, and RB1 mutations are common for psammomatous meningioma and angiomatous tumours. Variants typical for angiomatous (brain) meningioma are PIK3CA, KIT, PTPN11, CDH1, SMAD4, and SMARCB1; the variants typical for psammomatous meningioma are APC, FGFR2, HNF1A, STK11, and JAK3. The RET splice variant (c.1880-2A>C) found in both meningioma tumours is reported (rs193922699) as likely pathogenic in the Single Nucleotide Polymorphism Database (dbSNP). All missense variants detected in these two meningiomas are found in the cancer-driver genes. The eight variants we found in genes such as EGFR, PDGFRA, SMO, FLT3, PIK3CA, PTPN11, CDH1, and RB1 are glioma-driver genes. We did not find any mutations in genes such as BRAF, IDH1, CDKN2A, PTEN, and TP53, which are also listed as cancer-driver genes in gliomas. Mutation profiling utilising NGS technology in meningiomas could help in the accurate diagnosis and classification of these tumours and also in developing more effective treatments.
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Affiliation(s)
- Mohiuddin M Taher
- Science and Technology Unit and Deanship of Scientific Research, Umm Al-Qura University, Makkah, SAU
- Medical Genetics, Umm Al-Qura University, Makkah, SAU
| | - Khalid M Ashour
- Neurological Surgery, Alexandria University, Alexandria, EGY
- Neurosurgery, Al-Noor Specialty Hospital, Ministry of Health, Makkah, SAU
| | | | - Albatool Mansouri
- Neurosurgey, Al-Noor Specialty Hospital, Ministry of Health, Makkah, SAU
| | | | - Weam Filfilan
- Pathology and Laboratory Medicine, Al-Noor Specialty Hospital, Ministry of Health, Makkah, SAU
| | - Ghassan Y Bakhsh
- General Medicine, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Makkah, SAU
| | - Najwa A Bantan
- Radiology, Al-Noor Specialty Hospital, Ministry of Health, Makkah, SAU
| | - Muhammad Saeed
- Radiology, Al-Noor Specialty Hospital, Ministry of Health, Makkah, SAU
| | - Khalid AlQuthami
- Laboratory Medicine and Blood Bank, Al-Noor Specialty Hospital, Ministry of Health, Makkah, SAU
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Meredith DM, Pisapia DJ. 2021 World Health Organization Classification of Brain Tumors. Continuum (Minneap Minn) 2023; 29:1638-1661. [PMID: 38085892 DOI: 10.1212/con.0000000000001355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVE The classification of brain tumors is a rapidly evolving field that requires extensive integration of molecular diagnostic findings from an expanding set of platforms and assays. This article summarizes the schema presented in the 5th edition of the World Health Organization (WHO) classification of central nervous system (CNS) tumors while highlighting diagnostic molecular findings and discussing the strengths and weaknesses of commonly available testing modalities. LATEST DEVELOPMENTS Several major changes in practice were introduced with the 5th edition of the CNS WHO classification, including molecular grading of adult diffuse gliomas, the introduction of many new entities within the spectrum of pediatric gliomas and glioneuronal tumors, and the widespread adoption of methylation classes as useful or even necessary diagnostic criteria. Additionally, several revisions to nomenclature (eg, IDH-mutant gliomas) were introduced for simplicity and to disambiguate from other tumor types. ESSENTIAL POINTS The classification of brain tumors continues to grow in complexity alongside our improved understanding of their nuanced molecular underpinnings.
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Youngblood MW, Erson-Omay Z, Li C, Najem H, Coșkun S, Tyrtova E, Montejo JD, Miyagishima DF, Barak T, Nishimura S, Harmancı AS, Clark VE, Duran D, Huttner A, Avşar T, Bayri Y, Schramm J, Boetto J, Peyre M, Riche M, Goldbrunner R, Amankulor N, Louvi A, Bilgüvar K, Pamir MN, Özduman K, Kilic T, Knight JR, Simon M, Horbinski C, Kalamarides M, Timmer M, Heimberger AB, Mishra-Gorur K, Moliterno J, Yasuno K, Günel M. Super-enhancer hijacking drives ectopic expression of hedgehog pathway ligands in meningiomas. Nat Commun 2023; 14:6279. [PMID: 37805627 PMCID: PMC10560290 DOI: 10.1038/s41467-023-41926-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/25/2023] [Indexed: 10/09/2023] Open
Abstract
Hedgehog signaling mediates embryologic development of the central nervous system and other tissues and is frequently hijacked by neoplasia to facilitate uncontrolled cellular proliferation. Meningiomas, the most common primary brain tumor, exhibit Hedgehog signaling activation in 6.5% of cases, triggered by recurrent mutations in pathway mediators such as SMO. In this study, we find 35.6% of meningiomas that lack previously known drivers acquired various types of somatic structural variations affecting chromosomes 2q35 and 7q36.3. These cases exhibit ectopic expression of Hedgehog ligands, IHH and SHH, respectively, resulting in Hedgehog signaling activation. Recurrent tandem duplications involving IHH permit de novo chromatin interactions between super-enhancers within DIRC3 and a locus containing IHH. Our work expands the landscape of meningioma molecular drivers and demonstrates enhancer hijacking of Hedgehog ligands as a route to activate this pathway in neoplasia.
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Affiliation(s)
- Mark W Youngblood
- Yale Program in Brain Tumor Research, Yale School of Medicine, New Haven, CT, USA
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA
- Department of Neurological Surgery, Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Zeynep Erson-Omay
- Yale Program in Brain Tumor Research, Yale School of Medicine, New Haven, CT, USA
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Chang Li
- Yale Program in Brain Tumor Research, Yale School of Medicine, New Haven, CT, USA
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
- Department of Neurosurgery, Sun Yat-sen University Cancer Center, 510060, Guangzhou, P. R. China
| | - Hinda Najem
- Department of Neurological Surgery, Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Süleyman Coșkun
- Yale Program in Brain Tumor Research, Yale School of Medicine, New Haven, CT, USA
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
- Department of Biological Sciences, Middle East Technical University, 06800, Ankara, Turkey
| | - Evgeniya Tyrtova
- Yale Program in Brain Tumor Research, Yale School of Medicine, New Haven, CT, USA
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
- Department of Neurosurgery, University of Washington, Seattle, WA, USA
| | - Julio D Montejo
- Yale Program in Brain Tumor Research, Yale School of Medicine, New Haven, CT, USA
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
- Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Danielle F Miyagishima
- Yale Program in Brain Tumor Research, Yale School of Medicine, New Haven, CT, USA
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA
| | - Tanyeri Barak
- Yale Program in Brain Tumor Research, Yale School of Medicine, New Haven, CT, USA
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Sayoko Nishimura
- Yale Program in Brain Tumor Research, Yale School of Medicine, New Haven, CT, USA
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Akdes Serin Harmancı
- Yale Program in Brain Tumor Research, Yale School of Medicine, New Haven, CT, USA
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Victoria E Clark
- Yale Program in Brain Tumor Research, Yale School of Medicine, New Haven, CT, USA
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
| | - Daniel Duran
- Yale Program in Brain Tumor Research, Yale School of Medicine, New Haven, CT, USA
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
- Department of Neurosurgery, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Anita Huttner
- Yale Program in Brain Tumor Research, Yale School of Medicine, New Haven, CT, USA
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Timuçin Avşar
- Department of Neurosurgery, Bahcesehir University, School of Medicine, Istanbul, Turkey
| | - Yasar Bayri
- Department of Neurosurgery, Marmara University School of Medicine, 34854, Istanbul, Turkey
| | | | - Julien Boetto
- Department of Neurosurgery, Hopital Pitie-Salpetriere, AP-HP & Sorbonne Université, F-75103, Paris, France
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Matthieu Peyre
- Department of Neurosurgery, Hopital Pitie-Salpetriere, AP-HP & Sorbonne Université, F-75103, Paris, France
| | - Maximilien Riche
- Department of Neurosurgery, Hopital Pitie-Salpetriere, AP-HP & Sorbonne Université, F-75103, Paris, France
| | - Roland Goldbrunner
- Center for Neurosurgery, University Hospital of Cologne, 50937, Cologne, Germany
| | - Nduka Amankulor
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Angeliki Louvi
- Yale Program in Brain Tumor Research, Yale School of Medicine, New Haven, CT, USA
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Kaya Bilgüvar
- Yale Program in Brain Tumor Research, Yale School of Medicine, New Haven, CT, USA
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA
- Yale Center for Genome Analysis, Yale University West Campus, Orange, CT, USA
- Department of Medical Genetics Acibadem Mehmet Ali Aydınlar University, School of Medicine, Istanbul, 34848, Turkey
| | - M Necmettin Pamir
- Department of Neurosurgery, Acibadem Mehmet Ali Aydınlar University, School of Medicine, Istanbul, 34848, Turkey
| | - Koray Özduman
- Department of Neurosurgery, Acibadem Mehmet Ali Aydınlar University, School of Medicine, Istanbul, 34848, Turkey
| | - Türker Kilic
- Department of Neurosurgery, Bahcesehir University, School of Medicine, Istanbul, Turkey
| | - James R Knight
- Yale Center for Genome Analysis, Yale University West Campus, Orange, CT, USA
| | - Matthias Simon
- University of Bonn Medical School, 53105, Bonn, Germany
- Department of Neurosurgery, Bethel Clinic, University of Bielefeld Medical Center OWL, Bielefeld, Germany
| | - Craig Horbinski
- Department of Neurological Surgery, Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michel Kalamarides
- Department of Neurosurgery, Hopital Pitie-Salpetriere, AP-HP & Sorbonne Université, F-75103, Paris, France
| | - Marco Timmer
- Center for Neurosurgery, University Hospital of Cologne, 50937, Cologne, Germany
| | - Amy B Heimberger
- Department of Neurological Surgery, Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ketu Mishra-Gorur
- Yale Program in Brain Tumor Research, Yale School of Medicine, New Haven, CT, USA
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Jennifer Moliterno
- Yale Program in Brain Tumor Research, Yale School of Medicine, New Haven, CT, USA
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
- Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Katsuhito Yasuno
- Yale Program in Brain Tumor Research, Yale School of Medicine, New Haven, CT, USA.
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA.
| | - Murat Günel
- Yale Program in Brain Tumor Research, Yale School of Medicine, New Haven, CT, USA.
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA.
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA.
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.
- Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA.
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Shen Y, Liu X, Yang W. Angiomatous meningioma with bizarre nuclei: A case report. Mol Clin Oncol 2023; 18:46. [PMID: 37206430 PMCID: PMC10189420 DOI: 10.3892/mco.2023.2642] [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: 12/23/2022] [Accepted: 03/31/2023] [Indexed: 05/21/2023] Open
Abstract
Angiomatous meningioma (AM) is a relatively rare subtype of WHO grade I meningioma. A relatively rare case of AM was recently encountered in a 45-year-old woman. The present case not only observed the typical AM histological pattern but also a large number of cells with bizarre, large, deeply staining and unevenly distributed nuclei. These cells with bizarre nuclei showed a similar pattern of immunoreactivity as meningeal epithelial cells. Although the presence of a large number of cells with bizarre nuclei in this case increased tumour cell atypia, the cells did not differ with regard to proliferative activity and mitotic imaging. Therefore, the patient was ultimately diagnosed as having AM with bizarre nuclei, WHO grade I. This manifestation of nuclear atypia and pleomorphism may be due to 'degenerative changes' in pre-existing, long-established vascular lesions, similar to those seen in degenerative schwannomas and symplastic haemangioma, rather than being considered an indicator of malignancy.
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Affiliation(s)
- Yanling Shen
- Department of Pathology, Army 73rd Group Military Hospital of PLA and Xiamen University Affiliated Chenggong Hospital, Xiamen, Fujian 361000, P.R. China
| | - Xueqing Liu
- Department of Pathology, Army 73rd Group Military Hospital of PLA and Xiamen University Affiliated Chenggong Hospital, Xiamen, Fujian 361000, P.R. China
| | - Wensheng Yang
- Department of Pathology, Army 73rd Group Military Hospital of PLA and Xiamen University Affiliated Chenggong Hospital, Xiamen, Fujian 361000, P.R. China
- Correspondence to: Mr. Wensheng Yang, Department of Pathology, Army 73rd Group Military Hospital of PLA and Xiamen University Affiliated Chenggong Hospital, 94 Wenyuan Road, Xiamen, Fujian 361000, P.R. China
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Abstract
Meningiomas comprise a histologically and clinically diverse set of tumors arising from the meningothelial lining of the central nervous system. In the past decade, remarkable progress has been made in deciphering the biology of these common neoplasms. Nevertheless, effective systemic or molecular therapies for meningiomas remain elusive and are active areas of preclinical and clinical investigation. Thus, standard treatment modalities for meningiomas are limited to maximal safe resection, radiotherapy, or radiosurgery. This review examines the history, clinical rationale, and future directions of radiotherapy and radiosurgery as integral and effective treatments for meningiomas.
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Affiliation(s)
- William C Chen
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Calixto-Hope G Lucas
- Department of Pathology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Stephen T Magill
- Department of Neurological Surgery, Northwestern University, Chicago, IL 60611, USA
| | - C Leland Rogers
- Radiation Oncology, GammaWest Cancer Services, Salt Lake City, UT, USA
| | - David R Raleigh
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA 94143, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA
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El-Abtah ME, Murayi R, Lee J, Recinos PF, Kshettry VR. Radiological Differentiation Between Intracranial Meningioma and Solitary Fibrous Tumor/Hemangiopericytoma: A Systematic Literature Review. World Neurosurg 2023; 170:68-83. [PMID: 36403933 DOI: 10.1016/j.wneu.2022.11.062] [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: 09/03/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Intracranial solitary fibrous tumor (SFT) is characterized by aggressive local behavior and high post-resection recurrence rates. It is difficult to distinguish between SFT and meningiomas, which are typically benign. The goal of this study was to systematically review radiological features that differentiate meningioma and SFT. METHODS We performed a systematic review in accordance with PRISMA guidelines to identify studies that used imaging techniques to identify radiological differentiators of SFT and meningioma. RESULTS Eighteen studies with 1565 patients (SFT: 662; meningiomas: 903) were included. The most commonly used imaging modality was diffusion weighted imaging, which was reported in 11 studies. Eight studies used a combination of diffusion weighted imaging and T1- and T2-weighted sequences to distinguish between SFT and meningioma. Compared to all grades/subtypes of meningioma, SFT is associated with higher apparent diffusion coefficient, presence of narrow-based dural attachments, lack of dural tail, less peritumoral brain edema, extensive serpentine flow voids, and younger age at initial diagnosis. Tumor volume was a poor differentiator of SFT and meningioma, and overall, there were less consensus findings in studies exclusively comparing angiomatous meningiomas and SFT. CONCLUSIONS Clinicians can differentiate SFT from meningiomas on preoperative imaging by looking for higher apparent diffusion coefficient, lack of dural tail/narrow-based dural attachment, less peritumoral brain edema, and vascular flow voids on neuroimaging, in addition to younger age at diagnosis. Distinguishing between angiomatous meningioma and SFT is much more challenging, as both are highly vascular pathologies. Tumor volume has limited utility in differentiating between SFT and various grades/subtypes of meningioma.
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Affiliation(s)
- Mohamed E El-Abtah
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Roger Murayi
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jonathan Lee
- Department of Radiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Pablo F Recinos
- Department of Neurological Surgery and Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA; Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Varun R Kshettry
- Department of Neurological Surgery and Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA; Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA.
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Noureldine MHA, Shimony N, Jallo GI. Benign Spinal Tumors. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:583-606. [PMID: 37452955 DOI: 10.1007/978-3-031-23705-8_23] [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
Benign spinal intradural tumors are relatively rare and include intramedullary tumors with a favorable histology such as low-grade astrocytomas and ependymomas, as well as intradural extramedullary tumors such as meningiomas and schwannomas. The effect on the neural tissue is usually a combination of mass effect and neuronal involvement in cases of infiltrative tumors. The new understanding of molecular profiling of different tumors allowed us to better define central nervous system tumors and tailor treatment accordingly. The mainstay of management of many intradural spinal tumors is maximal safe surgical resection. This goal is more achievable with intradural extramedullary tumors; yet, with a meticulous surgical approach, many of the intramedullary tumors are amenable for safe gross-total or near-total resection. The nature of these tumors is benign; hence, a different way to measure outcome success is pursued and usually depends on functional rather than oncological or survival outcomes.
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Affiliation(s)
- Mohammad Hassan A Noureldine
- Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Institute for Brain Protection Sciences, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
| | - Nir Shimony
- Institute of Neuroscience, Geisinger Medical Center, Geisinger Commonwealth School of Medicine, Danville, PA, USA
- Institute for Brain Protections Sciences, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
- Department of Surgery, St Jude Children's Research Hospital, Memphis, USA
| | - George I Jallo
- Institute for Brain Protections Sciences, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA.
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9
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Vaubel RA, Kumar R, Weiskittel TM, Jenkins S, Dasari S, Uhm JH, Lachance DH, Brown PD, Van Gompel JJ, Jenkins RB, Kipp BR, Sukov WR, Giannini C, Johnson DR, Raghunathan A. Genomic markers of recurrence risk in atypical meningioma following gross total resection. Neurooncol Adv 2023; 5:vdad004. [PMID: 36845294 PMCID: PMC9950854 DOI: 10.1093/noajnl/vdad004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background Meningiomas are the most common primary central nervous system (CNS) tumor in adults and CNS World Health Organization grade 2 (atypical) meningiomas show an intermediate risk of recurrence/progression. Molecular parameters are needed to better inform management following gross total resection (GTR). Methods We performed comprehensive genomic analysis of tumor tissue from 63 patients who underwent radiologically confirmed GTR of a primary grade 2 meningioma, including a CLIA-certified target next-generation sequencing panel (n = 61), chromosomal microarray (n = 63), genome-wide methylation profiling (n = 62), H3K27me3 immunohistochemistry (n = 62), and RNA-sequencing (n = 19). Genomic features were correlated with long-term clinical outcomes (median follow-up: 10 years) using Cox proportional hazards regression modeling and published molecular prognostic signatures were evaluated. Results The presence of specific copy number variants (CNVs), including -1p, -10q, -7p, and -4p, was the strongest predictor of decreased recurrence-free survival (RFS) within our cohort (P < .05). NF2 mutations were frequent (51%) but did not show a significant association with RFS. DNA methylation-based classification assigned tumors to DKFZ Heidelberg benign (52%) or intermediate (47%) meningioma subclasses and was not associated with RFS. H3K27 trimethylation (H3K27me3) was unequivocally lost in 4 tumors, insufficient for RFS analysis. Application of published integrated histologic/molecular grading systems did not improve prediction of recurrence risk over the presence of -1p or -10q alone. Conclusions CNVs are strong predictors of RFS in grade 2 meningiomas following GTR. Our study supports incorporation of CNV profiling into clinical evaluation to better guide postoperative patient management, which can be readily implemented using existing, clinically validated technologies.
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Affiliation(s)
- Rachael A Vaubel
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rahul Kumar
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Taylor M Weiskittel
- Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Sarah Jenkins
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Surendra Dasari
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Joon H Uhm
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jamie J Van Gompel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert B Jenkins
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Benjamin R Kipp
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - William R Sukov
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Caterina Giannini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Derek R Johnson
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Aditya Raghunathan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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10
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Maier AD. Malignant meningioma. APMIS 2022; 130 Suppl 145:1-58. [DOI: 10.1111/apm.13276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Andrea Daniela Maier
- Department of Neurosurgery, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
- Department of Pathology, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
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11
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Ng HK, Li KKW, Chung NYF, Chan JYT, Poon MFM, Wong QHW, Kwan JSH, Poon WS, Chen H, Chan DTM, Shi ZF, Mao Y. Molecular landscapes of longitudinal NF2/22q and non-NF2/22q meningiomas show different life histories. Brain Pathol 2022; 33:e13120. [PMID: 36167400 PMCID: PMC10154375 DOI: 10.1111/bpa.13120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/13/2022] [Indexed: 11/28/2022] Open
Abstract
Recurrence is a major complication of some meningiomas. Although there were many studies on biomarkers associated with higher grades or increased aggressiveness, few studies specifically examined longitudinal samples of primary meningiomas and recurrences from the same patients for molecular life history. We studied 99 primary and recurrent meningiomas from 42 patients by FISH for 22q, 1q, 1p, 3p, 5q, 6q, 10p, 10q, 14q, 18q, CDKN2A/B homozygous deletion, ALT (Alternative Lengthening of Telomere), TERT re-arrangement, targeted sequencing and TERTp sequencing. Although NF2 mutation and 22q were well known to be aetiological events in meningiomas, we found that in these paired meningiomas, combining the two events resulted in an NF2/22q group (57 tumors from 25 patients) which were almost mutually exclusive with those cases without these two changes (42 tumors from 17 patients) for NF2/22q. No other molecular changes were totally unique to NF2/22q or non-NF2/22q tumors. For molecular evolution, NF2/22q meningiomas had higher cytogenetic abnormalities than non-NF2/22q meningiomas (p = 0.003). Most of the cytogenetic changes in NF2/22q meningiomas were present from the outset whereas for non-NF2/22q meningiomas, cytogenetic events were uncommon in the primary tumors and most were acquired in recurrences. For non-NF2/22q tumors, CDKN2A/B homozygous deletion, 1q gain, 18p loss, 3p loss, and ALT were preferentially found in recurrences. Mutations were largely conserved between primary and recurrent tumors. Phylogenetic trees showed 11/11 patients with multiple recurrent tumors had a conserved evolutionary pattern. We conclude that for molecular life history, NF2 and 22q should be regarded as a group. NF2/22q recurring meningiomas showed more cytogenetic abnormalities in the primary tumors, whereas non-NF2/22q meningiomas showed CDKN2A/B deletion and other cytogenetic abnormalities and ALT at recurrences. Although chromosome 1p loss is a known poor prognostic marker in meningiomas, it was also associated with a shorter TBR (time between resection) in this cohort (p = 0.002).
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Affiliation(s)
- Ho-Keung Ng
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong and Shanghai Brain Consortium (HSBC), Hong Kong, China
| | - Kay Ka-Wai Li
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong and Shanghai Brain Consortium (HSBC), Hong Kong, China
| | - Nellie Yuk-Fei Chung
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
| | - Janice Yuen-Tung Chan
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
| | - Manix Fung-Man Poon
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
| | - Queenie Hoi-Wing Wong
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
| | - Johnny Sheung-Him Kwan
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
| | - Wai-Sang Poon
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Hong Chen
- Department of Pathology, Huashan Hospital, Fudan University, Hong Kong, China
| | - Danny Tat-Ming Chan
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Zhi-Feng Shi
- Hong Kong and Shanghai Brain Consortium (HSBC), Hong Kong, China.,Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Ying Mao
- Hong Kong and Shanghai Brain Consortium (HSBC), Hong Kong, China.,Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
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12
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Landscape of genetic variants in sporadic meningiomas captured with clinical genomics. Acta Neurochir (Wien) 2022; 164:2491-2503. [PMID: 35881312 DOI: 10.1007/s00701-022-05316-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/12/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Meningiomas are the most common primary central nervous system tumor. Previous studies have characterized recurrent genetic alterations that can predict patient prognosis and potentially provide new avenues for therapeutic intervention. Continued efforts to characterize the genomic changes in meningioma samples can aid in the discovery of therapeutic targets and appropriate patient stratification. METHODS We performed targeted genomic sequencing on 25 primary and 2 recurrent meningiomas using a 500-gene panel, including canonical meningioma drivers. We further detail the genomic profiles and relevant clinical findings in three cases of angiomatous meningiomas and two recurrent atypical meningiomas. RESULTS Our approach uncovers a diverse landscape of genomic variants in meningioma samples including mutations in established meningioma-related genes NF2, AKT1, PIK3CA, and TRAF7. In addition to known meningioma drivers, we uncover variants in genes encoding other PI3K subunits, Notch/hedgehog/Wnt signaling pathway components, and chromatin regulators. We additionally identify 22 genes mutated across multiple samples. Three patients included in the study were diagnosed with angiomatous WHO grade I meningiomas, all three of which contained variants in the PI3K-AKT signaling pathway previously described to regulate tumor angiogenesis. Analysis of patient-matched primary and recurrent atypical meningiomas revealed clonal enrichment for mutations in the SWI/SNF complex subunits ARID1A and SMARCA4. CONCLUSIONS Targeted genomics implemented in neuro-oncology care can enhance our understanding of the genetic underpinnings of central nervous system tumors, including meningiomas. These molecular signatures may be clinically useful in dictating treatment strategies and patient follow-up.
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13
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Bi WL, Santagata S. Skull Base Tumors: Neuropathology and Clinical Implications. Neurosurgery 2022; 90:243-261. [PMID: 34164689 DOI: 10.1093/neuros/nyab209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Tumors that arise in and around the skull base comprise a wide range of common and rare entities. Recent studies have advanced our understanding of their pathogenesis, which in some cases, have significantly influenced clinical practice. The genotype of meningiomas is strongly associated with their phenotype, including histologic subtype and tumor location, and clinical outcome. A single molecular alteration, NAB2-STAT6 fusion, has redefined the category of solitary fibrous tumors to include the previous entity hemangiopericytomas. Schwannomas, both sporadic and familial, are characterized by near ubiquitous alterations in NF2 , with additional mutations in SMARCB1 or LZTR1 in schwannomatosis. In pituitary adenohypophyseal tumors, cell lineage transcription factors such as SF-1, T-PIT, and PIT-1 are now essential for classification, providing a more rigorous taxonomy for tumors that were previously considered null cell adenomas. The pituicyte lineage transcription factor TTF-1 defines neurohypophyseal tumors, which may represent a single nosological entity with a spectrum of morphologic manifestations (ie, granular cell tumor, pituicytoma, and spindle cell oncocytoma). Likewise, the notochord cell lineage transcription factor brachyury defines chordoma, discriminating them from chondrosarcomas. The identification of nonoverlapping genetic drivers of adamantinomatous craniopharyngiomas and papillary craniopharyngiomas indicates that these are distinct tumor entities and has led to successful targeted treatment of papillary craniopharyngiomas using BRAF and/or mitogen-activated protein kinase inhibitors. Similarly, dramatic therapeutic responses have been achieved in patients with Langerhans cell histiocytosis, both with BRAF -mutant and BRAF -wildtype tumors. Familiarity with the pathology of skull base tumors, their natural history, and molecular features is essential for optimizing patient care.
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Affiliation(s)
- Wenya Linda Bi
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School , Boston , Massachusetts , USA
| | - Sandro Santagata
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School , Boston , Massachusetts , USA
- Laboratory of Systems Pharmacology, Harvard Medical School , Boston , Massachusetts , USA
- Ludwig Center at Harvard, Harvard Medical School , Boston , Massachusetts , USA
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14
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Robert SM, Vetsa S, Nadar A, Vasandani S, Youngblood MW, Gorelick E, Jin L, Marianayagam N, Erson-Omay EZ, Günel M, Moliterno J. The integrated multiomic diagnosis of sporadic meningiomas: a review of its clinical implications. J Neurooncol 2021; 156:205-214. [PMID: 34846640 PMCID: PMC8816740 DOI: 10.1007/s11060-021-03874-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/09/2021] [Indexed: 12/28/2022]
Abstract
Introduction Meningiomas are generally considered “benign,” however, these tumors can demonstrate variability in behavior and a surprising aggressiveness with elevated rates of recurrence. The advancement of next-generation molecular technologies have led to the understanding of the genomic and epigenomic landscape of meningiomas and more recent correlations with clinical characteristics and behavior. Methods Based on a thorough review of recent peer-reviewed publications (PubMed) and edited texts, we provide a molecular overview of meningiomas with a focus on relevant clinical implications. Results The identification of specific somatic driver mutations has led to the classification of several major genomic subgroups, which account for more than 80% of sporadic meningiomas, and can be distinguished using noninvasive clinical variables to help guide management decisions. Other somatic genomic modifications, including non-coding alterations and copy number variations, have also been correlated with tumor characteristics. Furthermore, epigenomic modifications in meningiomas have recently been described, with DNA methylation being the most widely studied and potentially most clinically relevant. Based on these molecular insights, several clinical trials are currently underway in an effort to establish effective medical therapeutic options for meningioma. Conclusion As we enhance our multiomic understanding of meningiomas, our ability to care for patients with these tumors will continue to improve. Further biological insights will lead to additional progress in precision medicine for meningiomas.
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Affiliation(s)
- Stephanie M Robert
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
| | - Shaurey Vetsa
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Arushii Nadar
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Sagar Vasandani
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Mark W Youngblood
- Department of Neurological Surgery, Northwestern University, Chicago, IL, USA
| | - Evan Gorelick
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Lan Jin
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
| | - Neelan Marianayagam
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - E Zeynep Erson-Omay
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Murat Günel
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Jennifer Moliterno
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA.
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA.
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15
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Ogasawara C, Philbrick BD, Adamson DC. Meningioma: A Review of Epidemiology, Pathology, Diagnosis, Treatment, and Future Directions. Biomedicines 2021; 9:biomedicines9030319. [PMID: 33801089 PMCID: PMC8004084 DOI: 10.3390/biomedicines9030319] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 12/19/2022] Open
Abstract
Meningiomas are the most common intracranial tumor, making up more than a third of all primary central nervous system (CNS) tumors. They are mostly benign tumors that can be observed or preferentially treated with gross total resection that provides good outcomes. Meningiomas with complicated histology or in compromising locations has proved to be a challenge in treating and predicting prognostic outcomes. Advances in genomics and molecular characteristics of meningiomas have uncovered potential use for more accurate grading and prediction of prognosis and recurrence. With the study and detection of genomic aberrancies, specific biologic targets are now being trialed for possible management of meningiomas that are not responsive to standard surgery and radiotherapy treatment. This review summarizes current epidemiology, etiology, molecular characteristics, diagnosis, treatments, and current treatment trials.
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Affiliation(s)
- Christian Ogasawara
- Department of Surgery, University of Hawaii School of Medicine, Honolulu, HI 96813, USA;
| | - Brandon D. Philbrick
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA 30322, USA;
| | - D. Cory Adamson
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA 30322, USA;
- Department of Neurosurgery, Atlanta VA Medical Center, Atlanta, GA 30322, USA
- Correspondence: ; Tel.: +1-(919)-698-3152
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16
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Toland A, Huntoon K, Dahiya SM. Meningioma: A Pathology Perspective. Neurosurgery 2021; 89:11-21. [PMID: 33588439 DOI: 10.1093/neuros/nyab001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/02/2020] [Indexed: 12/14/2022] Open
Abstract
Meningiomas are dural-based neoplasms that account for ∼37% of all intracranial tumors in the adult population. They can occur anywhere within the central nervous system and have a predilection for females. The World Health Organization classifies meningiomas into 3 grades based on increased risk of recurrence and associated mortality in grade III tumors. Although most tumors are categorized as low-grade, up to ∼15%-20% demonstrate more aggressive behavior. With the long-recognized association with neurofibromatosis type 2 gene mutation, putative driver mutations can be attributed to ∼80% of tumors. Several germline mutations have also been identified in some cases of familial meningiomatosis such as SMARCE1, SUFU, PTEN, and BAP1. Finally, in addition to genetic data, epigenetic alterations, specifically deoxyribonucleic acid methylation, are being increasingly recognized for their prognostic value, potentially adding objectivity to a currently subjective grading scheme.
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Affiliation(s)
- Angus Toland
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Kristin Huntoon
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Sonika M Dahiya
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
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17
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A clinico-pathological and neuro-radiological study of angiomatous meningioma: Aggressive look with benign behaviour. J Clin Neurosci 2020; 83:43-48. [PMID: 33342627 DOI: 10.1016/j.jocn.2020.11.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/28/2020] [Accepted: 11/23/2020] [Indexed: 12/24/2022]
Abstract
Angiomatous meningioma is a rare variant tumor classified as WHO grade 1 meningioma and accounts for about 2.1% of all meningioma. Their clinical presentation, surgical management, and prognosis are almost similar to the classical meningioma. Despite of benign nature and being comparatively small in size, they look aggressive on radiology images like massive peritumoral edema and intense contrast enhancement. Being a unique subtype of meningioma, the studies on angiomatous meningioma are very limited. In this cross sectional retrospective study, we described the clinical presentation, radiology, histopathological features and differential diagnosis of 30 cases of angiomatous meningioma from a single centre. The clinical parameters include demographic profile, symptoms and radiological findings including location, extent, pattern, histopathology with World Health Organization (WHO) grade-2016, extent of tumour excision, recurrence and surgical outcome. Incidence of angiomatous meningioma in our study was 2.46% with male predominance. The most common location in our study was convexity. 27 out of 30 had histopathology reports of angiomatous meningioma and 3 had lipoangiomatous meningioma. The high vascularity and disproportionate peri-tumoral edema makes it a surgical challenge for excision. The complications and surgical outcome were analysed. The radiological anticipation of tumour subtype, meticulous pre-operative planning and intraoperative precautions remains a key for success.
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18
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Ahrendsen JT, Hsu N, Wolf Z, Bryke C, Varma H. Multiple Whole Chromosomal Gains Define Angiomatous Meningiomas and Are Absent From the Tumor Vasculature. J Neuropathol Exp Neurol 2020; 79:618-625. [PMID: 32357369 DOI: 10.1093/jnen/nlaa031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/04/2020] [Indexed: 01/27/2023] Open
Abstract
Angiomatous meningioma is a variant with prominent vascularity that can mimic other highly vascularized tumors and present diagnostic challenges. Unlike most meningioma variants, where NF2 gene loss on chromosome 22 is the most common genetic abnormality, angiomatous meningiomas are unique in having multiple whole chromosome gains (polysomies). We analyzed 38 meningiomas, 9 angiomatous (including 2 atypical and 1 anaplastic), and 29 nonangiomatous meningiomas, using array comparative genomic hybridization (aCGH). Angiomatous meningiomas showed multiple chromosomal alterations including polysomies and copy neutral loss of heterozygosity in comparison to nonangiomatous variants. The most frequent gains were of chromosomes 5 and 20 (100% and 89% of cases, respectively); none showed chromosome 22 loss. Furthermore, using fluorescence in situ hybridization we show that the vasculature lacked chromosomal polysomy. While generally benign, we present 2 grade II and the first cytogenetically confirmed grade III angiomatous meningioma, demonstrating their potentially aggressive behavior. Thus, multiple polysomies define angiomatous meningioma and aCGH can distinguish this variant from nonangiomatous meningiomas and other histological mimics in diagnostically challenging cases. Furthermore, the prominent vasculature is not neoplastic and likely induced by angiogenic factors. Together, these findings suggest a distinct tumorigenic pathway in angiomatous meningiomas.
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Affiliation(s)
- Jared T Ahrendsen
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Nancy Hsu
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Zena Wolf
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Christine Bryke
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Hemant Varma
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
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19
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Suppiah S, Nassiri F, Bi WL, Dunn IF, Hanemann CO, Horbinski CM, Hashizume R, James CD, Mawrin C, Noushmehr H, Perry A, Sahm F, Sloan A, Von Deimling A, Wen PY, Aldape K, Zadeh G. Molecular and translational advances in meningiomas. Neuro Oncol 2020; 21:i4-i17. [PMID: 30649490 DOI: 10.1093/neuonc/noy178] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Meningiomas are the most common primary intracranial neoplasm. The current World Health Organization (WHO) classification categorizes meningiomas based on histopathological features, but emerging molecular data demonstrate the importance of genomic and epigenomic factors in the clinical behavior of these tumors. Treatment options for symptomatic meningiomas are limited to surgical resection where possible and adjuvant radiation therapy for tumors with concerning histopathological features or recurrent disease. At present, alternative adjuvant treatment options are not available in part due to limited historical biological analysis and clinical trial investigation on meningiomas. With advances in molecular and genomic techniques in the last decade, we have witnessed a surge of interest in understanding the genomic and epigenomic landscape of meningiomas. The field is now at the stage to adopt this molecular knowledge to refine meningioma classification and introduce molecular algorithms that can guide prediction and therapeutics for this tumor type. Animal models that recapitulate meningiomas faithfully are in critical need to test new therapeutics to facilitate rapid-cycle translation to clinical trials. Here we review the most up-to-date knowledge of molecular alterations that provide insight into meningioma behavior and are ready for application to clinical trial investigation, and highlight the landscape of available preclinical models in meningiomas.
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Affiliation(s)
- Suganth Suppiah
- Division of Neurosurgery, University Health Network, University of Toronto, Ontario, Canada.,MacFeeters-Hamilton Center for Neuro-Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Farshad Nassiri
- Division of Neurosurgery, University Health Network, University of Toronto, Ontario, Canada.,MacFeeters-Hamilton Center for Neuro-Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Wenya Linda Bi
- Centre for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ian F Dunn
- Centre for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Clemens Oliver Hanemann
- Institute of Translational and Stratified Medicine, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, United Kingdom
| | - Craig M Horbinski
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Rintaro Hashizume
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Charles David James
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Christian Mawrin
- Institute of Neuropathology, Otto-von-Guericke University, Magdeburg, Germany
| | - Houtan Noushmehr
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Arie Perry
- Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | - Felix Sahm
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Andrew Sloan
- Department of Neurological Surgery, University Hospital-Case Medical Center, Cleveland, Ohio, USA
| | - Andreas Von Deimling
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kenneth Aldape
- Department of Laboratory Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.,MacFeeters-Hamilton Center for Neuro-Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, University Health Network, University of Toronto, Ontario, Canada.,MacFeeters-Hamilton Center for Neuro-Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada
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20
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Bale TA, Benhamida J, Roychoudury S, Villafania L, Wrzolek MA, Bouffard JP, Bapat K, Ladanyi M, Rosenblum MK. Infarction with associated pseudosarcomatous changes mimics anaplasia in otherwise grade I meningiomas. Mod Pathol 2020; 33:1298-1306. [PMID: 32047229 PMCID: PMC8392373 DOI: 10.1038/s41379-020-0491-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 12/26/2022]
Abstract
We describe a morphologically distinct pattern of tumor infarction and associated sarcoma-like changes, mimicking focal anaplasia, in otherwise WHO grade I meningiomas. The described cases (n = 9) all demonstrated a discrete spindle-cell (pseudosarcomatous) component with brisk mitotic activity (12-14 mitoses/10 HPF), elevated Ki-67 (mean 75.5 ± 25.0%, quantified), absence of PR, SSTR2A, or EMA expression, and potential SMA expression (50%). Despite these high-grade features, all nine patients remained free of progression or recurrence post resection (follow-up mean: 49.8 months). In contrast, among a comparison (control) cohort of consecutive WHO grade II and III meningiomas (n = 16), as expected, progression rate was high (68.8%, P = 0.002, Fisher's exact, average time to progression = 25 months, follow-up mean: 39.8 months). While necrosis was a frequent feature among atypical/anaplastic meningiomas (12/16, 75%), and elevated mitoses and proliferative index were present consistent with histologic grade, a well-defined zonal pattern with pseudosarcomatous component was not present among these tumors. DNA methylation-based analysis readily distinguished meningiomas by copy number profiles and DNA-based methylation meningioma random forest classification analysis (meningioma v2.4 classifier developed at University of Heidelberg); all pseudosarcomatous cases analyzed (4/9) matched with high level calibrated classifier score to "MC benign-1", with isolated loss of chromosome 22q identified as the sole copy number alteration. In contrast, multiple chromosomal losses were detected among the comparison cohort and classifier results demonstrated good concordance with histologic grade. Our findings suggest that pseudosarcomatous alterations represent reactive changes to central meningioma infarction, rather than focal anaplasia, and further support the use of DNA methylation-based analysis as a useful adjunct for predicting meningioma behavior. These indolent tumors should be distinguished from their atypical and anaplastic counterparts.
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Affiliation(s)
- Tejus A Bale
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Jamal Benhamida
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Liliana Villafania
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monika A Wrzolek
- Department of Pathology, Staten Island University Hospital, New York, NY, USA
| | | | - Kalyani Bapat
- Department of Pathology, White Plains Hospital, New York, NY, USA
| | - Marc Ladanyi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc K Rosenblum
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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21
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Helgager J, Driver J, Hoffman S, Bi WL. Molecular Advances in Central Nervous System Mesenchymal Tumors. Surg Pathol Clin 2020; 13:291-303. [PMID: 32389268 DOI: 10.1016/j.path.2020.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Mesenchymal tumors of the central nervous system (CNS) comprise an array of neoplasms that may arise from or secondarily affect the CNS and its immediate surroundings. This review focuses on meningiomas and solitary fibrous tumors, the most common primary CNS mesenchymal tumors, and discusses recent advances in unveiling the molecular landscapes of these neoplasms. An effort is made to underscore those molecular findings most relevant to tumor diagnostics and prognostication from a practical perspective. As molecular techniques become more readily used at the clinical level, such alterations may strengthen formal grading schemes and lend themselves to treatment with targeted therapies.
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Affiliation(s)
- Jeffrey Helgager
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph Driver
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Samantha Hoffman
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Wenya Linda Bi
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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22
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Meredith DM. Advances in Diagnostic Immunohistochemistry for Primary Tumors of the Central Nervous System. Adv Anat Pathol 2020; 27:206-219. [PMID: 30720470 DOI: 10.1097/pap.0000000000000225] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
As genomic characterization becomes increasingly necessary for accurate diagnosis of tumors of the central nervous system, identification of rapidly assessible biomarkers is equally important to avoid excessive cost and delay in initiation of therapy. This article reviews novel immunohistochemical markers that may be used to determine mutation status, activation of signaling pathways, druggable targets, and cell lineage in many diverse tumor types. In particular, recently added entities to the 2016 WHO classification of central nervous system tumors will be addressed, including IDH-mutant gliomas, diffuse midline glioma, epithelioid glioblastoma, angiocentric glioma, RELA-rearranged ependymoma, embryonal tumors (medulloblastoma, atypical teratoid/rhabdoid tumor, pineoblastoma, embryonal tumor with multilayered rosettes, and other genetically defined high-grade neuroepithelial tumors), and meningiomas associated with germline alterations.
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23
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Neill SG, Hauenstein J, Li MM, Liu YJ, Luo M, Saxe DF, Ligon AH. Copy number assessment in the genomic analysis of CNS neoplasia: An evidence-based review from the cancer genomics consortium (CGC) working group on primary CNS tumors. Cancer Genet 2020; 243:19-47. [PMID: 32203924 DOI: 10.1016/j.cancergen.2020.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/12/2020] [Accepted: 02/19/2020] [Indexed: 12/20/2022]
Abstract
The period from the 1990s to the 2010s has witnessed a burgeoning sea change in the practice of surgical neuropathology due to the incorporation of genomic data into the assessment of a range of central nervous system (CNS) neoplasms. This change has since matured into the adoption of genomic information into the definition of several World Health Organization (WHO)-established diagnostic entities. The data needed to accomplish the modern diagnosis of CNS neoplasia includes DNA copy number aberrations that may be assessed through a variety of mechanisms. Through a review of the relevant literature and professional practice guidelines, here we provide a condensed and scored overview of the most critical DNA copy number aberrations to assess for a selection of primary CNS neoplasms.
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Affiliation(s)
- Stewart G Neill
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Jennifer Hauenstein
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Marilyn M Li
- Department of Pathology, Division of Genomic Diagnostics, Children's Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, PA, United States
| | - Yajuan J Liu
- Department of Pathology, University of Washington School of Medicine, Seattle, WA, United States
| | - Minjie Luo
- Department of Pathology, Division of Genomic Diagnostics, Children's Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, PA, United States
| | - Debra F Saxe
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Azra H Ligon
- Department of Pathology, Center for Advanced Molecular Diagnostics, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, United States
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24
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Lee YS, Lee YS. Molecular characteristics of meningiomas. J Pathol Transl Med 2020; 54:45-63. [PMID: 31964111 PMCID: PMC6986967 DOI: 10.4132/jptm.2019.11.05] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/05/2019] [Indexed: 12/12/2022] Open
Abstract
Meningioma is the most common primary intracranial tumor in adults. The grading of meningioma is based on World Health Organization criteria, which rely on histopathological features alone. This grading system is unable to conclusively predict the clinical behavior of these tumors (i.e., recurrence or prognosis in benign or atypical grades). Advances in molecular techniques over the last decade that include genomic and epigenomic data associated with meningiomas have been used to identify genetic biomarkers that can predict tumor behavior. This review summarizes the molecular characteristics of meningioma using genetic and epigenetic biomarkers. Molecular alterations that can predict meningioma behavior may be integrated into the upcoming World Health Organization grading system.
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Affiliation(s)
- Young Suk Lee
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youn Soo Lee
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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25
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Al-Rashed M, Foshay K, Abedalthagafi M. Recent Advances in Meningioma Immunogenetics. Front Oncol 2020; 9:1472. [PMID: 31970090 PMCID: PMC6960175 DOI: 10.3389/fonc.2019.01472] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 12/09/2019] [Indexed: 12/26/2022] Open
Abstract
Meningiomas are relatively common, and typically benign intracranial tumors, which in many cases can be cured by surgical resection. However, less prevalent, high grade meningiomas, grow quickly, and recur frequently despite treatment, leading to poor patient outcomes. Across tumor grades, subjective guidelines for histological analysis can preclude accurate diagnosis, and an insufficient understanding of recurrence risk can cloud the choice of optimal treatment. Improved diagnostic and prognostic markers capable of discerning between the 15 heterogeneous WHO recognized meningioma subtypes are necessary to improve disease management and identify new targeted drug treatments. In this review, we show the advances in molecular profiling and immunophenotyping of meningiomas, which may lead to the development of new personalized therapeutic strategies.
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Affiliation(s)
- May Al-Rashed
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Kara Foshay
- Inova Neuroscience and Spine Institute, Inova Health Systems, Falls Church, VA, United States
- Virginia Commonwealth University School of Medicine, Inova Campus, Richmond, VA, United States
| | - Malak Abedalthagafi
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City, King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
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26
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Ansari SF, Shah KJ, Hassaneen W, Cohen-Gadol AA. Vascularity of meningiomas. HANDBOOK OF CLINICAL NEUROLOGY 2020; 169:153-165. [PMID: 32553286 DOI: 10.1016/b978-0-12-804280-9.00010-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Information on the vascular supply to meningiomas is critical to the neurosurgeon. Most meningiomas are supplied by the external carotid artery, though many get pial contribution as well. Angiogenesis is critical for these neoplasms to grow. Vascular endothelial growth factor (VEGF) has been a popular target of research to decrease angiogenesis. Peritumoral brain edema (PTBE) is occasionally seen in meningiomas, which makes surgical resection more challenging. The exact cause of PTBE remains unclear, but a number of factors have been postulated to contribute. Assessment of the vascularity of meningiomas is best carried out with angiography, but noninvasive techniques are improving, diminishing the need for more invasive imaging. Embolization of tumors can be performed to minimize perioperative blood loss and potentially lower surgical morbidity. However, it has not been shown to improve outcomes, and procedural risks exist. Higher grade tumors commonly have higher vascularity. Higher vascular meningiomas are more likely to recur and have higher levels of VEGF. The vascularity of meningiomas remains a topic of interest and is the focus of many research projects.
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Affiliation(s)
- Shaheryar F Ansari
- Department of Neurological Surgery, Indiana University, Indianapolis, IN, United States
| | - Kushal J Shah
- Department of Neurological Surgery, Indiana University, Indianapolis, IN, United States; Department of Neurosurgery, University of Kansas, Kansas City, MO, United States
| | - Wael Hassaneen
- Department of Neurological Surgery, Indiana University, Indianapolis, IN, United States; Carle Neuroscience Institute, Carle Foundation Hospital, Urbana, IL, United States; Department of Neurosurgery, Carle Illinois College of Medicine, Champaign, IL, United States
| | - Aaron A Cohen-Gadol
- Department of Neurological Surgery, Indiana University, Indianapolis, IN, United States.
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27
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Chkheidze R, Cimino PJ, Hatanpaa KJ, White CL, Ferreira M, Piccirillo SGM, Li L, Rajaram S, Nyagilo JO, Burns DK, Raisanen JM, Cai C. Distinct Expression Patterns of Carbonic Anhydrase IX in Clear Cell, Microcystic, and Angiomatous Meningiomas. J Neuropathol Exp Neurol 2019; 78:1081-1088. [DOI: 10.1093/jnen/nlz091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Abstract
Clear cell, microcytic, and angiomatous meningiomas are 3 vasculature-rich variants with overlapping morphological features but different prognostic and treatment implications. Distinction between them is not always straightforward. We compared the expression patterns of the hypoxia marker carbonic anhydrase IX (CA-IX) in meningiomas with predominant clear cell (n = 15), microcystic (n = 9), or angiomatous (n = 11) morphologies, as well as 117 cases of other World Health Organization recognized histological meningioma variants. Immunostaining for SMARCE1 protein, whose loss-of-function has been associated with clear cell meningiomas, was performed on all clear cell meningiomas, and selected variants of meningiomas as controls. All clear cell meningiomas showed absence of CA-IX expression and loss of nuclear SMARCE1 expression. All microcystic and angiomatous meningiomas showed diffuse CA-IX immunoreactivity and retained nuclear SMARCE1 expression. In other meningioma variants, CA-IX was expressed in a hypoxia-restricted pattern and was highly associated with atypical features such as necrosis, small cell change, and focal clear cell change. In conclusion, CA-IX may serve as a useful diagnostic marker in differentiating clear cell, microcystic, and angiomatous meningiomas.
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Affiliation(s)
- Rati Chkheidze
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas; Department of Pathology; Department of Neurological Surgery, University of Washington, Seattle, Washington; Department of Internal Medicine; Department of Neurology and Neurotherapeutics; and Lyda Hill Department of Bioinformatics, UT Southwestern Medical Center, Dallas, Texas
| | - Patrick J Cimino
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas; Department of Pathology; Department of Neurological Surgery, University of Washington, Seattle, Washington; Department of Internal Medicine; Department of Neurology and Neurotherapeutics; and Lyda Hill Department of Bioinformatics, UT Southwestern Medical Center, Dallas, Texas
| | - Kimmo J Hatanpaa
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas; Department of Pathology; Department of Neurological Surgery, University of Washington, Seattle, Washington; Department of Internal Medicine; Department of Neurology and Neurotherapeutics; and Lyda Hill Department of Bioinformatics, UT Southwestern Medical Center, Dallas, Texas
| | - Charles L White
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas; Department of Pathology; Department of Neurological Surgery, University of Washington, Seattle, Washington; Department of Internal Medicine; Department of Neurology and Neurotherapeutics; and Lyda Hill Department of Bioinformatics, UT Southwestern Medical Center, Dallas, Texas
| | - Manuel Ferreira
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas; Department of Pathology; Department of Neurological Surgery, University of Washington, Seattle, Washington; Department of Internal Medicine; Department of Neurology and Neurotherapeutics; and Lyda Hill Department of Bioinformatics, UT Southwestern Medical Center, Dallas, Texas
| | - Sara G M Piccirillo
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas; Department of Pathology; Department of Neurological Surgery, University of Washington, Seattle, Washington; Department of Internal Medicine; Department of Neurology and Neurotherapeutics; and Lyda Hill Department of Bioinformatics, UT Southwestern Medical Center, Dallas, Texas
| | - Li Li
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas; Department of Pathology; Department of Neurological Surgery, University of Washington, Seattle, Washington; Department of Internal Medicine; Department of Neurology and Neurotherapeutics; and Lyda Hill Department of Bioinformatics, UT Southwestern Medical Center, Dallas, Texas
| | - Satwik Rajaram
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas; Department of Pathology; Department of Neurological Surgery, University of Washington, Seattle, Washington; Department of Internal Medicine; Department of Neurology and Neurotherapeutics; and Lyda Hill Department of Bioinformatics, UT Southwestern Medical Center, Dallas, Texas
| | - James O Nyagilo
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas; Department of Pathology; Department of Neurological Surgery, University of Washington, Seattle, Washington; Department of Internal Medicine; Department of Neurology and Neurotherapeutics; and Lyda Hill Department of Bioinformatics, UT Southwestern Medical Center, Dallas, Texas
| | - Dennis K Burns
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas; Department of Pathology; Department of Neurological Surgery, University of Washington, Seattle, Washington; Department of Internal Medicine; Department of Neurology and Neurotherapeutics; and Lyda Hill Department of Bioinformatics, UT Southwestern Medical Center, Dallas, Texas
| | - Jack M Raisanen
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas; Department of Pathology; Department of Neurological Surgery, University of Washington, Seattle, Washington; Department of Internal Medicine; Department of Neurology and Neurotherapeutics; and Lyda Hill Department of Bioinformatics, UT Southwestern Medical Center, Dallas, Texas
| | - Chunyu Cai
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas; Department of Pathology; Department of Neurological Surgery, University of Washington, Seattle, Washington; Department of Internal Medicine; Department of Neurology and Neurotherapeutics; and Lyda Hill Department of Bioinformatics, UT Southwestern Medical Center, Dallas, Texas
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28
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Kuroi Y, Akagawa H, Shibuya M, Onda H, Maegawa T, Kasuya H. Identification of shared genomic aberrations between angiomatous and microcystic meningiomas. Neurooncol Adv 2019; 1:vdz028. [PMID: 32642661 PMCID: PMC7212863 DOI: 10.1093/noajnl/vdz028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Angiomatous and microcytic meningiomas are classified as rare subtypes of grade I meningiomas by World Health Organization (WHO). They typically exhibit distinct histopathological features as indicated by their WHO titles; however, these angiomatous and microcystic features are often intermixed. Recently, angiomatous meningiomas were reported to show characteristic chromosomal polysomies unlike the other WHO grade I meningiomas. In the present study, we hypothesize that microcystic meningiomas share similar cytogenetic abnormalities with angiomatous meningioma. Methods We performed copy number analysis using single nucleotide polymorphism (SNP) arrays for three angiomatous and eight microcystic meningiomas. Of these, three angiomatous and three microcystic meningiomas were also analyzed by whole exome sequencing and RNA sequencing. Results We first analyzed three angiomatous and three microcystic meningiomas for which both frozen tissues and peripheral blood were accessible. Copy number analysis confirmed previously reported multiple polysomies in angiomatous meningiomas, which were entirely replicated in microcystic meningiomas when analyzed on different analytical platforms with five additional samples prepared from formalin-fixed paraffin-embedded tumors. Polysomy of chromosome 5 was found in all cases, along with chromosome 6, 12, 17, 18, and 20 in more than half of the cases including both angiomatous and microcystic meningiomas. Furthermore, next generation sequencing did not reveal any distinctive somatic point mutations or differences in gene expression characterizing either angiomatous or microcystic meningiomas, indicating a common genetic mechanism underlying tumorigenesis. Conclusions Angiomatous and microcystic meningiomas have substantially similar genetic profiles represented by the characteristic patterns of multiple polysomies originating from chromosome 5 amplification.
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Affiliation(s)
- Yasuhiro Kuroi
- Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.,Tokyo Women's Medical University, Institute for Integrated Medical Sciences (TIIMS), Tokyo, Japan
| | - Hiroyuki Akagawa
- Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.,Tokyo Women's Medical University, Institute for Integrated Medical Sciences (TIIMS), Tokyo, Japan
| | - Makoto Shibuya
- Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.,Central Laboratory, Hachioji Medical Center, Tokyo Medical University, Tokyo, Japan
| | - Hideaki Onda
- Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.,Division of Neurosurgery, Kofu Neurosurgical Hospital, Kofu, Yamanashi, Japan
| | - Tatsuya Maegawa
- Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.,Tokyo Women's Medical University, Institute for Integrated Medical Sciences (TIIMS), Tokyo, Japan
| | - Hidetoshi Kasuya
- Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.,Tokyo Women's Medical University, Institute for Integrated Medical Sciences (TIIMS), Tokyo, Japan
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29
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Sievers P, Stichel D, Hielscher T, Schrimpf D, Reinhardt A, Wefers AK, Reuss D, Jones DTW, Bewerunge-Hudler M, Hartmann C, Baumgarten P, Wirsching HG, Winther-Kristensen B, Brokinkel B, Ketter R, Idoate Gastearena MA, Lamszus K, Seiz-Rosenhagen M, Mawrin C, Harter PN, Felsberg J, Hänggi D, Herold-Mende C, Berghoff AS, Weller M, Pfister SM, Wick W, Reifenberger G, Preusser M, von Deimling A, Sahm F. Chordoid meningiomas can be sub-stratified into prognostically distinct DNA methylation classes and are enriched for heterozygous deletions of chromosomal arm 2p. Acta Neuropathol 2018; 136:975-978. [PMID: 30382370 DOI: 10.1007/s00401-018-1924-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Philipp Sievers
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Damian Stichel
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Schrimpf
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Annekathrin Reinhardt
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Annika K Wefers
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David Reuss
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David T W Jones
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Pediatric Glioma Research Group, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Melanie Bewerunge-Hudler
- Genomics and Proteomics Core Facility, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christian Hartmann
- Department of Neuropathology, Institute of Pathology, Hannover Medical School (MHH), Hannover, Germany
| | - Peter Baumgarten
- Institute of Neurology (Edinger Institute), University Hospital and Medical Faculty, Goethe University, Frankfurt, Germany
- Department of Neurosurgery, University Hospital and Medical Faculty, Goethe University, Frankfurt, Germany
| | - Hans-Georg Wirsching
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Bjarne Winther-Kristensen
- Department of Pathology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Benjamin Brokinkel
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Ralf Ketter
- Department of Neurosurgery, University Hospital Saarland, Homburg, Saar, Germany
| | | | - Katrin Lamszus
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marcel Seiz-Rosenhagen
- Department of Neurosurgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christian Mawrin
- Department of Neuropathology, University Magdeburg, Magdeburg, Germany
| | - Patrick N Harter
- Institute of Neurology (Edinger Institute), University Hospital and Medical Faculty, Goethe University, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Frankfurt, Germany
| | - Jörg Felsberg
- Institute of Neuropathology, Heinrich Heine University, Düsseldorf, Germany
- German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Düsseldorf, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christel Herold-Mende
- Division of Experimental Neurosurgery, Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Anna Sophie Berghoff
- Clinical Division of Oncology, Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Stefan M Pfister
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, University Hospital Heidelberg, Heidelberg, Germany
| | - Wolfgang Wick
- Department of Neurology and Neurooncology Program, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Guido Reifenberger
- Institute of Neuropathology, Heinrich Heine University, Düsseldorf, Germany
- German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Düsseldorf, Germany
| | - Matthias Preusser
- Clinical Division of Oncology, Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Andreas von Deimling
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany.
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany.
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30
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Dunn IF, Du Z, Touat M, Sisti MB, Wen PY, Umeton R, Dubuc AM, Ducar M, Canoll PD, Severson E, Elvin JA, Ramkissoon SH, Lin JR, Cabrera L, Acevedo B, Sorger PK, Ligon KL, Santagata S, Reardon DA. Mismatch repair deficiency in high-grade meningioma: a rare but recurrent event associated with dramatic immune activation and clinical response to PD-1 blockade. JCO Precis Oncol 2018; 2018. [PMID: 30801050 DOI: 10.1200/po.18.00190] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Ian F Dunn
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA
| | - Ziming Du
- Department of Pathology, Brigham and Women's Hospital, Boston, MA.,Ludwig Center at Harvard Medical School, Boston, MA
| | - Mehdi Touat
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.,Department of Oncologic Pathology, Dana-Farber Cancer Institute, Boston, MA
| | - Michael B Sisti
- Department of Neurosurgery, Columbia University Medical Center, New York City, NY
| | - Patrick Y Wen
- Department of Neurology, Brigham and Women's Hospital, Boston, MA.,Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Renato Umeton
- Department of Informatics, Dana-Farber Cancer Institute, Boston, MA
| | - Adrian M Dubuc
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
| | - Matthew Ducar
- Department of Informatics, Dana-Farber Cancer Institute, Boston, MA.,Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA
| | - Peter D Canoll
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York City, NY
| | | | | | - Shakti H Ramkissoon
- Foundation Medicine, Inc., Morrisville, NC.,Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jia-Ren Lin
- Ludwig Center at Harvard Medical School, Boston, MA.,Laboratory of Systems Pharmacology, Harvard Medical School, Boston, MA
| | - Lais Cabrera
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Brenda Acevedo
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Peter K Sorger
- Ludwig Center at Harvard Medical School, Boston, MA.,Laboratory of Systems Pharmacology, Harvard Medical School, Boston, MA.,Department of Systems Biology, Harvard Medical School, Boston, MA
| | - Keith L Ligon
- Department of Pathology, Brigham and Women's Hospital, Boston, MA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.,Department of Oncologic Pathology, Dana-Farber Cancer Institute, Boston, MA
| | - Sandro Santagata
- Department of Pathology, Brigham and Women's Hospital, Boston, MA.,Ludwig Center at Harvard Medical School, Boston, MA.,Department of Oncologic Pathology, Dana-Farber Cancer Institute, Boston, MA.,Laboratory of Systems Pharmacology, Harvard Medical School, Boston, MA
| | - David A Reardon
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.,Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA
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31
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Ariës IM, Bodaar K, Karim SA, Chonghaile TN, Hinze L, Burns MA, Pfirrmann M, Degar J, Landrigan JT, Balbach S, Peirs S, Menten B, Isenhart R, Stevenson KE, Neuberg DS, Devidas M, Loh ML, Hunger SP, Teachey DT, Rabin KR, Winter SS, Dunsmore KP, Wood BL, Silverman LB, Sallan SE, Van Vlierberghe P, Orkin SH, Knoechel B, Letai AG, Gutierrez A. PRC2 loss induces chemoresistance by repressing apoptosis in T cell acute lymphoblastic leukemia. J Exp Med 2018; 215:3094-3114. [PMID: 30404791 PMCID: PMC6279404 DOI: 10.1084/jem.20180570] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 09/07/2018] [Accepted: 10/19/2018] [Indexed: 12/20/2022] Open
Abstract
Mitochondrial apoptotic priming predicts response to cancer chemotherapy, but the mechanisms underlying variability in this mitochondrial phenotype among closely related tumors are poorly understood. Ariës et al. show that PRC2 loss-of-function mutations induce resistance to mitochondrial apoptosis in T-ALL. The tendency of mitochondria to undergo or resist BCL2-controlled apoptosis (so-called mitochondrial priming) is a powerful predictor of response to cytotoxic chemotherapy. Fully exploiting this finding will require unraveling the molecular genetics underlying phenotypic variability in mitochondrial priming. Here, we report that mitochondrial apoptosis resistance in T cell acute lymphoblastic leukemia (T-ALL) is mediated by inactivation of polycomb repressive complex 2 (PRC2). In T-ALL clinical specimens, loss-of-function mutations of PRC2 core components (EZH2, EED, or SUZ12) were associated with mitochondrial apoptosis resistance. In T-ALL cells, PRC2 depletion induced resistance to apoptosis induction by multiple chemotherapeutics with distinct mechanisms of action. PRC2 loss induced apoptosis resistance via transcriptional up-regulation of the LIM domain transcription factor CRIP2 and downstream up-regulation of the mitochondrial chaperone TRAP1. These findings demonstrate the importance of mitochondrial apoptotic priming as a prognostic factor in T-ALL and implicate mitochondrial chaperone function as a molecular determinant of chemotherapy response.
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Affiliation(s)
- Ingrid M Ariës
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Kimberly Bodaar
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Salmaan A Karim
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Triona Ni Chonghaile
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.,Deparment of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Laura Hinze
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Melissa A Burns
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, MA.,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Maren Pfirrmann
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - James Degar
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Jack T Landrigan
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Sebastian Balbach
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, MA.,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.,Department of Pediatric Oncology, University Hospital Muenster, Muenster, Germany
| | - Sofie Peirs
- Center for Medical Genetics, Ghent University, Ghent, Belgium.,Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Björn Menten
- Center for Medical Genetics, Ghent University, Ghent, Belgium
| | - Randi Isenhart
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Kristen E Stevenson
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA
| | - Donna S Neuberg
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Mignon L Loh
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Stephen P Hunger
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - David T Teachey
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Karen R Rabin
- Division of Pediatric Hematology/Oncology, Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX
| | - Stuart S Winter
- Cancer and Blood Disorders Department, Children's Minnesota, Minneapolis, MN
| | | | - Brent L Wood
- Department of Laboratory Medicine, University of Washington, Seattle, WA
| | - Lewis B Silverman
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, MA.,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Stephen E Sallan
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, MA.,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Pieter Van Vlierberghe
- Center for Medical Genetics, Ghent University, Ghent, Belgium.,Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Stuart H Orkin
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, MA.,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.,Howard Hughes Medical Institute, Boston, MA
| | - Birgit Knoechel
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, MA.,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Anthony G Letai
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Alejandro Gutierrez
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, MA .,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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DNA methylation-based reclassification of olfactory neuroblastoma. Acta Neuropathol 2018; 136:255-271. [PMID: 29730775 DOI: 10.1007/s00401-018-1854-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/15/2018] [Accepted: 04/26/2018] [Indexed: 02/07/2023]
Abstract
Olfactory neuroblastoma/esthesioneuroblastoma (ONB) is an uncommon neuroectodermal neoplasm thought to arise from the olfactory epithelium. Little is known about its molecular pathogenesis. For this study, a retrospective cohort of n = 66 tumor samples with the institutional diagnosis of ONB was analyzed by immunohistochemistry, genome-wide DNA methylation profiling, copy number analysis, and in a subset, next-generation panel sequencing of 560 tumor-associated genes. DNA methylation profiles were compared to those of relevant differential diagnoses of ONB. Unsupervised hierarchical clustering analysis of DNA methylation data revealed four subgroups among institutionally diagnosed ONB. The largest group (n = 42, 64%, Core ONB) presented with classical ONB histology and no overlap with other classes upon methylation profiling-based t-distributed stochastic neighbor embedding (t-SNE) analysis. A second DNA methylation group (n = 7, 11%) with CpG island methylator phenotype (CIMP) consisted of cases with strong expression of cytokeratin, no or scarce chromogranin A expression and IDH2 hotspot mutation in all cases. T-SNE analysis clustered these cases together with sinonasal carcinoma with IDH2 mutation. Four cases (6%) formed a small group characterized by an overall high level of DNA methylation, but without CIMP. The fourth group consisted of 13 cases that had heterogeneous DNA methylation profiles and strong cytokeratin expression in most cases. In t-SNE analysis, these cases mostly grouped among sinonasal adenocarcinoma, squamous cell carcinoma, and undifferentiated carcinoma. Copy number analysis indicated highly recurrent chromosomal changes among Core ONB with a high frequency of combined loss of chromosome 1-4, 8-10, and 12. NGS sequencing did not reveal highly recurrent mutations in ONB, with the only recurrently mutated genes being TP53 and DNMT3A. In conclusion, we demonstrate that institutionally diagnosed ONB are a heterogeneous group of tumors. Expression of cytokeratin, chromogranin A, the mutational status of IDH2 as well as DNA methylation patterns may greatly aid in the precise classification of ONB.
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Shankar GM, Santagata S. BAP1 mutations in high-grade meningioma: implications for patient care. Neuro Oncol 2018; 19:1447-1456. [PMID: 28482042 DOI: 10.1093/neuonc/nox094] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
We have recently shown that the breast cancer (BRCA)1-associated protein-1 tumor suppressor gene (BAP1) is inactivated in a subset of clinically aggressive meningiomas that display rhabdoid histomorphology. Immunohistochemistry for BAP1 protein provides a rapid and inexpensive method for screening suspected cases. Notably, some patients with BAP1-mutant meningiomas have germline BAP1 mutations and BAP1 tumor predisposition syndrome (TPDS). It appears that nearly all patients with germline BAP1 mutations develop malignancies by age 55, most frequently uveal melanoma, cutaneous melanoma, pleural or peritoneal malignant mesothelioma, or renal cell carcinoma, although other cancers have also been associated with BAP1 TPDS. Therefore, when confronted with a patient with a potentially high-grade rhabdoid meningioma, it is important that neuropathologists assess the BAP1 status of the tumor and that the patient's family history of cancer is carefully ascertained. In the appropriate clinical setting, genetic counseling and germline BAP1 DNA sequencing should be performed. A cancer surveillance program for individuals who carry germline BAP1 mutations may help identify tumors such as uveal melanoma, cutaneous melanoma, and renal cell carcinoma at early and treatable stages. Because BAP1-mutant meningiomas are rare tumors, multi-institutional efforts will be needed to evaluate therapeutic strategies and to further define the clinicopathologic features of these tumors.
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Affiliation(s)
- Ganesh M Shankar
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts; Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts; Ludwig Center at Harvard, Boston, Massachusetts
| | - Sandro Santagata
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts; Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts; Ludwig Center at Harvard, Boston, Massachusetts
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34
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Du Z, Santagata S. Uncovering the links between systemic hormones and oncogenic signaling in the pathogenesis of meningioma. Ann Oncol 2018; 29:537-540. [DOI: 10.1093/annonc/mdy010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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35
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Shankar GM, Abedalthagafi M, Vaubel RA, Merrill PH, Nayyar N, Gill CM, Brewster R, Bi WL, Agarwalla PK, Thorner AR, Reardon DA, Al-Mefty O, Wen PY, Alexander BM, van Hummelen P, Batchelor TT, Ligon KL, Ligon AH, Meyerson M, Dunn IF, Beroukhim R, Louis DN, Perry A, Carter SL, Giannini C, Curry WT, Cahill DP, Barker FG, Brastianos PK, Santagata S. Germline and somatic BAP1 mutations in high-grade rhabdoid meningiomas. Neuro Oncol 2017; 19:535-545. [PMID: 28170043 DOI: 10.1093/neuonc/now235] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 10/04/2016] [Indexed: 12/30/2022] Open
Abstract
Background Patients with meningiomas have widely divergent clinical courses. Some entirely recover following surgery alone, while others have relentless tumor recurrences. This clinical conundrum is exemplified by rhabdoid meningiomas, which are designated in the World Health Organization Classification of Tumours as high grade, despite only a subset following an aggressive clinical course. Patient management decisions are further exacerbated by high rates of interobserver variability, biased against missing possibly aggressive tumors. Objective molecular determinants are needed to guide classification and clinical decision making. Methods To define genomic aberrations of rhabdoid meningiomas, we performed sequencing of cancer-related genes in 27 meningiomas from 18 patients with rhabdoid features and evaluated breast cancer [BRCA]1-associated protein 1 (BAP1) expression by immunohistochemistry in 336 meningiomas. We assessed outcomes, germline status, and family history in patients with BAP1-negative rhabdoid meningiomas. Results The tumor suppressor gene BAP1, a ubiquitin carboxy-terminal hydrolase, is inactivated in a subset of high-grade rhabdoid meningiomas. Patients with BAP1-negative rhabdoid meningiomas had reduced time to recurrence compared with patients with BAP1-retained rhabdoid meningiomas (Kaplan-Meier analysis, 26 mo vs 116 mo, P < .001; hazard ratio 12.89). A subset of patients with BAP1-deficient rhabdoid meningiomas harbored germline BAP1 mutations, indicating that rhabdoid meningiomas can be a harbinger of the BAP1 cancer predisposition syndrome. Conclusion We define a subset of aggressive rhabdoid meningiomas that can be recognized using routine laboratory tests. We implicate ubiquitin deregulation in the pathogenesis of these high-grade malignancies. In addition, we show that familial and sporadic BAP1-mutated rhabdoid meningiomas are clinically aggressive, requiring intensive clinical management.
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Affiliation(s)
- Ganesh M Shankar
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Broad Institute of MIT and Harvard, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Division of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Malak Abedalthagafi
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Pathology, King Fahad Medical City, Riyadh, Saudi Arabia.,King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Rachael A Vaubel
- Department of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Parker H Merrill
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Naema Nayyar
- Division of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Corey M Gill
- Division of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ryan Brewster
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Hospital, Boston, Massachusetts, USA
| | - Pankaj K Agarwalla
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aaron R Thorner
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - David A Reardon
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Center for Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Ossama Al-Mefty
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Brigham and Hospital, Boston, Massachusetts, USA
| | - Patrick Y Wen
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Center for Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian M Alexander
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Paul van Hummelen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Tracy T Batchelor
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Keith L Ligon
- Harvard Medical School, Boston, Massachusetts, USA.,Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Azra H Ligon
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Clinical Cytogenetics Laboratory, Center for Advanced Molecular Diagnostics, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Matthew Meyerson
- Broad Institute of MIT and Harvard, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ian F Dunn
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Brigham and Hospital, Boston, Massachusetts, USA.,Center for Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Rameen Beroukhim
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Center for Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - David N Louis
- Harvard Medical School, Boston, Massachusetts, USA.,Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Arie Perry
- Department of Pathology and Neurological Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Scott L Carter
- Harvard Medical School, Boston, Massachusetts, USA.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Joint Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Caterina Giannini
- Department of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - William T Curry
- Harvard Medical School, Boston, Massachusetts, USA.,Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel P Cahill
- Harvard Medical School, Boston, Massachusetts, USA.,Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Frederick G Barker
- Harvard Medical School, Boston, Massachusetts, USA.,Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Priscilla K Brastianos
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Broad Institute of MIT and Harvard, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Division of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sandro Santagata
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Ludwig Center at Harvard, Boston, Massachusetts, USA
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Hua L, Luan S, Li H, Zhu H, Tang H, Liu H, Chen X, Bozinov O, Xie Q, Gong Y. Angiomatous Meningiomas Have a Very Benign Outcome Despite Frequent Peritumoral Edema at Onset. World Neurosurg 2017; 108:465-473. [PMID: 28844928 DOI: 10.1016/j.wneu.2017.08.096] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/13/2017] [Accepted: 08/14/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Angiomatous meningioma (AM) is a rare subtype of meningioma characterized by highly vascular tumor tissue comprising predominantly variable sized hyalinized blood vessels. The aim of this study is to evaluate the clinical radiologic features of AM and the long-term prognosis in a single neurosurgical center. METHODS A total of 93 patients who underwent surgical resection of AMs between 2003 and 2008 were enrolled for analysis. Clinical information, treatment, and radiologic images were collected and analyzed; follow-up was carried out as well. Expression of estrogen receptor, progesterone receptor, and vascular endothelial growth factor was analyzed by immunohistochemistry. RESULTS Forty-eight females and 45 males were identified. Forty-four patients (47.31%) manifested as hypersignal in T1-weighted imaging sequences and 68 (73.12%) as hypersignal in T2-weighted imaging, and a characteristic ringlike signal was observed in 28 patients (30.11%). Eighty-one cases (87.10%) showed different degrees of peritumor brain edema and it was significantly correlated with the vascular endothelial growth factor expression (P < 0.001). Simpson I resection was achieved in 63 patients (67.74%), grade II in 27 patients (29.03%), and grade III in 3 patients (3.23%). The extent of resection was not associated with the postoperative neurologic function (P = 0.546). Only 4 patients experienced recurrences during the follow-up and these 4 patients were stable until the last follow-up. CONCLUSIONS AMs were a special subtype of meningioma with distinctive radiologic features. AMs manifest benign behavior with a satisfying outcome, which makes Simpson grade II resection an option.
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Affiliation(s)
- Lingyang Hua
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shihai Luan
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Haixia Li
- Department of Pathology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hongda Zhu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hailiang Tang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hanqiu Liu
- Department of Radiology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiancheng Chen
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Oliver Bozinov
- Department of Neurosurgery, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Qing Xie
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Ye Gong
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Department of Critical Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
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Bi WL, Greenwald NF, Abedalthagafi M, Wala J, Gibson WJ, Agarwalla PK, Horowitz P, Schumacher SE, Esaulova E, Mei Y, Chevalier A, Ducar M, Thorner AR, van Hummelen P, Stemmer-Rachamimov A, Artyomov M, Al-Mefty O, Dunn GP, Santagata S, Dunn IF, Beroukhim R. Genomic landscape of high-grade meningiomas. NPJ Genom Med 2017; 2. [PMID: 28713588 PMCID: PMC5506858 DOI: 10.1038/s41525-017-0014-7] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
High-grade meningiomas frequently recur and are associated with high rates of morbidity and mortality. To determine the factors that promote the development and evolution of these tumors, we analyzed the genomes of 134 high-grade meningiomas and compared this information with data from 587 previously published meningiomas. High-grade meningiomas had a higher mutation burden than low-grade meningiomas but did not harbor any statistically significant mutated genes aside from NF2. High-grade meningiomas also possessed significantly elevated rates of chromosomal gains and losses, especially among tumors with monosomy 22. Meningiomas previously treated with adjuvant radiation had significantly more copy number alterations than radiation-induced or radiation-naïve meningiomas. Across serial recurrences, genomic disruption preceded the emergence of nearly all mutations, remained largely uniform across time, and when present in low-grade meningiomas, correlated with subsequent progression to a higher grade. In contrast to the largely stable copy number alterations, mutations were strikingly heterogeneous across tumor recurrences, likely due to extensive geographic heterogeneity in the primary tumor. While high-grade meningiomas harbored significantly fewer overtly targetable alterations than low-grade meningiomas, they contained numerous mutations that are predicted to be neoantigens, suggesting that immunologic targeting may be of therapeutic value.
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Affiliation(s)
- Wenya Linda Bi
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Noah F Greenwald
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Malak Abedalthagafi
- Division of Neuropathology, Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.,Research Center, King Fahad Medical City, Riyadh, Saudi Arabia.,The Saudi Human Genome Project Lab, King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Jeremiah Wala
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Will J Gibson
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Pankaj K Agarwalla
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Peleg Horowitz
- Department of Surgery, The University of Chicago, Chicago, IL, USA
| | - Steven E Schumacher
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Ekaterina Esaulova
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA.,Computer Technologies Department, ITMO University, Saint Petersburg, Russia
| | - Yu Mei
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Matthew Ducar
- Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Aaron R Thorner
- Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Paul van Hummelen
- Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Maksym Artyomov
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Ossama Al-Mefty
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gavin P Dunn
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA.,Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA.,Center for Human Immunology and Immunotherapy Programs, Washington University School of Medicine, St. Louis, MO, USA
| | - Sandro Santagata
- Division of Neuropathology, Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Ian F Dunn
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rameen Beroukhim
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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Smith MJ, Ahn S, Lee JI, Bulman M, Plessis DD, Suh YL. SMARCE1 mutation screening in classification of clear cell meningiomas. Histopathology 2017; 70:814-820. [PMID: 27891692 DOI: 10.1111/his.13135] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 11/23/2016] [Indexed: 01/10/2023]
Abstract
AIMS Clear cell meningioma (CCM) is a rare subtype of meningioma and shows not only unusual histology, but also unique clinical features. Recently, SMARCE1 mutations have been shown to cause spinal and cranial CCMs. We present 12 cases which were diagnosed with CCM in a single institution between 1997 and 2014, and investigate their SMARCE1 mutation status. METHODS AND RESULTS To investigate the SMARCE1 mutation status of these tumours, we used a combination of Sanger sequencing and multiplex ligation-dependent probe amplification analysis and also performed SMARCE1 immunohistochemical staining. We found both SMARCE1 mutational hits, including novel SMARCE1 mutations, in six of eight tested patients. Immunohistochemical analysis showed loss of SMARCE1 protein staining in all but two cases. Two individuals who were diagnosed originally with CCM were negative for SMARCE1 mutations, but tested positive for NF2 mutations. As a result, these two tumours were re-analysed and eventually reclassified, as a microcystic and a mixed pattern of meningothelial meningioma with focal clear cell areas, respectively. CONCLUSIONS These results expand the spectrum of pathogenic variants in SMARCE1 and show that mutation screening can help to facilitate meningioma classification. This may have implications for prognosis and future clinical management of patients, as CCMs are classed as grade II tumours, while microcystic and meningothelial meningiomas are classed as grade I.
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Affiliation(s)
- Miriam J Smith
- Manchester Centre for Genomic Medicine, Manchester Academic Health Sciences Centre (MAHSC), St Mary's Hospital, University of Manchester, Manchester, UK
| | - Soomin Ahn
- Department of Pathology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jung-Il Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Michael Bulman
- Manchester Centre for Genomic Medicine, Manchester Academic Health Sciences Centre (MAHSC), St Mary's Hospital, University of Manchester, Manchester, UK
| | - Daniel du Plessis
- Department of Cellular Pathology and Greater Manchester Neurosciences Centre, Salford Royal Hospitals NHS Foundation Trust, Salford, UK
| | - Yeon-Lim Suh
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Apps JR, Martinez-Barbera JP. Molecular pathology of adamantinomatous craniopharyngioma: review and opportunities for practice. Neurosurg Focus 2016; 41:E4. [DOI: 10.3171/2016.8.focus16307] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Since the first identification of CTNNB1 mutations in adamantinomatous craniopharyngioma (ACP), much has been learned about the molecular pathways and processes that are disrupted in ACP pathogenesis. To date this understanding has not translated into tangible patient benefit.
The recent development of novel techniques and a range of preclinical models now provides an opportunity to begin to support treatment decisions and develop new therapeutics based on molecular pathology.
In this review the authors summarize many of the key findings and pathways implicated in ACP pathogenesis and discuss the challenges that need to be tackled to translate these basic science findings for the benefit of patients.
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Genetic landscape of meningioma. Brain Tumor Pathol 2016; 33:237-247. [DOI: 10.1007/s10014-016-0271-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 09/06/2016] [Indexed: 12/27/2022]
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Bi WL, Abedalthagafi M, Horowitz P, Agarwalla PK, Mei Y, Aizer AA, Brewster R, Dunn GP, Al-Mefty O, Alexander BM, Santagata S, Beroukhim R, Dunn IF. Genomic landscape of intracranial meningiomas. J Neurosurg 2016; 125:525-35. [DOI: 10.3171/2015.6.jns15591] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Meningiomas are the most common primary intracranial neoplasms in adults. Current histopathological grading schemes do not consistently predict their natural history. Classic cytogenetic studies have disclosed a progressive course of chromosomal aberrations, especially in high-grade meningiomas. Furthermore, the recent application of unbiased next-generation sequencing approaches has implicated several novel genes whose mutations underlie a substantial percentage of meningiomas. These insights may serve to craft a molecular taxonomy for meningiomas and highlight putative therapeutic targets in a new era of rational biology-informed precision medicine.
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Affiliation(s)
- Wenya Linda Bi
- 1Department of Neurosurgery, Brigham and Women's Hospital
- 4Department of Cancer Biology, Dana-Farber Cancer Institute; and
| | - Malak Abedalthagafi
- 2Department of Pathology, Division of Neuropathology, Brigham and Women's Hospital,
| | - Peleg Horowitz
- 1Department of Neurosurgery, Brigham and Women's Hospital
| | - Pankaj K. Agarwalla
- 3Department of Neurosurgery, Massachusetts General Hospital
- 4Department of Cancer Biology, Dana-Farber Cancer Institute; and
| | - Yu Mei
- 1Department of Neurosurgery, Brigham and Women's Hospital
| | - Ayal A. Aizer
- 5Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Ryan Brewster
- 2Department of Pathology, Division of Neuropathology, Brigham and Women's Hospital,
| | - Gavin P. Dunn
- 6Department of Neurosurgery, Pathology, and Immunology, Center for Human Immunology and Immunotherapy Programs, Washington University School of Medicine, St. Louis, Missouri
| | | | - Brian M. Alexander
- 5Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Sandro Santagata
- 2Department of Pathology, Division of Neuropathology, Brigham and Women's Hospital,
| | - Rameen Beroukhim
- 4Department of Cancer Biology, Dana-Farber Cancer Institute; and
| | - Ian F. Dunn
- 1Department of Neurosurgery, Brigham and Women's Hospital
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Ben Nsir A, Chabaane M, Krifa H, Jeme H, Hattab N. Intracranial angiomatous meningiomas: A 15-year, multicenter study. Clin Neurol Neurosurg 2016; 149:111-7. [PMID: 27513979 DOI: 10.1016/j.clineuro.2016.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 07/19/2016] [Accepted: 08/01/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Angiomatous meningiomas (AMs) represent a rare subtype of meningiomas in which the vascular component prevail. They represent less than 1% of all intracranial tumors and approximately 2.1% of all meningeal tumors (Hasselblatt et al., 2004). The purpose of this study was to determine the clinical characteristics, radiological features and prognosis of AMs based on a Tunisian multicenter experience in the management of 58 successive cases of intracranial AMs. To the best of our knowledge, this is the largest series reported to date. METHODS We retrospectively reviewed 58 patients of AM treated in the departments of Neurosurgery of The Tunisian National Institute of Neurology, Sahloul University Hospital and Fattouma Bourguiba University Hospital from January 2001 to December 2015. Clinical characteristics, radiographic features and treatment modality, in the form of radical surgery, were noted. Statistical analysis was done with regards to recurrence free survival (RFS) and overall survival (OS) using Kaplan-Meier survival analysis. RESULTS The median age of the patients on admission was 53.0 years (8-78). Twenty-two patients were males and thirty-six were females. The median duration of symptoms prior to presentation was six months. Signs of increased intracranial pressure were the most common presenting symptom followed by seizures, motor weakness and cranial nerves paresis. Cystic changes were observed in 50% of cases, moderate to severe peritumoral edema in 81% of cases and multiple signal voids suggestive of blood vessels in 86.2% of cases. Forty-two patients underwent Simpson I excision (72.4%) while fourteen had Simpson II excision (24.1%). A Simpson III resection was realized in two patients (3.5%). The surgical resection was hemorrhagic in 63.8% of cases and in 13.8% of cases, several blood transfusions were necessary to maintain hemodynamic stability. No adjunctive treatment was administered. Six out of the fifty-six patients of the Simpson I/II groups recurred while one of the two patients with Simpson III resection had tumor regrowth. Median duration of RFS was 103 months. Second surgery was realized in all cases with no subsequent recurrence. The extent of tumor resection and the location were found to correlate with the risk of developing recurrences (P=0.001). CONCLUSIONS AMs represent a rare subtype of meningioma characterized by variable cystic components, large peritumoral edema and multiple areas of vascular signal voids. The mainstay of the treatment is gross total resection, ideally following a preoperative embolization. The fate of the tumor remnant after incomplete tumor resection still needs to be evaluated and we do not recommend the systematic use of post-operative adjuvant RT in all cases. As local recurrence can develop many years after initial treatment, Long-term follow-up is mandatory.
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Affiliation(s)
- A Ben Nsir
- Department of Neurosurgery, Fattouma Bourguiba University Hospital - The University of Medicine of Monastir, Monastir, 5000, Tunisia.
| | - M Chabaane
- Department of Neurosurgery, Fattouma Bourguiba University Hospital - The University of Medicine of Monastir, Monastir, 5000, Tunisia.
| | - H Krifa
- Department of Neurosurgery, Sahloul University Hospital - The University of Medicine of Sousse, Sousse, Tunisia.
| | - H Jeme
- Department of Neurosurgery, The Tunisian National Institute of Neurology - The University of Medicine of Tunis El Manar, Tunis, Tunisia,.
| | - N Hattab
- Department of Neurosurgery, Fattouma Bourguiba University Hospital - The University of Medicine of Monastir, Monastir, 5000, Tunisia.
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Bi WL, Zhang M, Wu WW, Mei Y, Dunn IF. Meningioma Genomics: Diagnostic, Prognostic, and Therapeutic Applications. Front Surg 2016; 3:40. [PMID: 27458586 PMCID: PMC4933705 DOI: 10.3389/fsurg.2016.00040] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/27/2016] [Indexed: 01/24/2023] Open
Abstract
There has been a recent revolution in our understanding of the genetic factors that drive meningioma, punctuating an equilibrium that has existed since Cushing’s germinal studies nearly a century ago. A growing appreciation that meningiomas share similar biologic features with other malignancies has allowed extrapolation of management strategies and lessons from intra-axial central nervous system neoplasms and systemic cancers to meningiomas. These features include a natural proclivity for invasion, frequent intratumoral heterogeneity, and correlation between biologic profile and clinical behavior. Next-generation sequencing has characterized recurrent somatic mutations in NF2, TRAF7, KLF4, AKT1, SMO, and PIK3CA, which are collectively present in ~80% of sporadic meningiomas. Genomic features of meningioma further associate with tumor location, histologic subtype, and possibly clinical behavior. Such genomic decryption, along with advances in targeted pharmacotherapy, provides a maturing integrated view of meningiomas. We review recent advances in meningioma genomics and probe their potential applications in diagnostic, therapeutic, and prognostic frontiers.
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Affiliation(s)
- Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Michael Zhang
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Winona W Wu
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Yu Mei
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Ian F Dunn
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
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El-Gewely MR, Andreassen M, Walquist M, Ursvik A, Knutsen E, Nystad M, Coucheron DH, Myrmel KS, Hennig R, Johansen SD. Differentially Expressed MicroRNAs in Meningiomas Grades I and II Suggest Shared Biomarkers with Malignant Tumors. Cancers (Basel) 2016; 8:E31. [PMID: 26950155 PMCID: PMC4810115 DOI: 10.3390/cancers8030031] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 02/19/2016] [Accepted: 02/24/2016] [Indexed: 12/18/2022] Open
Abstract
Meningiomas represent the most common primary tumors of the central nervous system, but few microRNA (miRNA) profiling studies have been reported so far. Deep sequencing of small RNA libraries generated from two human meningioma biopsies WHO grades I (benign) and II (atypical) were compared to excess dura controls. Nineteen differentially expressed miRNAs were validated by RT-qPCR using tumor RNA from 15 patients and 5 meninges controls. Tumor suppressor miR-218 and miR-34a were upregulated relative to normal controls, however, miR-143, miR-193b, miR-451 and oncogenic miR-21 were all downregulated. From 10 selected putative mRNA targets tested by RT-qPCR only four were differentially expressed relative to normal controls. PTEN and E-cadherin (CDH1) were upregulated, but RUNX1T1 was downregulated. Proliferation biomarker p63 was upregulated with nuclear localization, but not detected in most normal arachnoid tissues. Immunoreactivity of E-cadherin was detected in the outermost layer of normal arachnoids, but was expressed throughout the tumors. Nuclear Cyclin D1 expression was positive in all studied meningiomas, while its expression in arachnoid was limited to a few trabecular cells. Meningiomas of grades I and II appear to share biomarkers with malignant tumors, but with some additional tumor suppressor biomarkers expression. Validation in more patients is of importance.
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Affiliation(s)
- Mohamed Raafat El-Gewely
- Department of Medical Biology, Faculty of Health Sciences, UiT-The Arctic University of Norway, NO-9037 Tromsø, Norway.
| | - Morten Andreassen
- Department of Medical Biology, Faculty of Health Sciences, UiT-The Arctic University of Norway, NO-9037 Tromsø, Norway.
| | - Mari Walquist
- Department of Medical Biology, Faculty of Health Sciences, UiT-The Arctic University of Norway, NO-9037 Tromsø, Norway.
| | - Anita Ursvik
- Department of Medical Biology, Faculty of Health Sciences, UiT-The Arctic University of Norway, NO-9037 Tromsø, Norway.
| | - Erik Knutsen
- Department of Medical Biology, Faculty of Health Sciences, UiT-The Arctic University of Norway, NO-9037 Tromsø, Norway.
| | - Mona Nystad
- Department of Clinical Medicine, Women's Health and Perinatology Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, NO-9037 Tromsø, Norway.
- Department of Obstetrics and Gynecology, University Hospital of North Norway, NO-9038 Tromsø, Norway.
- Department of Medical Genetics, Division of Child and Adolescent Health, University Hospital of North Norway, NO-9038 Tromsø, Norway.
| | - Dag H Coucheron
- Department of Medical Biology, Faculty of Health Sciences, UiT-The Arctic University of Norway, NO-9037 Tromsø, Norway.
| | | | - Rune Hennig
- Department of Neurosurgery, University Hospital of North Norway, NO-9038 Tromsø, Norway.
- Department of Clinical Medicine, Division of Neurosurgery, Faculty of Health Sciences, UiT-The Arctic University of Norway, NO-9037 Tromsø, Norway.
| | - Steinar D Johansen
- Department of Medical Biology, Faculty of Health Sciences, UiT-The Arctic University of Norway, NO-9037 Tromsø, Norway.
- Marine Genomics Group, Faculty of Biosciences and Aquaculture, Nord University NO-8049 Bodø, Norway.
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Abedalthagafi M, Bi WL, Aizer AA, Merrill PH, Brewster R, Agarwalla PK, Listewnik ML, Dias-Santagata D, Thorner AR, Van Hummelen P, Brastianos PK, Reardon DA, Wen PY, Al-Mefty O, Ramkissoon SH, Folkerth RD, Ligon KL, Ligon AH, Alexander BM, Dunn IF, Beroukhim R, Santagata S. Oncogenic PI3K mutations are as common as AKT1 and SMO mutations in meningioma. Neuro Oncol 2016; 18:649-55. [PMID: 26826201 DOI: 10.1093/neuonc/nov316] [Citation(s) in RCA: 198] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 12/02/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Meningiomas are the most common primary intracranial tumor in adults. Identification of SMO and AKT1 mutations in meningiomas has raised the possibility of targeted therapies for some patients. The frequency of such mutations in clinical cohorts and the presence of other actionable mutations in meningiomas are important to define. METHODS We used high-resolution array-comparative genomic hybridization to prospectively characterize copy-number changes in 150 meningiomas and then characterized these samples for mutations in AKT1, KLF4, NF2, PIK3CA, SMO, and TRAF7. RESULTS Similar to prior reports, we identified AKT1 and SMO mutations in a subset of non-NF2-mutant meningiomas (ie, ∼9% and ∼6%, respectively). Notably, we detected oncogenic mutations in PIK3CA in ∼7% of non-NF2-mutant meningiomas. AKT1, SMO, and PIK3CA mutations were mutually exclusive. AKT1, KLF4, and PIK3CA mutations often co-occurred with mutations in TRAF7. PIK3CA-mutant meningiomas showed limited chromosomal instability and were enriched in the skull base. CONCLUSION This work identifies PI3K signaling as an important target for precision medicine trials in meningioma patients.
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Affiliation(s)
- Malak Abedalthagafi
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (M.A., P.H.M., R.B., M.L.L., S.H.R., R.D.F., K.L.L., A.H.L., S.S.); Department of Pathology, King Fahad Medical City, Riyadh, Saudi Arabia (M.A.); King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia (M.A.); Harvard Medical School, Boston, Massachusetts (M.A., A.A.A., D.D.-S., P.K.B., D.A.R., P.Y.W., O.A.-M., S.H.R., R.D.F., K.L.L., A.H.L., B.M.A., I.F.D., R.B., S.S.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (W.L.B., O.A.-M., I.F.D.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A., B.M.A.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (P.K.A.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (D.D.-S.); Center for Cancer Genomic Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts (A.R.T., P.V.H.); Department of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts (P.K.B.); Center of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R., P.Y.W, R.B.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (K.L.L., R.B.); Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA (S.S.)
| | - Wenya Linda Bi
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (M.A., P.H.M., R.B., M.L.L., S.H.R., R.D.F., K.L.L., A.H.L., S.S.); Department of Pathology, King Fahad Medical City, Riyadh, Saudi Arabia (M.A.); King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia (M.A.); Harvard Medical School, Boston, Massachusetts (M.A., A.A.A., D.D.-S., P.K.B., D.A.R., P.Y.W., O.A.-M., S.H.R., R.D.F., K.L.L., A.H.L., B.M.A., I.F.D., R.B., S.S.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (W.L.B., O.A.-M., I.F.D.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A., B.M.A.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (P.K.A.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (D.D.-S.); Center for Cancer Genomic Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts (A.R.T., P.V.H.); Department of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts (P.K.B.); Center of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R., P.Y.W, R.B.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (K.L.L., R.B.); Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA (S.S.)
| | - Ayal A Aizer
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (M.A., P.H.M., R.B., M.L.L., S.H.R., R.D.F., K.L.L., A.H.L., S.S.); Department of Pathology, King Fahad Medical City, Riyadh, Saudi Arabia (M.A.); King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia (M.A.); Harvard Medical School, Boston, Massachusetts (M.A., A.A.A., D.D.-S., P.K.B., D.A.R., P.Y.W., O.A.-M., S.H.R., R.D.F., K.L.L., A.H.L., B.M.A., I.F.D., R.B., S.S.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (W.L.B., O.A.-M., I.F.D.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A., B.M.A.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (P.K.A.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (D.D.-S.); Center for Cancer Genomic Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts (A.R.T., P.V.H.); Department of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts (P.K.B.); Center of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R., P.Y.W, R.B.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (K.L.L., R.B.); Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA (S.S.)
| | - Parker H Merrill
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (M.A., P.H.M., R.B., M.L.L., S.H.R., R.D.F., K.L.L., A.H.L., S.S.); Department of Pathology, King Fahad Medical City, Riyadh, Saudi Arabia (M.A.); King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia (M.A.); Harvard Medical School, Boston, Massachusetts (M.A., A.A.A., D.D.-S., P.K.B., D.A.R., P.Y.W., O.A.-M., S.H.R., R.D.F., K.L.L., A.H.L., B.M.A., I.F.D., R.B., S.S.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (W.L.B., O.A.-M., I.F.D.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A., B.M.A.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (P.K.A.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (D.D.-S.); Center for Cancer Genomic Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts (A.R.T., P.V.H.); Department of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts (P.K.B.); Center of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R., P.Y.W, R.B.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (K.L.L., R.B.); Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA (S.S.)
| | - Ryan Brewster
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (M.A., P.H.M., R.B., M.L.L., S.H.R., R.D.F., K.L.L., A.H.L., S.S.); Department of Pathology, King Fahad Medical City, Riyadh, Saudi Arabia (M.A.); King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia (M.A.); Harvard Medical School, Boston, Massachusetts (M.A., A.A.A., D.D.-S., P.K.B., D.A.R., P.Y.W., O.A.-M., S.H.R., R.D.F., K.L.L., A.H.L., B.M.A., I.F.D., R.B., S.S.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (W.L.B., O.A.-M., I.F.D.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A., B.M.A.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (P.K.A.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (D.D.-S.); Center for Cancer Genomic Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts (A.R.T., P.V.H.); Department of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts (P.K.B.); Center of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R., P.Y.W, R.B.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (K.L.L., R.B.); Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA (S.S.)
| | - Pankaj K Agarwalla
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (M.A., P.H.M., R.B., M.L.L., S.H.R., R.D.F., K.L.L., A.H.L., S.S.); Department of Pathology, King Fahad Medical City, Riyadh, Saudi Arabia (M.A.); King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia (M.A.); Harvard Medical School, Boston, Massachusetts (M.A., A.A.A., D.D.-S., P.K.B., D.A.R., P.Y.W., O.A.-M., S.H.R., R.D.F., K.L.L., A.H.L., B.M.A., I.F.D., R.B., S.S.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (W.L.B., O.A.-M., I.F.D.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A., B.M.A.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (P.K.A.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (D.D.-S.); Center for Cancer Genomic Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts (A.R.T., P.V.H.); Department of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts (P.K.B.); Center of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R., P.Y.W, R.B.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (K.L.L., R.B.); Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA (S.S.)
| | - Marc L Listewnik
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (M.A., P.H.M., R.B., M.L.L., S.H.R., R.D.F., K.L.L., A.H.L., S.S.); Department of Pathology, King Fahad Medical City, Riyadh, Saudi Arabia (M.A.); King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia (M.A.); Harvard Medical School, Boston, Massachusetts (M.A., A.A.A., D.D.-S., P.K.B., D.A.R., P.Y.W., O.A.-M., S.H.R., R.D.F., K.L.L., A.H.L., B.M.A., I.F.D., R.B., S.S.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (W.L.B., O.A.-M., I.F.D.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A., B.M.A.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (P.K.A.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (D.D.-S.); Center for Cancer Genomic Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts (A.R.T., P.V.H.); Department of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts (P.K.B.); Center of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R., P.Y.W, R.B.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (K.L.L., R.B.); Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA (S.S.)
| | - Dora Dias-Santagata
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (M.A., P.H.M., R.B., M.L.L., S.H.R., R.D.F., K.L.L., A.H.L., S.S.); Department of Pathology, King Fahad Medical City, Riyadh, Saudi Arabia (M.A.); King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia (M.A.); Harvard Medical School, Boston, Massachusetts (M.A., A.A.A., D.D.-S., P.K.B., D.A.R., P.Y.W., O.A.-M., S.H.R., R.D.F., K.L.L., A.H.L., B.M.A., I.F.D., R.B., S.S.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (W.L.B., O.A.-M., I.F.D.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A., B.M.A.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (P.K.A.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (D.D.-S.); Center for Cancer Genomic Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts (A.R.T., P.V.H.); Department of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts (P.K.B.); Center of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R., P.Y.W, R.B.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (K.L.L., R.B.); Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA (S.S.)
| | - Aaron R Thorner
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (M.A., P.H.M., R.B., M.L.L., S.H.R., R.D.F., K.L.L., A.H.L., S.S.); Department of Pathology, King Fahad Medical City, Riyadh, Saudi Arabia (M.A.); King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia (M.A.); Harvard Medical School, Boston, Massachusetts (M.A., A.A.A., D.D.-S., P.K.B., D.A.R., P.Y.W., O.A.-M., S.H.R., R.D.F., K.L.L., A.H.L., B.M.A., I.F.D., R.B., S.S.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (W.L.B., O.A.-M., I.F.D.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A., B.M.A.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (P.K.A.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (D.D.-S.); Center for Cancer Genomic Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts (A.R.T., P.V.H.); Department of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts (P.K.B.); Center of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R., P.Y.W, R.B.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (K.L.L., R.B.); Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA (S.S.)
| | - Paul Van Hummelen
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (M.A., P.H.M., R.B., M.L.L., S.H.R., R.D.F., K.L.L., A.H.L., S.S.); Department of Pathology, King Fahad Medical City, Riyadh, Saudi Arabia (M.A.); King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia (M.A.); Harvard Medical School, Boston, Massachusetts (M.A., A.A.A., D.D.-S., P.K.B., D.A.R., P.Y.W., O.A.-M., S.H.R., R.D.F., K.L.L., A.H.L., B.M.A., I.F.D., R.B., S.S.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (W.L.B., O.A.-M., I.F.D.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A., B.M.A.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (P.K.A.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (D.D.-S.); Center for Cancer Genomic Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts (A.R.T., P.V.H.); Department of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts (P.K.B.); Center of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R., P.Y.W, R.B.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (K.L.L., R.B.); Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA (S.S.)
| | - Priscilla K Brastianos
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (M.A., P.H.M., R.B., M.L.L., S.H.R., R.D.F., K.L.L., A.H.L., S.S.); Department of Pathology, King Fahad Medical City, Riyadh, Saudi Arabia (M.A.); King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia (M.A.); Harvard Medical School, Boston, Massachusetts (M.A., A.A.A., D.D.-S., P.K.B., D.A.R., P.Y.W., O.A.-M., S.H.R., R.D.F., K.L.L., A.H.L., B.M.A., I.F.D., R.B., S.S.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (W.L.B., O.A.-M., I.F.D.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A., B.M.A.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (P.K.A.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (D.D.-S.); Center for Cancer Genomic Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts (A.R.T., P.V.H.); Department of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts (P.K.B.); Center of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R., P.Y.W, R.B.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (K.L.L., R.B.); Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA (S.S.)
| | - David A Reardon
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (M.A., P.H.M., R.B., M.L.L., S.H.R., R.D.F., K.L.L., A.H.L., S.S.); Department of Pathology, King Fahad Medical City, Riyadh, Saudi Arabia (M.A.); King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia (M.A.); Harvard Medical School, Boston, Massachusetts (M.A., A.A.A., D.D.-S., P.K.B., D.A.R., P.Y.W., O.A.-M., S.H.R., R.D.F., K.L.L., A.H.L., B.M.A., I.F.D., R.B., S.S.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (W.L.B., O.A.-M., I.F.D.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A., B.M.A.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (P.K.A.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (D.D.-S.); Center for Cancer Genomic Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts (A.R.T., P.V.H.); Department of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts (P.K.B.); Center of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R., P.Y.W, R.B.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (K.L.L., R.B.); Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA (S.S.)
| | - Patrick Y Wen
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (M.A., P.H.M., R.B., M.L.L., S.H.R., R.D.F., K.L.L., A.H.L., S.S.); Department of Pathology, King Fahad Medical City, Riyadh, Saudi Arabia (M.A.); King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia (M.A.); Harvard Medical School, Boston, Massachusetts (M.A., A.A.A., D.D.-S., P.K.B., D.A.R., P.Y.W., O.A.-M., S.H.R., R.D.F., K.L.L., A.H.L., B.M.A., I.F.D., R.B., S.S.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (W.L.B., O.A.-M., I.F.D.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A., B.M.A.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (P.K.A.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (D.D.-S.); Center for Cancer Genomic Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts (A.R.T., P.V.H.); Department of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts (P.K.B.); Center of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R., P.Y.W, R.B.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (K.L.L., R.B.); Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA (S.S.)
| | - Ossama Al-Mefty
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (M.A., P.H.M., R.B., M.L.L., S.H.R., R.D.F., K.L.L., A.H.L., S.S.); Department of Pathology, King Fahad Medical City, Riyadh, Saudi Arabia (M.A.); King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia (M.A.); Harvard Medical School, Boston, Massachusetts (M.A., A.A.A., D.D.-S., P.K.B., D.A.R., P.Y.W., O.A.-M., S.H.R., R.D.F., K.L.L., A.H.L., B.M.A., I.F.D., R.B., S.S.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (W.L.B., O.A.-M., I.F.D.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A., B.M.A.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (P.K.A.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (D.D.-S.); Center for Cancer Genomic Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts (A.R.T., P.V.H.); Department of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts (P.K.B.); Center of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R., P.Y.W, R.B.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (K.L.L., R.B.); Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA (S.S.)
| | - Shakti H Ramkissoon
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (M.A., P.H.M., R.B., M.L.L., S.H.R., R.D.F., K.L.L., A.H.L., S.S.); Department of Pathology, King Fahad Medical City, Riyadh, Saudi Arabia (M.A.); King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia (M.A.); Harvard Medical School, Boston, Massachusetts (M.A., A.A.A., D.D.-S., P.K.B., D.A.R., P.Y.W., O.A.-M., S.H.R., R.D.F., K.L.L., A.H.L., B.M.A., I.F.D., R.B., S.S.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (W.L.B., O.A.-M., I.F.D.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A., B.M.A.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (P.K.A.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (D.D.-S.); Center for Cancer Genomic Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts (A.R.T., P.V.H.); Department of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts (P.K.B.); Center of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R., P.Y.W, R.B.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (K.L.L., R.B.); Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA (S.S.)
| | - Rebecca D Folkerth
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (M.A., P.H.M., R.B., M.L.L., S.H.R., R.D.F., K.L.L., A.H.L., S.S.); Department of Pathology, King Fahad Medical City, Riyadh, Saudi Arabia (M.A.); King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia (M.A.); Harvard Medical School, Boston, Massachusetts (M.A., A.A.A., D.D.-S., P.K.B., D.A.R., P.Y.W., O.A.-M., S.H.R., R.D.F., K.L.L., A.H.L., B.M.A., I.F.D., R.B., S.S.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (W.L.B., O.A.-M., I.F.D.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A., B.M.A.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (P.K.A.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (D.D.-S.); Center for Cancer Genomic Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts (A.R.T., P.V.H.); Department of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts (P.K.B.); Center of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R., P.Y.W, R.B.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (K.L.L., R.B.); Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA (S.S.)
| | - Keith L Ligon
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (M.A., P.H.M., R.B., M.L.L., S.H.R., R.D.F., K.L.L., A.H.L., S.S.); Department of Pathology, King Fahad Medical City, Riyadh, Saudi Arabia (M.A.); King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia (M.A.); Harvard Medical School, Boston, Massachusetts (M.A., A.A.A., D.D.-S., P.K.B., D.A.R., P.Y.W., O.A.-M., S.H.R., R.D.F., K.L.L., A.H.L., B.M.A., I.F.D., R.B., S.S.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (W.L.B., O.A.-M., I.F.D.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A., B.M.A.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (P.K.A.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (D.D.-S.); Center for Cancer Genomic Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts (A.R.T., P.V.H.); Department of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts (P.K.B.); Center of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R., P.Y.W, R.B.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (K.L.L., R.B.); Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA (S.S.)
| | - Azra H Ligon
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (M.A., P.H.M., R.B., M.L.L., S.H.R., R.D.F., K.L.L., A.H.L., S.S.); Department of Pathology, King Fahad Medical City, Riyadh, Saudi Arabia (M.A.); King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia (M.A.); Harvard Medical School, Boston, Massachusetts (M.A., A.A.A., D.D.-S., P.K.B., D.A.R., P.Y.W., O.A.-M., S.H.R., R.D.F., K.L.L., A.H.L., B.M.A., I.F.D., R.B., S.S.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (W.L.B., O.A.-M., I.F.D.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A., B.M.A.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (P.K.A.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (D.D.-S.); Center for Cancer Genomic Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts (A.R.T., P.V.H.); Department of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts (P.K.B.); Center of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R., P.Y.W, R.B.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (K.L.L., R.B.); Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA (S.S.)
| | - Brian M Alexander
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (M.A., P.H.M., R.B., M.L.L., S.H.R., R.D.F., K.L.L., A.H.L., S.S.); Department of Pathology, King Fahad Medical City, Riyadh, Saudi Arabia (M.A.); King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia (M.A.); Harvard Medical School, Boston, Massachusetts (M.A., A.A.A., D.D.-S., P.K.B., D.A.R., P.Y.W., O.A.-M., S.H.R., R.D.F., K.L.L., A.H.L., B.M.A., I.F.D., R.B., S.S.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (W.L.B., O.A.-M., I.F.D.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A., B.M.A.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (P.K.A.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (D.D.-S.); Center for Cancer Genomic Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts (A.R.T., P.V.H.); Department of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts (P.K.B.); Center of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R., P.Y.W, R.B.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (K.L.L., R.B.); Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA (S.S.)
| | - Ian F Dunn
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (M.A., P.H.M., R.B., M.L.L., S.H.R., R.D.F., K.L.L., A.H.L., S.S.); Department of Pathology, King Fahad Medical City, Riyadh, Saudi Arabia (M.A.); King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia (M.A.); Harvard Medical School, Boston, Massachusetts (M.A., A.A.A., D.D.-S., P.K.B., D.A.R., P.Y.W., O.A.-M., S.H.R., R.D.F., K.L.L., A.H.L., B.M.A., I.F.D., R.B., S.S.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (W.L.B., O.A.-M., I.F.D.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A., B.M.A.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (P.K.A.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (D.D.-S.); Center for Cancer Genomic Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts (A.R.T., P.V.H.); Department of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts (P.K.B.); Center of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R., P.Y.W, R.B.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (K.L.L., R.B.); Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA (S.S.)
| | - Rameen Beroukhim
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (M.A., P.H.M., R.B., M.L.L., S.H.R., R.D.F., K.L.L., A.H.L., S.S.); Department of Pathology, King Fahad Medical City, Riyadh, Saudi Arabia (M.A.); King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia (M.A.); Harvard Medical School, Boston, Massachusetts (M.A., A.A.A., D.D.-S., P.K.B., D.A.R., P.Y.W., O.A.-M., S.H.R., R.D.F., K.L.L., A.H.L., B.M.A., I.F.D., R.B., S.S.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (W.L.B., O.A.-M., I.F.D.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A., B.M.A.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (P.K.A.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (D.D.-S.); Center for Cancer Genomic Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts (A.R.T., P.V.H.); Department of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts (P.K.B.); Center of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R., P.Y.W, R.B.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (K.L.L., R.B.); Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA (S.S.)
| | - Sandro Santagata
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (M.A., P.H.M., R.B., M.L.L., S.H.R., R.D.F., K.L.L., A.H.L., S.S.); Department of Pathology, King Fahad Medical City, Riyadh, Saudi Arabia (M.A.); King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia (M.A.); Harvard Medical School, Boston, Massachusetts (M.A., A.A.A., D.D.-S., P.K.B., D.A.R., P.Y.W., O.A.-M., S.H.R., R.D.F., K.L.L., A.H.L., B.M.A., I.F.D., R.B., S.S.); Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (W.L.B., O.A.-M., I.F.D.); Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts (A.A.A., B.M.A.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (P.K.A.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (D.D.-S.); Center for Cancer Genomic Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts (A.R.T., P.V.H.); Department of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts (P.K.B.); Center of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R., P.Y.W, R.B.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (K.L.L., R.B.); Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA (S.S.)
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Fogh SE, Johnson DR, Barker FG, Brastianos PK, Clarke JL, Kaufmann TJ, Oberndorfer S, Preusser M, Raghunathan A, Santagata S, Theodosopoulos PV. Case-Based Review: meningioma. Neurooncol Pract 2016; 3:120-134. [PMID: 31386096 DOI: 10.1093/nop/npv063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Indexed: 12/30/2022] Open
Abstract
Meningioma is by far the most common primary intracranial tumor in adults. Treatment of meningioma is complex due to a tremendous amount of variability in tumor behavior. Many patients are incidentally found to have tumors that will remain asymptomatic throughout their lives. It is important to identify these patients so that they can be spared from potentially morbid interventions. On the other end of the spectrum, high-grade meningiomas can behave very aggressively. When treatment is necessary, surgical resection is the cornerstone of meningioma therapy. Studies spanning decades have demonstrated that extent of resection correlates with prognosis. Radiation therapy, either in the form of external beam radiation therapy or stereotactic radiosurgery, represents another important therapeutic tool that can be used in place of or as a supplement to surgery. There are no chemotherapeutic agents of proven efficacy against meningioma, and chemotherapy treatment is generally reserved for patients who have exhausted surgical and radiotherapy options. Ongoing and future studies will help to answer unresolved questions such as the optimum use of radiation in resected WHO grade II meningiomas and the efficacy of additional chemotherapy agents.
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Affiliation(s)
- Shannon E Fogh
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA (S.E.F.); Department of Radiology, Mayo Clinic, Rochester, MN, USA (D.R.J., T.J.K.); Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (F.G.B.); Division of Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (P.K.B.); Department of Neurology and Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (J.L.C.); Department of Neurology, Karl Landsteiner University Clinic, St Pölten, Austria (S.O.); Department of Internal Medicine, Medical University, Vienna, CCC, Austria (M.P.); Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA (A.R.); Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (S.S.); Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (P.V.T.)
| | - Derek R Johnson
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA (S.E.F.); Department of Radiology, Mayo Clinic, Rochester, MN, USA (D.R.J., T.J.K.); Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (F.G.B.); Division of Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (P.K.B.); Department of Neurology and Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (J.L.C.); Department of Neurology, Karl Landsteiner University Clinic, St Pölten, Austria (S.O.); Department of Internal Medicine, Medical University, Vienna, CCC, Austria (M.P.); Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA (A.R.); Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (S.S.); Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (P.V.T.)
| | - Fred G Barker
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA (S.E.F.); Department of Radiology, Mayo Clinic, Rochester, MN, USA (D.R.J., T.J.K.); Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (F.G.B.); Division of Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (P.K.B.); Department of Neurology and Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (J.L.C.); Department of Neurology, Karl Landsteiner University Clinic, St Pölten, Austria (S.O.); Department of Internal Medicine, Medical University, Vienna, CCC, Austria (M.P.); Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA (A.R.); Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (S.S.); Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (P.V.T.)
| | - Priscilla K Brastianos
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA (S.E.F.); Department of Radiology, Mayo Clinic, Rochester, MN, USA (D.R.J., T.J.K.); Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (F.G.B.); Division of Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (P.K.B.); Department of Neurology and Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (J.L.C.); Department of Neurology, Karl Landsteiner University Clinic, St Pölten, Austria (S.O.); Department of Internal Medicine, Medical University, Vienna, CCC, Austria (M.P.); Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA (A.R.); Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (S.S.); Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (P.V.T.)
| | - Jennifer L Clarke
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA (S.E.F.); Department of Radiology, Mayo Clinic, Rochester, MN, USA (D.R.J., T.J.K.); Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (F.G.B.); Division of Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (P.K.B.); Department of Neurology and Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (J.L.C.); Department of Neurology, Karl Landsteiner University Clinic, St Pölten, Austria (S.O.); Department of Internal Medicine, Medical University, Vienna, CCC, Austria (M.P.); Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA (A.R.); Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (S.S.); Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (P.V.T.)
| | - Timothy J Kaufmann
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA (S.E.F.); Department of Radiology, Mayo Clinic, Rochester, MN, USA (D.R.J., T.J.K.); Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (F.G.B.); Division of Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (P.K.B.); Department of Neurology and Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (J.L.C.); Department of Neurology, Karl Landsteiner University Clinic, St Pölten, Austria (S.O.); Department of Internal Medicine, Medical University, Vienna, CCC, Austria (M.P.); Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA (A.R.); Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (S.S.); Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (P.V.T.)
| | - Stephan Oberndorfer
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA (S.E.F.); Department of Radiology, Mayo Clinic, Rochester, MN, USA (D.R.J., T.J.K.); Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (F.G.B.); Division of Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (P.K.B.); Department of Neurology and Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (J.L.C.); Department of Neurology, Karl Landsteiner University Clinic, St Pölten, Austria (S.O.); Department of Internal Medicine, Medical University, Vienna, CCC, Austria (M.P.); Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA (A.R.); Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (S.S.); Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (P.V.T.)
| | - Matthias Preusser
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA (S.E.F.); Department of Radiology, Mayo Clinic, Rochester, MN, USA (D.R.J., T.J.K.); Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (F.G.B.); Division of Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (P.K.B.); Department of Neurology and Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (J.L.C.); Department of Neurology, Karl Landsteiner University Clinic, St Pölten, Austria (S.O.); Department of Internal Medicine, Medical University, Vienna, CCC, Austria (M.P.); Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA (A.R.); Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (S.S.); Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (P.V.T.)
| | - Aditya Raghunathan
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA (S.E.F.); Department of Radiology, Mayo Clinic, Rochester, MN, USA (D.R.J., T.J.K.); Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (F.G.B.); Division of Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (P.K.B.); Department of Neurology and Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (J.L.C.); Department of Neurology, Karl Landsteiner University Clinic, St Pölten, Austria (S.O.); Department of Internal Medicine, Medical University, Vienna, CCC, Austria (M.P.); Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA (A.R.); Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (S.S.); Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (P.V.T.)
| | - Sandro Santagata
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA (S.E.F.); Department of Radiology, Mayo Clinic, Rochester, MN, USA (D.R.J., T.J.K.); Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (F.G.B.); Division of Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (P.K.B.); Department of Neurology and Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (J.L.C.); Department of Neurology, Karl Landsteiner University Clinic, St Pölten, Austria (S.O.); Department of Internal Medicine, Medical University, Vienna, CCC, Austria (M.P.); Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA (A.R.); Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (S.S.); Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (P.V.T.)
| | - Philip V Theodosopoulos
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA (S.E.F.); Department of Radiology, Mayo Clinic, Rochester, MN, USA (D.R.J., T.J.K.); Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (F.G.B.); Division of Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (P.K.B.); Department of Neurology and Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (J.L.C.); Department of Neurology, Karl Landsteiner University Clinic, St Pölten, Austria (S.O.); Department of Internal Medicine, Medical University, Vienna, CCC, Austria (M.P.); Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA (A.R.); Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (S.S.); Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (P.V.T.)
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Increased expression of the immune modulatory molecule PD-L1 (CD274) in anaplastic meningioma. Oncotarget 2016; 6:4704-16. [PMID: 25609200 PMCID: PMC4467109 DOI: 10.18632/oncotarget.3082] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 12/28/2014] [Indexed: 12/17/2022] Open
Abstract
There are no effective medical treatments for WHO grade III (anaplastic) meningioma. Patients with this high-grade malignancy have a median survival of less than two years. Therapeutics that modulate the mechanisms that inhibit local immune responses in the tumor microenvironment are showing significant and durable clinical responses in patients with treatment refractory high-grade tumors. We examined the immune infiltrate of 291 meningiomas including WHO grade I-III meningiomas using immunohistochemistry and we examined the expression of PD-L1 mRNA by RNAscope in situ hybridization and PD-L1 protein by immunohistochemistry. In meningioma, the tumor infiltrating lymphocytes are predominantly T cells. In anaplastic meningioma, there is a sharp decrease in the number of T cells, including the numbers of CD4+ and CD8+ T cells and cells expressing PD-1 and there is also an increase in the number of FOXP3 expressing immunoregulatory (Treg) cells. PD-L1 expression is increased in anaplastic meningioma – both mRNA and protein. Using patient derived meningioma cell, we confirm that PD-L1 is expressed in meningioma cells themselves, and not solely in infiltrating immune cells. This work indicates that high-grade meningioma harbor an immunosuppressive tumor microenviroment and that increased Treg cells and elevated PD-L1 may contribute to the aggressive phenotype of these tumors.
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Aizer AA, Abedalthagafi M, Bi WL, Horvath MC, Arvold ND, Al-Mefty O, Lee EQ, Nayak L, Rinne ML, Norden AD, Reardon DA, Wen PY, Ligon KL, Ligon AH, Beroukhim R, Dunn IF, Santagata S, Alexander BM. A prognostic cytogenetic scoring system to guide the adjuvant management of patients with atypical meningioma. Neuro Oncol 2015; 18:269-74. [PMID: 26323607 DOI: 10.1093/neuonc/nov177] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 07/31/2015] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The appropriate use of adjuvant therapy in patients with gross totally resected atypical meningioma requires an accurate assessment of recurrence risk. We sought to determine whether cytogenetic/genetic characterization may facilitate better estimation of the probability of recurrence. METHODS We first analyzed our clinical database, including high-resolution DNA copy number data, to identify 11 common copy number aberrations in a pilot cohort of meningiomas of all grades. We summed these aberrations to devise a cytogenetic abnormality score (CAS) and determined the CAS from archived tissue of a separate cohort of 32 patients with gross totally resected atypical meningioma managed with surgery alone. Propensity score adjusted Cox regression was used to determine whether the CAS was predictive of recurrence. RESULTS An association between higher CAS and higher grade was noted in our pilot cohort with heterogeneity among atypical tumors. Among the 32 patients who underwent gross total resection of an atypical meningioma, the CAS was not significantly associated with age, gender, performance status, or tumor size/location but was associated with the risk of recurrence on univariable analysis (hazard ratio per aberration = 1.52; 95% CI = 1.08-2.14; P = .02). After adjustment, the impact of the dichotomized number of copy aberrations remained significantly associated with recurrence risk (hazard ratio = 4.47; 95% CI = 1.01-19.87; P = .05). CONCLUSIONS The number of copy number aberrations is strongly associated with recurrence risk in patients with atypical meningioma following gross total resection and may inform the appropriate use of adjuvant radiation therapy in these patients or be useful for stratification in clinical trials.
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Affiliation(s)
- Ayal A Aizer
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (A.A.A., M.C.H., N.D.A., B.M.A.); Department of Pathology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (M.A., K.L.L., A.H.L., S.S.); Department of Neurosurgery, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (W.L.B., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (E.Q.L., L.N., M.L.R., A.D.N., D.A.R., P.Y.W., R.B.)
| | - Malak Abedalthagafi
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (A.A.A., M.C.H., N.D.A., B.M.A.); Department of Pathology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (M.A., K.L.L., A.H.L., S.S.); Department of Neurosurgery, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (W.L.B., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (E.Q.L., L.N., M.L.R., A.D.N., D.A.R., P.Y.W., R.B.)
| | - Wenya Linda Bi
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (A.A.A., M.C.H., N.D.A., B.M.A.); Department of Pathology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (M.A., K.L.L., A.H.L., S.S.); Department of Neurosurgery, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (W.L.B., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (E.Q.L., L.N., M.L.R., A.D.N., D.A.R., P.Y.W., R.B.)
| | - Margaret C Horvath
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (A.A.A., M.C.H., N.D.A., B.M.A.); Department of Pathology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (M.A., K.L.L., A.H.L., S.S.); Department of Neurosurgery, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (W.L.B., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (E.Q.L., L.N., M.L.R., A.D.N., D.A.R., P.Y.W., R.B.)
| | - Nils D Arvold
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (A.A.A., M.C.H., N.D.A., B.M.A.); Department of Pathology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (M.A., K.L.L., A.H.L., S.S.); Department of Neurosurgery, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (W.L.B., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (E.Q.L., L.N., M.L.R., A.D.N., D.A.R., P.Y.W., R.B.)
| | - Ossama Al-Mefty
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (A.A.A., M.C.H., N.D.A., B.M.A.); Department of Pathology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (M.A., K.L.L., A.H.L., S.S.); Department of Neurosurgery, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (W.L.B., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (E.Q.L., L.N., M.L.R., A.D.N., D.A.R., P.Y.W., R.B.)
| | - Eudocia Q Lee
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (A.A.A., M.C.H., N.D.A., B.M.A.); Department of Pathology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (M.A., K.L.L., A.H.L., S.S.); Department of Neurosurgery, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (W.L.B., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (E.Q.L., L.N., M.L.R., A.D.N., D.A.R., P.Y.W., R.B.)
| | - Lakshmi Nayak
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (A.A.A., M.C.H., N.D.A., B.M.A.); Department of Pathology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (M.A., K.L.L., A.H.L., S.S.); Department of Neurosurgery, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (W.L.B., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (E.Q.L., L.N., M.L.R., A.D.N., D.A.R., P.Y.W., R.B.)
| | - Mikael L Rinne
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (A.A.A., M.C.H., N.D.A., B.M.A.); Department of Pathology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (M.A., K.L.L., A.H.L., S.S.); Department of Neurosurgery, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (W.L.B., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (E.Q.L., L.N., M.L.R., A.D.N., D.A.R., P.Y.W., R.B.)
| | - Andrew D Norden
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (A.A.A., M.C.H., N.D.A., B.M.A.); Department of Pathology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (M.A., K.L.L., A.H.L., S.S.); Department of Neurosurgery, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (W.L.B., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (E.Q.L., L.N., M.L.R., A.D.N., D.A.R., P.Y.W., R.B.)
| | - David A Reardon
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (A.A.A., M.C.H., N.D.A., B.M.A.); Department of Pathology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (M.A., K.L.L., A.H.L., S.S.); Department of Neurosurgery, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (W.L.B., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (E.Q.L., L.N., M.L.R., A.D.N., D.A.R., P.Y.W., R.B.)
| | - Patrick Y Wen
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (A.A.A., M.C.H., N.D.A., B.M.A.); Department of Pathology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (M.A., K.L.L., A.H.L., S.S.); Department of Neurosurgery, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (W.L.B., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (E.Q.L., L.N., M.L.R., A.D.N., D.A.R., P.Y.W., R.B.)
| | - Keith L Ligon
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (A.A.A., M.C.H., N.D.A., B.M.A.); Department of Pathology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (M.A., K.L.L., A.H.L., S.S.); Department of Neurosurgery, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (W.L.B., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (E.Q.L., L.N., M.L.R., A.D.N., D.A.R., P.Y.W., R.B.)
| | - Azra H Ligon
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (A.A.A., M.C.H., N.D.A., B.M.A.); Department of Pathology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (M.A., K.L.L., A.H.L., S.S.); Department of Neurosurgery, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (W.L.B., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (E.Q.L., L.N., M.L.R., A.D.N., D.A.R., P.Y.W., R.B.)
| | - Rameen Beroukhim
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (A.A.A., M.C.H., N.D.A., B.M.A.); Department of Pathology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (M.A., K.L.L., A.H.L., S.S.); Department of Neurosurgery, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (W.L.B., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (E.Q.L., L.N., M.L.R., A.D.N., D.A.R., P.Y.W., R.B.)
| | - Ian F Dunn
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (A.A.A., M.C.H., N.D.A., B.M.A.); Department of Pathology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (M.A., K.L.L., A.H.L., S.S.); Department of Neurosurgery, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (W.L.B., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (E.Q.L., L.N., M.L.R., A.D.N., D.A.R., P.Y.W., R.B.)
| | - Sandro Santagata
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (A.A.A., M.C.H., N.D.A., B.M.A.); Department of Pathology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (M.A., K.L.L., A.H.L., S.S.); Department of Neurosurgery, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (W.L.B., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (E.Q.L., L.N., M.L.R., A.D.N., D.A.R., P.Y.W., R.B.)
| | - Brian M Alexander
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (A.A.A., M.C.H., N.D.A., B.M.A.); Department of Pathology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (M.A., K.L.L., A.H.L., S.S.); Department of Neurosurgery, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (W.L.B., O.A-M., I.F.D.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (E.Q.L., L.N., M.L.R., A.D.N., D.A.R., P.Y.W., R.B.)
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50
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Abedalthagafi MS, Bi WL, Merrill PH, Gibson WJ, Rose MF, Du Z, Francis JM, Du R, Dunn IF, Ligon AH, Beroukhim R, Santagata S. ARID1A and TERT promoter mutations in dedifferentiated meningioma. Cancer Genet 2015; 208:345-50. [PMID: 25963524 DOI: 10.1016/j.cancergen.2015.03.005] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 03/05/2015] [Accepted: 03/06/2015] [Indexed: 12/30/2022]
Abstract
Unlike patients with World Health Organization (WHO) grade I meningiomas, which are considered benign, patients with WHO grade III meningiomas have very high mortality rates. The principles underlying tumor progression in meningioma are largely unknown, yet a detailed understanding of these mechanisms will be required for effective management of patients with these high grade lethal tumors. We present a case of an intraventricular meningioma that at first presentation displayed remarkable morphologic heterogeneity-composed of distinct regions independently fulfilling histopathologic criteria for WHO grade I, II, and III designations. The lowest grade regions had classic meningothelial features, while the highest grade regions were markedly dedifferentiated. Whereas progression in meningiomas is generally observed during recurrence following radiation and systemic medical therapies, the current case offers us a snapshot of histologic progression and intratumoral heterogeneity in a native pretreatment context. Using whole exome sequencing and high resolution array-based comparative genomic hybridization, we observed marked genetic heterogeneity between the various areas. Notably, in the higher grade regions we found increased aneuploidy with progressive loss of heterozygosity, the emergence of mutations in the TERT promoter, and compromise of ARID1A. These findings provide new insights into intratumoral heterogeneity in the evolution of malignant phenotypes in anaplastic meningiomas and potential pathways of malignant progression.
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Affiliation(s)
- Malak S Abedalthagafi
- Division of Neuropathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Parker H Merrill
- Division of Neuropathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - William J Gibson
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Matthew F Rose
- Division of Neuropathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ziming Du
- Division of Neuropathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joshua M Francis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Rose Du
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ian F Dunn
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Azra H Ligon
- Clinical Cytogenetics Laboratory, Center for Advanced Molecular Diagnostics, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rameen Beroukhim
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Sandro Santagata
- Division of Neuropathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, USA.
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