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Rincon-Torroella J, Rakovec M, Khalafallah AM, Liu A, Bettegowda A, Kut C, Rodriguez FJ, Weingart J, Luciano M, Olivi A, Jallo GI, Brem H, Mukherjee D, Lim M, Bettegowda C. Clinical features and surgical outcomes of intracranial and spinal cord subependymomas. J Neurosurg 2022; 137:931-942. [PMID: 35148513 DOI: 10.3171/2021.12.jns211643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/02/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Subependymomas are low-grade ependymal tumors whose clinical characteristics, radiographic features, and postsurgical outcomes are incompletely characterized due to their rarity. The authors present an institutional case series and a systematic literature review to achieve a better understanding of subependymomas. METHODS Adult patients with histologically confirmed subependymoma or mixed subependymoma-ependymoma surgically treated at a tertiary hospital between 1992 and 2020 were identified. A systematic literature review of the PubMed, Embase, Web of Science, and Google Scholar databases from inception until December 4, 2020, was conducted according to PRISMA guidelines. Data extracted from both groups included demographics, radiographic features, tumor characteristics, management, and follow-up variables. RESULTS Forty-eight unique patients with subependymoma were identified by chart review; of these patients, 8 (16.7%) had mixed subependymoma-ependymoma tumors. The median age at diagnosis was 49 years (IQR 19.8 years), and 26 patients (54.2%) were male. Forty-two patients (87.5%) had intracranial subependymomas, and 6 (12.5%) had spinal tumors. The most common presentation was headache (n = 20, 41.7%), although a significant number of tumors were diagnosed incidentally (n = 16, 33.3%). Among the 42 patients with intracranial tumors, 15 (35.7%) had hydrocephalus, and the most common surgical strategy was a suboccipital approach with or without C1 laminectomy (n = 26, 61.9%). Gross-total resection (GTR) was achieved in 33 cases (68.7%), and 2 patients underwent adjuvant radiotherapy. Most patients had no major postsurgical complications (n = 34, 70.8%), and only 1 (2.1%) had recurrence after GTR. Of 2036 reports initially identified in the systematic review, 39 were eligible for inclusion, comprising 477 patients. Of 462 patients for whom tumor location was reported, 406 (87.9%) were intracranial, with the lateral ventricle as the most common location (n = 214, 46.3%). Spinal subependymomas occurred in 53 patients (11.5%), with 3 cases (0.6%) in multiple locations. Similar to the case series at the authors' institution, headache was the most common presenting symptom (n = 231, 54.0%) among the 428 patients whose presentation was reported. Twenty-seven patients (6.3%) were diagnosed incidentally, and 36 cases (8.4%) were found at autopsy. Extent of resection was reported for 350 patients, and GTR was achieved in 250 (71.4%). Fifteen of 337 patients (4.5%) had recurrence or progression. CONCLUSIONS The authors' case series and literature review demonstrate that patients with subependymoma are well managed with resection and generally have a favorable prognosis.
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Affiliation(s)
| | - Maureen Rakovec
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Adham M Khalafallah
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ann Liu
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anya Bettegowda
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carmen Kut
- 2Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fausto J Rodriguez
- 3Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jon Weingart
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mark Luciano
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alessandro Olivi
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - George I Jallo
- 4Department of Neurosurgery, Johns Hopkins Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, Florida; and
| | - Henry Brem
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Debraj Mukherjee
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- 5Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Michael Lim
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chetan Bettegowda
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Vasilica AM, Sefcikova V, Samandouras G. Genetic alterations in non-syndromic, familial gliomas in first degree relatives: A systematic review. Clin Neurol Neurosurg 2020; 198:106222. [PMID: 33039851 DOI: 10.1016/j.clineuro.2020.106222] [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: 06/11/2020] [Revised: 08/29/2020] [Accepted: 09/06/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Despite numerous reports in syndromic gliomas, the underlying genetic and molecular basis of familial, non-syndromic gliomas, in first degree relatives, remains unclear. This rare cohort of patients harboring invasive primary brain tumors with poor prognosis may provide a potential substrate of understanding the complex genetic cascade triggering tumorigenesis. METHODS A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) 2015 and The Cochrane Handbook of Systematic Reviews of Interventions. PubMed/MEDLINE, Embase and CENTRAL databases were accessed with set inclusion and exclusion criteria. RESULTS Following returns of 6756 articles, systematic analysis resulted in 48 papers, with 18 case series, 4 linkage analysis, 3 case-control studies, 1 cohort study, and 22 case reports. A total of 164 first degree relatives of 72 families were analyzed. The most common genetic alterations associated with non-syndromic familial gliomas reported to affect chromosomes 17 (51.1 % germline and 9.3 % tumor mutations), 22 (15.6 % germline and 6 % tumor mutations) and 1 and 19 (4.4 % germline and 9.3 % tumor mutations), with the most commonly affected genes TP53 (8.5 %) and NF2 (3.7 %). Tumor suppressors or cell-cycle regulators, cell signaling and transcription regulation or methylation were the most common gene function categories. CONCLUSION Four specific chromosomes (17, 22, 1 and 19) and two specific genes (TP53 and NF2) appear to be most commonly involved. This appears to be the first systematic review of genetic factors underlying non-syndromic glioma clustering in families. The defined list of genetic abnormalities, linked to familial gliomas, may facilitate therapeutic targets and future treatment design.
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Affiliation(s)
| | - Viktoria Sefcikova
- UCL Queen Square Institute of Neurology, University College London, Queen Square, London, United Kingdom.
| | - George Samandouras
- UCL Queen Square Institute of Neurology, University College London, Queen Square, London, United Kingdom; Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
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Chen BY, Praeger A, Christie M, Yuen T. Familial intracranial ependymoma mimicking an extra-lesion: A case report and review of the literature. J Clin Neurosci 2020; 74:250-253. [PMID: 32146015 DOI: 10.1016/j.jocn.2020.01.051] [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: 11/15/2019] [Accepted: 01/11/2020] [Indexed: 11/25/2022]
Abstract
Familial occurrence of intracranial ependymoma, in the absence of neurofibromatosis type 2 (NF2), is very rare with only a few cases reported in the literature. We report a 62-year-old man, who presented with a posterior fossa ependymoma with the majority of the lesion in the cerebellopontine angle, mimicking an extra-axial tumour. His two brothers also had 4th ventricular ependymomas requiring surgical resection. Such cases add weight to the suggestion of a genetically predisposing mutation in familial cases of intracranial ependymomas. Further genetic testing may help to elucidate the location of the genetic abnormality in patients with non-NF2 familial intracranial ependymomas and promote a better understanding of this rare pathological entity.
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Affiliation(s)
- Bi Yi Chen
- Department of Neurosurgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 3000, Australia
| | - Adrian Praeger
- Department of Neurosurgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 3000, Australia
| | - Michael Christie
- Department of Pathology, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 3000, Australia
| | - Tanya Yuen
- Department of Neurosurgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 3000, Australia; Department of Surgery, University of Melbourne, Parkville, VIC 3000, Australia.
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Moinuddin FM, Ikbar Khairunnisa N, Hirano H, Hanada T, Hiraki T, Kirishima M, Kamimura K, Arita K. Bilateral lateral ventricular subependymoma with extensive multiplicity presenting with hemorrhage. Neuroradiol J 2017; 31:27-31. [PMID: 28696174 DOI: 10.1177/1971400917718843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This 48-year-old-man who had undergone right thyroid lobectomy for undifferentiated thyroid carcinoma nine years earlier developed generalized seizures. His cerebrospinal fluid was xanthochromic with elevation of total protein. Computed tomography (CT) showed mixed-density bilateral ventricular masses. Magnetic resonance imaging (MRI) revealed multiple nodules in both lateral ventricles; they were heterogeneously enhanced by gadolinium. Diffuse hyperintensity in the right medial temporal lobe and bilateral subependymal area was noted on fluid-attenuated inversion recovery images. Susceptibility-weighted imaging showed low intensity in the masses and cerebellar sulci suggesting hemorrhage and hemosiderin deposition. The preoperative diagnosis was disseminated malignant tumor with recurring hemorrhage. Histological examination of biopsy specimens showed clusters of cells with small uniform nuclei embedded in a dense fibrillary matrix of glial cells and microcystic degeneration. Pseudo-rosettes indicating ependymoma were absent. Microhemorrhages and hemosiderin deposits were noted. Immunohistochemically, the background fibrillary matrix and neoplastic cells were positive for glial fibrillary acidic protein. Mutated isocitrate dehydrogenase-1 was negative. The MIB-1 index was 1.5%. The tumor was pathologically diagnosed as subependymoma containing microhemorrhages and hemosiderin deposits. The extensive multiplicity and hemorrhage encountered in this case have rarely been reported in patients with subependymoma.
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Affiliation(s)
- F M Moinuddin
- 1 Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan
| | - Novita Ikbar Khairunnisa
- 1 Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan.,2 Faculty of Medicine, Diponegoro University, Indonesia
| | - Hirofumi Hirano
- 1 Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan
| | - Tomoko Hanada
- 1 Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan
| | - Tsubasa Hiraki
- 3 Department of Pathology, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan
| | - Mari Kirishima
- 4 Department of Pathology, Kagoshima University Hospital, Japan
| | - Kiyohisa Kamimura
- 5 Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan
| | - Kazunori Arita
- 1 Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan
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