1
|
Pai V, Laughlin S, Ertl-Wagner B. Imaging of pediatric glioneuronal and neuronal tumors. Childs Nerv Syst 2024:10.1007/s00381-024-06502-9. [PMID: 38960918 DOI: 10.1007/s00381-024-06502-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/10/2024] [Indexed: 07/05/2024]
Abstract
Glioneuronal tumors (GNTs) are an expanding group of primary CNS neoplasms, commonly affecting children, adolescents and young adults. Most GNTs are relatively indolent, low-grade, WHO grade I lesions. In the pediatric age group, GNTs have their epicenter in the cerebral cortex and present with seizures. Alterations in the mitogen-activated protein kinase (MAPK) pathway, which regulates cell growth, are implicated in tumorigenesis. Imaging not only plays a key role in the characterization and pre-surgical evaluation of GNTs but is also crucial role in follow-up, especially with the increasing use of targeted inhibitors and immunotherapies. In this chapter, we review the clinical and imaging perspectives of common pediatric GNTs.
Collapse
Affiliation(s)
- Vivek Pai
- Division of Neuroradiology, Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, 170 Elizabeth Street, Toronto, ON, M5G 1E8, Canada
- Department of Medical Imaging, University of Toronto, 263 McCaul St, 4Th Floor, Toronto, ON, M5T 1W7, Canada
| | - Suzanne Laughlin
- Division of Neuroradiology, Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, 170 Elizabeth Street, Toronto, ON, M5G 1E8, Canada
- Department of Medical Imaging, University of Toronto, 263 McCaul St, 4Th Floor, Toronto, ON, M5T 1W7, Canada
| | - Birgit Ertl-Wagner
- Division of Neuroradiology, Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, 170 Elizabeth Street, Toronto, ON, M5G 1E8, Canada.
- Department of Medical Imaging, University of Toronto, 263 McCaul St, 4Th Floor, Toronto, ON, M5T 1W7, Canada.
| |
Collapse
|
2
|
Chen Y, Buchanan P, Brossier NM, Navalkele P. Incidence and survival characteristics of pediatric ganglioglioma from 2004 to 2018, with focus on infratentorial sites. Neurooncol Pract 2024; 11:328-335. [PMID: 38737603 PMCID: PMC11085854 DOI: 10.1093/nop/npae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Background Ganglioglioma (GG) is a slow-growing glioneuronal neoplasm, most frequently seen in the supratentorial location in older children and associated with epilepsy syndromes. GG is rare in the infratentorial location, hence we embarked upon analyzing the National Cancer Institute's (NCI) Survival, Epidemiology, and End Results (SEER) database to better evaluate GG outcomes by location in comparison to the broader pediatric low-grade glioma (pLGG) population. Methods Pediatric patients diagnosed with GG and pLGG from 2004 to 2018 were included in the study. Their demographic, clinical, and survival characteristics were analyzed using SEER*Stat. Results This study describes the largest cohort of pediatric GG, including 852 cases from year 2004 to 2018, with focus on infratentorial sites. Patients with brainstem GG or those with subtotally resected disease were identified as having higher risk of death. Conclusions Our analysis highlights brainstem GG as a high-risk, poor-prognostic subgroup and elaborates on the incidence and survival characteristic of this lesser-known subgroup.
Collapse
Affiliation(s)
- Yongzhen Chen
- Saint Louis University School of Medicine, 1402 S Grand Blvd, Saint Louis, Missouri, USA
| | - Paula Buchanan
- Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Nicole M Brossier
- Department of Pediatrics, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Pournima Navalkele
- Division of Oncology, Children’s Hospital Orange County, Orange, California, USA
| |
Collapse
|
3
|
Pereira BJA, de Almeida AN, Paiva WS, Tzu WH, Marie SKN. Natural history and neuro-oncological approach in spinal gangliogliomas: a systematic review. Neurosurg Rev 2024; 47:93. [PMID: 38403664 DOI: 10.1007/s10143-024-02327-x] [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: 11/11/2023] [Revised: 02/16/2024] [Accepted: 02/18/2024] [Indexed: 02/27/2024]
Abstract
To describe the natural history of spinal gangliogliomas (GG) in order to determine the most appropriate neuro-oncological management. A Medline search for relevant publications up to July 2023 using the key phrase "ganglioglioma spinal" and "ganglioglioma posterior fossa" led to the retrieval of 178 studies. This corpus provided the basis for the present review. As an initial selection step, the following inclusion criteria were adopted: (i) series and case reports on spinal GG; (ii) clinical outcomes were reported specifically for GG; (iii) GG was the only pathological diagnosis for the evaluation of the tumor; (iv) papers written only in English was evaluated; and (v) papers describing each case in the series were included. The World Health Organization (WHO) 2021 grading criteria for gangliogliomas were applied. A total of 107 tumors were evaluated (63 from male patients and 44 from female patients; 1.43 male/1.0 female ratio, mean age 18.34 ± 15.84 years). The most common site was the cervical spine, accounting for 43 cases (40.18%); GTR was performed in 35 cases (32.71%) and STR in 71 cases (66.35%), while this information was not reported in 1 case (0.94%). 8 deaths were reported (7.47%) involving 2 males (25%) and 6 females (75%) aged 4-78 years (mean 34.27 ± 18.22) years. GGs located on the spine displayed the same gender ratio as these tumors in general. The most frequent symptom was pain and motor impairment, while the most prevalent location was the cervical spinal cord. GTR of the tumor posed a challenge for neurosurgeons, due to the difficulty of resecting the lesion without damaging the spinal eloquent area, explaining the lower rate of cure for this tumor type.
Collapse
Affiliation(s)
- Benedito Jamilson Araújo Pereira
- Laboratory of Molecular and Cellular Biology (LIM15), Department of Neurology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Avenida Dr Arnaldo, 455/ 4º Andar/ sala 4110, São Paulo, SP, Cep: 01246-903, Brazil.
| | - Antônio Nogueira de Almeida
- Neurosurgery Division, Department of Neurology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Wellingson Silva Paiva
- Neurosurgery Division, Department of Neurology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Wen Hung Tzu
- Neurosurgery Division, Department of Neurology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Suely Kazue Nagahashi Marie
- Laboratory of Molecular and Cellular Biology (LIM15), Department of Neurology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Avenida Dr Arnaldo, 455/ 4º Andar/ sala 4110, São Paulo, SP, Cep: 01246-903, Brazil
| |
Collapse
|
4
|
Erkan B, Demir S, Akpinar E, Akkurt TS, Tanriverdi O, Gunaldi O. A rare tumor in the sellar region: ganglioglioma, a case report and a general overview. Childs Nerv Syst 2023; 39:3621-3626. [PMID: 37432397 DOI: 10.1007/s00381-023-06073-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/05/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Gangliogliomas are rare mixed neuronal-glial tumors of the central nervous system, accounting for less than 2% of intracranial tumors. CASE DESCRIPTION This report presents a rare case of ganglioglioma in the sellar region of a 3-year-old and 5-month-old pediatric patient. The patient underwent surgical intervention initially through a transnasal transsphenoidal approach and subsequently through a transcranial pterional craniotomy approach. Subsequently, radiotherapy and chemotherapy were administered for residual tumor tissue. The purpose of this report is to highlight the presence of ganglioglioma as a distinct diagnosis in sellar region tumors, discuss the surgical, radiotherapy, and/or chemotherapy treatment options for sellar region gangliogliomas based on the literature, and contribute the patient's follow-up and treatment outcomes to the existing literature. CONCLUSION Complete tumor resection may not be feasible in sellar region gangliogliomas, especially in pediatric cases, due to endocrinological and vision-related complications. In cases where complete resection is not possible, radiotherapy and/or chemotherapy may be considered. However, the optimal treatment approach has not yet been established, and further research is needed.
Collapse
Affiliation(s)
- Buruc Erkan
- Department of Neurosurgery, Health Science University, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
| | - Suat Demir
- Department of Neurosurgery, Health Science University, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Ebubekir Akpinar
- Department of Neurosurgery, Health Science University, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Tuce Soylemez Akkurt
- Department of Pathology, Health Science University, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Osman Tanriverdi
- Department of Neurosurgery, Health Science University, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Omur Gunaldi
- Department of Neurosurgery, Health Science University, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| |
Collapse
|
5
|
Khan A, Sadek AR, Fabian M, Nader-Sepahi A. Spinal anaplastic ganglioglioma. Br J Neurosurg 2023; 37:1186-1189. [PMID: 32969749 DOI: 10.1080/02688697.2020.1823936] [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: 04/03/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Abstract
Anaplastic gangliogliomas of the spinal cord are extremely rare with only four cases reported in the literature. Here we present the case of a 22-year-old female who presented acutely with quadraparesis and urinary retention. Radiographic imaging demonstrated an intramedullary lesion within the cervical spine. She underwent a cervical laminectomy and resection of the lesion under neurophysiological monitoring. Post-operatively, she regained some function, but remained paraparetic. Histopathology demonstrated an anaplastic ganglioglioma (WHO Grade 3). She subsequently underwent radiotherapy. Following surgery, she remained stable and had MRC Grade 3 Power in all four limbs. Herein, we describe a previously undescribed case of cervical anaplastic ganglioglioma and review the existing literature.
Collapse
Affiliation(s)
- Amad Khan
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ahmed-Ramadan Sadek
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Division of Clinical Neurosciences, School of Medicine, University of Southampton, Southampton, UK
| | - Mark Fabian
- Department of Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ali Nader-Sepahi
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| |
Collapse
|
6
|
Younes SW, Charoenkijkajorn C, Pakravan M, Mortensen PW, Rivera AL, Britz GW, Wong MS, Lee AG. Papilledema as the Presenting Sign of Pineal Ganglioglioma. J Neuroophthalmol 2023:00041327-990000000-00397. [PMID: 37418610 DOI: 10.1097/wno.0000000000001931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Affiliation(s)
- Sami W Younes
- Department of Ophthalmology (SWY, AGL), University of Texas Medical Branch, Galveston, Texas; Department of Ophthalmology (CC, MP, PWM, AGL), Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas; Departments of Pathology and Genomic Medicine (ALR) and Neurosurgery (GWB, MSW), Houston Methodist Hospital, Houston, Texas; Departments of Ophthalmology, Neurology, and Neurosurgery (AGL), Weill Cornell Medicine, New York, New York; University of Texas MD Anderson Cancer Center (AGL), Houston, Texas; Texas A and M College of Medicine (AGL), Bryan, Texas; and Department of Ophthalmology (AGL), The University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | | | | | | | | | | | | | | |
Collapse
|
7
|
Thoma C, McKenna G. Intraventricular ganglioglioma: a rare case report. J Surg Case Rep 2023; 2023:rjad235. [PMID: 37128233 PMCID: PMC10148748 DOI: 10.1093/jscr/rjad235] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/04/2023] [Indexed: 05/03/2023] Open
Abstract
We report a case of an intraventricular ganglioglioma in a 23-year-old male. The patient presented with a 3-day history of headache and vomiting. Preoperative brain imaging revealed a calcified lesion within the trigone of the right lateral ventricle, with irregular enhancement, causing entrapment of the temporal horn of the lateral ventricle. At surgery, the lesion was haemorrhagic, easily friable and exhibited evidence of a previous recent haemorrhage. Histological and immunohistochemical studies showed a ganglioglioma with World Health Organisation Grade 1 characteristics. Gangliogliomas of the central nervous system are uncommon, and rarely occur in the lateral ventricle.
Collapse
Affiliation(s)
- Constantinos Thoma
- Correspondence address. Barts & The London School of Medicine & Dentistry, London E1 2AD, UK. E-mail: /
| | - Gráinne McKenna
- Neurosurgical Department, Royal London Hospital, London E1 1FR, UK
| |
Collapse
|
8
|
Capitanio JF, Mortini P. Other Less Prevalent Tumors of the Central Nervous System. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:607-643. [PMID: 37452956 DOI: 10.1007/978-3-031-23705-8_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
The presented tumors in this chapter are somewhat very rare, and their management is still debated due to the scarcity of information about their cell of origin, behavior, and biology. Treatment options are still limited, but we are confident that in the near future by discovering the genetic and biological mechanisms that drive tumor growth we will be able to offer new target therapies that should be flanked by surgery, radiotherapy, and chemotherapeutic agents actually in use. The purpose of this chapter is to highlight the most important known characteristics of these tumors offering the chance to recognize the disease and then offer the best opportunity for treatment to patients. The 5th WHO Classification Central Nervous System features substantial changes by moving further to advance the role of molecular diagnostics in CNS tumor classification, but remaining rooted in other established approaches to tumor characterization, including histology and immunohistochemistry, and probably, the category of many tumors will change. Here, the most important characteristics of each neoplasm are summarized focusing on genetic mechanisms and molecular pathways, their histopathologic footprints, signs and symptoms, radiologic features, therapeutic approaches, and prognosis as well as follow-up protocols. Schematic classifications are also presented to offer a better understanding of the pathology.
Collapse
Affiliation(s)
- Jody Filippo Capitanio
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy.
| |
Collapse
|
9
|
Baig Mirza A, Gebreyohanes A, Knight J, Bartram J, Vastani A, Kalaitzoglou D, Lavrador JP, Kailaya-Vasan A, Maratos E, Bell D, Thomas N, Gullan R, Malik I, Grahovac G. Prognostic factors for surgically managed intramedullary spinal cord tumours: a single-centre case series. Acta Neurochir (Wien) 2022; 164:2605-2622. [PMID: 35829775 DOI: 10.1007/s00701-022-05304-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/11/2022] [Indexed: 01/26/2023]
Abstract
PURPOSE Intramedullary spinal cord tumours (IMSCTs) are comparatively rare neoplasms. We present a single-centre clinical case series of adult patients with surgically managed IMSCTs. METHODS We performed a retrospective analysis of electronic patient records in the time period spanning July 2010 to July 2021. All adult patients that had undergone surgical management for IMSCTs were eligible for inclusion. Baseline and post-operative clinical and radiological characteristics, along with follow-up data, were assessed. We also performed a literature review with a focus on surgical outcomes for IMSCTs. RESULTS Sixty-six patients matched our selection criteria, with a median age of 42 years (range 23-85). Thirty-four ependymomas, 17 haemangioblastomas, 12 astrocytomas, 2 lymphomas and 1 teratoma were included. Statistical analysis yielded several significant findings: IMSCTs spanning a greater number of vertebral levels are significantly associated with poor McCormick outcomes (p = 0.03), presence of gait disturbance before surgery is significantly associated with poor outcome for both post-operative McCormick and Nurick scores (p = 0.007), and radicular pain present pre-operatively is significantly associated with a good post-operative McCormick score (p = 0.045). Haemangioblastomas are significantly more likely to have a clear intra-operative dissection plane compared to ependymomas and astrocytomas (p = 0.009). However, astrocytomas have a significantly higher prevalence of good McCormick outcomes compared to ependymomas and haemangioblastomas (p = 0.03). CONCLUSION Histological diagnosis, cranio-caudal extent of the tumour and the presence or absence of baseline deficits-such as gait impairment and radicular pain-are significant in determining neurological outcomes after surgery for IMSCTs.
Collapse
Affiliation(s)
- Asfand Baig Mirza
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK.
| | - Axumawi Gebreyohanes
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - James Knight
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - James Bartram
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Amisha Vastani
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Dimitrios Kalaitzoglou
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Jose Pedro Lavrador
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Ahilan Kailaya-Vasan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Eleni Maratos
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - David Bell
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Nick Thomas
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Richard Gullan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Irfan Malik
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Gordan Grahovac
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| |
Collapse
|
10
|
First Case of a Cerebrocortical Ganglioglioma in a Dog. Vet Sci 2022; 9:vetsci9100514. [PMID: 36288127 PMCID: PMC9610530 DOI: 10.3390/vetsci9100514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/02/2022] [Accepted: 09/17/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Gangliogliomas are extremely rare tumors of the nervous system that contain a mixture of neoplastic glial and neuronal cells. The aim of the present paper is to describe the clinical presentation, magnetic resonance imaging findings and histopathological and immunophenotypical characteristics of a cerebral cortex ganglioglioma in a 7-year-old Border Collie. The dog presented an acute onset of tonic-clonic epileptic seizures. Magnetic resonance imaging revealed a well-defined large intra-axial mass located on the left forebrain, mainly affecting the frontal cortex. The histopathological examination of the mass revealed a diffuse proliferation of neoplastic glial cells mixed with anomalous neuronal bodies. Immunohistochemical analyses confirmed the presence of two different populations of neoplastic cells. Most neoplastic glial cells were immunoreactive to glial fibrillary acidic protein and the other subset of neoplastic cells were positive to neuronal markers such as PGP 9.5, synaptophysin and neuron-specific enolase, suggestive of neuronal cells. These findings confirmed the diagnosis of a cerebrocortical ganglioglioma. To the authors’ knowledge, this is the first description of a cerebral cortex ganglioglioma in a dog. Abstract Gangliogliomas are extremely rare tumors of the nervous system composed of neoplastic glial and neuronal cells. The aim of the present paper is to describe the clinical presentation, magnetic resonance imaging (MRI) findings and histopathological and immunophenotypical characteristics of a cerebral cortex ganglioglioma in a 7-year-old Border Collie. The dog presented an acute onset of tonic-clonic epileptic seizures. MRI revealed a well-defined large intra-axial mass located on the left forebrain, mainly affecting the frontal cortex. Following humane euthanasia, the histopathological examination of the mass revealed a diffuse proliferation of neoplastic glial cells mixed with anomalous neuronal bodies. Immunohistochemical analyses confirmed the presence of two different populations of neoplastic cells. Most neoplastic glial cells were immunoreactive to glial fibrillary acidic protein (GFAP) and the other subset of neoplastic cells were positive to neuronal markers such as PGP 9.5, synaptophysin (SYN) and neuron-specific enolase (NSE), suggestive of neuronal cells. These findings confirmed the diagnosis of a cerebrocortical ganglioglioma. To the authors knowledge, this is the first description of a ganglioglioma of the cerebral cortex in a dog.
Collapse
|
11
|
Al-Dalahmah OA, Wang L, Hsiao SJ, Lin CC, Mansukhani MM, Canoll P, Bruce JN, Zanazzi G. Pineal region ganglioglioma: A neoplasm with a bimodal age distribution. Surg Neurol Int 2022; 13:245. [PMID: 35855114 PMCID: PMC9282777 DOI: 10.25259/sni_443_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/19/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Gangliogliomas arise very rarely in the pineal region, where their natural histories and pathologic features are poorly understood.
Case Description:
In this report, we describe a 36-year-old woman who presented with a seizure followed by worsening headache, dizziness, confusion, and intermittent left facial numbness over the next few weeks. A head CT scan showed a partially calcified pineal region mass with hydrocephalus. After an endoscopic third ventriculostomy, the patient underwent a resection of the tumor that contained dysplastic ganglion cells and piloid glial cells. Molecular profiling of this CNS WHO Grade 1 ganglioglioma revealed polysomies of chromosomes 7 and 9, and a BUB1 variant of uncertain significance, without known MAP kinase pathway alterations. From a review of the literature, we found two distinct age distributions for pineal ganglioglioma, with modes at 1 and 36 years of age.
Conclusion:
Although very rare, this tumor should be considered in the differential diagnosis of pineal region tumors in children and young adults.
Collapse
Affiliation(s)
- Osama A. Al-Dalahmah
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, United States
| | - Linda Wang
- Department of Neurosurgery, Columbia University Irving Medical Center, New York, United States
| | - Susan J. Hsiao
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, United States
| | - Chun-Chieh Lin
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
| | - Mahesh M. Mansukhani
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, United States
| | - Peter Canoll
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, United States
| | - Jeffrey N. Bruce
- Department of Neurosurgery, Columbia University Irving Medical Center, New York, United States
| | - George Zanazzi
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
| |
Collapse
|
12
|
Cases-Cunillera S, van Loo KMJ, Pitsch J, Quatraccioni A, Sivalingam S, Salomoni P, Borger V, Dietrich D, Schoch S, Becker AJ. Heterogeneity and excitability of BRAFV600E-induced tumors is determined by Akt/mTOR-signaling state and Trp53-loss. Neuro Oncol 2022; 24:741-754. [PMID: 34865163 PMCID: PMC9071348 DOI: 10.1093/neuonc/noab268] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Developmental brain tumors harboring BRAFV600E somatic mutation are diverse. Here, we describe molecular factors that determine BRAFV600E-induced tumor biology and function. METHODS Intraventricular in utero electroporation in combination with the piggyBac transposon system was utilized to generate developmental brain neoplasms, which were comprehensively analyzed with regard to growth using near-infrared in-vivo imaging, transcript signatures by RNA sequencing, and neuronal activity by multielectrode arrays. RESULTS BRAF V600E expression in murine neural progenitors elicits benign neoplasms composed of enlarged dysmorphic neurons and neoplastic astroglia recapitulating ganglioglioma (GG) only in concert with active Akt/mTOR-signaling. Purely glial tumors resembling aspects of polymorphous low-grade neuroepithelial tumors of the young (PLNTYs) emerge from BRAFV600E alone. Additional somatic Trp53-loss is sufficient to generate anaplastic GGs (aGGs) with glioneuronal clonality. Functionally, only BRAFV600E/pAkt tumors intrinsically generate substantial neuronal activity and show enhanced relay to adjacent tissue conferring high epilepsy propensity. In contrast, PLNTY- and aGG models lack significant spike activity, which appears in line with the glial differentiation of the former and a dysfunctional tissue structure combined with reduced neuronal transcript signatures in the latter. CONCLUSION mTOR-signaling and Trp53-loss critically determine the biological diversity and electrical activity of BRAFV600E-induced tumors.
Collapse
Affiliation(s)
- Silvia Cases-Cunillera
- Institute of Neuropathology, Section for Translational Epilepsy Research, Medical Faculty, University of Bonn, Bonn, Germany
| | - Karen M J van Loo
- Institute of Neuropathology, Section for Translational Epilepsy Research, Medical Faculty, University of Bonn, Bonn, Germany
- Department of Epileptology, Neurology, RWTH Aachen University, Aachen, Germany
| | - Julika Pitsch
- Department of Epileptology, Medical Faculty, University of Bonn, Bonn, Germany
| | - Anne Quatraccioni
- Institute of Neuropathology, Section for Translational Epilepsy Research, Medical Faculty, University of Bonn, Bonn, Germany
| | - Sugirthan Sivalingam
- Institute of Neuropathology, Section for Translational Epilepsy Research, Medical Faculty, University of Bonn, Bonn, Germany
- Department of Human Genetics, Medical Faculty, University of Bonn, Bonn, Germany
| | - Paolo Salomoni
- Nuclear Function Group, German Centre for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Dirk Dietrich
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Susanne Schoch
- Department of Epileptology, Medical Faculty, University of Bonn, Bonn, Germany
| | - Albert J Becker
- Institute of Neuropathology, Section for Translational Epilepsy Research, Medical Faculty, University of Bonn, Bonn, Germany
| |
Collapse
|
13
|
Intradural Pediatric Spinal Tumors: An Overview from Imaging to Novel Molecular Findings. Diagnostics (Basel) 2021; 11:diagnostics11091710. [PMID: 34574050 PMCID: PMC8469574 DOI: 10.3390/diagnostics11091710] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/11/2021] [Accepted: 09/14/2021] [Indexed: 12/20/2022] Open
Abstract
Pediatric spinal tumors are rare and account for 10% of all central nervous system tumors in children. Onset usually occurs with chronic nonspecific symptoms and may depend on the intra- or extradural neoplastic location. Meningiomas, schwannomas, and neurofibromas are the most common intradural-extramedullary lesions, while astrocytomas and ependymomas represent the majority of intramedullary tumors. The new molecular discoveries regarding pediatric spinal cancer currently contribute to the diagnostic and therapeutic processes. Moreover, some familial genetic syndromes can be associated with the development of spinal tumors. Currently, magnetic resonance imaging (MRI) is the standard reference for the evaluation of pediatric spinal tumors. Our aim in this review was to describe the imaging of the most frequent intradural intra/extramedullary pediatric spinal tumors and to investigate the latest molecular findings and genetic syndromes.
Collapse
|
14
|
Gaddipati R, Ma J, Dayawansa S, Shan Y, Huang JH, Garrett D, Qaiser R. Lumbar Ganglioneuroma Presenting With Scoliosis. Cureus 2021; 13:e16794. [PMID: 34513400 PMCID: PMC8405311 DOI: 10.7759/cureus.16794] [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: 07/18/2021] [Accepted: 07/30/2021] [Indexed: 11/05/2022] Open
Abstract
Ganglioneuromas are rare, benign tumors arising from the sympathetic nervous system. The presentation of the tumor is variable and may be associated with scoliosis. Few reports of ganglioneuroma associated with scoliosis- exist and most involve the thoracic spine. Here, we present a 13-year-old female with scoliosis who was found to have a lumbar ganglioneuroma. The patient was treated with a subtotal resection and lumbar spinal fusion to correct her scoliosis in a single-stage operation. The patient's symptoms and scoliosis markedly improved following treatment without any complications. Additionally, we conducted an up-to-date literature review of ganglioneuromas associated with scoliosis that have been published in the last 20 years. We discuss variations in clinical presentation and surgical approach.
Collapse
Affiliation(s)
- Ravi Gaddipati
- Neurosurgery, Baylor Scott and White Medical Center - Temple, Temple, USA
| | - Joanna Ma
- Neurosurgery, Baylor Scott and White Medical Center - Temple, Temple, USA
| | - Samantha Dayawansa
- Neurosurgery, Baylor Scott and White Medical Center - Temple, Temple, USA
| | - Yuan Shan
- Pathology, Baylor Scott and White Medical Center - Temple, Temple, USA
| | - Jason H Huang
- Neurosurgery, Baylor Scott and White Medical Center - Temple, Temple, USA
| | - David Garrett
- Neurosurgery, Baylor Scott and White Medical Center - Temple, Temple, USA
| | - Rabia Qaiser
- Neurosurgery, Baylor Scott and White Medical Center - Temple, Temple, USA
| |
Collapse
|
15
|
Vlachos N, Lampros MG, Zigouris A, Voulgaris S, Alexiou GA. Anaplastic gangliogliomas of the spinal cord: a scoping review of the literature. Neurosurg Rev 2021; 45:295-304. [PMID: 34312775 DOI: 10.1007/s10143-021-01612-3] [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: 03/26/2021] [Revised: 06/24/2021] [Accepted: 07/18/2021] [Indexed: 11/24/2022]
Abstract
Gangliogliomas (GGs) are rare, usually low-grade tumors that account for 1-2% of all central nervous system (CNS) neoplasms. Spinal GGs are exceedingly rare (1% of all spinal tumors) and the presentation of anaplastic features in them is even rarer. According to the last World Health Organization (WHO) classification of CNS neoplasms, anaplastic GG (AGG) is classified as a malignant neoplasm (grade III). We performed a scoping review of the literature to elucidate the epidemiology, clinical features, histopathology, treatment, and outcome of primary spinal AGGs, which, to the best of our knowledge, is the first such review. Relevant studies were identified by a search of the MEDLINE and SCOPUS databases, using the following combination of search strings: (anaplastic ganglioglioma or malignant ganglioglioma or high grade ganglioglioma) AND (spine or spinal or spinal cord). We included studies related to primary or recurrent AGGs and malignant transformation of low-grade GGs. The search produced 15 eligible studies, plus two studies from the references, all of which were case reports of patients with spinal AGGs (17 studies with 22 patients). The mean age of the patients was 21.4 years and the sex ratio was 1:1, with male predominance. Motor impairment was the most common presentation, followed by sensory impairment, gait problems, urinary disturbances, and back pain. The thoracic spine was the most frequently involved area (14/22) followed by the cervical (6/22) and lumbar (5/22) spine. In terms of histology, the anaplastic features were usually predominant in the glial element, resembling high-grade astrocytomas, while the neuronal element was composed of the so-called dysplastic ganglion (neuronal) synaptophysin-positive cells, without mitotic figures. Complete surgical resection of the tumor without neurological compromise, plus adjuvant chemotherapy and radiotherapy, was the treatment protocol implemented in the two patients with the best outcome. Primary spinal AGG is an exceedingly rare entity, with only 22 cases being retrieved after an extensive literature search. They appear to affect children and young adults and tend to manifest aggressive behavior. Most studies report that only the glial component of AGGs presents high-grade malignant features, with low mitotic activity in the neuronal component. We therefore suggest that, pending novel targeted therapy, AGGs should be treated as high-grade gliomas, with an aggressive treatment protocol consisting of maximal safe resection and adjuvant chemotherapy and radiotherapy.
Collapse
Affiliation(s)
- Nikolaos Vlachos
- Department of Neurosurgery, University Hospital of Ioannina, PO BOX 103, 45500, Neohoropoulo, Ioannina, Greece
| | - Marios G Lampros
- Department of Neurosurgery, University Hospital of Ioannina, PO BOX 103, 45500, Neohoropoulo, Ioannina, Greece
| | - Andreas Zigouris
- Department of Neurosurgery, University Hospital of Ioannina, PO BOX 103, 45500, Neohoropoulo, Ioannina, Greece
| | - Spyridon Voulgaris
- Department of Neurosurgery, University Hospital of Ioannina, PO BOX 103, 45500, Neohoropoulo, Ioannina, Greece
| | - George A Alexiou
- Department of Neurosurgery, University Hospital of Ioannina, PO BOX 103, 45500, Neohoropoulo, Ioannina, Greece.
| |
Collapse
|
16
|
Cruz TZ, Ferreira-Pinto PHC, Brito ACG, Ururahy L, Sanchez JT, Nigri F. Ganglioglioma of the cervicothoracic spinal cord in a patient with neurofibromatosis type 1: A case report. Surg Neurol Int 2021; 12:313. [PMID: 34345454 PMCID: PMC8326088 DOI: 10.25259/sni_192_2021] [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: 02/24/2021] [Accepted: 05/26/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Gangliogliomas are rare tumors of the central nervous system. They are usually located intracranially and rarely in the spinal cord. There is no clear correlation between this tumor and neurofibromatosis type 1 (NF1) with only four cases described. The aim of this article is to describe one more case and add data to the literature regarding this rare association. Case Description: An 8-year-old boy with NF1 presented progressive asymmetrical paraparesis (Grade 4 medical research council scale on the right leg and Grade 3 on the left leg). The cervicothoracic spinal magnetic resonance imaging demonstrated an intramedullary lesion from C4 to T4 vertebrae. The patient underwent a microsurgical resection. A partial resection was performed due to a drop in the motor evoked potential signal amplitude during dissection. Pathology report revealed a ganglioglioma (World Health Organization Grade I). Postoperatively, the patient evolved with worsening of the paraparesis. A few weeks later, he has improved his preoperative functional neurological state (better strength and gait). Adjuvant radiotherapy was not used. The patient is being followed up at the neurosurgery outpatient clinic. Conclusion: This is another case of spinal ganglioglioma associated with NF1. The tumor must be included in the differential diagnosis of patients with NF1 and spinal lesions. Complete microsurgical resection remains the standard treatment for spinal gangliogliomas, however, in this specific case, it was decided to leave a portion of the tumor to prevent neurological damage. The prognosis and treatment of this condition associated with NF1 remains to be determined.
Collapse
Affiliation(s)
- Thainá Zanon Cruz
- Departament of Surgical Specialities and Neurosurgery, Neurosurgery Teaching and Assistance Unit, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil
| | - Pedro Henrique Costa Ferreira-Pinto
- Departament of Surgical Specialities and Neurosurgery, Neurosurgery Teaching and Assistance Unit, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil
| | | | - Leandro Ururahy
- Departament of Surgical Specialities and Neurosurgery, Neurosurgery Teaching and Assistance Unit, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil
| | - Jefferson Trivino Sanchez
- Departament of Surgical Specialities and Neurosurgery, Neurosurgery Teaching and Assistance Unit, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil
| | - Flavio Nigri
- Departament of Surgical Specialities and Neurosurgery, Neurosurgery Teaching and Assistance Unit, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil
| |
Collapse
|
17
|
Tuan TA, Duc NM. Giant Cerebellar Ganglioglioma Mimicking a Pilocytic Astrocytoma. J Clin Imaging Sci 2021; 11:3. [PMID: 33500838 PMCID: PMC7827300 DOI: 10.25259/jcis_212_2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 12/08/2020] [Indexed: 11/04/2022] Open
Abstract
A benign brain tumor, called a ganglioglioma (GG), can sometimes be found in the cerebrum. We describe an unusual pediatric case of GG in the cerebellum in this article. An 11-year-old male patient had a headache and epilepsy disorder. The head magnetic resonance imaging results revealed a giant cyst with an enhancing mural nodule in the right cerebellar hemisphere that flattened the fourth ventricle. Pilocytic astrocytoma was the provisional diagnosis based on clinical and imaging details. After radical mass eradication, a GG was demonstrated through histopathological analysis. Even though GG is an uncommon tumor, it should be included in the differential diagnosis for a cerebellar mass with both cystic and solid components in children.
Collapse
Affiliation(s)
- Tran Anh Tuan
- Departments of Radiology, Bach Mai Hospital, Ha Noi, Vietnam.,Hanoi Medical University, Ha Noi, Vietnam
| | - Nguyen Minh Duc
- Hanoi Medical University, Ha Noi, Vietnam.,Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.,Children's Hospital 02, Ho Chi Minh City, Vietnam
| |
Collapse
|
18
|
Klimko A, Dandes M, Paslaru F, Giovani A. Primary Anaplastic Ganglioglioma of the Temporal Lobe With Brainstem Involvement: A Case Report and Literature Review. Cureus 2020; 12:e12060. [PMID: 33447489 PMCID: PMC7802110 DOI: 10.7759/cureus.12060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Anaplastic ganglioglioma (AGG) is a rare and aggressive counterpart of the more benign and frequently encountered glioma. Herein, we present a 21-year-old female who presented with episodes of total amnesia and complex partial seizures, which led to the diagnosis of AGG localized to the medial temporal lobe. She subsequently underwent surgical cytoreduction of the tumor three times with adjuvant chemoradiotherapy. The extent of resection throughout the surgeries was hindered by the extension of the tumor to critical neurovascular structures; during the last surgery, invasion into the pons was noted, which posed a significant clinical challenge.
Collapse
Affiliation(s)
- Artsiom Klimko
- Division of Physiology and Neuroscience, University of Medicine and Pharmacy "Carol Davila", Bucharest, ROU
| | - Mariana Dandes
- Department of Neurological Surgery, Emergency Clinical Hospital "Arseni-Bagdasar", Bucharest, ROU
| | - Francesca Paslaru
- Department of Neurological Surgery, Emergency Clinical Hospital "Arseni-Bagdasar", Bucharest, ROU
| | - Andrei Giovani
- Department of Neurological Surgery, Emergency Clinical Hospital "Arseni-Bagdasar", Bucharest, ROU
| |
Collapse
|
19
|
|
20
|
Armas Melián K, Delgado López FJ, Medina Imbroda JM, Rodríguez Betancor D, Rodríguez Pons D. Intramedullary spinal cord ganglioglioma: Case report and comparative literature review. Neurocirugia (Astur) 2020; 32:124-133. [PMID: 33092982 DOI: 10.1016/j.neucir.2020.07.005] [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: 12/03/2019] [Revised: 04/20/2020] [Accepted: 07/16/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Intramedullary spinal cord gangliogliomas (ISCGGs) account for 35-40% of all intramedullary tumors in children. These tumors have a different algorithm for treatment and prognosis than other medullary tumors, such as astrocytomas and spinal ependymomas. The objective of the study was to review the literature and examine an approach to diagnosing and treating this tumor based on a case report of ISCGG diagnosed at our center. METHOD An exhaustive review of cases of ISCGG published via the PubMed-NCBI platform between 1911 and 2018 was performed, and each patient's epidemiological characteristics, tumor location, symptoms, radiological diagnosis and treatment were appended. RESULTS A total of 167 cases of ISCGG were found, including our own. In our sample, 52% of patients were female and the most commonly affected age group was 0-9 years of age (35% of patients). Motor deficit has been found to be the main symptom in a larger proportion of adults patients versus pediatric patients. On X-ray, this tumor shows greater hyperintensity and contrast uptake than astrocytomas and ependymomas, as well as a higher percentage of intratumoral cysts. The BRAFV600E mutation is less common in spinal as opposed to supratentorial gangliogliomas. Surgery with complete resection is the treatment of choice. Only 19% of the patients in the sample received radiotherapy, and only 9% received chemotherapy as their only line of treatment. CONCLUSIONS ISCGGs are common in the pediatric population and require strong suspicion for proper diagnosis and treatment, as the risk of recurrence of ISCGGs is 3 times greater than that of supratentorial gangliogliomas.
Collapse
Affiliation(s)
- Kevin Armas Melián
- Departamento de Neurocirugía, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Las Palmas, España.
| | - Francisco José Delgado López
- Departamento de Neurocirugía, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Las Palmas, España
| | - Juan Manuel Medina Imbroda
- Departamento de Neurocirugía, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Las Palmas, España
| | - Dailos Rodríguez Betancor
- Departamento de Neurocirugía, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Las Palmas, España
| | - Daniel Rodríguez Pons
- Departamento de Neurocirugía, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Las Palmas, España
| |
Collapse
|
21
|
Höhne J, Acerbi F, Falco J, Akçakaya MO, Schmidt NO, Kiris T, de Laurentis C, Ferroli P, Broggi M, Schebesch KM. Lighting Up the Tumor-Fluorescein-Guided Resection of Gangliogliomas. J Clin Med 2020; 9:jcm9082405. [PMID: 32731376 PMCID: PMC7465830 DOI: 10.3390/jcm9082405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 01/13/2023] Open
Abstract
(1) Background: Gangliogliomas comprise a small number of brain tumors. They usually present as World Health Organization (WHO) grade I, and they delineate on gadolinium-enhanced MRI; the surgical goal is wide radical resection, and the course thereafter is usually benign. Fluorescein sodium (FL) tends to accumulate in areas with altered blood–brain barrier (BBB). Thus far, the results provided by prospective and retrospective studies show that the utilization of this fluorophore may be associated with better visualization and improvement of resection for several tumors of the central nervous system. In this study, we retrospectively studied the effect of fluorescein sodium on visualization and resection of gangliogliomas. (2) Methods: Surgical databases in three neurosurgical departments (Regensburg University Hospital; Besta Institute, Milano, Italy; and Liv Hospital, Istanbul, Turkey), with approval by the local ethics committee, were retrospectively reviewed to find gangliogliomas surgically removed by a fluorescein-guided technique by the aid of a dedicated filter on the surgical microscope from April 2014 to February 2020. Eighteen patients (13 women, 5 men; mean age 22.9 years, range 3 to 78 years) underwent surgical treatment for gangliogliomas during 19 operations. Fluorescein was intravenously injected (5 mg/kg) after general anesthesia induction. Tumors were removed using a microsurgical technique with the YELLOW 560 Filter (YE560) (KINEVO/PENTERO 900, Carl Zeiss Meditec, Oberkochen, Germany). (3) Results: No side effects related to fluorescein occurred. In all tumors, contrast enhancement on preoperative MRI correlated with bright yellow fluorescence during the surgical procedure (17 gangliogliomas WHO grade I, 1 ganglioglioma WHO grade II). Fluorescein was considered helpful by the operating surgeon in distinguishing tumors from viable tissue in all cases (100%). Biopsy was intended in two operations, and subtotal resection was intended in one operation. In all other operations considered preoperatively eligible, gross total resection (GTR) was achieved in 12 out of 16 (75%) instances. (4) Conclusions: The use of FL and YE560 is a readily available method for safe fluorescence-guided tumor resection, possibly visualizing tumor margins intraoperatively similar to contrast enhancement in T1-weighted MRI. Our data suggested a positive effect of fluorescein-guided surgery on intraoperative visualization and extent of resection during resection of gangliogliomas.
Collapse
Affiliation(s)
- Julius Höhne
- Department of Neurosurgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (N.O.S.); (K.-M.S.)
- Correspondence: ; Tel.: +49-941-944-19007
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy; (F.A.); (J.F.); (C.d.L.); (P.F.); (M.B.)
| | - Jacopo Falco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy; (F.A.); (J.F.); (C.d.L.); (P.F.); (M.B.)
| | - Mehmet Osman Akçakaya
- Department of Neurosurgery Liv Hospital Ulus Affiliated with Istinye University Medical Faculty, Istanbul 34340, Turkey; (M.O.A.); (T.K.)
| | - Nils Ole Schmidt
- Department of Neurosurgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (N.O.S.); (K.-M.S.)
| | - Talat Kiris
- Department of Neurosurgery Liv Hospital Ulus Affiliated with Istinye University Medical Faculty, Istanbul 34340, Turkey; (M.O.A.); (T.K.)
| | - Camilla de Laurentis
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy; (F.A.); (J.F.); (C.d.L.); (P.F.); (M.B.)
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy; (F.A.); (J.F.); (C.d.L.); (P.F.); (M.B.)
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy; (F.A.); (J.F.); (C.d.L.); (P.F.); (M.B.)
| | - Karl-Michael Schebesch
- Department of Neurosurgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (N.O.S.); (K.-M.S.)
| |
Collapse
|
22
|
Ho CY, Bornhorst M, Almira-Suarez MI, Donev K, Grafe M, Gordish-Dressman H, Rodriguez FJ. Clinicopathologic Features of Diencephalic Neuronal and Glioneuronal Tumors. J Neuropathol Exp Neurol 2020; 79:67-73. [PMID: 31793986 DOI: 10.1093/jnen/nlz115] [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: 07/28/2019] [Revised: 09/25/2019] [Accepted: 10/31/2019] [Indexed: 11/12/2022] Open
Abstract
Neuronal/mixed glioneuronal tumors are central nervous system neoplasms composed of neoplastic neuronal cell components or a mixture of glial and neuronal elements. They occur in cerebral hemispheres, posterior fossa, and spinal cord. Compared with other tumors at these locations, diencephalic neuronal/glioneuronal tumors are very rare and therefore not well characterized. We hereby performed clinicopathologic evaluation on 10 neuronal/glioneuronal tumors arising from the diencephalic region. Morphologically, these tumors resemble their histologic counterparts in other locations, except that lymphocytic infiltrates and microcalcifications are more common than Rosenthal fibers or eosinophilic granular bodies. The BRAFV600 mutation rate is 75%. Given the high percentage of samples being small biopsy specimens, the subtle histologic features and molecular findings greatly aided in establishing the pathologic diagnosis in several cases. At a median follow-up of 42 months, 71% of the tumors demonstrated radiological recurrence or progression, with median progression-free survival of 18 months. Recurrence/progression is observed in tumors across different histologic subtypes, necessitating additional therapies in 56% of the cases. Despite their bland histology, diencephalic neuronal/glioneuronal tumors are not clinically indolent. Their frequent recurrences warrant a close follow-up, and the prevalent BRAF mutation makes MAPK pathway inhibition a plausible treatment option when conventional therapies fail.
Collapse
Affiliation(s)
- Cheng-Ying Ho
- Department of Pathology and Neurology, University of Maryland School of Medicine, Baltimore, Maryland (C-YH)
| | | | - M Isabel Almira-Suarez
- Division of Pathology (C-YH, MIA-S), Children's National Health System, Washington, District of Columbia
| | - Kliment Donev
- Department of Pathology, Beaumont Health, Royal Oak, Michigan (KD)
| | - Marjorie Grafe
- Department of Pathology, Oregon Heath & Science University, Portland, Oregon (MG)
| | | | - Fausto J Rodriguez
- Department of Pathology and Neurology, University of Maryland School of Medicine, Baltimore, Maryland (C-YH)
| |
Collapse
|
23
|
Diffuse midline glioma of the cervical spinal cord with H3 K27M genotype phenotypically mimicking anaplastic ganglioglioma: a case report and review of the literature. Brain Tumor Pathol 2020; 37:89-94. [PMID: 32451719 PMCID: PMC7324431 DOI: 10.1007/s10014-020-00365-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/08/2020] [Indexed: 02/07/2023]
Abstract
Here, we report on a 28-year old male patient presenting with neck and shoulder pain, dysesthesia of all four limbs and hypesthesia of both hands, without motor deficits. Magnetic resonance imaging showed an intradural, intramedullary mass of the cervical spinal cord of 6.4 cm length and 1.7 cm diameter. The patient underwent surgical resection. Histological and immunohistochemical evaluation showed pleomorphic glial tumor cells, mitoses, calcifications, and atypical ganglioid cells compatible with the morphology of anaplastic ganglioglioma (WHO Grade III). Extensive molecular workup revealed H3F3A K27M, TERT C228T and PDGFRα Y849C mutations indicating poor prognosis. The H3F3A K27M mutation assigned the tumor to the molecular group of diffuse midline glioma (WHO Grade IV). Epigenome-wide methylation profiling confirmed the methylation class of diffuse midline glioma. Thus, this is a very rare case of malignant glioma with H3 K27M genotype phenotypically mimicking anaplastic ganglioglioma. This case emphasizes the importance of comprehensive morphological and molecular workup including methylome profiling for advanced patient care.
Collapse
|
24
|
Oushy S, Perry A, Graffeo CS, Raghunathan A, Carlstrom LP, Daniels DJ. Pediatric ganglioglioma of the brainstem and cervicomedullary junction: a retrospective cohort study. J Neurosurg Pediatr 2020; 25:30-36. [PMID: 31585412 DOI: 10.3171/2019.7.peds1961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 07/29/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Ganglioglioma is a low-grade central nervous system neoplasm with a pediatric predominance, accounting for 10% of all brain tumors in children. Gangliogliomas of the cervicomedullary junction (GGCMJs) and brainstem (GGBSs) present a host of management challenges, including a significant risk of surgical morbidity. At present, understanding of the prognostic factors-including BRAF V600E status-is incomplete. Here, the authors report a single-institution GGCMJ and GGBS experience and review the pertinent literature. METHODS A prospectively maintained neurosurgical database at a large tertiary care academic referral center was retrospectively queried for cases of GGCMJ pathologically confirmed in the period from 1995 to 2015; appropriate cases were defined by diagnosis codes and keywords. Secondary supplemental chart review was conducted to confirm or capture relevant data. The primary study outcome was treatment failure as defined by evidence of radiographic recurrence or progression and/or clinical or functional decline. A review of the literature was conducted as well. RESULTS Five neurosurgically managed GGBS patients were identified, and the neoplasms in 4 were classified as GGCMJ. All 5 patients were younger than 18 years old (median 15 years, range 4-16 years) and 3 (60%) were female. One patient underwent gross-total resection, 2 underwent aggressive subtotal resection (STR), and 2 underwent stereotactic biopsy only. All patients who had undergone STR or biopsy required repeat resection for tumor control or progression. Progressive disease was treated with radiotherapy in 2 patients, chemotherapy in 2, and chemoradiotherapy alone in 1. Immunostaining for BRAF V600E was positive in 3 patients (60%). All 5 patients experienced at least one major complication, including wound infection, foot drop, hemiparesis, quadriparesis, cranial neuropathy, C2-3 subluxation, syringomyelia, hydrocephalus, aspiration, and coma. Overall mortality was 20%, with 1 death observed over 11 years of follow-up. CONCLUSIONS GGBS and GGCMJ are rare, benign posterior fossa tumors that carry significant perioperative morbidity. Contemporary management strategies are heterogeneous and include combinations of resection, radiotherapy, and chemotherapy. The BRAF V600E mutation is frequently observed in GGBS and GGCMJ and appears to have both prognostic and therapeutic significance with targeted biological agents.
Collapse
|
25
|
Liu JK, Dodson VN. Microsurgical resection of brainstem cervicomedullary ganglioglioma: operative video and technique of creating a surgical pseudoplane for near-total resection. NEUROSURGICAL FOCUS: VIDEO 2019; 1:V13. [PMID: 36284876 PMCID: PMC9557339 DOI: 10.3171/2019.10.focusvid.19413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/29/2019] [Indexed: 11/06/2022]
Abstract
Cervicomedullary gangliogliomas are rare low-grade neoplasms of the brainstem. They can be challenging lesions to resect due to the eloquent location in the brainstem. In some instances, the absence of a clear surgical plane between the tumor and normal neural tissue can prohibit a complete resection. Therefore, it is important to leave a thin rim of residual tumor at the tumor-brainstem interface in order to avoid irreversible neurological injury. In this operative video, the authors demonstrate the technique to develop a surgical pseudoplane using sharp microdissection for a cervicomedullary brainstem ganglioglioma without a clear interface between the tumor and normal neural tissue. This strategy allowed for radical near-total resection of the tumor, thereby maximizing the extent of removal while preserving neurological function. Postoperatively, the patient had normal neurological function and returned to work without any disability. In summary, due to the lack of a clear surgical dissection plane, a pseudoplane near the surgical interface can be performed using sharp dissection to facilitate radical near-total resection. The video can be found here: https://youtu.be/biD4G1Hh0yk.
Collapse
|
26
|
Efficacy of Dabrafenib for three children with brainstem BRAFV600E positive ganglioglioma. J Neurooncol 2019; 145:135-141. [DOI: 10.1007/s11060-019-03280-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/29/2019] [Indexed: 12/22/2022]
|
27
|
Garnier L, Ducray F, Verlut C, Mihai MI, Cattin F, Petit A, Curtit E. Prolonged Response Induced by Single Agent Vemurafenib in a BRAF V600E Spinal Ganglioglioma: A Case Report and Review of the Literature. Front Oncol 2019; 9:177. [PMID: 30984614 PMCID: PMC6448025 DOI: 10.3389/fonc.2019.00177] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 03/04/2019] [Indexed: 12/11/2022] Open
Abstract
Spinal ganglioglioma is a rare low-grade, slow-growing tumor of the central nervous system affecting mostly children and young adults. After surgery, some patients show tumor recurrence and/or malignant transformation. Gangliogliomas harbor molecular deficiencies such as mutations in the B-rapidly accelerated fibrosarcoma (BRAF) gene, resulting in activation of a downstream signaling pathway and cancer development. Vemurafenib is a BRAF inhibitor used to treat patients with BRAF V600E-mutated cancer. Although a few studies have reported the clinical responses in gangliogliomas, the sequence and duration of treatment have not been established. We describe a case of an adult with a progressive BRAF V600E mutant spinal cord ganglioglioma 9 years after surgery who was treated with vemurafenib. This treatment resulted in a partial response within 2 months, which was sustained for more than a year. The patient then decided to stop treatment because of side effects. Despite this decision, the tumor showed no sign of progression 21 months after treatment discontinuation. This is the first reported case of a response to vemurafenib in an adult with progressive spinal cord BRAF V600E-mutated ganglioglioma which was sustained after treatment discontinuation.
Collapse
Affiliation(s)
- Louis Garnier
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - François Ducray
- Department of Neuro-Oncology, Hospices Civils de Lyon, Lyon, France
| | - Clotilde Verlut
- Department of Neurology, University Hospital of Besançon, Besançon, France
| | | | - Françoise Cattin
- Department of Radiology, University Hospital of Besançon, Besançon, France
| | - Antoine Petit
- Department of Neurosurgery, University Hospital of Besançon, Besançon, France
| | - Elsa Curtit
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| |
Collapse
|
28
|
Deora H, Sumitra S, Nandeesh BN, Bhaskara Rao M, Arivazhagan A. Spinal Intramedullary Ganglioglioma in Children: An Unusual Location of a Common Pediatric Tumor. Pediatr Neurosurg 2019; 54:245-252. [PMID: 31212295 DOI: 10.1159/000500427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 04/16/2019] [Indexed: 11/19/2022]
Abstract
Ganglioglioma is a common CNS tumor in children, mostly found in the temporal lobe, causing epilepsy. Spinal gangliogliomas are very rare, accounting for 1.1% of all intramedullary spinal tumors. The management principles and the need for adjuvant therapy are not yet well defined in this cohort. BRAF V600E mutation in spinal ganglioglioma has been described in a few series recently. In this report, we describe 3 children with spinal ganglioglioma at different locations, and their expression of BRAF V600E mutation and follow-up. In addition, we review the recent literature on pediatric spinal ganglioglioma management.
Collapse
Affiliation(s)
- Harsh Deora
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Sivakoti Sumitra
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Malla Bhaskara Rao
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Arimappamagan Arivazhagan
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India,
| |
Collapse
|
29
|
Lundar T, Due-Tønnessen BJ, Fric R, Egge A, Krossnes B, Due-Tønnessen P, Stensvold E, Brandal P. Neurosurgical treatment of gangliogliomas in children and adolescents: long-term follow-up of a single-institution series of 32 patients. Acta Neurochir (Wien) 2018; 160:1207-1214. [PMID: 29680921 PMCID: PMC5948304 DOI: 10.1007/s00701-018-3550-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/11/2018] [Indexed: 11/28/2022]
Abstract
Object The object of this study was to delineate long-term results of the surgical treatment of pediatric tumors classified as ganglioglioma or gangliocytoma. Methods A cohort of consecutive patients 19 years or younger who had undergone primary resection of CNS tumors during the years 1980–2016 at a single institution were reviewed in this retrospective study of surgical morbidity, mortality, and academic achievement and/or work participation. Gross motor function and activities of daily living were scored using the Barthel Index (BI). Results Patient records for 32 consecutive children and adolescents who had undergone resection for a ganglioglioma were included in this study. Of the 32 patients, 13 were in the first decade at the first surgery, whereas 19 were in the second decade. The male/female ratio was 1.0 (16/16). No patient was lost to follow-up. The tumor was localized to the supratentorial compartment in 26 patients, to the posterior fossa in 5 patients, and to the spinal cord in 1 patient. Only two of the tumors were classified as anaplastic. Of the 30 low-grade tumors, 2 were classified as gangliocytomas, 6 were desmoplastic infantile gangliogliomas, and 22 were ordinary gangliogliomas. The aim of primary surgery was gross-total resection (GTR) and was achieved in 23 patients (71.9%). Altogether, 43 tumor resections were performed. Eight patients underwent a second resection from 1 to 10 years after primary surgery and three of these also had a third resection from 2 to 24 years after initial surgery. The reason for further resection was clinical (seizure control failure/recurrence of epilepsy or progressive neurological deficit) and/or residual tumor progression/recurrence. There was no operative mortality in this series and all 32 patients are alive with follow-up periods from 0.5 to 36 years (median 14 years). Observed 14-year survival is thus 100%. One out of two children with primary anaplastic tumor received local radiotherapy (proton) postoperatively. The other 31 patients did not have any kind of non-surgical adjuvant therapy. Twenty-one out of 26 children with supratentorial tumor had epilepsy as one of their presenting symptoms. Nineteen of these became seizure-free after initial surgery (18 of them after GTR), but 3 patients experienced recurrence of seizures within some years. Functional outcome in terms of ADL, schooling, and work participation was gratifying in most patients. Five patients have persistent hydrocephalus (HC), treated with ventriculoperitoneal (VP) shunts. Conclusion Low-grade gangliogliomas (GGs) can be surgically treated with good long-term results including seizure and tumor control as well as school and working participation.
Collapse
Affiliation(s)
- Tryggve Lundar
- Department of Neurosurgery, Oslo University Hospital, Postboks 4054, Nydalen, 0407, Oslo, Norway.
- Faculty of Medicine, University of Oslo, Oslo, Norway.
| | | | - Radek Fric
- Department of Neurosurgery, Oslo University Hospital, Postboks 4054, Nydalen, 0407, Oslo, Norway
| | - Arild Egge
- Department of Neurosurgery, Oslo University Hospital, Postboks 4054, Nydalen, 0407, Oslo, Norway
| | - Bård Krossnes
- Department of Pathology, Oslo University Hospital, Oslo, Norway
| | | | - Einar Stensvold
- Department of Pediatrics, Oslo University Hospital, Oslo, Norway
| | - Petter Brandal
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
30
|
Marks AM, Bindra RS, DiLuna ML, Huttner A, Jairam V, Kahle KT, Kieran MW. Response to the BRAF/MEK inhibitors dabrafenib/trametinib in an adolescent with a BRAF V600E mutated anaplastic ganglioglioma intolerant to vemurafenib. Pediatr Blood Cancer 2018; 65:e26969. [PMID: 29380516 DOI: 10.1002/pbc.26969] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/08/2017] [Accepted: 12/11/2017] [Indexed: 01/28/2023]
Abstract
Efficacy of BRAF V600E targeted therapies in brain tumors harboring the mutation has been shown in several case reports and is currently being studied in larger clinical trials. Monotherapy with vemurafenib has been associated with significant side effects, including rashes, papillomas, and squamous cell carcinomas. Here we describe an adolescent female with anaplastic ganglioglioma and significant skin reaction to vemurafenib with subsequent tumor response and tolerance to the BRAF/MEK inhibitor combination of dabrafenib and trametinib without recurrence of previous reaction.
Collapse
Affiliation(s)
- Asher M Marks
- Department of Pediatric Hematology/Oncology, Yale University School of Medicine, New Haven, Connecticut
| | - Ranjit S Bindra
- Department of Radiation Oncology, Yale University School of Medicine, New Haven, Connecticut
| | - Michael L DiLuna
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Anita Huttner
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Vikram Jairam
- Department of Radiation Oncology, Yale University School of Medicine, New Haven, Connecticut
| | | | - Mark W Kieran
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| |
Collapse
|
31
|
Terrier LM, Bauchet L, Rigau V, Amelot A, Zouaoui S, Filipiak I, Caille A, Almairac F, Aubriot-Lorton MH, Bergemer-Fouquet AM, Bord E, Cornu P, Czorny A, Dam Hieu P, Debono B, Delisle MB, Emery E, Farah W, Gauchotte G, Godfraind C, Guyotat J, Irthum B, Janot K, Le Reste PJ, Liguoro D, Loiseau H, Lot G, Lubrano V, Mandonnet E, Menei P, Metellus P, Milin S, Muckenstrum B, Roche PH, Rousseau A, Uro-Coste E, Vital A, Voirin J, Wager M, Zanello M, François P, Velut S, Varlet P, Figarella-Branger D, Pallud J, Zemmoura I. Natural course and prognosis of anaplastic gangliogliomas: a multicenter retrospective study of 43 cases from the French Brain Tumor Database. Neuro Oncol 2018; 19:678-688. [PMID: 28453747 DOI: 10.1093/neuonc/now186] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 07/21/2016] [Indexed: 12/11/2022] Open
Abstract
Background Anaplastic gangliogliomas (GGGs) are rare tumors whose natural history is poorly documented. We aimed to define their clinical and imaging features and to identify prognostic factors. Methods Consecutive cases of anaplastic GGGs in adults prospectively entered into the French Brain Tumor Database between March 2004 and April 2014 were screened. After diagnosis was confirmed by pathological review, clinical, imaging, therapeutic, and outcome data were collected retrospectively. Results Forty-three patients with anaplastic GGG (median age, 49.4 y) from 18 centers were included. Presenting symptoms were neurological deficit (37.2%), epileptic seizure (37.2%), or increased intracranial pressure (25.6%). Typical imaging findings were unifocal location (94.7%), contrast enhancement (88.1%), central necrosis (43.2%), and mass effect (47.6%). Therapeutic strategy included surgical resection (95.3%), adjuvant radiochemotherapy (48.8%), or radiotherapy alone (27.9%). Median progression-free survival (PFS) and overall survival (OS) were 8.0 and 24.7 months, respectively. Three- and 5-year tumor recurrence rates were 69% and 100%, respectively. The 5-year survival rate was 24.9%. Considering unadjusted significant prognostic factors, tumor midline crossing and frontal location were associated with shorter OS. Temporal and parietal locations were associated with longer and shorter PFS, respectively. None of these factors remained statistically significant in multivariate analysis. Conclusions We report a large series providing clinical, imaging, therapeutic, and prognostic features of adult patients treated for an intracerebral anaplastic GGG. Our results show that pathological diagnosis is difficult, that survivals are only slightly better than for glioblastomas, and that complete surgical resection followed with adjuvant chemoradiotherapy offers longer survival.
Collapse
Affiliation(s)
- Louis-Marie Terrier
- CHRU de Tours, Service de Neurochirurgie, Tours, France.,Université François-Rabelais de Tours, Inserm, Imagerie et Cerveau UMR U930, Tours, France
| | - Luc Bauchet
- Department of Neurosurgery and INSERM U1051, Hôpital Saint Eloi - Gui de Chauliac, Montpellier, France.,French Brain Tumor DataBase, ICM, Montpellier, France
| | - Valérie Rigau
- French Brain Tumor DataBase, ICM, Montpellier, France.,Department of Neuropathology and INSERM U1051, Hôpital Saint Eloi - Gui de Chauliac, Montpellier, France
| | - Aymeric Amelot
- Department of Neurosurgery, Hôpital La Pitié Salpétrière, APHP, Paris, France
| | - Sonia Zouaoui
- Department of Neurosurgery and INSERM U1051, Hôpital Saint Eloi - Gui de Chauliac, Montpellier, France.,French Brain Tumor DataBase, ICM, Montpellier, France
| | - Isabelle Filipiak
- Plateforme CIRE, UMR-PRC, 37380 Nouzilly, Centre INRA Val de Loire, France
| | - Agnès Caille
- Université François-Rabelais de Tours, Tours, France.,Inserm, CIC 1415, CHRU de Tours, Tours, France.,Service de Neurochirurgie, CHU Jean-Minjoz, 3 boulevard Alexander-Fleming, Besançon cedex, France
| | - Fabien Almairac
- Department of Neurosurgery, Hôpital Pasteur, University Hospital Center, 06000, Nice, France
| | - Marie-Hélène Aubriot-Lorton
- Department of Pathology, Hôpital François Mitterand, CHU de Dijon, 14 rue Paul Gaffarel, 21000 Dijon, France
| | | | - Eric Bord
- Department of Neurosurgery and Neurotraumatology, Nantes University Hospital, Nantes, France
| | - Philippe Cornu
- Department of Neurosurgery, Hôpital La Pitié Salpétrière, APHP, Paris, France
| | - Alain Czorny
- Service de Neurochirurgie, CHU Jean-Minjoz, 3 boulevard Alexander-Fleming, Besançon cedex, France
| | - Phong Dam Hieu
- Department of Neurosurgery, CHU de la Cavale Blanche, Brest, France
| | - Bertrand Debono
- Department of Neurosurgery, Cèdres Hospital, Toulouse, France
| | - Marie-Bernadette Delisle
- Laboratoire Universitaire d'Anatomie Patholgique, Neuropathologie humaine et expérimentale, CHU Rangueil, Toulouse, France
| | - Evelyne Emery
- Department of Neurosurgery, University Hospital of Caen, Caen, France
| | - Walid Farah
- Service de Neurochirurgie, Hôpital François Mitterand, CHU de Dijon, 14 rue Paul Gaffarel, 21000 Dijon, France
| | - Guillaume Gauchotte
- Department of Pathology, CHU Nancy and INSERM U954, Faculty of Medicine, Université de Lorraine, France
| | | | - Jacques Guyotat
- Department of Neurosurgery, Neurological Hospital, Lyon, France
| | - Bernard Irthum
- Service de neurochirurgie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 58, rue Montalembert, 63003 Clermont-Ferrand, France
| | - Kevin Janot
- Service de Neuroradiologie, CHRU de Tours, Tours, France
| | - Pierre-Jean Le Reste
- Department of Neurosurgery, University Hospital Pontchaillou, 2, Rue Henri Le Guilloux, 35000, Rennes, France
| | - Dominique Liguoro
- Service de neurochirurgie A, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - Hugues Loiseau
- Université de Bordeaux - Service de Neurochirurgie B, hôpital Pellegrin Tripode, Bordeaux, France
| | - Guillaume Lot
- Department of Neurosurgery, Fondation Ophtalmologique Rothschild, Paris, France
| | - Vincent Lubrano
- Service de neurochirurgie, hôpital de Rangueil, CHU de Toulouse, 1, avenue du Professeur-Jean-Poulhès, TSA, Toulouse, France
| | | | - Philippe Menei
- Département de neurochirurgie, CHU d'Angers, 4, rue Larrey, 49940 Angers cedex 9, France
| | - Philippe Metellus
- Département de neurochirurgie, Aix-Marseille université, CHU Timone, Assistance publique-Hôpitaux de Marseille, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - Serge Milin
- Department of Pathology, CHU de Poitiers, Hôpital la Milétrie, Poitiers, France
| | | | - Pierre-Hugues Roche
- Service de Neurochirurgie, Hôpital Nord, APHM, University Hospital of Marseille Aix-Marseille Univ, Marseille, France
| | - Audrey Rousseau
- Département de Pathologie Cellulaire et Tissulaire, Centre Hospitalo-universitaire d'Angers, 4 rue Larrey, Angers Cedex, France
| | - Emmanuelle Uro-Coste
- CHU Toulouse, Hôpital de Rangueil, Service d'Anatomie et Cytologie Pathologique, Toulouse, France
| | - Anne Vital
- Bordeaux Institute of Neuroscience, CNRS UMR 5227, F-33076, Bordeaux, France
| | - Jimmy Voirin
- Department of Neurosurgery, Strasbourg-Colmar Hospital, France
| | - Michel Wager
- Department of Neurosurgery, Imaging Laboratory, University Hospital Poitiers, 2 Rue de La Miletrie, Poitiers Cedex, France
| | - Marc Zanello
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Department of Neurosurgery, Sainte-Anne Hospital, Paris, France
| | | | - Stéphane Velut
- CHRU de Tours, Service de Neurochirurgie, Tours, France.,Université François-Rabelais de Tours, Inserm, Imagerie et Cerveau UMR U930, Tours, France
| | - Pascale Varlet
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Department of Neuropathology, Sainte-Anne Hospital, Paris, France
| | | | - Johan Pallud
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Department of Neurosurgery, Sainte-Anne Hospital, Paris, France
| | - Ilyess Zemmoura
- CHRU de Tours, Service de Neurochirurgie, Tours, France.,Université François-Rabelais de Tours, Inserm, Imagerie et Cerveau UMR U930, Tours, France
| | | |
Collapse
|
32
|
Surgical treatment of neuronal-glial tumors of mesial-basal part of temporal lobe: Long term outcome and control of epilepsy in pediatric patients. Neurol Neurochir Pol 2018; 52:2-8. [DOI: 10.1016/j.pjnns.2017.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 04/04/2017] [Indexed: 11/20/2022]
|
33
|
Pelliccia V, Deleo F, Gozzo F, Sartori I, Mai R, Cossu M, Tassi L. Early and late epilepsy surgery in focal epilepsies associated with long-term epilepsy-associated tumors. J Neurosurg 2017; 127:1147-1152. [DOI: 10.3171/2016.9.jns161176] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVEEpilepsy surgery is an effective means of treating focal epilepsy associated with long-term epilepsy-associated tumors. This study evaluated a large population of surgically treated patients with childhood onset of epilepsy and a histologically confirmed diagnosis of long-term epilepsy-associated tumors. The authors analyzed long-term seizure outcomes to establish whether the time of surgery and patients' ages were determinant factors.METHODSThe authors separately investigated several presurgical, surgical, and postsurgical variables in patients operated on before (pediatric group) and at or after (adult group) the age of 18 years. Patients with < 24 months of postsurgical follow-up were excluded from the analysis.RESULTSThe patients who underwent surgery before 18 years of age showed better seizure outcomes than those after 18 years of age (80% vs 53.3% Engel Class Ia outcome, respectively; p < 0.001). Multivariate analysis showed that the only variables significantly associated with seizure freedom were complete resection of the lesion, a shorter duration of epilepsy, and temporal lobe resection.CONCLUSIONSThe findings of this study indicate that pediatric patients are more responsive to epilepsy surgery and that a shorter duration of epilepsy, complete resection, and a temporal lobe localization are determinant factors for a positive seizure outcome.
Collapse
Affiliation(s)
- Veronica Pelliccia
- 1“Claudio Murani” Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy; and
| | - Francesco Deleo
- 2Clinical Epileptology and Experimental Neurophysiology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Neurologico “C. Besta,” Milan, Italy
| | - Francesca Gozzo
- 1“Claudio Murani” Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy; and
| | - Ivana Sartori
- 1“Claudio Murani” Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy; and
| | - Roberto Mai
- 1“Claudio Murani” Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy; and
| | - Massimo Cossu
- 1“Claudio Murani” Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy; and
| | - Laura Tassi
- 1“Claudio Murani” Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy; and
| |
Collapse
|
34
|
BRAF V600E mutation is a significant prognosticator of the tumour regrowth rate in brainstem gangliogliomas. J Clin Neurosci 2017; 46:50-57. [PMID: 28986151 DOI: 10.1016/j.jocn.2017.09.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 08/22/2017] [Accepted: 09/18/2017] [Indexed: 02/01/2023]
Abstract
BRAF V600E mutations are progression factors in paediatric low-grade gliomas. Furthermore, a high percentage of paediatric brainstem gangliogliomas have BRAF V600E mutations. However, their clinical significance, including possible connections between the biomarkers and ganglioglioma's clinical features, especially a brainstem counterpart, is unclear. To identify potential molecular features predictive of brainstem ganglioglioma's clinical outcomes, a retrospective cohort of 28 World Health Organization (WHO) grade I brainstem gangliogliomas was analysed for BRAF V600E, IDH1 R132H, and IDH2 R172K mutations, TERT C228T/C250T promoter mutation, H3F3A K27M mutation and MGMT methylation. The volume of tumours was calculated accurately by using 3D Slicer software. The clinical data of these patients were retrospectively analysed. In tumours with BRAF V600E mutations, the tumour regrowth rate was significantly faster than that of the wild type group (p=0.001). Moreover, the BRAF V600E mutant group had shorter progression-free survival (PFS) compared with wild type (p=0.012). On multivariate analysis, no factor was found to be an independent prognostic factor; however, tumours with faster regrowth rates had a strong trend towards an increased risk for shorter PFS (HR=1.027, p=0.056). No statistical analysis could be performed to evaluate factors affecting overall survival (OS). These data suggest that BRAF V600E can predict the regrowth rate of brainstem gangliogliomas after microsurgery, and a BRAF V600E-targeted therapeutic may be a promising early intervention measure for patients who harbour BRAF V600E mutation after microsurgery.
Collapse
|
35
|
Ganglioglioma of brain stem and cervicomedullary junction: A 50 years review of literature. J Clin Neurosci 2017; 44:34-46. [DOI: 10.1016/j.jocn.2017.06.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/13/2017] [Indexed: 11/18/2022]
|
36
|
Valvi S, Ziegler DS. Ganglioglioma Arising From Desmoplastic Medulloblastoma: A Case Report and Review of Literature. Pediatrics 2017; 139:peds.2016-1403. [PMID: 28232638 DOI: 10.1542/peds.2016-1403] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2016] [Indexed: 11/24/2022] Open
Abstract
We describe a case of medulloblastoma maturating into ganglioglioma during therapy. A 10-month-old boy was diagnosed with a desmoplastic medulloblastoma and was treated with gross total resection followed by induction chemotherapy. A recurrence in the tumor bed during therapy was managed with focal radiation therapy and consolidation chemotherapy. After further progression, the recurrent tumor was resected completely. The histopathology revealed a benign ganglioglioma with no residual medulloblastoma. This case raises the possibility that a malignant medulloblastoma can differentiate into a benign tumor and suggests that differentiation therapy may have value in the treatment of medulloblastoma.
Collapse
Affiliation(s)
- Santosh Valvi
- Princess Margaret Hospital for Children, Perth, Western Australia, Australia;
| | - David S Ziegler
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia; and.,School of Women's and Children's Health, University of New South Wales, Australia
| |
Collapse
|
37
|
Pagès M, Beccaria K, Boddaert N, Saffroy R, Besnard A, Castel D, Fina F, Barets D, Barret E, Lacroix L, Bielle F, Andreiuolo F, Tauziède-Espariat A, Figarella-Branger D, Puget S, Grill J, Chrétien F, Varlet P. Co-occurrence of histone H3 K27M and BRAF V600E mutations in paediatric midline grade I ganglioglioma. Brain Pathol 2017; 28:103-111. [PMID: 27984673 DOI: 10.1111/bpa.12473] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 12/01/2016] [Indexed: 12/31/2022] Open
Abstract
Ganglioglioma (GG) is a grade I tumor characterized by alterations in the MAPK pathway, including BRAF V600E mutation. Recently, diffuse midline glioma with an H3 K27M mutation was added to the WHO 2016 classification as a new grade IV entity. As co-occurrence of H3 K27M and BRAF V600E mutations has been reported in midline tumors and anaplastic GG, we searched for BRAF V600E and H3 K27M mutations in a series of 54 paediatric midline grade I GG (midline GG) to determine the frequency of double mutations and its relevance for prognosis. Twenty-seven patients (50%) possessed the BRAF V600E mutation. The frequency of the co-occurrence of H3F3A/BRAF mutations at diagnosis was 9.3%. No H3 K27M mutation was detected in the absence of the BRAF V600E mutation. Double-immunostaining revealed that BRAF V600E and H3 K27M mutant proteins were present in both the glial and neuronal components. Immunopositivity for the BRAF V600E mutant protein correlated with BRAF mutation status as detected by massARRAY or digital droplet PCR. The median follow-up of patients with double mutation was 4 years. One patient died of progressive disease 8 years after diagnosis, whereas the four other patients were all alive with stable disease at the last clinical follow-up (at 9 months, 1 year and 7 years) without adjuvant therapy. We demonstrate in this first series of midline GGs that the H3 K27M mutation can occur in association with the BRAF V600E mutation in grade I glioneuronal tumors. Despite the presence of H3 K27M mutations, these cases should not be graded and treated as grade IV tumors because they have a better spontaneous outcome than classic diffuse midline H3 K27M-mutant glioma. These data suggest that H3 K27M cannot be considered a specific hallmark of grade IV diffuse gliomas and highlight the importance of integrated histomolecular diagnosis in paediatric brain tumors.
Collapse
Affiliation(s)
- Mélanie Pagès
- Department of Neuropathology, Sainte-Anne Hospital, Paris, France.,Paris V Descartes University, Paris, France.,Institut National de la Santé et de la Recherche Médicale, INSERM Unit 1000 "Neuroimaging & Psychiatry,", Université Paris Sud, Orsay
| | - Kevin Beccaria
- Department of Paediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France
| | - Nathalie Boddaert
- Department of Paediatric Neuroradiology, Necker Enfants Malades Hospital, Paris, France
| | - Raphaël Saffroy
- Department of Biochemistry, Paul Brousse Hospital, Paris, France
| | - Aurore Besnard
- Department of Neuropathology, Sainte-Anne Hospital, Paris, France
| | - David Castel
- UMR8203 "Vectorologie et Thérapeutiques Anticancéreuses," CNRS, Gustave Roussy, Univ. Paris-Sud, Université Paris-Saclay, Villejuif, 94805, France.,Département de Cancérologie de l'Enfant et de l'Adolescent, Gustave Roussy, Univ. Paris-Sud, Université Paris-Saclay, Villejuif, 94805, France
| | - Frédéric Fina
- Service de transfert d'Oncologie Biologique, LBM APHM Marseille, France
| | - Doriane Barets
- APHM, Hôpital de la Timone, Service d'Anatomie Pathologique et de Neuropathologie, Marseille, France
| | - Emilie Barret
- UMR8203 "Vectorologie et Thérapeutiques Anticancéreuses," CNRS, Gustave Roussy, Univ. Paris-Sud, Université Paris-Saclay, Villejuif, 94805, France.,Département de Cancérologie de l'Enfant et de l'Adolescent, Gustave Roussy, Univ. Paris-Sud, Université Paris-Saclay, Villejuif, 94805, France
| | - Ludovic Lacroix
- Departement de Biologie et Pathologie Médicales, Gustave Roussy, Univ. Paris-Sud, Université Paris-Saclay, Villejuif, 94805, France
| | - Franck Bielle
- Department of Neuropathology, Laboratoire Escourolle, Hôpitaux Universitaires Pitié Salpêtrière Charles Foix, AP-HP, Paris, France
| | | | | | - Dominique Figarella-Branger
- APHM, Hôpital de la Timone, Service d'Anatomie Pathologique et de Neuropathologie, Marseille, France.,Aix-Marseille Université, Inserm, CRO2 UMR_S 911, Marseille, France
| | - Stéphanie Puget
- Department of Paediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France
| | - Jacques Grill
- UMR8203 "Vectorologie et Thérapeutiques Anticancéreuses," CNRS, Gustave Roussy, Univ. Paris-Sud, Université Paris-Saclay, Villejuif, 94805, France.,Département de Cancérologie de l'Enfant et de l'Adolescent, Gustave Roussy, Univ. Paris-Sud, Université Paris-Saclay, Villejuif, 94805, France
| | - Fabrice Chrétien
- Department of Neuropathology, Sainte-Anne Hospital, Paris, France.,Paris V Descartes University, Paris, France.,Infection & Epidemiology Department, Human Histopathology and Animal Models Unit, Institut Pasteur, Paris, France
| | - Pascale Varlet
- Department of Neuropathology, Sainte-Anne Hospital, Paris, France.,Paris V Descartes University, Paris, France.,Institut National de la Santé et de la Recherche Médicale, INSERM Unit 1000 "Neuroimaging & Psychiatry,", Université Paris Sud, Orsay
| |
Collapse
|
38
|
Yamada S, Yamazaki T, Nakata S, Nobusawa S, Ikota H, Ide M, Mizushima K, Harigaya Y, Hirato J, Yokoo H. Dentatorubral-pallidoluysian atrophy (DRPLA) with a small ganglioglioma component containing neurofibrillary tangles and polyglutamine aggregation. Neuropathology 2017; 37:335-340. [DOI: 10.1111/neup.12365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 12/16/2016] [Accepted: 12/16/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Seiji Yamada
- Department of Human Pathology; Gunma University Graduate School of Medicine; Maebashi Japan
| | - Tatsuya Yamazaki
- Department of Human Pathology; Gunma University Graduate School of Medicine; Maebashi Japan
| | - Satoshi Nakata
- Department of Human Pathology; Gunma University Graduate School of Medicine; Maebashi Japan
| | - Sumihito Nobusawa
- Department of Human Pathology; Gunma University Graduate School of Medicine; Maebashi Japan
| | - Hayato Ikota
- Department of Human Pathology; Gunma University Graduate School of Medicine; Maebashi Japan
| | - Munenori Ide
- Department of Pathology; Maebashi Red Cross Hospital; Maebashi Gunma Japan
| | - Kazuyuki Mizushima
- Department of Neurology; Maebashi Red Cross Hospital; Maebashi Gunma Japan
| | - Yasuo Harigaya
- Department of Neurology; Maebashi Red Cross Hospital; Maebashi Gunma Japan
| | - Junko Hirato
- Department of Pathology; Gunma University Hospital; Maebashi Gunma Japan
| | - Hideaki Yokoo
- Department of Human Pathology; Gunma University Graduate School of Medicine; Maebashi Japan
| |
Collapse
|
39
|
|
40
|
Ravat S, Iyer V, Muzumdar D, Shah U, Pradhan P, Jain N, Godge Y. Clinical characteristics, surgical and neuropsychological outcomes in drug resistant tumoral temporal lobe epilepsy. Int J Surg 2016; 36:436-442. [DOI: 10.1016/j.ijsu.2015.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 09/28/2015] [Accepted: 10/17/2015] [Indexed: 11/29/2022]
|
41
|
Boissonneau S, Terrier LM, De La Rosa Morilla S, Troude L, Lavieille JP, Roche PH. Cerebellopontine angle gangliogliomas: Report of two cases. Neurochirurgie 2016; 62:266-270. [PMID: 27771109 DOI: 10.1016/j.neuchi.2016.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 06/14/2016] [Accepted: 07/09/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Gangliogliomas are rare tumors of the central nervous system. We report two unusual cases of gangliogliomas located in the cerebellopontine angle (CPA). POPULATION AND METHODS The first patient was a 57-year-old woman, who presented with dizziness and harbored a non-enhanced heterogeneous mass located in the cisternal space of the CPA. A partial microsurgical removal was performed, and the pathological examination concluded a grade I ganglioglioma according to the WHO Classification. The postoperative course was uneventful without any adjuvant treatment and the 5-year imaging follow-up indicated a stable remnant tumor. The second patient was a 35-year-old male who presented with acute vertigo and imbalance associated with recent prominent headaches; MR imaging showed a large heterogeneous and post-contrast enhanced tumor mass located in the CPA cistern with a mass effect on the brain. An optimal subtotal surgical resection was performed. The pathologists concluded a WHO grade III ganglioglioma. In spite of adjuvant radiotherapy and chemotherapy, the evolution proved unfavorable and patient died from cancer complications within a 2-year period. In both cases, the precise origin of the tumor could not be clearly identified even if the major component was present in the cisternal space. CONCLUSION Gangliogliomas growing into the cisternal spaces are exceedingly rare particularly in the CPA. Due to its infiltrating behavior and major difficulties to identify the tumor margins, total resection is not routinely feasible. The histological grading is the most important predictor for oncological prognosis.
Collapse
Affiliation(s)
- S Boissonneau
- Department of Neurosurgery, Assistance publique-Hôpitaux de Marseille, Aix-Marseille University, 13015 Marseille, France.
| | - L-M Terrier
- Department of Neurosurgery, CHRU de Tours, University François-Rabelais, 37000 Tours, France
| | - S De La Rosa Morilla
- Department of Neurosurgery, Assistance publique-Hôpitaux de Marseille, Aix-Marseille University, 13015 Marseille, France
| | - L Troude
- Department of Neurosurgery, Assistance publique-Hôpitaux de Marseille, Aix-Marseille University, 13015 Marseille, France
| | - J P Lavieille
- Department of ENT Surgery, Assistance publique-Hôpitaux de Marseille, Aix-Marseille University, 13015 Marseille, France
| | - P-H Roche
- Department of Neurosurgery, Assistance publique-Hôpitaux de Marseille, Aix-Marseille University, 13015 Marseille, France
| |
Collapse
|
42
|
Glioneuronal tumors of cerebral hemisphere in children: correlation of surgical resection with seizure outcomes and tumor recurrences. Childs Nerv Syst 2016; 32:1839-48. [PMID: 27659827 DOI: 10.1007/s00381-016-3140-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 06/01/2016] [Indexed: 01/05/2023]
Abstract
OBJECT Glioneuronal tumors are common neoplasms among the cerebral hemisphere during childhood. They consist of several histological types, of which gangliogliomas (GGs) and dysembryoplastic neuroepithelial tumors (DNTs) are most common and often present with seizures. A great majority of glioneuronal tumors are benign. However, there are conflict reports regarding postoperative tumor recurrence rates and seizure control. The authors analyzed and compared these tumors for their locations and histology and the tumor and seizure control following resection. METHODS The authors conducted a retrospective analysis of patients with pediatric glioneuronal tumors in the cerebral hemisphere. All histology reports and neuroimaging are reviewed. Seizure group and non-seizure group were compared with their tumor types and locations. The extent of tumor resections were divided into gross total resection (GTR) and subtotal resection (STR). Postoperative tumor recurrence-free survival (RFS) and seizure-free survival for patients who had the initial surgery done at our institution were calculated using Kaplan-Meier method. RESULTS There were 90 glioneuronal tumors including 58 GGs, 22 DNTs, 3 papillary glioneuronal tumor, 3 desmoplastic infantile gangliogliomas, 3 anaplastic GGs, and 1 central neurocytoma. Seventy-one patients (seizure group) presented with seizures. The temporal lobe is the most common location, 50 % in this series. GTR was attained in 79 patients and STR in 11. All of the patients with GTR had lesionectomy, and only six of them had extended corticectomy or partial lobectomy. Postoperative seizure outcome showed that 64 (90 %) of seizure group had Engel's class I, but five patients subsequently developed recurrent seizures. Patients with DNTs had a higher seizure recurrence rate. Tumor RFS was 87 % at 5 years and 75.5 % at 10 years. There are no significant difference in tumor recurrences between GGs and DNTs (p = 0.876). Comparison between GRT (67) and STR (9) showed that in spite of the better 5-year tumor RFSs among GRT group (94 %) than STR group (66 %), the 10-year RFSs showed no significant difference between GRT and STR groups (p = 0.719). Recurrent seizures are often related to recurrent tumor. CONCLUSION Lesionectomy alone often provides a high-rate seizure freedom. GGs and DNTs are benign tumor, but recurrences of GGs and DNTs are not uncommon. They may show late recurrences in spite of GTR. These patients need longer follow-up for 10 years. Recurrent seizures are often related to a tumor recurrence.
Collapse
|
43
|
Wang JL, Hong CS, Otero J, Puduvalli VK, Elder JB. Genetic Characterization of a Multifocal Ganglioglioma Originating Within the Spinal Cord. World Neurosurg 2016; 96:608.e1-608.e4. [PMID: 27671879 DOI: 10.1016/j.wneu.2016.09.063] [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] [Received: 07/15/2016] [Revised: 09/13/2016] [Accepted: 09/14/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Gangliogliomas are rare, low-grade intra-axial tumors that exhibit both neuronal and glial components. Although the vast majority present as an intracranial lesion, a rare subset exist as isolated lesions of the spinal cord. Gangliogliomas have also been shown to harbor mutations in the p53 tumor suppressor gene and BRAF oncogene. Previous studies in ganglioglioma have correlated p53 mutations with histologic transformation and BRAF mutations with worse prognosis. CASE DESCRIPTION In this report, we describe a 35-year-old female who presented with multifocal ganglioglioma, involving both the conus medullaris and filum terminale. The dominant lesion in the filum terminale was resected, which revealed World Health Organization I grade, p53 mutant, and BRAF wildtype status. Our study documents the first report of a multifocal ganglioglioma, originating within the spinal cord. CONCLUSIONS Importantly, this case contradicts previous reports of p53 and BRAF mutations portending worsened tumor behavior and prognosis and demonstrates that further studies are needed to delineate the role of genetic characterization in the biologic understanding and management of gangliogliomas.
Collapse
Affiliation(s)
- Joshua L Wang
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christopher S Hong
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jose Otero
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Vinay K Puduvalli
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - J Bradley Elder
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
| |
Collapse
|
44
|
Zanello M, Pages M, Tauziède-Espariat A, Saffroy R, Puget S, Lacroix L, Dezamis E, Devaux B, Chrétien F, Andreiuolo F, Sainte-Rose C, Zerah M, Dhermain F, Dumont S, Louvel G, Meder JF, Grill J, Dufour C, Pallud J, Varlet P. Clinical, Imaging, Histopathological and Molecular Characterization of Anaplastic Ganglioglioma. J Neuropathol Exp Neurol 2016; 75:971-980. [PMID: 27539475 DOI: 10.1093/jnen/nlw074] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Anaplastic ganglioglioma (AGG) is a rare and malignant variant of ganglioglioma. According to the World Health Organization classification version 2016, their histopathological grading criteria are still ill-defined. The aim of the present study was to assess the clinical, imaging, histopathological, and molecular characteristics and outcomes of AGGs in a large consecutive and retrospective adult and pediatric case series. Eighteen patients with AGGs (13 adults and 5 children) were identified (14 de novo and 4 secondary) from a cohort of 222 gangliogliomas (GG) (8%) treated at our institution between 2000 and 2015. AGGs represented a very aggressive disease with poor outcome (median progression-free survival, 10 months; median overall survival, 27 months). They were located in the temporal lobe only in 22% and presented with seizures (44%) or increased intracranial pressure (44%) at diagnosis. Concerning histopathological and molecular data, they shared morphological characteristics and BRAF V600E mutation (39%) with their benign counterparts but also showed hTERT promoter mutation (61%), p53 accumulation (39%), ATRX loss (17%), or p.K27M H3F3A mutation (17%). AGGs are malignant neoplasms requiring aggressive oncological treatment. In the perspective of targeted therapies, AGGs should be screened for BRAF V600E, hTERT, ATRX, and mutations of histone genes.
Collapse
Affiliation(s)
- Marc Zanello
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Mélanie Pages
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Arnault Tauziède-Espariat
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Raphael Saffroy
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Stéphanie Puget
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Ludovic Lacroix
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Edouard Dezamis
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Bertrand Devaux
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Fabrice Chrétien
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Felipe Andreiuolo
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Christian Sainte-Rose
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Michel Zerah
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Frédéric Dhermain
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Sarah Dumont
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Guillaume Louvel
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Jean-François Meder
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Jacques Grill
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Christelle Dufour
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Johan Pallud
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| | - Pascale Varlet
- From the Department of Neurosurgery(MZ, ED, BD, JP), Department of Neuropathology, Sainte-Anne Hospital, Paris, France(MP, AT-E, FC, FA, PV), Department of Biochemistry, Paul Brousse Hospital, Paris, France(RS) Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France(SP, CS-R, MZ), Paris Descartes University, Paris, France(MZ, MP, AT-E, SP, ED, BD, FC, FA, CS-R, MZ, J-FM, JP, PV), Department of Medical Biology and Pathology(LL), Department of Neurooncology, Gustave Roussy Institute, Villejuif, France(FD, SD, GL), Department of Neuroradiology, Sainte-Anne Hospital, Paris, France(J-FM) and Department of Pediatric Oncology, Gustave Roussy Institute, Villejuif, France(JG, CD)
| |
Collapse
|
45
|
Harreld JH, Hwang SN, Qaddoumi I, Tatevossian RG, Li X, Dalton J, Haupfear K, Li Y, Ellison DW. Relative ADC and Location Differ between Posterior Fossa Pilocytic Astrocytomas with and without Gangliocytic Differentiation. AJNR Am J Neuroradiol 2016; 37:2370-2375. [PMID: 27469209 DOI: 10.3174/ajnr.a4892] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/13/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Pilocytic astrocytomas, the most common posterior fossa tumors in children, are characterized by KIAA1549-BRAF fusions and shows excellent 5-year survival rates. Pilocytic astrocytoma with gangliocytic differentiation, a recently defined pilocytic astrocytoma variant that includes glial and neuronal elements similar to a ganglioglioma, may be distinguished from a classic ganglioglioma by molecular, radiologic, and histopathologic features. This study investigated whether imaging could distinguish posterior fossa pilocytic astrocytoma with and without gangliocytic differentiation. MATERIALS AND METHODS Preoperative MRIs (± CTs) of 41 children (age range, 7 months to 15 years; mean age, 7.3 ± 3.7 years; 58.5% male) with pilocytic astrocytoma with gangliocytic differentiation (n = 7) or pilocytic astrocytoma (n = 34) were evaluated; differences in tumor location, morphology, and minimum relative ADC between tumor types were compared (Wilcoxon rank sum test, Fisher exact test). Histopathology and BRAF fusion/mutation status were reviewed. Associations of progression-free survival with diagnosis, imaging features, and BRAF status were examined by Cox proportional hazards models. RESULTS Pilocytic astrocytoma with gangliocytic differentiation appeared similar to pilocytic astrocytoma but had lower minimum relative ADC (mean, 1.01 ± 0.17 compared with 2.01 ± 0.38 for pilocytic astrocytoma; P = .0005) and was more commonly located within midline structures (P = .0034). BRAF status was similar for both groups. Non-total resection (hazard ratio, 52.64; P = .0002), pilocytic astrocytoma with gangliocytic differentiation diagnosis (hazard ratio, 4.66; P = .0104), and midline involvement (hazard ratio, 3.32; P = .0433) were associated with shorter progression-free survival. CONCLUSIONS Minimum relative ADC and tumor location may be useful adjuncts to histopathology in differentiating pilocytic astrocytoma with gangliocytic differentiation from pilocytic astrocytoma. Shorter progression-free survival in pilocytic astrocytoma with gangliocytic differentiation is likely due to a propensity for involvement of midline structures and poor resectability.
Collapse
Affiliation(s)
- J H Harreld
- From the Departments of Diagnostic Imaging (J.H.H., S.N.H.)
| | - S N Hwang
- From the Departments of Diagnostic Imaging (J.H.H., S.N.H.)
| | | | | | - X Li
- Biostatistics (X.L., Y.L.), St. Jude Children's Research Hospital, Memphis, Tennessee
| | - J Dalton
- Pathology (R.G.T., J.D., K.H., D.W.E.)
| | | | - Y Li
- Biostatistics (X.L., Y.L.), St. Jude Children's Research Hospital, Memphis, Tennessee
| | | |
Collapse
|
46
|
Tobin MK, Geraghty JR, Engelhard HH, Linninger AA, Mehta AI. Intramedullary spinal cord tumors: a review of current and future treatment strategies. Neurosurg Focus 2016; 39:E14. [PMID: 26235012 DOI: 10.3171/2015.5.focus15158] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Intramedullary spinal cord tumors have low incidence rates but are associated with difficult treatment options. The majority of patients with these tumors can be initially treated with an attempted resection. Unfortunately, those patients who cannot undergo gross-total resection or have subtotal resection are left with few treatment options, such as radiotherapy and chemotherapy. These adjuvant treatments, however, are associated with the potential for significant adverse side effects and still leave patients with a poor prognosis. To successfully manage these patients and improve both their quality of life and prognosis, novel treatment options must be developed to supplement subtotal resection. New research is underway investigating alternative therapeutic approaches for these patients, including directed, localized drug delivery and nanomedicine techniques. These and other future investigations will hopefully lead to promising new therapies for these devastating diseases.
Collapse
|
47
|
Brainstem gangliogliomas: prognostic factors, surgical indications and functional outcomes. J Neurooncol 2016; 128:445-53. [PMID: 27112924 DOI: 10.1007/s11060-016-2131-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
Abstract
To explore the prognostic factors and discuss the surgical indications of brainstem gangliogliomas. Twenty-one patients with brainstem ganglioglioma were surgically treated at our hospital between 2006 and 2014. The clinical, radiological, operative, and pathological findings of these patients were retrospectively reviewed. The 3-years overall survival and event-free survival (EFS) rates were 90.5 % and 68.4 %, respectively. Four patients (4/18, 22 %) experienced a recurrence with a mean recurrence-free survival of 5.5 months and a mean follow-up of 37 months. Three patients died of surgery-related complications. Three growth patterns were identified: exophytic (6/21), intrinsic (2/21), and endo-exophytic (13/21). Eight patients (8/15, 53 %) harbored a BRAF V600E mutation. All recurrent tumors were endo-exophytic, and except the one without molecular information, were BRAF V600E mutants. A Cox hazard proportion ratio model was used to identify factors influencing EFS, including sex, age, location, growth patterns, extent of resection (EOR), and BRAF V600E mutation status. On univariate analysis, none of these factors reached statistical significance. Among them, EOR and growth patterns were strongly associated with each other (Fisher's exact test, P < 0.01). A multivariate analysis demonstrated that growth patterns were the only factor associated with EFS (P = 0.02; HR 49.05; 95 % CI 1.76-1365.13). Growth patterns may be useful to select surgery candidates and predict prognosis for patients with brainstem gangliogliomas. BRAF V600E was frequently present and appeared to be associated with shorter recurrence-free survival. Studies on BRAF V600E-targeted therapy for patients with high surgical risks are needed.
Collapse
|
48
|
Varshneya K, Sarmiento JM, Nuño M, Lagman C, Mukherjee D, Nuño K, Babu H, Patil CG. A national perspective of adult gangliogliomas. J Clin Neurosci 2016; 30:65-70. [PMID: 27083133 DOI: 10.1016/j.jocn.2015.12.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 12/27/2015] [Indexed: 11/30/2022]
Abstract
Gangliogliomas (GG) are rare tumors of the nervous system. Patient characteristics and clinical outcomes of low and high-grade GG have been difficult to elucidate in the adult population. This study aims to further elaborate on GG treatment and overall survival utilizing a larger cohort than previously published. The USA National Cancer Database was utilized to evaluate adult (age 18years and older) patients diagnosed with GG between 2004 and 2006. Descriptive statistics and Kaplan-Meier overall survival estimates were provided. A total of 198 adult GG patients were diagnosed between 2004 and 2006. Of these, 181 (91.4%) were low-grade and 17 (8.6%) high-grade GG. Overall, the median age was 36years; approximately 50% of patients were female, and 86.5% Caucasian. Most patients (59%) had near/gross total resection. Radiation and chemotherapy were prescribed in 18 (9.1%) and 11 (5.7%) patients, respectively. Radiation (64.7% versus 3.9%, p<.0001) and chemotherapy (47.1% versus 1.7%, p<.0001) were more frequently given to patients with high-grade tumors than low-grade. The median overall survival of high-grade GG was 44.4months (95% confidence interval [CI]: 10.5-92.5) while the corresponding estimate for low-grade tumors was not reached. Older age (hazard ratio [HR] 1.72, 95% CI: 1.26-2.34) and high tumor grade (HR 3.91, 95% CI: 1.43-10.8) were found to be associated with poor survival. Adult GG have a temporal lobe predilection and overall gross total resection rate of 59%. Older patients with high-grade tumors had an increased hazard of mortality. High-grade GG were significantly more likely to be treated with radiation therapy and chemotherapy.
Collapse
Affiliation(s)
- Kunal Varshneya
- Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, 127 S. San Vicente Boulevard, Suite A6600, Los Angeles, CA 90048, USA
| | - J Manuel Sarmiento
- Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, 127 S. San Vicente Boulevard, Suite A6600, Los Angeles, CA 90048, USA
| | - Miriam Nuño
- Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, 127 S. San Vicente Boulevard, Suite A6600, Los Angeles, CA 90048, USA
| | - Carlito Lagman
- Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, 127 S. San Vicente Boulevard, Suite A6600, Los Angeles, CA 90048, USA
| | - Debraj Mukherjee
- Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, 127 S. San Vicente Boulevard, Suite A6600, Los Angeles, CA 90048, USA
| | - Karla Nuño
- Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, 127 S. San Vicente Boulevard, Suite A6600, Los Angeles, CA 90048, USA
| | - Harish Babu
- Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, 127 S. San Vicente Boulevard, Suite A6600, Los Angeles, CA 90048, USA
| | - Chirag G Patil
- Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, 127 S. San Vicente Boulevard, Suite A6600, Los Angeles, CA 90048, USA.
| |
Collapse
|
49
|
Syed HR, Rhee JW, Jha RT, Felbaum D, Kalhorn CG. Concurrent Intraventricular and Sacral Spinal Drop Metastasis of Ganglioglioma in an Adult Patient: A Case Report and Review of Literature. Cureus 2016; 8:e538. [PMID: 27158568 PMCID: PMC4846394 DOI: 10.7759/cureus.538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Gangliogliomas are uncommon tumors of the central nervous system and rarely occur in the lateral ventricle or present with drop metastasis. We report a 49-year-old male who presented with a six-week history of left leg pain and numbness. Clinical examination revealed no focal neurological deficits. Magnetic resonance imaging (MRI) demonstrated enhancing nodular lesions in the sacral spine abutting the S2 nerve root. Further imaging of the neuroaxis demonstrated a cystic lesion in the left frontal horn of the lateral ventricle. Gross total surgical resection of the ventricular lesion was performed through a transcortical approach, followed by resection of the sacral spinal drop metastasis in a staged manner. A histopathological analysis revealed the diagnosis of low-grade ganglioglioma. To our knowledge, this is the first reported case of a low-grade intraventricular ganglioglioma presenting with symptoms associated with drop metastasis in an adult patient.
Collapse
Affiliation(s)
- Hasan R Syed
- Neurosurgery, Medstar Georgetown University Hospital
| | | | - Ribhu T Jha
- Neurosurgery, Medstar Georgetown University Hospital
| | | | | |
Collapse
|
50
|
Aguilera D, Janss A, Mazewski C, Castellino RC, Schniederjan M, Hayes L, Brahma B, Fogelgren L, MacDonald TJ. Successful Retreatment of a Child with a Refractory Brainstem Ganglioglioma with Vemurafenib. Pediatr Blood Cancer 2016; 63:541-3. [PMID: 26579623 DOI: 10.1002/pbc.25787] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 09/01/2015] [Indexed: 02/05/2023]
Abstract
A child with brainstem ganglioglioma underwent subtotal resection and focal radiation. Magnetic resonance imaging confirmed tumor progression 6 months later. Another partial resection revealed viable BRAF V600E-positive residual tumor. Vemurafenib (660 mg/m(2) /dose) was administered twice daily, resulting in >70% tumor reduction with sustained clinical improvement for 1 year. Vemurafenib was then terminated, but significant tumor progression occurred 3 months later. Vemurafenib was restarted, resulting in partial response. Toxicities included Grade I pruritus and Grade II rash. Vemurafenib was effectively crushed and administered in solution via nasogastric tube. We demonstrate benefit from restarting vemurafenib therapy.
Collapse
Affiliation(s)
- Dolly Aguilera
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Anna Janss
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Claire Mazewski
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Robert Craig Castellino
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | | | - Laura Hayes
- Department of Radiology, Children's HealthCare of Atlanta at Scottish Rite, Atlanta, Georgia
| | - Barunashish Brahma
- Department of Neurosurgery, Children's Health Care of Atlanta, Emory University, School of Medicine, Atlanta, Georgia
| | - Lauren Fogelgren
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Tobey J MacDonald
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|