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Maldonado F, Geraldo AF, Guarnizo A, Fernández-Ponce N, Baroni L, Rugilo C. Central nervous system embryonal tumor with PLAGL1 amplification: a case report of a novel entity focusing on imaging findings. Childs Nerv Syst 2024:10.1007/s00381-024-06422-8. [PMID: 38642111 DOI: 10.1007/s00381-024-06422-8] [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: 03/03/2024] [Accepted: 04/17/2024] [Indexed: 04/22/2024]
Abstract
The embryonal central nervous system (CNS) tumor with PLAGL1 (pleomorphic adenoma gene-like) amplification is a novel type of pediatric neoplasm with a distinct methylation profile, described for the first time in 2022. It may be located anywhere in the neuroaxis and, as its name implies, it is driven by the amplification and overexpression of one of the PLAG family genes. Although the associated clinical, immunohistopathological, and molecular characteristics are well characterized in the seminal report of this entity, data on the radiological features is still lacking. Here, we present a case report of a 4-year-old girl with a biopsy-proven PLAGL1-amplified brainstem tumor and provide a detailed description of the corresponding conventional neuroimaging characteristics, aiming to better delineate this entity and to increase the awareness of this pathology in the radiological community.
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Affiliation(s)
- Francisco Maldonado
- Diagnostic Neuroradiology Unit, Department of Radiology, Hospital de Pediatría Prof Dr Juan P Garrahan, Combate de los Pozos 1881 (C 1245 AAM), Buenos Aires, Argentina.
| | - Ana Filipa Geraldo
- Diagnostic Neuroradiology Unit, Department of Radiology, Centro Hospitalar Vila Nova de Gaia/Espinho (CHVNG/E), Vila Nova de Gaia, Portugal
| | - Angela Guarnizo
- Diagnostic Neuroradiology Unit, Department of Radiology, Fundación Santa Fe de Bogotá, Carrera 7 #117-15, 110111, Bogota, Colombia
| | - Nicolás Fernández-Ponce
- Department of Neuro-Oncology, Hospital de Pediatría Prof Dr Juan P Garrahan, Combate de los Pozos 1881, C 1245 AAM, Buenos Aires, Argentina
| | - Lorena Baroni
- Department of Neuro-Oncology, Hospital de Pediatría Prof Dr Juan P Garrahan, Combate de los Pozos 1881, C 1245 AAM, Buenos Aires, Argentina
| | - Carlos Rugilo
- Diagnostic Neuroradiology Unit, Department of Radiology, Hospital de Pediatría Prof Dr Juan P Garrahan, Combate de los Pozos 1881 (C 1245 AAM), Buenos Aires, Argentina
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Lampros M, Alexiou GA. Brain and Spinal Cord Tumors of Embryonic Origin. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:405-420. [PMID: 37452947 DOI: 10.1007/978-3-031-23705-8_15] [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
Embryonal tumors (ETs) of the central nervous system (CNS) comprise a large heterogeneous group of highly malignant tumors that predominantly affect children and adolescents. Currently, the neoplasms classified as ET are the medulloblastoma (MB), embryonal tumors with multilayered rosettes (ETMR), medulloepithelioma (ME), CNS neuroblastoma (NB), CNS ganglioneuroblastoma (GNB), atypical teratoid/rhabdoid tumors (AT/RT), and CNS embryonal tumors with rhabdoid features. All these tumors are classified as malignant-grade IV neoplasms, and the prognosis of patients with these neoplasms is very poor. Currently, except for the histological classification of MB, the recently utilized WHO classification accepts a novel molecular classification of MBs into four distinct molecular subgroups: wingless/integrated (WNT)-activated, sonic hedgehog (Shh), and the numerical Group3 and Group 4. The combination of both histological and genetic classifications has substantial prognostic significance, and patients are categorized as low risk with over 90% survival, the standard risk with 75-90% survival, high risk with 50-75% survival, and very high risk with survival rate lower than 50%. Children under three years are predominantly affected by AT/RT and represent about 20% of all CNS tumors in this age group. AT/RT is typically located in the posterior fossa (mainly in cerebellopontine angle) in 50-60% of the cases. The pathogenesis of this neoplasm is strongly associated with loss of function of the SMARCB1 (INI1, hSNF5) gene located at the 22q11.23 chromosome, or very rarely with alterations in (SMARCA4) BRG1 gene. The cells of this neoplasm resemble those of other neuronal tumors, and hence, immunochemistry markers have been utilized, such as smooth muscle actin, epithelial membrane antigen, vimentin, and lately antibodies for INI1. ETMRs are characterized by the presence of ependymoblastic rosettes formed by undifferentiated neuroepithelial cells and neuropil. The tumorigenesis of ETMRs is strongly related to the amplification of the pluripotency factor Chr19q13.41 miRNA cluster (C19MC) present in around 90% of the cases. Additionally, the expression of LIN28A is a highly sensitive and specific marker of ETMR diagnosis, as it is overexpressed in almost all cases of ETMR and is related to poor patient outcomes. The treatment of patients with ETs includes a combination of surgical resection, radiotherapy (focal or craniospinal), and chemotherapeutic agents. Currently, there is a trend to reduce the dose of craniospinal irradiation in the treatment of low-risk MBs. Novel targeted therapies are expected in the treatment of patients with MBs due to the identification of the main driver genes. Survival rates vary between ET types and their subtypes, with ganglioneuroblastoma having over 95% 5-year survival rate, while ATRT is probably linked with the worst prognosis with a 30% 5-year survival rate.
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Affiliation(s)
- Marios Lampros
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | - George A Alexiou
- Department of Neurosurgery, School of Medicine, University of Ioannina, 45500, Ioannina, Greece.
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Cardoen L, Tauziède-Espariat A, Dangouloff-Ros V, Moalla S, Nicolas N, Roux CJ, Bouchoucha Y, Bourdeaut F, Beccaria K, Bolle S, Pierron G, Dufour C, Doz F, Boddaert N, Brisse H. Imaging Features with Histopathologic Correlation of CNS High-Grade Neuroepithelial Tumors with a BCOR Internal Tandem Duplication. AJNR Am J Neuroradiol 2022; 43:151-156. [PMID: 34887247 PMCID: PMC8757552 DOI: 10.3174/ajnr.a7367] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/27/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE A new brain tumor entity occurring in early childhood characterized by a somatic BCL6 corepressor gene internal tandem duplication was recently described. The aim of this study was to describe the radiologic pattern of these tumors and correlate this pattern with histopathologic findings. MATERIALS AND METHODS This retrospective, noninterventional study included 10 children diagnosed with a CNS tumor, either by ribonucleic acid-sequencing analysis or deoxyribonucleic acid methylation analysis. Clinical, radiologic, and histopathologic data were collected. A neuropathologist reviewed 9 tumor samples. Preoperative images were analyzed in consensus by 7 pediatric radiologists. RESULTS All tumors were relatively large (range, 4.7-9.2 cm) intra-axial peripheral masses with well-defined borders and no peritumoral edema. All tumors showed mild and heterogeneous enhancement and marked restriction on DWI of the solid portions. Perfusion imaging showed a relatively lower CBF in the tumor than in the adjacent normal parenchyma. Nine of 10 tumors showed areas of necrosis, with the presence of hemorrhage in 8/10 and calcifications in 4/7. Large intratumoral macroscopic veins were observed in 9/10 patients. No intracranial or spinal leptomeningeal dissemination was noted at diagnosis. CONCLUSIONS CNS tumors with a BCL6 corepressor gene internal tandem duplication present as large intra-axial peripheral masses with well-defined borders, no edema, restricted diffusion, weak contrast enhancement, frequent central necrosis, hemorrhage and calcifications, intratumoral veins, and no leptomeningeal dissemination at the time of diagnosis. Knowledge of these imaging characteristics may aid in histologic, genomic, and molecular profiling of brain tumors in young children.
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Affiliation(s)
- L. Cardoen
- From the Imaging Department (L.C., N.N., H.J.B.)
| | - A. Tauziède-Espariat
- Department of Neuropathology (A.T.-E.), Centre Hospitalier Sainte Anne, Paris, France
| | - V. Dangouloff-Ros
- Pediatric Radiology Department (V.D.-R., C.-J.R., N.B.), Assistance Publique–Hôpitaux de Paris, Hôpital Universitaire Necker-Enfants Malades, Paris, France,Institut Imagine (V.D.-R., N.B.), Université de Paris, Unité Médicale de Recherche (UMR) 1163, Paris, France,Université de Paris (V.D.-R., K.B., F.D., N.B.), Institut National de la Santé et de la Recherche Médicale, ERL UA10, Paris, France
| | | | - N. Nicolas
- From the Imaging Department (L.C., N.N., H.J.B.)
| | - C.-J. Roux
- Pediatric Radiology Department (V.D.-R., C.-J.R., N.B.), Assistance Publique–Hôpitaux de Paris, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Y. Bouchoucha
- SIREDO Oncology Center Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer (Y.B., F.B., F.D.)
| | - F. Bourdeaut
- SIREDO Oncology Center Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer (Y.B., F.B., F.D.)
| | - K. Beccaria
- Department of Neurosurgery (K.B.),Université de Paris (V.D.-R., K.B., F.D., N.B.), Institut National de la Santé et de la Recherche Médicale, ERL UA10, Paris, France
| | | | - G. Pierron
- Department of Biopathology and Genetics (G.P.), Institut Curie, Paris, France
| | - C. Dufour
- Paediatric and Adolescent Oncology (C.D.), Gustave Roussy, Villejuif, France
| | - F. Doz
- SIREDO Oncology Center Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer (Y.B., F.B., F.D.),Université de Paris (V.D.-R., K.B., F.D., N.B.), Institut National de la Santé et de la Recherche Médicale, ERL UA10, Paris, France
| | - N. Boddaert
- Pediatric Radiology Department (V.D.-R., C.-J.R., N.B.), Assistance Publique–Hôpitaux de Paris, Hôpital Universitaire Necker-Enfants Malades, Paris, France,Institut Imagine (V.D.-R., N.B.), Université de Paris, Unité Médicale de Recherche (UMR) 1163, Paris, France,Université de Paris (V.D.-R., K.B., F.D., N.B.), Institut National de la Santé et de la Recherche Médicale, ERL UA10, Paris, France
| | - H.J. Brisse
- From the Imaging Department (L.C., N.N., H.J.B.),Université Paris Saclay (H.J.B.), Institut National de la Santé et de la Recherche Médicale, LITO U1288, Orsay, France
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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.
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