Epidemiological trends of histopathologically WHO classified CNS tumors in developing countries: systematic review

Overlapping variants in the blood, tissues and cell lines for patients with intracranial meningiomas are predominant in stem cell-related genes

OBJECTIVE

Bulk tissue genomic analysis of meningiomas identified common somatic mutations, however, it often excluded blood-related variants. In contrast, genomic characterisation of primary cell lines that can provide critical information regarding growth and proliferation, have been rare. In our work, we identified the variants that are present in the blood, tissues and corresponding cell lines that are likely to be predictive, tumorigenic and progressive.

METHOD

Whole-exome sequencing was used to identify variants and distinguish related pathways that exist in 42 blood, tissues and corresponding cell lines (BTCs) samples for patients with intracranial meningiomas. Conventional sequencing was used for the confirmation of variants. Integrative analysis of the gene expression for the corresponding samples was utilised for further interpretations.

RESULTS

In total, 926 BTC variants were detected, implicating 845 genes. A pathway analysis of all BTC genes with damaging variants indicated the 'cell morphogenesis involved in differentiation' stem cell-related pathway to be the most frequently affected pathway. Concordantly, five stem cell-related genes, GPRIN2, ALDH3B2, ASPN, THSD7A and SIGLEC6, showed BTC variants in at least five of the patients. Variants that were heterozygous in the blood and homozygous in the tissues or the corresponding cell lines were rare (average: 1.3 ± 0.3%), and included variants in the RUNX2 and CCDC114 genes. An analysis comparing the variants detected only in tumours with aggressive features indicated a total of 240 BTC genes, implicating the 'homophilic cell adhesion via plasma membrane adhesion molecules' pathway, and identifying the stem cell-related transcription coactivator NCOA3/AIB1/SRC3 as the most frequent BTC gene. Further analysis of the possible impact of the poly-Q mutation present in the NCOA3 gene indicated associated deregulation of 15 genes, including the up-regulation of the stem cell related SEMA3D gene and the angiogenesis related VEGFA gene.

CONCLUSION

Stem cell-related pathways and genes showed high prevalence in the BTC variants, and novel variants in stem cell-related genes were identified for meningioma. These variants can potentially be used as predictive, tumorigenic and progressive biomarkers for meningioma.

Incidence of Gliomas in Municipalities of Zenica - Doboj Canton in Bosnia and Herzegovina - A 10-Year Study

Objective:

To determine the incidence of gliomas in Zenica - Doboj Canton. Moreover, to analyse its potential connection to sociodemographic characteristics and its distribution throughout municipalities of Zenica - Doboj Canton in the period of 2009-2019.

Method:

This retrospective, descriptive - analytical, 10 - year study included 146 patients from Zenica -Doboj Canton. Data were obtained and reviewed from patient’s medical records. Patients’ sociodemographic characteristics and pathohistological diagnosis were included in the study. Age, gender, and the place of birth were analysed and correlated with types and grades of glial tumors according to the World Health Organisation’s latest classification.

Results:

The study consisted of 146 patients including 84 (58%) males and 62 (42%) females. The most common pathohistological diagnosis was glioblastoma multiforme, a grade IV glioma in both females (26%) and males (35%), in total 91 (62%) patients, and the rarest was oligoastrocytoma, in 2 (1%) cases. The municipality of Kakanj had the highest incidence of glioma with 29 out of total of 146 cases (0.077%) and the highest incidence in females (0.069%) with 13 cases. The municipality of Vareš had the highest incidence of glioma (0.114%) with 5 out of 84 male cases, while in the cities of Breza and Olovo any cases with glioma were not detected The results showed statistically significant differences in incidences of gliomas according to the region of residence.

Conclusion

The analysis of data indicated that there are significant connections between the occurrence of gliomas and sociodemographic characteristics of patients from Zenica - Doboj Canton.

The Epidemiology of Primary Central Nervous System Tumors at the National Neurologic Institute in Saudi Arabia: A Ten-Year Single-Institution Study

Objectives

This study is aimed at describing the epidemiological trends of primary CNS tumors in children and adults at the National Neurologic Institute in Saudi Arabia.

Methods

A retrospective epidemiological approach was used where data was obtained from the department of pathology registry files and pathology reports. The records of all patients registered from January 2005 to December 2014 with a diagnosis of primary CNS tumor (brain and spinal cord) were selected. Data about sex, age, tumor location, and histologic type were collected. The classification was based on the International Classification of Diseases for Oncology, 3rd Edition (ICD-O-3).

Results

Nine hundred and ninety-two (992) cases of primary CNS tumors throughout the ten years (2005 to 2014) were reviewed. There were 714 (71.97%) adults and 278 (28.02%) in the pediatric age group. Nonmalignant tumors dominated the adult population (60.08%) while malignant tumors were more frequent in the pediatric population. Gliomas constituted the most common neoplastic category in children and adults. The most common single tumor entity was meningioma (26.99%, ICD-O-3 histology codes 9530/0, 9539/1, and 9530/3). Medulloblastomas (ICD-O-3 histology codes 9470, 9471, and 9474) were the most common single tumor entity in the pediatric age group (26.62%).

Conclusions

This is an institution-based, detailed, and descriptive epidemiological study of patients with primary CNS tumors in Saudi Arabia. In contrast to other regional and international studies, the medulloblastomas in our institution are more frequent than pilocytic astrocytomas. Limitations to our study included the referral bias and histology-based methodology.

Malignant Transformation and Spine Metastasis of an Intracranial Grade I Meningioma: In Situ Immunofluorescence Analysis of Cancer Stem Cells Case Report and Literature Review

BACKGROUND

Malignant meningiomas are rare neoplasms of the central nervous system that occur de novo or rarely as a result of transformation. They have a higher rate of recurrence and metastasis accompanied by a significantly shorter survivorship compared with benign variants. Meningioma cancer stem cells (CSCs) have been previously shown to be associated with resistance and aggressiveness. However, the role they play in meningioma progression is still being investigated.

CASE DESCRIPTION

We report a 29-year-old man who underwent a resection of a grade I meningioma in 2011. The patient had multiple local recurrences of the tumor that showed an aggressive change in behavior and transformation to grade III meningioma, and developed extracranial metastasis to the cervical spine. He underwent multiple operations and received radiotherapy. Analysis of the tissues indicated the presence of CSC markers before metastasis, and showed increased expressions of associated markers in the metastasized tissue. In addition, similar to the patient's profile, the pharmacological testing of a primary cell line retrieved from the metastasized tissues showed a high level of drug tolerance and a diminished ability to initiate apoptosis.

CONCLUSIONS

Malignant progression of grade I meningioma can occur, and its eventuality may be anticipated by detecting CSCs. We performed a comprehensive literature review of relevant cases and discussed the clinical, diagnostic, and management characteristics of the reported cases.

In situ characterization of stem cells-like biomarkers in meningiomas

Background

Meningioma cancer stem cells (MCSCs) contribute to tumor aggressiveness and drug resistance. Successful therapies developed for inoperable, recurrent, or metastatic tumors must target these cells and restrict their contribution to tumor progression. Unfortunately, the identity of MCSCs remains elusive, and MSCSs’ in situ spatial distribution, heterogeneity, and relationship with tumor grade, remain unclear.

Methods

Seven tumors classified as grade II or grade III, including one case of metastatic grade III, and eight grade I meningioma tumors, were analyzed for combinations of ten stem cell (SC)-related markers using immunofluorescence of consecutive sections. The correlation of expression for all markers were investigated. Three dimensional spatial distribution of markers were qualitatively analyzed using a grid, designed as a repository of information for positive staining. All statistical analyses were completed using Statistical Analysis Software Package.

Results

The patterns of expression for SC-related markers were determined in the context of two dimensional distribution and cellular features. All markers could be detected in all tumors, however, Frizzled 9 and GFAP had differential expression in grade II/III compared with grade I meningioma tissues. Correlation analysis showed significant relationships between the expression of GFAP and CD133 as well as SSEA4 and Vimentin. Data from three dimensional analysis showed a complex distribution of SC markers, with increased gene hetero-expression being associated with grade II/III tumors. Sub regions that showed multiple co-staining of markers including CD133, Frizzled 9, GFAP, Vimentin, and SSEA4, but not necessarily the proliferation marker Ki67, were highly associated with grade II/III meningiomas.

Conclusion

The distribution and level of expression of CSCs markers in meningiomas are variable and show hetero-expression patterns that have a complex spatial nature, particularly in grade II/III meningiomas. Thus, results strongly support the notion of heterogeneous populations of CSCs, even in grade I meningiomas, and call for the use of multiple markers for the accurate identification of individual CSC subgroups. Such identification will lead to practical clinical diagnostic protocols that can quantitate CSCs, predict tumor recurrence, assist in guiding treatment selection for inoperable tumors, and improve follow up of therapy.

Electronic supplementary material

The online version of this article (10.1186/s12935-018-0571-6) contains supplementary material, which is available to authorized users.

Pleomorphism and drug resistant cancer stem cells are characteristic of aggressive primary meningioma cell lines

Background

Meningioma tumors arise in arachnoid membranes, and are the most reported central nervous system (CNS) tumors worldwide. Up to 20% of grade I meningioma tumors reoccur and currently predictive cancer stem cells (CSCs) markers for aggressive and drug resistant meningiomas are scarce.

Methods

Meningioma tissues and primary cell lines were investigated using whole transcriptome microarray analysis, immunofluorescence staining of CSCs markers (including CD133, Sox2, Nestin, and Frizzled 9), and drug treatment with cisplatin or etoposide.

Results

Unsupervised hierarchical clustering of six meningioma samples separated tissues into two groups. Analysis identified stem cells related pathways to be differential between the two groups and indicated the de-regulation of the stem cell associated genes Reelin (RELN), Calbindin 1 (CALB1) and Anterior Gradient 2 Homolog (AGR2). Immunofluorescence staining for four tissues confirmed stemness variation in situ. Biological characterization of fifteen meningioma primary cell lines concordantly separated cells into two functionally distinct sub-groups. Pleomorphic cell lines (NG type) grew significantly faster than monomorphic cell lines (G type), had a higher number of cells that express Ki67, and were able to migrate aggressively in vitro. In addition, NG type cell lines had a lower expression of nuclear Caspase-3, and had a significantly higher number of CSCs co-positive for CD133+ Sox2+ or AGR2+ BMI1+. Importantly, these cells were more tolerant to cisplatin and etoposide treatment, showed a lower level of nuclear Caspase-3 in treated cells and harbored drug resistant CSCs.

Conclusion

Collectively, analyses of tissues and primary cell lines revealed stem cell associated genes as potential targets for aggressive and drug resistant meningiomas.

Electronic supplementary material

The online version of this article (doi:10.1186/s12935-017-0441-7) contains supplementary material, which is available to authorized users.

Histopathological Analysis of Brain Tumours- A Seven Year Study from a Tertiary Care Centre in South India

INTRODUCTION

Tumours of central nervous system constitute 1%-2% of tumours in adults. The incidence of brain tumours has been reported to be around 3.9 and 3.0/one lac/year in males and females respectively. A few studies are available from India which show a lower incidence of brain tumours compared to the developed countries. Not much is known about the epidemiology of brain tumours in the population from South India.

AIM

To identify the age groups, gender distribution, topography and different histological types of brain tumours.

MATERIALS AND METHODS

A total of 510 cases of brain tumours were identified over a period of seven years which were included in the present study. We retrieved the slides of these cases and reviewed them. Immunohistochemistry in required cases were done. Age and gender distribution, clinical presentation, site of tumour and histopathologic patterns with grade were noted and the data was analysed with SPSS software version 17.0.

RESULTS

Our analysis showed that most of the brain tumours occur between 40-60 years of age, with a male to female ratio of 0.9:1. Majority of cases involved dura and cerebral lobes except for the occipital lobe, and meningioma and glial tumours were the most common broad histological types. WHO grade IV tumours and metastasis were common in males compared to females.

CONCLUSION

This study revealed the distribution of brain tumours in patients attending our institution. The results obtained were comparable with available worldwide data.