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Yokoda RT, Cobb WS, Yong RL, Crary JF, Viapiano MS, Walker JM, Umphlett M, Tsankova NM, Richardson TE. CDKN2A mutations have equivalent prognostic significance to homozygous deletion in IDH-mutant astrocytoma. J Neuropathol Exp Neurol 2023; 82:845-852. [PMID: 37550258 DOI: 10.1093/jnen/nlad063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
Homozygous deletion of CDKN2A/B is currently considered a molecular signature for grade 4 in IDH-mutant astrocytomas, irrespective of tumor histomorphology. The 2021 WHO Classification of CNS Tumors does not currently include grading recommendations for histologically lower-grade (grade 2-3) IDH-mutant astrocytoma with CDKN2A mutation or other CDKN2A alterations, and little is currently known about the prognostic implications of these alternative CDKN2A inactivating mechanisms. To address this, we evaluated a cohort of institutional and publicly available IDH-mutant astrocytomas, 15 with pathogenic mutations in CDKN2A, 47 with homozygous CDKN2A deletion, and 401 with retained/wildtype CDKN2A. The IDH-mutant astrocytomas with mutant and deleted CDKN2A had significantly higher overall copy number variation compared to those with retained/wildtype CDKN2A, consistent with more aggressive behavior. Astrocytoma patients with CDKN2A mutation had significantly worse progression-free (p = 0.0025) and overall survival (p < 0.0001) compared to grade-matched patients with wildtype CDKN2A, but statistically equivalent progression-free survival and overall survival outcomes to patients with CDKN2A deletion. No significant survival difference was identified between CDKN2A mutant cases with or without loss of the second allele. These findings suggest that CDKN2A mutation has a detrimental effect on survival in otherwise lower-grade IDH-mutant astrocytomas, similar to homozygous CDKN2A deletion, and should be considered for future grading schemes.
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Affiliation(s)
- Raquel T Yokoda
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Raymund L Yong
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John F Crary
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mariano S Viapiano
- Department of Neuroscience and Physiology, State University of New York, Upstate Medical University, Syracuse, New York, USA
- Department of Neurosurgery, State University of New York, Upstate Medical University, Syracuse, New York, USA
| | - Jamie M Walker
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Melissa Umphlett
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nadejda M Tsankova
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Timothy E Richardson
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Kothari K, Damoi JO, Zeizafoun N, Asiimwe P, Glerum K, Bakaleke M, Giibwa A, Umphlett M, Marin M, Zhang LP. Increasing access to pathology services in low- and middle-income countries through innovative use of telepathology. Surg Endosc 2023; 37:7206-7211. [PMID: 37365395 DOI: 10.1007/s00464-023-10220-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION In low- and middle-income countries (LMICs), surgical care can be limited by access to pathology services. In Uganda, the pathologist-to-population ratio is less than 1 to 1 million people. The Kyabirwa Surgical Center in Jinja, Uganda, created a telepathology service in collaboration with an academic institution in New York City. This study demonstrated the feasibility and considerations of implementing a telepathology model to supplement the critical pathology needs of a low-income country. METHODS This was a retrospective, single-center study of an ambulatory surgery center with pathology capability using virtual microscopy. The remote pathologist (also known as a telepathologist) controlled the microscope and reviewed histology images transmitted across the network in real time. In addition, this study collected demographics, clinical histories, the surgeon's preliminary diagnoses, and the pathology reports from the center's electronic medical record. RESULTS Nikon's NIS Element Software was used as a dynamic, robotic microscopy model with a video conferencing platform for communication. An underground fiber optic cable established Internet connectivity. After a two-hour tutorial session, the lab technician and pathologist were able to proficiently use the software. The remote pathologist read (1) pathology slides with inconclusive reports from external pathology labs, and (2) tissues labeled by the surgeon as suspicious for malignancy, which belonged to patients who lacked financial means for pathology services. Between April 2021 and July 2022, tissue samples of 110 patients were examined by a telepathologist. The most common malignancies on histology were squamous cell carcinoma of the esophagus, ductal carcinoma of the breast, and colorectal adenocarcinoma. CONCLUSION With the increasing availability of video conference platforms and network connections, telepathology is an emerging field that can be used by surgeons in LMICs to improve access to pathology services, confirming histological diagnosis of malignancies to ensure appropriate treatment.
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Affiliation(s)
- Krsna Kothari
- Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA.
| | | | - Nebras Zeizafoun
- Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | | | - Katie Glerum
- Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | | | | | - Melissa Umphlett
- Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Michael Marin
- Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Linda P Zhang
- Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
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Vij M, Cho BB, Yokoda RT, Rashidipour O, Umphlett M, Richardson TE, Tsankova NM. P16 immunohistochemistry is a sensitive and specific surrogate marker for CDKN2A homozygous deletion in gliomas. Acta Neuropathol Commun 2023; 11:73. [PMID: 37138345 PMCID: PMC10155323 DOI: 10.1186/s40478-023-01573-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 04/22/2023] [Indexed: 05/05/2023] Open
Abstract
Molecular characterization of gliomas has uncovered genomic signatures with significant impact on tumor diagnosis and prognostication. CDKN2A is a tumor suppressor gene involved in cell cycle control. Homozygous deletion of the CDKN2A/B locus has been implicated in both gliomagenesis and tumor progression through dysregulated cell proliferation. In histologically lower grade gliomas, CDKN2A homozygous deletion is associated with more aggressive clinical course and is a molecular marker of grade 4 status in the 2021 WHO diagnostic system. Despite its prognostic utility, molecular analysis for CDKN2A deletion remains time consuming, expensive, and is not widely available. This study assessed whether semi-quantitative immunohistochemistry for expression of p16, the protein product of CDKN2A, can serve as a sensitive and a specific marker for CDKN2A homozygous deletion in gliomas. P16 expression was quantified by immunohistochemistry in 100 gliomas, representing both IDH-wildtype and IDH-mutant tumors of all grades, using two independent pathologists' scores and QuPath digital pathology analysis. Molecular CDKN2A status was determined using next-generation DNA sequencing, with homozygous CDKN2A deletion detected in 48% of the tumor cohort. Classifying CDKN2A status based on p16 tumor cell expression (0-100%) demonstrated robust performance over a wide range of thresholds, with receiver operating characteristic curve area of 0.993 and 0.997 (blinded and unblinded pathologist p16 scores, respectively) and 0.969 (QuPath p16 score). Importantly, in tumors with pathologist-scored p16 equal to or less than 5%, the specificity for predicting CDKN2A homozygous deletion was 100%; and in tumors with p16 greater than 20%, specificity for excluding CDKN2A homozygous deletion was also 100%. Conversely, tumors with p16 scores of 6-20% represented gray zone with imperfect correlation to CDKN2A status. The findings indicate that p16 immunohistochemistry is a reliable surrogate marker of CDKN2A homozygous deletion in gliomas, with recommended p16 cutoff scores of ≤ 5% for confirming and > 20% for excluding biallelic CDKN2A loss.
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Affiliation(s)
- Meenakshi Vij
- Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Benjamin B Cho
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Raquel T Yokoda
- Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Omid Rashidipour
- Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Melissa Umphlett
- Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Timothy E Richardson
- Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Nadejda M Tsankova
- Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
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Dullea JT, Chaluts D, Vasan V, Rutland JW, Gill CM, Ellis E, Kinoshita Y, McBride RB, Bederson J, Donovan M, Sebra R, Umphlett M, Shrivastava RK. NF2 mutation associated with accelerated time to recurrence for older patients with atypical meningiomas. Br J Neurosurg 2023:1-7. [PMID: 37096420 PMCID: PMC10598238 DOI: 10.1080/02688697.2023.2204927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 02/01/2023] [Accepted: 04/15/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Meningiomas occur more frequently in older adults, with the incidence rates increasing from 5.8/100,000 for adults 35-44 years old to 55.2/100,000 for those 85+. Due to the increased risk of surgical management in older adults, there is a need to characterize the risk factors for aggressive disease course to inform management decisions in this population. We therefore sought to determine age-stratified relationships between tumour genomics and recurrence after resection of atypical meningiomas. METHODS We identified 137 primary and recurrent Grade 2 meningiomas from our existing meningioma genomic sequencing database. We examined the differential distribution of genomic alterations in those older than 65 compared to younger. We then performed an age stratified survival analysis to model recurrence for a mutation identified as differentially present. RESULTS In our cohort of 137 patients with grade 2 meningiomas, alterations in NF2 were present at a higher rate in older adults compared to younger (37.8% in < 65 vs. 55.3% in > 65; recurrence adjusted p-value =0.04). There was no association between the presence of NF2 and recurrence in the whole cohort. In the age-stratified model for those less than 65 years old, there was again no relationship. For patients in the older age stratum, there is a relationship between NF2 and worsened recurrence outcomes (HR = 3.64 (1.125 - 11.811); p = 0.031). CONCLUSIONS We found that mutations in NF2 were more common in older adults. Further, the presence of mutant NF2 was associated with an increased risk of recurrence in older adults.
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Affiliation(s)
- Jonathan T. Dullea
- Department of Neurosurgery, Icahn School of Medicine at
Mount Sinai, New York, NY
| | - Danielle Chaluts
- Department of Neurosurgery, Icahn School of Medicine at
Mount Sinai, New York, NY
| | - Vikram Vasan
- Department of Neurosurgery, Icahn School of Medicine at
Mount Sinai, New York, NY
| | - John W. Rutland
- Department of Neurosurgery, Icahn School of Medicine at
Mount Sinai, New York, NY
| | - Corey M. Gill
- Department of Neurosurgery, Icahn School of Medicine at
Mount Sinai, New York, NY
| | - Ethan Ellis
- Department of Genetics and Genomic Sciences, Icahn School
of Medicine at Mount Sinai, New York, NY
| | - Yayoi Kinoshita
- Department of Pathology, Icahn School of Medicine at Mount
Sinai, New York, NY
| | - Russell B. McBride
- Department of Pathology, Icahn School of Medicine at Mount
Sinai, New York, NY
- The Institute for Translational Epidemiology, Icahn School
of Medicine at Mount Sinai, New York, NY
| | - Joshua Bederson
- Department of Neurosurgery, Icahn School of Medicine at
Mount Sinai, New York, NY
| | - Michael Donovan
- Department of Pathology, Icahn School of Medicine at Mount
Sinai, New York, NY
| | - Robert Sebra
- Department of Genetics and Genomic Sciences, Icahn School
of Medicine at Mount Sinai, New York, NY
- Sema4, A Mount Sinai venture, Stamford, CT
| | - Melissa Umphlett
- Department of Pathology, Icahn School of Medicine at Mount
Sinai, New York, NY
| | - Raj K. Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at
Mount Sinai, New York, NY
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Carr MT, Hernandez-Marquez GC, Vij M, Chin X, Delman BN, Umphlett M, Germano IM. Third Ventricular Subependymomas: Clinical features and Outcomes over Two Decades. World Neurosurg 2023:S1878-8750(23)00326-1. [PMID: 36918095 DOI: 10.1016/j.wneu.2023.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Subependymomas are uncommon, benign slow-growing neoplasms of the central nervous system (CNS) preferentially arising within the fourth and lateral ventricles. Third ventricle involvement has been described rarely. This study's aim is to provide the first systematic review on third ventricular subependymomas (TVSE) by analyzing all reported cases over two decades and describing a case example. METHODS MEDLINE and EMBASE databases were searched for the twenty years ending January 1, 2022, using relevant MesH and non-MeSH terms, including "subependymoma," and "third ventricle." Methodology followed PRISMA guidelines. RESULTS Of 804 identified studies, 131 met inclusion eligibility. The literature yielded 17 TVSE patients plus our example (18 total). 83% (15/18) presented in adulthood (average age 42±19 years), of which 73% were women. The pediatric cohort age was 5±1 year, 67% (4/6) of which were girls. The most common presenting symptom in both cohorts was headache (80%), followed by memory disturbances and vomitus. In adults, symptomatic tumors were approached by open craniotomy in all but one case, most using a transcallosal approach. Gross total resection (GTR) was obtained in 73%. A ventriculoperitoneal shunt was inserted in 2/15 adult and 4/6 pediatric cases. Overall, both cohorts showed symptomatic improvement without disease recurrence. One patient expired peri-operatively. CONCLUSIONS Subependymomas should be considered in the differential diagnosis of third ventricular tumors. TVSE's clinical presentation mainly parallels hydrocephalus symptoms, hence awareness is of vital importance for timely treatment. Surgical goal should be GTR, which can be curative and offers greatest clinical improvement across the population.
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Affiliation(s)
- Matthew T Carr
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Meenakshi Vij
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Xing Chin
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bradley N Delman
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Melissa Umphlett
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Isabelle M Germano
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Richardson TE, Yokoda RT, Rashidipour O, Vij M, Snuderl M, Brem S, Hatanpaa KJ, McBrayer SK, Abdullah KG, Umphlett M, Walker JM, Tsankova NM. Mismatch repair protein mutations in isocitrate dehydrogenase (IDH)-mutant astrocytoma and IDH-wild-type glioblastoma. Neurooncol Adv 2023; 5:vdad085. [PMID: 37554222 PMCID: PMC10406418 DOI: 10.1093/noajnl/vdad085] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Mutations in mismatch repair (MMR) genes (MSH2, MSH6, MLH1, and PMS2) are associated with microsatellite instability and a hypermutator phenotype in numerous systemic cancers, and germline MMR mutations have been implicated in multi-organ tumor syndromes. In gliomas, MMR mutations can function as an adaptive response to alkylating chemotherapy, although there are well-documented cases of germline and sporadic mutations, with detrimental effects on patient survival. METHODS The clinical, pathologic, and molecular features of 18 IDH-mutant astrocytomas and 20 IDH-wild-type glioblastomas with MMR mutations in the primary tumor were analyzed in comparison to 361 IDH-mutant and 906 IDH-wild-type tumors without MMR mutations. In addition, 12 IDH-mutant astrocytomas and 18 IDH-wild-type glioblastomas that developed MMR mutations between initial presentation and tumor recurrence were analyzed in comparison to 50 IDH-mutant and 104 IDH-wild-type cases that remained MMR-wild-type at recurrence. RESULTS In both IDH-mutant astrocytoma and IDH-wild-type glioblastoma cohorts, the presence of MMR mutation in primary tumors was associated with significantly higher tumor mutation burden (TMB) (P < .0001); however, MMR mutations only resulted in worse overall survival in the IDH-mutant astrocytomas (P = .0069). In addition, gain of MMR mutation between the primary and recurrent surgical specimen occurred more frequently with temozolomide therapy (P = .0073), and resulted in a substantial increase in TMB (P < .0001), higher grade (P = .0119), and worse post-recurrence survival (P = .0022) in the IDH-mutant astrocytoma cohort. CONCLUSIONS These results suggest that whether present initially or in response to therapy, MMR mutations significantly affect TMB but appear to only influence the clinical outcome in IDH-mutant astrocytoma subsets.
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Affiliation(s)
- Timothy E Richardson
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Raquel T Yokoda
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Omid Rashidipour
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Meenakshi Vij
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Matija Snuderl
- Department of Pathology, New York University Langone Health, New York, New York, USA
| | - Steven Brem
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kimmo J Hatanpaa
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Samuel K McBrayer
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Children’s Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kalil G Abdullah
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Melissa Umphlett
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jamie M Walker
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nadejda M Tsankova
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Vasan V, Dullea JT, Devarajan A, Ali M, Rutland JW, Gill CM, Kinoshita Y, McBride RB, Gliedman P, Bederson J, Donovan M, Sebra R, Umphlett M, Shrivastava RK. NF2 mutations are associated with resistance to radiation therapy for grade 2 and grade 3 recurrent meningiomas. J Neurooncol 2023; 161:309-316. [PMID: 36436149 DOI: 10.1007/s11060-022-04197-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/11/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE High grade meningiomas have a prognosis characterized by elevated recurrence rates and radiation resistance. Recent work has highlighted the importance of genomics in meningioma prognostication. This study aimed to assess the relationship between the most common meningioma genomic alteration (NF2) and response to postoperative radiation therapy (RT). METHODS From an institutional tissue bank, grade 2 and 3 recurrent meningiomas with both > 30 days of post-surgical follow-up and linked targeted next-generation sequencing were identified. Time to radiographic recurrence was determined with retrospective review. The adjusted hazard of recurrence was estimated using Cox-regression for patients treated with postoperative RT stratified by NF2 mutational status. RESULTS Of 53 atypical and anaplastic meningiomas (29 NF2 wild-type, 24 NF2 mutant), 19 patients underwent postoperative RT. When stratified by NF2 wild-type, postoperative RT in NF2 wild-type patients was associated with a 78% reduction in the risk of recurrence (HR 0.216; 95%CI 0.068-0.682; p = 0.009). When stratified by NF2 mutation, there was a non-significant increase in the risk of recurrence for NF2 mutant patients who received postoperative RT compared to those who did not (HR 2.43; 95%CI 0.88-6.73, p = 0.087). CONCLUSION This study demonstrated a protective effect of postoperative RT in NF2 wild-type patients with recurrent high grade meningiomas. Further, postoperative RT may be associated with no improvement and perhaps an accelerated time to recurrence in NF2 mutant tumors. These differences in recurrence rates provide evidence that NF2 may be a valuable prognostic marker in treatment decisions regarding postoperative RT. Further prospective studies are needed to validate this relationship.
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Affiliation(s)
- Vikram Vasan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Floor 8, New York, NY, 10129, USA.
| | - Jonathan T Dullea
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alex Devarajan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Muhammad Ali
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John W Rutland
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Corey M Gill
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Floor 8, New York, NY, 10129, USA
| | - Yayoi Kinoshita
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Russell B McBride
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,The Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul Gliedman
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua Bederson
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Donovan
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert Sebra
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Sema4, A Mount Sinai Venture, Stamford, CT, USA
| | - Melissa Umphlett
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raj K Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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8
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Vij M, Yokoda RT, Rashidipour O, Tran I, Vasudevaraja V, Snuderl M, Yong RL, Cobb WS, Umphlett M, Walker JM, Tsankova NM, Richardson TE. The prognostic impact of subclonal IDH1 mutation in grade 2-4 astrocytomas. Neurooncol Adv 2023; 5:vdad069. [PMID: 37324217 PMCID: PMC10263115 DOI: 10.1093/noajnl/vdad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Background Isocitrate dehydrogenase (IDH) mutations are thought to represent an early oncogenic event in glioma evolution, found with high penetrance across tumor cells; however, in rare cases, IDH mutation may exist only in a small subset of the total tumor cells (subclonal IDH mutation). Methods We present 2 institutional cases with subclonal IDH1 R132H mutation. In addition, 2 large publicly available cohorts of IDH-mutant astrocytomas were mined for cases harboring subclonal IDH mutations (defined as tumor cell fraction with IDH mutation ≤0.67) and the clinical and molecular features of these subclonal cases were compared to clonal IDH-mutant astrocytomas. Results Immunohistochemistry (IHC) performed on 2 institutional World Health Organization grade 4 IDH-mutant astrocytomas revealed only a minority of tumor cells in each case with IDH1 R132H mutant protein, and next-generation sequencing (NGS) revealed remarkably low IDH1 variant allele frequencies compared to other pathogenic mutations, including TP53 and/or ATRX. DNA methylation classified the first tumor as high-grade IDH-mutant astrocytoma with high confidence (0.98 scores). In the publicly available datasets, subclonal IDH mutation was present in 3.9% of IDH-mutant astrocytomas (18/466 tumors). Compared to clonal IDH-mutant astrocytomas (n = 156), subclonal cases demonstrated worse overall survival in grades 3 (P = .0106) and 4 (P = .0184). Conclusions While rare, subclonal IDH1 mutations are present in a subset of IDH-mutant astrocytomas of all grades, which may lead to a mismatch between IHC results and genetic/epigenetic classification. These findings suggest a possible prognostic role of IDH mutation subclonality, and highlight the potential clinical utility of quantitative IDH1 mutation evaluation by IHC and NGS.
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Affiliation(s)
- Meenakshi Vij
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Raquel T Yokoda
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Omid Rashidipour
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ivy Tran
- Department of Pathology, NYU Langone Health, New York, New York, USA
| | | | - Matija Snuderl
- Department of Pathology, NYU Langone Health, New York, New York, USA
| | - Raymund L Yong
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Melissa Umphlett
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jamie M Walker
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nadejda M Tsankova
- Nadejda M. Tsankova, MD, PhD, Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, Icahn Building, 9-20E, New York, NY 10029, USA ()
| | - Timothy E Richardson
- Corresponding Authors: Timothy E. Richardson, DO, PhD, Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building, 15.58, New York, NY 10029, USA ()
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9
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Galbraith K, Vasudevaraja V, Serrano J, Shen G, Tran I, Abdallat N, Wen M, Patel S, Movahed-Ezazi M, Faustin A, Spino-Keeton M, Roberts LG, Maloku E, Drexler SA, Liechty BL, Pisapia D, Krasnozhen-Ratush O, Rosenblum M, Shroff S, Boué DR, Davidson C, Mao Q, Suchi M, North P, Hopp A, Segura A, Jarzembowski JA, Parsons L, Johnson MD, Mobley B, Samore W, McGuone D, Gopal PP, Canoll PD, Horbinski C, Fullmer JM, Farooqi MS, Gokden M, Wadhwani NR, Richardson TE, Umphlett M, Tsankova NM, DeWitt JC, Sen C, Placantonakis DG, Pacione D, Wisoff JH, Teresa Hidalgo E, Harter D, William CM, Cordova C, Kurz SC, Barbaro M, Orringer DA, Karajannis MA, Sulman EP, Gardner SL, Zagzag D, Tsirigos A, Allen JC, Golfinos JG, Snuderl M. Clinical utility of whole-genome DNA methylation profiling as a primary molecular diagnostic assay for central nervous system tumors-A prospective study and guidelines for clinical testing. Neurooncol Adv 2023; 5:vdad076. [PMID: 37476329 PMCID: PMC10355794 DOI: 10.1093/noajnl/vdad076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
Background Central nervous system (CNS) cancer is the 10th leading cause of cancer-associated deaths for adults, but the leading cause in pediatric patients and young adults. The variety and complexity of histologic subtypes can lead to diagnostic errors. DNA methylation is an epigenetic modification that provides a tumor type-specific signature that can be used for diagnosis. Methods We performed a prospective study using DNA methylation analysis as a primary diagnostic method for 1921 brain tumors. All tumors received a pathology diagnosis and profiling by whole genome DNA methylation, followed by next-generation DNA and RNA sequencing. Results were stratified by concordance between DNA methylation and histopathology, establishing diagnostic utility. Results Of the 1602 cases with a World Health Organization histologic diagnosis, DNA methylation identified a diagnostic mismatch in 225 cases (14%), 78 cases (5%) did not classify with any class, and in an additional 110 (7%) cases DNA methylation confirmed the diagnosis and provided prognostic information. Of 319 cases carrying 195 different descriptive histologic diagnoses, DNA methylation provided a definitive diagnosis in 273 (86%) cases, separated them into 55 methylation classes, and changed the grading in 58 (18%) cases. Conclusions DNA methylation analysis is a robust method to diagnose primary CNS tumors, improving diagnostic accuracy, decreasing diagnostic errors and inconclusive diagnoses, and providing prognostic subclassification. This study provides a framework for inclusion of DNA methylation profiling as a primary molecular diagnostic test into professional guidelines for CNS tumors. The benefits include increased diagnostic accuracy, improved patient management, and refinements in clinical trial design.
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Affiliation(s)
- Kristyn Galbraith
- Department of Pathology, NYU Langone Health, New York, Department of Pathology, NYU Langone, New York, USA
| | - Varshini Vasudevaraja
- Department of Pathology, NYU Langone Health, New York, Department of Pathology, NYU Langone, New York, USA
| | - Jonathan Serrano
- Department of Pathology, NYU Langone Health, New York, Department of Pathology, NYU Langone, New York, USA
| | - Guomiao Shen
- Department of Pathology, NYU Langone Health, New York, Department of Pathology, NYU Langone, New York, USA
| | - Ivy Tran
- Department of Pathology, NYU Langone Health, New York, Department of Pathology, NYU Langone, New York, USA
| | - Nancy Abdallat
- Department of Pathology, NYU Langone Health, New York, Department of Pathology, NYU Langone, New York, USA
| | - Mandisa Wen
- Department of Pathology, NYU Langone Health, New York, Department of Pathology, NYU Langone, New York, USA
| | - Seema Patel
- Department of Pathology, NYU Langone Health, New York, Department of Pathology, NYU Langone, New York, USA
| | - Misha Movahed-Ezazi
- Department of Pathology, NYU Langone Health, New York, Department of Pathology, NYU Langone, New York, USA
| | - Arline Faustin
- Department of Pathology, NYU Langone Health, New York, Department of Pathology, NYU Langone, New York, USA
| | - Marissa Spino-Keeton
- Department of Pathology, NYU Langone Health, New York, Department of Pathology, NYU Langone, New York, USA
| | - Leah Geiser Roberts
- Department of Pathology, NYU Langone Health, New York, Department of Pathology, NYU Langone, New York, USA
| | - Ekrem Maloku
- Department of Pathology, NYU Langone Health, New York, Department of Pathology, NYU Langone, New York, USA
| | - Steven A Drexler
- Department of Pathology and Laboratory Medicine, NYU, Mineola, New York, USA
- Current affiliations: Department of Pathology, Mount Sinai South Nassau Hospital, Oceanside, New York, USA
| | - Benjamin L Liechty
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College - New York Presbyterian Hospital, New York, New York, USA
| | - David Pisapia
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College - New York Presbyterian Hospital, New York, New York, USA
| | - Olga Krasnozhen-Ratush
- Department of Pathology and Laboratory Medicine, Baystate Health, Springfield, Massachusetts, USA
| | - Marc Rosenblum
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Seema Shroff
- Department of Pathology and Laboratory Medicine, AdventHealth Orlando, Orlando, Florida, USA
| | - Daniel R Boué
- Department of Pathology and Laboratory Medicine, Nationwide Children’s Hospital, and the Ohio State University, Columbus, Ohio, USA
| | | | - Qinwen Mao
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Mariko Suchi
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Paula North
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Annette Segura
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jason A Jarzembowski
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lauren Parsons
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mahlon D Johnson
- Department of Pathology, University of Rochester School of Medicine, New York, USA
| | - Bret Mobley
- Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Wesley Samore
- Department of Pathology, Advocate Aurora Health, Chicago, Illinois, USA
| | - Declan McGuone
- Department of Pathology, Yale University School of Medicine, Connecticut, USA
| | - Pallavi P Gopal
- Department of Pathology, Yale University School of Medicine, Connecticut, USA
| | - Peter D Canoll
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, USA
| | - Craig Horbinski
- Departments of Pathology and Neurosurgery, Feinberg School of Medicine, Northwestern University, Illinois, USA
| | - Joseph M Fullmer
- Department of Pathology, Beaumont Hospital, Royal Oak, Michigan, USA
| | - Midhat S Farooqi
- Department of Pathology and Laboratory Medicine, Children’s Mercy Kansas City, Kansas City, Missouri, USA
| | - Murat Gokden
- Department of Pathology, University of Arkansas and Arkansas Children’s Hospital, Little Rock, Arkansas, USA
| | - Nitin R Wadhwani
- Department of Pathology and Laboratory Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago, Illinois, USA
| | - Timothy E Richardson
- Department of Pathology and Laboratory Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Melissa Umphlett
- Department of Pathology and Laboratory Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nadejda M Tsankova
- Department of Pathology and Laboratory Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John C DeWitt
- Department of Pathology, University of Vermont Medical Center
| | - Chandra Sen
- Department of Neurosurgery, NYU Langone, New York, New York, USA
| | | | - Donato Pacione
- Department of Neurosurgery, NYU Langone, New York, New York, USA
| | - Jeffrey H Wisoff
- Department of Neurosurgery, NYU Langone, New York, New York, USA
| | | | - David Harter
- Department of Neurosurgery, NYU Langone, New York, New York, USA
| | - Christopher M William
- Department of Pathology, NYU Langone Health, New York, Department of Pathology, NYU Langone, New York, USA
| | - Christine Cordova
- Department of Neuro-oncology, NYU Langone, New York, New York, USA
- Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH
| | - Sylvia C Kurz
- Department of Neuro-oncology, NYU Langone, New York, New York, USA
- Department of Interdisciplinary Neuro-Oncology, Comprehensive Cancer Center, University of Tuebingen, Tübingen, Germany
| | - Marissa Barbaro
- Department of Neuro-oncology, NYU Langone, New York, New York, USA
| | | | - Matthias A Karajannis
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Erik P Sulman
- Department of Radiation Oncology, NYU Langone, New York, New York, USA
| | | | - David Zagzag
- Department of Pathology, NYU Langone Health, New York, Department of Pathology, NYU Langone, New York, USA
- Department of Neurosurgery, NYU Langone, New York, New York, USA
| | | | - Jeffrey C Allen
- Department of Pediatrics, NYU Langone, New York, New York, USA
| | - John G Golfinos
- Department of Neurosurgery, NYU Langone, New York, New York, USA
| | - Matija Snuderl
- Department of Pathology, NYU Langone Health, New York, Department of Pathology, NYU Langone, New York, USA
- Laura and Isaac Perlmutter Cancer Center, New York, New York, USA
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10
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Dullea JT, Vasan V, Rutland JW, Gill CM, Chaluts D, Ranti D, Ellis E, Subramanium V, Arrighi-Allisan A, Kinoshita Y, McBride RB, Bederson J, Donovan M, Sebra R, Umphlett M, Shrivastava RK. Association between tumor mutations and meningioma recurrence in Grade I/II disease. Oncoscience 2022; 9:70-81. [PMID: 36514795 PMCID: PMC9733702 DOI: 10.18632/oncoscience.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Meningiomas are common intracranial tumors with variable prognoses not entirely captured by commonly used classification schemes. We sought to determine the relationship between meningioma mutations and oncologic outcomes using a targeted next-generation sequencing panel. MATERIALS AND METHODS We identified 184 grade I and II meningiomas with both >90 days of post-surgical follow-up and linked targeted next-generation sequencing. For mutated genes in greater than 5% of the sample, we computed progression-free survival Cox-regression models stratified by gene. We then built a multi-gene model by including all gene predictors with a p-value of less than 0.20. Starting with that model, we performed backward selection to identify the most predictive factors. RESULTS ATM (HR = 4.448; 95% CI: 1.517-13.046), CREBBP (HR = 2.727; 95% CI = 1.163-6.396), and POLE (HR = 0.544; HR = 0.311-0.952) were significantly associated with alterations in disease progression after adjusting for clinical and pathologic factors. In the multi-gene model, only POLE remained a significant predictor of recurrence after adjusting for the same clinical covariates. Backwards selection identified recurrence status, resection extent, and mutations in ATM (HR = 7.333; 95% CI = 2.318-23.195) and POLE (HR = 0.413; 95% CI = 0.229-0.743) as predictive of recurrence. CONCLUSIONS Mutations in ATM and CREBBP were associated with accelerated meningioma recurrence, and mutations in POLE were protective of recurrence. Each mutation has potential implications for treatment. The effect of these mutations on oncologic outcomes and as potential targets for intervention warrants future study.
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Affiliation(s)
- Jonathan T. Dullea
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA,Correspondence to:Jonathan T. Dullea, email:
| | - Vikram Vasan
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA
| | - John W. Rutland
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA
| | - Corey M. Gill
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA
| | - Danielle Chaluts
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA
| | - Daniel Ranti
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA
| | - Ethan Ellis
- 4Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA
| | - Varun Subramanium
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA
| | - Annie Arrighi-Allisan
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA
| | - Yayoi Kinoshita
- 2Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA
| | - Russell B. McBride
- 2Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA,3The Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA
| | - Joshua Bederson
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA
| | - Michael Donovan
- 2Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA
| | - Robert Sebra
- 4Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA,5Sema4, A Mount Sinai Venture, Stamford, CT 06902, USA
| | - Melissa Umphlett
- 2Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA
| | - Raj K. Shrivastava
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA
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11
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Chaluts D, Dullea JT, Ali M, Vasan V, Devarajan A, Rutland JW, Gill CM, Ellis E, Kinoshita Y, McBride RB, Bederson J, Donovan M, Sebra R, Umphlett M, Shrivastava RK. ARID1A mutation associated with recurrence and shorter progression-free survival in atypical meningiomas. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04442-y. [DOI: 10.1007/s00432-022-04442-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022]
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12
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Dullea J, Rutland J, Gill CM, Ranti D, Arrighi-Allisan AE, Kinoshita Y, McBride R, Bederson JB, Donovan M, Sebra R, Fowkes M, Umphlett M, Shrivastava RK. 821 Association Between Tumor Mutations and Meningioma Recurrence in Grade I/II Disease. Neurosurgery 2022. [DOI: 10.1227/neu.0000000000001880_821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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13
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Rutland JW, Dullea JT, Gill CM, Chaluts D, Ranti D, Ellis E, Arrighi-Allisan A, Kinoshita Y, McBride RB, Bederson J, Donovan M, Sebra R, Fowkes M, Umphlett M, Shrivastava RK. Association of mutations in DNA polymerase epsilon with increased CD8+ cell infiltration and prolonged progression-free survival in patients with meningiomas. Neurosurg Focus 2022; 52:E7. [PMID: 35104796 DOI: 10.3171/2021.11.focus21592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/16/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Prior studies have demonstrated a relationship between underlying tumor genetics and lymphocyte infiltration in meningiomas. In this study, the authors aimed to further characterize the relationship between meningioma genomics, CD4+ and CD8+ T-cell infiltration, and oncological outcomes of meningiomas. Understanding specific characteristics of the inflammatory infiltration could have implications for treatment and prognostication. METHODS Immunohistochemically stained meningioma slides were reviewed to assess the CD4+ and CD8+ cell infiltration burden. The relationship between immune cell infiltration and tumor genomics was then assessed using an adjusted ANOVA model. For a specific gene identified by the ANOVA, the relationship between that mutation and tumor recurrence was assessed using Cox regression. RESULTS In immunohistochemically stained samples from a subcohort of 25 patients, the mean number of CD4+ cells was 42.2/400× field and the mean number of CD8+ cells was 69.8/400× field. Elevated CD8+ cell infiltration was found to be associated with the presence of a mutation in the gene encoding for DNA polymerase epsilon, POLE (51.6 cells/hpf in wild-type tumors vs 95.9 cells/hpf in mutant tumors; p = 0.0199). In a retrospective cohort of 173 patients, the presence of any mutation in POLE was found to be associated with a 46% reduction in hazard of progression (HR 0.54, 95% CI 0.311-0.952; p = 0.033). The most frequent mutation was a near-C-terminal nonsense mutation. CONCLUSIONS A potential association was found between mutant POLE and both an increase in CD8+ cell infiltration and progression-free survival. The predominant mutation was found outside of the known exonuclease hot spot; however, it was still associated with a slight increase in mutational burden, CD8+ cell infiltration, and progression-free survival. Alterations in gene expression, resulting from alterations in POLE, may yield an increased presentation of neoantigens, and, thus, greater CD8+ cell-mediated apoptosis of neoplastic cells. These findings have suggested the utility of checkpoint inhibitors in the treatment of POLE-mutant meningiomas.
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Affiliation(s)
- John W Rutland
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai
| | - Jonathan T Dullea
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai
| | - Corey M Gill
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai
| | - Danielle Chaluts
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai
| | - Daniel Ranti
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai
| | - Ethan Ellis
- 2Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai
| | | | - Yayoi Kinoshita
- 3Department of Pathology, Icahn School of Medicine at Mount Sinai
| | - Russell B McBride
- 3Department of Pathology, Icahn School of Medicine at Mount Sinai.,4The Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York; and
| | - Joshua Bederson
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai
| | - Michael Donovan
- 3Department of Pathology, Icahn School of Medicine at Mount Sinai
| | - Robert Sebra
- 2Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai.,5Sema4, A Mount Sinai venture, Stamford, Connecticut
| | - Mary Fowkes
- 3Department of Pathology, Icahn School of Medicine at Mount Sinai
| | - Melissa Umphlett
- 3Department of Pathology, Icahn School of Medicine at Mount Sinai
| | - Raj K Shrivastava
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai
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14
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Umphlett M, Bilal KH, Martini ML, Suwala AK, Ahuja S, Rashidipour O, Germano I, Snuderl M, Morgenstern P, Tsankova NM. IDH-mutant astrocytoma with EGFR amplification-Genomic profiling in four cases and review of literature. Neurooncol Adv 2022; 4:vdac067. [PMID: 35669011 PMCID: PMC9159664 DOI: 10.1093/noajnl/vdac067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Melissa Umphlett
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Pathology, Mount Sinai West, New York, New York, USA
| | | | - Michael L Martini
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Abigail K Suwala
- Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany
- Department of Neurological Surgery, Helen Diller Research Center, University of California San Francisco, San Francisco, California, USA
| | - Sadhna Ahuja
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Omid Rashidipour
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Isabelle Germano
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Matija Snuderl
- Department of Pathology, NYU Langone Medical Health, New York, New York, USA
| | - Peter Morgenstern
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nadejda M Tsankova
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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15
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Gill CM, D'Andrea MR, Tomita S, Suhner J, Umphlett M, Zakashansky K, Blank SV, Tsankova N, Shrivastava RK, Fowkes M, Kolev V. Tumor immune microenvironment in brain metastases from gynecologic malignancies. Cancer Immunol Immunother 2021; 70:2951-2960. [PMID: 33713153 PMCID: PMC10992931 DOI: 10.1007/s00262-021-02909-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 03/04/2021] [Indexed: 01/02/2023]
Abstract
INTRODUCTION The density and distribution of the tumor immune microenvironment associated with brain metastases (BM) from gynecologic malignancies are unknown and have not been previously reported. We sought to describe the clinical features of a cohort of patients with BM from gynecologic malignancies and to characterize the tumor immune microenvironment from available archival surgical specimens. METHODS We performed a retrospective review of electronic medical records from 2002 to 2018 for patients with BM from gynecologic malignancies. Data on patient characteristics, treatment regimens, and clinical outcomes were procured. CD4, CD8, CD45RO, CD68, CD163, and FOXP3 immunohistochemistry were evaluated from available archival surgical specimens from primary disease site and neurosurgical resection. RESULTS A cohort of 44 patients with BM from gynecologic malignancies was identified, 21 (47.7%) endometrial primaries and 23 (52.3%) ovarian primaries. Tumor-infiltrating lymphocytes (TILs) and tumor-associated macrophages (TAMs) were evaluated in 13 primary cases and 15 BM cases. For the 13 primary cases, CD4+ TILs were evident in 76.9% of cases, CD8+ in 92.3%, CD45RO+ in 92.3%, and FOXP3+ in 46.2%, as well as CD68+ TAMs in 100% and CD163+ in 100%. For the 15 BM cases, CD4+ TILs were evident in 60.0% of cases, CD8+ in 93.3%, CD45RO+ in 73.3%, and FOXP3+ in 35.7%, as well as CD68+ TAMs in 86.7% and CD163+ in 100%. CONCLUSION An active tumor immune microenvironment is present with similar distribution in the primary disease site and BM from patients with gynecologic malignancies.
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Affiliation(s)
- Corey M Gill
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Megan R D'Andrea
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Shannon Tomita
- Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Jessa Suhner
- Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Melissa Umphlett
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Konstantin Zakashansky
- Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Stephanie V Blank
- Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Nadejda Tsankova
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Raj K Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Mary Fowkes
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Valentin Kolev
- Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
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16
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Gill CM, Loewenstern J, Rutland JW, Arib H, Francoeur N, Wang YC, Fishman N, Pain M, Umphlett M, Kinoshita Y, McBride RB, Bederson J, Donovan M, Smith M, Sebra R, Shrivastava RK, Fowkes M. Recurrent IDH mutations in high-grade meningioma. Neuro Oncol 2021; 22:1044-1045. [PMID: 32179909 DOI: 10.1093/neuonc/noaa065] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Corey M Gill
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joshua Loewenstern
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John W Rutland
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hanane Arib
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nancy Francoeur
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ying-Chih Wang
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nataly Fishman
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Margaret Pain
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Melissa Umphlett
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Yayoi Kinoshita
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Russell B McBride
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York.,The Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joshua Bederson
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael Donovan
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Melissa Smith
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert Sebra
- Sema4, A Mount Sinai venture, Stamford, Connecticut
| | - Raj K Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mary Fowkes
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
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Gil CM, Loewenstern J, Rutland J, Arib H, Pain M, Umphlett M, Kinoshita Y, McBride R, Bederson JB, Donovan M, Sebra R, Fowkes M, Shrivastava RK. SWI/SNF Chromatin Remodeling Complex Alterations in Meningioma. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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18
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Gill CM, Loewenstern J, Rutland J, Arib H, Pain M, Umphlett M, Kinoshita Y, McBride R, Bederson JB, Donovan M, Sebra R, Fowkes M, Shrivastava RK. Peritumoral Edema Correlates with Mutational Burden in Meningiomas. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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19
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Gill C, Tomita S, Suhner J, D'Andrea M, Umphlett M, Blank S, Tsankova N, Shrivastava R, Fowkes M, Kolev V. Tumor infiltrating lymphocytes in brain metastases from gynecological malignancies. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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Gill CM, Loewenstern J, Rutland JW, Arib H, Pain M, Umphlett M, Kinoshita Y, McBride RB, Bederson J, Donovan M, Sebra R, Fowkes M, Shrivastava RK. Peritumoral edema correlates with mutational burden in meningiomas. Neuroradiology 2020; 63:73-80. [PMID: 32789536 DOI: 10.1007/s00234-020-02515-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/04/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Meningiomas are the most common primary central nervous system tumor. Emerging data supports that higher mutational burden portends worse clinical outcomes in meningiomas. However, there is a lack of imaging biomarkers that are associated with tumor genomics in meningiomas. METHODS We performed next-generation targeted sequencing in a cohort of 75 primary meningiomas and assessed preoperative imaging for tumor volume and peritumoral brain edema (PTBE). An Edema Index was calculated. RESULTS Meningiomas that were high grade (WHO grade II or grade III) had significantly larger tumor volume and were more likely to present with PTBE. Moreover, PTBE was associated with brain invasion on histopathology and reduced overall survival. There was a direct association between Edema Index and mutational burden. For every one increase in Edema Index, the number of single nucleotide variants increased by 1.09-fold (95% CI: 1.02, 1.2) (P = 0.01). CONCLUSION These data support that Edema Index may serve as a novel imaging biomarker that can inform underlying mutational burden in patients with meningiomas.
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Affiliation(s)
- Corey M Gill
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Joshua Loewenstern
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - John W Rutland
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Hanane Arib
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Margaret Pain
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Melissa Umphlett
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yayoi Kinoshita
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Russell B McBride
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,The Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua Bederson
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Michael Donovan
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert Sebra
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Sema4, A Mount Sinai venture, Stamford, CT, USA
| | - Mary Fowkes
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raj K Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
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21
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D'Andrea MR, Gill CM, Umphlett M, Tsankova NM, Fowkes M, Bederson JB, Brastianos PK, Shrivastava RK. Brain Metastases from Biliary Tract Cancers: A Case Series and Review of the Literature in the Genomic Era. Oncologist 2020; 25:447-453. [PMID: 31694894 PMCID: PMC7216433 DOI: 10.1634/theoncologist.2019-0306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/12/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Biliary tract cancers (BTCs) are highly fatal malignancies that make up less than 1% of all cancers. BTC is often diagnosed at an unresectable stage; surgical resection remains the only definitive treatment. Brain metastases (BMs) from BTC are extremely rare, and few studies on patients with BMs from BTC exist. The aim of this study was to identify clinical characteristics associated with poor prognosis for patients with BMs from BTC. MATERIALS AND METHODS We performed a retrospective review of electronic medical records for patients with BMs from BTC managed at Mount Sinai Hospital from 2000 to 2017. Data on patient characteristics, magnetic resonance imaging findings, treatment regimens, and clinical outcomes were analyzed. RESULTS We identified 1,910 patients with BTC. Nine patients developed BMs, with an incidence of 0.47%. Of these nine patients, six had intrahepatic cholangiocarcinoma, two had extrahepatic cholangiocarcinoma, and one had gallbladder cancer. Six (66.7%) patients had one BM, one (11.1%) patient had two BMs, and two (22.2%) patients had three or more BMs. Four (44.4%) patients underwent BM resection, and seven (77.8%) received BM radiation. Median overall survival from time of BM diagnosis was 3.8 months (95% confidence interval 0.1-16.9). CONCLUSION Development of BMs from BTC is rare; however, prognosis is less than 4 months. BM diagnosis can occur within 2 years of primary diagnosis. As targeted therapeutics emerge, future studies ought to focus on identifying genomic BM markers associated with BTC subtypes. IMPLICATIONS FOR PRACTICE In the largest retrospective study of biliary tract cancer brain metastases, the clinical presentation and outcomes are reported of nine patients with an extremely rare clinical entity. The genomic literature and potential therapeutic targets for these patients with limited treatment options is comprehensively and exhaustively discussed.
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Affiliation(s)
- Megan R. D'Andrea
- Department of Neurosurgery, Mount Sinai Medical CenterNew YorkNew YorkUSA
| | - Corey M. Gill
- Department of Neurosurgery, Mount Sinai Medical CenterNew YorkNew YorkUSA
| | - Melissa Umphlett
- Department of Pathology, Mount Sinai Medical CenterNew YorkNew YorkUSA
| | | | - Mary Fowkes
- Department of Pathology, Mount Sinai Medical CenterNew YorkNew YorkUSA
| | - Joshua B. Bederson
- Department of Neurosurgery, Mount Sinai Medical CenterNew YorkNew YorkUSA
| | - Priscilla K. Brastianos
- Department of Neurology and Cancer Center, Massachusetts General HospitalBostonMassachusettsUSA
| | - Raj K. Shrivastava
- Department of Neurosurgery, Mount Sinai Medical CenterNew YorkNew YorkUSA
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22
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Gill CM, Loewenstern J, Rutland JW, Arib H, Pain M, Umphlett M, Kinoshita Y, McBride RB, Bederson J, Donovan M, Sebra R, Fowkes M, Shrivastava RK. STK11 mutation status is associated with decreased survival in meningiomas. Neurol Sci 2020; 41:2585-2589. [PMID: 32253637 DOI: 10.1007/s10072-020-04372-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 03/24/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Emerging evidence suggests that STK11 mutations may influence clinical outcome and response to immunotherapy in cancer. MATERIALS AND METHODS Next-generation targeted sequencing of STK11 mutation status in a large cohort of 188 meningiomas. RESULTS STK11 loss-of-function mutations were identified in 3.7% of meningiomas. STK11 mutations were found in both low- and high-grade lesions and samples from primary and recurrent disease. There was a 2.8-fold increased risk of death for patients whose meningioma harbored an STK11 mutation, after controlling for lesion grade and occurrence status. The median overall survival for patients with STK11-mutated meningiomas was 4.4 years compared with 16.8 years. CONCLUSION These data identify recurrent STK11 mutations in a subset of meningiomas. Genotyping of STK11 is encouraged for meningioma patients undergoing immunotherapy-based therapy.
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Affiliation(s)
- Corey M Gill
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Joshua Loewenstern
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - John W Rutland
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Hanane Arib
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Margaret Pain
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Melissa Umphlett
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yayoi Kinoshita
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Russell B McBride
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,The Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua Bederson
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Michael Donovan
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert Sebra
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Sema4, A Mount Sinai Venture, Stamford, CT, USA
| | - Mary Fowkes
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raj K Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
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Gill CM, Loewenstern J, Rutland JW, Arib H, Pain M, Umphlett M, Kinoshita Y, McBride RB, Bederson J, Donovan M, Sebra R, Fowkes M, Shrivastava RK. In Reply: Retention of ATRX and DAXX Expression in Meningiomas. Neurosurgery 2020; 86:E244-E246. [PMID: 31803910 DOI: 10.1093/neuros/nyz504] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Corey M Gill
- Department of Neurosurgery Icahn School of Medicine at Mount Sinai New York, New York
| | - Joshua Loewenstern
- Department of Neurosurgery Icahn School of Medicine at Mount Sinai New York, New York
| | - John W Rutland
- Department of Neurosurgery Icahn School of Medicine at Mount Sinai New York, New York
| | - Hanane Arib
- Department of Genetics and Genomic Sciences Icahn School of Medicine at Mount Sinai New York, New York
| | - Margaret Pain
- Department of Neurosurgery Icahn School of Medicine at Mount Sinai New York, New York
| | - Melissa Umphlett
- Department of Pathology Icahn School of Medicine at Mount Sinai New York, New York
| | - Yayoi Kinoshita
- Department of Pathology Icahn School of Medicine at Mount Sinai New York, New York
| | - Russell B McBride
- Department of Pathology Icahn School of Medicine at Mount Sinai New York, New York.,The Institute for Translational Epidemiology Icahn School of Medicine at Mount Sinai New York, New York
| | - Joshua Bederson
- Department of Neurosurgery Icahn School of Medicine at Mount Sinai New York, New York
| | - Michael Donovan
- Department of Pathology Icahn School of Medicine at Mount Sinai New York, New York
| | - Robert Sebra
- Department of Genetics and Genomic Sciences Icahn School of Medicine at Mount Sinai New York, New York.,Sema4 A Mount Sinai Venture Stamford, Connecticut
| | - Mary Fowkes
- Department of Pathology Icahn School of Medicine at Mount Sinai New York, New York
| | - Raj K Shrivastava
- Department of Neurosurgery Icahn School of Medicine at Mount Sinai New York, New York
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24
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D'Andrea MR, Gill CM, Umphlett M, Govindaraj S, Del Signore A, Bederson JB, Iloreta AMC, Shrivastava RK. Benefit of Endoscopic Surgery in the Management of Acute Invasive Skull Base Fungal Rhinosinusitis. J Neurol Surg B Skull Base 2020; 82:e330-e334. [PMID: 34306957 DOI: 10.1055/s-0040-1701681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 12/24/2019] [Indexed: 10/20/2022] Open
Abstract
Objective This article aims to characterize 14 patients who underwent purely endoscopic surgical debridement of acute invasive skull base fungal rhinosinusitis, and to evaluate postoperative outcomes and risk for recurrence. Design Retrospective cohort study. Setting Tertiary single-institution neurosurgery department. Participants We performed a retrospective analysis of all patients with skull base fungal infections treated with a purely endoscopic surgical approach at Mount Sinai Hospital from 1998 to 2018. Main Outcome Measures Clinical presentation, number of recurrences, and mortality rate. Results The most common underlying medical comorbidities were hematologic malignancy in 8 (57.1%) patients and poorly controlled diabetes mellitus in 7 (50%) patients. Presenting symptoms included headache (50%), eye pain (35.7%), facial pain (28.6%), visual changes (21.4%), and nasal congestion (14.3%). The fungal organisms identified on culture were Aspergillus (42.9%), Mucorales (28.6%), Fusarium (14.3%), Penicillium (7.1%), and unspecified (7.1%). Eight (57.1%) patients developed recurrence and required multiple surgical debridements. Patients who had only a hematologic malignancy were more likely to require multiple surgical debridements compared with those who did not have a hematologic malignancy or those who had both hematologic malignancy and underlying diabetes mellitus ( p = 0.03). The mortality rate from surgery was 42.9%. Conclusion Surgical endoscopic intervention is an option for definitive management of acute invasive skull base fungal rhinosinusitis; however, postoperative mortality and risk of recurrence requiring additional surgical interventions remains high. Patients with hematologic malignancy may be more susceptible to recurrent infection requiring multiple surgical debridements. We recommend early aggressive multimodal treatment. Multiple debridements may be warranted in most cases; close clinical surveillance is needed during neurosurgical intervention.
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Affiliation(s)
- Megan R D'Andrea
- Department of Neurosurgery, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, United States
| | - Corey M Gill
- Department of Neurosurgery, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, United States
| | - Melissa Umphlett
- Department of Pathology, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, United States
| | - Satish Govindaraj
- Department of Otolaryngology, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, United States
| | - Anthony Del Signore
- Department of Otolaryngology, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, United States
| | - Joshua B Bederson
- Department of Neurosurgery, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, United States
| | - Alfred M C Iloreta
- Department of Otolaryngology, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, United States
| | - Raj K Shrivastava
- Department of Neurosurgery, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, United States
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25
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Umphlett M, Shea S, Tome-Garcia J, Zhang Y, Hormigo A, Fowkes M, Tsankova NM, Yong RL. Widely metastatic glioblastoma with BRCA1 and ARID1A mutations: a case report. BMC Cancer 2020; 20:47. [PMID: 31959133 PMCID: PMC6971940 DOI: 10.1186/s12885-020-6540-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 01/13/2020] [Indexed: 01/08/2023] Open
Abstract
Background Glioblastoma (GBM) is a highly malignant brain neoplasm with poor survival. Despite its aggressive nature, metastatic spread of GBM is identified only rarely. While the molecular alterations associated with GBM and its subtypes are well-described, there remains a gap in understanding which alterations may predispose towards metastasis. In this report, we present a case of GBM with multi-organ metastases and discuss its genomic alterations. Case presentation A 74-year-old woman was diagnosed with left occipital glioblastoma (IDH-wildtype, MGMT-unmethylated), for which she underwent resection, standard chemoradiation, and then stereotactic radiosurgery (SRS) for local recurrence. One month after SRS, work-up for a pathologic hip fracture revealed a left breast mass, lytic lesions involving pelvic bones, and multiple pulmonary and hepatic lesions. Biopsies of the breast and bone lesions both demonstrated metastatic IDH-wildtype GBM. For worsening neurologic symptoms, the patient underwent debulking of a large right temporal lobe recurrence and expired shortly thereafter. Autopsy confirmed metastatic GBM in multiple systemic sites, including bilateral lungs, heart, liver, thyroid, left breast, small bowel, omentum, peritoneal surfaces, visceral surfaces, left pelvic bone, and hilar lymph nodes. Targeted sequencing was performed on tissue samples obtained pre- and postmortem, as well as on cell cultures and an orthotopic mouse xenograft derived from premortem surgical specimens. A BRCA1 mutation (p.I571T) was the only variant found in common among the primary, recurrence, and metastatic specimens, suggesting its likely status as an early driver mutation. Multiple subclonal ARID1A mutations, which promote genomic instability through impairment of DNA mismatch repair, were identified only in the recurrence. Mutational spectrum analysis demonstrated a high percentage of C:G to T:A transitions in the post-treatment samples but not in the primary tumor. Conclusion This case report examines a rare case of widely metastatic IDH-wildtype GBM with a clonal somatic mutation in BRCA1. Post-treatment recurrent tumor in the brain and in multiple systemic organs exhibited evidence of acquired DNA mismatch repair deficiency, which may be explained by functional loss of ARID1A. We identify a potential role for immune checkpoint and PARP inhibitors in the treatment of metastatic GBM.
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Affiliation(s)
- Melissa Umphlett
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stephanie Shea
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jessica Tome-Garcia
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yizhou Zhang
- Departments of Neurosurgery and Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adilia Hormigo
- Department of Neurology, Medicine (Division Hem-Onc), Neurosurgery and the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mary Fowkes
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nadejda M Tsankova
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raymund L Yong
- Departments of Neurosurgery and Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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26
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Loewenstern J, Shuman W, Rutland JW, Kessler RA, Kohli KM, Umphlett M, Pain M, Bederson J, Fowkes M, Shrivastava RK. Preoperative and Histological Predictors of Recurrence and Survival in Atypical Meningioma After Initial Gross Total Resection. World Neurosurg 2019; 128:e148-e156. [DOI: 10.1016/j.wneu.2019.04.069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 04/07/2019] [Accepted: 04/08/2019] [Indexed: 12/16/2022]
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27
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Loewenstern J, Rutland J, Gill C, Arib H, Pain M, Umphlett M, Kinoshita Y, McBride R, Donovan M, Sebra R, Bederson J, Fowkes M, Shrivastava R. Comparative genomic analysis of driver mutations in matched primary and recurrent meningiomas. Oncotarget 2019; 10:3506-3517. [PMID: 31191822 PMCID: PMC6544407 DOI: 10.18632/oncotarget.26941] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 04/21/2019] [Indexed: 11/25/2022] Open
Abstract
A significant proportion of low-grade WHO grade I and higher-grade WHO grade II or III meningiomas are at risk to develop post-resection recurrence. Though recent studies investigated genomic alterations within histological subtypes of meningiomas, few have compared genomic profiles of primary meningiomas matched to their recurrences. The present study aimed to identify oncogenic driver mutations that may indicate risk of meningioma recurrence and aggressive clinical course. Seventeen patients treated for low-grade (n = 8) or high-grade (n = 9) meningioma and underwent both primary and recurrent resection between 2007-2017 were reviewed. Tumor specimens (n = 38) underwent genomic sequencing of known oncogenic driver mutations. Primary and recurrent tumors were compared using matched-pair analyses for mutational associations with clinical outcomes including functional status, progression-free survival (PFS) and overall survival (OS). Most common driver mutations included POLE and NF2. There was no enrichment for any driver mutation from primary to recurrent tumor specimen. NF2 mutant meningiomas were associated with larger tumor size (8-fold increase), presence of vasogenic edema, and higher mitotic proliferation on univariate and independently on multivariate regression (p's < 0.05) after controlling for preoperative and tumor features. Tumors with POLE driver mutations were associated with decreased functional status at last postoperative follow-up (p = 0.022) relative to presentation. Mutation status was not associated with PFS or OS on multivariate Cox regression, but rather with grade of resection (p = 0.046) for PFS. While primary and recurrent tumors exhibited similar driver mutations within patients, the identification of driver mutations associated with clinical outcomes is crucial for guiding potential targeted treatments in recurrent meningiomas.
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Affiliation(s)
- Joshua Loewenstern
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - John Rutland
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Corey Gill
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Hanane Arib
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Margaret Pain
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Melissa Umphlett
- Department of Pathology, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Yayoi Kinoshita
- Department of Pathology, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Russell McBride
- Department of Pathology, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Michael Donovan
- Department of Pathology, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Robert Sebra
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Joshua Bederson
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Mary Fowkes
- Department of Pathology, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Raj Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, NY, New York, USA
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28
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Seifert AC, Umphlett M, Hefti M, Fowkes M, Xu J. Formalin tissue fixation biases myelin-sensitive MRI. Magn Reson Med 2019; 82:1504-1517. [PMID: 31125149 DOI: 10.1002/mrm.27821] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Chemical fixatives such as formalin form cross-links between proteins and affect the relaxation times and diffusion properties of tissue. These fixation-induced changes likely also affect myelin density measurements produced by quantitative magnetization transfer and myelin water imaging. In this work, we evaluate these myelin-sensitive MRI methods for fixation-induced biases. METHODS We perform quantitative magnetization transfer, myelin water imaging, and deuterium oxide-exchanged zero TE imaging on unfixed human spinal cord tissue at 9.4 Tesla and repeat these measurements after 1 day and 31 days of formalin fixation. RESULTS The quantitative magnetization-transfer bound pool fraction increased by 30.7% ± 21.1% after 1 day of fixation and by 42.6% ± 33.9% after 31 days of fixation. Myelin water fraction increased by 39.7% ± 15.5% and 37.0% ± 15.9% at these same time points, and mean T2 of the myelin water pool nearly doubled. Reference-normalized deuterium oxide-exchanged zero TE signal intensity increased by 8.17% ± 6.03% after 31 days of fixation but did not change significantly after 1 day of fixation. After fixation, specimen cross-sectional area decreased by approximately 5%; after correction for shrinkage, changes in deuterium oxide-exchanged zero TE intensity were nearly eliminated. CONCLUSION Bound pool fraction and myelin water fraction are significantly increased by formalin fixation, whereas deuterium oxide-exchanged zero TE intensity is minimally affected. Changes in quantitative magnetization transfer and myelin water imaging may be due in part to delamination and formation of vacuoles in the myelin sheath. Deuterium oxide-exchanged signal intensity may be altered by fixation-induced changes in myelin lipid solid-state 1 H T1 . We urge caution in the comparison of these measurements across subjects or specimens in different states, especially unfixed versus fixed tissue.
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Affiliation(s)
- Alan C Seifert
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY.,Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Melissa Umphlett
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Marco Hefti
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mary Fowkes
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Junqian Xu
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY.,Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY
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Lieber AC, McNeill IT, Scaggiante J, Nistal DA, Fowkes M, Umphlett M, Pan J, Roussos P, Mobbs CV, Mocco J, Kellner CP. Biopsy During Minimally Invasive Intracerebral Hemorrhage Clot Evacuation. World Neurosurg 2018; 124:S1878-8750(18)32881-X. [PMID: 30590212 PMCID: PMC8407056 DOI: 10.1016/j.wneu.2018.12.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND The safety and efficacy of brain parenchyma biopsy during minimally invasive (MIS) intracerebral hemorrhage (ICH) clot evacuation has not been previously reported. The objective of this study was to establish the safety and diagnostic efficacy of brain biopsy during MIS ICH clot evacuation and to validate the modified Boston criteria as a predictor of cerebral amyloid angiopathy (CAA) in this cohort. METHODS From October 2016 to March 2018, superficial and perihematomal biopsies were collected for 40 patients undergoing MIS ICH clot evacuation and analyzed by the pathology department to assess for various ICH etiologies. Additionally, the admission magnetic resonance imaging or computed tomography scan of each patient was analyzed and evaluated for the likelihood of a CAA etiology based on the modified Boston criteria. Student t test was used to analyze intergroup differences in continuous variables, and a 2-tailed Fisher exact test was used to determine intergroup differences of categorical variables, with significance set at P < 0.05. RESULTS Two of the 40 patients (5%) experienced postoperative rebleed. Four of the 40 patients (10%) had evidence of CAA on biopsy. Patients with CAA on biopsy were older (P = 0.005) and had a higher prevalence of parietal lobe (P = 0.02) and occipital lobe (P = 0.001) hemorrhage. The modified Boston criteria had a sensitivity of 100% (95% confidence interval [CI], 39.6%-100%) and a specificity of 72.2% (95% CI, 54.6%-84.2%) for predicting CAA on biopsy. CONCLUSIONS Brain biopsy in MIS ICH clot evacuation is safe and allows for the diagnosis of various ICH etiologies.
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Affiliation(s)
- Adam C Lieber
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Ian T McNeill
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Jacopo Scaggiante
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Dominic A Nistal
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Mary Fowkes
- Department of Pathology, Mount Sinai Hospital, New York, New York, USA
| | - Melissa Umphlett
- Department of Pathology, Mount Sinai Hospital, New York, New York, USA
| | - Jonathan Pan
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Panos Roussos
- Department of Genetics and Genomic Sciences, Mount Sinai Hospital, New York, New York, USA; Department of Psychiatry, Mount Sinai Hospital, New York, New York, USA; Mental Illness Research, Education, and Clinical Center (VISN 2 South), James J. Peters VA Medical Center, Bronx, New York, USA
| | - Charles V Mobbs
- Department of Neuroscience, Mount Sinai Hospital, New York, New York, USA
| | - J Mocco
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
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Loewenstern J, Kessler RA, Kohli K, Umphlett M, Pain M, Bederson JB, Fowkes M, Shrivastava RK. 145 Preoperative and Histological Features Predict Recurrence and Survival in Atypical Meningioma After Primary Total Resection. Neurosurgery 2018. [DOI: 10.1093/neuros/nyy303.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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31
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Jahan-Tigh RR, Alston JL, Umphlett M. Basal cell carcinoma with metastasis to the lung in an African American man. J Am Acad Dermatol 2010; 63:e87-9. [DOI: 10.1016/j.jaad.2010.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Revised: 12/30/2009] [Accepted: 01/03/2010] [Indexed: 10/19/2022]
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