1
|
Sari R, Altinoz MA, Ozyar E, Danyeli AE, Elmaci I. A pediatric cerebral tumor with MN1 alteration and pathological features mimicking carcinoma metastasis: may the terminology "high grade neuroepithelial tumor with MN1 alteration" still be relevant? Childs Nerv Syst 2021; 37:2967-2974. [PMID: 34269865 DOI: 10.1007/s00381-021-05289-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/06/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Astroblastoma, MN1-altered (old name: high-grade neuroepithelial tumor/HGNET with MN1 alteration) is a recently described central nervous system tumor mostly affecting pediatric patients and profoundly young girls. Differential pathological diagnoses of these tumors include ependymoma, pleomorphic xanthoastrocytoma, embryonal tumor with multilayered rosettes, meningioma, and even glioblastoma. As the treatment approaches to these tumors differ, it is essential to increase the awareness about these tumors in the neurosurgical community. CLINICAL PRESENTATION A 7-year-old female patient admitted with a 7-day history of headache, nausea, and vomiting. A contrasted MRI scan revealed a left parietal 4 × 4 × 5 cm mass with central necrosis and peripheral contrast enhancement. The tumor's histopathological findings were suggestive of a metastatic carcinoma with unknown primary, yet further genetic analysis revealed MN1 alteration. Peculiarly, the tumor pathomorphological features were not compatible with astroblastomas and exerted features strongly indicating a metastatic cancer; however, systemic PET and whole-body MRI failed to detect a primary malignancy. OUTCOME AND CONCLUSIONS Eighteen months after gross-total tumor resection, an in-field and out-field multifocal recurrence developed which required a second surgery and subsequent chemo-radiotherapy. The patient is doing well for 1 year after the second treatment regimen at the time of this report. Despite the final cIMPACT6 classification in 2020 advised to define all MN1 altered brain tumors as astroblastomas, there exist prognostic differences in MN1-altered tumors with and without morphological features of astroblastoma. Rare morphological variants of MN1-altered tumors shall be recognized for their future prognostic and clinical classification. HGNET with MN1 alteration seems still be a more proper definition of such malignancies as an umbrella term.
Collapse
Affiliation(s)
- Ramazan Sari
- Department of Neurosurgery, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Meric A Altinoz
- Department of Medical Biochemistry, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Enis Ozyar
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Ayca Ersen Danyeli
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Ilhan Elmaci
- Department of Neurosurgery, Acibadem Maslak Hospital, Istanbul, Turkey. .,Department of Neurosurgery, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.
| |
Collapse
|
2
|
De Lima L, Sürme MB, Gessi M, Mastronuzzi A, Miele E, Tamburrini G, Massimi L. Central nervous system high-grade neuroepithelial tumor with BCOR alteration (CNS HGNET-BCOR)-case-based reviews. Childs Nerv Syst 2020; 36:1589-1599. [PMID: 32542405 DOI: 10.1007/s00381-020-04692-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/19/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION High-grade neuroepithelial tumor with BCOR alteration (HGNET BCOR) has been recently classified as a new category of tumors among those previously known as PNET. They are molecularly characterized by the mutation of the BCOR gene, a corepressor of BCL6 a gene (which has an important role in immune responses). Only case reports and very small series have been published so far; therefore, their behavior and management are still under investigation. The goal of the present case-based review is to provide a summary about the state of the art on these tumors. METHODS AND RESULTS The pertinent review has been reviewed, and an exemplary case has been reported (15-month-old boy with large HGNET BCOR of the left cerebellopontine angle). So far, 24 cases have been described, with a 5.5 mean age at diagnosis and a 1.4 male/female ratio. The cerebellar hemisphere is the more frequently involved region. No metastases are usually detected at diagnosis, though they are common in case of tumor recurrence. There are no specific radiological or pathological features to differentiate HGNET BCOR from other brain malignant neuroepithelial tumors so that the differential diagnosis is obtained by DNA methylation profiling. The management possibly relies on surgery and (high dose) chemotherapy and radiotherapy but without a dedicated protocol yet. The overall survival after 48-month follow-up is 50%. A gross total resection, which is mandatory for a better outcome, is achievable in the majority of cases. CONCLUSIONS The clinical research on HGNET BCOR is just at the beginning. New targets and wide-ranging clinical trials are needed to get an optimal management.
Collapse
Affiliation(s)
- Lazaro De Lima
- Neurochirurgia Infantile, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mehmet Beşir Sürme
- Neurochirurgia Infantile, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco Gessi
- Unità di Neuropatologia, Divisione di Patologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angela Mastronuzzi
- Oncoematologia-Terapia Cellulare e Genica dei Tumori Pediatrici, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Evelina Miele
- Oncoematologia-Terapia Cellulare e Genica dei Tumori Pediatrici, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Gianpiero Tamburrini
- Neurochirurgia Infantile, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Massimi
- Neurochirurgia Infantile, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
- Università Cattolica del Sacro Cuore, Rome, Italy.
- Pediatric Neurosurgery - A. Gemelli Hospital, Largo A. Gemelli, 8, 00168, Rome, Italy.
| |
Collapse
|
3
|
Tauziède-Espariat A, Pagès M, Roux A, Siegfried A, Uro-Coste E, Nicaise Y, Sevely A, Gambart M, Boetto S, Dupuy M, Richard P, Perbet R, Vinchon M, Caron S, Andreiuolo F, Gareton A, Lechapt E, Chrétien F, Puget S, Grill J, Boddaert N, Varlet P. Pediatric methylation class HGNET-MN1: unresolved issues with terminology and grading. Acta Neuropathol Commun 2019; 7:176. [PMID: 31707996 PMCID: PMC6842469 DOI: 10.1186/s40478-019-0834-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/25/2019] [Indexed: 12/13/2022] Open
|
4
|
Ferris SP, Velazquez Vega J, Aboian M, Lee JC, Van Ziffle J, Onodera C, Grenert JP, Saunders T, Chen YY, Banerjee A, Kline CN, Gupta N, Raffel C, Samuel D, Ruiz-Diaz I, Magaki S, Wilson D, Neltner J, Al-Hajri Z, Phillips JJ, Pekmezci M, Bollen AW, Tihan T, Schniederjan M, Cha S, Perry A, Solomon DA. High-grade neuroepithelial tumor with BCOR exon 15 internal tandem duplication-a comprehensive clinical, radiographic, pathologic, and genomic analysis. Brain Pathol 2019; 30:46-62. [PMID: 31104347 DOI: 10.1111/bpa.12747] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [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: 04/16/2019] [Accepted: 05/14/2019] [Indexed: 12/30/2022] Open
Abstract
High-grade neuroepithelial tumor with BCOR exon 15 internal tandem duplication (HGNET BCOR ex15 ITD) is a recently proposed tumor entity of the central nervous system (CNS) with a distinct methylation profile and characteristic genetic alteration. The complete spectrum of histologic features, accompanying genetic alterations, clinical outcomes, and optimal treatment for this new tumor entity are largely unknown. Here, we performed a comprehensive assessment of 10 new cases of HGNET BCOR ex15 ITD. The tumors mostly occurred in young children and were located in the cerebral or cerebellar hemispheres. On imaging all tumors were large, well-circumscribed, heterogeneous masses with variable enhancement and reduced diffusion. They were histologically characterized by predominantly solid growth, glioma-like fibrillarity, perivascular pseudorosettes, and palisading necrosis, but absence of microvascular proliferation. They demonstrated sparse to absent GFAP expression, no synaptophysin expression, variable OLIG2 and NeuN positivity, and diffuse strong BCOR nuclear positivity. While BCOR exon 15 internal tandem duplication was the solitary pathogenic alteration identified in six cases, four cases contained additional alterations including CDKN2A/B homozygous deletion, TERT amplification or promoter hotspot mutation, and damaging mutations in TP53, BCORL1, EP300, SMARCA2 and STAG2. While the limited clinical follow-up in prior reports had indicated a uniformly dismal prognosis for this tumor entity, this cohort includes multiple long-term survivors. Our study further supports inclusion of HGNET BCOR ex15 ITD as a distinct CNS tumor entity and expands the known clinicopathologic, radiographic, and genetic features.
Collapse
Affiliation(s)
- Sean P Ferris
- Department of Pathology, University of California, San Francisco, CA
| | | | - Mariam Aboian
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
| | - Julieann C Lee
- Department of Pathology, University of California, San Francisco, CA
| | - Jessica Van Ziffle
- Department of Pathology, University of California, San Francisco, CA.,Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA
| | - Courtney Onodera
- Department of Pathology, University of California, San Francisco, CA.,Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA
| | - James P Grenert
- Department of Pathology, University of California, San Francisco, CA.,Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA
| | - Tara Saunders
- Department of Pathology, University of California, San Francisco, CA
| | - Yunn-Yi Chen
- Department of Pathology, University of California, San Francisco, CA
| | - Anu Banerjee
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, CA
| | - Cassie N Kline
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, CA.,Department of Neurology, University of California, San Francisco, CA
| | - Nalin Gupta
- Department of Neurological Surgery, University of California, San Francisco, CA
| | - Corey Raffel
- Department of Neurological Surgery, University of California, San Francisco, CA
| | - David Samuel
- Department of Hematology-Oncology, Valley Children's Hospital, Madera, CA
| | - Irune Ruiz-Diaz
- Department of Pathology, Hospital Universitario Donostia, Gipuzkoa, Spain
| | - Shino Magaki
- Department of Pathology and Human Anatomy, Loma Linda University Medical Center, Loma Linda, CA
| | - Dianne Wilson
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, KY
| | - Janna Neltner
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, KY
| | - Zahra Al-Hajri
- Department of Histopathology, Khoula Hospital, Muscat, Sultanate of Oman
| | - Joanna J Phillips
- Department of Pathology, University of California, San Francisco, CA.,Department of Neurological Surgery, University of California, San Francisco, CA
| | - Melike Pekmezci
- Department of Pathology, University of California, San Francisco, CA
| | - Andrew W Bollen
- Department of Pathology, University of California, San Francisco, CA
| | - Tarik Tihan
- Department of Pathology, University of California, San Francisco, CA
| | | | - Soonmee Cha
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
| | - Arie Perry
- Department of Pathology, University of California, San Francisco, CA.,Department of Neurological Surgery, University of California, San Francisco, CA
| | - David A Solomon
- Department of Pathology, University of California, San Francisco, CA.,Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA
| |
Collapse
|
5
|
Pagès M, Pajtler KW, Puget S, Castel D, Boddaert N, Tauziède-Espariat A, Picot S, Debily MA, Kool M, Capper D, Sainte-Rose C, Chrétien F, Pfister SM, Pietsch T, Grill J, Varlet P, Andreiuolo F. Diagnostics of pediatric supratentorial RELA ependymomas: integration of information from histopathology, genetics, DNA methylation and imaging. Brain Pathol 2018; 29:325-335. [PMID: 30325077 PMCID: PMC7379587 DOI: 10.1111/bpa.12664] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [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: 09/17/2018] [Accepted: 10/02/2018] [Indexed: 12/26/2022] Open
Abstract
Ependymoma with RELA fusion has been defined as a novel entity of the revised World Health Organization 2016 classification of tumors of the central nervous system (CNS), characterized by fusion transcripts of the RELA gene and consequent pathological activation of the NFkB pathway. These tumors represent the majority of supratentorial ependymomas in children. The validation of diagnostic tools to identify this clinically relevant ependymoma entity is essential. Here, we have used interphase fluorescent in situ hybridization (FISH) for C11orf95 and RELA, immunohistochemistry (IHC) for p65‐RelA and the recently developed DNA methylation‐based classification besides conventional histopathology, and compared the precision of the methods in 40 supratentorial pediatric brain tumors diagnosed as ependymomas in the past years. Reverse transcription PCR (RT‐PCR) and RNA sequencing were performed to explore discordant cases. Furthermore, we integrated imaging and clinical features as additional layers of information. The concordance between nuclear RelA expression by IHC and RELA FISH was 100%. Concordance between IHC and DNA methylation profiling, and between FISH and DNA methylation profiling was also high (96.4% and 95.2%, respectively). Thirty‐four out of 40 (85%) cases were confirmed by integrated diagnoses as ependymal tumors, including 22 RELA‐fused ependymomas (71% of ependymal tumors), two YAP1‐fused ependymomas (6%), six non‐RELA/non‐YAP1 ependymomas (18%) and four ependymal/subependymal mixed tumors (12%). Ependymal/subependymal mixed tumors had an excellent clinical outcome despite the presence of histopathological signs of malignancy, suggesting that these tumors should not be diagnosed as classic ependymomas. DNA methylation profiling helped in the differential diagnosis of RELA‐fused ependymomas. IHC and FISH, which are available in the majority of pathology laboratories, are valuable tools to identify RELA‐fused ependymomas.
Collapse
Affiliation(s)
- Mélanie Pagès
- Department of Neuropathology, Sainte-Anne Hospital, Paris, France.,Paris V Descartes University, Paris Cité Sorbonne, Paris, France.,Institut National de la Santé et de la recherche Médicale, INSERM Unit 1000 « Neuroimaging & Psychiatrie », Université Paris Sud, Orsay, France
| | - Kristian W Pajtler
- Hopp Children's Cancer Centre at the NCT (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Centre (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany.,Department of Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stéphanie Puget
- Paris V Descartes University, Paris Cité Sorbonne, Paris, France.,Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France
| | - David Castel
- UMR8203 « Vectorologie et Thérapeutiques Anticancéreuses » Centre National de la Recherche Scientifique.,Département de Cancérologie de l'Enfant et de l'Adolescent, Gustave Roussy, Univ. Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Nathalie Boddaert
- Paris V Descartes University, Paris Cité Sorbonne, Paris, France.,Radiology Department, Necker Enfants Malades Hospital, AP-HP, Paris, France.,Institut National de la Santé et de la recherche Médicale, INSERM UMR 1163, Institut Imagine, and INSERM U1000, Paris, France
| | | | - Stéphanie Picot
- UMR8203 « Vectorologie et Thérapeutiques Anticancéreuses » Centre National de la Recherche Scientifique
| | - Marie-Anne Debily
- UMR8203 « Vectorologie et Thérapeutiques Anticancéreuses » Centre National de la Recherche Scientifique.,Université d'Evry-Val d'Essonne, Evry, France
| | - Marcel Kool
- Hopp Children's Cancer Centre at the NCT (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Centre (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - David Capper
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Christian Sainte-Rose
- Paris V Descartes University, Paris Cité Sorbonne, Paris, France.,Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France
| | - Fabrice Chrétien
- Department of Neuropathology, Sainte-Anne Hospital, Paris, France.,Paris V Descartes University, Paris Cité Sorbonne, Paris, France.,Infection & Epidemiology Department, Human Histopathology and Animal Models Unit, Institut Pasteur, Paris, France
| | - Stefan M Pfister
- Hopp Children's Cancer Centre at the NCT (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Centre (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany.,Department of Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Torsten Pietsch
- Institute of Neuropathology, University of Bonn Medical Centre, Bonn, Germany
| | - Jacques Grill
- UMR8203 « Vectorologie et Thérapeutiques Anticancéreuses » Centre National de la Recherche Scientifique.,Département de Cancérologie de l'Enfant et de l'Adolescent, Gustave Roussy, Univ. Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Pascale Varlet
- Department of Neuropathology, Sainte-Anne Hospital, Paris, France.,Paris V Descartes University, Paris Cité Sorbonne, Paris, France.,Institut National de la Santé et de la recherche Médicale, INSERM Unit 1000 « Neuroimaging & Psychiatrie », Université Paris Sud, Orsay, France
| | | |
Collapse
|