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Yang MJ, Whelan R, Madden J, Mulcahy Levy JM, Kleinschmidt-DeMasters BK, Hankinson TC, Foreman NK, Handler MH. Intracranial Ewing sarcoma: four pediatric examples. Childs Nerv Syst 2018; 34:441-448. [PMID: 29285586 PMCID: PMC5808087 DOI: 10.1007/s00381-017-3684-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 11/29/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Ewing sarcoma typically arises in bone and is unrelated to intraparenchymal small blue cell embryonal central nervous system (CNS) tumors previously designated primitive neuroectodermal tumors (PNETs). When the CNS is impacted, it is usually secondary to local extension from either the epidural space, skull, or intracranial or spinal metastases. Primary examples within the cranial vault are rare, usually dural-based, and are largely case reports in the literature. We detail four pediatric patients with solitary, primary intracranial Ewing sarcoma, all manifesting the archetypal EWRS1 gene rearrangement that confirms diagnosis. PROCEDURE Neurosurgical Department records, spanning 21 years (1995-2016), were reviewed to identify patients. Demographics, clinical history, pathological/genetic features, and clinical course were retrieved from the medical record and personal files of the authors. RESULTS Four patients, one male and three females, age 5 to 16 years, were identified. One presented in extremis from a large lesion, two with soft tissue masses, and the fourth as an incidental finding after being involved in a motor vehicle collision. Three had clear bony involvement: a 10-year-old girl with a large left temporal lesion had clear origin in the skull, with spiculated calcified striations throughout the mass; a 9-year-old girl presented with a bony left petrous apex mass; and a 16-year-old girl presented with a left temporal mass with extension to the dura and underlying bone erosion. Only the 5-year-old boy had a large left frontoparietal mass traversing the falx with no bony contact. All four tumors manifested the diagnostic EWSR1 mutation and were treated with an Ewing sarcoma regimen. Outcomes were variable, with one patient showing progressive metastatic disease and death 3 years after presentation, one patient with disease-free survival 10.5 years after completion of therapy, and one alive and well at the completion of therapy 1 year after diagnosis. One patient completed therapy recently with post-therapy scans showing no evidence of disease. CONCLUSION Testing for the EWSR1 mutation confirms the diagnosis of Ewing sarcoma and excludes other types of embryonal CNS tumors. Long-term disease-free survival is possible with adherence to the appropriate therapeutic regimen after gross surgical resection.
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Lummus SC, Donson AM, Gowan K, Jones KL, Vibhakar R, Foreman NK, Kleinschmidt-DeMasters BK. p16 Loss and E2F/cell cycle deregulation in infant posterior fossa ependymoma. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26656. [PMID: 28548702 PMCID: PMC5647247 DOI: 10.1002/pbc.26656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 05/02/2017] [Accepted: 05/10/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Posterior fossa (PF) ependymomas (EPNs) in infants less than 1 year of age (iEPN-PF) have a poorer clinical outcome than EPNs in older children. While radiation therapy is the standard of care for the latter, it is withheld in infants to avoid neurotoxicity to immature brain. It is unknown whether the adverse outcome in iEPN-PFs is due to treatment differences or aggressive biology. We examined this question using molecular profiling. METHODS Six anaplastic iEPN-PFs were subjected to transcriptomic analysis and FISH for p16 loss and gains of 1q, and compared with anaplastic PF EPNs from older children. Results were validated by immunohistochemistry (IHC). RESULTS All six iEPN-PFs were grouped within EPN PF subgroup A (PFA). E2F targets and G2M checkpoint were identified as the most enriched gene sets in iEPN-PF, which was validated in a larger independent cohort. Accordingly, MIB-1 IHC demonstrated a higher mitotic rate in iEPN-PFs than noninfant anaplastic EPN PFA. Genetic and protein analyses demonstrated that p16 loss and low p16 protein expression is a hallmark of iEPN-PF, and that none harbored 1q gains. Kaplan-Meier analysis confirmed the poorer clinical outcome of the iEPN-PF cohort. CONCLUSIONS Biological differences, characterized by loss of p16 expression without gains of 1q in iEPN-PFs, as well as deregulated E2F target gene transcription, are indicative of deregulated p16-CDK4/6-pRB-E2F pathway activity. This may underlie the poor clinical outcome seen in this group of iEPN-PFs, rather than the withholding of radiation therapy. Results suggest a potential actionable therapy for iEPN-PF, namely cyclin-dependent kinase 4/6 (CDK4/6) inhibitors.
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Nunes RH, Hsu CC, da Rocha AJ, do Amaral LLF, Godoy LFS, Watkins TW, Marussi VH, Warmuth-Metz M, Alves HC, Goncalves FG, Kleinschmidt-DeMasters BK, Osborn AG. Multinodular and Vacuolating Neuronal Tumor of the Cerebrum: A New "Leave Me Alone" Lesion with a Characteristic Imaging Pattern. AJNR Am J Neuroradiol 2017; 38:1899-1904. [PMID: 28705817 DOI: 10.3174/ajnr.a5281] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 05/03/2017] [Indexed: 11/07/2022]
Abstract
Multinodular and vacuolating neuronal tumor of the cerebrum is a recently reported benign, mixed glial neuronal lesion that is included in the 2016 updated World Health Organization classification of brain neoplasms as a unique cytoarchitectural pattern of gangliocytoma. We report 33 cases of presumed multinodular and vacuolating neuronal tumor of the cerebrum that exhibit a remarkably similar pattern of imaging findings consisting of a subcortical cluster of nodular lesions located on the inner surface of an otherwise normal-appearing cortex, principally within the deep cortical ribbon and superficial subcortical white matter, which is hyperintense on FLAIR. Only 4 of our cases are biopsy-proven because most were asymptomatic and incidentally discovered. The remaining were followed for a minimum of 24 months (mean, 3 years) without interval change. We demonstrate that these are benign, nonaggressive lesions that do not require biopsy in asymptomatic patients and behave more like a malformative process than a true neoplasm.
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Robinson C, Kleinschmidt-DeMasters BK. IDH1-Mutation in Diffuse Gliomas in Persons Age 55 Years and Over. J Neuropathol Exp Neurol 2017; 76:151-154. [PMID: 28110298 DOI: 10.1093/jnen/nlw112] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Diffuse astrocytoma (DA), anaplastic astrocytoma (AA), and glioblastoma (GBM) are defined by the World Health Organization (WHO) based on IDH-mutational status. The vast majority of IDH-mutated gliomas (90% of which involve a mutation in IDH1 R132H, which can be assessed by IDH1 immunohistochemistry [IHC]) occur in persons younger than 55 years of age. This raises the question as to the prevalence of IDH-mutant tumors in older persons and whether the gliomas in older patients should be routinely tested. Since January 1, 2014, we have employed a standard screening panel for all gliomas regardless of patient age. From 578 total gliomas tested, 88 were IDH-mutant DA/AA/GBMs and 11 IDH-mutant tumors were in persons age 55 and older. Of the 11 IDH-mutant examples in the older group, 9 were first clinical presentations of the tumor, 4 of which were in persons age 70 or older (oldest, 76 years). We assessed whether the typical profile of nuclear ATRX loss with or without strong nuclear p53 IHC occurred in these and younger patients and found that ATRX/p53 IHC patterns paralleled those in younger patients. We conclude that, although infrequent, IDH IHC is strongly recommended for all ages of adult patients with diffuse gliomas.
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Greer A, Foreman NK, Donson A, Davies KD, Kleinschmidt-DeMasters BK. Desmoplastic infantile astrocytoma/ganglioglioma with rare BRAF V600D mutation. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26350. [PMID: 27860162 PMCID: PMC5589269 DOI: 10.1002/pbc.26350] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 10/13/2016] [Accepted: 10/13/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Desmoplastic infantile astrocytoma (DIA) and desmoplastic infantile gangliogliomas (DIGs) are rare, massive, cystic and solid tumors of infants usually found in superficial cerebral hemispheres. They manifest prominent desmoplastic stroma, admixed neoplastic astrocytes, primitive-appearing small cells, and additional neoplastic ganglion cells in the case of DIGs. While v-Raf murine sarcoma viral oncogene homolog B (BRAF) mutation is found in up to 50% of pediatric gangliogliomas, two recent studies found that it was rare in DIA/DIGs; we sought to assess BRAF status in DIA/DIGs from our institution. PROCEDURE Departmental files from 2000 to 2016 were reviewed to identify cases. Clinical, neuroimaging, histological, and immunohistochemistry (IHC) features were assessed; the latter included IHC for astrocytic and neuronal markers and BRAF VE1. BRAF mutational assessment by Sanger and next-generation sequencing was attempted in all cases. RESULTS All six identified cases (four males-two females; three DIA-three DIG) occurred in children <1-year old, were large, cerebral-hemispheric, cystic and solid, and enhancing tumors. Only one case, a DIG with prominent aggregates of neoplastic ganglion cells, showed either BRAF VE1 IHC positivity or mutation by Sanger and next-generation sequencing (rare c. 1799_1800delinsAT; p. V600D). Four of six archival cases were BRAF VE1 IHC negative, but failed mutational sequencing. CONCLUSION Five of six classic DIA/DIGs were negative for BRAF mutation; previous series have identified BRAF mutation in two of 18 and one of 14 cases, although all were the more common BRAF V600E. We were unable to find other examples of glial tumors in public databases with this rare BRAF V600D mutation. Identification of BRAF mutational opens the possibility of BRAF-targeted therapies for the subset of DIA/DIG that clinically progress postresection.
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Kiseljak-Vassiliades K, Mills TS, Zhang Y, Xu M, Lillehei KO, Kleinschmidt-DeMasters BK, Wierman ME. Elucidating the Role of the Desmosome Protein p53 Apoptosis Effector Related to PMP-22 in Growth Hormone Tumors. Endocrinology 2017; 158:1450-1460. [PMID: 28323918 PMCID: PMC5460826 DOI: 10.1210/en.2016-1841] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 02/06/2017] [Indexed: 01/26/2023]
Abstract
Densely granulated and sparsely granulated (SG) growth hormone (GH) pituitary adenomas differ in biological behavior, which may be correlated with their known differences in cytoplasmic keratin distribution and E-cadherin expression. We wanted to explore candidate genes that might further explain this behavior. Exon expression microarray was performed on 21 GH tumors (10 SG and 11 densely granulated) and 20 normal control pituitaries from autopsy. Bioinformatic analyses confirmed a differential molecular signature between normal pituitary and GH tumors as well as between the GH tumor subtypes. There was a consistent downregulation of transcripts involved in the structure and function of the desmosome, including desmoplakin (eightfold), desmoglein 2 (sixfold), plakophilin 2 (sevenfold), and p53 apoptosis effector related to PMP-22 (PERP; sixfold) in SG tumors compared with normal pituitary. PERP is lost in more aggressive SG human GH pituitary tumors. PERP re-expression in GH3 rat GH tumor cells resulted in decreased colony formation compared with vector transfectants, confirming the role of PERP as a tumor suppressor with no effects on proliferation. Increased PERP expression was associated with loss of a survival advantage in a hypoxic environment, as assessed by terminal deoxynucleotidyltransferase-mediated dUTP nick end labeling (P < 0.05) and cleaved caspase-3 (P < 0.05). Downregulation of desmosomal formation transcripts including PERP may contribute to the aggressive phenotype seen in SG GH pituitary tumors and their behavior in response to surgery and medical therapy.
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Kleinschmidt-DeMasters BK, Lillehei KO, Hankinson TC. Review of xanthomatous lesions of the sella. Brain Pathol 2017; 27:377-395. [PMID: 28236350 DOI: 10.1111/bpa.12498] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 02/09/2017] [Indexed: 12/28/2022] Open
Abstract
Xanthomatous lesions of the sellar region have traditionally been divided into two separate categories, xanthomatous hypophysitis (XH) and xanthogranuloma (XG) of the sellar region. The seminal article on XH, a condition typified by foamy histiocytes and lymphoplasmacytic infiltrates in the pituitary gland/sellar region, but usually little or no hemosiderin pigment, detailed three patients. However, most reports since that time have been single cases, making understanding of the entity difficult. In contrast, the seminal report on XG, characterized by sellar region cholesterol clefts, lymphoplasmacytic infiltrates, marked hemosiderin deposits, fibrosis, multinucleated giant cells around cholesterol clefts, eosinophilic granular necrotic debris, and accumulation of macrophages, included 37 patients, allowing more insights into etiology. Few examples could be linked to adamantinomatous craniopharyngioma, and although ciliated epithelium similar to that of Rathke cleft cyst (RCC) was identified up to 35% of the 37 cases, it could not be proven that XG was related to hemorrhage into RCC. Case reports since that time, however, occasionally linked XG to RCC when an etiology could be identified at all, and a few recognized that a spectrum exists in xanthomatous lesions of the sella. They review literature, adding 23 cases from our own experience, to confirm that overlap occurs between XH and XG, and that the majority-but not all-can be linked to RCC leakage/rupture/hemorrhage. It was suggested that progressive accumulation of hemosiderin pigment in the lesion, possibly caused by the multiple episodes of bleeding, could account for the transition of at least some cases of XH to XG.
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Kleinschmidt-DeMasters BK, Donson A, Foreman NK, Dorris K. H3 K27M Mutation in Gangliogliomas can be Associated with Poor Prognosis. Brain Pathol 2017; 27:846-850. [PMID: 28378357 DOI: 10.1111/bpa.12455] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Hankinson TC, Kleinschmidt-DeMasters BK. Adamantinomatous craniopharyngioma and xanthomatous lesions of the sella. Brain Pathol 2017; 27:356-357. [PMID: 28236347 DOI: 10.1111/bpa.12497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 02/15/2017] [Indexed: 11/29/2022] Open
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Mulcahy Levy JM, Zahedi S, Griesinger AM, Morin A, Davies KD, Aisner DL, Kleinschmidt-DeMasters BK, Fitzwalter BE, Goodall ML, Thorburn J, Amani V, Donson AM, Birks DK, Mirsky DM, Hankinson TC, Handler MH, Green AL, Vibhakar R, Foreman NK, Thorburn A. Autophagy inhibition overcomes multiple mechanisms of resistance to BRAF inhibition in brain tumors. eLife 2017; 6. [PMID: 28094001 PMCID: PMC5241115 DOI: 10.7554/elife.19671] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 12/18/2016] [Indexed: 12/11/2022] Open
Abstract
Kinase inhibitors are effective cancer therapies, but tumors frequently develop resistance. Current strategies to circumvent resistance target the same or parallel pathways. We report here that targeting a completely different process, autophagy, can overcome multiple BRAF inhibitor resistance mechanisms in brain tumors. BRAFV600Emutations occur in many pediatric brain tumors. We previously reported that these tumors are autophagy-dependent and a patient was successfully treated with the autophagy inhibitor chloroquine after failure of the BRAFV600E inhibitor vemurafenib, suggesting autophagy inhibition overcame the kinase inhibitor resistance. We tested this hypothesis in vemurafenib-resistant brain tumors. Genetic and pharmacological autophagy inhibition overcame molecularly distinct resistance mechanisms, inhibited tumor cell growth, and increased cell death. Patients with resistance had favorable clinical responses when chloroquine was added to vemurafenib. This provides a fundamentally different strategy to circumvent multiple mechanisms of kinase inhibitor resistance that could be rapidly tested in clinical trials in patients with BRAFV600E brain tumors. DOI:http://dx.doi.org/10.7554/eLife.19671.001 Cancers of the brain and spine are the second most common kind of tumor in children, after cancers of the blood and bone marrow. Yet brain and spine tumors kill more children than any other cancer, in part because many become resistant to treatment. Like in other cancers, cells in brain and spine tumors often use a process called autophagy to survive the treatments that are used to try and kill them. This process allows cells to recycle proteins and other things inside the cell and use them for energy when the cell is under stress. In 2014, researchers reported that brain tumors carrying a mutation called BRAFV600E rely on autophagy to survive treatment with medications that target this mutation. These findings suggested that blocking autophagy might make the medications more effective against BRAFV600Emutant tumors and overcome the resistance. Now, Mulcahy Levy et al. – who include most of the researchers involved in the 2014 study – report that blocking autophagy does indeed overcome this kind of resistance in multiple types of tumor. The experiments made use of human brain tumor cells that can be grown in the laboratory and have been widely studied, as well as samples collected from patients. Mulcahy Levy et al. were able to block autophagy in the tumor cells by using genetic methods and, importantly, by using an approved and inexpensive drug that could be rapidly translated into clinical trials. Together these findings suggest that blocking autophagy in patients might be a safe and effective strategy to improve their response to existing therapies that target the BRAFV600E mutation. Future clinical trials are now needed to test more patients and verify if this treatment plan can be broadly effective in patients with these types of brain cancers. DOI:http://dx.doi.org/10.7554/eLife.19671.002
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Shows J, Marshall C, Perry A, Kleinschmidt-DeMasters BK. Genetics of Glioblastomas in Rare Anatomical Locations: Spinal Cord and Optic Nerve. Brain Pathol 2016; 26:120-3. [PMID: 26443345 DOI: 10.1111/bpa.12327] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 09/16/2015] [Indexed: 10/23/2022] Open
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Roberts S, Borges MT, Lillehei KO, Kleinschmidt-DeMasters BK. Double separate versus contiguous pituitary adenomas: MRI features and endocrinological follow up. Pituitary 2016; 19:472-81. [PMID: 27209585 DOI: 10.1007/s11102-016-0727-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Double pituitary adenomas are defined as two adenomas within a gland. These have distinct light microscopic and immunohistochemical features and may be clearly-separate or contiguous. Most reports have focused on the various hormonal combinations in double tumors rather than on any potential increased risk for residual mass or endocrinopathy. METHODS Departmental files were searched to identify all double adenomas from 1/1/2000 to 3/1/2016, with review of magnetic resonance imaging (MRI) to determine if the dual nature of the lesions could be discerned retrospectively after histologic diagnosis of double adenoma. All cases were immunostained for standard anterior pituitary hormones. RESULTS Eight cases were identified: 2 follicle-stimulating hormone (FSH)/alpha subunit (ASU) + prolactinoma (PRL); 1 PRL + corticotroph (ACTH); 1 hormone-negative + PRL; 1 ACTH + ASU/growth hormone (GH)/PRL; 1 GH/PR + PRL; 1 FSH/ASU, + ACTH; 1 GH + luteinizing hormone (LH). One patient had clearly-separate lesions identified preoperatively and required two surgical procedures for gross total resection. A second patient had 2 lesions recognized at surgery and afterwards on retrospective neuroimaging. The remaining 6 patients had double adenomas discovered at the time of histologic examination that were not resolvable at surgery or on retrospective neuroimaging. Four patients, 2 with clearly-separate and 2 with contiguous double adenomas, had persistent MRI abnormalities, and one had continued endocrine abnormalities. CONCLUSIONS Double contiguous pituitary adenomas are difficult to anticipate preoperatively or to resolve intraoperatively. Although double contiguous adenomas are much more common than double separate lesions, both have a risk for subtotal resection and, thus, residual mass and/or endocrinopathy may ensue.
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Ormond DR, Kleinschmidt-DeMasters BK. Diffuse astrocytoma arising within a demyelinating plaque. J Neurooncol 2016; 128:373-5. [PMID: 27033061 DOI: 10.1007/s11060-016-2118-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/23/2016] [Indexed: 11/24/2022]
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Kleinschmidt-DeMasters BK, Donson AM, Richmond AM, Pekmezci M, Tihan T, Foreman NK. SOX10 Distinguishes Pilocytic and Pilomyxoid Astrocytomas From Ependymomas but Shows No Differences in Expression Level in Ependymomas From Infants Versus Older Children or Among Molecular Subgroups. J Neuropathol Exp Neurol 2016; 75:295-8. [PMID: 26945037 DOI: 10.1093/jnen/nlw010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
SOX10 is important in nonneoplastic oligodendroglial development, but mRNA transcripts and protein expression are identified in a wider variety of CNS glial neoplasms than oligodendrogliomas. We previously demonstrated high levels of SOX10 mRNA and protein in pilocytic astrocytomas (PAs) but not ependymomas (EPNs). We now extend these studies to investigate subsets of these 2 tumors that affect infants, pilomyxoid astrocytomas (PMAs) and infant (<1 year) ependymomas (iEPNs). By gene expression microarray analysis, we found that iEPNs and all EPNs in older children showed very low SOX10 expression levels, on average 7.1-fold below normal control tissues. EPN groups showed no significant difference in SOX10 expression between iEPN and EPN. PAs/PMAs had 24.1/29.4-fold higher transcript levels, respectively, than those in normal tissues. Using immunohistochemical analysis of adult, pediatric, and infantile EPNs and of PAs/PMAs, we found that EPNs from multiple anatomical locations and both age groups (n = 228) never showed 3+ diffuse nuclear immunostaining for SOX10; the majority were scored at 0 or 1+. Conversely, almost all pediatric and adult PAs and PMAs (n = 47) were scored as 3+. These results suggest that in select settings, SOX10 immunohistochemistry can supplement the diagnosis of PMA and PA and aid in distinguishing them from EPNs.
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Kiseljak-Vassiliades K, Xu M, Mills TS, Smith EE, Silveira LJ, Lillehei KO, Kerr JM, Kleinschmidt-DeMasters BK, Wierman ME. Differential somatostatin receptor (SSTR) 1-5 expression and downstream effectors in histologic subtypes of growth hormone pituitary tumors. Mol Cell Endocrinol 2015; 417:73-83. [PMID: 26391562 PMCID: PMC4641524 DOI: 10.1016/j.mce.2015.09.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/11/2015] [Accepted: 09/17/2015] [Indexed: 12/27/2022]
Abstract
PURPOSE The aim of this study was to examine whether differential expression of somatostatin receptors (SSTR) 1-5 and downstream effectors are different in densely (DG) and sparsely (SG) granulated histological growth hormone (GH) pituitary tumor subtypes. METHODS The study included 33 acromegalic patients with 23 DG and 10 SG tumors. SSTR1-5 were measured by qPCR and immunoblotting. Signaling candidates downstream of SSTR2 were also assessed. RESULTS SSTR2 mRNA and protein levels were significantly higher in DG compared to SG tumors. Downstream of SSTR2, p27(kip1) was decreased (2.6-fold) in SG compared to DG tumors, suggesting a potential mechanism of SSA resistance in SG tumors with intact SSTR2 expression. Re-expression of E-cadherin in GH pituitary cell increased p27(kip1) levels. CONCLUSIONS Histological subtyping correlated with SSTR2, E cadherin and p27(kip) protein levels and these may serve as useful biomarkers in GH tumors to predict behavior and response to therapy with SSA.
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Mrachek EKS, Davis D, Kleinschmidt-DeMasters BK. Dual use of E-cadherin and D2-40 immunostaining in unusual meningioma subtypes. Am J Clin Pathol 2015; 144:923-34. [PMID: 26573000 DOI: 10.1309/ajcpsulj6dw5rehr] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Meningiomas usually can be readily diagnosed on H&E alone, although occasionally immunohistochemistry (IHC) confirmation is desirable. Studies exploring the diagnostic utility of either podoplanin (D2-40) or E-cadherin IHC in meningiomas have conflicted, and no studies exist in which the two IHCs have been used in combination for diagnosis. METHODS E-cadherin and D2-40 IHC was performed on 77 meningiomas (31 ordinary; eight microcystic; four rare myxoid; six metaplastic; six invasive of orbit, muscle, and/or soft tissue; two metastatic; six brain-invasive World Health Organization [WHO] grade II, nine non-brain-invasive WHO grade II; and five anaplastic WHO grade III), with semi-quantitative scoring on a three-tier scale (0, focal [1+], strong/diffuse [2+]). RESULTS All meningiomas were either E-cadherin or D2-40 IHC+, with 69 of 77 showing dual immunostaining, most at the 2+ level. No downregulation of E-cadherin IHC was found in invasive or high-grade meningiomas. CONCLUSIONS Dual E-cadherin/D2-40 IHC can supplement diagnosis of meningioma.
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Gump JM, Donson AM, Birks DK, Amani VM, Rao KK, Griesinger AM, Kleinschmidt-DeMasters BK, Johnston JM, Anderson RCE, Rosenfeld A, Handler M, Gore L, Foreman N, Hankinson TC. Identification of targets for rational pharmacological therapy in childhood craniopharyngioma. Acta Neuropathol Commun 2015; 3:30. [PMID: 25990246 PMCID: PMC4438576 DOI: 10.1186/s40478-015-0211-5] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 05/05/2015] [Indexed: 12/16/2022] Open
Abstract
Introduction Pediatric adamantinomatous craniopharyngioma (ACP) is a histologically benign but clinically aggressive brain tumor that arises from the sellar/suprasellar region. Despite a high survival rate with current surgical and radiation therapy (75–95 % at 10 years), ACP is associated with debilitating visual, endocrine, neurocognitive and psychological morbidity, resulting in excheptionally poor quality of life for survivors. Identification of an effective pharmacological therapy could drastically decrease morbidity and improve long term outcomes for children with ACP. Results Using mRNA microarray gene expression analysis of 15 ACP patient samples, we have found several pharmaceutical targets that are significantly and consistently overexpressed in our panel of ACP relative to other pediatric brain tumors, pituitary tumors, normal pituitary and normal brain tissue. Among the most highly expressed are several targets of the kinase inhibitor dasatinib – LCK, EPHA2 and SRC; EGFR pathway targets – AREG, EGFR and ERBB3; and other potentially actionable cancer targets – SHH, MMP9 and MMP12. We confirm by western blot that a subset of these targets is highly expressed in ACP primary tumor samples. Conclusions We report here the first published transcriptome for ACP and the identification of targets for rational therapy. Experimental drugs targeting each of these gene products are currently being tested clinically and pre-clinically for the treatment of other tumor types. This study provides a rationale for further pre-clinical and clinical studies of novel pharmacological treatments for ACP. Development of mouse and cell culture models for ACP will further enable the translation of these targets from the lab to the clinic, potentially ushering in a new era in the treatment of ACP.
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Kiseljak-Vassiliades K, Carlson NE, Borges MT, Kleinschmidt-DeMasters BK, Lillehei KO, Kerr JM, Wierman ME. Growth hormone tumor histological subtypes predict response to surgical and medical therapy. Endocrine 2015; 49:231-41. [PMID: 25129651 PMCID: PMC4331291 DOI: 10.1007/s12020-014-0383-y] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 08/02/2014] [Indexed: 12/16/2022]
Abstract
Growth hormone (GH) pituitary tumors are associated with significant morbidity and mortality. Current treatments, including surgery and medical therapy with somatostatin analogs (SSA), dopamine agonists and/or a GH receptor antagonist, result in disease remission in approximately half of patients. Predictors of GH tumor response to different therapies have been incompletely defined based on histologic subtype, particularly densely (DG) versus sparsely (SG) granulated adenomas. The aim of this study was to examine our own institutional experience with GH adenomas and correlate how subtype related to clinical parameters as well as response to surgery and medical therapies. A retrospective chart review of 101 acromegalic patients operated by a single neurosurgeon was performed. Clinical data were correlated with histologic subtype and disease control, as defined by IGF-1 levels, and random growth hormone levels in response to surgery and/or medical therapies. SG tumors, compared to DG, occurred in younger patients (p = 0.0010), were 3-fold larger (p = 0.0030) but showed no differences in tumor-invasion characteristics (p = 0.12). DG tumors had a higher rate of remission in response to surgery compared to SG, 65.7 vs. 14.3 % (p < 0.0001), as well as to medical therapy with SSAs (68.8 % for DG vs. 28.6 % for SG tumors; p = 0.028). SG tumors not controlled with SSAs consistently responded to a switch to, or addition of, a GH receptor antagonist. Histological GH tumor subtyping implicates a different clinical phenotype and biologic behavior, and provides prognostic significance for surgical success and response to medical therapies.
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Kleinschmidt-DeMasters BK, Lopes MBS, Prayson RA. An Algorithmic Approach to Sellar Region Masses. Arch Pathol Lab Med 2015; 139:356-72. [DOI: 10.5858/arpa.2014-0020-oa] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context
Most sellar region masses (85%–90%) are pituitary adenomas; however, other neoplasms or even inflammatory or cystic nonneoplastic lesions may occasionally be encountered in this location. A practical, non–electron-microscopically based approach is essential for the daily practice of diagnosing and subclassifying adenomatous and nonadenomatous sellar region lesions.
Objective
To provide an algorithmic approach to sellar region masses for the pathologist and to formulate a cost-effective, limited panel of stains and immunostains that can be used in daily practice at most small to medium-sized centers.
Design
Pool collective experience of 3 neuropathologists practicing at academic medical centers with expertise in diagnosis and treatment of sellar region masses to craft a single-page algorithmic diagram and to liberally illustrate the range of lesions present in the sellar region.
Results
After formulating a differential diagnosis, the general pathologist can generate a confident final diagnosis of adenoma using 1 histochemical (reticulin) and 1 immunohistochemical (synaptophysin) stain, supplemented by 5 immunohistochemical stains (CAM5.2, follicle-stimulating hormone, growth hormone, prolactin, and adrenocorticotropic hormone), which provide subtyping of the adenoma in the overwhelming majority of examples. CAM5.2 and clinical information further help identify clinically aggressive variants such as sparsely granulated growth hormone adenomas and silent adrenocorticotropic hormone adenomas, respectively. MIB-1, thyroid transcription factor 1, and S-100 protein can be of further assistance in select cases where increased mitotic activity or possible nonadenomatous spindle cell lesions are suspected.
Conclusions
Adenomas, normal anterior or posterior gland, and nonadenomatous masses can be easily diagnosed in a nontertiary pathology laboratory setting.
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Ney D, Kleinschmidt-DeMasters BK, Carlson J, Damek D, Gaspar L, Kavanagh B, Waziri A, Lillehei K, Reddy K, Chen C. RT-24 * EXTENT OF CEREBRAL RADIONECROSIS IN PATIENTS WITH NEWLY DIAGNOSED GLIOBLASTOMA (GBM) TREATED ON A CLINICAL TRIAL WITH HYPOFRACTIONATED INTENSITY-MODULATED RADIATION THERAPY (HYPO-IMRT) COMBINED WITH TEMOZOLOMIDE (TMZ) AND BEVACIZUMAB (BEV). Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou270.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lummus SC, Aisner DL, Sams SB, Foreman NK, Lillehei KO, Kleinschmidt-DeMasters BK. Massive dissemination from spinal cord gangliogliomas negative for BRAF V600E: report of two rare adult cases. Am J Clin Pathol 2014; 142:254-60. [PMID: 25015869 DOI: 10.1309/ajcpibsv67uvjrqv] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES Metastatic leptomeningeal spread from spinal cord gangliogliomas (GGs) is exceedingly rare. METHODS Two adult women, aged 27 and 51 years, died of massive disseminations of cervicothoracic GGs 4 and 6 years, respectively, after initial diagnoses; full autopsies were performed. BRAF status was assessed by VE1 immunohistochemistry (IHC), Sanger sequencing, and a single-nucleotide base extension assay (SNaPshot, Applied Biosystems, Princeton, NJ). RESULTS The 27-year-old underwent two biopsies, chemotherapy, radiation, and ventriculoperitoneal shunt placement; she developed craniospinal and peritoneal dissemination. Autopsy confirmed shunt-mediated peritoneal metastases, microscopic bone marrow involvement, and profuse spinal and supratentorial leptomeningeal and parenchymal spread. The 51-year-old underwent two resections, radiation, and chemotherapy and developed pancytopenia with biopsy-proven bony metastases 15 months before death. Autopsy demonstrated leptomeningeal, subpial, and subependymal metastases. The tumors in both primary and metastatic sites were BRAF negative by VE1 IHC and two different mutational analyses. This compared with negative BRAF results for an additional four nonmetastatic adult nonsupratentorial GGs and in our study. CONCLUSIONS We document two rare cases of massively metastatic spinal cord GGs in adult patients who were negative for BRAF V600E mutations via multiple methods.
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Bertozzi AI, Munzer C, Fouyssac F, Andre N, Boetto S, Leblond P, Bourdeaut F, Dufour C, Deshpande RK, Bhat KG, Mahalingam S, Muscat A, Cain J, Ferguson M, Popovski D, Algar E, Rossello FJ, Jayasekara S, Watkins DN, Hodge J, Ashley D, Hishii M, Saito M, Arai H, Han ZY, Richer W, Lucchesi C, Freneaux P, Nicolas A, Grison C, Pierron G, Delattre O, Bourdeaut F, Epari S, TS N, Gupta T, Chinnaswamy G, Sastri JG, Shetty P, Moiyadi A, Jalali R, Fay-McClymont T, Johnston D, Janzen L, Guger S, Scheinemann K, Fleming A, Fryer C, Hukin J, Mabbott D, Huang A, Bouffet E, Lafay-Cousin L, Kawamura A, Yamamoto K, Nagashima T, Bartelheim K, Benesch M, Buchner J, Gerss J, Hasselblatt M, Kortmann RD, Fleischack G, Quiroga E, Reinhard H, Schneppenheim R, Seeringer A, Siebert R, Timmermann B, Warmuth-Metz M, Schmid I, Fruhwald MC, Fruhwald MC, Bartelheim K, Seeringer A, Kerl K, Kortmann RD, Warmuth-Metz M, Hasselblatt M, Schneppenheim R, Siebert R, Klingebiel T, Al-Kofide A, Khafaga Y, Al-Hindi H, Dababo M, Ul-Haq A, Anas M, Barria MG, Siddiqui K, Hassounah M, Ayas M, Al-Shail E, Hasselblatt M, Jeibmann A, Eikmeier K, Linge A, Johann P, Koos B, Bartelheim K, Kool M, Pfister SM, Fruhwald MC, Paulus W, Hasselblatt M, Schuller U, Junckerstorff R, Rosenblum MK, Alassiri AH, Rossi S, Bartelheim K, Schmid I, Gottardo N, Toledano H, Viscardi E, Witkowski L, Nagel I, Oyen F, Foulkes WD, Paulus W, Siebert R, Schneppenheim R, Fruhwald MC, Schrey D, Malietzis G, Chi S, Dufour C, Lafay-Cousin L, Marshall L, Carceller F, Moreno L, Zacharoulis S, Bhardwaj R, Chakravadhanula M, Ozals V, Hampton C, Metpally R, Grillner P, Asmundsson J, Gustavsson B, Holm S, Johann PD, Korshunov A, Ryzhova M, Kerl K, Milde T, Witt O, Jones DTW, Hovestadt V, Gajjar A, Hasselblatt M, Fruhwald M, Pfister S, Kool M, Finetti M, Pons ADC, Selby M, Smith A, Crosier S, Wood J, Skalkoyannis B, Bailey S, Clifford S, Williamson D, Seeringer A, Bartelheim K, Kerl K, Hasselblatt M, Rutkowski S, Timmermann B, Kortmann RD, Schneppenheim R, Warmuth-Metz M, Gerss J, Siebert R, Graf N, Boos J, Nysom K, Fruhwald MC, Kerl K, Moreno N, Holsten T, Ahlfeld J, Mertins J, Hotfilder M, Kool M, Bartelheim K, Schleicher S, Handgretinger R, Fruhwald M, Meisterernst M, Kerl K, Schmidt C, Ahlfeld J, Moreno N, Dittmar S, Pfister S, Fruhwald M, Kool M, Meisterernst M, Schuller U, Chan GCF, Shing MMK, Yuen HL, Li RCH, Ling SL, Slavc I, Peyrl A, Chocholous M, Azizi A, Czech T, Dieckmann K, Haberler C, Leiss U, Gotti G, Biassoni V, Schiavello E, Spreafico F, Pecori E, Gandola L, Massimino M, Mertins J, Kornelius K, Moreno N, Holsten T, Fruhwald M, Kool M, Meisterernst M, Yano H, Nakayama N, Ohe N, Ozeki M, Kanda K, Kimura T, Hori T, Fukao T, Iwama T, Weil AG, Diaz A, Gernsback J, Bhatia S, Ragheb J, Niazi T, Khatib Z, Kerl K, Holsten T, Moreno N, Zoghbi A, Meisterernst AM, Birks D, Griesinger A, Amani V, Donson A, Posner R, Dunham C, Kleinschmidt-DeMasters BK, Handler M, Vibhakar R, Foreman N, Bhardwaj R, Ozals V, Hampton C, Zhou L, Catchpoole D, Chakravadhanula M, Kakkar A, Biswas A, Suri V, Sharma M, Kale S, Mahapatra A, Sarkar C, Torchia J, Picard D, Ho KC, Khuong-Quang DA, Louterneau L, Bourgey M, Chan T, Golbourn B, Cousin LL, Taylor MD, Dirks P, Rutka JT, Bouffet E, Hawkins C, Majewski J, Kim SK, Jabado N, Huang A, Chang JHC, Confer M, Chang A, Goldman S, Dunn M, Hartsell W. ATYPICAL TERATOID RHABDOID TUMOUR. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sterns RH, Silver S, Kleinschmidt-DeMasters BK, Rojiani AM. Current perspectives in the management of hyponatremia: prevention of CPM. Expert Rev Neurother 2014; 7:1791-7. [DOI: 10.1586/14737175.7.12.1791] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Wong JC, O'Neill B, Hawkins CE, Kleinschmidt-DeMasters BK, Hazrati LN. Child Neurology: Pediatric seizures with hyaline astrocytic inclusions. Neurology 2013; 81:e14-6. [PMID: 23858415 DOI: 10.1212/wnl.0b013e31829bfe54] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Birks DK, Donson AM, Patel PR, Sufit A, Algar EM, Dunham C, Kleinschmidt-DeMasters BK, Handler MH, Vibhakar R, Foreman NK. Pediatric rhabdoid tumors of kidney and brain show many differences in gene expression but share dysregulation of cell cycle and epigenetic effector genes. Pediatr Blood Cancer 2013; 60:1095-102. [PMID: 23382118 PMCID: PMC4681512 DOI: 10.1002/pbc.24481] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 11/01/2012] [Indexed: 11/05/2022]
Abstract
BACKGROUND Rhabdoid tumors (RTs) are aggressive tumors of early childhood that occur most often in brain (AT/RTs) or kidney (KRTs). Regardless of location, they are characterized by loss of functional SMARCB1 protein, a component of the SWI/SNF chromatin remodeling complex. The aim of this study was to determine genes and biological process dysregulated in common to both AT/RTs and KRTs. PROCEDURE Gene expression for AT/RTs was compared to that of other brain tumors and normal brain using microarray data from our lab. Similar analysis was performed for KRTs and other kidney tumors and normal kidney using data from GEO. Dysregulated genes common to both analyses were analyzed for functional significance. RESULTS Unsupervised hierarchical clustering of RTs identified three major subsets: two comprised of AT/RTs, and one of KRTs. Compared to other tumors, 1,187, 663, and 539 genes were dysregulated in each subset, respectively. Only 14 dysregulated genes were common to all three subsets. Compared to normal tissue, 5,209, 4,275, and 2,841 genes were dysregulated in each subset, with an overlap of 610 dysregulated genes. Among these genes, processes associated with cell proliferation, MYC activation, and epigenetic dysregulation were common to all three RT subsets. CONCLUSIONS The low overlap of dysregulated genes in AT/RTs and KRTs suggests that factors in addition to SMARCB1 loss play a role in determining subsequent gene expression. Drugs which target cell cycle or epigenetic genes may be useful in all RTs. Additionally, targeted therapies tailored to specific RT subset molecular profiles should be considered.
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