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Pajtler KW. Toward an integrated histomolecular diagnosis of supratentorial ependymoma. Neuro Oncol 2016; 18:893-4. [PMID: 27044295 DOI: 10.1093/neuonc/now054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kristian W Pajtler
- Division of Pediatric Neuro-oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany and Department of Pediatric Oncology, Hematology and Immunology, University Hospital, Heidelberg, Germany
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752
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Wu J, Armstrong TS, Gilbert MR. Biology and management of ependymomas. Neuro Oncol 2016; 18:902-13. [PMID: 27022130 DOI: 10.1093/neuonc/now016] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 01/04/2016] [Indexed: 12/20/2022] Open
Abstract
Ependymomas are rare primary tumors of the central nervous system in children and adults that comprise histologically similar but genetically distinct subgroups. The tumor biology is typically more associated with the site of origin rather than being age-specific. Genetically distinct subgroups have been identified by genomic studies based on locations in classic grade II and III ependymomas. They are supratentorial ependymomas with C11orf95-RELA fusion or YAP1 fusion, infratentorial ependymomas with or without a hypermethylated phenotype (CIMP), and spinal cord ependymomas. Myxopapillary ependymomas and subependymomas have different biology than ependymomas with typical WHO grade II or III histology. Surgery and radiotherapy are the mainstays of treatment, while the role of chemotherapy has not yet been established. An in-depth understanding of tumor biology, developing reliable animal models that accurately reflect tumor molecule features, and high throughput drug screening are essential for developing new therapies. Collaborative efforts between scientists, physicians, and advocacy groups will enhance the translation of laboratory findings into clinical trials. Improvements in disease control underscore the need to incorporate assessment and management of patients' symptoms to ensure that treatment advances translate into improvement in quality of life.
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Affiliation(s)
- Jing Wu
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (J.W., M.R.G.); Department of Family Health, University of Texas Health Science Center at Houston, Houston, Texas (T.S.A.)
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (J.W., M.R.G.); Department of Family Health, University of Texas Health Science Center at Houston, Houston, Texas (T.S.A.)
| | - Mark R Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (J.W., M.R.G.); Department of Family Health, University of Texas Health Science Center at Houston, Houston, Texas (T.S.A.)
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753
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Figarella-Branger D, Lechapt-Zalcman E, Tabouret E, Jünger S, de Paula AM, Bouvier C, Colin C, Jouvet A, Forest F, Andreiuolo F, Quintin-Roue I, Machet MC, Heitzmann A, Milin S, Sevestre H, Godfraind C, Labrousse F, Metellus P, Scavarda D, Pietsch T. Supratentorial clear cell ependymomas with branching capillaries demonstrate characteristic clinicopathological features and pathological activation of nuclear factor-kappaB signaling. Neuro Oncol 2016; 18:919-27. [PMID: 26984744 DOI: 10.1093/neuonc/now025] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 01/31/2016] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Clear cell ependymoma is one of the 4 main histological subtypes of ependymomas defined by the World Health Organization (WHO) classification of tumors of the CNS. DNA methylation profiling can distinguish 4 subgroups of intracranial ependymomas, including supratentorial (ST) ependymomas with Yes-associated protein 1 fusion (YAP1), ST ependymomas with fusion of v-rel avian reticuloendotheliosis viral oncogene homolog A (RELA), posterior fossa ependymomas with balanced genome, and posterior fossa ependymomas with chromosomal instability. In addition, trisomy 19 is a genomic hallmark of ependymomas with rich branching capillaries. However, the relation of histological and molecular subtypes is unclear. METHODS Here, we report a series of 20 ependymomas histologically defined by clear cells and branching capillaries. RESULTS We observed a strong male predominance. Median age at surgery was 10.4 years (range, 0.8-68.4). All cases were ST, cortical, contrast enhancing, and most often frontal, cystic, and calcified. All tumors qualified as WHO grade III. Some of them exhibited neuronal differentiation. Trisomy 19 was recorded in 13 cases. All samples strongly accumulated p65RelA protein within nuclei, indicating pathological activation of the nuclear factor-kappaB pathway. We identified causative C11ORF95-RELA fusion in almost all cases. Median progression-free survival and overall survival were 11.4 years (95% CI: 5.1-17.8) and not reached, respectively. CONCLUSION ST clear cell ependymomas with branching capillaries display characteristic clinicopathological features and are associated with pathological activation of nuclear factor-kappaB signaling, which may indicate a potential novel target for therapy in these patients.
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Affiliation(s)
- Dominique Figarella-Branger
- Department of Pathology and Neuropathology, Assistance Publique des Hôpitaux de Marseille (APHM), CHU Timone, Marseille, France (D.F.-B, E.T., A.M.d.P, C.B.); Aix-Marseille Université, Inserm, Marseille, France (D.F.-B, E.T., C.B., C.C.); Department of Pathology, CHU Caen, Hôpital de la Côte de Nacre, Caen, France (E.L.-Z); Department of Neurooncology, APHM, Marseille, France (E.T.); Department of Neuropathology, University of Bonn, Medical Center Sigmund-Freud, Bonn, Germany (S.J., T.P.); Department of Pathology and Neuropathology, Hospices civils de Lyon, Bron, France (A.J.); Department of Pathology, CHU de Saint-Etienne, Saint-Etienne, France (F.F.); Department of Neuropathology, CHU Sainte Anne, Paris, France (F.A.); Department of Pathology, CHU de Brest, Hôpital de la Cavale Blanche, Brest, France (I.Q.-R); Department of Pathology, CHU de Tours, Hôpital Trousseau, Tours, France (M.-C.M.); Department of Pathology, CHR d'Orléans, Hôpital de la Source, Orléans, France (A.H.); Department of Pathology, CHU de Poitiers, Hôpital la Milétrie, Poitiers, France (S.M.); Department of Pathology, CHU d'Amiens, Amiens, France (H.S.); Department of Pathology, CHU de Clermont-Ferrand, Clermont-Ferrand, France (C.G.); Department of Pathology, CHU de Limoges, Limoges, France (F.L.); Department of Neurosurgery, APHM, CHU Timone, Marseille, France (P.M.); Department of Pediatric Neurosurgery, APHM, CHU Timone, Marseille, France (D.S.)
| | - Emmanuèle Lechapt-Zalcman
- Department of Pathology and Neuropathology, Assistance Publique des Hôpitaux de Marseille (APHM), CHU Timone, Marseille, France (D.F.-B, E.T., A.M.d.P, C.B.); Aix-Marseille Université, Inserm, Marseille, France (D.F.-B, E.T., C.B., C.C.); Department of Pathology, CHU Caen, Hôpital de la Côte de Nacre, Caen, France (E.L.-Z); Department of Neurooncology, APHM, Marseille, France (E.T.); Department of Neuropathology, University of Bonn, Medical Center Sigmund-Freud, Bonn, Germany (S.J., T.P.); Department of Pathology and Neuropathology, Hospices civils de Lyon, Bron, France (A.J.); Department of Pathology, CHU de Saint-Etienne, Saint-Etienne, France (F.F.); Department of Neuropathology, CHU Sainte Anne, Paris, France (F.A.); Department of Pathology, CHU de Brest, Hôpital de la Cavale Blanche, Brest, France (I.Q.-R); Department of Pathology, CHU de Tours, Hôpital Trousseau, Tours, France (M.-C.M.); Department of Pathology, CHR d'Orléans, Hôpital de la Source, Orléans, France (A.H.); Department of Pathology, CHU de Poitiers, Hôpital la Milétrie, Poitiers, France (S.M.); Department of Pathology, CHU d'Amiens, Amiens, France (H.S.); Department of Pathology, CHU de Clermont-Ferrand, Clermont-Ferrand, France (C.G.); Department of Pathology, CHU de Limoges, Limoges, France (F.L.); Department of Neurosurgery, APHM, CHU Timone, Marseille, France (P.M.); Department of Pediatric Neurosurgery, APHM, CHU Timone, Marseille, France (D.S.)
| | - Emeline Tabouret
- Department of Pathology and Neuropathology, Assistance Publique des Hôpitaux de Marseille (APHM), CHU Timone, Marseille, France (D.F.-B, E.T., A.M.d.P, C.B.); Aix-Marseille Université, Inserm, Marseille, France (D.F.-B, E.T., C.B., C.C.); Department of Pathology, CHU Caen, Hôpital de la Côte de Nacre, Caen, France (E.L.-Z); Department of Neurooncology, APHM, Marseille, France (E.T.); Department of Neuropathology, University of Bonn, Medical Center Sigmund-Freud, Bonn, Germany (S.J., T.P.); Department of Pathology and Neuropathology, Hospices civils de Lyon, Bron, France (A.J.); Department of Pathology, CHU de Saint-Etienne, Saint-Etienne, France (F.F.); Department of Neuropathology, CHU Sainte Anne, Paris, France (F.A.); Department of Pathology, CHU de Brest, Hôpital de la Cavale Blanche, Brest, France (I.Q.-R); Department of Pathology, CHU de Tours, Hôpital Trousseau, Tours, France (M.-C.M.); Department of Pathology, CHR d'Orléans, Hôpital de la Source, Orléans, France (A.H.); Department of Pathology, CHU de Poitiers, Hôpital la Milétrie, Poitiers, France (S.M.); Department of Pathology, CHU d'Amiens, Amiens, France (H.S.); Department of Pathology, CHU de Clermont-Ferrand, Clermont-Ferrand, France (C.G.); Department of Pathology, CHU de Limoges, Limoges, France (F.L.); Department of Neurosurgery, APHM, CHU Timone, Marseille, France (P.M.); Department of Pediatric Neurosurgery, APHM, CHU Timone, Marseille, France (D.S.)
| | - Stephanie Jünger
- Department of Pathology and Neuropathology, Assistance Publique des Hôpitaux de Marseille (APHM), CHU Timone, Marseille, France (D.F.-B, E.T., A.M.d.P, C.B.); Aix-Marseille Université, Inserm, Marseille, France (D.F.-B, E.T., C.B., C.C.); Department of Pathology, CHU Caen, Hôpital de la Côte de Nacre, Caen, France (E.L.-Z); Department of Neurooncology, APHM, Marseille, France (E.T.); Department of Neuropathology, University of Bonn, Medical Center Sigmund-Freud, Bonn, Germany (S.J., T.P.); Department of Pathology and Neuropathology, Hospices civils de Lyon, Bron, France (A.J.); Department of Pathology, CHU de Saint-Etienne, Saint-Etienne, France (F.F.); Department of Neuropathology, CHU Sainte Anne, Paris, France (F.A.); Department of Pathology, CHU de Brest, Hôpital de la Cavale Blanche, Brest, France (I.Q.-R); Department of Pathology, CHU de Tours, Hôpital Trousseau, Tours, France (M.-C.M.); Department of Pathology, CHR d'Orléans, Hôpital de la Source, Orléans, France (A.H.); Department of Pathology, CHU de Poitiers, Hôpital la Milétrie, Poitiers, France (S.M.); Department of Pathology, CHU d'Amiens, Amiens, France (H.S.); Department of Pathology, CHU de Clermont-Ferrand, Clermont-Ferrand, France (C.G.); Department of Pathology, CHU de Limoges, Limoges, France (F.L.); Department of Neurosurgery, APHM, CHU Timone, Marseille, France (P.M.); Department of Pediatric Neurosurgery, APHM, CHU Timone, Marseille, France (D.S.)
| | - André Maues de Paula
- Department of Pathology and Neuropathology, Assistance Publique des Hôpitaux de Marseille (APHM), CHU Timone, Marseille, France (D.F.-B, E.T., A.M.d.P, C.B.); Aix-Marseille Université, Inserm, Marseille, France (D.F.-B, E.T., C.B., C.C.); Department of Pathology, CHU Caen, Hôpital de la Côte de Nacre, Caen, France (E.L.-Z); Department of Neurooncology, APHM, Marseille, France (E.T.); Department of Neuropathology, University of Bonn, Medical Center Sigmund-Freud, Bonn, Germany (S.J., T.P.); Department of Pathology and Neuropathology, Hospices civils de Lyon, Bron, France (A.J.); Department of Pathology, CHU de Saint-Etienne, Saint-Etienne, France (F.F.); Department of Neuropathology, CHU Sainte Anne, Paris, France (F.A.); Department of Pathology, CHU de Brest, Hôpital de la Cavale Blanche, Brest, France (I.Q.-R); Department of Pathology, CHU de Tours, Hôpital Trousseau, Tours, France (M.-C.M.); Department of Pathology, CHR d'Orléans, Hôpital de la Source, Orléans, France (A.H.); Department of Pathology, CHU de Poitiers, Hôpital la Milétrie, Poitiers, France (S.M.); Department of Pathology, CHU d'Amiens, Amiens, France (H.S.); Department of Pathology, CHU de Clermont-Ferrand, Clermont-Ferrand, France (C.G.); Department of Pathology, CHU de Limoges, Limoges, France (F.L.); Department of Neurosurgery, APHM, CHU Timone, Marseille, France (P.M.); Department of Pediatric Neurosurgery, APHM, CHU Timone, Marseille, France (D.S.)
| | - Corinne Bouvier
- Department of Pathology and Neuropathology, Assistance Publique des Hôpitaux de Marseille (APHM), CHU Timone, Marseille, France (D.F.-B, E.T., A.M.d.P, C.B.); Aix-Marseille Université, Inserm, Marseille, France (D.F.-B, E.T., C.B., C.C.); Department of Pathology, CHU Caen, Hôpital de la Côte de Nacre, Caen, France (E.L.-Z); Department of Neurooncology, APHM, Marseille, France (E.T.); Department of Neuropathology, University of Bonn, Medical Center Sigmund-Freud, Bonn, Germany (S.J., T.P.); Department of Pathology and Neuropathology, Hospices civils de Lyon, Bron, France (A.J.); Department of Pathology, CHU de Saint-Etienne, Saint-Etienne, France (F.F.); Department of Neuropathology, CHU Sainte Anne, Paris, France (F.A.); Department of Pathology, CHU de Brest, Hôpital de la Cavale Blanche, Brest, France (I.Q.-R); Department of Pathology, CHU de Tours, Hôpital Trousseau, Tours, France (M.-C.M.); Department of Pathology, CHR d'Orléans, Hôpital de la Source, Orléans, France (A.H.); Department of Pathology, CHU de Poitiers, Hôpital la Milétrie, Poitiers, France (S.M.); Department of Pathology, CHU d'Amiens, Amiens, France (H.S.); Department of Pathology, CHU de Clermont-Ferrand, Clermont-Ferrand, France (C.G.); Department of Pathology, CHU de Limoges, Limoges, France (F.L.); Department of Neurosurgery, APHM, CHU Timone, Marseille, France (P.M.); Department of Pediatric Neurosurgery, APHM, CHU Timone, Marseille, France (D.S.)
| | - Carole Colin
- Department of Pathology and Neuropathology, Assistance Publique des Hôpitaux de Marseille (APHM), CHU Timone, Marseille, France (D.F.-B, E.T., A.M.d.P, C.B.); Aix-Marseille Université, Inserm, Marseille, France (D.F.-B, E.T., C.B., C.C.); Department of Pathology, CHU Caen, Hôpital de la Côte de Nacre, Caen, France (E.L.-Z); Department of Neurooncology, APHM, Marseille, France (E.T.); Department of Neuropathology, University of Bonn, Medical Center Sigmund-Freud, Bonn, Germany (S.J., T.P.); Department of Pathology and Neuropathology, Hospices civils de Lyon, Bron, France (A.J.); Department of Pathology, CHU de Saint-Etienne, Saint-Etienne, France (F.F.); Department of Neuropathology, CHU Sainte Anne, Paris, France (F.A.); Department of Pathology, CHU de Brest, Hôpital de la Cavale Blanche, Brest, France (I.Q.-R); Department of Pathology, CHU de Tours, Hôpital Trousseau, Tours, France (M.-C.M.); Department of Pathology, CHR d'Orléans, Hôpital de la Source, Orléans, France (A.H.); Department of Pathology, CHU de Poitiers, Hôpital la Milétrie, Poitiers, France (S.M.); Department of Pathology, CHU d'Amiens, Amiens, France (H.S.); Department of Pathology, CHU de Clermont-Ferrand, Clermont-Ferrand, France (C.G.); Department of Pathology, CHU de Limoges, Limoges, France (F.L.); Department of Neurosurgery, APHM, CHU Timone, Marseille, France (P.M.); Department of Pediatric Neurosurgery, APHM, CHU Timone, Marseille, France (D.S.)
| | - Anne Jouvet
- Department of Pathology and Neuropathology, Assistance Publique des Hôpitaux de Marseille (APHM), CHU Timone, Marseille, France (D.F.-B, E.T., A.M.d.P, C.B.); Aix-Marseille Université, Inserm, Marseille, France (D.F.-B, E.T., C.B., C.C.); Department of Pathology, CHU Caen, Hôpital de la Côte de Nacre, Caen, France (E.L.-Z); Department of Neurooncology, APHM, Marseille, France (E.T.); Department of Neuropathology, University of Bonn, Medical Center Sigmund-Freud, Bonn, Germany (S.J., T.P.); Department of Pathology and Neuropathology, Hospices civils de Lyon, Bron, France (A.J.); Department of Pathology, CHU de Saint-Etienne, Saint-Etienne, France (F.F.); Department of Neuropathology, CHU Sainte Anne, Paris, France (F.A.); Department of Pathology, CHU de Brest, Hôpital de la Cavale Blanche, Brest, France (I.Q.-R); Department of Pathology, CHU de Tours, Hôpital Trousseau, Tours, France (M.-C.M.); Department of Pathology, CHR d'Orléans, Hôpital de la Source, Orléans, France (A.H.); Department of Pathology, CHU de Poitiers, Hôpital la Milétrie, Poitiers, France (S.M.); Department of Pathology, CHU d'Amiens, Amiens, France (H.S.); Department of Pathology, CHU de Clermont-Ferrand, Clermont-Ferrand, France (C.G.); Department of Pathology, CHU de Limoges, Limoges, France (F.L.); Department of Neurosurgery, APHM, CHU Timone, Marseille, France (P.M.); Department of Pediatric Neurosurgery, APHM, CHU Timone, Marseille, France (D.S.)
| | - Fabien Forest
- Department of Pathology and Neuropathology, Assistance Publique des Hôpitaux de Marseille (APHM), CHU Timone, Marseille, France (D.F.-B, E.T., A.M.d.P, C.B.); Aix-Marseille Université, Inserm, Marseille, France (D.F.-B, E.T., C.B., C.C.); Department of Pathology, CHU Caen, Hôpital de la Côte de Nacre, Caen, France (E.L.-Z); Department of Neurooncology, APHM, Marseille, France (E.T.); Department of Neuropathology, University of Bonn, Medical Center Sigmund-Freud, Bonn, Germany (S.J., T.P.); Department of Pathology and Neuropathology, Hospices civils de Lyon, Bron, France (A.J.); Department of Pathology, CHU de Saint-Etienne, Saint-Etienne, France (F.F.); Department of Neuropathology, CHU Sainte Anne, Paris, France (F.A.); Department of Pathology, CHU de Brest, Hôpital de la Cavale Blanche, Brest, France (I.Q.-R); Department of Pathology, CHU de Tours, Hôpital Trousseau, Tours, France (M.-C.M.); Department of Pathology, CHR d'Orléans, Hôpital de la Source, Orléans, France (A.H.); Department of Pathology, CHU de Poitiers, Hôpital la Milétrie, Poitiers, France (S.M.); Department of Pathology, CHU d'Amiens, Amiens, France (H.S.); Department of Pathology, CHU de Clermont-Ferrand, Clermont-Ferrand, France (C.G.); Department of Pathology, CHU de Limoges, Limoges, France (F.L.); Department of Neurosurgery, APHM, CHU Timone, Marseille, France (P.M.); Department of Pediatric Neurosurgery, APHM, CHU Timone, Marseille, France (D.S.)
| | - Felipe Andreiuolo
- Department of Pathology and Neuropathology, Assistance Publique des Hôpitaux de Marseille (APHM), CHU Timone, Marseille, France (D.F.-B, E.T., A.M.d.P, C.B.); Aix-Marseille Université, Inserm, Marseille, France (D.F.-B, E.T., C.B., C.C.); Department of Pathology, CHU Caen, Hôpital de la Côte de Nacre, Caen, France (E.L.-Z); Department of Neurooncology, APHM, Marseille, France (E.T.); Department of Neuropathology, University of Bonn, Medical Center Sigmund-Freud, Bonn, Germany (S.J., T.P.); Department of Pathology and Neuropathology, Hospices civils de Lyon, Bron, France (A.J.); Department of Pathology, CHU de Saint-Etienne, Saint-Etienne, France (F.F.); Department of Neuropathology, CHU Sainte Anne, Paris, France (F.A.); Department of Pathology, CHU de Brest, Hôpital de la Cavale Blanche, Brest, France (I.Q.-R); Department of Pathology, CHU de Tours, Hôpital Trousseau, Tours, France (M.-C.M.); Department of Pathology, CHR d'Orléans, Hôpital de la Source, Orléans, France (A.H.); Department of Pathology, CHU de Poitiers, Hôpital la Milétrie, Poitiers, France (S.M.); Department of Pathology, CHU d'Amiens, Amiens, France (H.S.); Department of Pathology, CHU de Clermont-Ferrand, Clermont-Ferrand, France (C.G.); Department of Pathology, CHU de Limoges, Limoges, France (F.L.); Department of Neurosurgery, APHM, CHU Timone, Marseille, France (P.M.); Department of Pediatric Neurosurgery, APHM, CHU Timone, Marseille, France (D.S.)
| | - Isabelle Quintin-Roue
- Department of Pathology and Neuropathology, Assistance Publique des Hôpitaux de Marseille (APHM), CHU Timone, Marseille, France (D.F.-B, E.T., A.M.d.P, C.B.); Aix-Marseille Université, Inserm, Marseille, France (D.F.-B, E.T., C.B., C.C.); Department of Pathology, CHU Caen, Hôpital de la Côte de Nacre, Caen, France (E.L.-Z); Department of Neurooncology, APHM, Marseille, France (E.T.); Department of Neuropathology, University of Bonn, Medical Center Sigmund-Freud, Bonn, Germany (S.J., T.P.); Department of Pathology and Neuropathology, Hospices civils de Lyon, Bron, France (A.J.); Department of Pathology, CHU de Saint-Etienne, Saint-Etienne, France (F.F.); Department of Neuropathology, CHU Sainte Anne, Paris, France (F.A.); Department of Pathology, CHU de Brest, Hôpital de la Cavale Blanche, Brest, France (I.Q.-R); Department of Pathology, CHU de Tours, Hôpital Trousseau, Tours, France (M.-C.M.); Department of Pathology, CHR d'Orléans, Hôpital de la Source, Orléans, France (A.H.); Department of Pathology, CHU de Poitiers, Hôpital la Milétrie, Poitiers, France (S.M.); Department of Pathology, CHU d'Amiens, Amiens, France (H.S.); Department of Pathology, CHU de Clermont-Ferrand, Clermont-Ferrand, France (C.G.); Department of Pathology, CHU de Limoges, Limoges, France (F.L.); Department of Neurosurgery, APHM, CHU Timone, Marseille, France (P.M.); Department of Pediatric Neurosurgery, APHM, CHU Timone, Marseille, France (D.S.)
| | - Marie-Christine Machet
- Department of Pathology and Neuropathology, Assistance Publique des Hôpitaux de Marseille (APHM), CHU Timone, Marseille, France (D.F.-B, E.T., A.M.d.P, C.B.); Aix-Marseille Université, Inserm, Marseille, France (D.F.-B, E.T., C.B., C.C.); Department of Pathology, CHU Caen, Hôpital de la Côte de Nacre, Caen, France (E.L.-Z); Department of Neurooncology, APHM, Marseille, France (E.T.); Department of Neuropathology, University of Bonn, Medical Center Sigmund-Freud, Bonn, Germany (S.J., T.P.); Department of Pathology and Neuropathology, Hospices civils de Lyon, Bron, France (A.J.); Department of Pathology, CHU de Saint-Etienne, Saint-Etienne, France (F.F.); Department of Neuropathology, CHU Sainte Anne, Paris, France (F.A.); Department of Pathology, CHU de Brest, Hôpital de la Cavale Blanche, Brest, France (I.Q.-R); Department of Pathology, CHU de Tours, Hôpital Trousseau, Tours, France (M.-C.M.); Department of Pathology, CHR d'Orléans, Hôpital de la Source, Orléans, France (A.H.); Department of Pathology, CHU de Poitiers, Hôpital la Milétrie, Poitiers, France (S.M.); Department of Pathology, CHU d'Amiens, Amiens, France (H.S.); Department of Pathology, CHU de Clermont-Ferrand, Clermont-Ferrand, France (C.G.); Department of Pathology, CHU de Limoges, Limoges, France (F.L.); Department of Neurosurgery, APHM, CHU Timone, Marseille, France (P.M.); Department of Pediatric Neurosurgery, APHM, CHU Timone, Marseille, France (D.S.)
| | - Anne Heitzmann
- Department of Pathology and Neuropathology, Assistance Publique des Hôpitaux de Marseille (APHM), CHU Timone, Marseille, France (D.F.-B, E.T., A.M.d.P, C.B.); Aix-Marseille Université, Inserm, Marseille, France (D.F.-B, E.T., C.B., C.C.); Department of Pathology, CHU Caen, Hôpital de la Côte de Nacre, Caen, France (E.L.-Z); Department of Neurooncology, APHM, Marseille, France (E.T.); Department of Neuropathology, University of Bonn, Medical Center Sigmund-Freud, Bonn, Germany (S.J., T.P.); Department of Pathology and Neuropathology, Hospices civils de Lyon, Bron, France (A.J.); Department of Pathology, CHU de Saint-Etienne, Saint-Etienne, France (F.F.); Department of Neuropathology, CHU Sainte Anne, Paris, France (F.A.); Department of Pathology, CHU de Brest, Hôpital de la Cavale Blanche, Brest, France (I.Q.-R); Department of Pathology, CHU de Tours, Hôpital Trousseau, Tours, France (M.-C.M.); Department of Pathology, CHR d'Orléans, Hôpital de la Source, Orléans, France (A.H.); Department of Pathology, CHU de Poitiers, Hôpital la Milétrie, Poitiers, France (S.M.); Department of Pathology, CHU d'Amiens, Amiens, France (H.S.); Department of Pathology, CHU de Clermont-Ferrand, Clermont-Ferrand, France (C.G.); Department of Pathology, CHU de Limoges, Limoges, France (F.L.); Department of Neurosurgery, APHM, CHU Timone, Marseille, France (P.M.); Department of Pediatric Neurosurgery, APHM, CHU Timone, Marseille, France (D.S.)
| | - Serge Milin
- Department of Pathology and Neuropathology, Assistance Publique des Hôpitaux de Marseille (APHM), CHU Timone, Marseille, France (D.F.-B, E.T., A.M.d.P, C.B.); Aix-Marseille Université, Inserm, Marseille, France (D.F.-B, E.T., C.B., C.C.); Department of Pathology, CHU Caen, Hôpital de la Côte de Nacre, Caen, France (E.L.-Z); Department of Neurooncology, APHM, Marseille, France (E.T.); Department of Neuropathology, University of Bonn, Medical Center Sigmund-Freud, Bonn, Germany (S.J., T.P.); Department of Pathology and Neuropathology, Hospices civils de Lyon, Bron, France (A.J.); Department of Pathology, CHU de Saint-Etienne, Saint-Etienne, France (F.F.); Department of Neuropathology, CHU Sainte Anne, Paris, France (F.A.); Department of Pathology, CHU de Brest, Hôpital de la Cavale Blanche, Brest, France (I.Q.-R); Department of Pathology, CHU de Tours, Hôpital Trousseau, Tours, France (M.-C.M.); Department of Pathology, CHR d'Orléans, Hôpital de la Source, Orléans, France (A.H.); Department of Pathology, CHU de Poitiers, Hôpital la Milétrie, Poitiers, France (S.M.); Department of Pathology, CHU d'Amiens, Amiens, France (H.S.); Department of Pathology, CHU de Clermont-Ferrand, Clermont-Ferrand, France (C.G.); Department of Pathology, CHU de Limoges, Limoges, France (F.L.); Department of Neurosurgery, APHM, CHU Timone, Marseille, France (P.M.); Department of Pediatric Neurosurgery, APHM, CHU Timone, Marseille, France (D.S.)
| | - Henri Sevestre
- Department of Pathology and Neuropathology, Assistance Publique des Hôpitaux de Marseille (APHM), CHU Timone, Marseille, France (D.F.-B, E.T., A.M.d.P, C.B.); Aix-Marseille Université, Inserm, Marseille, France (D.F.-B, E.T., C.B., C.C.); Department of Pathology, CHU Caen, Hôpital de la Côte de Nacre, Caen, France (E.L.-Z); Department of Neurooncology, APHM, Marseille, France (E.T.); Department of Neuropathology, University of Bonn, Medical Center Sigmund-Freud, Bonn, Germany (S.J., T.P.); Department of Pathology and Neuropathology, Hospices civils de Lyon, Bron, France (A.J.); Department of Pathology, CHU de Saint-Etienne, Saint-Etienne, France (F.F.); Department of Neuropathology, CHU Sainte Anne, Paris, France (F.A.); Department of Pathology, CHU de Brest, Hôpital de la Cavale Blanche, Brest, France (I.Q.-R); Department of Pathology, CHU de Tours, Hôpital Trousseau, Tours, France (M.-C.M.); Department of Pathology, CHR d'Orléans, Hôpital de la Source, Orléans, France (A.H.); Department of Pathology, CHU de Poitiers, Hôpital la Milétrie, Poitiers, France (S.M.); Department of Pathology, CHU d'Amiens, Amiens, France (H.S.); Department of Pathology, CHU de Clermont-Ferrand, Clermont-Ferrand, France (C.G.); Department of Pathology, CHU de Limoges, Limoges, France (F.L.); Department of Neurosurgery, APHM, CHU Timone, Marseille, France (P.M.); Department of Pediatric Neurosurgery, APHM, CHU Timone, Marseille, France (D.S.)
| | - Catherine Godfraind
- Department of Pathology and Neuropathology, Assistance Publique des Hôpitaux de Marseille (APHM), CHU Timone, Marseille, France (D.F.-B, E.T., A.M.d.P, C.B.); Aix-Marseille Université, Inserm, Marseille, France (D.F.-B, E.T., C.B., C.C.); Department of Pathology, CHU Caen, Hôpital de la Côte de Nacre, Caen, France (E.L.-Z); Department of Neurooncology, APHM, Marseille, France (E.T.); Department of Neuropathology, University of Bonn, Medical Center Sigmund-Freud, Bonn, Germany (S.J., T.P.); Department of Pathology and Neuropathology, Hospices civils de Lyon, Bron, France (A.J.); Department of Pathology, CHU de Saint-Etienne, Saint-Etienne, France (F.F.); Department of Neuropathology, CHU Sainte Anne, Paris, France (F.A.); Department of Pathology, CHU de Brest, Hôpital de la Cavale Blanche, Brest, France (I.Q.-R); Department of Pathology, CHU de Tours, Hôpital Trousseau, Tours, France (M.-C.M.); Department of Pathology, CHR d'Orléans, Hôpital de la Source, Orléans, France (A.H.); Department of Pathology, CHU de Poitiers, Hôpital la Milétrie, Poitiers, France (S.M.); Department of Pathology, CHU d'Amiens, Amiens, France (H.S.); Department of Pathology, CHU de Clermont-Ferrand, Clermont-Ferrand, France (C.G.); Department of Pathology, CHU de Limoges, Limoges, France (F.L.); Department of Neurosurgery, APHM, CHU Timone, Marseille, France (P.M.); Department of Pediatric Neurosurgery, APHM, CHU Timone, Marseille, France (D.S.)
| | - François Labrousse
- Department of Pathology and Neuropathology, Assistance Publique des Hôpitaux de Marseille (APHM), CHU Timone, Marseille, France (D.F.-B, E.T., A.M.d.P, C.B.); Aix-Marseille Université, Inserm, Marseille, France (D.F.-B, E.T., C.B., C.C.); Department of Pathology, CHU Caen, Hôpital de la Côte de Nacre, Caen, France (E.L.-Z); Department of Neurooncology, APHM, Marseille, France (E.T.); Department of Neuropathology, University of Bonn, Medical Center Sigmund-Freud, Bonn, Germany (S.J., T.P.); Department of Pathology and Neuropathology, Hospices civils de Lyon, Bron, France (A.J.); Department of Pathology, CHU de Saint-Etienne, Saint-Etienne, France (F.F.); Department of Neuropathology, CHU Sainte Anne, Paris, France (F.A.); Department of Pathology, CHU de Brest, Hôpital de la Cavale Blanche, Brest, France (I.Q.-R); Department of Pathology, CHU de Tours, Hôpital Trousseau, Tours, France (M.-C.M.); Department of Pathology, CHR d'Orléans, Hôpital de la Source, Orléans, France (A.H.); Department of Pathology, CHU de Poitiers, Hôpital la Milétrie, Poitiers, France (S.M.); Department of Pathology, CHU d'Amiens, Amiens, France (H.S.); Department of Pathology, CHU de Clermont-Ferrand, Clermont-Ferrand, France (C.G.); Department of Pathology, CHU de Limoges, Limoges, France (F.L.); Department of Neurosurgery, APHM, CHU Timone, Marseille, France (P.M.); Department of Pediatric Neurosurgery, APHM, CHU Timone, Marseille, France (D.S.)
| | - Philippe Metellus
- Department of Pathology and Neuropathology, Assistance Publique des Hôpitaux de Marseille (APHM), CHU Timone, Marseille, France (D.F.-B, E.T., A.M.d.P, C.B.); Aix-Marseille Université, Inserm, Marseille, France (D.F.-B, E.T., C.B., C.C.); Department of Pathology, CHU Caen, Hôpital de la Côte de Nacre, Caen, France (E.L.-Z); Department of Neurooncology, APHM, Marseille, France (E.T.); Department of Neuropathology, University of Bonn, Medical Center Sigmund-Freud, Bonn, Germany (S.J., T.P.); Department of Pathology and Neuropathology, Hospices civils de Lyon, Bron, France (A.J.); Department of Pathology, CHU de Saint-Etienne, Saint-Etienne, France (F.F.); Department of Neuropathology, CHU Sainte Anne, Paris, France (F.A.); Department of Pathology, CHU de Brest, Hôpital de la Cavale Blanche, Brest, France (I.Q.-R); Department of Pathology, CHU de Tours, Hôpital Trousseau, Tours, France (M.-C.M.); Department of Pathology, CHR d'Orléans, Hôpital de la Source, Orléans, France (A.H.); Department of Pathology, CHU de Poitiers, Hôpital la Milétrie, Poitiers, France (S.M.); Department of Pathology, CHU d'Amiens, Amiens, France (H.S.); Department of Pathology, CHU de Clermont-Ferrand, Clermont-Ferrand, France (C.G.); Department of Pathology, CHU de Limoges, Limoges, France (F.L.); Department of Neurosurgery, APHM, CHU Timone, Marseille, France (P.M.); Department of Pediatric Neurosurgery, APHM, CHU Timone, Marseille, France (D.S.)
| | - Didier Scavarda
- Department of Pathology and Neuropathology, Assistance Publique des Hôpitaux de Marseille (APHM), CHU Timone, Marseille, France (D.F.-B, E.T., A.M.d.P, C.B.); Aix-Marseille Université, Inserm, Marseille, France (D.F.-B, E.T., C.B., C.C.); Department of Pathology, CHU Caen, Hôpital de la Côte de Nacre, Caen, France (E.L.-Z); Department of Neurooncology, APHM, Marseille, France (E.T.); Department of Neuropathology, University of Bonn, Medical Center Sigmund-Freud, Bonn, Germany (S.J., T.P.); Department of Pathology and Neuropathology, Hospices civils de Lyon, Bron, France (A.J.); Department of Pathology, CHU de Saint-Etienne, Saint-Etienne, France (F.F.); Department of Neuropathology, CHU Sainte Anne, Paris, France (F.A.); Department of Pathology, CHU de Brest, Hôpital de la Cavale Blanche, Brest, France (I.Q.-R); Department of Pathology, CHU de Tours, Hôpital Trousseau, Tours, France (M.-C.M.); Department of Pathology, CHR d'Orléans, Hôpital de la Source, Orléans, France (A.H.); Department of Pathology, CHU de Poitiers, Hôpital la Milétrie, Poitiers, France (S.M.); Department of Pathology, CHU d'Amiens, Amiens, France (H.S.); Department of Pathology, CHU de Clermont-Ferrand, Clermont-Ferrand, France (C.G.); Department of Pathology, CHU de Limoges, Limoges, France (F.L.); Department of Neurosurgery, APHM, CHU Timone, Marseille, France (P.M.); Department of Pediatric Neurosurgery, APHM, CHU Timone, Marseille, France (D.S.)
| | - Torsten Pietsch
- Department of Pathology and Neuropathology, Assistance Publique des Hôpitaux de Marseille (APHM), CHU Timone, Marseille, France (D.F.-B, E.T., A.M.d.P, C.B.); Aix-Marseille Université, Inserm, Marseille, France (D.F.-B, E.T., C.B., C.C.); Department of Pathology, CHU Caen, Hôpital de la Côte de Nacre, Caen, France (E.L.-Z); Department of Neurooncology, APHM, Marseille, France (E.T.); Department of Neuropathology, University of Bonn, Medical Center Sigmund-Freud, Bonn, Germany (S.J., T.P.); Department of Pathology and Neuropathology, Hospices civils de Lyon, Bron, France (A.J.); Department of Pathology, CHU de Saint-Etienne, Saint-Etienne, France (F.F.); Department of Neuropathology, CHU Sainte Anne, Paris, France (F.A.); Department of Pathology, CHU de Brest, Hôpital de la Cavale Blanche, Brest, France (I.Q.-R); Department of Pathology, CHU de Tours, Hôpital Trousseau, Tours, France (M.-C.M.); Department of Pathology, CHR d'Orléans, Hôpital de la Source, Orléans, France (A.H.); Department of Pathology, CHU de Poitiers, Hôpital la Milétrie, Poitiers, France (S.M.); Department of Pathology, CHU d'Amiens, Amiens, France (H.S.); Department of Pathology, CHU de Clermont-Ferrand, Clermont-Ferrand, France (C.G.); Department of Pathology, CHU de Limoges, Limoges, France (F.L.); Department of Neurosurgery, APHM, CHU Timone, Marseille, France (P.M.); Department of Pediatric Neurosurgery, APHM, CHU Timone, Marseille, France (D.S.)
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754
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Chen C, Chen L, Yao Y, Qin Z, Chen H. Nucleolin overexpression is associated with an unfavorable outcome for ependymoma: a multifactorial analysis of 176 patients. J Neurooncol 2016; 127:43-52. [PMID: 26615563 DOI: 10.1007/s11060-015-2007-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 11/20/2015] [Indexed: 10/22/2022]
Abstract
Ependymoma typically has a better overall survival rate than most gliomas. Only a few comprehensive clinical studies have been published, but these are mostly from Western countries and use small sample sizes. Histopathological classification is not sufficient to show variable outcomes, and fails to show prognostic markers of the diverse outcomes; hence, it is essential to understand biological mechanisms. In this study, 176 ependymoma samples (World Health Organization grade II and III) were reviewed at Huashan Hospital. Both children and adults were included. We performed multifactorial analyses of clinical prognostic factors and the biomolecular marker expressions of nucleolin, epidermal growth factor receptor (EGFR) and caveolae-associated protein caveolin-1 by immunohistochemistry. We identified the probabilities of progression-free survival and overall survival using univariate and multivariate statistical methods. The participants were diagnosed with ependymomas between 2002 and 2010, including distributions of tumor locations in intracranial and extracranial regions. Nucleolin was overexpressed in 67 % of our samples, demonstrating a subgroup with poor outcome; particularly infratentorial and anaplastic ependymomas. There was no significant correlation between the expression of EGFR and caveolin-1 and clinical outcomes. Clinically, inferior prognosis was observed with regard to age (<18 years), intracranial location, high grade ependymomas, and incomplete resection. We found that nucleolin was an unfavorable prognostic predictor for ependymomas. Moreover, our findings show a subset of aggravating outcomes in high-grade and posterior fossa tumors.
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Affiliation(s)
- Chunjui Chen
- Department of Neurosurgery, Huashan Hospital Shanghai Medical College, Fudan University, No 12, Middle Wulumuqi Road, Shanghai, 200040, China
| | - Lingchao Chen
- Department of Neurosurgery, Huashan Hospital Shanghai Medical College, Fudan University, No 12, Middle Wulumuqi Road, Shanghai, 200040, China
| | - Yu Yao
- Department of Neurosurgery, Huashan Hospital Shanghai Medical College, Fudan University, No 12, Middle Wulumuqi Road, Shanghai, 200040, China
| | - Zhiyong Qin
- Department of Neurosurgery, Huashan Hospital Shanghai Medical College, Fudan University, No 12, Middle Wulumuqi Road, Shanghai, 200040, China.
| | - Hong Chen
- Department of Neuropathology, Huashan Hospital Shanghai Medical College, Fudan University, No 12, Middle Wulumuqi Road, Shanghai, 200040, China
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755
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Ernst A, Jones DTW, Maass KK, Rode A, Deeg KI, Jebaraj BMC, Korshunov A, Hovestadt V, Tainsky MA, Pajtler KW, Bender S, Brabetz S, Gröbner S, Kool M, Devens F, Edelmann J, Zhang C, Castelo-Branco P, Tabori U, Malkin D, Rippe K, Stilgenbauer S, Pfister SM, Zapatka M, Lichter P. Telomere dysfunction and chromothripsis. Int J Cancer 2016; 138:2905-14. [PMID: 26856307 DOI: 10.1002/ijc.30033] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 01/23/2016] [Accepted: 01/25/2016] [Indexed: 12/28/2022]
Abstract
Chromothripsis is a recently discovered form of genomic instability, characterized by tens to hundreds of clustered DNA rearrangements resulting from a single dramatic event. Telomere dysfunction has been suggested to play a role in the initiation of this phenomenon, which occurs in a large number of tumor entities. Here, we show that telomere attrition can indeed lead to catastrophic genomic events, and that telomere patterns differ between cells analyzed before and after such genomic catastrophes. Telomere length and telomere stabilization mechanisms diverge between samples with and without chromothripsis in a given tumor subtype. Longitudinal analyses of the evolution of chromothriptic patterns identify either stable patterns between matched primary and relapsed tumors, or loss of the chromothriptic clone in the relapsed specimen. The absence of additional chromothriptic events occurring between the initial tumor and the relapsed tumor sample points to telomere stabilization after the initial chromothriptic event which prevents further shattering of the genome.
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Affiliation(s)
- Aurélie Ernst
- Division of Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David T W Jones
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kendra K Maass
- Division Functional Architecture of the Cell, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Agata Rode
- Division of Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Katharina I Deeg
- Genome Organization and Function, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Andrey Korshunov
- Department of Neuropathology University Hospital, Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Volker Hovestadt
- Division of Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael A Tainsky
- Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI
| | - Kristian W Pajtler
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sebastian Bender
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sebastian Brabetz
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Susanne Gröbner
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marcel Kool
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Frauke Devens
- Division of Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Cindy Zhang
- Division of Pediatric Hematology-Oncology and the Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Pedro Castelo-Branco
- Division of Pediatric Hematology-Oncology and the Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Uri Tabori
- Division of Pediatric Hematology-Oncology and the Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - David Malkin
- Division of Hematology/Oncology and Department of Pediatrics, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Karsten Rippe
- Genome Organization and Function, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Stefan M Pfister
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marc Zapatka
- Division of Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Peter Lichter
- Division of Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany
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756
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Lee CH, Chung CK, Ohn JH, Kim CH. The Similarities and Differences between Intracranial and Spinal Ependymomas : A Review from a Genetic Research Perspective. J Korean Neurosurg Soc 2016; 59:83-90. [PMID: 26962412 PMCID: PMC4783489 DOI: 10.3340/jkns.2016.59.2.83] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 11/20/2015] [Accepted: 01/01/2016] [Indexed: 11/27/2022] Open
Abstract
Ependymomas occur in both the brain and spine. The prognosis of these tumors sometimes differs for different locations. The genetic landscape of ependymoma is very heterogeneous despite the similarity of histopathologic findings. In this review, we describe the genetic differences between spinal ependymomas and their intracranial counterparts to better understand their prognosis. From the literature review, many studies have reported that spinal cord ependymoma might be associated with NF2 mutation, NEFL overexpression, Merlin loss, and 9q gain. In myxopapillary ependymoma, NEFL and HOXB13 overexpression were reported to be associated. Prior studies have identified HIC-1 methylation, 4.1B deletion, and 4.1R loss as common features in intracranial ependymoma. Supratentorial ependymoma is usually characterized by NOTCH-1 mutation and p75 expression. TNC mutation, no hypermethylation of RASSF1A, and GFAP/NeuN expression may be diagnostic clues of posterior fossa ependymoma. Although MEN1, TP53, and PTEN mutations are rarely reported in ependymoma, they may be related to a poor prognosis, such as recurrence or metastasis. Spinal ependymoma has been found to be quite different from intracranial ependymoma in genetic studies, and the favorable prognosis in spinal ependymoma may be the result of the genetic differences. A more detailed understanding of these various genetic aberrations may enable the identification of more specific prognostic markers as well as the development of customized targeted therapies.
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Affiliation(s)
- Chang-Hyun Lee
- Department of Neurosurgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.; Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.; Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea.; Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.; Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea
| | - Jung Hun Ohn
- Bioinformatics, Samsung Gene Institute, Samsung Medical Center, Seoul, Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.; Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.; Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea.; Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
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757
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Sturm D, Orr BA, Toprak UH, Hovestadt V, Jones DTW, Capper D, Sill M, Buchhalter I, Northcott PA, Leis I, Ryzhova M, Koelsche C, Pfaff E, Allen SJ, Balasubramanian G, Worst BC, Pajtler KW, Brabetz S, Johann PD, Sahm F, Reimand J, Mackay A, Carvalho DM, Remke M, Phillips JJ, Perry A, Cowdrey C, Drissi R, Fouladi M, Giangaspero F, Łastowska M, Grajkowska W, Scheurlen W, Pietsch T, Hagel C, Gojo J, Lötsch D, Berger W, Slavc I, Haberler C, Jouvet A, Holm S, Hofer S, Prinz M, Keohane C, Fried I, Mawrin C, Scheie D, Mobley BC, Schniederjan MJ, Santi M, Buccoliero AM, Dahiya S, Kramm CM, von Bueren AO, von Hoff K, Rutkowski S, Herold-Mende C, Frühwald MC, Milde T, Hasselblatt M, Wesseling P, Rößler J, Schüller U, Ebinger M, Schittenhelm J, Frank S, Grobholz R, Vajtai I, Hans V, Schneppenheim R, Zitterbart K, Collins VP, Aronica E, Varlet P, Puget S, Dufour C, Grill J, Figarella-Branger D, Wolter M, Schuhmann MU, Shalaby T, Grotzer M, van Meter T, Monoranu CM, Felsberg J, Reifenberger G, Snuderl M, Forrester LA, Koster J, Versteeg R, Volckmann R, van Sluis P, Wolf S, Mikkelsen T, Gajjar A, Aldape K, Moore AS, Taylor MD, Jones C, Jabado N, Karajannis MA, Eils R, Schlesner M, Lichter P, von Deimling A, Pfister SM, Ellison DW, Korshunov A, Kool M. New Brain Tumor Entities Emerge from Molecular Classification of CNS-PNETs. Cell 2016; 164:1060-1072. [PMID: 26919435 PMCID: PMC5139621 DOI: 10.1016/j.cell.2016.01.015] [Citation(s) in RCA: 590] [Impact Index Per Article: 73.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/22/2015] [Accepted: 01/08/2016] [Indexed: 12/11/2022]
Abstract
Primitive neuroectodermal tumors of the central nervous system (CNS-PNETs) are highly aggressive, poorly differentiated embryonal tumors occurring predominantly in young children but also affecting adolescents and adults. Herein, we demonstrate that a significant proportion of institutionally diagnosed CNS-PNETs display molecular profiles indistinguishable from those of various other well-defined CNS tumor entities, facilitating diagnosis and appropriate therapy for patients with these tumors. From the remaining fraction of CNS-PNETs, we identify four new CNS tumor entities, each associated with a recurrent genetic alteration and distinct histopathological and clinical features. These new molecular entities, designated "CNS neuroblastoma with FOXR2 activation (CNS NB-FOXR2)," "CNS Ewing sarcoma family tumor with CIC alteration (CNS EFT-CIC)," "CNS high-grade neuroepithelial tumor with MN1 alteration (CNS HGNET-MN1)," and "CNS high-grade neuroepithelial tumor with BCOR alteration (CNS HGNET-BCOR)," will enable meaningful clinical trials and the development of therapeutic strategies for patients affected by poorly differentiated CNS tumors.
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Affiliation(s)
- Dominik Sturm
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
- Department of Pediatric Oncology, Hematology & Immunology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Brent A. Orr
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105-3678, USA
| | - Umut H. Toprak
- Division of Theoretical Bioinformatics, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Volker Hovestadt
- Division of Molecular Genetics, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - David T. W. Jones
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - David Capper
- Department of Neuropathology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), 69120 Heidelberg
| | - Martin Sill
- Division of Biostatistics, German Cancer Research Center (DKFZ) Heidelberg and German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Ivo Buchhalter
- Division of Theoretical Bioinformatics, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Paul A. Northcott
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Irina Leis
- Department of Neuropathology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Marina Ryzhova
- NN Burdenko Neurosurgical Institute, Moscow, 125047 Russia
| | - Christian Koelsche
- Department of Neuropathology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), 69120 Heidelberg
| | - Elke Pfaff
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
- Department of Pediatric Oncology, Hematology & Immunology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Sariah J. Allen
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105-3678, USA
| | - Gnanaprakash Balasubramanian
- Division of Applied Bioinformatics, German Cancer Research Center (DKFZ), National Center for Tumor Diseases (NCT), and German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Barbara C. Worst
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
- Department of Pediatric Oncology, Hematology & Immunology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Kristian W. Pajtler
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Sebastian Brabetz
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Pascal D. Johann
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
- Department of Pediatric Oncology, Hematology & Immunology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), 69120 Heidelberg
| | - Jüri Reimand
- Ontario Institute for Cancer Research, M5G 0A3, Toronto, ON M5G 1L7, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5G 1L7, Canada
| | - Alan Mackay
- Division of Molecular Pathology, The Institute of Cancer Research, SW7 3RP, London, United Kingdom
| | - Diana M. Carvalho
- Division of Molecular Pathology, The Institute of Cancer Research, SW7 3RP, London, United Kingdom
| | - Marc Remke
- Program in Developmental and Stem Cell Biology, Division of Neurosurgery, Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, University of Toronto, Toronto, ON M4N 1X8, Canada
| | - Joanna J. Phillips
- Brain Tumor Research Center, University of California, San Francisco, CA 94158-9001, USA
- Neuropathology, Department of Pathology, University of California, San Francisco, CA 94143-0102, USA
- Department of Neurological Surgery, University of California, San Francisco, CA 94143-0112, USA
| | - Arie Perry
- Brain Tumor Research Center, University of California, San Francisco, CA 94158-9001, USA
- Neuropathology, Department of Pathology, University of California, San Francisco, CA 94143-0102, USA
- Department of Neurological Surgery, University of California, San Francisco, CA 94143-0112, USA
| | - Cynthia Cowdrey
- Brain Tumor Research Center, University of California, San Francisco, CA 94158-9001, USA
| | - Rachid Drissi
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Maryam Fouladi
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Felice Giangaspero
- Department of Radiological, Oncological and Anatomic-Pathological Sciences, Sapienza University of Rome, 00185 Rome, Italy
- IRCCS Neuromed, 86077 Pozzilli, Molise, Italy
| | - Maria Łastowska
- Department of Pathology, Children's Memorial Health Institute, 04-730 Warsaw, Poland
| | - Wiesława Grajkowska
- Department of Pathology, Children's Memorial Health Institute, 04-730 Warsaw, Poland
| | - Wolfram Scheurlen
- Cnopf'sche Kinderklinik, Nürnberg Children's Hospital, 90419 Nürnberg, Germany
| | - Torsten Pietsch
- Department of Neuropathology, University of Bonn Medical School, 53105 Bonn, Germany
| | - Christian Hagel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Johannes Gojo
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria
- Department of Medicine I, Institute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
| | - Daniela Lötsch
- Department of Medicine I, Institute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
| | - Walter Berger
- Department of Medicine I, Institute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
| | - Irene Slavc
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Christine Haberler
- Institute of Neurology, Medical University of Vienna, 1097 Vienna, Austria
| | - Anne Jouvet
- Neuro-Oncology and Neuro-Inflammation Team, Inserm U1028, CNRS UMR 5292, University Lyon-1, Neuroscience Center, 69000 Lyon, France, and Centre de Pathologie et de Neuropathologie Est, Hospices Civils de Lyon, 69003 Lyon, France
| | - Stefan Holm
- Department of Women's and Children's Health (KBH), Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Silvia Hofer
- Department of Oncology, Luzerner Kantonsspital, 6000 Luzern 16, Luzern, Switzerland
| | - Marco Prinz
- Institute of Neuropathology, University of Freiburg, Germany & BIOSS Centre for Biological Signalling Studies, University of Freiburg, 79106 Freiburg, Germany
| | - Catherine Keohane
- Department of Pathology, University College Cork and Cork University Hospital Wilton, Cork, Ireland
| | - Iris Fried
- Department of Pediatric Hematology and Oncology, Hadassah Medical Center, Jerusalem, Israel
| | - Christian Mawrin
- Institute of Neuropathology, University Hospital, Otto-von-Guericke University, 39120 Magdeburg, Germany
| | - David Scheie
- Department of Pathology, Copenhagen University Hospital, 2100 København Ø, Denmark
| | - Bret C. Mobley
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Matthew J. Schniederjan
- Department of Pathology and Laboratory Administration, Children's Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Mariarita Santi
- Department of Pathology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Anna M. Buccoliero
- Pathology Unit, Anna Meyer Children's University Hospital, 50141 Florence, Italy
| | - Sonika Dahiya
- Department of Pathology and Immunology, Washington University, St. Louis, MO 63110, USA
| | - Christof M. Kramm
- Division of Pediatric Hematology and Oncology, Department of Child and Adolescent Health, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - André O. von Bueren
- Division of Pediatric Hematology and Oncology, Department of Child and Adolescent Health, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Katja von Hoff
- Department of Pediatric Haematology and Oncology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Stefan Rutkowski
- Department of Pediatric Haematology and Oncology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Christel Herold-Mende
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | | | - Till Milde
- Department of Pediatric Oncology, Hematology & Immunology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ) Heidelberg, 69120 Heidelberg, Germany
| | - Martin Hasselblatt
- Institute of Neuropathology, University Hospital Münster, 48149 Münster, Germany
| | - Pieter Wesseling
- Department of Pathology, VU University Medical Center Amsterdam, 1008 MB Amsterdam, The Netherlands
- Department of Pathology, Radboud University Nijmegen Medical Center, Nijmegen, 6525 GA, The Netherlands
| | - Jochen Rößler
- Department of Pediatric Hematology/Oncology, Center of Pediatrics and Adolescent Medicine, University Medical Center Freiburg, 79106 Freiburg, Germany
| | - Ulrich Schüller
- Department of Neuropathology, Ludwig-Maximilians-University, and German Cancer Consortium (DKTK) partner site Munich, 81377 Munich, Germany
| | - Martin Ebinger
- Department of Hematology and Oncology, Children's University Hospital Tübingen, and German Cancer Consortium (DKTK) partner site Tübingen, 72076 Tübingen, Germany
| | - Jens Schittenhelm
- Department of Neuropathology, Institute of Pathology and Neuropathology, University of Tübingen, and German Cancer Consortium (DKTK) partner site Tübingen, 72076 Tübingen, Germany
| | - Stephan Frank
- Department of Neuropathology, Institute of Pathology, Basel University Hospital, 4031 Basel, Switzerland
| | - Rainer Grobholz
- Department of Pathology, Medical Center Aarau, 5001 Aarau, Switzerland
| | - Istvan Vajtai
- Department of Pathology, University Hospital Bern, 3010 Bern, Switzerland
| | - Volkmar Hans
- Department of Neuropathology, Medical Center Bielefeld, 33617 Bielefeld, Germany
| | - Reinhard Schneppenheim
- Department of Pediatric Haematology and Oncology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Karel Zitterbart
- Department of Pediatric Oncology, University Hospital Brno and Masaryk University, Faculty of Medicine, 613 00 Brno, Czech Republic
| | - V. Peter Collins
- Division of Molecular Histopathology, Department of Pathology, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
| | - Eleonora Aronica
- Department of Neuropathology, AMC, University of Amsterdam, Amsterdam, 1105 AZ, The Netherlands
| | - Pascale Varlet
- Department of Neuropathology, Hôpital Sainte-Anne, 75674, Paris, France
| | - Stephanie Puget
- Pediatric Neurosurgery Department, Necker Enfants Malades Hospital, 75015, Paris, France
| | - Christelle Dufour
- Brain Tumor Program, Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Institute, University Paris Sud, 94805, Villejuif, France
| | - Jacques Grill
- Brain Tumor Program, Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Institute, University Paris Sud, 94805, Villejuif, France
| | - Dominique Figarella-Branger
- Department of Pathology and Neuropathology, la Timone Hospital, AP-HM and UMR911 CR02, Aix-Marseille University, 13385 Marseille, France
| | - Marietta Wolter
- Department of Neuropathology, Heinrich-Heine-University, and German Cancer Consortium (DKTK) partner site Essen/Düsseldorf, 40225 Düsseldorf, Germany
| | - Martin U. Schuhmann
- Department of Neurosurgery, Section of Pediatric Neurosurgery, University Hospital Tübingen, and German Cancer Consortium (DKTK) partner site Tübingen, 72076 Tübingen, Germany
| | - Tarek Shalaby
- Neuro-Oncology Program, Division of Oncology, University Children's Hospital Zurich, 8032 Zürich, Switzerland
| | - Michael Grotzer
- Neuro-Oncology Program, Division of Oncology, University Children's Hospital Zurich, 8032 Zürich, Switzerland
| | | | - Camelia-Maria Monoranu
- Department of Neuropathology, Institute of Pathology, University of Würzburg, and Comprehensive Cancer Center (CCC) Mainfranken, University and University Hospital, 97080 Würzburg, Germany
| | - Jörg Felsberg
- Department of Neuropathology, Heinrich-Heine-University, and German Cancer Consortium (DKTK) partner site Essen/Düsseldorf, 40225 Düsseldorf, Germany
| | - Guido Reifenberger
- Department of Neuropathology, Heinrich-Heine-University, and German Cancer Consortium (DKTK) partner site Essen/Düsseldorf, 40225 Düsseldorf, Germany
| | - Matija Snuderl
- Department of Pathology, Division of Neuropathology, NYU Langone Medical Center, New York, NY 10016, USA
| | | | - Jan Koster
- Department of Oncogenomics, AMC, University of Amsterdam, Amsterdam, 1105 AZ, The Netherlands
| | - Rogier Versteeg
- Department of Oncogenomics, AMC, University of Amsterdam, Amsterdam, 1105 AZ, The Netherlands
| | - Richard Volckmann
- Department of Oncogenomics, AMC, University of Amsterdam, Amsterdam, 1105 AZ, The Netherlands
| | - Peter van Sluis
- Department of Oncogenomics, AMC, University of Amsterdam, Amsterdam, 1105 AZ, The Netherlands
| | - Stephan Wolf
- Genomics and Proteomics Core Facility, High Throughput Sequencing Unit, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Tom Mikkelsen
- Departments of Neurology and Neurosurgery, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Amar Gajjar
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Kenneth Aldape
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Andrew S. Moore
- The University of Queensland Diamantina Institute, Translational Research Institute; UQ Child Health Research Centre, The University of Queensland; Queensland Children's Medical Research Institute, Children's Health Queensland Hospital and Health Service; Brisbane, Australia
| | - Michael D. Taylor
- Program in Developmental and Stem Cell Biology, Division of Neurosurgery, Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, University of Toronto, Toronto, ON M4N 1X8, Canada
| | - Chris Jones
- Division of Molecular Pathology, The Institute of Cancer Research, SW7 3RP, London, United Kingdom
| | - Nada Jabado
- McGill University and Genome Quebec Innovation Centre, Montreal, QC H3A 1A4, Canada
| | - Matthias A. Karajannis
- Departments of Pediatrics and Otolaryngology, Division of Pediatric Hematology/Oncology, NYU Langone Medical Center and Laura and Isaac Perlmutter Cancer Center, NY 10016, New York, USA
| | - Roland Eils
- Division of Theoretical Bioinformatics, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
- Department for Bioinformatics and Functional Genomics, Institute for Pharmacy and Molecular Biotechnology (IPMB) and BioQuant, Heidelberg University, Heidelberg, Germany
- Heidelberg Center for Personalized Oncology, DKFZ-HIPO, DKFZ, Im Neuenheimer Feld 580, 69120 Heidelberg, Germany
| | - Matthias Schlesner
- Division of Theoretical Bioinformatics, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Peter Lichter
- Division of Molecular Genetics, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
- Heidelberg Center for Personalized Oncology, DKFZ-HIPO, DKFZ, Im Neuenheimer Feld 580, 69120 Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), 69120 Heidelberg
| | - Stefan M. Pfister
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
- Department of Pediatric Oncology, Hematology & Immunology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - David W. Ellison
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105-3678, USA
| | - Andrey Korshunov
- Department of Neuropathology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), 69120 Heidelberg
| | - Marcel Kool
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
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758
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Yu FX, Zhao B, Guan KL. Hippo Pathway in Organ Size Control, Tissue Homeostasis, and Cancer. Cell 2016; 163:811-28. [PMID: 26544935 DOI: 10.1016/j.cell.2015.10.044] [Citation(s) in RCA: 1552] [Impact Index Per Article: 194.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Indexed: 12/16/2022]
Abstract
Two decades of studies in multiple model organisms have established the Hippo pathway as a key regulator of organ size and tissue homeostasis. By inhibiting YAP and TAZ transcription co-activators, the Hippo pathway regulates cell proliferation, apoptosis, and stemness in response to a wide range of extracellular and intracellular signals, including cell-cell contact, cell polarity, mechanical cues, ligands of G-protein-coupled receptors, and cellular energy status. Dysregulation of the Hippo pathway exerts a significant impact on cancer development. Further investigation of the functions and regulatory mechanisms of this pathway will help uncovering the mystery of organ size control and identify new targets for cancer treatment.
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Affiliation(s)
- Fa-Xing Yu
- Children's Hospital and Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China.
| | - Bin Zhao
- Life Sciences Institute and Innovation Center for Cell Signaling Network, Zhejiang University, Hangzhou, Zhejiang 310058, China
| | - Kun-Liang Guan
- Department of Pharmacology and Moores Cancer Center, University of California, San Diego, La Jolla, CA 92093, USA.
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759
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Epidermal growth factor receptor overexpression is common and not correlated to gene copy number in ependymoma. Childs Nerv Syst 2016; 32:281-90. [PMID: 26686534 DOI: 10.1007/s00381-015-2981-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 12/04/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to investigate the epidermal growth factor receptor (EGFR) status in ependymoma specimens, as there is a need for new prognostic and druggable targets in this disease. METHODS Ependymomas (WHO grade II, n = 40; WHO grade III, n = 15) located spinal (n = 35), infratentorial (n = 14), and supratentorial (n = 6) of 53 patients with a median age of 40 (range, 2-79) years were analyzed for Ki-67, p53, and EGFR expression by immunohistochemistry using a tissue microarray and for EGFR gene copy number alterations/mutations. Results were correlated to clinical data. RESULTS EGFR overexpression was found in 30/60% of ependymomas depending on the antibody used and was more pronounced in WHO grade III. High EGFR gene copy number gains were found in 6 (11%) ependymomas with half of them being amplifications. EGFR amplified ependymomas displayed an EGFR overexpression with both antibodies in two of three cases. A missense mutation in exon 20 of EGFR (S768I) was detected in one amplified case. CONCLUSIONS EGFR is frequently overexpressed in ependymomas. Other mechanisms than amplification of the EGFR gene appear to contribute to EGFR overexpression in most cases. EGFR mutations may be present in a small subset of ependymomas.
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760
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Abstract
PURPOSE OF REVIEW Central nervous system tumors represent the most common solid tumors in children and are a leading cause of cancer-related fatalities in this age group. Here, we provide an update on insights gained through molecular profiling of the most common malignant childhood brain tumors. RECENT FINDINGS Genomic profiling studies of medulloblastoma, ependymoma, and diffuse intrinsic pontine glioma (diffuse midline glioma, with H3-K27M mutation), have refined, if not redefined, the diagnostic classification and therapeutic stratification of patients with these tumors. They detail the substantial genetic heterogeneity across each disease type and, importantly, link genotypic information to clinical course. The most aggressive, treatment-resistant (and also treatment-sensitive) forms within each disease entity are identified, and their potentially actionable targets. SUMMARY Molecularly based classification of pediatric brain tumors provides a critical framework for the more precise stratification and treatment of children with brain tumors.
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761
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Gliomatosis cerebri: no evidence for a separate brain tumor entity. Acta Neuropathol 2016; 131:309-319. [PMID: 26493382 DOI: 10.1007/s00401-015-1495-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 10/11/2015] [Accepted: 10/11/2015] [Indexed: 01/01/2023]
Abstract
Gliomatosis cerebri (GC) is presently considered a distinct astrocytic glioma entity according to the WHO classification for CNS tumors. It is characterized by widespread, typically bilateral infiltration of the brain involving three or more lobes. Genetic studies of GC have to date been restricted to the analysis of individual glioma-associated genes, which revealed mutations in the isocitrate dehydrogenase 1 (IDH1) and tumor protein p53 (TP53) genes in subsets of patients. Here, we report on a genome-wide analysis of DNA methylation and copy number aberrations in 25 GC patients. Results were compared with those obtained for 105 patients with various types of conventional, i.e., non-GC gliomas including diffuse astrocytic gliomas, oligodendrogliomas and glioblastomas. In addition, we assessed the prognostic role of methylation profiles and recurrent DNA copy number aberrations in GC patients. Our data reveal that the methylation profiles in 23 of the 25 GC tumors corresponded to either IDH mutant astrocytoma (n = 6), IDH mutant and 1p/19q codeleted oligodendroglioma (n = 5), or IDH wild-type glioblastoma including various molecular subgroups, i.e., H3F3A-G34 mutant (n = 1), receptor tyrosine kinase 1 (RTK1, n = 4), receptor tyrosine kinase 2 (classic) (RTK2, n = 2) or mesenchymal (n = 5) glioblastoma groups. Two tumors showed methylation profiles of normal brain tissue due to low tumor cell content. While histological grading (WHO grade IV vs. WHO grade II and III) was not prognostic, the molecular classification as classic/RTK2 or mesenchymal glioblastoma was associated with worse overall survival. Multivariate Cox regression analysis revealed MGMT promoter methylation as a positive prognostic factor. Taken together, DNA-based large-scale molecular profiling indicates that GC comprises a genetically and epigenetically heterogeneous group of diffuse gliomas that carry DNA methylation and copy number profiles closely matching the common molecularly defined glioma entities. These data support the removal of GC as a distinct glioma entity in the upcoming revision of the WHO classification.
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762
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Thomas C, Sill M, Ruland V, Witten A, Hartung S, Kordes U, Jeibmann A, Beschorner R, Keyvani K, Bergmann M, Mittelbronn M, Pietsch T, Felsberg J, Monoranu CM, Varlet P, Hauser P, Olar A, Grundy RG, Wolff JE, Korshunov A, Jones DT, Bewerunge-Hudler M, Hovestadt V, von Deimling A, Pfister SM, Paulus W, Capper D, Hasselblatt M. Methylation profiling of choroid plexus tumors reveals 3 clinically distinct subgroups. Neuro Oncol 2016; 18:790-6. [PMID: 26826203 DOI: 10.1093/neuonc/nov322] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 12/15/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Choroid plexus tumors are intraventricular neoplasms derived from the choroid plexus epithelium. A better knowledge of molecular factors involved in choroid plexus tumor biology may aid in identifying patients at risk for recurrence. METHODS Methylation profiles were examined in 29 choroid plexus papillomas (CPPs, WHO grade I), 32 atypical choroid plexus papillomas (aCPPs, WHO grade II), and 31 choroid plexus carcinomas (CPCs, WHO grade III) by Illumina Infinium HumanMethylation450 Bead Chip Array. RESULTS Unsupervised hierarchical clustering identified 3 subgroups: methylation cluster 1 (pediatric CPP and aCPP of mainly supratentorial location), methylation cluster 2 (adult CPP and aCPP of mainly infratentorial location), and methylation cluster 3 (pediatric CPP, aCPP, and CPC of supratentorial location). In methylation cluster 3, progression-free survival (PFS) accounted for a mean of 72 months (CI, 55-89 mo), whereas only 1 of 42 tumors of methylation clusters 1 and 2 progressed (P< .001). On stratification of outcome data according to WHO grade, all CPCs clustered within cluster 3 and were associated with shorter overall survival (mean, 105 mo [CI, 81-128 mo]) and PFS (mean, 55 mo [CI, 36-73 mo]). The aCPP of methylation cluster 3 also progressed frequently (mean, 69 mo [CI, 44-93 mo]), whereas no tumor progression was observed in aCPP of methylation clusters 1 and 2 (P< .05). Only 1 of 29 CPPs recurred. CONCLUSIONS Methylation profiling of choroid plexus tumors reveals 3 distinct subgroups (ie, pediatric low-risk choroid plexus tumors [cluster 1], adult low-risk choroid plexus tumors [cluster 2], and pediatric high-risk choroid plexus tumors [cluster 3]) and may provide useful prognostic information in addition to histopathology.
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Affiliation(s)
- Christian Thomas
- Institute of Neuropathology, University Hospital Münster, Münster, Germany (C.T., V.R., A.J., W.P., M.H.); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany (M.S.); Core Facility Genomics of the Medical Faculty Münster, Münster, Germany (A.W.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (S.H., U.K.); Department of Neuropathology, Institute for Pathology and Neuropathology, University of Tübingen, Tübingen, Germany (R.B.); Faculty of Medicine, Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany (K.K.); Department of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany (M.B.); Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany (M.M.); Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany (T.P.); Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (J.F.); Department of Neuropathology, Institute of Pathology, University of Würzburg, and Comprehensive Cancer Center Mainfranken (CCCM), Würzburg, Germany (C.M.M.); Department of Neuropathology, Sainte-Anne Hospital, Paris, France (P.V.); 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary (P.H.); Department of Hematopathology, Molecular Diagnostic Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O.); Children's Brain Tumour Research Centre, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK (R.G.G.); Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio (J.E.W.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (A.K., A.v.D., D.C.); Clinical Cooperation Unit Neuropathology, German Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), German Cancer Research Ce
| | - Martin Sill
- Institute of Neuropathology, University Hospital Münster, Münster, Germany (C.T., V.R., A.J., W.P., M.H.); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany (M.S.); Core Facility Genomics of the Medical Faculty Münster, Münster, Germany (A.W.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (S.H., U.K.); Department of Neuropathology, Institute for Pathology and Neuropathology, University of Tübingen, Tübingen, Germany (R.B.); Faculty of Medicine, Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany (K.K.); Department of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany (M.B.); Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany (M.M.); Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany (T.P.); Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (J.F.); Department of Neuropathology, Institute of Pathology, University of Würzburg, and Comprehensive Cancer Center Mainfranken (CCCM), Würzburg, Germany (C.M.M.); Department of Neuropathology, Sainte-Anne Hospital, Paris, France (P.V.); 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary (P.H.); Department of Hematopathology, Molecular Diagnostic Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O.); Children's Brain Tumour Research Centre, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK (R.G.G.); Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio (J.E.W.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (A.K., A.v.D., D.C.); Clinical Cooperation Unit Neuropathology, German Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), German Cancer Research Ce
| | - Vincent Ruland
- Institute of Neuropathology, University Hospital Münster, Münster, Germany (C.T., V.R., A.J., W.P., M.H.); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany (M.S.); Core Facility Genomics of the Medical Faculty Münster, Münster, Germany (A.W.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (S.H., U.K.); Department of Neuropathology, Institute for Pathology and Neuropathology, University of Tübingen, Tübingen, Germany (R.B.); Faculty of Medicine, Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany (K.K.); Department of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany (M.B.); Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany (M.M.); Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany (T.P.); Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (J.F.); Department of Neuropathology, Institute of Pathology, University of Würzburg, and Comprehensive Cancer Center Mainfranken (CCCM), Würzburg, Germany (C.M.M.); Department of Neuropathology, Sainte-Anne Hospital, Paris, France (P.V.); 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary (P.H.); Department of Hematopathology, Molecular Diagnostic Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O.); Children's Brain Tumour Research Centre, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK (R.G.G.); Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio (J.E.W.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (A.K., A.v.D., D.C.); Clinical Cooperation Unit Neuropathology, German Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), German Cancer Research Ce
| | - Anika Witten
- Institute of Neuropathology, University Hospital Münster, Münster, Germany (C.T., V.R., A.J., W.P., M.H.); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany (M.S.); Core Facility Genomics of the Medical Faculty Münster, Münster, Germany (A.W.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (S.H., U.K.); Department of Neuropathology, Institute for Pathology and Neuropathology, University of Tübingen, Tübingen, Germany (R.B.); Faculty of Medicine, Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany (K.K.); Department of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany (M.B.); Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany (M.M.); Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany (T.P.); Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (J.F.); Department of Neuropathology, Institute of Pathology, University of Würzburg, and Comprehensive Cancer Center Mainfranken (CCCM), Würzburg, Germany (C.M.M.); Department of Neuropathology, Sainte-Anne Hospital, Paris, France (P.V.); 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary (P.H.); Department of Hematopathology, Molecular Diagnostic Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O.); Children's Brain Tumour Research Centre, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK (R.G.G.); Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio (J.E.W.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (A.K., A.v.D., D.C.); Clinical Cooperation Unit Neuropathology, German Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), German Cancer Research Ce
| | - Stefan Hartung
- Institute of Neuropathology, University Hospital Münster, Münster, Germany (C.T., V.R., A.J., W.P., M.H.); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany (M.S.); Core Facility Genomics of the Medical Faculty Münster, Münster, Germany (A.W.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (S.H., U.K.); Department of Neuropathology, Institute for Pathology and Neuropathology, University of Tübingen, Tübingen, Germany (R.B.); Faculty of Medicine, Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany (K.K.); Department of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany (M.B.); Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany (M.M.); Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany (T.P.); Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (J.F.); Department of Neuropathology, Institute of Pathology, University of Würzburg, and Comprehensive Cancer Center Mainfranken (CCCM), Würzburg, Germany (C.M.M.); Department of Neuropathology, Sainte-Anne Hospital, Paris, France (P.V.); 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary (P.H.); Department of Hematopathology, Molecular Diagnostic Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O.); Children's Brain Tumour Research Centre, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK (R.G.G.); Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio (J.E.W.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (A.K., A.v.D., D.C.); Clinical Cooperation Unit Neuropathology, German Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), German Cancer Research Ce
| | - Uwe Kordes
- Institute of Neuropathology, University Hospital Münster, Münster, Germany (C.T., V.R., A.J., W.P., M.H.); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany (M.S.); Core Facility Genomics of the Medical Faculty Münster, Münster, Germany (A.W.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (S.H., U.K.); Department of Neuropathology, Institute for Pathology and Neuropathology, University of Tübingen, Tübingen, Germany (R.B.); Faculty of Medicine, Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany (K.K.); Department of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany (M.B.); Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany (M.M.); Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany (T.P.); Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (J.F.); Department of Neuropathology, Institute of Pathology, University of Würzburg, and Comprehensive Cancer Center Mainfranken (CCCM), Würzburg, Germany (C.M.M.); Department of Neuropathology, Sainte-Anne Hospital, Paris, France (P.V.); 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary (P.H.); Department of Hematopathology, Molecular Diagnostic Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O.); Children's Brain Tumour Research Centre, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK (R.G.G.); Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio (J.E.W.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (A.K., A.v.D., D.C.); Clinical Cooperation Unit Neuropathology, German Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), German Cancer Research Ce
| | - Astrid Jeibmann
- Institute of Neuropathology, University Hospital Münster, Münster, Germany (C.T., V.R., A.J., W.P., M.H.); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany (M.S.); Core Facility Genomics of the Medical Faculty Münster, Münster, Germany (A.W.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (S.H., U.K.); Department of Neuropathology, Institute for Pathology and Neuropathology, University of Tübingen, Tübingen, Germany (R.B.); Faculty of Medicine, Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany (K.K.); Department of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany (M.B.); Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany (M.M.); Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany (T.P.); Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (J.F.); Department of Neuropathology, Institute of Pathology, University of Würzburg, and Comprehensive Cancer Center Mainfranken (CCCM), Würzburg, Germany (C.M.M.); Department of Neuropathology, Sainte-Anne Hospital, Paris, France (P.V.); 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary (P.H.); Department of Hematopathology, Molecular Diagnostic Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O.); Children's Brain Tumour Research Centre, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK (R.G.G.); Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio (J.E.W.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (A.K., A.v.D., D.C.); Clinical Cooperation Unit Neuropathology, German Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), German Cancer Research Ce
| | - Rudi Beschorner
- Institute of Neuropathology, University Hospital Münster, Münster, Germany (C.T., V.R., A.J., W.P., M.H.); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany (M.S.); Core Facility Genomics of the Medical Faculty Münster, Münster, Germany (A.W.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (S.H., U.K.); Department of Neuropathology, Institute for Pathology and Neuropathology, University of Tübingen, Tübingen, Germany (R.B.); Faculty of Medicine, Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany (K.K.); Department of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany (M.B.); Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany (M.M.); Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany (T.P.); Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (J.F.); Department of Neuropathology, Institute of Pathology, University of Würzburg, and Comprehensive Cancer Center Mainfranken (CCCM), Würzburg, Germany (C.M.M.); Department of Neuropathology, Sainte-Anne Hospital, Paris, France (P.V.); 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary (P.H.); Department of Hematopathology, Molecular Diagnostic Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O.); Children's Brain Tumour Research Centre, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK (R.G.G.); Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio (J.E.W.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (A.K., A.v.D., D.C.); Clinical Cooperation Unit Neuropathology, German Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), German Cancer Research Ce
| | - Kathy Keyvani
- Institute of Neuropathology, University Hospital Münster, Münster, Germany (C.T., V.R., A.J., W.P., M.H.); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany (M.S.); Core Facility Genomics of the Medical Faculty Münster, Münster, Germany (A.W.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (S.H., U.K.); Department of Neuropathology, Institute for Pathology and Neuropathology, University of Tübingen, Tübingen, Germany (R.B.); Faculty of Medicine, Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany (K.K.); Department of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany (M.B.); Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany (M.M.); Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany (T.P.); Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (J.F.); Department of Neuropathology, Institute of Pathology, University of Würzburg, and Comprehensive Cancer Center Mainfranken (CCCM), Würzburg, Germany (C.M.M.); Department of Neuropathology, Sainte-Anne Hospital, Paris, France (P.V.); 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary (P.H.); Department of Hematopathology, Molecular Diagnostic Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O.); Children's Brain Tumour Research Centre, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK (R.G.G.); Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio (J.E.W.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (A.K., A.v.D., D.C.); Clinical Cooperation Unit Neuropathology, German Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), German Cancer Research Ce
| | - Markus Bergmann
- Institute of Neuropathology, University Hospital Münster, Münster, Germany (C.T., V.R., A.J., W.P., M.H.); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany (M.S.); Core Facility Genomics of the Medical Faculty Münster, Münster, Germany (A.W.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (S.H., U.K.); Department of Neuropathology, Institute for Pathology and Neuropathology, University of Tübingen, Tübingen, Germany (R.B.); Faculty of Medicine, Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany (K.K.); Department of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany (M.B.); Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany (M.M.); Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany (T.P.); Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (J.F.); Department of Neuropathology, Institute of Pathology, University of Würzburg, and Comprehensive Cancer Center Mainfranken (CCCM), Würzburg, Germany (C.M.M.); Department of Neuropathology, Sainte-Anne Hospital, Paris, France (P.V.); 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary (P.H.); Department of Hematopathology, Molecular Diagnostic Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O.); Children's Brain Tumour Research Centre, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK (R.G.G.); Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio (J.E.W.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (A.K., A.v.D., D.C.); Clinical Cooperation Unit Neuropathology, German Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), German Cancer Research Ce
| | - Michel Mittelbronn
- Institute of Neuropathology, University Hospital Münster, Münster, Germany (C.T., V.R., A.J., W.P., M.H.); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany (M.S.); Core Facility Genomics of the Medical Faculty Münster, Münster, Germany (A.W.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (S.H., U.K.); Department of Neuropathology, Institute for Pathology and Neuropathology, University of Tübingen, Tübingen, Germany (R.B.); Faculty of Medicine, Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany (K.K.); Department of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany (M.B.); Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany (M.M.); Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany (T.P.); Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (J.F.); Department of Neuropathology, Institute of Pathology, University of Würzburg, and Comprehensive Cancer Center Mainfranken (CCCM), Würzburg, Germany (C.M.M.); Department of Neuropathology, Sainte-Anne Hospital, Paris, France (P.V.); 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary (P.H.); Department of Hematopathology, Molecular Diagnostic Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O.); Children's Brain Tumour Research Centre, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK (R.G.G.); Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio (J.E.W.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (A.K., A.v.D., D.C.); Clinical Cooperation Unit Neuropathology, German Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), German Cancer Research Ce
| | - Torsten Pietsch
- Institute of Neuropathology, University Hospital Münster, Münster, Germany (C.T., V.R., A.J., W.P., M.H.); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany (M.S.); Core Facility Genomics of the Medical Faculty Münster, Münster, Germany (A.W.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (S.H., U.K.); Department of Neuropathology, Institute for Pathology and Neuropathology, University of Tübingen, Tübingen, Germany (R.B.); Faculty of Medicine, Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany (K.K.); Department of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany (M.B.); Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany (M.M.); Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany (T.P.); Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (J.F.); Department of Neuropathology, Institute of Pathology, University of Würzburg, and Comprehensive Cancer Center Mainfranken (CCCM), Würzburg, Germany (C.M.M.); Department of Neuropathology, Sainte-Anne Hospital, Paris, France (P.V.); 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary (P.H.); Department of Hematopathology, Molecular Diagnostic Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O.); Children's Brain Tumour Research Centre, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK (R.G.G.); Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio (J.E.W.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (A.K., A.v.D., D.C.); Clinical Cooperation Unit Neuropathology, German Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), German Cancer Research Ce
| | - Jörg Felsberg
- Institute of Neuropathology, University Hospital Münster, Münster, Germany (C.T., V.R., A.J., W.P., M.H.); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany (M.S.); Core Facility Genomics of the Medical Faculty Münster, Münster, Germany (A.W.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (S.H., U.K.); Department of Neuropathology, Institute for Pathology and Neuropathology, University of Tübingen, Tübingen, Germany (R.B.); Faculty of Medicine, Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany (K.K.); Department of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany (M.B.); Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany (M.M.); Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany (T.P.); Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (J.F.); Department of Neuropathology, Institute of Pathology, University of Würzburg, and Comprehensive Cancer Center Mainfranken (CCCM), Würzburg, Germany (C.M.M.); Department of Neuropathology, Sainte-Anne Hospital, Paris, France (P.V.); 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary (P.H.); Department of Hematopathology, Molecular Diagnostic Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O.); Children's Brain Tumour Research Centre, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK (R.G.G.); Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio (J.E.W.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (A.K., A.v.D., D.C.); Clinical Cooperation Unit Neuropathology, German Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), German Cancer Research Ce
| | - Camelia M Monoranu
- Institute of Neuropathology, University Hospital Münster, Münster, Germany (C.T., V.R., A.J., W.P., M.H.); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany (M.S.); Core Facility Genomics of the Medical Faculty Münster, Münster, Germany (A.W.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (S.H., U.K.); Department of Neuropathology, Institute for Pathology and Neuropathology, University of Tübingen, Tübingen, Germany (R.B.); Faculty of Medicine, Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany (K.K.); Department of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany (M.B.); Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany (M.M.); Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany (T.P.); Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (J.F.); Department of Neuropathology, Institute of Pathology, University of Würzburg, and Comprehensive Cancer Center Mainfranken (CCCM), Würzburg, Germany (C.M.M.); Department of Neuropathology, Sainte-Anne Hospital, Paris, France (P.V.); 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary (P.H.); Department of Hematopathology, Molecular Diagnostic Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O.); Children's Brain Tumour Research Centre, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK (R.G.G.); Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio (J.E.W.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (A.K., A.v.D., D.C.); Clinical Cooperation Unit Neuropathology, German Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), German Cancer Research Ce
| | - Pascale Varlet
- Institute of Neuropathology, University Hospital Münster, Münster, Germany (C.T., V.R., A.J., W.P., M.H.); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany (M.S.); Core Facility Genomics of the Medical Faculty Münster, Münster, Germany (A.W.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (S.H., U.K.); Department of Neuropathology, Institute for Pathology and Neuropathology, University of Tübingen, Tübingen, Germany (R.B.); Faculty of Medicine, Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany (K.K.); Department of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany (M.B.); Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany (M.M.); Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany (T.P.); Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (J.F.); Department of Neuropathology, Institute of Pathology, University of Würzburg, and Comprehensive Cancer Center Mainfranken (CCCM), Würzburg, Germany (C.M.M.); Department of Neuropathology, Sainte-Anne Hospital, Paris, France (P.V.); 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary (P.H.); Department of Hematopathology, Molecular Diagnostic Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O.); Children's Brain Tumour Research Centre, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK (R.G.G.); Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio (J.E.W.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (A.K., A.v.D., D.C.); Clinical Cooperation Unit Neuropathology, German Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), German Cancer Research Ce
| | - Peter Hauser
- Institute of Neuropathology, University Hospital Münster, Münster, Germany (C.T., V.R., A.J., W.P., M.H.); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany (M.S.); Core Facility Genomics of the Medical Faculty Münster, Münster, Germany (A.W.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (S.H., U.K.); Department of Neuropathology, Institute for Pathology and Neuropathology, University of Tübingen, Tübingen, Germany (R.B.); Faculty of Medicine, Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany (K.K.); Department of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany (M.B.); Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany (M.M.); Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany (T.P.); Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (J.F.); Department of Neuropathology, Institute of Pathology, University of Würzburg, and Comprehensive Cancer Center Mainfranken (CCCM), Würzburg, Germany (C.M.M.); Department of Neuropathology, Sainte-Anne Hospital, Paris, France (P.V.); 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary (P.H.); Department of Hematopathology, Molecular Diagnostic Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O.); Children's Brain Tumour Research Centre, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK (R.G.G.); Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio (J.E.W.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (A.K., A.v.D., D.C.); Clinical Cooperation Unit Neuropathology, German Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), German Cancer Research Ce
| | - Adriana Olar
- Institute of Neuropathology, University Hospital Münster, Münster, Germany (C.T., V.R., A.J., W.P., M.H.); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany (M.S.); Core Facility Genomics of the Medical Faculty Münster, Münster, Germany (A.W.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (S.H., U.K.); Department of Neuropathology, Institute for Pathology and Neuropathology, University of Tübingen, Tübingen, Germany (R.B.); Faculty of Medicine, Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany (K.K.); Department of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany (M.B.); Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany (M.M.); Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany (T.P.); Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (J.F.); Department of Neuropathology, Institute of Pathology, University of Würzburg, and Comprehensive Cancer Center Mainfranken (CCCM), Würzburg, Germany (C.M.M.); Department of Neuropathology, Sainte-Anne Hospital, Paris, France (P.V.); 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary (P.H.); Department of Hematopathology, Molecular Diagnostic Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O.); Children's Brain Tumour Research Centre, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK (R.G.G.); Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio (J.E.W.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (A.K., A.v.D., D.C.); Clinical Cooperation Unit Neuropathology, German Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), German Cancer Research Ce
| | - Richard G Grundy
- Institute of Neuropathology, University Hospital Münster, Münster, Germany (C.T., V.R., A.J., W.P., M.H.); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany (M.S.); Core Facility Genomics of the Medical Faculty Münster, Münster, Germany (A.W.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (S.H., U.K.); Department of Neuropathology, Institute for Pathology and Neuropathology, University of Tübingen, Tübingen, Germany (R.B.); Faculty of Medicine, Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany (K.K.); Department of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany (M.B.); Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany (M.M.); Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany (T.P.); Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (J.F.); Department of Neuropathology, Institute of Pathology, University of Würzburg, and Comprehensive Cancer Center Mainfranken (CCCM), Würzburg, Germany (C.M.M.); Department of Neuropathology, Sainte-Anne Hospital, Paris, France (P.V.); 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary (P.H.); Department of Hematopathology, Molecular Diagnostic Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O.); Children's Brain Tumour Research Centre, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK (R.G.G.); Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio (J.E.W.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (A.K., A.v.D., D.C.); Clinical Cooperation Unit Neuropathology, German Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), German Cancer Research Ce
| | - Johannes E Wolff
- Institute of Neuropathology, University Hospital Münster, Münster, Germany (C.T., V.R., A.J., W.P., M.H.); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany (M.S.); Core Facility Genomics of the Medical Faculty Münster, Münster, Germany (A.W.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (S.H., U.K.); Department of Neuropathology, Institute for Pathology and Neuropathology, University of Tübingen, Tübingen, Germany (R.B.); Faculty of Medicine, Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany (K.K.); Department of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany (M.B.); Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany (M.M.); Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany (T.P.); Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (J.F.); Department of Neuropathology, Institute of Pathology, University of Würzburg, and Comprehensive Cancer Center Mainfranken (CCCM), Würzburg, Germany (C.M.M.); Department of Neuropathology, Sainte-Anne Hospital, Paris, France (P.V.); 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary (P.H.); Department of Hematopathology, Molecular Diagnostic Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O.); Children's Brain Tumour Research Centre, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK (R.G.G.); Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio (J.E.W.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (A.K., A.v.D., D.C.); Clinical Cooperation Unit Neuropathology, German Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), German Cancer Research Ce
| | - Andrey Korshunov
- Institute of Neuropathology, University Hospital Münster, Münster, Germany (C.T., V.R., A.J., W.P., M.H.); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany (M.S.); Core Facility Genomics of the Medical Faculty Münster, Münster, Germany (A.W.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (S.H., U.K.); Department of Neuropathology, Institute for Pathology and Neuropathology, University of Tübingen, Tübingen, Germany (R.B.); Faculty of Medicine, Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany (K.K.); Department of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany (M.B.); Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany (M.M.); Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany (T.P.); Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (J.F.); Department of Neuropathology, Institute of Pathology, University of Würzburg, and Comprehensive Cancer Center Mainfranken (CCCM), Würzburg, Germany (C.M.M.); Department of Neuropathology, Sainte-Anne Hospital, Paris, France (P.V.); 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary (P.H.); Department of Hematopathology, Molecular Diagnostic Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O.); Children's Brain Tumour Research Centre, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK (R.G.G.); Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio (J.E.W.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (A.K., A.v.D., D.C.); Clinical Cooperation Unit Neuropathology, German Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), German Cancer Research Ce
| | - David T Jones
- Institute of Neuropathology, University Hospital Münster, Münster, Germany (C.T., V.R., A.J., W.P., M.H.); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany (M.S.); Core Facility Genomics of the Medical Faculty Münster, Münster, Germany (A.W.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (S.H., U.K.); Department of Neuropathology, Institute for Pathology and Neuropathology, University of Tübingen, Tübingen, Germany (R.B.); Faculty of Medicine, Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany (K.K.); Department of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany (M.B.); Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany (M.M.); Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany (T.P.); Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (J.F.); Department of Neuropathology, Institute of Pathology, University of Würzburg, and Comprehensive Cancer Center Mainfranken (CCCM), Würzburg, Germany (C.M.M.); Department of Neuropathology, Sainte-Anne Hospital, Paris, France (P.V.); 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary (P.H.); Department of Hematopathology, Molecular Diagnostic Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O.); Children's Brain Tumour Research Centre, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK (R.G.G.); Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio (J.E.W.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (A.K., A.v.D., D.C.); Clinical Cooperation Unit Neuropathology, German Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), German Cancer Research Ce
| | - Melanie Bewerunge-Hudler
- Institute of Neuropathology, University Hospital Münster, Münster, Germany (C.T., V.R., A.J., W.P., M.H.); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany (M.S.); Core Facility Genomics of the Medical Faculty Münster, Münster, Germany (A.W.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (S.H., U.K.); Department of Neuropathology, Institute for Pathology and Neuropathology, University of Tübingen, Tübingen, Germany (R.B.); Faculty of Medicine, Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany (K.K.); Department of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany (M.B.); Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany (M.M.); Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany (T.P.); Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (J.F.); Department of Neuropathology, Institute of Pathology, University of Würzburg, and Comprehensive Cancer Center Mainfranken (CCCM), Würzburg, Germany (C.M.M.); Department of Neuropathology, Sainte-Anne Hospital, Paris, France (P.V.); 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary (P.H.); Department of Hematopathology, Molecular Diagnostic Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O.); Children's Brain Tumour Research Centre, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK (R.G.G.); Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio (J.E.W.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (A.K., A.v.D., D.C.); Clinical Cooperation Unit Neuropathology, German Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), German Cancer Research Ce
| | - Volker Hovestadt
- Institute of Neuropathology, University Hospital Münster, Münster, Germany (C.T., V.R., A.J., W.P., M.H.); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany (M.S.); Core Facility Genomics of the Medical Faculty Münster, Münster, Germany (A.W.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (S.H., U.K.); Department of Neuropathology, Institute for Pathology and Neuropathology, University of Tübingen, Tübingen, Germany (R.B.); Faculty of Medicine, Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany (K.K.); Department of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany (M.B.); Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany (M.M.); Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany (T.P.); Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (J.F.); Department of Neuropathology, Institute of Pathology, University of Würzburg, and Comprehensive Cancer Center Mainfranken (CCCM), Würzburg, Germany (C.M.M.); Department of Neuropathology, Sainte-Anne Hospital, Paris, France (P.V.); 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary (P.H.); Department of Hematopathology, Molecular Diagnostic Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O.); Children's Brain Tumour Research Centre, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK (R.G.G.); Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio (J.E.W.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (A.K., A.v.D., D.C.); Clinical Cooperation Unit Neuropathology, German Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), German Cancer Research Ce
| | - Andreas von Deimling
- Institute of Neuropathology, University Hospital Münster, Münster, Germany (C.T., V.R., A.J., W.P., M.H.); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany (M.S.); Core Facility Genomics of the Medical Faculty Münster, Münster, Germany (A.W.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (S.H., U.K.); Department of Neuropathology, Institute for Pathology and Neuropathology, University of Tübingen, Tübingen, Germany (R.B.); Faculty of Medicine, Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany (K.K.); Department of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany (M.B.); Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany (M.M.); Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany (T.P.); Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (J.F.); Department of Neuropathology, Institute of Pathology, University of Würzburg, and Comprehensive Cancer Center Mainfranken (CCCM), Würzburg, Germany (C.M.M.); Department of Neuropathology, Sainte-Anne Hospital, Paris, France (P.V.); 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary (P.H.); Department of Hematopathology, Molecular Diagnostic Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O.); Children's Brain Tumour Research Centre, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK (R.G.G.); Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio (J.E.W.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (A.K., A.v.D., D.C.); Clinical Cooperation Unit Neuropathology, German Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), German Cancer Research Ce
| | - Stefan M Pfister
- Institute of Neuropathology, University Hospital Münster, Münster, Germany (C.T., V.R., A.J., W.P., M.H.); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany (M.S.); Core Facility Genomics of the Medical Faculty Münster, Münster, Germany (A.W.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (S.H., U.K.); Department of Neuropathology, Institute for Pathology and Neuropathology, University of Tübingen, Tübingen, Germany (R.B.); Faculty of Medicine, Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany (K.K.); Department of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany (M.B.); Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany (M.M.); Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany (T.P.); Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (J.F.); Department of Neuropathology, Institute of Pathology, University of Würzburg, and Comprehensive Cancer Center Mainfranken (CCCM), Würzburg, Germany (C.M.M.); Department of Neuropathology, Sainte-Anne Hospital, Paris, France (P.V.); 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary (P.H.); Department of Hematopathology, Molecular Diagnostic Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O.); Children's Brain Tumour Research Centre, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK (R.G.G.); Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio (J.E.W.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (A.K., A.v.D., D.C.); Clinical Cooperation Unit Neuropathology, German Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), German Cancer Research Ce
| | - Werner Paulus
- Institute of Neuropathology, University Hospital Münster, Münster, Germany (C.T., V.R., A.J., W.P., M.H.); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany (M.S.); Core Facility Genomics of the Medical Faculty Münster, Münster, Germany (A.W.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (S.H., U.K.); Department of Neuropathology, Institute for Pathology and Neuropathology, University of Tübingen, Tübingen, Germany (R.B.); Faculty of Medicine, Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany (K.K.); Department of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany (M.B.); Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany (M.M.); Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany (T.P.); Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (J.F.); Department of Neuropathology, Institute of Pathology, University of Würzburg, and Comprehensive Cancer Center Mainfranken (CCCM), Würzburg, Germany (C.M.M.); Department of Neuropathology, Sainte-Anne Hospital, Paris, France (P.V.); 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary (P.H.); Department of Hematopathology, Molecular Diagnostic Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O.); Children's Brain Tumour Research Centre, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK (R.G.G.); Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio (J.E.W.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (A.K., A.v.D., D.C.); Clinical Cooperation Unit Neuropathology, German Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), German Cancer Research Ce
| | - David Capper
- Institute of Neuropathology, University Hospital Münster, Münster, Germany (C.T., V.R., A.J., W.P., M.H.); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany (M.S.); Core Facility Genomics of the Medical Faculty Münster, Münster, Germany (A.W.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (S.H., U.K.); Department of Neuropathology, Institute for Pathology and Neuropathology, University of Tübingen, Tübingen, Germany (R.B.); Faculty of Medicine, Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany (K.K.); Department of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany (M.B.); Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany (M.M.); Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany (T.P.); Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (J.F.); Department of Neuropathology, Institute of Pathology, University of Würzburg, and Comprehensive Cancer Center Mainfranken (CCCM), Würzburg, Germany (C.M.M.); Department of Neuropathology, Sainte-Anne Hospital, Paris, France (P.V.); 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary (P.H.); Department of Hematopathology, Molecular Diagnostic Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O.); Children's Brain Tumour Research Centre, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK (R.G.G.); Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio (J.E.W.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (A.K., A.v.D., D.C.); Clinical Cooperation Unit Neuropathology, German Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), German Cancer Research Ce
| | - Martin Hasselblatt
- Institute of Neuropathology, University Hospital Münster, Münster, Germany (C.T., V.R., A.J., W.P., M.H.); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany (M.S.); Core Facility Genomics of the Medical Faculty Münster, Münster, Germany (A.W.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (S.H., U.K.); Department of Neuropathology, Institute for Pathology and Neuropathology, University of Tübingen, Tübingen, Germany (R.B.); Faculty of Medicine, Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany (K.K.); Department of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany (M.B.); Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany (M.M.); Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany (T.P.); Department of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (J.F.); Department of Neuropathology, Institute of Pathology, University of Würzburg, and Comprehensive Cancer Center Mainfranken (CCCM), Würzburg, Germany (C.M.M.); Department of Neuropathology, Sainte-Anne Hospital, Paris, France (P.V.); 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary (P.H.); Department of Hematopathology, Molecular Diagnostic Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O.); Children's Brain Tumour Research Centre, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK (R.G.G.); Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio (J.E.W.); Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany (A.K., A.v.D., D.C.); Clinical Cooperation Unit Neuropathology, German Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), German Cancer Research Ce
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Treatment and survival of supratentorial and posterior fossa ependymomas in adults. J Clin Neurosci 2016; 28:24-30. [PMID: 26810473 DOI: 10.1016/j.jocn.2015.11.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 11/29/2015] [Indexed: 02/04/2023]
Abstract
Ependymoma is a rare primary brain or spinal cord tumor that arises from the ependyma, a tissue of the central nervous system. This study analyzed a large cohort of adult supratentorial and posterior fossa ependymoma tumors in order to elucidate factors associated with overall survival. We utilized the USA National Cancer Database to study adult World Health Organization grade II/III supratentorial and posterior fossa ependymoma patients treated between 1998 and 2011. Overall survival was estimated by the Kaplan-Meier method and factors associated with survival were determined using a multivariate Cox proportional hazards model. Among 1318 patients, 1055 (80.0%) had grade II and 263 (20.0%) anaplastic tumors located in the posterior fossa (64.3%) and supratentorial region (35.7%). Overall average age was 44.3years, 48.0% of patients were female, 86.5% were Caucasian, and 36.8% underwent near/gross total surgical resection. Radiotherapy was given to 662 patients (50.8%) and 75 (5.9%) received chemotherapy. Older age at diagnosis (hazard ratio [HR] 1.51, p<0.0001), high tumor grade (HR 1.82, p=0.005), and large tumor size (HR 1.66, p=0.008) were associated with poor survival. Females compared to males (HR 0.67, p=0.03) and patients with posterior fossa tumors versus supratentorial (HR 0.64, p=0.04) had a survival advantage. Our study showed that older patients, with supratentorial tumors, and high histological grade had an increased risk of mortality. A survival benefit was captured in females and patients with posterior fossa tumors. Adjuvant radiotherapy and chemotherapy did not confer a survival benefit among all patients, even after stratification by tumor grade or anatomical location.
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764
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Masui K, Mischel PS, Reifenberger G. Molecular classification of gliomas. HANDBOOK OF CLINICAL NEUROLOGY 2016; 134:97-120. [PMID: 26948350 DOI: 10.1016/b978-0-12-802997-8.00006-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The identification of distinct genetic and epigenetic profiles in different types of gliomas has revealed novel diagnostic, prognostic, and predictive molecular biomarkers for refinement of glioma classification and improved prediction of therapy response and outcome. Therefore, the new (2016) World Health Organization (WHO) classification of tumors of the central nervous system breaks with the traditional principle of diagnosis based on histologic criteria only and incorporates molecular markers. This will involve a multilayered approach combining histologic features and molecular information in an "integrated diagnosis". We review the current state of diagnostic molecular markers for gliomas, focusing on isocitrate dehydrogenase 1 or 2 (IDH1/IDH2) gene mutation, α-thalassemia/mental retardation syndrome X-linked (ATRX) gene mutation, 1p/19q co-deletion and telomerase reverse transcriptase (TERT) promoter mutation in adult tumors, as well as v-raf murine sarcoma viral oncogene homolog B1 (BRAF) and H3 histone family 3A (H3F3A) aberrations in pediatric gliomas. We also outline prognostic and predictive molecular markers, including O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation, and discuss the potential clinical relevance of biologic glioblastoma subtypes defined by integration of multiomics data. Commonly used methods for individual marker detection as well as novel large-scale DNA methylation profiling and next-generation sequencing approaches are discussed. Finally, we illustrate how advances in molecular diagnostics affect novel strategies of targeted therapy, thereby raising new challenges and identifying new leads for personalized treatment of glioma patients.
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Affiliation(s)
- Kenta Masui
- Department of Pathology, Tokyo Women's Medical University, Shinjku-ku, Tokyo, Japan; Ludwig Institute for Cancer Research, University of California San Diego, La Jolla, CA, USA
| | - Paul S Mischel
- Ludwig Institute for Cancer Research, University of California San Diego, La Jolla, CA, USA
| | - Guido Reifenberger
- Department of Neuropathology, Heinrich Heine University, Düsseldorf, Germany.
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765
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Aldape K, Pfister SM. Next-generation molecular diagnostics. HANDBOOK OF CLINICAL NEUROLOGY 2016; 134:121-130. [PMID: 26948351 DOI: 10.1016/b978-0-12-802997-8.00007-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The classification of brain tumors is based on the time-honored tradition of histologic examination, coupled with clinicopathologic correlation, and is based on the fundamental importance of microscopic morphologic interpretation. Supplementation by immunohistochemical markers is of substantial value to distinguish related entities and to confirm morphologic impressions. The use of techniques such as fluorescent in situ hybridization (FISH) is also critical in specific situations. However, with these practices, it is clear that the use of state-of-the-art molecular techniques has great promise to add to classification to (1) reduce the subjectivity inherent in interobserver discordance, particularly with specific entities; and (2) elucidate the biologic diversity of entities that are not resolvable by routine methods. In this chapter, we discuss these possibilities, focusing on several tumor types affecting the central nervous system, including diffuse glioma and ependymoma.
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Affiliation(s)
- Kenneth Aldape
- Department of Pathology, University Health Network and Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
| | - Stefan M Pfister
- Division of Pediatric Neurooncology, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany; Department of Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
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766
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Abstract
Next-generation sequencing (NGS) approaches are highly applicable to clinical studies. We review recent advances in sequencing technologies, as well as their benefits and tradeoffs, to provide an overview of clinical genomics from study design to computational analysis. Sequencing technologies enable genomic, transcriptomic, and epigenomic evaluations. Studies that use a combination of whole genome, exome, mRNA, and bisulfite sequencing are now feasible due to decreasing sequencing costs. Single-molecule sequencing increases read length, with the MinIONTM nanopore sequencer, which offers a uniquely portable option at a lower cost. Many of the published comparisons we review here address the challenges associated with different sequencing methods. Overall, NGS techniques, coupled with continually improving analysis algorithms, are useful for clinical studies in many realms, including cancer, chronic illness, and neurobiology. We, and others in the field, anticipate the clinical use of NGS approaches will continue to grow, especially as we shift into an era of precision medicine.
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Affiliation(s)
- Priyanka Vijay
- Department of Physiology and Biophysics, Weill Cornell Medical College, New York, New York. Tri-Institutional Training Program in Computational Biology and Medicine, Weill Cornell Medical College, New York, New York
| | - Alexa B.R. McIntyre
- Department of Physiology and Biophysics, Weill Cornell Medical College, New York, New York. Tri-Institutional Training Program in Computational Biology and Medicine, Weill Cornell Medical College, New York, New York
| | - Christopher E. Mason
- Department of Physiology and Biophysics, Weill Cornell Medical College, New York, New York. Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Weill Cornell Medical College, New York, New York. Feil Family Brain and Mind Research Institute, New York, New York
| | - Jeffrey P. Greenfield
- Department of Neurological Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Sheng Li
- Department of Neurological Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
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767
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The Challenge of Cancer Genomics in Rare Nervous System Neoplasms: Malignant Peripheral Nerve Sheath Tumors as a Paradigm for Cross-Species Comparative Oncogenomics. THE AMERICAN JOURNAL OF PATHOLOGY 2015; 186:464-77. [PMID: 26740486 DOI: 10.1016/j.ajpath.2015.10.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 10/20/2015] [Indexed: 12/12/2022]
Abstract
Comprehensive genomic analyses of common nervous system cancers provide new insights into their pathogenesis, diagnosis, and treatment. Although analogous studies of rare nervous system tumors are needed, there are major barriers to performing such studies. Cross-species comparative oncogenomics, identifying driver mutations in mouse cancer models and validating them in human tumors, is a promising alternative. Although still in its infancy, this approach is being applied to malignant peripheral nerve sheath tumors (MPNSTs), rare Schwann cell-derived malignancies that occur sporadically, after radiotherapy, and in neurofibromatosis type 1. Studies of human neurofibromatosis type 1-associated tumors suggest that NF1 tumor suppressor loss in Schwann cells triggers cell-autonomous and intercellular changes, resulting in development of benign neurofibromas; subsequent neurofibroma-MPNST progression is caused by aberrant growth factor signaling and mutations affecting the p16(INK4A)-cyclin D1-CDK4-Rb and p19(ARF)-Mdm2-p53 cell cycle pathways. Mice with Nf1, Trp53, and/or Cdkn2a mutations that overexpress the Schwann cell mitogen neuregulin-1 or overexpress the epidermal growth factor receptor validate observations in human tumors and, to various degrees, model human tumorigenesis. Genomic analyses of MPNSTs arising in neuregulin-1 and epidermal growth factor receptor-overexpressing mice and forward genetic screens with Sleeping Beauty transposons implicate additional signaling cascades in MPNST pathogenesis. These studies confirm the utility of mouse models for MPNST driver gene discovery and provide new insights into the complexity of MPNST pathogenesis.
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768
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Gupta K, Salunke P. Understanding Ependymoma Oncogenesis: an Update on Recent Molecular Advances and Current Perspectives. Mol Neurobiol 2015; 54:15-21. [PMID: 26712502 DOI: 10.1007/s12035-015-9646-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 12/16/2015] [Indexed: 01/12/2023]
Abstract
Remarkable progress has been made in the last decade in understanding the biology and oncogenesis of this relatively rare childhood brain tumor-the ependymoma. Surgery and irradiation are the mainstays of therapeutic options; chemotherapy is yet to predictably affect outcome, and its role is currently being explored in several clinical trials. While WHO scores this tumor into three grades, grading of ependymoma into grade II and grade III is controversial because of its elusive histological criteria where no cut-offs have been defined for mitoses or percentage of tumor depicting increased cellularity. Grading remains unreliable in predicting outcome in several instances. There is a compelling need to integrate the molecular biomarkers highlighted in several studies over the past decade into patient risk stratification to help in better predicting the clinical outcome and to design effective tailored therapy. Genomic and transcriptomic studies lately have defined distinct molecular subgroups within ependymoma arising at three anatomic compartments-supratentorial, posterior fossa, and spinal cord. Review of pertinent literature on several seminal studies that have established a paradigm shift in understanding the oncogenesis of ependymoma has been carried out. The outcome, impact, and clinical relevance of these studies are also discussed. The review provides an update on progress and recent advances in understanding the biology and oncogenesis of ependymoma. The establishment of robust subgroups which are demographically, clinically, and molecularly distinct will provide new avenues for further refinement of therapeutic strategies.
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Affiliation(s)
- Kirti Gupta
- Neuropathology fellowship (St Jude, Memphis), Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Pravin Salunke
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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769
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Connolly ID, Ali R, Li Y, Gephart MH. Genetic and molecular distinctions in spinal ependymomas: A review. Clin Neurol Neurosurg 2015; 139:210-5. [DOI: 10.1016/j.clineuro.2015.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 10/08/2015] [Accepted: 10/09/2015] [Indexed: 12/17/2022]
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770
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Choi SK, Lee SH, Kim B, Minn YK, Kim KN, Kim SH. Findings from frozen sections of spinal subependymomas: Is it possible to differentiate this diagnosis from other common spinal tumors? Brain Tumor Pathol 2015; 33:19-26. [DOI: 10.1007/s10014-015-0237-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 10/18/2015] [Indexed: 11/28/2022]
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771
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Gajjar A, Bowers DC, Karajannis MA, Leary S, Witt H, Gottardo NG. Pediatric Brain Tumors: Innovative Genomic Information Is Transforming the Diagnostic and Clinical Landscape. J Clin Oncol 2015; 33:2986-98. [PMID: 26304884 DOI: 10.1200/jco.2014.59.9217] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Pediatric neuro-oncology has undergone an exciting and dramatic transformation during the past 5 years. This article summarizes data from collaborative group and institutional trials that have advanced the science of pediatric brain tumors and survival of patients with these tumors. Advanced genomic analysis of the entire spectrum of pediatric brain tumors has heralded an era in which stakeholders in the pediatric neuro-oncology community are being challenged to reconsider their current research and diagnostic and treatment strategies. The incorporation of this new information into the next-generation treatment protocols will unleash new challenges. This review succinctly summarizes the key advances in our understanding of the common pediatric brain tumors (ie, medulloblastoma, low- and high-grade gliomas, diffuse intrinsic pontine glioma, and ependymoma) and some selected rare tumors (ie, atypical teratoid/rhabdoid tumor and CNS primitive neuroectodermal tumor). The potential impact of this new information on future clinical protocols also is discussed. Cutting-edge genomics technologies and the information gained from such studies are facilitating the identification of molecularly defined subgroups within patients with particular pediatric brain tumors. The number of evaluable patients in each subgroup is small, particularly in the subgroups of rare diseases. Therefore, international collaboration will be crucial to draw meaningful conclusions about novel approaches to treating pediatric brain tumors.
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Affiliation(s)
- Amar Gajjar
- Amar Gajjar, St Jude Children's Research Hospital, Memphis, TN; Daniel C. Bowers, University of Texas Southwestern Medical Center, Dallas, TX; Matthias A. Karajannis, New York University (NYU) Perlmutter Cancer Center and NYU Langone Medical Center, New York, NY; Sarah Leary, University of Washington School of Medicine and Fred Hutchinson Cancer Research Center, Seattle, WA; Hendrik Witt, German Cancer Research Center and University of Heidelberg, Heidelberg, Germany; and Nicholas G. Gottardo, Princess Margaret Hospital for Children and The University of Western Australia, Perth, Western Australia, Australia.
| | - Daniel C Bowers
- Amar Gajjar, St Jude Children's Research Hospital, Memphis, TN; Daniel C. Bowers, University of Texas Southwestern Medical Center, Dallas, TX; Matthias A. Karajannis, New York University (NYU) Perlmutter Cancer Center and NYU Langone Medical Center, New York, NY; Sarah Leary, University of Washington School of Medicine and Fred Hutchinson Cancer Research Center, Seattle, WA; Hendrik Witt, German Cancer Research Center and University of Heidelberg, Heidelberg, Germany; and Nicholas G. Gottardo, Princess Margaret Hospital for Children and The University of Western Australia, Perth, Western Australia, Australia
| | - Matthias A Karajannis
- Amar Gajjar, St Jude Children's Research Hospital, Memphis, TN; Daniel C. Bowers, University of Texas Southwestern Medical Center, Dallas, TX; Matthias A. Karajannis, New York University (NYU) Perlmutter Cancer Center and NYU Langone Medical Center, New York, NY; Sarah Leary, University of Washington School of Medicine and Fred Hutchinson Cancer Research Center, Seattle, WA; Hendrik Witt, German Cancer Research Center and University of Heidelberg, Heidelberg, Germany; and Nicholas G. Gottardo, Princess Margaret Hospital for Children and The University of Western Australia, Perth, Western Australia, Australia
| | - Sarah Leary
- Amar Gajjar, St Jude Children's Research Hospital, Memphis, TN; Daniel C. Bowers, University of Texas Southwestern Medical Center, Dallas, TX; Matthias A. Karajannis, New York University (NYU) Perlmutter Cancer Center and NYU Langone Medical Center, New York, NY; Sarah Leary, University of Washington School of Medicine and Fred Hutchinson Cancer Research Center, Seattle, WA; Hendrik Witt, German Cancer Research Center and University of Heidelberg, Heidelberg, Germany; and Nicholas G. Gottardo, Princess Margaret Hospital for Children and The University of Western Australia, Perth, Western Australia, Australia
| | - Hendrik Witt
- Amar Gajjar, St Jude Children's Research Hospital, Memphis, TN; Daniel C. Bowers, University of Texas Southwestern Medical Center, Dallas, TX; Matthias A. Karajannis, New York University (NYU) Perlmutter Cancer Center and NYU Langone Medical Center, New York, NY; Sarah Leary, University of Washington School of Medicine and Fred Hutchinson Cancer Research Center, Seattle, WA; Hendrik Witt, German Cancer Research Center and University of Heidelberg, Heidelberg, Germany; and Nicholas G. Gottardo, Princess Margaret Hospital for Children and The University of Western Australia, Perth, Western Australia, Australia
| | - Nicholas G Gottardo
- Amar Gajjar, St Jude Children's Research Hospital, Memphis, TN; Daniel C. Bowers, University of Texas Southwestern Medical Center, Dallas, TX; Matthias A. Karajannis, New York University (NYU) Perlmutter Cancer Center and NYU Langone Medical Center, New York, NY; Sarah Leary, University of Washington School of Medicine and Fred Hutchinson Cancer Research Center, Seattle, WA; Hendrik Witt, German Cancer Research Center and University of Heidelberg, Heidelberg, Germany; and Nicholas G. Gottardo, Princess Margaret Hospital for Children and The University of Western Australia, Perth, Western Australia, Australia
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772
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Pajtler KW, Pfister SM, Kool M. Molecular dissection of ependymomas. Oncoscience 2015; 2:827-8. [PMID: 26682265 PMCID: PMC4671940 DOI: 10.18632/oncoscience.202] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 08/17/2015] [Indexed: 12/26/2022] Open
Affiliation(s)
- Kristian W Pajtler
- Division of Pediatric Neurooncology, German Cancer Research Center DKFZ, Heidelberg, Germany
| | - Stefan M Pfister
- Division of Pediatric Neurooncology, German Cancer Research Center DKFZ, Heidelberg, Germany
| | - Marcel Kool
- Division of Pediatric Neurooncology, German Cancer Research Center DKFZ, Heidelberg, Germany
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773
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Weller M, Wick W, Aldape K, Brada M, Berger M, Pfister SM, Nishikawa R, Rosenthal M, Wen PY, Stupp R, Reifenberger G. Glioma. Nat Rev Dis Primers 2015; 1:15017. [PMID: 27188790 DOI: 10.1038/nrdp.2015.17] [Citation(s) in RCA: 657] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Gliomas are primary brain tumours that are thought to derive from neuroglial stem or progenitor cells. On the basis of their histological appearance, they have been traditionally classified as astrocytic, oligodendroglial or ependymal tumours and assigned WHO grades I-IV, which indicate different degrees of malignancy. Tremendous progress in genomic, transcriptomic and epigenetic profiling has resulted in new concepts of classifying and treating gliomas. Diffusely infiltrating gliomas in adults are now separated into three overarching tumour groups with distinct natural histories, responses to treatment and outcomes: isocitrate dehydrogenase (IDH)-mutant, 1p/19q co-deleted tumours with mostly oligodendroglial morphology that are associated with the best prognosis; IDH-mutant, 1p/19q non-co-deleted tumours with mostly astrocytic histology that are associated with intermediate outcome; and IDH wild-type, mostly higher WHO grade (III or IV) tumours that are associated with poor prognosis. Gliomas in children are molecularly distinct from those in adults, the majority being WHO grade I pilocytic astrocytomas characterized by circumscribed growth, favourable prognosis and frequent BRAF gene fusions or mutations. Ependymal tumours can be molecularly subdivided into distinct epigenetic subgroups according to location and prognosis. Although surgery, radiotherapy and alkylating agent chemotherapy are still the mainstay of treatment, individually tailored strategies based on tumour-intrinsic dominant signalling pathways and antigenic tumour profiles may ultimately improve outcome. For an illustrated summary of this Primer, visit: http://go.nature.com/TXY7Ri.
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Affiliation(s)
- Michael Weller
- Department of Neurology and Brain Tumor Center, University Hospital Zurich and University of Zurich, Frauenklinikstrasse 26, CH-8091 Zurich, Switzerland
| | - Wolfgang Wick
- Neurology Clinic, University of Heidelberg and German Cancer Research Center, Heidelberg, Germany
| | - Ken Aldape
- Department of Pathology, University Health Network, Toronto, Ontario, Canada
| | - Michael Brada
- Department of Molecular and Clinical Cancer Medicine and Department of Radiation Oncology, University of Liverpool and Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Mitchell Berger
- Department of Neurological Surgery and Brain Tumor Research Center, University of California, San Francisco, California, USA
| | - Stefan M Pfister
- Division of Pediatric Neuro-Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Pediatric Haematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Ryo Nishikawa
- Department of Neuro-Oncology and Neurosurgery, Saitama Medical University, Saitama, Japan
| | - Mark Rosenthal
- Department of Medical Oncology, The Royal Melbourne Hospital, Victoria 3050, Australia
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Roger Stupp
- Department of Oncology and Brain Tumor Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Guido Reifenberger
- Department of Neuropathology, Heinrich Heine University Düsseldorf, and German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) Heidelberg, partner site Essen/Düsseldorf, Germany
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774
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Abstract
Ependymomas have a variable prognosis. In this issue of Cancer Cell, Pajtler and colleagues identify nine subgroups of ependymoma using DNA methylation profiles. Two subgroups, predominately pediatric, are responsible for most of the mortality, with all others having nearly 100% overall survival after 5 years.
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Affiliation(s)
- Tenley C Archer
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Harvard University, Cambridge, MA 02138, USA; Broad Institute of MIT and Harvard, Harvard University, Cambridge, MA 02138, USA
| | - Scott L Pomeroy
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Harvard University, Cambridge, MA 02138, USA; Broad Institute of MIT and Harvard, Harvard University, Cambridge, MA 02138, USA.
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775
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Gabriel AS, Lafta FM, Schwalbe EC, Nakjang S, Cockell SJ, Iliasova A, Enshaei A, Schwab C, Rand V, Clifford SC, Kinsey SE, Mitchell CD, Vora A, Harrison CJ, Moorman AV, Strathdee G. Epigenetic landscape correlates with genetic subtype but does not predict outcome in childhood acute lymphoblastic leukemia. Epigenetics 2015; 10:717-26. [PMID: 26237075 PMCID: PMC4622588 DOI: 10.1080/15592294.2015.1061174] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 05/29/2015] [Accepted: 06/05/2015] [Indexed: 11/19/2022] Open
Abstract
Although children with acute lymphoblastic leukemia (ALL) generally have a good outcome, some patients do relapse and survival following relapse is poor. Altered DNA methylation is highly prevalent in ALL and raises the possibility that DNA methylation-based biomarkers could predict patient outcome. In this study, genome-wide methylation analysis, using the Illumina Infinium HumanMethylation450 BeadChip platform, was carried out on 52 diagnostic patient samples from 4 genetic subtypes [ETV6-RUNX1, high hyperdiploidy (HeH), TCF3-PBX1 and dic(9;20)(p11-13;q11)] in a 1:1 case-control design with patients who went on to relapse (as cases) and patients achieving long-term remission (as controls). Pyrosequencing assays for selected loci were used to confirm the array-generated data. Non-negative matrix factorization consensus clustering readily clustered samples according to genetic subgroups and gene enrichment pathway analysis suggested that this is in part driven by epigenetic disruption of subtype specific signaling pathways. Multiple bioinformatics approaches (including bump hunting and individual locus analysis) were used to identify CpG sites or regions associated with outcome. However, no associations with relapse were identified. Our data revealed that ETV6-RUNX1 and dic(9;20) subtypes were mostly associated with hypermethylation; conversely, TCF3-PBX1 and HeH were associated with hypomethylation. We observed significant enrichment of the neuroactive ligand-receptor interaction pathway in TCF3-PBX1 as well as an enrichment of genes involved in immunity and infection pathways in ETV6-RUNX1 subtype. Taken together, our results suggest that altered DNA methylation may have differential impacts in distinct ALL genetic subtypes.
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Affiliation(s)
- Alem S Gabriel
- Northern Institute for Cancer Research; Faculty of Medical Sciences; Newcastle University; Newcastle upon Tyne, UK
| | - Fadhel M Lafta
- Northern Institute for Cancer Research; Faculty of Medical Sciences; Newcastle University; Newcastle upon Tyne, UK
| | - Edward C Schwalbe
- Northern Institute for Cancer Research; Faculty of Medical Sciences; Newcastle University; Newcastle upon Tyne, UK
- Department of Applied Sciences; Northumbria University; Newcastle upon Tyne, UK
| | - Sirintra Nakjang
- Northern Institute for Cancer Research; Faculty of Medical Sciences; Newcastle University; Newcastle upon Tyne, UK
- Bioinformatics Support Unit; Faculty of Medical Sciences; Newcastle University; Newcastle upon Tyne, UK
| | - Simon J Cockell
- Bioinformatics Support Unit; Faculty of Medical Sciences; Newcastle University; Newcastle upon Tyne, UK
| | - Alice Iliasova
- Northern Institute for Cancer Research; Faculty of Medical Sciences; Newcastle University; Newcastle upon Tyne, UK
- Department of Applied Sciences; Northumbria University; Newcastle upon Tyne, UK
| | - Amir Enshaei
- Northern Institute for Cancer Research; Faculty of Medical Sciences; Newcastle University; Newcastle upon Tyne, UK
| | - Claire Schwab
- Northern Institute for Cancer Research; Faculty of Medical Sciences; Newcastle University; Newcastle upon Tyne, UK
| | - Vikki Rand
- Northern Institute for Cancer Research; Faculty of Medical Sciences; Newcastle University; Newcastle upon Tyne, UK
| | - Steven C Clifford
- Northern Institute for Cancer Research; Faculty of Medical Sciences; Newcastle University; Newcastle upon Tyne, UK
| | - Sally E Kinsey
- Department of Pediatric Haematology and Oncology; Leeds General Infirmary; Leeds, UK
| | - Chris D Mitchell
- Department of Pediatric Oncology; John Radcliffe Hospital; Oxford, UK
| | - Ajay Vora
- Department of Pediatric Oncology; John Radcliffe Hospital; Oxford, UK
| | - Christine J Harrison
- Northern Institute for Cancer Research; Faculty of Medical Sciences; Newcastle University; Newcastle upon Tyne, UK
| | - Anthony V Moorman
- Northern Institute for Cancer Research; Faculty of Medical Sciences; Newcastle University; Newcastle upon Tyne, UK
| | - Gordon Strathdee
- Northern Institute for Cancer Research; Faculty of Medical Sciences; Newcastle University; Newcastle upon Tyne, UK
- Department of Haematology; Great Ormond Street Hospital; London, UK
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