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Herrera CM, McMahon E, Swaney DL, Sherry J, Pha K, Adams-Boone K, Johnson JR, Krogan NJ, Stevers M, Solomon D, Elwell C, Engel J. The Chlamydia trachomatis Inc Tri1 interacts with TRAF7 to displace native TRAF7 interacting partners. Microbiol Spectr 2024; 12:e0045324. [PMID: 38814079 PMCID: PMC11218536 DOI: 10.1128/spectrum.00453-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/23/2024] [Indexed: 05/31/2024] Open
Abstract
Chlamydia trachomatis is the leading cause of bacterial sexually transmitted infections in the USA and of preventable blindness worldwide. This obligate intracellular pathogen replicates within a membrane-bound inclusion, but how it acquires nutrients from the host while avoiding detection by the innate immune system is incompletely understood. C. trachomatis accomplishes this in part through the translocation of a unique set of effectors into the inclusion membrane, the inclusion membrane proteins (Incs). Incs are ideally positioned at the host-pathogen interface to reprogram host signaling by redirecting proteins or organelles to the inclusion. Using a combination of co-affinity purification, immunofluorescence confocal imaging, and proteomics, we characterize the interaction between an early-expressed Inc of unknown function, Tri1, and tumor necrosis factor receptor-associated factor 7 (TRAF7). TRAF7 is a multi-domain protein with a RING finger ubiquitin ligase domain and a C-terminal WD40 domain. TRAF7 regulates several innate immune signaling pathways associated with C. trachomatis infection and is mutated in a subset of tumors. We demonstrate that Tri1 and TRAF7 specifically interact during infection and that TRAF7 is recruited to the inclusion. We further show that the predicted coiled-coil domain of Tri1 is necessary to interact with the TRAF7 WD40 domain. Finally, we demonstrate that Tri1 displaces the native TRAF7 binding partners, mitogen-activated protein kinase kinase kinase 2 (MEKK2), and MEKK3. Together, our results suggest that by displacing TRAF7 native binding partners, Tri1 has the capacity to alter TRAF7 signaling during C. trachomatis infection.IMPORTANCEChlamydia trachomatis is the leading cause of bacterial sexually transmitted infections in the USA and preventable blindness worldwide. Although easily treated with antibiotics, the vast majority of infections are asymptomatic and therefore go untreated, leading to infertility and blindness. This obligate intracellular pathogen evades the immune response, which contributes to these outcomes. Here, we characterize the interaction between a C. trachomatis-secreted effector, Tri1, and a host protein involved in innate immune signaling, TRAF7. We identified host proteins that bind to TRAF7 and demonstrated that Tri1 can displace these proteins upon binding to TRAF7. Remarkably, the region of TRAF7 to which these host proteins bind is often mutated in a subset of human tumors. Our work suggests a mechanism by which Tri1 may alter TRAF7 signaling and has implications not only in the pathogenesis of C. trachomatis infections but also in understanding the role of TRAF7 in cancer.
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Affiliation(s)
- Clara M. Herrera
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Eleanor McMahon
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Danielle L. Swaney
- Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, California, USA
| | - Jessica Sherry
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Khavong Pha
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Kathleen Adams-Boone
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jeffrey R. Johnson
- Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, California, USA
| | - Nevan J. Krogan
- Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, California, USA
| | - Meredith Stevers
- Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | - David Solomon
- Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | - Cherilyn Elwell
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Joanne Engel
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Department of Microbiology and Immunology, University of California San Francisco, San Francisco, California, USA
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Palma-Milla C, Prat-Planas A, Soengas-Gonda E, Centeno-Pla M, Sánchez-Pozo J, Lazaro-Rodriguez I, Quesada-Espinosa JF, Arteche-Lopez A, Olival J, Pacio-Miguez M, Palomares-Bralo M, Santos-Simarro F, Cancho-Candela R, Vázquez-López M, Seidel V, Martinez-Monseny AF, Casas-Alba D, Grinberg D, Balcells S, Serrano M, Rabionet R, Martin MA, Urreizti R. Expanding the Phenotypic Spectrum of TRAF7-Related Cardiac, Facial, and Digital Anomalies With Developmental Delay: Report of 11 New Cases and Literature Review. Pediatr Neurol 2024; 155:8-17. [PMID: 38569228 DOI: 10.1016/j.pediatrneurol.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/22/2024] [Accepted: 03/07/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND TRAF7-related cardiac, facial, and digital anomalies with developmental delay (CAFDADD), a multisystemic neurodevelopmental disorder caused by germline missense variants in the TRAF7 gene, exhibits heterogeneous clinical presentations. METHODS We present a detailed description of 11 new TRAF7-related CAFDADD cases, featuring eight distinct variants, including a novel one. RESULTS Phenotypic analysis and a comprehensive review of the 58 previously reported cases outline consistent clinical presentations, emphasizing dysmorphic features, developmental delay, endocrine manifestations, and cardiac defects. In this enlarged collection, novelties include a wider range of cognitive dysfunction, with some individuals exhibiting normal development despite early psychomotor delay. Communication challenges, particularly in expressive language, are prevalent, necessitating alternative communication methods. Autistic traits, notably rigidity, are observed in the cohort. Also, worth highlighting are hearing loss, sleep disturbances, and endocrine anomalies, including growth deficiency. Cardiac defects, frequently severe, pose early-life complications. Facial features, including arched eyebrows, contribute to the distinct gestalt. A novel missense variant, p.(Arg653Leu), further underscores the complex relationship between germline TRAF7 variants and somatic changes linked to meningiomas. CONCLUSIONS Our comprehensive analysis expands the phenotypic spectrum, emphasizing the need for oncological evaluations and proposing an evidence-based schedule for clinical management. This study contributes to a better understanding of TRAF7-related CAFDADD, offering insights for improved diagnosis, intervention, and patient care.
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Affiliation(s)
- Carmen Palma-Milla
- Unidad de Dismorfología y Genética (UDisGen), Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Genetics, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - Aina Prat-Planas
- Faculty of Biology, Department of Genetics, Microbiology and Statistics, Institute of Biomedicine (IBUB), Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain
| | - Emma Soengas-Gonda
- Unidad de Dismorfología y Genética (UDisGen), Hospital Universitario 12 de Octubre, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Mónica Centeno-Pla
- Faculty of Biology, Department of Genetics, Microbiology and Statistics, Institute of Biomedicine (IBUB), Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain; Clinical Biochemistry Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Jaime Sánchez-Pozo
- Unidad de Dismorfología y Genética (UDisGen), Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Pediatric Endocrinology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Irene Lazaro-Rodriguez
- Unidad de Dismorfología y Genética (UDisGen), Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Pediatric Endocrinology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Juan F Quesada-Espinosa
- Unidad de Dismorfología y Genética (UDisGen), Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Genetics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ana Arteche-Lopez
- Unidad de Dismorfología y Genética (UDisGen), Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Genetics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jonathan Olival
- Genomic Unit, Molecular and Genetic Medicine Section, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Marta Pacio-Miguez
- INGEMM, Institute of Medical Genetics, Hospital Universitario La Paz, Madrid, Spain
| | - María Palomares-Bralo
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; INGEMM, Institute of Medical Genetics, Hospital Universitario La Paz, Madrid, Spain; ITHACA - European Reference Network, INGEMM, Institute of Medical Genetics, Hospital Universitario La Paz, Madrid, Spain
| | - Fernando Santos-Simarro
- Unidad de Diagnóstico Molecular y Genética Clínica, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Ramón Cancho-Candela
- Neuropediatrics, Faculty of Medicine, Hospital Universitario Río Hortega, Universidad de Valladolid, Valladolid, Spain
| | | | - Veronica Seidel
- Clinical Genetics, Pediatrics Department, Hospital Gregorio Marañón, Madrid, Spain
| | - Antonio F Martinez-Monseny
- Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain; Department of Genetic Medicine, Pediatric Institute of Rare Diseases (IPER), Hospital Sant Joan de Déu, Barcelona, Spain
| | - Didac Casas-Alba
- Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain; Department of Genetic Medicine, Pediatric Institute of Rare Diseases (IPER), Hospital Sant Joan de Déu, Barcelona, Spain
| | - Daniel Grinberg
- Faculty of Biology, Department of Genetics, Microbiology and Statistics, Institute of Biomedicine (IBUB), Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain
| | - Susanna Balcells
- Faculty of Biology, Department of Genetics, Microbiology and Statistics, Institute of Biomedicine (IBUB), Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain
| | - Mercedes Serrano
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain; Pediatric Neurology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Raquel Rabionet
- Faculty of Biology, Department of Genetics, Microbiology and Statistics, Institute of Biomedicine (IBUB), Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain
| | - Miguel A Martin
- Unidad de Dismorfología y Genética (UDisGen), Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Genetics, Hospital Universitario 12 de Octubre, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Grupo de Enfermedades Mitocondriales y Neurometabólicas, Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Roser Urreizti
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain; Clinical Biochemistry Department, Hospital Sant Joan de Déu, Barcelona, Spain
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Kelam J, Kelam N, Filipović N, Komić L, Racetin A, Komić D, Kostić S, Kuzmić Prusac I, Vukojević K. Expression of Congenital Anomalies of the Kidney and Urinary Tract (CAKUT) Candidate Genes EDA2R, PCDH9, and TRAF7 in Normal Human Kidney Development and CAKUT. Genes (Basel) 2024; 15:702. [PMID: 38927638 PMCID: PMC11203332 DOI: 10.3390/genes15060702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 06/28/2024] Open
Abstract
Approximately half of the cases of chronic kidney disease (CKD) in childhood are caused by congenital anomalies of the kidney and urinary tract (CAKUT). Specific genes were identified as having significant importance in regard to the underlying genetic factors responsible for the CAKUT phenotype, and in our research, we focused on analyzing and comparing the expression levels of ectodysplasin A2 receptor (EDA2R), protocadherin9 (PCDH9), and TNF receptor-associated factor 7 (TRAF7) proteins in the cortex and medulla of healthy control kidneys during developmental phases 2, 3, and 4. We also performed an analysis of the area percentages of the mentioned proteins in the cortical and medullary sections of healthy embryonic and fetal kidneys compared to those affected by CAKUT, including duplex kidneys (DK), horseshoe kidneys (HK), hypoplastic kidneys (HYP), and dysplastic kidneys (DYS). We found that the CAKUT candidate gene proteins EDA2R, PCDH9, and TRAF7 are all expressed during normal human kidney development stages. In DYS, the expression of EDA2R was higher than in normal kidneys, likely due to EDA2R's role in apoptosis, which was upregulated in specific cases and could possibly contribute to the formation of DYS. The expression of PCDH9 was lower in HK, which can be attributed to the possible role of PCDH9 in cell migration suppression. Decreased PCDH9 expression is linked to increased cell migration, potentially contributing to the development of HK. The level of TRAF7 expression was reduced in all examined kidney disorders compared to normal kidneys, suggesting that this reduction might be attributed to the crucial role of TRAF7 in the formation of endothelium and ciliogenesis, both of which are essential for normal kidney development. Further research is required to ascertain the function of these proteins in both the typical development of the kidney and in CAKUT.
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Affiliation(s)
- Jelena Kelam
- Department of Family Medicine, Split-Dalmatia County Health Center, 21000 Split, Croatia; (J.K.); (L.K.)
| | - Nela Kelam
- Department of Anatomy, Histology and Embryology, University of Split School of Medicine, 21000 Split, Croatia; (N.K.); (N.F.); (A.R.); (D.K.); (S.K.)
| | - Natalija Filipović
- Department of Anatomy, Histology and Embryology, University of Split School of Medicine, 21000 Split, Croatia; (N.K.); (N.F.); (A.R.); (D.K.); (S.K.)
| | - Luka Komić
- Department of Family Medicine, Split-Dalmatia County Health Center, 21000 Split, Croatia; (J.K.); (L.K.)
| | - Anita Racetin
- Department of Anatomy, Histology and Embryology, University of Split School of Medicine, 21000 Split, Croatia; (N.K.); (N.F.); (A.R.); (D.K.); (S.K.)
| | - Dora Komić
- Department of Anatomy, Histology and Embryology, University of Split School of Medicine, 21000 Split, Croatia; (N.K.); (N.F.); (A.R.); (D.K.); (S.K.)
| | - Sandra Kostić
- Department of Anatomy, Histology and Embryology, University of Split School of Medicine, 21000 Split, Croatia; (N.K.); (N.F.); (A.R.); (D.K.); (S.K.)
| | - Ivana Kuzmić Prusac
- Department of Pathology, University Hospital Center Split, 21000 Split, Croatia;
| | - Katarina Vukojević
- Department of Anatomy, Histology and Embryology, University of Split School of Medicine, 21000 Split, Croatia; (N.K.); (N.F.); (A.R.); (D.K.); (S.K.)
- Department of Anatomy, School of Medicine, University of Mostar, 88000 Mostar, Bosnia and Herzegovina
- Center for Translational Research in Biomedicine, School of Medicine, University of Split, 21000 Split, Croatia
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Li R, Zhang Y, Li G, Wei C, Xiong H, Chang X. Treatment of childhood intraneural perineurioma: A case report and literature review. Heliyon 2024; 10:e26089. [PMID: 38434310 PMCID: PMC10907645 DOI: 10.1016/j.heliyon.2024.e26089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/09/2024] [Accepted: 02/07/2024] [Indexed: 03/05/2024] Open
Abstract
Background Intraneural perineurioma is a rare, benign slow-growing lesion that usually involves a single main trunk nerve during childhood and young adulthood. The treatment of intraneural perineurioma is still a subject of controversy, especially in fast-growing children. To date, there was no systemic analysis of intraneural perineurioma in children. Method A case of Intraneural perineurioma affecting the left sciatic nerve with 2 years of follow-up was presented. A systematic review was performed on literature published before June 2023, focusing on intraneural perineurioma diagnosed at no older than 18 years old. Result A 9-year-old boy presented with progressive left foot-drop and abnormal gait for 2 years. The electromyography and magnetic resonance neurography study confirmed neuropathy involving the left sciatic nerves and its branches. Pathological investigation of the left sural nerve confirmed the diagnosis of intraneural perineurioma. The boy received physical therapy, and the disease was stable during the 2 years of follow-up. Fifty-seven childhood cases were identified in literature. Five patients with oral intraneural perineurioma underwent excision of the mass with good outcomes. In the other 52 patients with peripheral nerve involvement, 25 of them received surgical treatment, with different outcomes according to different operations. Out of 33 cases with precise lesion sizes, the length of the lesion in patients without nerve resection was significantly longer than that in patients with nerve resection (12.86 ± 7.44 cm vs 4.57 ± 4.5 cm. p < 0.05). Conclusions Intraneural perineuriomas are rare benign tumors with slow progression. The options for surgery should be cautiously considered in childhood patients with long segmental peripheral nerve involvement.
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Affiliation(s)
- Rongpei Li
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
- Department of Pediatrics, Jining First People's Hospital, Shandong, 272011, China
| | - Yao Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - Guanggui Li
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
- Department of Pediatrics, The First People's Hospital of Zunyi, Guizhou, 563099, China
| | - Cuijie Wei
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - Hui Xiong
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - Xingzhi Chang
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
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5
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Herrera CM, McMahon E, Swaney DL, Sherry J, Pha K, Adams-Boone K, Johnson JR, Krogan NJ, Stevers M, Solomon D, Elwell C, Engel J. The Chlamydia trachomatis Inc Tri1 interacts with TRAF7 to displace native TRAF7 interacting partners. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.02.26.581999. [PMID: 38464023 PMCID: PMC10925117 DOI: 10.1101/2024.02.26.581999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Chlamydia trachomatis is the leading cause of bacterial sexually transmitted infections in the US and of preventable blindness worldwide. This obligate intracellular pathogen replicates within a membrane-bound inclusion, but how it acquires nutrients from the host while avoiding detection by the innate immune system is incompletely understood. C. trachomatis accomplishes this in part through the translocation of a unique set of effectors into the inclusion membrane, the inc lusion membrane proteins (Incs). Incs are ideally positioned at the host-pathogen interface to reprogram host signaling by redirecting proteins or organelles to the inclusion. Using a combination of co-affinity purification, immunofluorescence confocal imaging, and proteomics, we characterize the interaction between an early-expressed Inc of unknown function, Tri1, and tumor necrosis factor receptor associated factor 7 (TRAF7). TRAF7 is a multi-domain protein with a RING finger ubiquitin ligase domain and a C-terminal WD40 domain. TRAF7 regulates several innate immune signaling pathways associated with C. trachomatis infection and is mutated in a subset of tumors. We demonstrate that Tri1 and TRAF7 specifically interact during infection and that TRAF7 is recruited to the inclusion. We further show that the predicted coiled-coil domain of Tri1 is necessary to interact with the TRAF7 WD40 domain. Finally, we demonstrate that Tri1 displaces the native TRAF7 binding partners, mitogen activated protein kinase kinase kinase 2 (MEKK2) and MEKK3. Together, our results suggest that by displacing TRAF7 native binding partners, Tri1 has the capacity to alter TRAF7 signaling during C. trachomatis infection. Importance Chlamydia trachomatis is the leading cause of bacterial sexually transmitted infections in the US and preventable blindness worldwide. Although easily treated with antibiotics, the vast majority of infections are asymptomatic and therefore go untreated, leading to infertility and blindness. This obligate intracellular pathogen evades the immune response, which contributes to these outcomes. Here, we characterize the interaction between a C. trachomatis secreted effector, Tri1, and a host protein involved in innate immune signaling, TRAF7. We identified host proteins that bind to TRAF7 and demonstrate that Tri1 can displace these proteins upon binding to TRAF7. Remarkably, the region of TRAF7 to which these host proteins bind is often mutated in a subset of human tumors. Our work suggests a mechanism by which Tri1 may alter TRAF7 signaling and has implications not only in the pathogenesis of C. trachomatis infections, but also in understanding the role of TRAF7 in cancer.
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Giannini C, Righi A. Peripheral nerve tumors. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:251-271. [PMID: 38697744 DOI: 10.1016/b978-0-323-90108-6.00016-8] [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: 05/05/2024]
Abstract
The chapter is focused on the neoplastic peripheral nerve lesions, which primarily involve "cranial and paraspinal nerves," as outlined in the CNS volume (WHO_Classification_of_Tumours_Editorial_Board, 2021). These include classic peripheral nerve sheath tumors such as schwannoma, neurofibroma, intraneural perineurioma, and malignant peripheral nerve sheath tumors, with their variants as well as new and more precisely defined entities, including hybrid nerve sheath tumors and malignant melanotic nerve sheath tumor (previously melanotic schwannoma).
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Affiliation(s)
- Caterina Giannini
- Division of Anatomic Pathology, Laboratory Medicine/Pathology and Neurosurgery, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, United States; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy.
| | - Alberto Righi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Miller TA, Ross DC. Sciatic and tibial neuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:165-181. [PMID: 38697738 DOI: 10.1016/b978-0-323-90108-6.00003-x] [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: 05/05/2024]
Abstract
The sciatic nerve is the body's largest peripheral nerve. Along with their two terminal divisions (tibial and fibular), their anatomic location makes them particularly vulnerable to trauma and iatrogenic injuries. A thorough understanding of the functional anatomy is required to adequately localize lesions in this lengthy neural pathway. Proximal disorders of the nerve can be challenging to precisely localize among a range of possibilities including lumbosacral pathology, radiculopathy, or piriformis syndrome. A correct diagnosis is based upon a thorough history and physical examination, which will then appropriately direct adjunctive investigations such as imaging and electrodiagnostic testing. Disorders of the sciatic nerve and its terminal branches are disabling for patients, and expert assessment by rehabilitation professionals is important in limiting their impact. Applying techniques established in the upper extremity, surgical reconstruction of lower extremity nerve dysfunction is rapidly improving and evolving. These new techniques, such as nerve transfers, require electrodiagnostic assessment of both the injured nerve(s) as well as healthy, potential donor nerves as part of a complete neurophysiological examination.
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Affiliation(s)
- Thomas A Miller
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, St. Joseph's Health Care, Parkwood Institute, London, ON, Canada.
| | - Douglas C Ross
- Division of Plastic Surgery, Schulich School of Medicine and Dentistry, Western University, St. Joseph's Health Care, Roth McFarlane Hand and Upper Limb Centre, London, ON, Canada
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8
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Lenartowicz KA, Smith BW, Jack MM, Wilson TJ, Klein CJ, Amrami KK, Spinner RJ. What is new in intraneural perineurioma? Acta Neurochir (Wien) 2023; 165:3539-3547. [PMID: 37684428 DOI: 10.1007/s00701-023-05765-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023]
Abstract
Since the initial description of intraneural (IN) perineurioma in 1964, advances in the understanding of the clinical presentation, diagnostic imaging, pathologic features, and genetic underpinnings have changed how this pathology is managed. IN perineuriomas are rare, benign peripheral nerve sheath tumors, most frequently coming to clinical attention when patients present with painless, progressive weakness or sensory loss in adolescence or young adulthood. The gold standard of diagnosis has traditionally been with targeted tissue biopsy demonstrating "pseudo-onion bulb" formation with positive epithelial membrane antigen (EMA) staining. However, modern magnetic resonance imaging is allowing some patients to forgo biopsy. Recent genetic studies of IN perineuriomas have demonstrated common TRAF7 point mutations and rare NF2 mutations, which may present targets for diagnosis or therapy in the future. Current advances have allowed for us to provide improved patient counseling with informed understanding for various clinical scenarios. With the workup and diagnosis now clearly defined, the next frontier is for improving the lives of patients with IN perineuriomas through the interaction between restoration of functional deficits and advances in our understanding of the genetics of this entity.
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Affiliation(s)
| | - Brandon W Smith
- Department of Neurosurgery, Duke University, Durham, NC, USA
| | - Megan M Jack
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA
| | - Thomas J Wilson
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, USA
| | | | | | - Robert J Spinner
- Departement of Neurologic Surgery, Mayo Clinic, Gonda 8-214, Rochester, MN, 55905, USA.
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Maldonado AA, Klein CJ, Spinner RJ. CORRESPONDENCE TO: Monárrez R, Chen Z, Dubin JA, Ingari JV. Rare peripheral nerve tumor of the median nerve. Hand Surg Rehabil 2023. HAND SURGERY & REHABILITATION 2023; 42:447-448. [PMID: 37507089 DOI: 10.1016/j.hansur.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023]
Affiliation(s)
- Andres A Maldonado
- Mayo Clinic, Departments of Neurologic Surgery and Radiology, Rochester, MN, USA
| | | | - Robert J Spinner
- Mayo Clinic, Departments of Neurologic Surgery and Radiology, Rochester, MN, USA.
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Kasago I, Aypar U, Sukhadia P, Vanderbilt C, Ladanyi M, Hurd T, Pulitzer M. A novel case of cutaneous myxoid spindle cell neoplasm with FMR1-ALK gene fusion and CD34/S100 co-expression. J Cutan Pathol 2023; 50:505-510. [PMID: 36325885 PMCID: PMC10154434 DOI: 10.1111/cup.14354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/29/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
A novel class of superficial CD34+ and S100+ cutaneous spindle cell neoplasm harboring ALK rearrangements has recently been described. Morphologically, these neoplasms have been characterized by bland spindled cells organized in whorls and cords against myxoid stroma, eventuating in the designation "superficial ALK-rearranged myxoid spindle cell neoplasm." Here, we report a 78-year-old male with a 3-mm pink papule on the chest, clinically concerning for cutaneous carcinoma. Biopsy of the specimen showed a biphasic tumor with hypercellular and hypocellular zones consisting of epithelioid cells and monomorphic, bland spindled cells. The spindled cells were arranged in perineurial-like concentric whorls and cords embedded in a myxo-collagenous stroma. Neoplastic cells were diffusely positive for CD34, S100, and D5F3-ALK, without SOX10 expression. Negative markers included GLUT1, EMA, factor XIIIa, desmin, actin, and SMA. ALK-rearrangement was identified on fluorescence in situ hybridization break-apart assay. A corresponding novel FMR1-ALK fusion was found by next-generation sequencing (NGS) based RNA sequencing. Identification of this new FMR1-ALK fusion signature adds to the spectrum of diagnostic genomic alterations in this newly described class of tumors.
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Affiliation(s)
- Israel Kasago
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Umut Aypar
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Purvil Sukhadia
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chad Vanderbilt
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc Ladanyi
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tierra Hurd
- Department of Medicine, Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Melissa Pulitzer
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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11
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Balaini N, Prakash M, Shree R, Mahesh KV. Hypertrophic Mononeuropathy. Neurol India 2023; 71:617. [PMID: 37322789 DOI: 10.4103/0028-3886.378702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Neeraj Balaini
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mahesh Prakash
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritu Shree
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Karthik V Mahesh
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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12
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Harter PN, Weber KJ, Ronellenfitsch MW. [Histological and molecular characteristics of tumours of the peripheral nervous system]. PATHOLOGIE (HEIDELBERG, GERMANY) 2023; 44:197-208. [PMID: 37115287 DOI: 10.1007/s00292-023-01198-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 04/29/2023]
Abstract
Tumours of the peripheral nervous system occur sporadically in adults and except for a minority of entities, these tumours are usually benign. The most common are nerve sheath tumours. Because these tumours grow in direct proximity or even invade peripheral nerve bundles, they can lead to severe pain and motion deficits. From the neurosurgical perspective these tumours are technically challenging, and especially for tumours with an invasive growth pattern complete resection may not be possible. Peripheral nervous system tumours that are associated with tumour syndromes such as neurofibromatosis type 1 and 2 or schwannomatosis are a particular clinical challenge. The goal of the current article is to present histological and molecular characteristics of peripheral nervous system tumours. Furthermore, future targeted therapy strategies are presented.
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Affiliation(s)
- Patrick N Harter
- Zentrum für Neuropathologie und Prionforschung, Ludwig-Maximilians-Universität München, Feodor-Lynen Straße 23, 81377, München, Deutschland.
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partnerstandort München, München, Deutschland.
- Comprehensive Cancer Center München (CCC München), Ludwig-Maximilians-Universität München, München, Deutschland.
| | - Katharina J Weber
- Neurologisches Institut (Edinger Institut), Universitätsklinikum, Goethe Universität Frankfurt am Main, Frankfurt, Deutschland
- Deutsches Konsortium für Translationale Krebsforschung (DKTK) Frankfurt/Mainz, Frankfurt, Deutschland
- Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland
- Frankfurt Cancer Institute (FCI), Frankfurt am Main, Deutschland
| | - Michael W Ronellenfitsch
- Deutsches Konsortium für Translationale Krebsforschung (DKTK) Frankfurt/Mainz, Frankfurt, Deutschland
- Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland
- Frankfurt Cancer Institute (FCI), Frankfurt am Main, Deutschland
- Dr. Senckenbergisches Institut für Neuroonkologie, Universitätsklinikum, Goethe Universität Frankfurt am Main, Frankfurt, Deutschland
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13
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Mishra-Gorur K, Barak T, Kaulen LD, Henegariu O, Jin SC, Aguilera SM, Yalbir E, Goles G, Nishimura S, Miyagishima D, Djenoune L, Altinok S, Rai DK, Viviano S, Prendergast A, Zerillo C, Ozcan K, Baran B, Sencar L, Goc N, Yarman Y, Ercan-Sencicek AG, Bilguvar K, Lifton RP, Moliterno J, Louvi A, Yuan S, Deniz E, Brueckner M, Gunel M. Pleiotropic role of TRAF7 in skull-base meningiomas and congenital heart disease. Proc Natl Acad Sci U S A 2023; 120:e2214997120. [PMID: 37043537 PMCID: PMC10120005 DOI: 10.1073/pnas.2214997120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 02/27/2023] [Indexed: 04/13/2023] Open
Abstract
While somatic variants of TRAF7 (Tumor necrosis factor receptor-associated factor 7) underlie anterior skull-base meningiomas, here we report the inherited mutations of TRAF7 that cause congenital heart defects. We show that TRAF7 mutants operate in a dominant manner, inhibiting protein function via heterodimerization with wild-type protein. Further, the shared genetics of the two disparate pathologies can be traced to the common origin of forebrain meninges and cardiac outflow tract from the TRAF7-expressing neural crest. Somatic and inherited mutations disrupt TRAF7-IFT57 interactions leading to cilia degradation. TRAF7-mutant meningioma primary cultures lack cilia, and TRAF7 knockdown causes cardiac, craniofacial, and ciliary defects in Xenopus and zebrafish, suggesting a mechanistic convergence for TRAF7-driven meningiomas and developmental heart defects.
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Affiliation(s)
- Ketu Mishra-Gorur
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT06510
| | - Tanyeri Barak
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT06510
| | - Leon D. Kaulen
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT06510
| | | | - Sheng Chih Jin
- Department of Genetics, Yale School of Medicine, New Haven, CT06510
| | | | - Ezgi Yalbir
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT06510
| | - Gizem Goles
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT06510
| | - Sayoko Nishimura
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT06510
| | | | - Lydia Djenoune
- Cardiology Division, Department of Medicine, Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA02129
| | - Selin Altinok
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT06510
| | - Devendra K. Rai
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT06510
| | - Stephen Viviano
- Department of Pediatrics, Yale School of Medicine, New Haven, CT06510
| | - Andrew Prendergast
- Department of Internal Medicine, Section of Cardiology, Yale Cardiovascular Research Center, Yale School of Medicine, New Haven, CT06510
| | - Cynthia Zerillo
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT06510
| | - Kent Ozcan
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT06510
| | - Burcin Baran
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT06510
| | - Leman Sencar
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT06510
| | - Nukte Goc
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT06510
| | - Yanki Yarman
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT06510
| | | | - Kaya Bilguvar
- Department of Genetics, Yale School of Medicine, New Haven, CT06510
| | - Richard P. Lifton
- Department of Genetics, Yale School of Medicine, New Haven, CT06510
- Laboratory of Human Genetics and Genomics, The Rockefeller University, New York, NY10065
| | - Jennifer Moliterno
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT06510
- Yale Program in Brain Tumor Research, Yale School of Medicine, New Haven, CT06510
| | - Angeliki Louvi
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT06510
- Department of Neuroscience, Yale School of Medicine, New Haven, CT06510
| | - Shiaulou Yuan
- Cardiology Division, Department of Medicine, Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA02129
| | - Engin Deniz
- Department of Pediatrics, Yale School of Medicine, New Haven, CT06510
| | - Martina Brueckner
- Department of Pediatrics, Yale School of Medicine, New Haven, CT06510
| | - Murat Gunel
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT06510
- Department of Genetics, Yale School of Medicine, New Haven, CT06510
- Yale Program in Brain Tumor Research, Yale School of Medicine, New Haven, CT06510
- Department of Neuroscience, Yale School of Medicine, New Haven, CT06510
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14
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Aru MG, Davis JL, Stacy GS, Mills MK, Yablon CM, Hanrahan CJ, McCallum R, Nomura EC, Hansford BG. Beyond schwannomas and neurofibromas: a radiological and histopathological review of lesser-known benign lesions that arise in association with peripheral nerves. Skeletal Radiol 2023; 52:649-669. [PMID: 36280619 DOI: 10.1007/s00256-022-04207-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 02/02/2023]
Abstract
Peripheral nerve sheath tumors comprise a significant percentage of both benign and malignant soft tissue tumors. The vast majority of these lesions are schwannomas and neurofibromas, which most radiologists are familiar with including the well-described multimodality imaging features. However, numerous additional often under-recognized benign entities associated with nerves exist. These rarer entities are becoming increasingly encountered with the proliferation of cross-sectional imaging, particularly magnetic resonance imaging (MRI). It is important for the radiologist to have a basic understanding of these entities as many have near-pathognomonic MR imaging features as well as specific clinical presentations that when interpreted in concert, often allows for a limited differential or single best diagnosis. The ability to provide a prospective, pre-intervention diagnosis based solely on imaging and clinical presentation is crucial as several of these entities are "do not touch" lesions, for which even a biopsy may have deleterious consequences. To our knowledge, the majority of these benign entities associated with nerves have only been described in scattered case reports or small case series. Therefore, the aim of this article is to provide a radiopathologic comprehensive review of these benign entities that arise in association with nerves with a focus on characteristic MRI features, unique histopathologic findings, and entity specific clinical exam findings/presentation.
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Affiliation(s)
- Marco G Aru
- Department of Diagnostic Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
| | - Jessica L Davis
- Department of Pathology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, L-471, Portland, OR, 97239, USA
| | - Gregory S Stacy
- Department of Diagnostic Radiology, University of Chicago, 5841 South Maryland Avenue, MC2026, Chicago, IL, 60637, USA
| | - Megan K Mills
- Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E, Rm #1A71, Salt Lake City, UT, 84132, USA
| | - Corrie M Yablon
- Department of Diagnostic Radiology, University of Michigan Health System, 1500 E. Medical Center Dr, TC2910Q, Ann Arbor, MI, 48109, USA
| | - Christopher J Hanrahan
- Department of Diagnostic Radiology, University of Utah School of Medicine, Intermountain Healthcare, Salt Lake City, UT, 84132, USA
| | - Raluca McCallum
- Department of Diagnostic Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Eric C Nomura
- Department of Pathology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, L-471, Portland, OR, 97239, USA
| | - Barry G Hansford
- Department of Diagnostic Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
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15
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Lenartowicz KA, Monie DD, Amrami KK, Klein CJ, Giannini C, Spinner RJ. Hybrid tumors with perineurioma components: a systematic review of the literature and illustrative case. Acta Neurochir (Wien) 2023; 165:935-945. [PMID: 36396843 PMCID: PMC10073291 DOI: 10.1007/s00701-022-05413-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/26/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Hybrid peripheral nerve sheath tumors (HPNST) are a newly recognized class of peripheral nerve sheath tumor, composed of at least two areas characteristic of perineurioma, schwannoma, or neurofibroma. The literature consists only of case reports and small series; therefore, we present an illustrative case and an analysis of all reported cases of HPNST with a perineurioma component in the literature. METHODS A systematic search of the literature was performed to identify all reported cases of hybrid perineurioma-schwannoma or perineurioma-neurofibroma in the world's literature. Individual cases were analyzed for demographics, clinical features, imaging, and outcomes. RESULTS A total of 159 cases were identified across 41 studies. Hybrid tumors tended to present in mid-adulthood (median 38.5 years), predominantly affected females (57%, 89/156), as a painless (63%, 63/100) mass, or swelling. Ten patients (10/74, 14%) had a history of neurofibromatosis 1, and 2 patients a history of neurofibromatosis 2 (2/74, 3%). The majority (78%, 122/157) of cases occurred superficially, most commonly in the lower extremity (25%, 39/157). Perineurioma-schwannoma was the most reported (86%, 137/159) pathologic diagnosis, with 3 cases presenting with malignant features. Two cases reocurred after resection. CONCLUSION HPNST tend to occur in mid-adulthood and present as slowly progressive, painless, superficial masses, with a heterogeneous appearance on imaging. These entities pose a unique diagnostic challenge and likely remain under-recognized in the literature and current clinical practice. They pose low risk of recurrence or malignant transformation, and future work regarding the association with neurofibromatosis and genetic profiles is needed.
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Affiliation(s)
- Karina A Lenartowicz
- Mayo Clinic Alix School of Medicine, Mayo Clinic, 200 First St SW, MN, 55905, Rochester, USA
| | - Dileep D Monie
- Mayo Clinic Alix School of Medicine, Mayo Clinic, 200 First St SW, MN, 55905, Rochester, USA
| | - Kimberly K Amrami
- Department of Radiology, Mayo Clinic, 200 First St SW, MN, 55905, Rochester, USA
| | - Christopher J Klein
- Department of Neurology, Mayo Clinic, 200 First St SW, MN, 55905, Rochester, USA
| | - Caterina Giannini
- Department of Anatomic Pathology, Mayo Clinic, 200 First St SW, MN, 55905, Rochester, USA
| | - Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, 200 First St SW, MN, 55905, Rochester, USA.
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16
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Pellerino A, Verdijk RM, Nichelli L, Andratschke NH, Idbaih A, Goldbrunner R. Diagnosis and Treatment of Peripheral and Cranial Nerve Tumors with Expert Recommendations: An EUropean Network for RAre CANcers (EURACAN) Initiative. Cancers (Basel) 2023; 15:cancers15071930. [PMID: 37046591 PMCID: PMC10093509 DOI: 10.3390/cancers15071930] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/12/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
The 2021 WHO classification of the CNS Tumors identifies as "Peripheral nerve sheath tumors" (PNST) some entities with specific clinical and anatomical characteristics, histological and molecular markers, imaging findings, and aggressiveness. The Task Force has reviewed the evidence of diagnostic and therapeutic interventions, which is particularly low due to the rarity, and drawn recommendations accordingly. Tumor diagnosis is primarily based on hematoxylin and eosin-stained sections and immunohistochemistry. Molecular analysis is not essential to establish the histological nature of these tumors, although genetic analyses on DNA extracted from PNST (neurofibromas/schwannomas) is required to diagnose mosaic forms of NF1 and SPS. MRI is the gold-standard to delineate the extension with respect to adjacent structures. Gross-total resection is the first choice, and can be curative in benign lesions; however, the extent of resection must be balanced with preservation of nerve functioning. Radiotherapy can be omitted in benign tumors after complete resection and in NF-related tumors, due to the theoretic risk of secondary malignancies in a tumor-suppressor syndrome. Systemic therapy should be considered in incomplete resected plexiform neurofibromas/MPNSTs. MEK inhibitor selumetinib can be used in NF1 children ≥2 years with inoperable/symptomatic plexiform neurofibromas, while anthracycline-based treatment is the first choice for unresectable/locally advanced/metastatic MPNST. Clinical trials on other MEK1-2 inhibitors alone or in combination with mTOR inhibitors are under investigation in plexiform neurofibromas and MPNST, respectively.
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Affiliation(s)
- Alessia Pellerino
- Division of Neuro-Oncology, Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, 10126 Turin, Italy
| | - Robert M Verdijk
- Department of Pathology, Section Ophthalmic Pathology, Erasmus MC University Medical Center Rotterdam, 3015 Rotterdam, The Netherlands
- Department of Pathology, Leiden University Medical Center, 2333 Leiden, The Netherlands
| | - Lucia Nichelli
- Department of Neuroradiology, Sorbonne Université, 75005 Paris, France
- Assistance Publique-Hôpitaux de Paris, 75610 Paris, France
- Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, 75013 Paris, France
| | - Nicolaus H Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, 8006 Zurich, Switzerland
| | - Ahmed Idbaih
- AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Sorbonne Université, 75005 Paris, France
- Inserm, CNRS, UMR S 1127, Institut du Cerveau-Paris Brain Institute, 75013 Paris, France
- ICM, Service de Neurologie 2-Mazarin, 75013 Paris, France
| | - Roland Goldbrunner
- Center for Neurosurgery, Department of General Neurosurgery, University of Cologne, 50923 Cologne, Germany
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17
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Dermawan JK, Villafania L, Bale T, Singer S, D’Angelo SP, Tap WD, Antonescu CR. TRAF7-mutated Fibromyxoid Spindle Cell Tumors Are Associated With an Aggressive Clinical Course and Harbor an Undifferentiated Sarcoma Methylation Signature: A Molecular and Clinicopathologic Study of 3 Cases. Am J Surg Pathol 2023; 47:270-277. [PMID: 36395468 PMCID: PMC9840690 DOI: 10.1097/pas.0000000000001997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
TRAF7 somatic mutations are rare and have been reported in meningiomas, intraneural perineuriomas, and mesotheliomas. Triggered by an index case of an unclassified low-grade mesenchymal tumor with TRAF7 mutation as the only genetic alteration, we searched our files and identified 2 additional cases with similar features. The tumors arose in 2 females and 1 male, aged 63 to 75 years old (median: 67 y). They were infiltrative deep soft tissue masses involving the shoulder, chest wall, and thigh, measuring 7.0 to 9.1 cm in greatest dimensions. One tumor was locally aggressive, and 2 were associated with lung and bone metastases. The tumors displayed alternating fibrous and myxoid stroma with mild to moderate cellularity and consisted of uniform spindle cells with open chromatin, inconspicuous nucleoli and scant cytoplasm. Significant mitotic activity or necrosis were not present. However, the metastatic tumor of 1 case showed an epithelioid morphology and brisk mitotic activity. Immunohistochemically, the tumors showed nonspecific and focal smooth muscle actin or CD34 expression. By DNA sequencing, all 3 cases harbored TRAF7 missense mutations involving the C-terminal WD40 domains as the only somatic mutations, showed nonrecurrent focal copy number alterations, and were negative for gene fusions by targeted RNA sequencing. On methylation profiling, the tumors clustered with the undifferentiated sarcoma and myxofibrosarcoma methylation classes and were distinct from morphologic mimics. On follow-up (5 to 36 mo), 2 patients died of disease following aggressive chemotherapeutic regimens. We describe a novel TRAF7- mutated mesenchymal tumor characterized by aggressive clinical behavior despite the histologic appearance of a low-grade fibromyxoid spindle cell tumor.
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Affiliation(s)
- Josephine K. Dermawan
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Liliana Villafania
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tejus Bale
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Samuel Singer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sandra P. D’Angelo
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William D. Tap
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cristina R. Antonescu
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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18
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A radiolucency in the posterior mandible. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 135:161-168. [PMID: 36229371 DOI: 10.1016/j.oooo.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 10/17/2022]
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19
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Plexal intraneural perineurioma: an analysis of the clinicoradiologic presentation of this rare variant. Acta Neurochir (Wien) 2023; 165:927-934. [PMID: 36596935 DOI: 10.1007/s00701-022-05442-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/23/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Intraneural (IN) perineurioma is a rare benign peripheral nerve sheath tumor, typically presenting as a painless, progressive mononeuropathy in adolescents. A rare plexal variant has been described, although there are little data describing its clinicoradiologic features. Herein, we present the largest case series of plexal IN perineuriomas reported in the literature. METHODS Electronic medical records (EMR) from 1990 to 2022 from a single academic institution were reviewed for a diagnosis of IN perineurioma involving the brachial or lumbosacral plexus. This identified 18 patients, of which 17 had available MR imaging. We reviewed the EMR for demographics, clinical presentation, imaging characteristics, and surgical outcomes. RESULTS Eighteen patients were identified. Most patients were male (11/18, 61%) and first developed symptoms at the age of 9.6 years (range 7 months to 55 years). Diagnosis occurred on average at the age of 22 years (4-57 years), which is significantly earlier than distal IN perineurioma (p = 0.0096). All patients (100%, 17/17) presented with motor polyneuropathy and muscular atrophy in multiple nerve distributions, with associated sensory loss (12/17, 71%). Most plexal lesions occurred in the brachial plexus (66%, 12/18). Five (29%, 5/17) patients presented with a hand/foot discrepancy, and 5 patients (29%) had a limb length discrepancy. Five patients underwent tendon transfer, of which two had failure of tendon transfer at most recent follow-up (50%, 2/4) due to progression of neurologic loss affecting the donors. Of patients managed nonoperatively, 87% of patients (6/7) with follow-up information demonstrated disease progression with worsening motor function or sensory loss, and 2 patients demonstrated progression on imaging at most recent follow-up. CONCLUSIONS Plexal perineurioma represents an uncommon variant of IN perineurioma that presents as a progressive motor and sensory polyneuropathy in childhood or early adolescence. Surgical management remains controversial, and tendon transfer tends to result in poor long-term surgical outcomes.
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20
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Rottmann D, Abdulfatah E, Pantanowitz L. Molecular testing of soft tissue tumors. Diagn Cytopathol 2023; 51:12-25. [PMID: 35808975 PMCID: PMC10084007 DOI: 10.1002/dc.25013] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/27/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The diagnosis of soft tissue tumors is challenging, especially when the evaluable material procured is limited. As a result, diagnostic ancillary testing is frequently needed. Moreover, there is a trend in soft tissue pathology toward increasing use of molecular results for tumor classification and prognostication. Hence, diagnosing newer tumor entities such as CIC-rearranged sarcoma explicitly requires molecular testing. Molecular testing can be accomplished by in situ hybridization, polymerase chain reaction, as well as next generation sequencing, and more recently such testing can even be accomplished leveraging an immunohistochemical proxy. CONCLUSION This review evaluates the role of different molecular tests in characterizing soft tissue tumors belonging to various cytomorphologic categories that have been sampled by small biopsy and cytologic techniques.
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Affiliation(s)
- Douglas Rottmann
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Eman Abdulfatah
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Liron Pantanowitz
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
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21
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Practical Approach to Histological Diagnosis of Peripheral Nerve Sheath Tumors: An Update. Diagnostics (Basel) 2022; 12:diagnostics12061463. [PMID: 35741273 PMCID: PMC9222088 DOI: 10.3390/diagnostics12061463] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 12/01/2022] Open
Abstract
Peripheral nerve sheath tumors encompass a wide spectrum of lesions with different biological behavior, including both benign and malignant neoplasms as well as the recent diagnostic category, i.e., “atypical neurofibromatous neoplasm with uncertain biologic potential” to be used only for NF1 patients. Neurofibromas and schwannomas are benign Schwann-cell-derived peripheral nerve sheath tumors arising as isolated lesions or within the context of classical neurofibromatosis or schwannomatoses. Multiple tumors are a hallmark of neurofibromatosis type 1(NF1) and related forms, NF2-related-schwannomatosis (formerly NF2) or SMARCB1/LZTR1-related schwannomatoses. Perineuriomas are benign, mostly sporadic, peripheral nerve sheath tumors that show morphological, immunohistochemical, and ultrastructural features reminiscent of perineurial differentiation. Hybrid tumors exist, with the most common lesions represented by a variable mixture of neurofibromas, schwannomas, and perineuriomas. Conversely, malignant peripheral nerve sheath tumors are soft tissue sarcomas that may arise from a peripheral nerve or a pre-existing neurofibroma, and in about 50% of cases, these tumors are associated with NF1. The present review emphasizes the main clinicopathologic features of each pathological entity, focusing on the diagnostic clues and unusual morphological variants.
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22
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Maldonado AA, Spinner RJ, Carter JM, Klein CJ. LETTER TO EDITOR: "Orofacial overgrowth with peripheral nerve enlargement and perineuriomatous pseudo-onion bulb proliferations is part of the PIK3CA-related overgrowth spectrum". HGG ADVANCES 2022; 3:100110. [PMID: 35519824 PMCID: PMC9065421 DOI: 10.1016/j.xhgg.2022.100110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Robert J. Spinner
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
- Corresponding author
| | - Jodi M. Carter
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
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23
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Ebner BA, Eschbacher KL, Jack MM, Dragana M, Spinner RJ, Giannini C. Brachial plexus lipomatosis with perineurial pseudoonion bulb formation: Result of a mosaic PIK3CA mutation in the para-axial mesoderm state. Brain Pathol 2022; 32:e13057. [PMID: 35224812 PMCID: PMC9245934 DOI: 10.1111/bpa.13057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- Blake A. Ebner
- Department of Laboratory Medicine and PathologyMayo ClinicRochesterMinnesotaUSA
| | | | - Megan M. Jack
- Department of NeurosurgeryMayo ClinicRochesterMinnesotaUSA
| | - Milosevic Dragana
- Department of Laboratory Medicine and PathologyMayo ClinicRochesterMinnesotaUSA
| | | | - Caterina Giannini
- Department of Laboratory Medicine and PathologyMayo ClinicRochesterMinnesotaUSA
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24
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Gomes CC. Recurrent driver mutations in benign tumors. MUTATION RESEARCH. REVIEWS IN MUTATION RESEARCH 2022; 789:108412. [PMID: 35690415 DOI: 10.1016/j.mrrev.2022.108412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/02/2022] [Accepted: 02/09/2022] [Indexed: 06/15/2023]
Abstract
The understanding of the molecular pathogenesis of benign tumors may bring essential information to clarify the process of tumorigenesis, and ultimately improve the understanding of events such as malignant transformation. The definition of benign neoplasia is not always straightforward and herein the issues surrounding this concept are discussed. Benign neoplasms share all cancer hallmarks with malignancies, except for metastatic potential. Recently, next-generation sequencing has provided unprecedented opportunities to unravel the genetic basis of benign neoplasms and, so far, we have learned that benign neoplasms are indeed characterized by the presence of genetic mutations, including genes rearrangements. Driver mutations in advanced cancer are those that confer growth advantage, and which have been positively selected during cancer evolution. Herein, some discussion will be brought about this concept in the context of cancer prevention, involving precursor lesions and benign neoplasms. When considering early detection and cancer prevention, a driver mutation should not only be advantageous (i.e., confer survival advantage), but predisposing (i.e., promoting a cancer phenotype). By including the benign counterparts of malignant neoplasms in tumor biology studies, it is possible to evaluate the risk posed by a given mutation and to differentiate advantageous from predisposing mutations, further refining the concept of driver mutations. Therefore, the study of benign neoplasms should be encouraged because it provides valuable information on tumorigenesis central for understanding the progression from initiation to malignant transformation.
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Affiliation(s)
- Carolina Cavalieri Gomes
- Department of Pathology, Biological Sciences Institute, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
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25
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Zhang Q, Zhang X, Dong W. TRAF7 contributes to tumor progression by promoting ubiquitin-proteasome mediated degradation of P53 in hepatocellular carcinoma. Cell Death Discov 2021; 7:352. [PMID: 34775479 PMCID: PMC8590685 DOI: 10.1038/s41420-021-00749-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/20/2021] [Accepted: 11/01/2021] [Indexed: 12/24/2022] Open
Abstract
It has been proved that TRAFs family proteins played malfunctioning roles in the development of human cancers. TRAF7 is the last one of TRAFs family proteins to be found, which was demonstrated to be involved in a serious of cancers development. In this study, we systematically investigated the molecular mechanisms of TRAF7 in facilitating hepatocellular carcinoma (HCC). We discovered that TRAF7 was overexpressed in tumor tissues and the increased TRAF7 expression was closely associated with tumor size, histologic grade, TNM stage and poor prognostication. TRAF7 overexpression repressed cell apoptosis and promoted cell proliferation, invasion and migration, whereas knockdown of TRAF7 in HCC cells had totally opposite effects. Besides, we identified the interaction between TRAF7 and P53 in HCC and demonstrated that TRAF7 promoted ubiquitin-proteasome mediated degradation of P53 at K48 site. The rescue assays further proved that the function of TRAF7 in inhibiting apoptosis and promoting tumor development was depended on P53 in HCC. Overall, this work identified that TARF7 promoted tumorigenesis by targeted degradation P53 for ubiquitin-mediated proteasome pathway. Targeting the TRAF7-P53 axis may provide new insights in the pathogenesis of HCC, and pave the way for developing novel strategies for HCC prevention and treatment.
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Affiliation(s)
- Qi Zhang
- Department of General Medicine, Renmin Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Xinqi Zhang
- Department of General Medicine, Renmin Hospital of Wuhan University, Wuhan, 430071, Hubei, China.
| | - Weiguo Dong
- Department of General Medicine, Renmin Hospital of Wuhan University, Wuhan, 430071, Hubei, China.
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26
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Paprocka J, Nowak M, Nieć M, Janik I, Rydzanicz M, Robert Ś, Klaniewska M, Rutkowska K, Płoski R, Jezela-Stanek A. Case Report: Blepharophimosis and Ptosis as Leading Dysmorphic Features of Rare Congenital Malformation Syndrome With Developmental Delay - New Cases With TRAF7 Variants. Front Med (Lausanne) 2021; 8:708717. [PMID: 34513876 PMCID: PMC8428514 DOI: 10.3389/fmed.2021.708717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/27/2021] [Indexed: 12/18/2022] Open
Abstract
Germline variants in tumor necrosis factor receptor-associated factor 7 (TRAF7) gene have recently been described in about 50 patients with developmental delay and cardiac, facial, and digital anomalies (CAFDADD). We aimed to depict further the clinical and genetic spectrum associated with TRAF7 germline variants in two additional patients, broaden the mutational spectrum, and support the characteristic clinical variety to facilitate the diagnostics of the syndrome among physician involved in the evaluation of patients with developmental delay/congenital malformations.
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Affiliation(s)
- Justyna Paprocka
- Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Magdalena Nowak
- Students' Scientific Society, Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Maria Nieć
- Students' Scientific Society, Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Izabela Janik
- Students' Scientific Society, Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | | | - Śmigiel Robert
- Department of Paediatrics, Division of Propaedeutic of Paediatrics and Rare Disorders, Wroclaw Medical University, Wroclaw, Poland
| | - Magdalena Klaniewska
- Department of Paediatrics, Division of Propaedeutic of Paediatrics and Rare Disorders, Wroclaw Medical University, Wroclaw, Poland
| | - Karolina Rutkowska
- Department of Medical Genetics, Medical University of Warsaw, Warsaw, Poland
| | - Rafał Płoski
- Department of Medical Genetics, Medical University of Warsaw, Warsaw, Poland
| | - Aleksandra Jezela-Stanek
- Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
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27
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Spinner RJ. A novel mechanism for the formation and propagation of neural tumors and lesions through neural highways. Clin Anat 2021; 34:1165-1172. [PMID: 34309059 DOI: 10.1002/ca.23768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 07/09/2021] [Accepted: 07/10/2021] [Indexed: 12/25/2022]
Abstract
By recognizing anatomic and radiologic patterns of rare and often misdiagnosed peripheral nerve tumors/lesions, we have defined mechanisms for the propagation of neural diseases. The novel concept of the nervous system serving as a complex system of "highways" driving the neural and perineural spread of these lesions is described in three examples: Intraneural dissection of joint fluid in intraneural ganglion cysts, perineural spread of cancer cells, and dissemination of unknown concentrations of neurotrophic/inhibitory factors for growth in hamartomas/choristomas of nerve. Further mapping of these pathways to identify the natural history of diseases, the spectrum of disease evolution, the role of genetic mutations, and how these neural pathways interface with the lymphatic, vascular, and cerebrospinal systems may lead to advances in targeted treatments.
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Affiliation(s)
- Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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28
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Lenartowicz KA, Goyal A, Mauermann ML, Wilson TJ, Spinner RJ. Clinical Features, Natural History, and Outcomes of Intraneural Perineuriomas: A Systematic Review of the Literature. World Neurosurg 2021; 154:120-131.e8. [PMID: 34284162 DOI: 10.1016/j.wneu.2021.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intraneural perineurioma is a rare peripheral nerve sheath tumor characterized by localized proliferation of perineurial cells. The literature consists predominantly of case reports and institutional series, with inconsistent and confusing nomenclature. We present a pooled analysis of all reported cases of intraneural perineurioma in the literature. METHODS A systematic search of PubMed, MEDLINE, Embase, and Scopus was performed according to PRISMA guidelines to identify all reported cases of intraneural perineurioma in the literature. Individual cases were pooled and analyzed for demographics, clinical features, and outcomes. RESULTS A total of 172 cases were identified across 72 studies, of which 149 were found in major peripheral nerves and their branches. Median age of patients at diagnosis and onset of symptoms was 18 years (interquartile range [IQR], 12-34 years) years and 13.5 years (IQR, 8-26 years), respectively, with 54.4% (81/149) being female. The most common sites were the sciatic nerve or its branches (41.9%), median nerve (13.5%), radial nerve (12.2%), and brachial plexus (12.2%). Most patients were managed conservatively (52.9%; 72/136). Among those managed conservatively with available follow-up (n = 31), median follow-up was 11 months, and most (67.7%, n = 21) reported no change in neurologic status, although worsening was noted in 29.0% (9/31). Among surgically managed cases (n = 64), the most common intervention was resection with or without repair (62.5%; 40/64), neurolysis (25%; 16/64), or tendon transfers without resection (12.5%; 8/64). No lesion recurred after surgical resection. CONCLUSIONS Intraneural perineurioma represents a benign focal lesion presenting with weakness and atrophy affecting adolescents and young adults. Most cases are managed nonoperatively and surgical treatment strategies are varied.
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Affiliation(s)
| | - Anshit Goyal
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Thomas J Wilson
- Department of Neurologic Surgery, Stanford University, Palo Alto, California, USA
| | - Robert J Spinner
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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29
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Najm P, Zhao P, Steklov M, Sewduth RN, Baietti MF, Pandolfi S, Criem N, Lechat B, Maia TM, Van Haver D, Corthout N, Eyckerman S, Impens F, Sablina AA. Loss-of-Function Mutations in TRAF7 and KLF4 Cooperatively Activate RAS-Like GTPase Signaling and Promote Meningioma Development. Cancer Res 2021; 81:4218-4229. [PMID: 34215617 DOI: 10.1158/0008-5472.can-20-3669] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 03/02/2021] [Accepted: 06/29/2021] [Indexed: 11/16/2022]
Abstract
Meningiomas are the most common benign brain tumors. Mutations of the E3 ubiquitin ligase TRAF7 occur in 25% of meningiomas and commonly cooccur with mutations in KLF4, yet the functional link between TRAF7 and KLF4 mutations remains unclear. By generating an in vitro meningioma model derived from primary meningeal cells, we elucidated the cooperative interactions that promote meningioma development. By integrating TRAF7-driven ubiquitinome and proteome alterations in meningeal cells and the TRAF7 interactome, we identified TRAF7 as a proteostatic regulator of RAS-related small GTPases. Meningioma-associated TRAF7 mutations disrupted either its catalytic activity or its interaction with RAS GTPases. TRAF7 loss in meningeal cells altered actin dynamics and promoted anchorage-independent growth by inducing CDC42 and RAS signaling. TRAF deficiency-driven activation of the RAS/MAPK pathway promoted KLF4-dependent transcription that led to upregulation of the tumor-suppressive Semaphorin pathway, a negative regulator of small GTPases. KLF4 loss of function disrupted this negative feedback loop and enhanced mutant TRAF7-mediated cell transformation. Overall, this study provides new mechanistic insights into meningioma development, which could lead to novel treatment strategies. SIGNIFICANCE: The intricate molecular cross-talk between the ubiquitin ligase TRAF7 and the transcription factor KLF4 provides a first step toward the identification of new therapies for patients with meningioma.
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Affiliation(s)
- Paul Najm
- VIB-KU Leuven Center for Cancer Biology, Leuven, Belgium.,Department of Oncology, KU Leuven, Leuven, Belgium
| | - Peihua Zhao
- VIB-KU Leuven Center for Cancer Biology, Leuven, Belgium.,Department of Oncology, KU Leuven, Leuven, Belgium
| | - Mikhail Steklov
- VIB-KU Leuven Center for Cancer Biology, Leuven, Belgium.,Department of Oncology, KU Leuven, Leuven, Belgium
| | - Raj Nayan Sewduth
- VIB-KU Leuven Center for Cancer Biology, Leuven, Belgium.,Department of Oncology, KU Leuven, Leuven, Belgium
| | - Maria Francesca Baietti
- VIB-KU Leuven Center for Cancer Biology, Leuven, Belgium.,Department of Oncology, KU Leuven, Leuven, Belgium
| | - Silvia Pandolfi
- VIB-KU Leuven Center for Cancer Biology, Leuven, Belgium.,Department of Oncology, KU Leuven, Leuven, Belgium
| | - Nathan Criem
- VIB-KU Leuven Center for Cancer Biology, Leuven, Belgium.,Department of Oncology, KU Leuven, Leuven, Belgium
| | - Benoit Lechat
- VIB-KU Leuven Center for Cancer Biology, Leuven, Belgium.,Department of Oncology, KU Leuven, Leuven, Belgium
| | - Teresa Mendes Maia
- VIB Center for Medical Biotechnology, Ghent, Belgium.,Department of Biomolecular Medicine, Ghent University, Ghent, Belgium.,VIB Proteomics Core, VIB-UGent Center for Medical Biotechnology, Ghent, Belgium
| | - Delphi Van Haver
- VIB Center for Medical Biotechnology, Ghent, Belgium.,Department of Biomolecular Medicine, Ghent University, Ghent, Belgium.,VIB Proteomics Core, VIB-UGent Center for Medical Biotechnology, Ghent, Belgium
| | - Nikky Corthout
- VIB LiMoNe & Leuven Bio Imaging Core, VIB-KU Leuven Center For Brain & Disease Research, Leuven, Belgium
| | - Sven Eyckerman
- VIB Center for Medical Biotechnology, Ghent, Belgium.,Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Francis Impens
- VIB Center for Medical Biotechnology, Ghent, Belgium.,Department of Biomolecular Medicine, Ghent University, Ghent, Belgium.,VIB Proteomics Core, VIB-UGent Center for Medical Biotechnology, Ghent, Belgium
| | - Anna A Sablina
- VIB-KU Leuven Center for Cancer Biology, Leuven, Belgium. .,Department of Oncology, KU Leuven, Leuven, Belgium
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30
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Dickson BC, Antonescu CR, Demicco EG, Leong I, Anderson ND, Swanson D, Zhang L, Fletcher CD, Hornick JL. Hybrid schwannoma-perineurioma frequently harbors VGLL3 rearrangement. Mod Pathol 2021; 34:1116-1124. [PMID: 33649458 PMCID: PMC8154639 DOI: 10.1038/s41379-021-00783-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 12/11/2022]
Abstract
Benign peripheral nerve tumors include schwannoma, neurofibroma, and perineurioma, as well as a recently recognized group of tumors with dual patterns of differentiation. The molecular pathogenesis of these so-called "hybrid" tumors remains poorly understood. Following identification of a novel CHD7-VGLL3 fusion gene in a hybrid schwannoma-perineurioma, we evaluated an expanded cohort of this tumor-type-as well as tumors with VGLL3 rearrangement identified from a curated molecular database-to characterize the prevalence of fusion genes among these tumors. Eighteen tumors met the inclusion criteria for this study. RNA sequencing identified VGLL3 rearrangement in 14 of these cases; the partner genes included CHD7 (ten cases), CHD9 (two cases), and MAMLD1 (two cases). Two cases possessed altogether unrelated fusions, including: DST-BRAF and SQSTM1-CDX1 fusion genes. Finally, two cases lacked identifiable fusion products. These findings highlight the molecular diversity of these neoplasms, with frequent rearrangement of VGLL3. More importantly, despite their dual pattern of differentiation, our results reveal the pathogenesis of hybrid schwannoma-perineurioma is unrelated to conventional schwannoma and perineurioma, thereby implying this tumor represents an altogether pathologically distinct entity.
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Affiliation(s)
- Brendan C. Dickson
- Department of Pathology & Laboratory Medicine, Mount Sinai Hospital, 600 University Ave, Toronto, Ontario, Canada M5G 1X5; Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto, Ontario, Canada,Corresponding Authors: Brendan C. Dickson, MD, MSc, Pathology & Laboratory Medicine, Mount Sinai Hospital, 600 University Ave, Suite 6.500.12.5, Toronto, Ontario, Canada M5G 1X5, P: (416) 586-4800 / F: (416) 586-8628, ; Jason L. Hornick, MD, PhD, Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts, USA 02115, P: (617) 525-7257 / F: (617) 566-3897,
| | | | - Elizabeth G. Demicco
- Department of Pathology & Laboratory Medicine, Mount Sinai Hospital, 600 University Ave, Toronto, Ontario, Canada M5G 1X5; Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Iona Leong
- Department of Pathology & Laboratory Medicine, Mount Sinai Hospital, 600 University Ave, Toronto, Ontario, Canada M5G 1X5; Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nathaniel D. Anderson
- Cellular Genetics Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - David Swanson
- Department of Pathology & Laboratory Medicine, Mount Sinai Hospital, 600 University Ave, Toronto, Ontario, Canada M5G 1X5; Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lei Zhang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christopher D.M. Fletcher
- Department of Pathology, Brigham and Women’s Hospital, 75 Francis Street, Boston, Massachusetts, USA, 02115; Harvard Medical School, Boston, Massachusetts, USA
| | - Jason L. Hornick
- Department of Pathology, Brigham and Women’s Hospital, 75 Francis Street, Boston, Massachusetts, USA, 02115; Harvard Medical School, Boston, Massachusetts, USA,Corresponding Authors: Brendan C. Dickson, MD, MSc, Pathology & Laboratory Medicine, Mount Sinai Hospital, 600 University Ave, Suite 6.500.12.5, Toronto, Ontario, Canada M5G 1X5, P: (416) 586-4800 / F: (416) 586-8628, ; Jason L. Hornick, MD, PhD, Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts, USA 02115, P: (617) 525-7257 / F: (617) 566-3897,
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31
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Manzoor NF, Harmsen H, Perkins EL, Aulino JM, Haynes DS. Facial Nerve Intraneural Perineurioma Masquerading as a Schwannoma. JAMA Otolaryngol Head Neck Surg 2021; 146:970-972. [PMID: 32857124 DOI: 10.1001/jamaoto.2020.2098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Nauman F Manzoor
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hannah Harmsen
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elizabeth L Perkins
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joseph M Aulino
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David S Haynes
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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32
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Panagopoulos I, Gorunova L, Andersen K, Tafjord S, Lund-Iversen M, Lobmaier I, Micci F, Heim S. Recurrent Fusion of the GRB2 Associated Binding Protein 1 ( GAB1) Gene With ABL Proto-oncogene 1 ( ABL1) in Benign Pediatric Soft Tissue Tumors. Cancer Genomics Proteomics 2021; 17:499-508. [PMID: 32859628 DOI: 10.21873/cgp.20206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/22/2020] [Accepted: 06/01/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND/AIM Fusions of the ABL proto-oncogene 1 gene (ABL1 in 9q34) are common in leukemias but rare in solid tumors. The most notable is the t(9;22)(q34;q11)/BCR-ABL1 coding for a chimeric tyrosine kinase. We herein report an ABL1-fusion in a pediatric tumor. MATERIALS AND METHODS G-banding, fluorescence in situ hybridization, reverse transcription polymerase chain reaction and Sanger sequencing were performed on a soft tissue perineurioma found in the left musculus erector spinae of a child. RESULTS A der(4)t(4;9)(q31;q34) and a fusion of the GRB2 associated binding protein 1 (GAB1 in 4q31) gene with ABL1 were found. A literature search revealed 3 more cases with similar genetic and clinicopathological characteristics: a soft tissue perineurioma with t(2;9;4)(p23;q34;q31) and ABL1 rearrangement, a soft tissue angiofibroma with a GAB1-ABL1 chimeric gene, and a solitary fibrous tumor carrying a der(4)t(4;9)(q31.1;q34). CONCLUSION GAB1-ABL1 is a recurrent fusion gene in benign pediatric tumors.
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Affiliation(s)
- Ioannis Panagopoulos
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Ludmila Gorunova
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Kristin Andersen
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Svetlana Tafjord
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Marius Lund-Iversen
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Ingvild Lobmaier
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Francesca Micci
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Sverre Heim
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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33
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Belakhoua SM, Rodriguez FJ. Diagnostic Pathology of Tumors of Peripheral Nerve. Neurosurgery 2021; 88:443-456. [PMID: 33588442 DOI: 10.1093/neuros/nyab021] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 09/09/2021] [Indexed: 02/07/2023] Open
Abstract
Neoplasms of the peripheral nervous system represent a heterogenous group with a wide spectrum of morphological features and biological potential. They range from benign and curable by complete excision (schwannoma and soft tissue perineurioma) to benign but potentially aggressive at the local level (plexiform neurofibroma) to the highly malignant (malignant peripheral nerve sheath tumors [MPNST]). In this review, we discuss the diagnostic and pathologic features of common peripheral nerve sheath tumors, particularly those that may be encountered in the intracranial compartment or in the spine and paraspinal region. The discussion will cover schwannoma, neurofibroma, atypical neurofibromatous neoplasms of uncertain biological potential, intraneural and soft tissue perineurioma, hybrid nerve sheath tumors, MPNST, and the recently renamed enigmatic tumor, malignant melanotic nerve sheath tumor, formerly referred to as melanotic schwannoma. We also discuss the diagnostic relevance of these neoplasms to specific genetic and familial syndromes of nerve, including neurofibromatosis 1, neurofibromatosis 2, and schwannomatosis. In addition, we discuss updates in our understanding of the molecular alterations that represent key drivers of these neoplasms, including neurofibromatosis type 1 and type 2, SMARCB1, LZTR1, and PRKAR1A loss, as well as the acquisition of CDKN2A/B mutations and alterations in the polycomb repressor complex members (SUZ12 and EED) in the malignant progression to MPNST. In summary, this review covers practical aspects of pathologic diagnosis with updates relevant to neurosurgical practice.
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Affiliation(s)
- Sarra M Belakhoua
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- School of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Fausto J Rodriguez
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Sydney Kimmel Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Itami H, Fujii T, Nakai T, Takeda M, Kishi Y, Taniguchi F, Terada C, Okada F, Nitta Y, Matsuoka M, Sasaki S, Sugimoto S, Uchiyama T, Morita K, Kasai T, Kawaguchi R, Ohbayashi C. TRAF7 mutations and immunohistochemical study of uterine adenomatoid tumor compared with malignant mesothelioma. Hum Pathol 2021; 111:59-66. [PMID: 33667423 DOI: 10.1016/j.humpath.2021.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/17/2021] [Accepted: 02/22/2021] [Indexed: 12/12/2022]
Abstract
Adenomatoid tumors (ATs) are benign mesothelial tumors with a good prognosis and usually occur in female and male genital tracts, including in the uterus. ATs are genetically defined by tumor necrosis factor receptor-associated factor (TRAF) 7 mutations, and a high number of AT cases show immunosuppression. On the other hand, malignant mesotheliomas (MMs) are malignant mesothelial tumors with a very poor prognosis. Genetic alterations in TRAF, methylthioadenosine phosphorylase(MTAP), and BRCA-associated nuclear protein 1 (BAP1) in ATs derived from the uterus and MMs of pleural or peritoneal origin were compared by gene sequence analysis or immunohistochemical approaches. Formalin-fixed paraffin-embedded tissues derived from patients were used for immunohistochemical staining of L1 cell adhesion molecule (L1CAM), BAP1, MTAP, and sialylated protein HEG homolog 1 (HEG1) in 51 uterine AT cases and 34 pleural or peritoneal MM cases and for next-generation sequencing of the TRAF7 gene in 44 AT cases and 21 MM cases. ATs had a significantly higher rate of L1CAM expression than MMs, whereas MMs had a significantly higher rate of loss of MTAP and BAP1 expression than ATs. There was no difference in the rate of HEG1 expression between the tumor types. Most of the ATs (37/44; 84%) had somatic mutations in TRAF7, but none of the MMs had somatic mutations in TRAF7 (0/21; 0%). In addition, a low number of AT cases were associated with a history of immunosuppression (9/51; 17.6%). TRAF7 mutation is one of the major factors distinguishing the development of AT from MM, and immunosuppression might not be associated with most AT cases.
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Affiliation(s)
- Hiroe Itami
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan.
| | - Tomomi Fujii
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
| | - Tokiko Nakai
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
| | - Maiko Takeda
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan; Department of Laboratory Medicine and Pathology, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Yohei Kishi
- Department of Obstetrics and Gynecology, Takanohara Central Hospital, Nara, Japan
| | - Fumiaki Taniguchi
- Department of Obstetrics and Gynecology, Takanohara Central Hospital, Nara, Japan
| | - Chiyoko Terada
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
| | - Fumi Okada
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
| | - Yuji Nitta
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
| | - Minami Matsuoka
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
| | - Shoh Sasaki
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
| | - Sumire Sugimoto
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
| | - Tomoko Uchiyama
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
| | - Kohei Morita
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
| | - Takahiko Kasai
- Department of Laboratory Medicine and Pathology, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Ryuji Kawaguchi
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Japan
| | - Chiho Ohbayashi
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
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Everson MC, Pendleton C, Jack MM, Smith BW, Carter JM, Spinner RJ. Sporadic Malignant Perineurioma: A Rare Diagnosis Among Malignant Peripheral Nerve Sheath Tumors. World Neurosurg 2021; 149:e36-e41. [PMID: 33647483 DOI: 10.1016/j.wneu.2021.02.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/21/2021] [Accepted: 02/21/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Malignant perineurioma is a rare subset of malignant peripheral nerve sheath tumors (MPNSTs) with ultrastructural and immunohistochemical features of perineurial differentiation, distinguishing it from other MPNSTs, which typically demonstrate Schwannian features. The clinical course and prognosis of this rare tumor is not well defined. METHODS The electronic medical records were searched for patients with a diagnosis of MPNST. Patients with a pathologic diagnosis of malignant perineurioma or MPNST with perineurial features were identified and further evaluated. RESULTS Five patients with malignant perineurioma, or MPNST with perineurial features, were identified. Four patients (2 male and 2 female) were included with tumors associated with a common digital nerve, small muscular branch to the deltoid, sciatic nerve, and accessory nerve. One patient with the pathology diagnosis meeting inclusion criteria was excluded, as no clinical information was available for this patient. CONCLUSIONS Patients in our series presented at varied stages of disease. Clinical courses after diagnosis of malignant perineurioma, where follow-up was available, were largely uncomplicated with regard to recurrence and metastatic disease. Careful follow-up is indicated, and further work is needed to characterize the clinical course of these rare tumors.
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Affiliation(s)
- Megan C Everson
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
| | - Courtney Pendleton
- Department of Neurologic Surgery, Stony Brook University, Stony Brook, New York, USA
| | - Megan M Jack
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Brandon W Smith
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jodi M Carter
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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36
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Vizcaino MA, Belzberg A, Ahlawat S, Belakhoua S, Chen L, Staedtke V, Rodriguez FJ. Localized Hypertrophic Neuropathy as a Neoplastic Manifestation of KRAS-Mediated RASopathy. J Neuropathol Exp Neurol 2020; 79:647-651. [PMID: 32388560 DOI: 10.1093/jnen/nlaa034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Indexed: 12/12/2022] Open
Abstract
Localized hypertrophic neuropathy is a rare Schwann cell proliferation that usually affects single nerves from the extremities, and it is of unclear etiology in its pure form. RASopathies are a defined group of genetic diseases with overlapping clinical features, usually secondary to germline mutations in genes encoding either components or regulators of the RAS/MAPK pathway. Herein, we report an 11-year-old boy presenting with café au lait spots and right leg length discrepancy. A fascicular nerve biopsy of the tibial nerve demonstrated a Schwann cell proliferation with prominent onion-bulb formation, satisfying criteria for localized hypertrophic neuropathy. Molecular genetic analysis demonstrated identical KRAS mutations (c38_40dupGCG) in the peripheral nerve lesion and melanocytes from café au lait spots, but not in blood, supporting a diagnosis of a KRAS-mediated rasopathy with mosaicism. Immunohistochemical staining in the peripheral nerve lesion demonstrated strong pERK staining consistent with downstream MAPK pathway activation. This report suggests that at least a subset of localized hypertrophic neuropathies are bonafide, well-differentiated Schwann cell neoplasms developing through oncogenic RAS signaling, which provides new insights into the controversial entity historically known as localized hypertrophic neuropathy.
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Affiliation(s)
- M Adelita Vizcaino
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Allan Belzberg
- Department of Neurosurgery, Baltimore, Maryland.,Sydney Kimmel Cancer Center, Baltimore, Maryland
| | | | - Sarra Belakhoua
- Department of Pathology, Baltimore, Maryland.,Johns Hopkins University School of Medicine, Baltimore, Maryland.,University of Tunis el Manar School of Medicine, Tunis, Tunisia
| | - Liam Chen
- Department of Pathology, Baltimore, Maryland
| | - Verena Staedtke
- Department of Neurology, Baltimore, Maryland.,Sydney Kimmel Cancer Center, Baltimore, Maryland
| | - Fausto J Rodriguez
- Department of Pathology, Baltimore, Maryland.,Department of Ophthalmology, Baltimore, Maryland.,Sydney Kimmel Cancer Center, Baltimore, Maryland
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Zhou HY, Jiang S, Ma FX, Lu H. Peripheral nerve tumors of the hand: Clinical features, diagnosis, and treatment. World J Clin Cases 2020; 8:5086-5098. [PMID: 33269245 PMCID: PMC7674743 DOI: 10.12998/wjcc.v8.i21.5086] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/15/2020] [Accepted: 09/25/2020] [Indexed: 02/05/2023] Open
Abstract
The majority of the tumors arising from the peripheral nerves of the hand are relatively benign. However, a tumor diagnosed as malignant peripheral nerve sheath tumor (MPNST) has destructive consequences. Clinical signs and symptoms are usually caused by direct and indirect effects of the tumor, such as nerve invasion or compression and infiltration of surrounding tissues. Definitive diagnosis is made by tumor biopsy. Complete surgical removal with maximum reservation of residual neurologic function is the most appropriate intervention for most symptomatic benign peripheral nerve tumors (PNTs) of the hand; however, MPNSTs require surgical resection with a sufficiently wide margin or even amputation to improve prognosis. In this article, we review the clinical presentation and radiographic features, summarize the evidence for an accurate diagnosis, and discuss the available treatment options for PNTs of the hand.
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Affiliation(s)
- Hai-Ying Zhou
- Department of Orthopedics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Shuai Jiang
- Department of Orthopedics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Fei-Xia Ma
- Department of Breast Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
| | - Hui Lu
- Department of Orthopedics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
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38
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Zhou W, Lin D, Zhong Z, Ye Q. Roles of TRAFs in Ischemia-Reperfusion Injury. Front Cell Dev Biol 2020; 8:586487. [PMID: 33224951 PMCID: PMC7674171 DOI: 10.3389/fcell.2020.586487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/05/2020] [Indexed: 12/13/2022] Open
Abstract
Tumor necrosis factor receptor-associated factor (TRAF) proteins are a family of signaling molecules that function downstream of multiple receptor signaling pathways, and they play a pivotal role in the regulation of intracellular biological progresses. These TRAF-dependent signaling pathways and physiological functions have been involved in the occurrence and progression of ischemia-reperfusion injury (IRI), which is a common pathophysiological process that occurs in a wide variety of clinical events, including ischemic shock, organ transplantation, and thrombolytic therapy, resulting in a poor prognosis and high mortality. IRI occurs in multiple organs, including liver, kidney, heart, lung, brain, intestine, and retina. In recent years, mounting compelling evidence has confirmed that the genetic alterations of TRAFs can cause subversive phenotype changes during IRI of those organs. In this review, based on current knowledge, we summarized and analyzed the regulatory effect of TRAFs on the IRI of various organs, providing clear direction and a firm theoretical basis for the development of treatment strategies to manipulate TRAF proteins or TRAF-dependent signaling pathways in IRI-related diseases.
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Affiliation(s)
- Wei Zhou
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Engineering Research Center of Natural Polymer-based Medical Materials in Hubei Province, Wuhan, China
| | - Danni Lin
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Engineering Research Center of Natural Polymer-based Medical Materials in Hubei Province, Wuhan, China.,The First Affiliated Hospital, Zhejiang University School of Medicine, Department of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial Key Laboratory of Pancreatic Disease, Innovation Center for the Study of Pancreatic Diseases, Hangzhou, China
| | - Zibiao Zhong
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Engineering Research Center of Natural Polymer-based Medical Materials in Hubei Province, Wuhan, China
| | - Qifa Ye
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Engineering Research Center of Natural Polymer-based Medical Materials in Hubei Province, Wuhan, China.,The Third Xiangya Hospital of Central South University, Research Center of National Health Ministry on Transplantation Medicine Engineering and Technology, Changsha, China
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39
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Association of intraneural perineurioma with neurofibromatosis type 2. Acta Neurochir (Wien) 2020; 162:1891-1897. [PMID: 32529330 DOI: 10.1007/s00701-020-04439-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/27/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Neurofibromatosis type 2 (NF2) is a genetic disorder characterized by mutations of the NF2 tumor suppressor gene that predisposes patients to develop multiple tumors in the peripheral and central nervous system. The most common neoplasms associated with the disease are schwannomas and meningiomas. Both have been shown to contain abnormalities in chromosome 22 and the NF2 gene, suggesting a genetic component to their pathogenesis. Perineuriomas are rare benign tumors arising from the perineural cells. They are commonly classified as intraneural and soft tissue perineuriomas. Several studies have reported mutations in genes on chromosome 22 in both types of perineuriomas, and there are reports of soft tissue perineuriomas associated with NF2 gene mutations. Despite this, perineuriomas are not considered as part of the NF2 constellation of tumors. METHOD The electronic medical records were searched for patients with a radiologic or pathologic diagnosis of intraneural perineurioma. Patients with clinical signs and genetic testing consistent with a diagnosis of NF2 were further evaluated. RESULTS Of 112 patients meeting inclusion criteria, there were two cases of intraneural perineurioma in patients with NF2 treated at our institution (1.8%). We include a third patient treated at another facility for whom we performed a virtual consultation. CONCLUSIONS The rarity of both NF2 and perineuriomas could explain the rarity of perineuriomas in the setting of NF2. Furthermore, there is divergent intraneural and soft tissue perineurioma somatic mutation pathogenesis, and there may be cytogenetic overlap between perineuriomas and multiple tumor syndromes. Our observed occurrence of intraneural perineurioma in the setting of NF2 in several patients provides further evidence of a potential link between the NF2 gene and the development of intraneural perineurioma.
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40
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Limb Undergrowth in Intraneural Perineuriomas: An Under-Recognized Association. World Neurosurg 2020; 141:e670-e676. [PMID: 32522650 DOI: 10.1016/j.wneu.2020.05.280] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/28/2020] [Accepted: 05/30/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Intraneural (IN) perineuriomas are a rare benign hypertrophic nerve tumor, most frequently occurring in young patients. Patients with IN perineurioma have been anecdotally found to have limb undergrowth; however, this has not been systematically evaluated. METHODS Archived electronic records from 1990 to 2018 from a single institution were reviewed for pathology or radiology reports documenting a diagnosis of IN perineurioma. This identified 111 patients; 3 patients with IN perineurioma of cranial nerves were excluded. We further reviewed the 108 patients and identified those with a documented limb length discrepancy (LLD) or hand/foot size discrepancy (HFD) and tried to correlate findings with nerve-territory distribution. RESULTS Twenty-seven (25.0%) patients had either LLD or HFD. Nine patients had only an LLD, 6 patients had only an HFD, and 12 patients had both. Patients with undergrowth were significantly younger at diagnosis than patients without (6.14 vs. 22.9 years, respectively). Although there was a trend toward a greater incidence of LLD in lower extremity IN perineuriomas, this was not statistically significant. Patients with proximal IN perineuriomas had a higher incidence of LLD or HFD than patients with distal IN perineuriomas. The difference between the 2 groups was statistically significant (P < 0.0001). All instances of undergrowth were explained by nerve-territory bone innervation. CONCLUSIONS Limb undergrowth occurs in the affected nerve territory and is likely under-reported in patients with IN perineuriomas. Within our series, patients with documented LLD and HFD were likely to be significantly younger at diagnosis than patients without undergrowth.
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Wilson TJ, Amrami KK, Howe BM, Spinner RJ. Clinical and Radiological Follow-up of Intraneural Perineuriomas. Neurosurgery 2020; 85:786-792. [PMID: 30481319 DOI: 10.1093/neuros/nyy476] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 09/11/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Management of intraneural perineuriomas remains controversial, largely due to the lack of knowledge regarding the natural history of these lesions. OBJECTIVE To describe the typical radiological growth pattern of intraneural perineuriomas and to determine how the pattern of growth relates to clinical progression. METHODS We performed a retrospective review of the magnetic resonance imaging (MRI) studies and serial clinical examinations of a cohort of patients with biopsy-proven intraneural perineuriomas who had 2 MRI studies at least 2 yr apart. The outcome of interest was radiological growth in length or width of the intraneural perineurioma. Radiological growth was tested for association with clinical progression. RESULTS Twenty patients were included in the study. By width, the lesions were on average larger on repeat imaging (P = .009). By absolute length, the lesions were on average longer on repeat imaging (P = .02). By lesion:landmark ratio, there was no difference in length of the lesions between sequential images (P = .09), with 10 (50%) lesions being shorter and 7 (35%) showing no change. No lesions grew to involve a new nerve or division of a nerve on sequential imaging. None of the variables tested were associated with clinical progression. CONCLUSION We found that intraneural perineuriomas only rarely grow in length, do not grow to involve new nerves or nerve divisions, and growth does not correlate with clinical progression. These findings have significant ramifications for management of these tumors.
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Affiliation(s)
- Thomas J Wilson
- Department of Neurosurgery, Stanford University, Stanford, California
| | | | - B Matthew Howe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
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PIK3CA mutations in lipomatosis of nerve with or without nerve territory overgrowth. Mod Pathol 2020; 33:420-430. [PMID: 31481664 DOI: 10.1038/s41379-019-0354-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 01/08/2023]
Abstract
Lipomatosis of nerve is a rare malformation characterized by a fibrolipomatous proliferation within peripheral nerve. Lipomatosis of nerve most frequently involves the median nerve, and manifests clinically as a compressive neuropathy. However, 30-60% of cases are associated with tissue overgrowth within the affected nerve's territory (e.g., macrodactyly for lipomatosis of nerve in the distal median nerve). Somatic activating PIK3CA mutations have been identified in peripheral nerve from patients with lipomatosis of nerve with type I macrodactyly, which is now classified as a PIK3CA-related overgrowth spectrum disorder. However, the PIK3CA mutation status of histologically confirmed lipomatosis of nerve, including cases involving proximal nerves, and cases without territory overgrowth, has not been determined. Fourteen histologically confirmed cases of lipomatosis of nerve involving the median (N = 6), brachial plexus (N = 1), ulnar (N = 3), plantar (N = 2), sciatic and superficial peroneal nerves (N = 1 each) were included. Ten cases had nerve territory overgrowth, ranging from macrodactyly to hemihypertrophy; and four cases had no territory overgrowth. Exome sequencing revealed "hotspot" activating PIK3CA missense mutations in 6/7 cases. Droplet digital polymerase chain reaction for the five most common PIK3CA mutations (p.H1047R, p.H1047L, p.E545K, p.E542K, and p.C420R) confirmed the exome results and identified an additional six cases with mutations (12/14 total). PIK3CA mutations were found in 8/10 cases with territory overgrowth (N = 7 p.H1047R and N = 1 p.E545K), including two proximal nerve cases with extremity overgrowth, and 4/4 cases without territory overgrowth (p.H1047R and p.H1047L, N = 2 each). The variant allele frequency of PIK3CA mutations (6-32%) did not correlate with the overgrowth phenotype. Three intraneural lipomas had no detected PIK3CA mutations. As PIK3CA mutations are frequent events in lipomatosis of nerve, irrespective of anatomic site or territory overgrowth, we propose that all phenotypic variants of this entity be classified within the PIK3CA-related overgrowth spectrum and termed "PIK3CA-related lipomatosis of nerve".
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43
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Uerschels AK, Krogias C, Junker A, Sure U, Wrede KH, Gembruch O. Modern treatment of perineuriomas: a case-series and systematic review. BMC Neurol 2020; 20:55. [PMID: 32054523 PMCID: PMC7017529 DOI: 10.1186/s12883-020-01637-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 02/06/2020] [Indexed: 12/17/2022] Open
Abstract
Background Perineuriomas are rare benign peripheral nerve sheath tumours of perineurial cell origin and can be classified into intraneural and extraneural perineuriomas. They most commonly present a mononeuropathy of gradual onset and slow progression, resulting in progressive neurological deficits like hypoesthesia or motor weakness. Therapy is still variable. Aim of the study was to compare our surgical treatment and our follow-up regime including high-resolution nerve sonography with the current literature to evaluate best treatment of perineuriomas. Methods Retrospective analysis of our dataset “peripheral nerve lesion” to identify patients suffering from perineuriomas between 01.01.2012 until 31.12.2018. Surgical treatment and the follow-up examination of three patients were described. Additionally, a systematic review including PubMed, the Cochrane Collaboration Library, Scopus and Google Scholar was performed for literature published between January 1, 1990 and October 31, 2019 independently by 2 authors. Results In the first case, the left ulnar nerve was affected. In the second case, the left peroneal nerve and in the third case the right median nerve was affected. High-resolution nerve sonography was performed in each case. All patients underwent interfascicular neurolysis combined with a targeted fascicular biopsy under electrophysiological monitoring. Neurological deficits improved subsidized by rehabilitation. Surgical therapy and the neurological outcome were compared with literature. Systematic review revealed 22 articles, which met the inclusion criteria. Therefore, demographics, surgical treatment and neurological outcome of 77 patients were analysed. Conclusions Perineuriomas are rare benign nerve sheath tumours with a slow progression, sometimes difficult to diagnose. Decompression and neurolysis may improve neurological deficits. High resolution nerve sonography might serve as a helpful additional diagnostic tool in this process.
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Affiliation(s)
- Anne-Kathrin Uerschels
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christos Krogias
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Andreas Junker
- Department of Neuropathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Karsten H Wrede
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Oliver Gembruch
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
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Hung YP, Dong F, Dubuc AM, Dal Cin P, Bueno R, Chirieac LR. Molecular characterization of localized pleural mesothelioma. Mod Pathol 2020; 33:271-280. [PMID: 31371807 PMCID: PMC7359734 DOI: 10.1038/s41379-019-0330-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 12/31/2022]
Abstract
Localized pleural mesothelioma is a rare solitary circumscribed pleural tumor that is microscopically similar to diffuse malignant pleural mesothelioma. However, the molecular characteristics and nosologic relationship with its diffuse counterpart remain unknown. In a consecutive cohort of 1110 patients with pleural mesotheliomas diagnosed in 2005-2018, we identified six (0.5%) patients diagnosed with localized pleural mesotheliomas. We gathered clinical history, evaluated the histopathology, and in select cases performed karyotypic analysis and targeted next-generation sequencing. The cohort included three women and three men (median age 63; range 28-76), often presenting incidentally during radiologic evaluation for unrelated conditions. Neoadjuvant chemotherapy was administered in two patients. All tumors (median size 5.0 cm; range 2.7-13.5 cm) demonstrated gross circumscription (with microscopic invasion into lung, soft tissue, and/or rib in four cases), mesothelioma histology (four biphasic and two epithelioid types), and mesothelial immunophenotype. Of four patients with at least 6-month follow-up, three were alive (up to 8.9 years). Genomic characterization identified several subgroups: (1) BAP1 mutations with deletions of CDKN2A and NF2 in two tumors; (2) TRAF7 mutations in two tumors, including one harboring trisomies of chromosomes 3, 5, 7, and X; and (3) genomic near-haploidization, characterized by extensive loss of heterozygosity sparing chromosomes 5 and 7. Localized pleural mesotheliomas appear genetically heterogeneous and include BAP1-mutated, TRAF7-mutated, and near-haploid subgroups. While the BAP1-mutated subgroup is similar to diffuse malignant pleural mesotheliomas, the TRAF7-mutated subgroup overlaps genetically with adenomatoid tumors and well-differentiated papillary mesotheliomas, in which recurrent TRAF7 mutations have been described. Genomic near-haploidization, identified recently in a subset of diffuse malignant pleural mesotheliomas, suggests a novel mechanism in the pathogenesis of both localized pleural mesothelioma and diffuse malignant pleural mesothelioma. Our findings describe distinctive genetic features of localized pleural mesothelioma, with both similarities to and differences from diffuse malignant pleural mesothelioma.
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Affiliation(s)
- Yin P. Hung
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA,Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Fei Dong
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Adrian M. Dubuc
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Paola Dal Cin
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Raphael Bueno
- Department of Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Lucian R. Chirieac
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
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Extraneural perineurioma: CT and MRI imaging characteristics. Skeletal Radiol 2020; 49:109-114. [PMID: 31267178 DOI: 10.1007/s00256-019-03264-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/13/2019] [Accepted: 06/17/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the CT and MRI characteristics of extraneural perineuriomas. MATERIALS AND METHODS With IRB approval, our institutional imaging database was retrospectively reviewed for cases of pathologically proven extraneural perineuriomas. CT and MRI features were recorded, correlative imaging analyzed, and the electronic medical record cross-referenced. RESULTS We identified ten patients [(seven males, three females, mean age 49.4 ± 18.3 years (range, 16-70 years)]. All cases were pathologically confirmed. Nine cases were conventional soft tissue extraneural perineuriomas, including one with "reticular" features and one with histologic features of malignancy; the tenth case contained admixed Schwann cells (hybrid perineurioma/schwannoma). Six out of ten patients underwent CT and ten of ten MRI evaluation. Nine out of ten MRIs were performed with IV contrast. Five lesions were subcutaneous, four intermuscular, and one intramuscular. Mean lesion diameter was 4.3 ± 2.7 cm (range, 0.9-10.2 cm). Nine out of ten lesions were well circumscribed; one had irregular margins. On CT, five of six were hypodense and one isodense compared to skeletal muscle. Most lesions were T1 isointense (5/10) or hypointense (4/10) and T2 hyperintense (7/10) relative to skeletal muscle, and demonstrated solid enhancement (6/9). There was no evidence of muscular denervation on any MRI exam, and a nerve of origin was identified in two out of ten cases. CONCLUSIONS Extraneural perineuriomas have a distinctly different imaging appearance from intraneural perineuriomas, manifesting as rounded or ovoid soft tissue masses, without evidence of muscular denervation, and usually without an apparent nerve of origin. Because these features mimic other benign and malignant soft tissue lesions, including sarcomas, biopsy or excision is needed for definitive diagnosis.
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Well-differentiated papillary mesothelioma of the peritoneum is genetically defined by mutually exclusive mutations in TRAF7 and CDC42. Mod Pathol 2019; 32:88-99. [PMID: 30171198 PMCID: PMC6309365 DOI: 10.1038/s41379-018-0127-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/28/2018] [Accepted: 07/28/2018] [Indexed: 01/10/2023]
Abstract
Well-differentiated papillary mesothelioma is an uncommon mesothelial neoplasm that most frequently arises in the peritoneal cavity of women of reproductive age. Whereas malignant mesothelioma is an aggressive tumor associated with poor outcome, well-differentiated papillary mesothelioma typically exhibits indolent behavior. However, histologically differentiating between these two entities can be challenging, necessitating the development of distinguishing biomarkers. While the genetic alterations that drive malignant mesothelioma have recently been determined, the molecular pathogenesis of well-differentiated papillary mesothelioma is unknown. Here we performed genomic profiling on a cohort of ten well-differentiated papillary mesothelioma of the peritoneum. We identified that all tumors harbored somatic missense mutations in either the TRAF7 or CDC42 genes, and lacked alterations involving BAP1, NF2, CDKN2A, DDX3X, SETD2, and ALK that are frequent in malignant mesothelioma. We recently identified that another mesothelial neoplasm, adenomatoid tumor of the genital tract, is genetically defined by somatic missense mutations in the TRAF7 gene, indicating a shared molecular pathogenesis between well-differentiated papillary mesothelioma and adenomatoid tumors. To the best of our knowledge, well-differentiated papillary mesothelioma is the first human tumor type found to harbor recurrent mutations in the CDC42 gene, which encodes a Rho family GTPase. Immunohistochemistry demonstrated intact BAP1 expression in all cases of well-differentiated papillary mesothelioma, indicating that this is a reliable marker for distinguishing well-differentiated papillary mesothelioma from malignant mesotheliomas that frequently display loss of expression. Additionally, all well-differentiated papillary mesothelioma demonstrated robust expression of L1 cell adhesion molecule (L1CAM), a marker of NF-kB pathway activation, similar to that observed in adenomatoid tumors. In contrast, we have previously shown that L1CAM staining is not observed in normal mesothelial cells and malignant mesotheliomas of the peritoneum. Together, these studies demonstrate that well-differentiated papillary mesothelioma is genetically defined by mutually exclusive mutations in TRAF7 and CDC42 that molecularly distinguish this entity from malignant mesothelioma.
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Zhu S, Jin J, Gokhale S, Lu AM, Shan H, Feng J, Xie P. Genetic Alterations of TRAF Proteins in Human Cancers. Front Immunol 2018; 9:2111. [PMID: 30294322 PMCID: PMC6158389 DOI: 10.3389/fimmu.2018.02111] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 08/28/2018] [Indexed: 12/25/2022] Open
Abstract
The tumor necrosis factor receptor (TNF-R)-associated factor (TRAF) family of cytoplasmic adaptor proteins regulate the signal transduction pathways of a variety of receptors, including the TNF-R superfamily, Toll-like receptors (TLRs), NOD-like receptors (NLRs), RIG-I-like receptors (RLRs), and cytokine receptors. TRAF-dependent signaling pathways participate in a diverse array of important cellular processes, including the survival, proliferation, differentiation, and activation of different cell types. Many of these TRAF-dependent signaling pathways have been implicated in cancer pathogenesis. Here we analyze the current evidence of genetic alterations of TRAF molecules available from The Cancer Genome Atlas (TCGA) and the Catalog of Somatic Mutations in Cancer (COSMIC) as well as the published literature, including copy number variations and mutation landscape of TRAFs in various human cancers. Such analyses reveal that both gain- and loss-of-function genetic alterations of different TRAF proteins are commonly present in a number of human cancers. These include pancreatic cancer, meningioma, breast cancer, prostate cancer, lung cancer, liver cancer, head and neck cancer, stomach cancer, colon cancer, bladder cancer, uterine cancer, melanoma, sarcoma, and B cell malignancies, among others. Furthermore, we summarize the key in vivo and in vitro evidence that demonstrates the causal roles of genetic alterations of TRAF proteins in tumorigenesis within different cell types and organs. Taken together, the information presented in this review provides a rationale for the development of therapeutic strategies to manipulate TRAF proteins or TRAF-dependent signaling pathways in different human cancers by precision medicine.
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Affiliation(s)
- Sining Zhu
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ, United States
- Graduate Program in Cellular and Molecular Pharmacology, Rutgers University, Piscataway, NJ, United States
| | - Juan Jin
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ, United States
- Department of Pharmacology, Anhui Medical University, Hefei, China
| | - Samantha Gokhale
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ, United States
- Graduate Program in Cellular and Molecular Pharmacology, Rutgers University, Piscataway, NJ, United States
| | - Angeli M. Lu
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ, United States
| | - Haiyan Shan
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ, United States
- Department of Obstetrics and Gynecology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Jianjun Feng
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ, United States
- Engineering Research Center of the Modern Technology for Eel Industry, Ministry of Education of the People's Republic of China, Fisheries College of Jimei University, Xiamen, China
| | - Ping Xie
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ, United States
- Member, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
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De Novo Missense Variants in TRAF7 Cause Developmental Delay, Congenital Anomalies, and Dysmorphic Features. Am J Hum Genet 2018; 103:154-162. [PMID: 29961569 DOI: 10.1016/j.ajhg.2018.06.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 06/12/2018] [Indexed: 11/20/2022] Open
Abstract
TRAF7 is a multi-functional protein involved in diverse signaling pathways and cellular processes. The phenotypic consequence of germline TRAF7 variants remains unclear. Here we report missense variants in TRAF7 in seven unrelated individuals referred for clinical exome sequencing. The seven individuals share substantial phenotypic overlap, with developmental delay, congenital heart defects, limb and digital anomalies, and dysmorphic features emerging as key unifying features. The identified variants are de novo in six individuals and comprise four distinct missense changes, including a c.1964G>A (p.Arg655Gln) variant that is recurrent in four individuals. These variants affect evolutionarily conserved amino acids and are located in key functional domains. Gene-specific mutation rate analysis showed that the occurrence of the de novo variants in TRAF7 (p = 2.6 × 10-3) and the recurrent de novo c.1964G>A (p.Arg655Gln) variant (p = 1.9 × 10-8) in our exome cohort was unlikely to have occurred by chance. In vitro analyses of the observed TRAF7 mutations showed reduced ERK1/2 phosphorylation. Our findings suggest that missense mutations in TRAF7 are associated with a multisystem disorder and provide evidence of a role for TRAF7 in human development.
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Adenomatoid tumors of the male and female genital tract are defined by TRAF7 mutations that drive aberrant NF-kB pathway activation. Mod Pathol 2018; 31:660-673. [PMID: 29148537 PMCID: PMC5906165 DOI: 10.1038/modpathol.2017.153] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/15/2017] [Accepted: 09/15/2017] [Indexed: 01/31/2023]
Abstract
Adenomatoid tumors are the most common neoplasm of the epididymis, and histologically similar adenomatoid tumors also commonly arise in the uterus and fallopian tube. To investigate the molecular pathogenesis of these tumors, we performed genomic profiling on a cohort of 31 adenomatoid tumors of the male and female genital tracts. We identified that all tumors harbored somatic missense mutations in the TRAF7 gene, which encodes an E3 ubiquitin ligase belonging to the family of tumor necrosis factor receptor-associated factors (TRAFs). These mutations all clustered into one of five recurrent hotspots within the WD40 repeat domains at the C-terminus of the protein. Functional studies in vitro revealed that expression of mutant but not wild-type TRAF7 led to increased phosphorylation of nuclear factor-kappa B (NF-kB) and increased expression of L1 cell adhesion molecule (L1CAM), a marker of NF-kB pathway activation. Immunohistochemistry demonstrated robust L1CAM expression in adenomatoid tumors that was absent in normal mesothelial cells, malignant peritoneal mesotheliomas and multilocular peritoneal inclusion cysts. Together, these studies demonstrate that adenomatoid tumors of the male and female genital tract are genetically defined by TRAF7 mutation that drives aberrant NF-kB pathway activation.
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