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Vivanco RA, Aguirre AS, Montero M, Perez-Davila M, Baehring J. Atypical presentation of dysembryoplastic neuroepithelial tumor in an adult without epilepsy: a case report. Int J Neurosci 2023:1-4. [PMID: 37800586 DOI: 10.1080/00207454.2023.2268269] [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: 06/03/2023] [Accepted: 10/03/2023] [Indexed: 10/07/2023]
Abstract
Aim of the study: Dysembryoplastic neuroepithelial tumor (DNET) is a rare glioneuronal tumor usually found in the temporal lobe of children and young adults. DNETs are commonly associated with drug-resistant partial seizures, with most cases diagnosed before age 20. Asymptomatic brain tumors are rare in the general healthy population, and the frequency of incidental DNETs in adults remains unknown.Materials and methods: We report the case of a 34-year-old healthy man who presented with a facial rash but was incidentally found to have a large T1 hypointense lesion in the left temporal cortex on neuroimaging. The patient opted for surgical removal of the mass, which was subsequently identified as a DNET, positive for a fibroblast growth factor receptor (FGFR) mutation.Results: This case report presents the first incidentally discovered DNET in an adult without epilepsy, highlighting its atypical presentation. In addition, the presence of an FGFR mutation emphasizes its role in DNET pathogenesis and potential therapeutic implications. DNETs exhibit varied behavior based on age, tumor location, and cortical dysplasia.Conclusions: In this case, the absence of seizure onset may be attributed to the lack of cortical dysplasia. Further research is needed to understand the incidence of DNETs and their association with seizure onset and cortical dysplasia.
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Affiliation(s)
- Ricardo A Vivanco
- School of Medicine, Universidad Catolica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - Alex S Aguirre
- School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador
| | - Marcelo Montero
- School of Medicine, Universidad de las Americas, Quito, Ecuador
| | | | - Joachim Baehring
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, USA
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Hirsch M, Beck J, Brandt A, Papadopoulou G, Wagner K, Urbach H, Schulze-Bonhage A. Trends in referral patterns to presurgical evaluation at a European reference center. Seizure 2023; 111:78-86. [PMID: 37549617 DOI: 10.1016/j.seizure.2023.07.024] [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: 03/10/2023] [Revised: 07/23/2023] [Accepted: 07/30/2023] [Indexed: 08/09/2023] Open
Abstract
PURPOSE To determine if growing evidence for epilepsy surgery as an early treatment option is reflected in the decrease of latencies between epilepsy onset and referral for presurgical evaluation METHODS: Retrospective analysis of latencies in 1646 patients (children and adults) from the time of epilepsy diagnosis to first presurgical workup in the period from 1999 to 2019 based on electronic patient charts at a tertiary epilepsy center. Time spans 1999-2009 and 2010-2019, prior to and following the ILAE definition of pharmacoresistance, and the role of etiological factors were assessed. RESULTS Over the whole period, the mean latency between diagnosis and a presurgical workup was 15.3 y. There was a significant reduction in the latencies between the periods 1999-2009 (16.9 y) and 2010-2019 (13.4 y), (p < 0.0001). In a linear regression analysis, the latency decreased by 2.6 months/year from 17.4 in 1999 to 13.1 y in 2019 (p < 0.001). Subgroup analyses showed significant decreases in latency to presurgical evaluation in patients with hippocampal sclerosis from 24.4 to 19.5 y, in malformations of cortical development from 16.4 to 13.2 y, and in nonlesional patients from 18.1 to 12.8 y, in contrast to patients with MR evidence for brain tumors with similar latencies across time (10.5 vs. 9.5 y, n.s.). CONCLUSION The reduction of the time span to a first presurgical evaluation was highly significant over time, yet moderate in its degree. Overall, the aim of early diagnostic evaluation for epilepsy surgery options after established pharmacoresistance was only achieved for a minority of patients.
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Affiliation(s)
- Martin Hirsch
- Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Armin Brandt
- Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Georgia Papadopoulou
- Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Kathrin Wagner
- Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Andreas Schulze-Bonhage
- Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Nafe R, Porto L, Samp PF, You SJ, Hattingen E. Adult-type and Pediatric-type Diffuse Gliomas : What the Neuroradiologist Should Know. Clin Neuroradiol 2023; 33:611-624. [PMID: 36941392 PMCID: PMC10449995 DOI: 10.1007/s00062-023-01277-z] [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: 11/25/2022] [Accepted: 02/03/2023] [Indexed: 03/22/2023]
Abstract
The classification of diffuse gliomas into the adult type and the pediatric type is the new basis for the diagnosis and clinical evaluation. The knowledge for the neuroradiologist should not remain limited to radiological aspects but should be based additionally on the current edition of the World Health Organization (WHO) classification of tumors of the central nervous system (CNS). This classification defines the 11 entities of diffuse gliomas, which are included in the 3 large groups of adult-type diffuse gliomas, pediatric-type diffuse low-grade gliomas, and pediatric-type diffuse high-grade gliomas. This article provides a detailed overview of important molecular, morphological, and clinical aspects for all 11 entities, such as typical genetic alterations, age distribution, variability of the tumor localization, variability of histopathological and radiological findings within each entity, as well as currently available statistical information on prognosis and outcome. Important differential diagnoses are also discussed.
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Affiliation(s)
- Reinhold Nafe
- Dept. Neuroradiology, Clinics of Johann Wolfgang-Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.
| | - Luciana Porto
- Dept. Neuroradiology, Clinics of Johann Wolfgang-Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Patrick-Felix Samp
- Dept. Neuroradiology, Clinics of Johann Wolfgang-Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Se-Jong You
- Dept. Neuroradiology, Clinics of Johann Wolfgang-Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Elke Hattingen
- Dept. Neuroradiology, Clinics of Johann Wolfgang-Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
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Diverse Patterns and Clinical Significance of 11C-Methionine PET in Dysembryoplastic Neuroepithelial Tumors. Clin Nucl Med 2022; 47:1040-1047. [PMID: 36342792 DOI: 10.1097/rlu.0000000000004400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE Dysembryoplastic neuroepithelial tumors (DNETs) are slow-growing epilepsy-associated tumors. Low or normal 11C-methionine (MET) PET uptake helps to differentiate DNETs from other low-grade gliomas. However, diverse MET-PET uptake in DNETs has been observed. The aim of this study is to measure the clinical significance and prognostic value of MET-PET in DNET management. PATIENTS AND METHODS Retrospective review of 26 DNET patients was done. Clinical characteristics, radiologic findings, and visual and quantitative MET-PET results were analyzed. PET uptake was calculated as the tumor-to-homotopic mirror ratio (TNRm) and tumor-to-contralateral cortex ratio (TNRc). The clinical activity of the tumors at the time of PET was classified into active and quiescent groups. The surgical outcome was defined as a composite of 2 different aspects: tumor progression and/or clinical events such as seizure recurrence or tumor bleeding. RESULTS Twenty-seven MET-PET examinations (20 initial MET-PET and 7 MET-PET during follow-up) were included. Clinically active tumors at the time of PET presented significantly higher values of TNRm and TNRc than quiescent tumors. High MET-PET uptake by visual grading, TNRm ≥ 1.90, and TNRc ≥ 1.85 exhibited poor prognosis for event-free survival. CONCLUSIONS MET-PET uptake correlates well with the clinical behavior of DNETs at the time of PET examination. Moreover, High MET-PET uptake is closely related to seizure recurrence if tumors are not entirely resected. Efforts to achieve gross total resection should be made for DNETs with high MET-PET uptake.
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Wang J, Luo X, Chen C, Deng J, Long H, Yang K, Qi S. Preoperative MRI for postoperative seizure prediction: a radiomics study of dysembryoplastic neuroepithelial tumor and a systematic review. Neurosurg Focus 2022; 53:E7. [DOI: 10.3171/2022.7.focus2254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 07/25/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE
In this systematic review the authors aimed to evaluate the effectiveness and superiority of radiomics in detecting tiny epilepsy lesions and to conduct original research in the use of radiomics for preliminary prediction of postoperative seizures in patients with dysembryoplastic neuroepithelial tumor (DNET).
METHODS
The PubMed and Web of Science databases were searched from the earliest record, January 1, 2018, to December 29, 2021, for reports of the detection of epilepsy using radiomics, and the resulting articles were carefully checked according to the PRISMA 2020 guidelines. The authors then conducted original research by evaluating MR images in 18 patients, who were then separated into two groups, the epilepsy recurrence group (ERG) and the epilepsy nonrecurrence group. The tumor region and the edema region were segmented manually by 3D Slicer. The radiomics data were extracted from MR images by using “Slicer Radiomics” running on Mac OS X. Tumor regions were observed with T1-weighted imaging, and edema with FLAIR imaging. Radiomics features with significant differences were selected through comparison according to epilepsy relapses performed with the Mann-Whitney U-test. The edema and tumor regions were also compared within groups to identify their distinctive features. Radiomics features were tested to verify their ability to predict recurrence epilepsy by receiver operating characteristic curve.
RESULTS
This systematic review located 9 original articles related to epilepsy and radiomics published from 2018 to 2021. The reported studies demonstrated that radiomics is useful for detecting tiny epilepsy lesions. Among the radiomics features used, the predictive ability of the area under the curve was more than 0.8. The heterogeneity of the peritumoral edema region was found to be higher in the ERG.
CONCLUSIONS
Satellite lesions in the peritumoral edema region of DNET patients may cause epilepsy recurrence, and radiomics is an emerging method to detect and evaluate these epilepsy-associated lesions.
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Affiliation(s)
- Jun Wang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University
- The First Clinical Medicine College, Southern Medical University; and
- Neural Networks Surgery Team, Southern Medical University, Guangzhou, China
| | - Xinyi Luo
- The First Clinical Medicine College, Southern Medical University; and
- Neural Networks Surgery Team, Southern Medical University, Guangzhou, China
| | - Chenghan Chen
- The First Clinical Medicine College, Southern Medical University; and
- Neural Networks Surgery Team, Southern Medical University, Guangzhou, China
| | - Jiahong Deng
- The First Clinical Medicine College, Southern Medical University; and
- Neural Networks Surgery Team, Southern Medical University, Guangzhou, China
| | - Hao Long
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University
- The First Clinical Medicine College, Southern Medical University; and
| | - Kaijun Yang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University
- The First Clinical Medicine College, Southern Medical University; and
| | - Songtao Qi
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University
- The First Clinical Medicine College, Southern Medical University; and
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Pagès M, Debily M, Fina F, Jones DTW, Saffroy R, Castel D, Blauwblomme T, Métais A, Bourgeois M, Lechapt‐Zalcman E, Tauziède‐Espariat A, Andreiuolo F, Chrétien F, Grill J, Boddaert N, Figarella‐Branger D, Beroukhim R, Varlet P. The genomic landscape of dysembryoplastic neuroepithelial tumours and a comprehensive analysis of recurrent cases. Neuropathol Appl Neurobiol 2022; 48:e12834. [PMID: 35836307 PMCID: PMC9542977 DOI: 10.1111/nan.12834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 05/24/2022] [Accepted: 07/07/2022] [Indexed: 11/28/2022]
Abstract
AIMS Dysembryoplastic neuroepithelial tumour (DNT) is a glioneuronal tumour that is challenging to diagnose, with a wide spectrum of histological features. Three histopathological patterns have been described: specific DNTs (both the simple form and the complex form) comprising the specific glioneuronal element, and also the non-specific/diffuse form which lacks it, and has unclear phenotype-genotype correlations with numerous differential diagnoses. METHODS We used targeted methods (immunohistochemistry, fluorescence in situ hybridisation and targeted sequencing) and large-scale genomic methodologies including DNA methylation profiling to perform an integrative analysis to better characterise a large retrospective cohort of 82 DNTs, enriched for tumours that showed progression on imaging. RESULTS We confirmed that specific DNTs are characterised by a single driver event with a high frequency of FGFR1 variants. However, a subset of DNA methylation-confirmed DNTs harbour alternative genomic alterations to FGFR1 duplication/mutation. We also demonstrated that a subset of DNTs sharing the same FGFR1 alterations can show in situ progression. In contrast to the specific forms, "non-specific/diffuse DNTs" corresponded to a heterogeneous molecular group encompassing diverse, newly-described, molecularly distinct entities. CONCLUSIONS Specific DNT is a homogeneous group of tumours sharing characteristics of paediatric low-grade gliomas: a quiet genome with a recurrent genomic alteration in the RAS-MAPK signalling pathway, a distinct DNA methylation profile and a good prognosis but showing progression in some cases. The "non-specific/diffuse DNTs" subgroup encompasses various recently described histomolecular entities, such as PLNTY and diffuse astrocytoma, MYB or MYBL1 altered.
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Affiliation(s)
- Mélanie Pagès
- GHU‐Paris – Sainte‐Anne Hospital, Department of NeuropathologyParis UniversityParisFrance
- Department of GeneticsInstitut CurieParisFrance
- SIREDO Paediatric Cancer CenterInstitut CurieParisFrance
- INSERM U830, Laboratory of Translational Research in Paediatric OncologyInstitut CurieParisFrance
- Paris Sciences Lettres Research UniversityParisFrance
| | - Marie‐Anne Debily
- Molecular Predictors and New Targets in Oncology, INSERM U981, Gustave RoussyUniversité Paris‐SaclayVillejuifFrance
- Département de Biologie, Univ. EvryUniversité Paris‐SaclayEvryFrance
| | - Frédéric Fina
- APHM, CHU TimoneService d'Anatomie Pathologique et de NeuropathologieMarseilleFrance
| | - David T. W. Jones
- Pediatric Glioma ResearchHopp Children's Cancer Center (KiTZ)HeidelbergGermany
- Pediatric Glioma Research GroupGerman Cancer Research Center (DKFZ)HeidelbergGermany
| | - Raphael Saffroy
- Oncogenetics Department, Assistance Publique‐Hôpitaux de Paris, Paul Brousse HospitalUniversité Paris‐SaclayVillejuifFrance
| | - David Castel
- Molecular Predictors and New Targets in Oncology, INSERM U981, Gustave RoussyUniversité Paris‐SaclayVillejuifFrance
- Département de Biologie, Univ. EvryUniversité Paris‐SaclayEvryFrance
| | - Thomas Blauwblomme
- Pediatric Neurosurgery Department, AP‐HPHôpital Universitaire Necker‐Enfants MaladesParisFrance
- Université de Paris‐ CitéParisFrance
| | - Alice Métais
- GHU‐Paris – Sainte‐Anne Hospital, Department of NeuropathologyParis UniversityParisFrance
| | - Marie Bourgeois
- Pediatric Neurosurgery Department, AP‐HPHôpital Universitaire Necker‐Enfants MaladesParisFrance
| | | | | | - Felipe Andreiuolo
- Department of NeuropathologyInstituto Estadual do Cérebro Paulo NiemeyerRio de JaneiroBrazil
- Pathology Division, D'Or Research Institute (IDOR)D'Or Hospitals NetworkRio de JaneiroBrazil
| | - Fabrice Chrétien
- GHU‐Paris – Sainte‐Anne Hospital, Department of NeuropathologyParis UniversityParisFrance
- Université de Paris‐ CitéParisFrance
| | - Jacques Grill
- Molecular Predictors and New Targets in Oncology, INSERM U981, Gustave RoussyUniversité Paris‐SaclayVillejuifFrance
- Département de Biologie, Univ. EvryUniversité Paris‐SaclayEvryFrance
- Department of Pediatric and Adolescent OncologyInstitut Gustave RoussyVillejuifFrance
| | - Nathalie Boddaert
- Pediatric Radiology Department, AP‐HPHôpital Universitaire Necker‐Enfants MaladesParisFrance
- INSERM ERL UA10Université de ParisParisFrance
- Institut ImagineUniversité de Paris, UMR 1163ParisFrance
| | - Dominique Figarella‐Branger
- APHM, CHU TimoneService d'Anatomie Pathologique et de NeuropathologieMarseilleFrance
- Institute of NeuroPhysiopatholyAix‐Marseille Univ, CNRS, INPMarseilleFrance
| | - Rameen Beroukhim
- Department of Medical OncologyDana‐Farber Cancer InstituteBostonMassachusettsUSA
- Cancer ProgramBroad InstituteCambridgeMassachusettsUSA
- Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | - Pascale Varlet
- GHU‐Paris – Sainte‐Anne Hospital, Department of NeuropathologyParis UniversityParisFrance
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Dysembryoplastic neuroepithelial tumors of childhood: Ege University experience. Childs Nerv Syst 2022; 38:1699-1706. [PMID: 35666284 DOI: 10.1007/s00381-022-05565-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/17/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Dysembryoplastic neuroepithelial tumors (DNETs) are rare, low-grade tumors of the central nervous system (CNS) of childhood. It is an important cause of intractable epilepsy, and it is surgically curable. We aimed to review our institutional experience with DNET in children. METHODS Medical records of children aged less than 18 years of age diagnosed with DNET between 2009 and 2020 at Ege University Hospital were reviewed. Clinical features of the patients including age, gender, initial symptoms, duration of symptoms, medical treatments, age at the time of surgery, tumor location, degree of surgical resection, and outcome of the patients were documented. RESULTS We reviewed the records of 17 patients with DNETs. Twelve of them were male (70%), 5 of them female (30%). The median age was 11 years (19 months-17 years). The major symptom was a seizure in all of the patients. Thirteen patients presented with complex partial seizures, whereas 2 had a simple partial seizure, and 2 generalized tonic-clonic seizures. Seven patients had drug resistant epilepsy and had received at least two anti-epileptic drugs before surgery. The median duration of symptoms was 6.6 months (0-48 months). In surgery, total surgical resection was performed in 15 patients, and 2 patients underwent partial resection. From these 15 patients, seven patients underwent lesionectomy of the tumor while the other eight patients had extended lesionectomy. The mean follow-up time was 107 months (54-144 months), the seizure control was achieved in 14 patients (82.4%) after surgery, but 3 patients experienced tumor recurrence in the follow-up. CONCLUSION In DNETs, the complete total resection of the lesion is generally associated with seizure-free outcomes. In the patients with partial resection and lesionectomy, MRI follow-up is recommended for recurrence.
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Takita H, Shimono T, Uda T, Ikota H, Kawashima T, Horiuchi D, Terayama E, Tsukamoto T, Miki Y. Malignant transformation of a dysembryoplastic neuroepithelial tumor presenting with intraventricular hemorrhage. Radiol Case Rep 2022; 17:939-943. [PMID: 35140831 PMCID: PMC8813558 DOI: 10.1016/j.radcr.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 10/26/2022] Open
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9
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DNET presenting with bleed: An infrequent event – Histopatho-radio-surgical report. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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10
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Chiang JCH, Harreld JH, Tanaka R, Li X, Wen J, Zhang C, Boué DR, Rauch TM, Boyd JT, Chen J, Corbo JC, Bouldin TW, Elton SW, Liu LWL, Schofield D, Lee SC, Bouffard JP, Georgescu MM, Dossani RH, Aguiar MA, Sances RA, Saad AG, Boop FA, Qaddoumi I, Ellison DW. Septal dysembryoplastic neuroepithelial tumor: a comprehensive clinical, imaging, histopathologic, and molecular analysis. Neuro Oncol 2020; 21:800-808. [PMID: 30726976 DOI: 10.1093/neuonc/noz037] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Dysembryoplastic neuroepithelial tumors (DNETs) are uncommon neural tumors presenting most often in children and young adults and associated with intractable seizures. Rare midline neoplasms with similar histological features to those found in DNETs have been described near the septum pellucidum and termed "DNET-like neoplasms of the septum pellucidum." Due to their rarity, these tumors have been described in just a few reports and their genetic alterations sought only in small series. METHODS We collected 20 of these tumors for a comprehensive study of their clinical, radiological, and pathological features. RNA sequencing or targeted DNA sequencing was undertaken on 18 tumors, and genome-wide DNA methylation profiling was possible with 11 tumors. Published cases (n = 22) were also reviewed for comparative purposes. RESULTS The commonest presenting symptoms and signs were related to raised intracranial pressure; 40% of cases required cerebrospinal fluid diversion. Epilepsy was seen in approximately one third of cases. All patients had an indolent disease course, despite metastasis within the neuraxis in a few cases. Radiologically, the septum verum/septal nuclei were involved in all cases and are the proposed site of origin for septal DNET (sDNET). Septal DNET showed a high frequency (~80%) of mutations of platelet derived growth factor receptor A (PDGFRA), and alterations in fibroblast growth factor receptor 1 (FGFR1) and neurofibromatosis type 1 (NF1) were also identified. In a genomic DNA methylation analysis alongside other neural tumors, sDNETs formed a separate molecular group. CONCLUSIONS Genetic alterations that are different from those of cerebral DNETs and a distinct methylome profile support the proposal that sDNET is a distinct disease entity.
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Affiliation(s)
- Jason C H Chiang
- Department of Pathology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Julie H Harreld
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Ryuma Tanaka
- Department of Oncology, Division of Neuro-Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Xiaoyu Li
- Department of Pathology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Ji Wen
- Department of Pathology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Chenran Zhang
- Department of Pediatric Neurosurgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Department of Surgery, Division of Pediatric Neurosurgery, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Daniel R Boué
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Tracy M Rauch
- Pathology Group of Louisiana, Baton Rouge, Louisiana, USA
| | - J Todd Boyd
- Clinical and Anatomic Pathology Laboratory, Dayton Children's, Dayton, Ohio, USA
| | - Jie Chen
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joseph C Corbo
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Thomas W Bouldin
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Scott W Elton
- Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Deborah Schofield
- Department of Pathology, Children's Hospital of The King's Daughters, Norfolk, Virginia, USA
| | - Sunhee C Lee
- Department of Surgical Pathology, Montefiore Medical Center/Moses Campus, Bronx, New York, USA
| | | | - Maria-Magdalena Georgescu
- Department of Pathology, Louisiana State University Health Science Center, Shreveport, Louisiana, USA
| | - Rimal H Dossani
- Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana, USA
| | - Maria A Aguiar
- Department of Pathology, Children's Hospital of The King's Daughters, Norfolk, Virginia, USA
| | - Richard A Sances
- Department of Pathology, East Tennessee Children's Hospital, Knoxville, Tennessee, USA
| | - Ali G Saad
- Department of Pathology, Methodist University Hospital, Memphis, Tennessee, USA
| | - Frederick A Boop
- Department of Surgery, Division of Pediatric Neurosurgery, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Ibrahim Qaddoumi
- Department of Pathology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - David W Ellison
- Department of Oncology, Division of Neuro-Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
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Ajithkumar T, Imbulgoda N, Rees E, Harris F, Horan G, Burke A, Jefferies S, Price S, Cross J, Allinson K. Uncommon low-grade brain tumors. Neuro Oncol 2020; 21:151-166. [PMID: 30239861 DOI: 10.1093/neuonc/noy151] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The 2016 World Health Organization (WHO) classification of primary central nervous system (CNS) tumors includes numerous uncommon (representing ≤1% of tumors) low-grade (grades I-II) brain neoplasms with varying clinical behaviors and outcomes. Generally, gross tumor or maximal safe resection is the primary treatment. Adjuvant treatments, though their exact role is unknown, may be considered individually based on pathological subtypes and a proper assessment of risks and benefits. Targetable mutations such as BRAF (proto-oncogene B-Raf), TRAIL (tumor necrosis factor apoptosis inducing ligand), and PDGFR (platelet derived growth factor receptor) have promising roles in future management.
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Affiliation(s)
- Thankamma Ajithkumar
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Naduni Imbulgoda
- Department of Oncology, National Cancer Institute, Maharagama, Sri Lanka
| | - Elliott Rees
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Fiona Harris
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Gail Horan
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Amos Burke
- Department of Paediatric Hematology, Oncology and Palliative Care, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Sarah Jefferies
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Stephen Price
- Department of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Justin Cross
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Kieren Allinson
- Department of Pathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
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12
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Ishi Y, Yamaguchi S, Hatanaka KC, Okamoto M, Motegi H, Kobayashi H, Terasaka S, Houkin K. Association of the FGFR1 mutation with spontaneous hemorrhage in low-grade gliomas in pediatric and young adult patients. J Neurosurg 2020; 134:733-741. [PMID: 32059187 DOI: 10.3171/2019.12.jns192155] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 12/02/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors aimed to investigate genetic alterations in low-grade gliomas (LGGs) in pediatric and young adult patients presenting with spontaneous hemorrhage. METHODS Patients younger than 30 years of age with a pathological diagnosis of World Health Organization (WHO) grade I or II glioma and who had undergone treatment at the authors' institution were retrospectively examined. BRAF V600E, FGFR1 N546/K656, IDH1 R132, IDH2 R172, and KIAA1549-BRAF (K-B) fusion genetic alterations were identified, and the presence of spontaneous tumoral hemorrhage was recorded. RESULTS Among 66 patients (39 with WHO grade I and 27 with grade II tumors), genetic analysis revealed K-B fusion in 18 (27.3%), BRAF V600E mutation in 14 (21.2%), IDH1/2 mutation in 8 (12.1%), and FGFR1 mutation in 4 (6.1%). Spontaneous hemorrhage was observed in 5 patients (7.6%); 4 of them had an FGFR1 mutation and 1 had K-B fusion. Univariate analysis revealed a statistically significant association of an FGFR1 mutation and a diencephalic location with spontaneous hemorrhage. Among 19 diencephalic cases including the optic pathway, hypothalamus, and thalamus, an FGFR1 mutation was significantly associated with spontaneous hemorrhage (p < 0.001). Four FGFR1 mutation cases illustrated the following results: 1) a 2-year-old female with pilomyxoid astrocytoma (PMA) harboring the FGFR1 K656E mutation presented with intraventricular hemorrhage (IVH); 2) a 6-year-old male with PMA harboring FGFR1 K656E and D652G mutations presented with intratumoral hemorrhage (ITH); 3) a 4-year-old female with diffuse astrocytoma harboring FGFR1 K656M and D652G mutations presented with IVH; and 4) a young adult patient with pilocytic astrocytoma with the FGFR1 N546K mutation presented with delayed ITH and IVH after 7 years of observation. CONCLUSIONS Although the mechanism remains unclear, the FGFR1 mutation is associated with spontaneous hemorrhage in pediatric and young adult LGG.
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Affiliation(s)
- Yukitomo Ishi
- 1Department of Neurosurgery, Hokkaido University School of Medicine, Kita-ku, Sapporo
| | - Shigeru Yamaguchi
- 1Department of Neurosurgery, Hokkaido University School of Medicine, Kita-ku, Sapporo
| | - Kanako C Hatanaka
- 2Department of Surgical Pathology, Hokkaido University Hospital, Kita-ku, Sapporo; and
| | - Michinari Okamoto
- 1Department of Neurosurgery, Hokkaido University School of Medicine, Kita-ku, Sapporo
| | - Hiroaki Motegi
- 1Department of Neurosurgery, Hokkaido University School of Medicine, Kita-ku, Sapporo
| | - Hiroyuki Kobayashi
- 1Department of Neurosurgery, Hokkaido University School of Medicine, Kita-ku, Sapporo.,3Department of Neurosurgery, Kashiwaba Neurosurgical Hospital, Toyohira-ku, Sapporo, Hokkaido, Japan
| | - Shunsuke Terasaka
- 1Department of Neurosurgery, Hokkaido University School of Medicine, Kita-ku, Sapporo.,3Department of Neurosurgery, Kashiwaba Neurosurgical Hospital, Toyohira-ku, Sapporo, Hokkaido, Japan
| | - Kiyohiro Houkin
- 1Department of Neurosurgery, Hokkaido University School of Medicine, Kita-ku, Sapporo.,3Department of Neurosurgery, Kashiwaba Neurosurgical Hospital, Toyohira-ku, Sapporo, Hokkaido, Japan
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13
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Lucas CHG, Villanueva-Meyer JE, Whipple N, Oberheim Bush NA, Cooney T, Chang S, McDermott M, Berger M, Cham E, Sun PP, Putnam A, Zhou H, Bollo R, Cheshier S, Poppe MM, Fung KM, Sung S, Glenn C, Fan X, Bannykh S, Hu J, Danielpour M, Li R, Alva E, Johnston J, Van Ziffle J, Onodera C, Devine P, Grenert JP, Lee JC, Pekmezci M, Tihan T, Bollen AW, Perry A, Solomon DA. Myxoid glioneuronal tumor, PDGFRA p.K385-mutant: clinical, radiologic, and histopathologic features. Brain Pathol 2019; 30:479-494. [PMID: 31609499 DOI: 10.1111/bpa.12797] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/07/2019] [Indexed: 02/06/2023] Open
Abstract
"Myxoid glioneuronal tumor, PDGFRA p.K385-mutant" is a recently described tumor entity of the central nervous system with a predilection for origin in the septum pellucidum and a defining dinucleotide mutation at codon 385 of the PDGFRA oncogene replacing lysine with either leucine or isoleucine (p.K385L/I). Clinical outcomes and optimal treatment for this new tumor entity have yet to be defined. Here, we report a comprehensive clinical, radiologic, and histopathologic assessment of eight cases. In addition to its stereotypic location in the septum pellucidum, we identify that this tumor can also occur in the corpus callosum and periventricular white matter of the lateral ventricle. Tumors centered in the septum pellucidum uniformly were associated with obstructive hydrocephalus, whereas tumors centered in the corpus callosum and periventricular white matter did not demonstrate hydrocephalus. While multiple patients were found to have ventricular dissemination or local recurrence/progression, all patients in this series remain alive at last clinical follow-up despite only biopsy or subtotal resection without adjuvant therapy in most cases. Our study further supports "myxoid glioneuronal tumor, PDGFRA p.K385-mutant" as a distinct CNS tumor entity and expands the spectrum of clinicopathologic and radiologic features of this neoplasm.
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Affiliation(s)
| | | | - Nicholas Whipple
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Nancy Ann Oberheim Bush
- Division of Neuro-Oncology, Department of Neurological Surgery, University of California, San Francisco, CA.,Department of Neurology, University of California, San Francisco, CA
| | - Tabitha Cooney
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, CA
| | - Susan Chang
- Division of Neuro-Oncology, Department of Neurological Surgery, University of California, San Francisco, CA.,Department of Neurology, University of California, San Francisco, CA
| | - Michael McDermott
- Department of Neurological Surgery, University of California, San Francisco, CA
| | - Mitchel Berger
- Department of Neurological Surgery, University of California, San Francisco, CA
| | - Elaine Cham
- Department of Pathology, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | - Peter P Sun
- Department of Neurosurgery, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | - Angelica Putnam
- Department of Pathology, University of Utah, Salt Lake City, UT
| | - Hong Zhou
- Department of Pathology, University of Utah, Salt Lake City, UT
| | - Robert Bollo
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah, Salt Lake City, UT
| | - Samuel Cheshier
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah, Salt Lake City, UT
| | - Matthew M Poppe
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Kar-Ming Fung
- Department of Pathology, University of Oklahoma, Oklahoma City, OK
| | - Sarah Sung
- Department of Neurology, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Chad Glenn
- Department of Neurosurgery, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Xuemo Fan
- Department of Pathology, Cedars Sinai Medical Center, Los Angeles, CA
| | - Serguei Bannykh
- Department of Pathology, Cedars Sinai Medical Center, Los Angeles, CA
| | - Jethro Hu
- Department of Neurology, Cedars Sinai Medical Center, Los Angeles, CA
| | - Moise Danielpour
- Department of Neurosurgery, Cedars Sinai Medical Center, Los Angeles, CA
| | - Rong Li
- Department of Pathology, Children's Hospital of Alabama, Birmingham, AL
| | - Elizabeth Alva
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Children's Hospital of Alabama, Birmingham, AL
| | - James Johnston
- Department of Neurosurgery, Children's Hospital of Alabama, Birmingham, AL
| | - Jessica Van Ziffle
- Department of Pathology, University of California, San Francisco, CA.,Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA
| | - Courtney Onodera
- Department of Pathology, University of California, San Francisco, CA.,Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA
| | - Patrick Devine
- Department of Pathology, University of California, San Francisco, CA.,Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA
| | - James P Grenert
- Department of Pathology, University of California, San Francisco, CA.,Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA
| | - Julieann C Lee
- Department of Pathology, University of California, San Francisco, CA
| | - Melike Pekmezci
- Department of Pathology, University of California, San Francisco, CA
| | - Tarik Tihan
- Department of Pathology, University of California, San Francisco, CA
| | - Andrew W Bollen
- Department of Pathology, University of California, San Francisco, CA
| | - Arie Perry
- Department of Pathology, University of California, San Francisco, CA.,Department of Neurological Surgery, University of California, San Francisco, CA
| | - David A Solomon
- Department of Pathology, University of California, San Francisco, CA.,Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA
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14
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El Ahmadieh TY, Cai C, Mickey BE. Dysembryoplastic Neuroepithelial Tumor with Enlarging Heterogeneously Enhancing Organizing Hematoma. World Neurosurg 2019; 131:177-179. [PMID: 31421300 DOI: 10.1016/j.wneu.2019.08.036] [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: 06/07/2019] [Revised: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 11/18/2022]
Abstract
This report portrays an unusual presentation of a dysembryoplastic neuroepithelial tumor characterized by a chronic, enlarging, heterogeneously enhancing organizing hematoma. Differential diagnoses included the malignant transformation of a low-grade glioma, radiation necrosis, and radiation-induced cavernoma. A dysembryoplastic neuroepithelial tumor may have atypical characteristics and behavior, so continued follow-up with serial imaging is recommended.
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Affiliation(s)
- Tarek Y El Ahmadieh
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Chunyu Cai
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Bruce E Mickey
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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15
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Yang J, Kim SK, Kim KJ, Chae JH, Lim BC, Wang KC, Park SH, Phi JH. Satellite lesions of DNET: implications for seizure and tumor control after resection. J Neurooncol 2019; 143:437-445. [DOI: 10.1007/s11060-019-03174-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/25/2019] [Indexed: 01/09/2023]
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16
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Phi JH, Kim SK. Clinical Pearls and Advances in Molecular Researches of Epilepsy-Associated Tumors. J Korean Neurosurg Soc 2019; 62:313-320. [PMID: 31085957 PMCID: PMC6514318 DOI: 10.3340/jkns.2019.0033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/07/2019] [Accepted: 03/17/2019] [Indexed: 11/30/2022] Open
Abstract
Brain tumors are the second most common type of structural brain lesion that causes chronic epilepsy. Patients with low-grade brain tumors often experience chronic drug-resistant epilepsy starting in childhood, which led to the concept of long-term epilepsy-associated tumors (LEATs). Dysembryoplastic neuroepithelial tumor and ganglioglioma are representative LEATs and are characterized by young age of onset, frequent temporal lobe location, benign tumor biology, and chronic epilepsy. Although highly relevant in clinical epileptology, the concept of LEATs has been criticized in the neuro-oncology field. Recent genomic and molecular studies have challenged traditional views on LEATs and low-grade gliomas. Molecular studies have revealed that lowgrade gliomas can largely be divided into three groups : LEATs, pediatric-type diffuse low-grade glioma (DLGG; astrocytoma and oligodendroglioma), and adult-type DLGG. There is substantial overlap between conventional LEATs and pediatric-type DLGG in regard to clinical features, histology, and molecular characteristics. LEATs and pediatric-type DLGG are characterized by mutations in BRAF, FGFR1, and MYB/MYBL1, which converge on the RAS-RAF-MAPK pathway. Gene (mutation)-centered classification of epilepsyassociated tumors could provide new insight into these heterogeneous and diverse neoplasms and may lead to novel molecular targeted therapies for epilepsy in the near future.
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Affiliation(s)
- Ji Hoon Phi
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Seung-Ki Kim
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Korea
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17
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Luzzi S, Elia A, Del Maestro M, Elbabaa SK, Carnevale S, Guerrini F, Caulo M, Morbini P, Galzio R. Dysembryoplastic Neuroepithelial Tumors: What You Need to Know. World Neurosurg 2019; 127:255-265. [PMID: 30981794 DOI: 10.1016/j.wneu.2019.04.056] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE An updated and comprehensive review on dysembryoplastic neuroepithelial tumor (DNET) focusing on differential diagnosis, atypical presentation, seizure outcome, and risk of malignant transformation. METHODS A PubMed/MEDLINE-based literature search has been performed using "dysembryoplastic neuroepithelial tumor" as a keyword. Two treated cases characterized by an atypical presentation have been reviewed. RESULTS Of 1162 articles, 200 relevant studies have been selected. DNET is a benign mixed neuronal-glial tumor causing drug-resistant epilepsy primarily in children and young adults. The typical radiological pattern is a magnetic resonance imaging (MRI) T1-hypointense, T2-, and fluid-attenuated inversion-recovery hyperintense multicystic lesion involving the cerebral cortex with no edema. Contrast enhancement may be present and a focal cortical dysplasia is commonly associated with it. MRI diffusion, perfusion, and spectroscopy have a paramount role in the differential diagnosis. The "specific glioneuronal elements" are pathognomonic. They are positive for S100 protein, synaptofisin, neuronal nuclei, oligodendrocyte transcription factor, neurite outgrowth inhibitor, and microtubule-associated protein 2, but negative for glial fibrillary acidic protein. As opposed to v-myb avian myeloblastosis viral oncogene homolog, isocitrate dehydrogenase-1/isocitrate dehydrogenase-2 mutation and codeletion 1p-19q, fibroblast growth factor receptor 1 and BRAF V600E mutations are present. The effectiveness of surgery on seizure outcome has been established. Rare malignant transformations have been reported, especially in extra-temporal and complex forms. CONCLUSIONS Advanced MRI techniques are fundamental in the differential diagnosis for DNET versus other low-grade gliomas. Immuno-phenotype assessment and search for fibroblast growth factor receptor 1 and BRAF V600E mutations limit the risk of misdiagnoses. A gross total tumor removal is generally associated with a seizure-free outcome. Recurrences and malignant transformations may rarely follow, legitimizing MRI surveillance in cases of subtotal tumor resection.
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Affiliation(s)
- Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; D.E.O.T. Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy.
| | - Angela Elia
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Mattia Del Maestro
- PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Samer K Elbabaa
- Pediatric Neurosurgery Department, Pediatric Neuroscience Center of Excellence, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Sergio Carnevale
- Unit of Pathological Anatomy, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Francesco Guerrini
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
| | - Patrizia Morbini
- Unit of Pathological Anatomy, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Renato Galzio
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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18
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Sinclair G, Martin H, Shamikh A, Samadi A, Cooray G, Bartek J, Al-Saffar Y, Svensson M, Dodoo E. Salvage gamma knife radiosurgery in the management of dysembryoplastic neuroepithelial tumors: Long-term outcome in a single-institution case series. Surg Neurol Int 2017; 8:174. [PMID: 28868186 PMCID: PMC5569391 DOI: 10.4103/sni.sni_482_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 05/30/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Dysembryoplastic neuroepithelial tumors (DNT/DNET) are rare epileptogenic tumors. Microsurgery remains the best treatment option, although case reports exist on the use of gamma knife radiosurgery (GKRS) in selected cases. We investigated the long-term outcome of GKRS-treated DNTs at our institution in the context of current diagnostic and treatment options. CASE DESCRIPTIONS We conducted a retrospective review of three consecutive adult patients (≥18 years) treated with salvage GKRS between 2002 and 2010 at Karolinska University Hospital, Stockholm, Sweden. The case series was supplemented by a review of current literature. A 20-year-old male underwent subtotal resection (STR) in 1997 and 2002 of DNT resulting in temporary control of intractable epilepsy despite antiepileptic drug treatment (AED). Long-term seizure control was obtained after GKRS of two separate residual DNT components along the surgical margin (2005 and 2010). A 27-year-old male undergoing gross total resection of the contrast-enhancing portion of a DNT (1999) resulted in temporary control of intractable epilepsy despite AEDs; lasting clinical control of seizures was achieved in 2002 after GKRS of a small, recurrent DNT component. A 28-year-old male underwent STR of DNT (1994 and 2004) resulting in temporary control of intractable epilepsy. Lasting seizure control was gained after GKRS of a residual tumor (2005). CONCLUSION GKRS as performed in our series was effective in terms of tumor and seizure control. No adverse radiation effects were recorded. Prospective studies are warranted to establish the role of GKRS in the treatment of DNTs.
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Affiliation(s)
- Georges Sinclair
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Heather Martin
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Alia Shamikh
- Department of Clinical Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Amir Samadi
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Gerald Cooray
- Department of Neurophysiology, Karolinska University Hospital, Stockholm, Sweden
| | - Jiri Bartek
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Yehya Al-Saffar
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Mikael Svensson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ernest Dodoo
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
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19
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Natural history of lesions with the MR imaging appearance of multinodular and vacuolating neuronal tumor. Neuroradiology 2017; 59:873-883. [DOI: 10.1007/s00234-017-1884-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 07/06/2017] [Indexed: 11/26/2022]
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20
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Nguyen HS, Doan N, Gelsomino M, Shabani S. Dysembryoplastic Neuroectodermal Tumor: An Analysis from the Surveillance, Epidemiology, and End Results Program, 2004–2013. World Neurosurg 2017; 103:380-385. [DOI: 10.1016/j.wneu.2017.04.093] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/12/2017] [Accepted: 04/13/2017] [Indexed: 12/25/2022]
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21
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Subcortical DNET in a Patient With an Enzymatic Deficiency: A Rare Case and Review of the Literature. J Pediatr Hematol Oncol 2016; 38:e291-e294. [PMID: 27271814 DOI: 10.1097/mph.0000000000000596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This case report describes a toddler with a medical history of biotinidase deficiency who presented with atypical seizures due to a brain tumor. METHODS This is a case report. RESULTS Electroencephalogram revealed a frontal lobe mass, with magnetic resonance imaging confirmation of a mass extending from the frontal lobe into the genu and anterior corpus callosum. She underwent a near-total resection, and pathology identified a dysembryoplastic neuroepithelial tumor. The patient is now seizure free and clinically doing well. CONCLUSIONS Children with biotinidase deficiency and atypical seizures should receive a full electroencephalogram evaluation, as brain tumors continue to be on the differential for seizures in this patient population.
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22
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Glioneuronal tumors of cerebral hemisphere in children: correlation of surgical resection with seizure outcomes and tumor recurrences. Childs Nerv Syst 2016; 32:1839-48. [PMID: 27659827 DOI: 10.1007/s00381-016-3140-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 06/01/2016] [Indexed: 01/05/2023]
Abstract
OBJECT Glioneuronal tumors are common neoplasms among the cerebral hemisphere during childhood. They consist of several histological types, of which gangliogliomas (GGs) and dysembryoplastic neuroepithelial tumors (DNTs) are most common and often present with seizures. A great majority of glioneuronal tumors are benign. However, there are conflict reports regarding postoperative tumor recurrence rates and seizure control. The authors analyzed and compared these tumors for their locations and histology and the tumor and seizure control following resection. METHODS The authors conducted a retrospective analysis of patients with pediatric glioneuronal tumors in the cerebral hemisphere. All histology reports and neuroimaging are reviewed. Seizure group and non-seizure group were compared with their tumor types and locations. The extent of tumor resections were divided into gross total resection (GTR) and subtotal resection (STR). Postoperative tumor recurrence-free survival (RFS) and seizure-free survival for patients who had the initial surgery done at our institution were calculated using Kaplan-Meier method. RESULTS There were 90 glioneuronal tumors including 58 GGs, 22 DNTs, 3 papillary glioneuronal tumor, 3 desmoplastic infantile gangliogliomas, 3 anaplastic GGs, and 1 central neurocytoma. Seventy-one patients (seizure group) presented with seizures. The temporal lobe is the most common location, 50 % in this series. GTR was attained in 79 patients and STR in 11. All of the patients with GTR had lesionectomy, and only six of them had extended corticectomy or partial lobectomy. Postoperative seizure outcome showed that 64 (90 %) of seizure group had Engel's class I, but five patients subsequently developed recurrent seizures. Patients with DNTs had a higher seizure recurrence rate. Tumor RFS was 87 % at 5 years and 75.5 % at 10 years. There are no significant difference in tumor recurrences between GGs and DNTs (p = 0.876). Comparison between GRT (67) and STR (9) showed that in spite of the better 5-year tumor RFSs among GRT group (94 %) than STR group (66 %), the 10-year RFSs showed no significant difference between GRT and STR groups (p = 0.719). Recurrent seizures are often related to recurrent tumor. CONCLUSION Lesionectomy alone often provides a high-rate seizure freedom. GGs and DNTs are benign tumor, but recurrences of GGs and DNTs are not uncommon. They may show late recurrences in spite of GTR. These patients need longer follow-up for 10 years. Recurrent seizures are often related to a tumor recurrence.
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23
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Nishikura N, Takano T, Ryujin F, Yoshioka S, Maruo Y, Takeuchi Y, Tamura K, Sakakibara T, Ito M. Remitted epilepsy with dysembryoplastic neuroepithelial tumor involving the thalamus. Pediatr Int 2016; 58:496-500. [PMID: 27163491 DOI: 10.1111/ped.12911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 09/11/2015] [Accepted: 09/28/2015] [Indexed: 11/29/2022]
Abstract
Dysembryoplastic neuroepithelial tumors (DNT) are benign hamartomatous tumors characterized by intractable epilepsy and common localization in the supratentorial cortex, but thalamic involvement in DNT is extremely rare. A 2-year 4-month-old boy presented with intractable epilepsy due to a tumorous lesion in the frontal lobe expanding to the thalamus. Under chronic intracranial electrocorticography guidance, partial lesionectomy with adjacent cortical resection was performed, and the lesion was pathologically diagnosed as DNT, complex form. Subsequently, the seizures completely disappeared without any neurological deficits despite the presence of full residual thalamic lesions. The epileptogenicity of DNT is closely associated with various clinicopathological factors, and the thalamic contribution to the seizure activity remains unclear. Due to the essential epileptogenic characteristics of DNT, the residual thalamic lesions and associated clinical features should be strictly observed in the future in the present case.
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Affiliation(s)
- Noriko Nishikura
- Department of Pediatrics, Shiga University of Medical Science, Otsu, Japan.,Department of Developmental and Behavioral Pediatrics, Shiga University of Medical Science, Otsu, Japan
| | - Tomoyuki Takano
- Department of Pediatrics, Shiga University of Medical Science, Otsu, Japan
| | - Fukiko Ryujin
- Department of Pediatrics, Shiga University of Medical Science, Otsu, Japan
| | - Seiichiro Yoshioka
- Department of Pediatrics, Shiga University of Medical Science, Otsu, Japan
| | - Yoshihiro Maruo
- Department of Pediatrics, Shiga University of Medical Science, Otsu, Japan
| | - Yoshihiro Takeuchi
- Department of Pediatrics, Shiga University of Medical Science, Otsu, Japan.,Department of Developmental and Behavioral Pediatrics, Shiga University of Medical Science, Otsu, Japan
| | - Kentaro Tamura
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | | | - Masayuki Ito
- Department of Mental Retardation and Birth Defect Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan
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24
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Abstract
This chapter describes the epidemiology, pathology, molecular characteristics, clinical and neuroimaging features, treatment, outcome, and prognostic factors of the rare glial tumors. This category includes subependymal giant cell astrocytoma, pleomorphic xanthoastrocytoma, astroblastoma, chordoid glioma of the third ventricle, angiocentric glioma, ganglioglioma, desmoplastic infantile astrocytoma and ganglioma, dysembryoplastic neuroepithelial tumor, papillary glioneuronal tumor, and rosette-forming glioneuronal tumor of the fourth ventricle. Many of these tumors, in particular glioneuronal tumors, prevail in children and young adults, are characterized by pharmacoresistant seizures, and have an indolent course, and long survival following surgical resection. Radiotherapy and chemotherapy are reserved for recurrent and/or aggressive forms. New molecular alterations are increasingly recognized.
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Affiliation(s)
- Riccardo Soffietti
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy.
| | - Roberta Rudà
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - David Reardon
- Center for Neuro-Oncology, Harvard Medical School and Dana-Farber Cancer Institute, Boston, USA
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25
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Abstract
Primary CNS tumors consist of a diverse group of neoplasms originating from various cell types in the CNS. Brain tumors are the most common solid malignancy in children under the age of 15 years and the second leading cause of cancer death after leukemia. The most common brain neoplasms in children differ consistently from those in older age groups. Pediatric brain tumors demonstrate distinct patterns of occurrence and biologic behavior according to sex, age, and race. This chapter highlights the imaging features of the most common tumors that affect the child's CNS (brain and spinal cord).
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Affiliation(s)
- Andre D Furtado
- Department of Radiology, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
| | - Ashok Panigrahy
- Department of Radiology, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Charles R Fitz
- Department of Radiology, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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McWilliams GD, SantaCruz K, Hart B, Clericuzio C. Occurrence of DNET and other brain tumors in Noonan syndrome warrants caution with growth hormone therapy. Am J Med Genet A 2015; 170A:195-201. [PMID: 26377682 DOI: 10.1002/ajmg.a.37379] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 08/30/2015] [Indexed: 11/12/2022]
Abstract
Noonan syndrome (NS) is an autosomal dominant developmental disorder caused by mutations in the RAS-MAPK signaling pathway that is well known for its relationship with oncogenesis. An 8.1-fold increased risk of cancer in Noonan syndrome has been reported, including childhood leukemia and solid tumors. The same study found a patient with a dysembryoplastic neuroepithelial tumor (DNET) and suggested that DNET tumors are associated with NS. Herein we report an 8-year-old boy with genetically confirmed NS and a DNET. Literature review identified eight other reports, supporting the association between NS and DNETs. The review also ascertained 13 non-DNET brain tumors in individuals with NS, bringing to 22 the total number of NS patients with brain tumors. Tumor growth while receiving growth hormone (GH) occurred in our patient and one other patient. It is unknown whether the development or progression of tumors is augmented by GH therapy, however there is concern based on epidemiological, animal and in vitro studies. This issue was addressed in a 2015 Pediatric Endocrine Society report noting there is not enough data available to assess the safety of GH therapy in children with neoplasia-predisposition syndromes. The authors recommend that GH use in children with such disorders, including NS, be undertaken with appropriate surveillance for malignancies. Our case report and literature review underscore the association of NS with CNS tumors, particularly DNET, and call attention to the recommendation that clinicians treating NS patients with GH do so with awareness of the possibility of increased neoplasia risk.
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Affiliation(s)
| | - Karen SantaCruz
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Blaine Hart
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Carol Clericuzio
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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Glioblastoma multiforme arising from dysembryoplastic neuroepithelial tumor in a child in the absence of therapy. J Pediatr Hematol Oncol 2014; 36:e536-9. [PMID: 24309599 DOI: 10.1097/mph.0000000000000063] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Dysembryoplastic neuroepithelial tumors (DNETs) are considered as low-grade tumors commonly associated with intractable seizures. We report a case of an unusual hemispheric DNET in a young child presenting with new-onset focal seizures. The tumor was notable for its atypical neuroimaging features and very rapid malignant transformation into a glioblastoma multiforme in the absence of radiation or chemotherapy, 1-year postdiagnosis. Our case highlights the malignant potential of atypical DNETs in the absence of therapy.
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Matyja E, Grajkowska W, Kunert P, Marchel A. A peculiar histopathological form of dysembryoplastic neuroepithelial tumor with separated pilocytic astrocytoma and rosette-forming glioneuronal tumor components. Neuropathology 2014; 34:491-8. [PMID: 24735014 DOI: 10.1111/neup.12124] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 03/18/2014] [Accepted: 03/19/2014] [Indexed: 12/22/2022]
Abstract
Dysembryoplastic neuroepithelial tumors (DNTs) mostly display typical clinical, neuroimaging and histopathological features, but sometimes they reveal heterogeneous or non-specific morphology, which results in diagnostic dilemmas. We present a case of a young adult with longstanding, intractable epilepsy associated with a multinodular cystic lesion in the temporal lobe. The lesion consisted of morphologically different components. In particular, a few cortical nodules displayed a specific glioneuronal element with floating neurons typically found in DNT. Two large, well-circumscribed nodules were entirely composed of biphasic, piloid, astroglial patterns that corresponded strictly to a pilocytic astrocytoma. The well-defined areas, which contained numerous distinct neurocytic-like rosettes, were identical with rosette-forming glioneuronal tumors (RGNTs). This type of neurocytic rosette was widespread within the surrounding piloid background. Some solid nodules exhibited increased cellularity, oligodendroglioma-like elements and a focal ribbon cell arrangement. The lesion was associated with advanced reactive gliosis and foci of dysplastic changes in the adjacent cortex. The clinico-radiological and main histopathological features were consistent with a diagnosis of a complex variant of DNT composed of pilocytic and rosette-forming glioneuronal components. Although both piloid tissue and rosette-like formations have been occasionally mentioned in DNT lesions, the present case of DNT was unique in its well-circumscribed, separate pilocytic and RGNT nodules. We concluded that it represented an unusual, mixed pilocytic/RGNT variant of DNT.
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Affiliation(s)
- Ewa Matyja
- Department of Experimental and Clinical Neuropathology, M. Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland; Department of Neurosurgery, M. Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland
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