1
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Boop SH, Shimony N, Boop FA. Review and update on pediatric ependymoma. Childs Nerv Syst 2023; 39:2667-2673. [PMID: 37493720 DOI: 10.1007/s00381-023-06091-z] [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: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 07/27/2023]
Abstract
Since our last Special Annual Issue dedicated to the topic of ependymoma in 2009, critical advancements have been made in the understanding of this disease which is largely confined to childhood. In the era of molecular profiling, the prior classification of ependymoma based on histology has become largely irrelevant, with multiple new subtypes of this disease now being described in the newest 2021 WHO CNS Tumor Classification System. Despite our advancements in understanding the underlying biology of these tumors, the mainstays of treatment-gross total surgical resection followed by confocal radiation therapy-have continued to yield the best treatment results across multiple studies and centers. Here, we provide an update on our understanding of the advancements made in tumor biology, surgical, and oncologic management of this disease. As we move into an era of more personalized medicine, it is critical to reflect on our historical understanding of different disease entities, to better understand the future directions of our treatments.
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Affiliation(s)
- Scott H Boop
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Nir Shimony
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
- Le Bonheur Neuroscience Institute, LeBonheur Children's Hospital, Memphis, TN, USA
- Department of Neurological Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
- Semmes Murphey Clinic, Memphis, TN, USA
| | - Frederick A Boop
- Department of Neurological Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
- Global Program, St. Jude Children's Research Hospital, Memphis, TN, USA.
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2
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Dibas M, Ghozy S, Morsy S, Abbas AS, Alkahtani S, Bin-Jumah M, Abdel-Daim MM. Novel nomograms predicting overall and cancer-specific survival of malignant ependymoma patients: a population-based study. J Neurosurg Sci 2023; 67:93-102. [PMID: 32972115 DOI: 10.23736/s0390-5616.20.05033-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Malignant ependymomas are rare cancerous tumors that are associated with increased morbidity and mortality in the affected patients. Lately, there has been a lot of controversy about the correct way to manage and predict the survival outcome of these patients. We aim in this retrospective cohort study to develop novel nomograms that can better predict the overall survival (OS) and cancer-specific survival (CSS) of these patients. METHODS This is a retrospective cohort study that was conducted through the Surveillance, Epidemiology, and End Results databases (SEER) between 1998 and 2016. Patients were excluded if they had an unknown diagnosis, unknown cause of death or those with survival duration less than a month. We used penalized regression models with the highest time-dependent area under the ROC curve (AUC) and most stable calibrations to construct the nomograms. By searching the SEER database and applying the eligibility criteria, we identified 3391 patients for the final analysis. RESULTS Nine penalized regression models were developed of which two models including adaptive elastic-net was selected for both OS and CSS. The model incorporated age, sex, year of diagnosis, site, race, radiation, chemotherapy, surgery, and type for the construction of nomograms. We aimed in this population-based cohort study to develop novel prediction tools that can help physicians estimate the survival of malignant ependymoma patients and provide better care. CONCLUSIONS Our nomograms appear to have high accuracy and applicability, which we hope that can predict the survival and improve the treatment and prognosis of these patients.
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Affiliation(s)
- Mahmoud Dibas
- College of Medicine, Sulaiman Al Rajhi Colleges, Al Bukayriyah, Saudi Arabia
| | - Sherief Ghozy
- Faculty of Medicine, Mansoura University, Mansoura, Egypt.,Department of Neurosurgery, El Sheikh Zayed Specialized Hospital, Giza, Egypt
| | - Sara Morsy
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Saad Alkahtani
- Department of Zoology, Science College, King Saud University, Riyadh, Saudi Arabia
| | - May Bin-Jumah
- Department of Biology, Faculty of Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Mohamed M Abdel-Daim
- Department of Zoology, College of Sciences, King Saud University, Riyadh, Saudi Arabia - .,Department of Pharmacology, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
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3
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Sasaki T, Uematsu Y, Fukai J, Tanaka S, Mukasa A, Saito N, Narita Y, Nakao N. Prognostic Factors and Histopathological Features of Pediatric Intracranial Ependymomas: Nationwide Brain Tumor Registry-based Study of Japan. Neurol Med Chir (Tokyo) 2022; 62:322-327. [PMID: 35545504 PMCID: PMC9357454 DOI: 10.2176/jns-nmc.2022-0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
To assess the clinicopathological features and prognostic factors of pediatric intracranial ependymomas and to explore the current diagnostic practice, we analyzed clinical data from the Brain Tumor Registry of Japan (BTRJ). Data of fifty children under 18 years of age diagnosed with intracranial ependymoma were extracted from the BTRJ database. Cases were reviewed for overall survival (OS) and progression-free survival (PFS), with attention to gender, preoperative Karnofsky performance status score, location of the tumor, the extent of resection, World Health Organization (WHO) histopathological grading, and adjuvant therapy. The median age at diagnosis was 6.1 years, ranging from 7 months to 17.6 years. Based on the WHO histopathological grading, 27 patients were classified under grade 2 (54%) and 23 patients were classified under grade 3 (46%). Gross total resection (GTR) was achieved in 30 patients (60%). The median follow-up time was 65 months. Five-year PFS and OS were 47.2 ± 7.3% and 73.3 ± 6.7%, respectively. GTR was associated with longer OS (P = 0.02). The histopathological grading was not an independent prognostic factor for the OS. Mitosis and microvascular proliferation were higher among patients with grade 3 than in those with grade 2, which aided in deciding the WHO grade. This nationwide study revealed the characteristics and outcomes of patients with childhood ependymomas. GTR was the factor most consistently associated with improved survival. In contrast, the histopathological grading in this cohort was not a significant prognostic factor. More reproducible and practical criteria for the diagnosis of intracranial ependymomas should be further pursued in future studies.
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Affiliation(s)
- Takahiro Sasaki
- Department of Neurological Surgery, School of Medicine, Wakayama Medical University
| | - Yuji Uematsu
- Department of Neurological Surgery, School of Medicine, Wakayama Medical University.,School of Health and Nursing Science, Wakayama Medical University
| | - Junya Fukai
- Department of Neurological Surgery, School of Medicine, Wakayama Medical University
| | - Shota Tanaka
- Department of Neurosurgery, the University of Tokyo Hospital
| | - Akitake Mukasa
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University
| | - Nobuhito Saito
- Department of Neurosurgery, the University of Tokyo Hospital
| | - Yoshitaka Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital
| | - Naoyuki Nakao
- Department of Neurological Surgery, School of Medicine, Wakayama Medical University
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4
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Zhou X, Su Y, Huang W, Lin X, Xing Z, Cao D. Differentiation between supratentorial pilocytic astrocytoma and extraventricular ependymoma using multiparametric MRI. Acta Radiol 2021; 63:1661-1668. [PMID: 34709088 DOI: 10.1177/02841851211054195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The differentiation of supratentorial pilocytic astrocytomas (STPAs) and supratentorial extraventricular ependymomas (STEEs) is clinically pivotal because of distinct therapeutic management and prognosis, which is sometimes challenging to both neuroradiologists and pathologists. PURPOSE To explore and compare the conventional and advanced magnetic resonance imaging (MRI) features between STPA and STEE. MATERIAL AND METHODS A total of 23 patients with STPAs and 23 patients with STEEs were reviewed in this study. All patients performed conventional MRI, susceptibility-weighted imaging (SWI), and diffusion-weighted imaging (DWI), and 34 patients (17 with STPAs and 17 with STEEs) examined dynamic susceptibility contrast-enhanced perfusion-weighted imaging (DSC-PWI) in addition. Clinical data, conventional MRI features, minimum relative apparent diffusion coefficient ratio (rADCmin), and maximum relative cerebral blood volume ratio (rCBVmax) were compared between the two groups and subgroups. The optimal cutoff values of rADCmin and rCBVmax with sensitivity and specificity were calculated. RESULTS STPA manifested similar to STEE as a solid-cystic mass but more frequently presented with a marked enhancing deep nodule (P = 0.02), no peritumoral edema (P = 0.036), higher rADCmin value (2.0 ± 0.5 vs. 0.9 ± 0.2; P < 0.001), and lower rCBVmax value (2.1 ± 0.4 vs. 14.4 ± 5.5; P < 0.001). The cutoff value of >1.39 for rADCmin and ≤ 2.81 for rCBVmax produced a high sensitivity of 95.65% and 100.0%, respectively, and all produced a specificity of 100.0% in differentiating STPAs from STEEs. CONCLUSION Multiparametric MRI techniques including conventional MRI, DWI, and DSC-PWI contribute to the differential diagnosis of STPA and STEE.
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Affiliation(s)
- Xiaofang Zhou
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
| | - Yan Su
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
| | - Wanrong Huang
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
| | - Xiaojun Lin
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
| | - Zhen Xing
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
| | - Dairong Cao
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
- Fujian Key Laboratory of Precision Medicine for Cancer, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, PR China
- Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, PR China
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5
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Baig Mirza A, Lavrador JP, Mancuso-Marcello M, Acharya S, Boardman TM, Bodi I, Gullan R, Vergani F, Bhangoo R, Ashkan K. Adult WHO grade II ependymomas: is Ki67 a sex-specific proliferation marker? J Surg Case Rep 2021; 2021:rjab333. [PMID: 34434542 PMCID: PMC8382314 DOI: 10.1093/jscr/rjab333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/14/2021] [Indexed: 11/13/2022] Open
Abstract
Ki67 is a marker for proliferation of a given cell population. Low expression of Ki67 may be associated with a favourable outcome. We investigate how the proliferation index correlates with the location, morphology and behaviour of WHO grade II ependymomas with a single-centre cohort study of adult patients admitted for surgery of WHO grade II ependymomas between 2008 and 2018. Seventeen patients were included, seven had supratentorial and 10 had infratentorial tumours. Three patients died and eight had recurrent disease. Age, gender, location, extent of resection, chemotherapy, radiotherapy and histological markers were not associated with tumour progression. Both unadjusted and adjusted analysis confirmed a higher Ki67 index in male patients. Sensitivity analysis further supported the correlation between Ki67 and male gender. Ki67 may be sex specific but does not seem to correlate with survival and time to recurrence in this series.
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Affiliation(s)
- Asfand Baig Mirza
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - José Pedro Lavrador
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Marco Mancuso-Marcello
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Shami Acharya
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | | | - Istvan Bodi
- Department of Neuropathology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Richard Gullan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Francesco Vergani
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Ranj Bhangoo
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
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6
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Tabasaran J, Schuhmann M, Ebinger M, Honegger J, Renovanz M, Schittenhelm J. PAX6 is frequently expressed in ependymal tumours and associated with prognostic relevant subgroups. J Clin Pathol 2021; 75:759-765. [PMID: 34183436 DOI: 10.1136/jclinpath-2021-207526] [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: 03/04/2021] [Accepted: 05/20/2021] [Indexed: 01/20/2023]
Abstract
AIMS An ependymoma shows divergent morphological and molecular features depending on their location. The paired box 6 (PAX6) transcription factor is a putative tumour suppressor and drives cancer cells towards a stem cell-like state. A transcriptome study reported high PAX6 expression in ependymal tumours, but data on protein expression are lacking. METHODS We, therefore, analysed PAX6 expression by immunohistochemistry in 172 ependymoma samples and correlated its expression to histology, WHO grade, anatomical location and molecular subgroups. RESULTS Mean PAX6 nuclear expression in ependymoma was 27.5% (95% CI 23.3 to 31.7). PAX6 expression in subependymoma (mean: 5%) was significantly lower compared with myxopapillary (30%), WHO grade II (26%) and anaplastic ependymoma (35%). Supratentorial ependymomas also displayed significant lower PAX6 levels (15%) compared with spinal cord tumours (30%). Expression levels in YAP1-fused ependymoma (41%) were higher compared with REL-associated protein (RELA)-fusion positive tumours (17%), while PAX6 expression was similar in posterior fossa group A (33%) and B (29%) ependymomas. Kaplan-Meier analysis in RELA-fusion positive ependymomas and posterior fossa group B showed a significant better outcome for PAX6 at or above the cut-off of 19.45% compared with tumours with PAX6 below the cut-off. CONCLUSIONS We demonstrate that PAX6 is frequently expressed in human ependymal tumours and immunohistochemistry may be helpful in determining prognostic relevant subgroups.
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Affiliation(s)
- Julian Tabasaran
- Department of Neuropathology, Institute of Pathology and Neuropathology, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Martin Schuhmann
- Department of Neurosurgery, Eberhard Karls University of Tuebingen, Baden-Württemberg, Germany.,Center for Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany.,Division of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Martin Ebinger
- Department Pediatric Hematology/Oncology, Children's University Hospital, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Jürgen Honegger
- Department of Neurosurgery, Eberhard Karls University of Tuebingen, Baden-Württemberg, Germany.,Center for Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Mirjam Renovanz
- Department of Neurosurgery, Eberhard Karls University of Tuebingen, Baden-Württemberg, Germany.,Center for Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany.,Interdisciplinary Division of Neuro-Oncology, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Jens Schittenhelm
- Department of Neuropathology, Institute of Pathology and Neuropathology, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany .,Center for Neuro-Oncology, Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
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An Insight into Pathophysiological Features and Therapeutic Advances on Ependymoma. Cancers (Basel) 2021; 13:cancers13133221. [PMID: 34203272 PMCID: PMC8269186 DOI: 10.3390/cancers13133221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 12/21/2022] Open
Abstract
Simple Summary Although biological information and the molecular classification of ependymoma have been studied, the treatment systems for ependymoma are still insufficient. In addition, because the disease occurs infrequently, it is difficult to obtain sufficient data to conduct large-scale or randomized clinical trials. Therefore, this study is intended to emphasize the importance of understanding its pathological characteristics and prognosis as well as developing treatments for ependymoma through multilateral studies. Abstract Glial cells comprise the non-sensory parts of the central nervous system as well as the peripheral nervous system. Glial cells, also known as neuroglia, constitute a significant portion of the mammalian nervous system and can be viewed simply as a matrix of neural cells. Despite being the “Nervenkitt” or “glue of the nerves”, they aptly serve multiple roles, including neuron repair, myelin sheath formation, and cerebrospinal fluid circulation. Ependymal cells are one of four kinds of glial cells that exert distinct functions. Tumorigenesis of a glial cell is termed a glioma, and in the case of an ependymal cell, it is called an ependymoma. Among the various gliomas, an ependymoma in children is one of the more challenging brain tumors to cure. Children are afflicted more severely by ependymal tumors than adults. It has appeared from several surveys that ependymoma comprises approximately six to ten percent of all tumors in children. Presently, the surgical removal of the tumor is considered a standard treatment for ependymomas. It has been conspicuously evident that a combination of irradiation therapy and surgery is much more efficacious in treating ependymomas. The main purpose of this review is to present the importance of both a deep understanding and ongoing research into histopathological features and prognoses of ependymomas to ensure that effective diagnostic methods and treatments can be developed.
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8
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Levine AB, Wong D, Fatehi M, Yip S. Ependymoma and Chordoma. Neurosurgery 2021; 87:860-870. [PMID: 33057707 DOI: 10.1093/neuros/nyaa329] [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: 03/30/2020] [Accepted: 05/31/2020] [Indexed: 11/14/2022] Open
Abstract
Ependymoma and chordoma are 2 tumors that occur throughout the craniospinal axis, and for which the extent of neurosurgical resection has a key prognostic role. Both tumors have distinctive pathologic features, yet can present significant diagnostic challenges to pathologists in cases without classical histology. The molecular understanding of ependymoma has had significant advances in the past decade, with the identification of 9 molecular groups with significant prognostic and clinical implications, while a comprehensive study of chordoma further emphasized the key role of brachyury overexpression in its pathogenesis. In this review, we discuss the pathogenesis, radiology and gross pathology, histology, and molecular features of these 2 tumors, as well as active research into targeted therapies, with an emphasis on practical diagnostic challenges, and the use of immunohistochemical and molecular tests in routine diagnostic practice.
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Affiliation(s)
- Adrian B Levine
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Derek Wong
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mostafa Fatehi
- Department of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephen Yip
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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9
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Achey RL, Vo S, Cioffi G, Gittleman H, Schroer J, Khanna V, Buerki R, Kruchko C, Barnholtz-Sloan JS. Ependymoma, NOS and anaplastic ependymoma incidence and survival in the United States varies widely by patient and clinical characteristics, 2000-2016. Neurooncol Pract 2020; 7:549-558. [PMID: 33014396 DOI: 10.1093/nop/npaa023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Ependymoma is a rare CNS tumor arising from the ependymal lining of the ventricular system. General differences in incidence and survival have been noted but not examined on a comprehensive scale for all ages and by histology. Despite the rarity of ependymomas, morbidity/mortality associated with an ependymoma diagnosis justifies closer examination. METHODS Incidence data were obtained from the Central Brain Tumor Registry of the United States in collaboration with the Centers for Disease Control and Prevention and the National Cancer Institute, and survival data from Surveillance Epidemiology and End Results, from 2000 to 2016 for anaplastic ependymoma and ependymoma, not otherwise specified (NOS). Age-adjusted incidence rates (IRs) per 100 000 person-years were analyzed by age, sex, race, and location. Survival analysis was performed with Kaplan-Meier curves and multivariable Cox proportional hazards models. RESULTS Incidence of anaplastic ependymoma was highest in ages 0 to 4 years. African American populations had lower incidence but had a 78% increased risk of death compared to white populations (hazard ratio [HR]: 1.78 [95% CI, 1.30-2.44]). Incidence was highest for anaplastic ependymoma in the supratentorial region. Adults (age 40+ years) had almost twice the risk of death compared to children (ages 0-14 years) (HR: 1.97 [95% CI, 1.45-2.66]). For ependymoma, NOS, subtotal resection had a risk of mortality 1.86 times greater than gross total resection ([HR: 1.86 [95% CI, 1.32-2.63]). CONCLUSIONS African American populations experienced higher mortality rates despite lower incidence compared to white populations. Extent of resection is an important prognostic factor for survival. This highlights need for further evaluation of treatment patterns and racial disparities in the care of patients with ependymoma subtypes.
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Affiliation(s)
- Rebecca L Achey
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sierra Vo
- Department of Mathematics, Applied Mathematics, and Statistics, Case Western Reserve, Cleveland, Ohio
| | - Gino Cioffi
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Haley Gittleman
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Julia Schroer
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Vishesh Khanna
- Department of Internal Medicine, Stanford University, Stanford, California
| | - Robin Buerki
- Department of Neurology, University Hospitals of Cleveland, Cleveland, Ohio
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois
| | - Jill S Barnholtz-Sloan
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Central Brain Tumor Registry of the United States, Hinsdale, Illinois
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10
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Comparison of Conventional, Diffusion, and Perfusion MRI Between Low-Grade and Anaplastic Extraventricular Ependymoma. AJR Am J Roentgenol 2020; 215:978-984. [PMID: 32809860 DOI: 10.2214/ajr.20.22764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study was to investigate and compare conventional MRI, DWI, and dynamic susceptibility contrast-enhanced perfusion-weighted imaging (DSC-PWI) characteristics between low-grade and anaplastic extraventricular ependymomas. MATERIALS AND METHODS. Twenty-six patients with extraventricular ependymomas (19 anaplastic and seven low-grade) who underwent preoperative MRI were enrolled in this retrospective study. Conventional MRI and DWI were performed in all patients; DSCPWI was performed in 15 patients (11 with anaplastic ependymoma and four with low-grade ependymoma). Demographics, conventional MRI features, minimum relative apparent diffusion coefficient (rADCmin), and maximum relative cerebral blood volume (rCBVmax) of the low-grade and anaplastic ependymomas were compared. Diagnostic performance with optimal cutoff values was determined. RESULTS. Anaplastic extraventricular ependymomas were more likely to be located in the superficial supratentorial cerebral hemisphere (p = 0.026) and to present with pial and cortical involvement (p = 0.028 and 0.013, respectively) and necrotic degeneration (p = 0.014). The mean rADCmin ± SD of anaplastic ependymoma was significantly lower than that of low-grade ependymoma (0.8 ± 0.2 vs 1.2 ± 0.3, p = 0.002). The mean rCBVmax of anaplastic ependymoma was significantly higher than that of low-grade ependymoma (15.7 ± 5.3 vs 9.0 ± 4.4, p = 0.042). The cutoff values in grading extraventricular ependymoma were 1.02 for rADCmin and 10.43 for rCBVmax. Combining conventional MRI, DWI, and DSC-PWI allowed the best differentiation of low-grade and anaplastic ependymoma (AUC = 1.00). CONCLUSION. Conventional MRI, DWI, and DSC-PWI techniques may aid in assessing and grading extraventricular ependymomas.
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11
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Ghali MGZ. Microsurgical techniques for achieving gross total resection of ependymomas of the fourth ventricle. Acta Chir Belg 2020; 120:149-166. [PMID: 32284025 DOI: 10.1080/00015458.2020.1711593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Ependymomas arising from the ventricular surface present a major challenge to achieving a complete operative extirpation when located in the fourth ventricle given the presence of significant adherence to the floor of the same. Overzealous dissection and removal of a tumor from this zone may precipitate potentially catastrophic neurological deficits attributable to cranial nucleopathies and cranial neuropathies. Consequently, the classic neurosurgical teaching has advised attempted gross total resection, leaving adherent residual in the floor of the fourth ventricle, in order to prevent the development of major cranial nucleopathies and cranial neuropathies. Following surgical tumoral extirpation, residual tumor is adjuvantly stereotactically irradiated. Authors have consequently developed novel neurophysiologically guided microsurgical techniques designed to remove adherent tumor from the fourth ventricular floor. These strategies have successfully and consistently facilitated gross total resection and improved clinical outcomes in patients harboring ependymomas of the fourth ventricle. We discuss and evaluate the innovation in microsurgical strategies developed to achieve complete operative extirpation of tumoral adherence to the floor of the fourth ventricle.
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Affiliation(s)
- Michael G. Z. Ghali
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
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12
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Lester A, McDonald KL. Intracranial ependymomas: molecular insights and translation to treatment. Brain Pathol 2020; 30:3-12. [PMID: 31433520 PMCID: PMC8018002 DOI: 10.1111/bpa.12781] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 08/14/2019] [Indexed: 12/11/2022] Open
Abstract
Ependymomas are primary central nervous system tumors (CNS), arising within the posterior fossa and supratentorial regions of the brain, and in the spine. Over the last decade, research has resulted in substantial insights into the molecular characteristics of ependymomas, and significant advances have been made in the establishment of a molecular classification system. Ependymomas both within and between the three CNS regions in which they arise, have been shown to contain distinct genetic, epigenetic and cytogenic aberrations, with at least three molecularly distinct subgroups identified within each region. However, these advances in molecular characterization have yet to be translated into clinical practice, with the standard treatment for ependymoma patients largely unchanged. This review summarizes the advances made in the molecular characterization of intracranial ependymomas, outlines the progress made in establishing preclinical models and proposes strategies for moving toward subgroup-specific preclinical investigations and treatment.
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Affiliation(s)
- Ashleigh Lester
- Adult Cancer Program, Lowy Cancer Research CentreUniversity of NSWSydneyAustralia
| | - Kerrie L. McDonald
- Adult Cancer Program, Lowy Cancer Research CentreUniversity of NSWSydneyAustralia
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Central nervous system ependymoma: clinical implications of the new molecular classification, treatment guidelines and controversial issues. Clin Transl Oncol 2019; 21:1450-1463. [PMID: 30868390 DOI: 10.1007/s12094-019-02082-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/07/2019] [Indexed: 10/27/2022]
Abstract
Ependymoma is an uncommon neuroepithelial tumor that may arise anywhere within the neuroaxis, both in children and in adults. It has been classically graded upon histopathological features, yet with limited clinical utility. Recently, DNA methylation profiling has provided a novel classification of ependymoma in nine molecular subgroups. This stratification method harbors prognostic value with supratentorial RELA-fusion and posterior fossa group A tumors showing a significantly shorter survival compared to the rest. Currently, the treatment of choice involves maximal safe resection and, in cases of residual disease, adjuvant conformal radiotherapy. Second-look surgery is also a feasible and recommended option for incompletely resected tumors. The role of chemotherapy is not yet established and can be considered in infants and children with relapsing disease or prior to re-intervention. Although targeted agents do not seem to play a role as adjuvant therapy, they are currently being tested for recurrent disease.
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Sun XY, Kong C, Lu SB, Sun SY, Guo MC, Ding JZ. Survival outcomes and prognostic factors of patients with intramedullary Grade II ependymomas after surgical treatments. J Clin Neurosci 2018; 57:136-142. [PMID: 30146401 DOI: 10.1016/j.jocn.2018.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 05/23/2018] [Accepted: 08/08/2018] [Indexed: 12/12/2022]
Abstract
This study evaluated survival outcomes of patients with intramedullary Grade II ependymomas and identify prognostic factors. Electronic searches of PubMed, EMBASE, OVID, the Cochrane Central Register of Controlled Trials were performed to identify trials according to the Cochrane Collaboration guidelines. The objects were intramedullary Grade II ependymoma according to 2007 WHO classification. Kaplan-Meier survival analysis with log-rank test was used to analyze progressive free survival (PFS) and overall survival (OS). Cox proportional hazard model was utilized for multivariate analysis with hazard ratio (HR) and 95% confidence interval (CI) calculated. P values <0.05 were considered statistically significant. A total of 28 studies including 138 cases of intramedullary Grade II ependymomas were retrieved. Patients who were classified as cellular ependymomas or papillary ependymomas had higher risks of progression than those who possessed typical Grade II ependymomas. Patients who were treated with adjuvant therapy had a higher risk of progression than those without adjuvant therapy. OS of patients with giant cell ependymoma was significantly shorter than those with typical Grade II ependymoma. Patients who had cellular or papillary subtype, adjuvant therapy would have a shorter estimated value of progression-free time and a higher risk of progression than typical Grade II ependymomas. Giant cell ependymoma patients would have a higher risk of fatality than those with typical Grade II ependymomas. Definite pathology type and appropriate treatments were foundations of intramedullary Grade II ependymomas' managements.
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Affiliation(s)
- Xiang-Yao Sun
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, China; National Clinical Research Center for Geriatric Diseases, China; Capital Medical University, China.
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, China; National Clinical Research Center for Geriatric Diseases, China
| | - Shi-Bao Lu
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, China; National Clinical Research Center for Geriatric Diseases, China.
| | - Si-Yuan Sun
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, China; National Clinical Research Center for Geriatric Diseases, China; Capital Medical University, China
| | - Ma-Chao Guo
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, China; National Clinical Research Center for Geriatric Diseases, China; Capital Medical University, China
| | - Jun-Zhe Ding
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, China; National Clinical Research Center for Geriatric Diseases, China; Capital Medical University, China
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Wang Y, Cai R, Wang R, Wang C, Chen C. Outcome predictors in the management of intramedullary classic ependymoma: An integrative survival analysis. Medicine (Baltimore) 2018; 97:e10870. [PMID: 29879023 PMCID: PMC5999504 DOI: 10.1097/md.0000000000010870] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
UNLABELLED This is a retrospective study.The aim of this study was to illustrate the survival outcomes of patients with classic ependymoma (CE) and identify potential prognostic factors.CE is the most common category of spinal ependymomas, but few published studies have discussed predictors of the survival outcome.A Boolean search of the PubMed, Embase, and OVID databases was conducted by 2 investigators independently. The objects were intramedullary grade II ependymoma according to 2007 WHO classification. Univariate Kaplan-Meier analysis and Log-Rank tests were performed to identify variables associated with progression-free survival (PFS) or overall survival (OS). Multivariate Cox regression was performed to assess hazard ratios (HRs) with 95% confidence intervals (95% CIs). Statistical analysis was performed by SPSS version 23.0 (IBM Corp.) with statistical significance defined as P < .05.A total of 35 studies were identified, including 169 cases of CE. The mean follow-up time across cases was 64.2 ± 51.5 months. Univariate analysis showed that patients who had undergone total resection (TR) had better PFS and OS than those with subtotal resection (STR) and biopsy (P = .002, P = .004, respectively). Within either univariate or multivariate analysis (P = .000, P = .07, respectively), histological type was an independent prognostic factor for PFS of CE [papillary type: HR 0.002, 95% CI (0.000-0.073), P = .001, tanycytic type: HR 0.010, 95% CI (0.000-0.218), P = .003].It was the first integrative analysis of CE to elucidate the correlation between kinds of factors and prognostic outcomes. Definite histological type and safely TR were foundation of CE's management. LEVEL OF EVIDENCE 4.
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Lee JW, Lim DH, Sung KW, Lee HJ, Yi ES, Yoo KH, Koo HH, Suh YL, Shin HJ. Multimodal treatment including tandem high-dose chemotherapy and autologous stem cell transplantation in children with anaplastic ependymomas. Pediatr Transplant 2018; 22:e13127. [PMID: 29453811 DOI: 10.1111/petr.13127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2017] [Indexed: 11/30/2022]
Abstract
In this study, we evaluated the results of multimodal treatment that included tandem HDCT/auto-SCT in children with anaplastic ependymomas. Fourteen patients with anaplastic ependymomas were enrolled from 2006 to 2014. Six cycles of induction chemotherapy were administered to all patients before they underwent tandem HDCT/auto-SCT. Patients who were older than 3 years of age were administered RT after two cycles of induction chemotherapy. In patients under 3 years of age, RT was either omitted or delayed until they reached 3 years of age, if the patients experienced CR after tandem HDCT/auto-SCT. All patients, including two who experienced disease progression during induction treatment, underwent the first HDCT/auto-SCT, and 13 subsequently underwent the second HDCT/auto-SCT. One patient died from hepatic VOD during the second HDCT/auto-SCT; other toxicities occurring during tandem HDCT/auto-SCT were manageable. Relapses or progression occurred in seven patients, and five of seven of them remain alive till date after salvage treatment, including surgery and RT. The 5-year overall and event-free survival rates were 85.1% ± 9.7% and 50.0% ± 13.4%, respectively. These findings suggest that multimodal treatment including tandem HDCT/auto-SCT could be a feasible option for improving survival in children with anaplastic ependymomas.
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Affiliation(s)
- Ji Won Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ki Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyeong Jin Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Sang Yi
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Keon Hee Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hong Hoe Koo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yeon-Lim Suh
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Diaz-Aguilar D, Terterov S, Tucker AM, Sedighim S, Scharnweber R, Wang S, Merna C, Rahman S. Simultaneous cerebrospinal fluid and hematologic metastases in a high-grade ependymoma. Surg Neurol Int 2018; 9:93. [PMID: 29770253 PMCID: PMC5938895 DOI: 10.4103/sni.sni_475_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 02/16/2018] [Indexed: 01/09/2023] Open
Abstract
Background Ependymomas are relatively uncommon tumors that constitute about 7% of all primary intracranial neoplasms. Among these, high-grade ependymomas are locally aggressive and recur most commonly at the primary site following resection. Ependymomas are also known to be the one glial neoplasm that tends to frequently metastasize inside and outside the central nervous system (CNS) that complicates workup and management. Metastasis due to surgical manipulation is common and neurosurgeons should be well-versed in the most effective methods to remove these tumors in order to avoid such metastases. Case Description Here, we report a case of a 28-year-old female who initially presented with a parenchymal World Health Organization (WHO) grade III anaplastic ependymoma of the occipital lobe without metastasis. After multiple resections, the patient showed no evidence of disease recurrence for 2 years. During follow-up, new metastasis to the frontal lobe as well as to the lung were discovered 2 years after the initial surgery, without recurrence at the tumor's primary site. Conclusions While uncommon, this case demonstrates the possibility for ependymomas to metastasize via cerebrospinal fluid to other locations within the CNS and hematologically to extraneural locations without recurring locally.
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Affiliation(s)
- Daniel Diaz-Aguilar
- Department of Neurosurgery, University of California, David Geffen School of Medicine, California, USA
| | - Sergei Terterov
- Department of Neurosurgery, University of California, David Geffen School of Medicine, California, USA
| | - Alexander M Tucker
- Department of Neurosurgery, University of California, David Geffen School of Medicine, California, USA
| | - Shaina Sedighim
- Department of Neurosurgery, University of California, David Geffen School of Medicine, California, USA.,Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Rudi Scharnweber
- Department of Neurosurgery, University of California, David Geffen School of Medicine, California, USA
| | - Stephanie Wang
- Department of Neurosurgery, University of California, David Geffen School of Medicine, California, USA
| | - Catherine Merna
- Department of Neurosurgery, University of California, David Geffen School of Medicine, California, USA
| | - Shayan Rahman
- Department of Neurosurgery, University of California, David Geffen School of Medicine, California, USA
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Teaching Case 2-2018: Sclerosing myxopapillary ependymoma mimicking whorling-sclerosing meningioma. Clin Neuropathol 2018; 37:51-52. [PMID: 29436365 PMCID: PMC5822135 DOI: 10.5414/np301099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2018] [Indexed: 11/18/2022] Open
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Malgulwar PB, Nambirajan A, Pathak P, Faruq M, Rajeshwari M, Singh M, Suri V, Sarkar C, Sharma MC. C11orf95-RELA fusions and upregulated NF-KB signalling characterise a subset of aggressive supratentorial ependymomas that express L1CAM and nestin. J Neurooncol 2018; 138:29-39. [PMID: 29354850 DOI: 10.1007/s11060-018-2767-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 01/14/2018] [Indexed: 12/16/2022]
Abstract
Ependymomas (EPN) show site specific genetic alterations and a recent DNA methylation profiling study identified nine molecular subgroups. C11orf95-RELA and YAP1 fusions characterise the RELA and YAP1 molecular subgroups, respectively, of supratentorial (ST)-EPNs. Current guidelines recommend molecular subgrouping over histological grade for accurate prognostication. Clinicopathological features of ST-EPNs in correlation with C11orf95-RELA and YAP1 fusions have been assessed in only few studies. We aimed to study these fusions in EPNs, and identify diagnostic and prognostic markers. qRT-PCR and Sanger Sequencing for the detection of C11orf95-RELA, YAP1-MAMLD1 and YAP1-FAM118B fusion transcripts, gene expression analysis for NFKB1, and immunohistochemistry for p53, MIB-1, nestin, VEGF, and L1CAM were performed. 88 EPNs (10-Grade I and 78-Grade II/III) from all sites were included. RELA fusions were unique to Grade II/III ST-EPNs, detected in 81.4% (22/27) and 18.5% (5/27) of pediatric and adult ST-EPNs respectively. ST-EPNs harbouring RELA fusions showed frequent grade III histology (81.5%), clear cell morphology (70.3%), upregulated NFKB1 expression, MIB-1 labelling indices (LI) ≥ 10% (77.8%), and immunopositivity for nestin (95.7%), VEGF (72%), L1CAM (79%), and p53 (64%). Presence of RELA fusions, L1CAM immunopositivity and MIB-1 LI ≥ 10% associated with poor outcome. L1CAM showed 81% concordance with RELA fusions. YAP1-MAMLD1 fusion was identified in a single RELA fusion negative adult anaplastic ST-EPN. RELA fusions are frequent in ST-EPNs and associate with poor outcome. L1CAM is a surrogate immunohistochemical marker. RELA fusion positive ST-EPNs strongly express nestin indicating increased stemness. Further evaluation of the interactions between NFKB and stem cell pathways is warranted.
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Affiliation(s)
- Prit Benny Malgulwar
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Aruna Nambirajan
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Pankaj Pathak
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Mohammed Faruq
- Genomics and Molecular Medicine Unit, Institute of Genomics and Integrative Biology-Council of Scientific and Industrial Research (IGIB-CSIR), New Delhi, India
| | - Madhu Rajeshwari
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Vaishali Suri
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Chitra Sarkar
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Mehar Chand Sharma
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
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Virág J, Haberler C, Baksa G, Piurkó V, Hegedüs Z, Reiniger L, Bálint K, Chocholous M, Kiss A, Lotz G, Glasz T, Schaff Z, Garami M, Hegedűs B. Region Specific Differences of Claudin-5 Expression in Pediatric Intracranial Ependymomas: Potential Prognostic Role in Supratentorial Cases. Pathol Oncol Res 2017; 23:245-252. [PMID: 27395057 PMCID: PMC5371650 DOI: 10.1007/s12253-016-0084-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/28/2016] [Indexed: 10/26/2022]
Abstract
Ependymomas are common pediatric brain tumors that originate from the ependyma and characterized by poor prognosis due to frequent recurrence. However, the current WHO grading system fails to accurately predict outcome. In a retrospective study, we analyzed 54 intracranial pediatric ependymomas and found a significantly higher overall survival in supratentorial cases when compared to infratentorial tumors. Next we performed region-specific immunohistochemical analysis of the ependyma in neonatal and adult ependyma from the central canal of spinal cord to the choroid plexus of lateral ventricles for components of cell-cell junctions including cadherins, claudins and occludin. We found robust claudin-5 expression in the choroid plexus epithelia but not in other compartments of the ependyma. Ultrastructural studies demonstrated distinct regional differences in cell-cell junction organization. Surprisingly, we found that 9 out of 20 supratentorial but not infratentorial ependymomas expressed high levels of the brain endothelial tight junction component claudin-5 in tumor cells. Importantly, we observed an increased overall survival in claudin-5 expressing supratentorial ependymoma. Our data indicates that claudin-5 expressing ependymomas may follow a distinct course of disease. The assessment of claudin-5 expression in ependymoma has the potential to become a useful prognostic marker in this pediatric malignancy.
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Affiliation(s)
- József Virág
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Christine Haberler
- Institute of Neuropathology, Medical University of Vienna, Vienna, Austria
| | - Gábor Baksa
- 1st Department of Anatomy, Semmelweis University, Budapest, Hungary
| | - Violetta Piurkó
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary
| | - Zita Hegedüs
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary
| | - Lilla Reiniger
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
- MTA-SE NAP, Brain Metastasis Research Group, Hungarian Academy of Sciences - Semmelweis University, Budapest, Hungary
| | - Katalin Bálint
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Monika Chocholous
- Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - András Kiss
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary
| | - Gábor Lotz
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary
| | - Tibor Glasz
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary
| | - Zsuzsa Schaff
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary
| | - Miklós Garami
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Balázs Hegedűs
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary.
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
- Molecular Oncology Research Group, Hungarian Academy of Sciences - Semmelweis University, Budapest, Hungary.
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Abstract
Gliomas form a heterogeneous group of tumors of the central nervous system (CNS) and are traditionally classified based on histologic type and malignancy grade. Most gliomas, the diffuse gliomas, show extensive infiltration in the CNS parenchyma. Diffuse gliomas can be further typed as astrocytic, oligodendroglial, or rare mixed oligodendroglial-astrocytic of World Health Organization (WHO) grade II (low grade), III (anaplastic), or IV (glioblastoma). Other gliomas generally have a more circumscribed growth pattern, with pilocytic astrocytomas (WHO grade I) and ependymal tumors (WHO grade I, II, or III) as the most frequent representatives. This chapter provides an overview of the histology of all glial neoplasms listed in the WHO 2016 classification, including the less frequent "nondiffuse" gliomas and mixed neuronal-glial tumors. For multiple decades the histologic diagnosis of these tumors formed a useful basis for assessment of prognosis and therapeutic management. However, it is now fully clear that information on the molecular underpinnings often allows for a more robust classification of (glial) neoplasms. Indeed, in the WHO 2016 classification, histologic and molecular findings are integrated in the definition of several gliomas. As such, this chapter and Chapter 6 are highly interrelated and neither should be considered in isolation.
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Abstract
Over the past 150 years since Virchow's initial characterization of ependymoma, incredible efforts have been made in the classification of these tumors and in the care of pediatric patients with this disease. While the advent of modern neurosurgery and the optimization of radiation have provided significant gains, a more complex but incomplete picture of pediatric ependymomas has begun to form through a combination of international collaborations and detailed genetic and histologic characterizations. This review includes and synthesizes the clinical understanding of pediatric ependymoma and their developing molecular insight into what is truly a family of malignancies in which distinct members require different surgical approaches, radiation plans, and targeted therapies.
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Affiliation(s)
- Nicholas A Vitanza
- Division of Child Neurology, Department of Neurology, Lucile Packard Children's Hospital at Stanford, Stanford University, Palo Alto, CA, USA
| | - Sonia Partap
- Division of Child Neurology, Department of Neurology, Lucile Packard Children's Hospital at Stanford, Stanford University, Palo Alto, CA, USA
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Gupta K, Chandrasekaran M, Garg R, Salunke P. Supratentorial "vascular" variant of ependymoma: a lesser known morphologic variant and a diagnostic pitfall. Childs Nerv Syst 2016; 32:1569-71. [PMID: 27392446 DOI: 10.1007/s00381-016-3158-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 06/26/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Kirti Gupta
- Department of Histopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Muralidaran Chandrasekaran
- Department of Histopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ravi Garg
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pravin Salunke
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Zakrzewska M, Fendler W, Zakrzewski K, Sikorska B, Grajkowska W, Dembowska-Bagińska B, Filipek I, Stefańczyk Ł, Liberski PP. Altered MicroRNA Expression Is Associated with Tumor Grade, Molecular Background and Outcome in Childhood Infratentorial Ependymoma. PLoS One 2016; 11:e0158464. [PMID: 27390862 PMCID: PMC4938415 DOI: 10.1371/journal.pone.0158464] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 06/16/2016] [Indexed: 11/18/2022] Open
Abstract
Background Ependymal tumors are the third most common group of brain tumors in children, accounting for about 10% of all primary brain neoplasms. According to the current WHO classification, they comprise four entities with the most frequent ependymoma and anaplastic ependymoma. The most of pediatric tumors are located within the posterior fossa, with a tendency to infiltrate the vital brain structures. This limits surgical resection and poses a considerable clinical problem. Moreover, there are no appropriate outcome prognostic factors besides the extent of surgical resection. Despite definition of molecular subgroups, the majority of childhood ependymomas present a balanced genome, which makes it difficult to establish molecular prognostic factors. Methods The purpose of our study was to explore whether miRNA expression could be used as prognostic markers in pediatric infratentorial ependymomas. We also performed a mRNA expression pattern analysis of NELL2 and LAMA2 genes, with immunohistochemical illustrations of representative cases. The miRNA and mRNA expression was measured in 53 pediatric infratentorial ependymomas using a real-time quantitative PCR. Results Three miRNAs were shown to efficiently differentiate between grade II and III ependymomas: miR-17-5p, miR-19a-3p, and miR-106b-5p. Survival analysis showed that the probabilities of overall (p = 0.036) and event-free survival (p = 0.002) were reduced with higher than median miRNA expression levels of miR-17-5p. Using multivariate analysis adjusted for patient's age, sex, tumor grade and localization, we showed statistically significant associations with event-free survival (p = 0004) and borderline statistical significance with overall survival (p = 0.057) for miR-17-5p. Correlation analysis of miR-19a, miR-17-5p, miR-106b revealed that their expression levels were significantly correlated with EZH2 expression, suggested marker of PFA ependymomas. Furthermore, lower expression level of LAMA2 mRNA was shown to be associated with an increased risk of death in covariate-adjusted analyses. Conclusions Our data provide a better understanding of pediatric ependymoma and suggests the presence of plausible molecular biomarkers connected with the outcome.
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Affiliation(s)
- Magdalena Zakrzewska
- Department of Molecular Pathology and Neuropathology, Medical University of Lodz, Lodz, Poland
- * E-mail:
| | - Wojciech Fendler
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | - Krzysztof Zakrzewski
- Department of Neurosurgery, Polish Mother Memorial Hospital Research Institute, Lodz, Poland
| | - Beata Sikorska
- Department of Molecular Pathology and Neuropathology, Medical University of Lodz, Lodz, Poland
| | - Wiesława Grajkowska
- Department of Pathology, Children’s Memorial Health Institute, Warsaw, Poland
- Department of Experimental and Clinical Neuropathology, M. Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | | | - Iwona Filipek
- Department of Pediatric Oncology, Children's Memorial Health Institute, Warsaw, Poland
| | | | - Paweł P. Liberski
- Department of Molecular Pathology and Neuropathology, Medical University of Lodz, Lodz, Poland
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New Concepts in the Imaging of Pediatric Brain Tumors: The Revival of Age-old Real Estate Principles. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0164-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Wu J, Armstrong TS, Gilbert MR. Biology and management of ependymomas. Neuro Oncol 2016; 18:902-13. [PMID: 27022130 DOI: 10.1093/neuonc/now016] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 01/04/2016] [Indexed: 12/20/2022] Open
Abstract
Ependymomas are rare primary tumors of the central nervous system in children and adults that comprise histologically similar but genetically distinct subgroups. The tumor biology is typically more associated with the site of origin rather than being age-specific. Genetically distinct subgroups have been identified by genomic studies based on locations in classic grade II and III ependymomas. They are supratentorial ependymomas with C11orf95-RELA fusion or YAP1 fusion, infratentorial ependymomas with or without a hypermethylated phenotype (CIMP), and spinal cord ependymomas. Myxopapillary ependymomas and subependymomas have different biology than ependymomas with typical WHO grade II or III histology. Surgery and radiotherapy are the mainstays of treatment, while the role of chemotherapy has not yet been established. An in-depth understanding of tumor biology, developing reliable animal models that accurately reflect tumor molecule features, and high throughput drug screening are essential for developing new therapies. Collaborative efforts between scientists, physicians, and advocacy groups will enhance the translation of laboratory findings into clinical trials. Improvements in disease control underscore the need to incorporate assessment and management of patients' symptoms to ensure that treatment advances translate into improvement in quality of life.
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Affiliation(s)
- Jing Wu
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (J.W., M.R.G.); Department of Family Health, University of Texas Health Science Center at Houston, Houston, Texas (T.S.A.)
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (J.W., M.R.G.); Department of Family Health, University of Texas Health Science Center at Houston, Houston, Texas (T.S.A.)
| | - Mark R Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (J.W., M.R.G.); Department of Family Health, University of Texas Health Science Center at Houston, Houston, Texas (T.S.A.)
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Lipomatous ependymoma: report of a rare differentiation pattern with a comprehensive review of literature. Brain Tumor Pathol 2016; 33:209-15. [DOI: 10.1007/s10014-016-0253-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 02/15/2016] [Indexed: 11/26/2022]
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Chen C, Chen L, Yao Y, Qin Z, Chen H. Nucleolin overexpression is associated with an unfavorable outcome for ependymoma: a multifactorial analysis of 176 patients. J Neurooncol 2016; 127:43-52. [PMID: 26615563 DOI: 10.1007/s11060-015-2007-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 11/20/2015] [Indexed: 10/22/2022]
Abstract
Ependymoma typically has a better overall survival rate than most gliomas. Only a few comprehensive clinical studies have been published, but these are mostly from Western countries and use small sample sizes. Histopathological classification is not sufficient to show variable outcomes, and fails to show prognostic markers of the diverse outcomes; hence, it is essential to understand biological mechanisms. In this study, 176 ependymoma samples (World Health Organization grade II and III) were reviewed at Huashan Hospital. Both children and adults were included. We performed multifactorial analyses of clinical prognostic factors and the biomolecular marker expressions of nucleolin, epidermal growth factor receptor (EGFR) and caveolae-associated protein caveolin-1 by immunohistochemistry. We identified the probabilities of progression-free survival and overall survival using univariate and multivariate statistical methods. The participants were diagnosed with ependymomas between 2002 and 2010, including distributions of tumor locations in intracranial and extracranial regions. Nucleolin was overexpressed in 67 % of our samples, demonstrating a subgroup with poor outcome; particularly infratentorial and anaplastic ependymomas. There was no significant correlation between the expression of EGFR and caveolin-1 and clinical outcomes. Clinically, inferior prognosis was observed with regard to age (<18 years), intracranial location, high grade ependymomas, and incomplete resection. We found that nucleolin was an unfavorable prognostic predictor for ependymomas. Moreover, our findings show a subset of aggravating outcomes in high-grade and posterior fossa tumors.
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Affiliation(s)
- Chunjui Chen
- Department of Neurosurgery, Huashan Hospital Shanghai Medical College, Fudan University, No 12, Middle Wulumuqi Road, Shanghai, 200040, China
| | - Lingchao Chen
- Department of Neurosurgery, Huashan Hospital Shanghai Medical College, Fudan University, No 12, Middle Wulumuqi Road, Shanghai, 200040, China
| | - Yu Yao
- Department of Neurosurgery, Huashan Hospital Shanghai Medical College, Fudan University, No 12, Middle Wulumuqi Road, Shanghai, 200040, China
| | - Zhiyong Qin
- Department of Neurosurgery, Huashan Hospital Shanghai Medical College, Fudan University, No 12, Middle Wulumuqi Road, Shanghai, 200040, China.
| | - Hong Chen
- Department of Neuropathology, Huashan Hospital Shanghai Medical College, Fudan University, No 12, Middle Wulumuqi Road, Shanghai, 200040, China
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Dorfer C, Tonn J, Rutka JT. Ependymoma: a heterogeneous tumor of uncertain origin and limited therapeutic options. HANDBOOK OF CLINICAL NEUROLOGY 2016; 134:417-431. [PMID: 26948369 DOI: 10.1016/b978-0-12-802997-8.00025-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Ependymomas are tumors that typically occur with an age-based site preference, with adults harboring supratentorial and spinal tumors and pediatric tumors being mainly in the posterior fossa. Despite their similar histologic appearance, the prognosis varies significantly by age and tumor location, with a better prognosis in increasing age. The mainstay of treatment remains surgical excision with or without radiation therapy as the tumor biology is poorly understood and chemotherapy is generally considered to be ineffective. More recently, molecular biology data have increased our understanding of the genetic and epigenetic changes that drive these tumors, but still it will take a lot of effort to find effective chemotherapeutic regimens. Currently, we are trying to define a subset of tumors, for which radiation therapy can be avoided.
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Affiliation(s)
- Christian Dorfer
- Division of Neurosurgery, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Joerg Tonn
- Department of Neurosurgery, University Clinic of Ludwig-Maximilians-University Munich-Großhadern, Munich, Germany
| | - James T Rutka
- Division of Neurosurgery, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada.
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30
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Gupta K, Salunke P. Understanding Ependymoma Oncogenesis: an Update on Recent Molecular Advances and Current Perspectives. Mol Neurobiol 2015; 54:15-21. [PMID: 26712502 DOI: 10.1007/s12035-015-9646-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 12/16/2015] [Indexed: 01/12/2023]
Abstract
Remarkable progress has been made in the last decade in understanding the biology and oncogenesis of this relatively rare childhood brain tumor-the ependymoma. Surgery and irradiation are the mainstays of therapeutic options; chemotherapy is yet to predictably affect outcome, and its role is currently being explored in several clinical trials. While WHO scores this tumor into three grades, grading of ependymoma into grade II and grade III is controversial because of its elusive histological criteria where no cut-offs have been defined for mitoses or percentage of tumor depicting increased cellularity. Grading remains unreliable in predicting outcome in several instances. There is a compelling need to integrate the molecular biomarkers highlighted in several studies over the past decade into patient risk stratification to help in better predicting the clinical outcome and to design effective tailored therapy. Genomic and transcriptomic studies lately have defined distinct molecular subgroups within ependymoma arising at three anatomic compartments-supratentorial, posterior fossa, and spinal cord. Review of pertinent literature on several seminal studies that have established a paradigm shift in understanding the oncogenesis of ependymoma has been carried out. The outcome, impact, and clinical relevance of these studies are also discussed. The review provides an update on progress and recent advances in understanding the biology and oncogenesis of ependymoma. The establishment of robust subgroups which are demographically, clinically, and molecularly distinct will provide new avenues for further refinement of therapeutic strategies.
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Affiliation(s)
- Kirti Gupta
- Neuropathology fellowship (St Jude, Memphis), Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Pravin Salunke
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Alshaya W, Mehta V, Wilson BA, Chafe S, Aronyk KE, Lu JQ. Low-grade ependymoma with late metastasis: autopsy case study and literature review. Childs Nerv Syst 2015; 31:1565-72. [PMID: 25957762 DOI: 10.1007/s00381-015-2744-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 04/30/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Ependymoma metastasis occurs usually along with local recurrence within 7 years after the initial diagnosis. Later spinal metastasis without local recurrence after the surgical resection has been rarely reported in patients with low-grade ependymomas but not with high-grade ependymomas. Here, we present a case with autopsy revealing late extensive supratentorial metastasis of a fourth ventricle classic WHO grade II ependymoma with no local recurrence or spinal metastasis. METHODS A 4-year-old boy underwent a gross total resection (GTR) of the fourth ventricle ependymoma and postoperative radiation therapy. Follow-up MRI showed no recurrence for the next 7 years, but a half year later, extra-axial tumors in the left cerebellopontine angle and right frontal lobe were observed. GTR of the left cerebellopontine angle ependymoma was performed, followed by additional radiation therapy. RESULTS He was stable for the following 2 years before MRI revealed growth of the right frontal tumor and new lesions. GTR of the right frontal tumor demonstrated similar pathologic features of ependymoma. Despite chemotherapy, follow-up MRIs exhibited increasing numbers and sizes of supratentorial tumors but no infratentorial or spinal tumors. He died 15 years after the initial diagnosis. Postmortem brain examination confirmed the supratentorial subarachnoid dissemination with multifocal metastases of classic ependymomas but no recurrence at the infratentorial sites. CONCLUSION Our case study and literature review suggest that low-grade ependymomas under the current WHO classification have the risk of late metastasis. Therefore, long-term follow-up of the whole neuroaxis is more important for the patients with low-grade ependymomas even in the absence of local recurrence.
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Affiliation(s)
- Wael Alshaya
- Department of Surgery, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
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Asaid M, Preece PD, Rosenthal MA, Drummond KJ. Ependymoma in adults: Local experience with an uncommon tumour. J Clin Neurosci 2015; 22:1392-6. [DOI: 10.1016/j.jocn.2015.03.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 02/22/2015] [Accepted: 03/03/2015] [Indexed: 11/30/2022]
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de Andrade FG, Marie SKN, Uno M, Matushita H, Taricco MA, Teixeira MJ, Rosemberg S, Oba-Shinjo SM. Immunohistochemical expression of cyclin D1 is higher in supratentorial ependymomas and predicts relapses in gross total resection cases. Neuropathology 2015; 35:312-23. [PMID: 25946121 DOI: 10.1111/neup.12195] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 12/21/2014] [Accepted: 12/22/2014] [Indexed: 12/29/2022]
Abstract
Ependymomas are tumors of the CNS. Although cyclin D1 overexpression has been related to several cancers, its prognostic value in ependymomas has not yet been fully established. We evaluated cyclin D1 expression by an immunohistochemistry analysis of 149 samples of ependymomas, including some relapses, corresponding to 121 patients. Eighty-one patients were adults, 60 were intracranial cases and 92 tumors were grade II. Gross total resection (GTR) was achieved in 62% of cases, and relapse was confirmed in 41.4% of cases. Cyclin D1 protein expression was analyzed by immunohistochemistry and scored with a labeling index (LI) calculated as the percentage of positively stained cells by intensity. We also analyzed expression of CCND1 and NOTCH1 in 33 samples of ependymoma by quantitative real-time PCR. A correlation between cyclin D1 LI score and anaplastic cases (P < 0.001), supratentorial location (P < 0.001) and age (P = 0.001) were observed. A stratified analysis demonstrated that cyclin D1 protein expression was strong in tumors with a supratentorial location, independent of the histological grade or age. Relapse was more frequent in cases with a higher cyclin D1 LI score (P = 0.046), and correlation with progression-free survival was observed in cases with GTR (P = 0.002). Only spinal canal tumor location and GTR were suggestive markers of PFS in multivarite analyses. Higher expression levels were observed in anaplastic cases for CCND1 (P = 0.002), in supratentorial cases for CCND1 (P = 0.008) and NOTCH1 (P = 0.011). There were correlations between the cyclin D1 mRNA and protein expression levels (P < 0.0001) and between CCND1 and NOTCH1 expression levels (P = 0.003). Higher cyclin D1 LI was predominant in supratentorial location and predict relapse in GTR cases. Cyclin D1 could be used as an immunohistochemical marker to guide follow-up and treatment in these cases.
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Affiliation(s)
- Fernanda Gonçalves de Andrade
- Laboratory of Cellular and Molecular Biology, Department of Neurology, University of Sao Paulo, Sao Paulo, Brazil.,Division of Neurosurgery, Department of Neurology, University of Sao Paulo, Sao Paulo, Brazil
| | - Suely Kazue Nagahashi Marie
- Laboratory of Cellular and Molecular Biology, Department of Neurology, University of Sao Paulo, Sao Paulo, Brazil
| | - Miyuki Uno
- Laboratory of Cellular and Molecular Biology, Department of Neurology, University of Sao Paulo, Sao Paulo, Brazil
| | - Hamilton Matushita
- Division of Neurosurgery, Department of Neurology, University of Sao Paulo, Sao Paulo, Brazil
| | - Mario Augusto Taricco
- Division of Neurosurgery, Department of Neurology, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Sergio Rosemberg
- Pathology, Hospital das Clinicas, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Sueli Mieko Oba-Shinjo
- Laboratory of Cellular and Molecular Biology, Department of Neurology, University of Sao Paulo, Sao Paulo, Brazil
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Severino M, Consales A, Doglio M, Tortora D, Morana G, Barra S, Nozza P, Garrè ML. Intradural Extramedullary Ependymoma with Leptomeningeal Dissemination: The First Case Report in a Child and Literature Review. World Neurosurg 2015; 84:865.e13-9. [PMID: 25862107 DOI: 10.1016/j.wneu.2015.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 03/31/2015] [Accepted: 04/01/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Primary intradural extramedullary ependymomas are very rare tumors and have never been described in children. CASE DESCRIPTION We report on an 11-year-old girl presenting with a 1-month history of neck pain, left arm weakness, paresthesia in the fingers of the left hand and gait disturbances. Magnetic resonance imaging on admission revealed an intradural extramedullary cystic lesion at the cervical level with craniospinal leptomeningeal nodules causing mild hydrocephalus. The multicystic lesion was surgically removed and neuropathologic examination revealed a World Health Organization grade II ependymoma. The patient underwent adjuvant radiotherapy with progressive reduction of the metastatic nodules. At her 2-year follow-up, the patient was symptom free with no evidence of recurrence on magnetic resonance imaging. CONCLUSIONS Although a rare entity, intradural extramedullary ependymomas should be included in the differential diagnosis of intradural extramedullary lesions in children. Surgical treatment seems to play a pivotal role in the prognosis of these rare tumors, with a possible role for adjunctive radiotherapy in the case of recurrence, anaplastic transformation, and metastasis.
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Affiliation(s)
| | | | - Matteo Doglio
- Neuroncology Unit, Istituto Giannina Gaslini, Genoa, Italy
| | | | - Giovanni Morana
- Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Salvina Barra
- Department of Radiation Oncology, IRCCS San Martino IST, Genoa, Italy
| | - Paolo Nozza
- Pathology Unit, Istituto Giannina Gaslini, Genoa, Italy
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Abstract
This article provides an overview of the intra-axial tumors that affect the cerebellum, which can be categorized by location and age. For each tumor, we review conventional neuroimaging findings and discuss the value of more advanced neuroimaging techniques. Current management strategies are also briefly discussed. Finally, cerebellar paraneoplastic disorders and medication-induced cerebellar disorders are discussed.
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Affiliation(s)
- Thomas J Pfiffner
- DENT Neurologic Institute, 3980 Sheridan Drive, Amherst, NY 14226, USA
| | - Ronak Jani
- DENT Neurologic Institute, 3980 Sheridan Drive, Amherst, NY 14226, USA
| | - Laszlo Mechtler
- DENT Neurologic Institute, Roswell Park Cancer Institute, 3980 Sheridan Drive, Buffalo, NY 14226, USA.
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36
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Nowak J, Seidel C, Berg F, Pietsch T, Friedrich C, von Hoff K, Rutkowski S, Warmuth-Metz M. MRI characteristics of ependymoblastoma: results from 22 centrally reviewed cases. AJNR Am J Neuroradiol 2014; 35:1996-2001. [PMID: 24948504 PMCID: PMC7966246 DOI: 10.3174/ajnr.a4002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 03/20/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Ependymoblastoma is a malignant embryonal tumor that develops in early childhood and has a dismal prognosis. Categorized by the World Health Organization as a subgroup of CNS-primitive neuroectodermal tumor, ependymoblastoma is histologically defined by "ependymoblastic rosettes." Because it is so rare, little is known about specific MR imaging characteristics of ependymoblastoma. We systematically analyzed and discussed MR imaging features of ependymoblastoma in a series of 22 consecutive patients. MATERIALS AND METHODS Ependymoblastoma cases were obtained from the database of the German multicenter HIT trials between 2002 and 2013. All cases within this study were centrally reviewed for histopathology, MR imaging findings, and multimodal therapy. For systematic analysis of initial MR imaging scans at diagnosis, we applied standardized criteria for reference image evaluation of pediatric brain tumors. RESULTS Ependymoblastomas are large tumors with well-defined tumor margins, iso- to hyperintense signal on T2WI, and diffusion restriction. Contrast enhancement is variable, with a tendency to mild or moderate enhancement. Subarachnoid spread is common in ependymoblastoma but can be absent initially. There was a male preponderance (1.75:1 ratio) for ependymoblastoma in our cohort. Mean age at diagnosis was 2.1 years. CONCLUSIONS With this study, we add the largest case collection to the limited published database of MR imaging findings in ependymoblastoma, together with epidemiologic data. However, future studies are needed to systematically compare MR imaging findings of ependymoblastoma with other CNS-primitive neuroectodermal tumors and ependymoma, to delineate imaging criteria that might help distinguish these pediatric brain tumor entities.
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Affiliation(s)
- J Nowak
- From the Reference Center for Neuroradiology (J.N., C.S., F.B., M.W.-M.), University Hospital of Würzburg, Würzburg, Germany
| | - C Seidel
- From the Reference Center for Neuroradiology (J.N., C.S., F.B., M.W.-M.), University Hospital of Würzburg, Würzburg, Germany Department of Radiology, Pathology Research (C.S.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - F Berg
- From the Reference Center for Neuroradiology (J.N., C.S., F.B., M.W.-M.), University Hospital of Würzburg, Würzburg, Germany Department of Radiology and Neuroradiology (F.B.), University of Witten/Herdecke, Cologne-Merheim Medical Center, Cologne, Germany
| | - T Pietsch
- Department of Neuropathology (T.P.), Brain Tumor Reference Center, Bonn, Germany
| | - C Friedrich
- Department of Pediatric Hematology and Oncology (C.F., K.v.H., S.R.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K von Hoff
- Department of Pediatric Hematology and Oncology (C.F., K.v.H., S.R.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Rutkowski
- Department of Pediatric Hematology and Oncology (C.F., K.v.H., S.R.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Warmuth-Metz
- From the Reference Center for Neuroradiology (J.N., C.S., F.B., M.W.-M.), University Hospital of Würzburg, Würzburg, Germany
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Vera-Bolanos E, Aldape K, Yuan Y, Wu J, Wani K, Necesito-Reyes MJ, Colman H, Dhall G, Lieberman FS, Metellus P, Mikkelsen T, Omuro A, Partap S, Prados M, Robins HI, Soffietti R, Wu J, Gilbert MR, Armstrong TS. Clinical course and progression-free survival of adult intracranial and spinal ependymoma patients. Neuro Oncol 2014; 17:440-7. [PMID: 25121770 DOI: 10.1093/neuonc/nou162] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 07/09/2014] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Ependymomas are rare CNS tumors. Previous studies describing the clinical course of ependymoma patients were restricted to small sample sizes, often with patients at a specific institution. METHODS Clinically annotated ependymoma tissue samples from 19 institutions were centrally reviewed. Patients were all adults aged 18 years or older at the time of diagnosis. Potential prognostic clinical factors identified on univariate analysis were included in a multivariate Cox proportional hazards model with backwards selection to model progression-free survival. RESULTS The 282 adult ependymoma patients were equally male and female with a mean age of 43 years (range, 18-80y) at diagnosis. The majority were grade II (78%) with the tumor grade for 20 cases being reclassified on central review (half to higher grade). Tumor locations were spine (46%), infratentorial (35%), and supratentorial (19%). Tumor recurrence occurred in 26% (n = 74) of patients with a median time to progression of 14 years. A multivariate Cox proportional hazards model identified supratentorial location (P < .01), grade III (anaplastic; P < .01), and subtotal resection, followed or not by radiation (P < .01), as significantly increasing risk of early progression. CONCLUSIONS We report findings from an ongoing, multicenter collaboration from a collection of clinically annotated adult ependymoma tumor samples demonstrating distinct predictors of progression-free survival. This unique resource provides the opportunity to better define the clinical course of ependymoma for clinical and translational studies.
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Affiliation(s)
- Elizabeth Vera-Bolanos
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Kenneth Aldape
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Ying Yuan
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Jimin Wu
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Khalida Wani
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Mary Jo Necesito-Reyes
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Howard Colman
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Girish Dhall
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Frank S Lieberman
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Philippe Metellus
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Tom Mikkelsen
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Antonio Omuro
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Sonia Partap
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Michael Prados
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - H Ian Robins
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Riccardo Soffietti
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Jing Wu
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Mark R Gilbert
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Terri S Armstrong
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
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Olsen TK, Gorunova L, Meling TR, Micci F, Scheie D, Due-Tønnessen B, Heim S, Brandal P. Genomic characterization of ependymomas reveals 6q loss as the most common aberration. Oncol Rep 2014; 32:483-90. [PMID: 24939246 PMCID: PMC4091878 DOI: 10.3892/or.2014.3271] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 04/17/2014] [Indexed: 12/18/2022] Open
Abstract
Ependymomas are rare tumors of the central nervous system (CNS). They are classified based on tumor histology and grade, but the prognostic value of the WHO grading system remains controversial. Treatment is mainly surgical and by radiation. An improved knowledge of ependymoma biology is important to elucidate the pathogenesis, to improve classification schemes, and to identify novel potential treatment targets. Only 113 ependymoma karyotypes with chromosome aberrations are registered in the Mitelman database. We present the first study of ependymoma genomes combining karyotyping and high resolution comparative genomic hybridization (HR-CGH). Nineteen tumor samples were collected from three pediatric and 15 adult patients treated at Oslo University Hospital between 2005 and 2012. Histological diagnoses included subependymoma and myxopapillary ependymoma (WHO grade I), ependymoma (WHO grade II) and anaplastic ependymoma (WHO grade III). Four tumors were intraspinal and 15 were intracranial. Seventeen samples were successfully karyotyped, HR-CGH analysis was undertaken on 17 samples, and 15 of 19 tumors were analyzed using both methods. Twelve tumors had karyotypic abnormalities, mostly gains or losses of whole chromosomes. Structural rearrangements were found in four tumors, in two of which 2p23 was identified as a breakpoint region. Twelve tumors displayed genomic imbalances by HR-CGH analysis with loss of material at 6q as the most common. 6q loss, which was detected by one or both methods in seven of 12 (58%) abnormal tumors, and 5p gain (observed in five tumors; 42%) were the most common genomic aberrations in this series.
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Affiliation(s)
- Thale Kristin Olsen
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, Oslo University Hospital - The Norwegian Radium Hospital, Nydalen, 0424 Oslo, Norway
| | - Ludmila Gorunova
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, Oslo University Hospital - The Norwegian Radium Hospital, Nydalen, 0424 Oslo, Norway
| | - Torstein R Meling
- Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, Nydalen, 0424 Oslo, Norway
| | - Francesca Micci
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, Oslo University Hospital - The Norwegian Radium Hospital, Nydalen, 0424 Oslo, Norway
| | - David Scheie
- Department of Pathology, Oslo University Hospital - Rikshospitalet, Nydalen, 0424 Oslo, Norway
| | - Bernt Due-Tønnessen
- Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, Nydalen, 0424 Oslo, Norway
| | - Sverre Heim
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, Oslo University Hospital - The Norwegian Radium Hospital, Nydalen, 0424 Oslo, Norway
| | - Petter Brandal
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, Oslo University Hospital - The Norwegian Radium Hospital, Nydalen, 0424 Oslo, Norway
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Feletti A, Marton E, Bendini M, Zanatta L, Valori L, Dei Tos AP, Di Paola F, Longatti P, Rossi S. Anaplastic ependymoma of the third ventricle. Brain Tumor Pathol 2014; 31:274-81. [PMID: 24643478 DOI: 10.1007/s10014-014-0184-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 03/04/2014] [Indexed: 11/28/2022]
Abstract
Supratentorial ependymomas are rare, especially in the third ventricle. We report the case of an ependymoma of the posterior third ventricle that was endoscopically removed just by aspiration through a flexible scope. Histologically, beside the typical pattern of growth with perivascular pseudorosettes, the tumor featured hypercellular areas with more than 10 mitoses per 10 high-power fields, consistent with grade III-anaplastic tumor. A few months later, a second neuroendoscopy offered the unique chance to appreciate the total absence of tumor tissue and the restored anatomy. However, consistently with the high grade, the tumor recurred in two different locations including the endoscopic trajectory, and spread through the cerebrospinal fluid. The patient underwent a second resective surgery and radiosurgery. Despite a cycle of chemotherapy, multiple lesions both in the ventricular system and at the level of cauda equina appeared 12 months later. A comprehensive review of intraventricular anaplastic ependymomas is also provided.
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Affiliation(s)
- Alberto Feletti
- Department of Neurosurgery, Treviso Hospital, University of Padova, Piazza Ospedale 1, 31100, Treviso, Italy,
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Esami citologico, istologico, immunoistochimico e genetico dei tumori del sistema nervoso centrale. Neurologia 2013. [DOI: 10.1016/s1634-7072(13)66018-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Andreiuolo F, Ferreira C, Puget S, Grill J. Current and evolving knowledge of prognostic factors for pediatric ependymomas. Future Oncol 2013; 9:183-91. [PMID: 23414469 DOI: 10.2217/fon.12.174] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Ependymomas are one of the most common pediatric malignant brain tumors. Prognosis, especially in young children, remains poor due to their inherent chemo- and radio-resistance and effective treatment remains one of the more difficult tasks in pediatric oncology: up to half of the patients may die from the disease. The only reproducible prognostic factor is the extent of surgery; neither histological grading nor other biomarkers can be used to reliably make treatment decisions in clinical practice. None of the studies identifying new biomarkers have been conducted prospectively, only few have been undertaken within the context of a clinical trial and most have been conducted with limited samples (often including adults and childhood samples). International collaboration is needed to improve ependymoma prognostication.
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Affiliation(s)
- Felipe Andreiuolo
- Centre National de la Recherche Scientifique Unité Mixte de Recherche 8203 Vectorology & Anticancer Therapeutics, Gustave Roussy Cancer Institute, Paris-Sud University, Villejuif, France
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Clear Cell Ependymoma in a Dog. J Comp Pathol 2013; 149:53-6. [DOI: 10.1016/j.jcpa.2012.11.236] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 10/10/2012] [Accepted: 11/18/2012] [Indexed: 11/20/2022]
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Eberhard N, Weis S, Reitsamer H, Kofler B. Expression of alarin in ependymoma and choroid plexus tumors. J Neurooncol 2013; 114:165-71. [DOI: 10.1007/s11060-013-1177-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 06/02/2013] [Indexed: 01/24/2023]
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Oh MC, Tarapore PE, Kim JM, Sun MZ, Safaee M, Kaur G, Aranda DM, Parsa AT. Spinal ependymomas: benefits of extent of resection for different histological grades. J Clin Neurosci 2013; 20:1390-7. [PMID: 23768966 DOI: 10.1016/j.jocn.2012.12.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 12/08/2012] [Indexed: 11/26/2022]
Abstract
Although the World Health Organization (WHO) categorizes spinal ependymomas into three histological grades, difference in surgical outcomes between WHO grades I and II tumors are unclear. For these benign tumors, prognosis may be best determined by factors other than tumor grade alone, such as extent of resection. To analyze the effects of the extent of resection on different grades of spinal ependymomas, we performed a comprehensive literature review to identify adult spinal ependymoma patients who received surgical resection with a clearly identifiable WHO grade. A total of 175 patients were identified. While grade III tumors carried the worst prognosis as expected (p<0.001), grade I and II tumors did not differ significantly in outcomes following surgery. Overall, gross total resection (GTR, 68.7%, 114/166) provided significantly improved progression-free survival (PFS, p<0.001) and overall survival (OS, p=0.022) compared to the subtotal resection group. Surprisingly, the highest GTR rate was achieved for grade II tumors (78.8%, 78/99; p<0.001) followed by grade I (58.9%, 33/56) and grade III tumors (27.3%, 3/11). Interestingly, PFS was significantly improved by GTR for grade II tumors (p<0.001), but not for grade I (p=0.705). Similar trends, although not statistically significant, were found for OS. Our results show that while GTR provides the best overall outcomes, GTR is most effective for classic grade II ependymomas, but not for grade I ependymomas. Despite having a lower WHO grade, myxopapillary ependymomas have a lower GTR rate, and benefit less from GTR.
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Affiliation(s)
- Michael C Oh
- Department of Neurological Surgery, University of California San Fransisco, 505 Parnassus Avenue, San Francisco, CA 94117, USA
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McCormick PC. Ependymomas. J Neurosurg Spine 2013; 19:1-2. [PMID: 23662889 DOI: 10.3171/2013.1.spine121111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Liu X, Sun B, Xu Q, Che X, Hu J, Gu S, Shou J. Outcomes in treatment for primary spinal anaplastic ependymomas: a retrospective series of 20 patients. J Neurosurg Spine 2013; 19:3-11. [PMID: 23662884 DOI: 10.3171/2013.3.spine12183] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Little is known regarding the anaplastic variant of primary ependymomas that involve the spinal cord. The aim of this study was to evaluate the clinical characteristics and treatment outcomes of primary spinal anaplastic ependymomas (PSAEs). METHODS Medical records were reviewed in 20 patients with pathologically proven PSAEs who underwent surgical treatment at the Department of Neurosurgery in Huashan Hospital between 1999 and 2008. RESULTS This series included 7 women and 13 men between the ages of 2 and 67 years (mean 31.9 years). The mean preoperative course was 9.3 months (range 20 days to 48 months). The most common PSAE locations were the cervical and thoracic spinal cords. The most common presenting symptom was weakness, followed by numbness, bowel or bladder dysfunction, and pain. Gross-total resection (GTR) was achieved in 17 patients, and a subtotal removal was performed in 3 patients. Nine patients received radiation therapy and/or chemotherapy. The mean follow-up duration was 83.5 months. Functional assessment of the 10 patients available at the latest follow-up evaluation showed that 2 had worsened and 8 remained unchanged from their preoperative status. There were 2 local recurrences and 1 lung metastasis. CONCLUSIONS Patients with PSAEs presented with a much shorter preoperative course than patients with Grade II ependymomas in previous studies. Patients with tumors that involved the cervical spinal cord experienced a worse outcome. Surgical removal of PSAEs, with the goal of GTR, is beneficial to patients. The role of radiation therapy and chemotherapy in PSAEs remains to be determined in further studies.
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Affiliation(s)
- XiaoDong Liu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
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Benesch M, Frappaz D, Massimino M. Spinal cord ependymomas in children and adolescents. Childs Nerv Syst 2012; 28:2017-28. [PMID: 22961356 DOI: 10.1007/s00381-012-1908-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 08/25/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Spinal cord ependymomas are very rare among children and adolescents. Due to their rarity, our current knowledge of these tumors is based on case reports and few retrospective case series. METHODS The present review summarizes the currently available literature on childhood spinal cord ependymomas. RESULTS Although overall survival rates are favorable, relapse incidence is high, particularly in myxopapillary ependymomas. Since long-term follow-up data are provided in a limited number of studies only, the true relapse incidence is unknown. Maximal safe radical surgery is the backbone of treatment for children with spinal cord ependymomas, but the impact of adjuvant treatment on progression and survival is still unclear. Presently, the decision to initiate non-surgical treatment depends primarily on the WHO grade of the tumor and the extent of resection. In terms of the known side effects, early radiotherapy should be avoided in children with WHO grade II spinal cord ependymomas irrespective of the extent of resection but is indicated in anaplastic spinal cord ependymomas both after complete and incomplete resection. The high relapse incidence in myxopapillary ependymomas argue for the use of early radiotherapy, but its definitive impact on progression has to be proven in larger series. Close surveillance is important due to the high recurrence rate in all patients with spinal cord ependymomas. CONCLUSION Prospective collection of both clinical and molecular data from a greater number of patients with spinal cord ependymomas within an international collaboration is the prerequisite to establish standardized management guidelines for these rare CNS tumors.
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Affiliation(s)
- Martin Benesch
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 38, 8036 Graz, Austria.
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Godfraind C, Kaczmarska JM, Kocak M, Dalton J, Wright KD, Sanford RA, Boop FA, Gajjar AJ, Merchant TE, Ellison DW. Distinct disease-risk groups in pediatric supratentorial and posterior fossa ependymomas. Acta Neuropathol 2012; 124:247-57. [PMID: 22526017 PMCID: PMC3554251 DOI: 10.1007/s00401-012-0981-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 03/16/2012] [Accepted: 04/04/2012] [Indexed: 02/01/2023]
Abstract
No reliable classification is in clinical use for the therapeutic stratification of children with ependymoma, such that disease risk might be identified and patients treated to ensure a combination of maximal cure rates and minimal adverse therapeutic effects. This study has examined associations between clinicopathologic and cytogenetic variables and outcome in a trial cohort of children with ependymoma, with the aim of defining a practical scheme for stratifying this heterogeneous tumor. Intracranial ependymomas (n = 146) from children treated on the RT1 trial at St. Jude Children's Research Hospital were evaluated for the status of multiple pathological features. Interphase FISH (iFISH) defined the status of loci on chromosomes 1q (EXO1), 6q (LATS1) and 9, including 9p21 (CDKN2A). Data relating to these clinicopathological and cytogenetic variables were compared with survival data in order to model disease risk groups. Extent of surgical resection was a significant determinant of outcome in both supratentorial and infratentorial compartments. Tumor cell density and mitotic count were associated with outcome among children with posterior fossa ependymomas (n = 119). Among pathologic features, only brain invasion was associated with outcome in children with supratentorial ependymomas (n = 27). For posterior fossa tumors, gain of 1q was independently associated with outcome and in combination with clinicopathological variables defined both a two-tier and three-tier system of disease risk. Among children developing posterior fossa ependymomas treated with maximal surgical resection and conformal radiotherapy, key clinicopathological variables and chromosome 1q status can be used to define tiers of disease risk. In contrast, risk factors for pediatric supratentorial tumors are limited to sub-total resection and brain invasion.
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Affiliation(s)
- Catherine Godfraind
- Laboratory of Pathology, Université Catholique de Louvain, Bruxelles, Belgium
| | - Joanna M. Kaczmarska
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Mehmet Kocak
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - James Dalton
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Karen D. Wright
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Robert A. Sanford
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Fredrick A. Boop
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Amar J. Gajjar
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Thomas E. Merchant
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - David W. Ellison
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
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