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Dangouloff-Ros V, Tauziède-Espariat A, Roux CJ, Levy R, Grévent D, Brunelle F, Gareton A, Puget S, Beccaria K, Blauwblomme T, Grill J, Dufour C, Varlet P, Boddaert N. CT and Multimodal MR Imaging Features of Embryonal Tumors with Multilayered Rosettes in Children. AJNR. AMERICAN JOURNAL OF NEURORADIOLOGY 2019; 40:732-736. [PMID: 30846437 DOI: 10.3174/ajnr.a6001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/28/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Embryonal tumors with multilayered rosettes, C19MC-altered, are brain tumors occurring in young children, which were clearly defined in the 2016 World Health Organization classification of central nervous system neoplasms. Our objective was to describe the multimodal imaging characteristics of this new entity. MATERIALS AND METHODS We performed a retrospective monocentric review of embryonal brain tumors and looked for embryonal tumors with multilayered rosettes with confirmed C19MC alteration. We gathered morphologic imaging data, as well as DWI and PWI data (using arterial spin-labeling and DSC). RESULTS We included 16 patients with a median age of 2 years 8 months. Tumors were both supratentorial (56%, 9/16) and infratentorial (44%, 7/16). Tumors were large (median diameter, 59 mm; interquartile range, 48-71 mm), with absent (75%, 12/16) or minimal (25%, 4/16) peritumoral edema. Enhancement was absent (20%, 3/15) or weak (73%, 11/15), whereas intratumoral macrovessels were frequently seen (94%, 15/16) and calcifications were present in 67% (10/15). Diffusion was always restricted, with a minimal ADC of 520 mm2/s (interquartile range, 495-540 mm2/s). Cerebral blood flow using arterial spin-labeling was low, with a maximal CBF of 43 mL/min/100 g (interquartile range, 33-55 mL/min/100 g 5). When available (3 patients), relative cerebral blood volume using DSC was high (range, 3.5-5.8). CONCLUSIONS Embryonal tumors with multilayered rosettes, C19MC-altered, have characteristic imaging features that could help in the diagnosis of this rare tumor in young children.
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Affiliation(s)
- V Dangouloff-Ros
- From the Departments of Pediatric Radiology (V.D.-R., C.-J.R., R.L., D.G., F.B., N.B.) .,University René Descartes (V.D.-R., A.T.-E., C.-J.R., R.L., D.G., F.B., S.P., K.B., T.B. P.V., N.B.), Pôle de Recherche et d'Enseignement Supérieur Sorbonne Paris Cité, Paris, France.,French National Institute of Health and Medical Research U1000 (V.D.-R., C.-J.R., R.L., D.G., F.B., N.B.), Paris, France.,Institut Imagine 1163 (V.D.-R., C.-J.R., R.L., D.G., F.B., N.B.), Paris, France
| | - A Tauziède-Espariat
- University René Descartes (V.D.-R., A.T.-E., C.-J.R., R.L., D.G., F.B., S.P., K.B., T.B. P.V., N.B.), Pôle de Recherche et d'Enseignement Supérieur Sorbonne Paris Cité, Paris, France.,Department of Neuropathology (A.T.-E., A.G., P.V.), Centre Hospitalier Sainte Anne, Paris, France
| | - C-J Roux
- From the Departments of Pediatric Radiology (V.D.-R., C.-J.R., R.L., D.G., F.B., N.B.).,University René Descartes (V.D.-R., A.T.-E., C.-J.R., R.L., D.G., F.B., S.P., K.B., T.B. P.V., N.B.), Pôle de Recherche et d'Enseignement Supérieur Sorbonne Paris Cité, Paris, France.,French National Institute of Health and Medical Research U1000 (V.D.-R., C.-J.R., R.L., D.G., F.B., N.B.), Paris, France.,Institut Imagine 1163 (V.D.-R., C.-J.R., R.L., D.G., F.B., N.B.), Paris, France
| | - R Levy
- From the Departments of Pediatric Radiology (V.D.-R., C.-J.R., R.L., D.G., F.B., N.B.).,University René Descartes (V.D.-R., A.T.-E., C.-J.R., R.L., D.G., F.B., S.P., K.B., T.B. P.V., N.B.), Pôle de Recherche et d'Enseignement Supérieur Sorbonne Paris Cité, Paris, France.,French National Institute of Health and Medical Research U1000 (V.D.-R., C.-J.R., R.L., D.G., F.B., N.B.), Paris, France.,Institut Imagine 1163 (V.D.-R., C.-J.R., R.L., D.G., F.B., N.B.), Paris, France
| | - D Grévent
- From the Departments of Pediatric Radiology (V.D.-R., C.-J.R., R.L., D.G., F.B., N.B.).,University René Descartes (V.D.-R., A.T.-E., C.-J.R., R.L., D.G., F.B., S.P., K.B., T.B. P.V., N.B.), Pôle de Recherche et d'Enseignement Supérieur Sorbonne Paris Cité, Paris, France.,French National Institute of Health and Medical Research U1000 (V.D.-R., C.-J.R., R.L., D.G., F.B., N.B.), Paris, France.,Institut Imagine 1163 (V.D.-R., C.-J.R., R.L., D.G., F.B., N.B.), Paris, France
| | - F Brunelle
- From the Departments of Pediatric Radiology (V.D.-R., C.-J.R., R.L., D.G., F.B., N.B.).,University René Descartes (V.D.-R., A.T.-E., C.-J.R., R.L., D.G., F.B., S.P., K.B., T.B. P.V., N.B.), Pôle de Recherche et d'Enseignement Supérieur Sorbonne Paris Cité, Paris, France.,French National Institute of Health and Medical Research U1000 (V.D.-R., C.-J.R., R.L., D.G., F.B., N.B.), Paris, France.,Institut Imagine 1163 (V.D.-R., C.-J.R., R.L., D.G., F.B., N.B.), Paris, France
| | - A Gareton
- Department of Neuropathology (A.T.-E., A.G., P.V.), Centre Hospitalier Sainte Anne, Paris, France
| | - S Puget
- Pediatric Neurosurgery (S.P., K.B., T.B.), Hôpital Necker Enfants Malades, Paris, France.,University René Descartes (V.D.-R., A.T.-E., C.-J.R., R.L., D.G., F.B., S.P., K.B., T.B. P.V., N.B.), Pôle de Recherche et d'Enseignement Supérieur Sorbonne Paris Cité, Paris, France
| | - K Beccaria
- Pediatric Neurosurgery (S.P., K.B., T.B.), Hôpital Necker Enfants Malades, Paris, France.,University René Descartes (V.D.-R., A.T.-E., C.-J.R., R.L., D.G., F.B., S.P., K.B., T.B. P.V., N.B.), Pôle de Recherche et d'Enseignement Supérieur Sorbonne Paris Cité, Paris, France
| | - T Blauwblomme
- Pediatric Neurosurgery (S.P., K.B., T.B.), Hôpital Necker Enfants Malades, Paris, France.,University René Descartes (V.D.-R., A.T.-E., C.-J.R., R.L., D.G., F.B., S.P., K.B., T.B. P.V., N.B.), Pôle de Recherche et d'Enseignement Supérieur Sorbonne Paris Cité, Paris, France
| | - J Grill
- Department of Pediatric and Adolescent Oncology (J.G., C.D.), Gustave Roussy Institute, Villejuif, France
| | - C Dufour
- Department of Pediatric and Adolescent Oncology (J.G., C.D.), Gustave Roussy Institute, Villejuif, France
| | - P Varlet
- University René Descartes (V.D.-R., A.T.-E., C.-J.R., R.L., D.G., F.B., S.P., K.B., T.B. P.V., N.B.), Pôle de Recherche et d'Enseignement Supérieur Sorbonne Paris Cité, Paris, France.,Department of Neuropathology (A.T.-E., A.G., P.V.), Centre Hospitalier Sainte Anne, Paris, France
| | - N Boddaert
- From the Departments of Pediatric Radiology (V.D.-R., C.-J.R., R.L., D.G., F.B., N.B.).,University René Descartes (V.D.-R., A.T.-E., C.-J.R., R.L., D.G., F.B., S.P., K.B., T.B. P.V., N.B.), Pôle de Recherche et d'Enseignement Supérieur Sorbonne Paris Cité, Paris, France.,French National Institute of Health and Medical Research U1000 (V.D.-R., C.-J.R., R.L., D.G., F.B., N.B.), Paris, France.,Institut Imagine 1163 (V.D.-R., C.-J.R., R.L., D.G., F.B., N.B.), Paris, France
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Sufit A, Donson AM, Birks DK, Knipstein J, Fenton LZ, Jedlicka P, Hankinson TC, Handler MH, Foreman NK. Diffuse intrinsic pontine tumors: a study of primitive neuroectodermal tumors versus the more common diffuse intrinsic pontine gliomas. J Neurosurg Pediatr 2012; 10:81-8. [PMID: 22747092 PMCID: PMC4690743 DOI: 10.3171/2012.3.peds11316] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The diagnosis of diffuse pontine tumors has largely been made on the basis of MRI since the early 1990 s. In cases of tumors considered "typical," as a rule, no biopsy specimen has been obtained, and the tumors have been considered diffuse intrinsic pontine gliomas (DIPGs). There have been sporadic reports that primitive neuroectodermal tumors (PNETs) of the pons may not be distinguishable from the DIPGs by radiological imaging. This study presents 2 cases of diffuse pontine PNETs with molecular evidence that these are indeed PNETs, distinct from DIPGs, thus supporting biopsy of diffuse pontine tumors as a standard of care. METHODS Biopsy specimens were obtained from 7 diffuse pontine tumors and snap frozen. Two of these 7 tumors were identified on the basis of pathological examination as PNETs. All 7 of the diffuse pontine tumors were analyzed for gene expression using the Affymetrix HG-U133 Plus 2.0 GeneChip microarray. Gene expression was compared with that of supratentorial PNETs, medulloblastomas, and low- and high-grade gliomas outside the brainstem. RESULTS Unsupervised hierarchical clustering analysis of gene expression demonstrated that pontine PNETs are most closely related to PNETs of the supratentorial region and not with gliomas. They do not cluster with the 5 DIPGs in the study. Thirty-eight genes, including GATA3, are uniquely differentially expressed in pontine PNETs compared with other types of pediatric brain tumors, including DIPGs and other PNETs at a false discovery rate statistical significance of less than 0.05. CONCLUSIONS The cluster and individual gene expression analyses indicate that pontine PNETs are intrinsically different from DIPGs. The 2 pontine PNET cases cluster with supratentorial PNETs, rather than with DIPGs, suggesting that these tumors should be treated with a PNET regimen, not with DIPG therapy. Since diagnosis by imaging is not reliable and the biology of the tumors is disparate, a biopsy should be performed to enable accurate diagnosis and direct potentially more effective treatments.
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Affiliation(s)
- Alexandra Sufit
- Division of Neuro-Oncology, Department of Pediatrics, The Children's Hospital of Colorado, University of Colorado, Aurora, Colorado 80045, USA.
| | - Andrew M. Donson
- Division of Neuro-Oncology, Department of Pediatrics, The Children's Hospital of Colorado, University of Colorado, Aurora, Colorado
| | - Diane K. Birks
- Division of Pediatric Neurosurgery, The Children's Hospital of Colorado, University of Colorado, Aurora, Colorado
| | - Jeffrey Knipstein
- Division of Neuro-Oncology, Department of Pediatrics, The Children's Hospital of Colorado, University of Colorado, Aurora, Colorado
| | - Laura Z. Fenton
- Division of Radiology, The Children's Hospital of Colorado, University of Colorado, Aurora, Colorado
| | - Paul Jedlicka
- Department of Pathology, The Children's Hospital of Colorado, University of Colorado, Aurora, Colorado
| | - Todd C. Hankinson
- Division of Pediatric Neurosurgery, The Children's Hospital of Colorado, University of Colorado, Aurora, Colorado
| | - Michael H. Handler
- Division of Pediatric Neurosurgery, The Children's Hospital of Colorado, University of Colorado, Aurora, Colorado
| | - Nicholas K. Foreman
- Division of Neuro-Oncology, Department of Pediatrics, The Children's Hospital of Colorado, University of Colorado, Aurora, Colorado
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