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Rao S, Goyal A, Johnson A, Sadashiva N, Kulanthaivelu K, Vazhayil V, Santosh V. MAPK pathway alterations in polymorphous low-grade neuroepithelial tumor of the young: diagnostic considerations. Brain Tumor Pathol 2024:10.1007/s10014-024-00487-8. [PMID: 39154303 DOI: 10.1007/s10014-024-00487-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 08/05/2024] [Indexed: 08/19/2024]
Abstract
Polymorphous low-grade neuroepithelial tumor of the young (PLNTY) is a recently recognised tumor type with indolent behaviour with characteristic imaging and histomolecular features. We describe the clinical, imaging, histo-molecular features of 15 cases diagnosed as low-grade glioma suggestive of PLNTY, over a period of 3 years. Immunohistochemistry (IHC) and fluorescence in situ hybridisation were used to assess molecular alterations. The tumors were seen predominantly in children (range 5-65 years). Most of the patients presented with history of seizures. Imaging revealed cortical-subcortical well demarcated solid-cystic tumor with intratumoral calcification. Histopathology revealed a low-grade tumor with oligodendroglia-Iike cells admixed with astrocytic cells immunopositive for CD34. BRAF p.V600E mutations and FGFR2 breakapart were observed in six cases each, while three showed FGFR3 breakapart. FGFR2 breakapart positive PLNTY were seen in children exclusively. The majority of cases were seizure free post-surgery, except two patients who succumbed to the illness. PLNTY, needs to be considered as a prime differential diagnosis in a solid-cystic tumor in a young patient with history of seizures. Characteristic clinical features, radiology, histomorphology with an IHC panel of OLIG2, GFAP and CD34 correlates with one of the MAPK alterations in PLNTY (BRAF p.V600E, FGFR2/3 gene rearrangement). In a resource limited setting, this limited panel may be sufficient for a correlative diagnosis.
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Affiliation(s)
- Shilpa Rao
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Aditi Goyal
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Allen Johnson
- Department of Neuroimaging and Intervention Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Nishanth Sadashiva
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Karthik Kulanthaivelu
- Department of Neuroimaging and Intervention Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Vikas Vazhayil
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Vani Santosh
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India.
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Rufus P, Chatterjee S. Second-look surgery in postoperative pediatric low-grade glioma. Childs Nerv Syst 2024:10.1007/s00381-024-06516-3. [PMID: 38970692 DOI: 10.1007/s00381-024-06516-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 06/20/2024] [Indexed: 07/08/2024]
Abstract
OBJECTIVE To review the literature on second-look surgery in pediatric low-grade gliomas (LGG) with a view to presenting both sides of the picture of re-exploration. METHODS Collection of material from recent literature on pediatric LGG. This was a retrospective review of these publications. RESULTS There are a number of publications recommending second-look surgery in selected cases, provided morbidity of the second surgery is minimum, and indeed some in which there is improvement in the neurodeficit after the second resection. CONCLUSION There seems a fair balance of articles recommending and dissuading the practice of second-look surgery, but in our limited experience we have found it useful in selected patients.
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Singh D, Joshi VP, Pattankar S, Maurya VP, Mishra R, Cincu R, Moscote-Salazar LR, Agrawal A. Polymorphous Low-Grade Neuroepithelial Tumor of the Young (PLNTY): Scoping Review of Case Reports and Case Series. Asian J Neurosurg 2024; 19:126-136. [PMID: 38974443 PMCID: PMC11226258 DOI: 10.1055/s-0044-1786700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Polymorphous low-grade neuroepithelial tumor of the young (PLNTY) is considered one of the low-grade neuroepithelial tumors, as per the World Health Organization 2021 classification of brain tumors. First described in 2016, these morphologically variable tumors are characterized by oligodendroglioma-like cellular components, infiltrative growth patterns, and cluster of differentiation 34 immunopositivity. A literature search of the PubMed/MEDLINE, SCOPUS, ScienceDirect, and COCHRANE databases (from inception to 20th June 2022) was carried out to identify relevant studies. To identify additional studies, we performed a recursive search of the bibliographies of the selected articles and published systematic reviews on this topic. The search yielded a total of 64 results. After removing duplicates, 26 articles were eligible for the review. The diagnostic criteria for these glioneuronal variants, representing a broad neuropathological spectrum, are not distinct and hence impede proper diagnosis and prognosis. Frequent genetic abnormalities involving mitogen-activated protein kinase pathway constituents, such as B-Raf proto-oncogene or fibroblast growth receptor 2/3, are harbored by PLNTYs. Recent advances in molecular diagnostics have resulted in more accurate tumor classification systems, based on gene expression profiles and DNA methylation patterns. Gross total resection seems curative, with a low recurrence rate. Malignant transformation is rare; however, adjuvant radiation therapy and chemotherapy may be beneficial in selected cases.
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Affiliation(s)
- Daulat Singh
- Department of Radiotherapy and Clinical Oncology, Government Doon Medical College, Dehradun, Uttarakhand, India
| | - Vijay P. Joshi
- Sparsh Neuro and Superspeciality Hospital, Solapur, Maharashtra, India
| | - Sanjeev Pattankar
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ved Prakash Maurya
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rakesh Mishra
- Department of Neurosurgery, Institute of Medical Sciences, Trauma Centre and Mahamana Centenary Superspeciality Hospital, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Rafael Cincu
- Department of Neurosurgery, General University Hospital, Valencia, Spain
| | | | - Amit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Saket Nagar, Bhopal, Madhya Pradesh, India
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Baumgartner ME, Lang SS, Tucker AM, Madsen PJ, Storm PB, Kennedy BC. Systematic review and cumulative analysis of clinical properties of BRAF V600E mutations in PLNTY histological samples. Childs Nerv Syst 2024; 40:1361-1366. [PMID: 38150037 DOI: 10.1007/s00381-023-06256-w] [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: 11/08/2023] [Accepted: 12/15/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE Polymorphous low-grade neuroepithelial tumors of the young (PLNTY) represent a rare pediatric-type tumor that most commonly presents as medically refractory epilepsy. PLNTY has only recently been recognized as a distinct clinical entity, having been first described in 2016 and added to the World Health Organization classification of CNS tumors in 2021. Molecular studies have determined that PLNTY is uniformly driven by aberrant MAPK pathway activation, with most tumors carrying either a BRAF V600E mutation or activating FGFR2 or FGFR3 fusion protein. Although it is known that these driver mutations are mutually exclusive, little is known about differences in clinical presentation or treatment outcomes between PLNTY cases driven by these distinct mutations. METHODS We performed a systematic review and cumulative analysis of PLNTY cases to assess whether or not PLNTY tumors carrying the BRAF V600E mutation exhibit different clinical behaviors. By searching the literature for all cases of PLNTY wherein BRAF V600E status was characterized, we compiled a dataset of 62 unique patient instances. Using a logistic regression-based approach, we assessed a primary outcome of what factors of a clinical presentation were associated with BRAF V600E mutations and a secondary outcome of what factors predicted total seizure freedom post-surgical resection. RESULTS PLNTY cases carrying BRAF V600E mutations in the literature were strongly positively associated with adult patients (p = 0.0055, OR = 6.556; 95% Conf. Int. = 1.737-24.742). BRAF V600E status was also positively associated with tumor involvement of the temporal lobe (p = 0.0046, OR = 11.036; 95% Conf. Int. = 2.100-58.006). Male sex was also positively associated with BRAF V600E status, but the result did not quite achieve statistical significance (p = 0.0731). BRAF V600E status was not found to be associated with post-operative seizure freedom. CONCLUSIONS These findings indicate that BRAF V600E-positive PLNTY exhibit characteristic clinical presentations but are not necessarily different in treatment responsiveness. Non-BRAF V600E tumors are more commonly associated with young patients.
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Affiliation(s)
| | - Shih-Shan Lang
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
- Division of Neurosurgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alexander M Tucker
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
- Division of Neurosurgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Peter J Madsen
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
- Division of Neurosurgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Phillip B Storm
- Division of Neurosurgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Neurosurgery, Center for Data Driven Discovery in Biomedicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Benjamin C Kennedy
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
- Division of Neurosurgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Marastoni E, Mulone D, Barresi V. Diffuse Gliomas with FGFR3:: TACC3 Fusion: Morphological and Molecular Features and Classification Challenges. Cancers (Basel) 2024; 16:1644. [PMID: 38730596 PMCID: PMC11083705 DOI: 10.3390/cancers16091644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 04/21/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
FGFR3::TACC3 fusion is a driver, potentially targetable, genetic alteration identified in approximately 4% of high-grade diffuse gliomas and rare cases with low-grade histology. Herein, we review the genetic and epigenetic features of these tumors and highlight the challenges in their classification and grading. Diffuse gliomas with FGFR3::TACC3 fusion display unique histopathological and molecular features, including an oligodendroglioma-like appearance, calcifications, and CD34 extravascular immunoreactivity. High-grade tumors exhibit molecular alterations and a DNA methylation profile typical of glioblastoma, suggesting that they may represent a subtype clinically characterized by a slightly better prognosis. Tumors with low-grade morphology are genetically and epigenetically heterogeneous. Some, exclusive to adults, have molecular alterations typical of glioblastoma, although most do not match any methylation classes, using version 12.5 of the Heidelberg classifier. Another group, which mostly affects children or adolescents, lacks the molecular features of glioblastoma and has a DNA methylation profile similar to that of low-grade glioneuronal tumors. In conclusion, diffuse gliomas with FGFR3::TACC3 fusion do not constitute a distinct nosological entity, owing to their genetic and epigenetic diversity. Further studies are warranted to clarify the biological aggressiveness of tumors with low-grade histology to refine the grading and determine the optimal treatment strategy.
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Affiliation(s)
| | | | - Valeria Barresi
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (E.M.); (D.M.)
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Cerron-Vela C, Gonçalves FG, Viaene AN, Tierradentro-García LO, Vossough A. Expanding the Imaging Spectrum of Polymorphous Low-Grade Neuroepithelial Tumor of the Young in Children. AJNR Am J Neuroradiol 2024; 45:483-487. [PMID: 38331958 PMCID: PMC11288552 DOI: 10.3174/ajnr.a8145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/16/2023] [Indexed: 02/10/2024]
Abstract
Polymorphous low-grade neuroepithelial tumors of the young (PLNTY) are rare brain tumors first described in 2017 and recently included in the 2021 5th World Health Organization Classification of Tumors of the Central Nervous System. They typically affect children and young adults. Few pediatric cases have been reported in the literature. The most common imaging features described, include location within the temporal lobe, involvement of the cortical/subcortical region, coarse calcifications, and well-defined margins with solid and cystic morphology, with slight-or-no enhancement. However, there is limited information on imaging features in children. We present the imaging spectrum of neuroimaging features in a series of pediatric patients with a histologically and molecularly proved PLNTY diagnosis. Coarse calcifications are uncommon in children compared with the adult literature, and they may develop with time. The transmantle-like sign can be observed, and adjacent cortical dysplasia may be seen. Seizure recurrence may occur despite gross total resection of the tumor.
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Affiliation(s)
- Carmen Cerron-Vela
- From the Department of Radiology (C.C.-V., F.G.G., L.O.T.-G., A.V.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Fabricio Guimarães Gonçalves
- From the Department of Radiology (C.C.-V., F.G.G., L.O.T.-G., A.V.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Angela N Viaene
- Department of Pathology and Laboratory Medicine (A.N.V.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Luis Octavio Tierradentro-García
- From the Department of Radiology (C.C.-V., F.G.G., L.O.T.-G., A.V.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Arastoo Vossough
- From the Department of Radiology (C.C.-V., F.G.G., L.O.T.-G., A.V.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Nair JN, Naidu B, Balasubramanian A, Krishnamurthy G. Polymorphous low-grade neuroepithelial tumour of young (PLNTY): the new kid on the block. Childs Nerv Syst 2024; 40:555-561. [PMID: 37796295 DOI: 10.1007/s00381-023-06162-1] [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: 05/08/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023]
Abstract
INTRODUCTION Polymorphous low grade neuroepithelial tumor of the young (PLNTY) is a newly described epileptogenic tumor first reported by Jason. T. Huse et al. in 2016. Only a very few cases have been reported so far and has been recently incorporated in the World Health Organization (WHO) Central Nervous System Classification of tumours, 5th edition, 2021. Here we report a rare case of PLNTY which closely resembles DNET (Dysembryoplastic neuroepithelial tumor) with plenty of interesting findings which would otherwise go unnoticed resulting in a nonspecific or misclassified diagnosis. CASE REPORT A 12 year old boy presented to the Neurosurgery OPD with seizures for the past five years and was given multiple antiepileptics for the same. Magnetic resonance imaging (MRI) showed a well-defined lobulated cortical mass with T1 hypo intensity and T2 hyperintensity in the left temporal lobe measuring 2.1 × 2 × 1.3 cm suggesting a DNET. Left temporal craniotomy and excision of the lesion was done. Frozen section showed features of a low grade glial neoplasm. Routine sections demonstrated polymorphous findings including oligodendroglia like features, neuronal nuclear pleomorphism, spindled astroglial elements, perivascular rosettes, calcification, and vascular mineralization. By immunohistochemistry (IHC), the tumor cells were diffusely positive for GFAP and CD34.Ki67 labelling index was low. A final diagnosis of PLNTY was made based on the above findings. The child has been epilepsy free since the past one-month post-surgery and is on follow up. DISCUSSION/CONCLUSION PLNTY is a newly discovered distinct pediatric low grade glial neoplasm which was earlier grouped into nonspecific forms of DNET. It is characterized morphologically and molecularly by the presence of oligodendroglial component, CD34 expression, BRAFV600E mutation and alterations in the MAP kinase pathway. They are known to behave in a low-grade fashion amenable to control by excision with occasional cases of recurrence reported. It is important to recognize and report similar tumors to determine the long-term risk of recurrence and create a more complete understanding on their radiology and molecular genetics.
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Affiliation(s)
- Jishnu N Nair
- Department of Neurosurgery, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
| | - Bhaskar Naidu
- Department of Neurosurgery, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
| | - Archana Balasubramanian
- Department of Pathology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India.
| | - Ganesh Krishnamurthy
- Department of Neurosurgery, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
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Meredith DM, Pisapia DJ. 2021 World Health Organization Classification of Brain Tumors. Continuum (Minneap Minn) 2023; 29:1638-1661. [PMID: 38085892 DOI: 10.1212/con.0000000000001355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVE The classification of brain tumors is a rapidly evolving field that requires extensive integration of molecular diagnostic findings from an expanding set of platforms and assays. This article summarizes the schema presented in the 5th edition of the World Health Organization (WHO) classification of central nervous system (CNS) tumors while highlighting diagnostic molecular findings and discussing the strengths and weaknesses of commonly available testing modalities. LATEST DEVELOPMENTS Several major changes in practice were introduced with the 5th edition of the CNS WHO classification, including molecular grading of adult diffuse gliomas, the introduction of many new entities within the spectrum of pediatric gliomas and glioneuronal tumors, and the widespread adoption of methylation classes as useful or even necessary diagnostic criteria. Additionally, several revisions to nomenclature (eg, IDH-mutant gliomas) were introduced for simplicity and to disambiguate from other tumor types. ESSENTIAL POINTS The classification of brain tumors continues to grow in complexity alongside our improved understanding of their nuanced molecular underpinnings.
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Vuong HG, Alzayadneh E, Reith TP, Eschbacher KL. Clinical significance of molecular subgroups of polymorphous low-grade neuroepithelial tumor of the young (PLNTY): A small single institutional case series and integrated analysis. Pathol Res Pract 2023; 252:154922. [PMID: 37984047 DOI: 10.1016/j.prp.2023.154922] [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: 10/09/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Polymorphous low-grade neuroepithelial tumor of the young (PLNTY) is a recently described entity. The clinicopathological features and prognosis of the molecular subgroups of these rare tumors is poorly understood. In this study, we presented a small case series of three new cases and integrated the data with published cases in the literature to characterize the similarities and differences of molecular subgroups of PLNTY. METHODS We searched our institutional archive for PLNTY cases and searched PubMed and Web of Science for relevant data. Demographic, clinical, radiologic, histopathological, molecular, and follow-up data of our four cases with published cases were integrated for final analyses. RESULTS We identified three institutional cases of PLNTY. The median age of our patients was 17 years (range: 13-42). All patients had a prior history of chronic seizures and all had tumors affecting the temporal lobes. Histopathologically, all cases showed oligodendroglial-like morphology with intratumoral calcifications and at least partially infiltrative growth patterns. Tumor cells were immunoreactive with CD34 and GFAP. Genetically, all cases harbored BRAF V600E mutations. Integrated analyses, including a total of 67 cases, demonstrated that PLNTYs with FGFR2 mutation were significantly younger (median age 11.0 years) than those with BRAF V600E or FGFR3 fusions (median age 41.0 and 16.0 years, respectively). All BRAF V600E-positive PLNTYs were free of tumor recurrence, while four of PLNTYs in other molecular subgroups developed tumor recurrence by imaging. CONCLUSION Our study suggests that PLNTYs have distinct clinicopathological features and are driven by genetic alterations in the MAPK pathway. The molecular subgroups of PLNTYs share similar findings, but also demonstrate distinct patient demographics.
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Affiliation(s)
- Huy Gia Vuong
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, United States
| | - Eyas Alzayadneh
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, United States
| | - Thomas P Reith
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, United States
| | - Kathryn L Eschbacher
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, United States.
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Golub D, Lynch DG, Pan PC, Liechty B, Slocum C, Bale T, Pisapia DJ, Juthani R. Polymorphous low-grade neuroepithelial tumor of the young with FGFR3-TACC3 fusion mimicking high-grade glioma: case report and series of high-grade correlates. Front Oncol 2023; 13:1307591. [PMID: 38074682 PMCID: PMC10698862 DOI: 10.3389/fonc.2023.1307591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/02/2023] [Indexed: 02/15/2024] Open
Abstract
Background Polymorphous low-grade neuroepithelial tumor of the young (PLNTY) is a recently described entity that can mimic high-grade glioma (HGG) in histologic and molecular features; however, factors predicting aggressive behavior in these tumors are unclear. Methods We present an indolent neuroepithelial neoplasm in a 59-year-old female with imaging initially suggestive of HGG, and a series of adult patients with HGG harboring FGFR3-TACC3 fusions are also presented for comparison. Results Pathology in the case patient revealed low-grade cytomorphology, microcalcifications, unusual neovascularization, and a low proliferation index. The lesion was diffusely CD34+ and harbored an FGFR3-TACC3 fusion and TERT promoter mutation. A diagnosis of PLNTY was therefore favored and the patient was observed with no progression at 15-month follow-up. In patients with HGG with FGFR3-TACC3 fusions, molecular findings included IDH-wildtype status, absence of 1p19q codeletion, CDKN2A loss, TERT promoter mutations and lack of MGMT promoter methylation. These patients demonstrated a median 15-month overall survival and a 6-month progression-free survival. Conclusion PLNTY is a rare low-grade entity that can display characteristics of HGG, particularly in adults. Presence of FGFR3-TACC3 fusions and other high-grade features should raise concern for a more malignant precursor lesion when a diagnosis of PLNTY is considered.
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Affiliation(s)
- Danielle Golub
- Department of Neurosurgery, Weill Cornell Medicine, New York, NY, United States
- Department of Neurosurgery, Northwell Health, Manhasset, NY, United States
| | - Daniel G. Lynch
- Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY, United States
| | - Peter C. Pan
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
- Department of Neurology, Columbia University, New York, NY, United States
| | - Benjamin Liechty
- Department of Pathology, Weill Cornell Medicine, New York, NY, United States
| | - Cheyanne Slocum
- Department of Pathology, Weill Cornell Medicine, New York, NY, United States
| | - Tejus Bale
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - David J. Pisapia
- Department of Pathology, Weill Cornell Medicine, New York, NY, United States
| | - Rupa Juthani
- Department of Neurosurgery, Weill Cornell Medicine, New York, NY, United States
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Chen J, Qi X, Zhang M, Zhang J, Han T, Wang C, Cai C. Review on neuroimaging in pediatric-type diffuse low-grade gliomas. Front Pediatr 2023; 11:1149646. [PMID: 37920791 PMCID: PMC10619148 DOI: 10.3389/fped.2023.1149646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 09/22/2023] [Indexed: 11/04/2023] Open
Abstract
The fifth edition of the World Health Organization Classification of Tumors of the Central Nervous System (WHO CNS5) has identified a new classification system for tumors of the brain and spinal cord, highlighting the pivotal role of molecular diagnosis in accurately categorizing neoplasms. In addition to previous classifications, one of the key distinctions lies in categorizing pediatric-type diffuse low-grade gliomas (pDLGGs) and pediatric-type diffuse high-grade gliomas (pDHGGs) as distinct tumor types. Although similar in histology and morphology, pediatric diffuse gliomas are completely different from the adult type with respect to the molecular genetic characteristics, prognosis, and treatment strategies. pDLGG includes four tumor types, namely, diffuse astrocytoma, MYB- or MYBL1-altered; angiocentric glioma; polymorphous low-grade neuroepithelial tumor of the young (PLNTY); and diffuse low-grade glioma, MAPK pathway-altered, three types of which are newly recognized tumor types. Herein, we review the clinical characteristics, histopathological and molecular genetic characteristics, neuroimaging features, and prognosis of pDLGG and summarize the neuroimaging key points in diagnosing different tumor types. This review aims to evaluate and update the relevant pDLGG features and advances in neuroimaging that may assist in differential diagnosis, surgery planning, and prognostic determination of these tumor types and provide accurate diagnostic information for clinical colleagues.
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Affiliation(s)
- Jing Chen
- Department of Medical Imaging, Tianjin Children's Hospital (Tianjin University Children's Hospital), Tianjin, China
| | - Xin Qi
- Department of Medical Imaging, Tianjin Children's Hospital (Tianjin University Children's Hospital), Tianjin, China
| | - Mengjie Zhang
- Department of Medical Imaging, Tianjin Children's Hospital (Tianjin University Children's Hospital), Tianjin, China
| | - Jing Zhang
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China
| | - Tong Han
- Department of Radiology, Tianjin Huanhu Hospital, Tianjin, China
| | - Chunxiang Wang
- Department of Medical Imaging, Tianjin Children's Hospital (Tianjin University Children's Hospital), Tianjin, China
| | - Chunquan Cai
- Tianjin Pediatric Research Institute, Tianjin Children's Hospital (Tianjin University Children's Hospital), Tianjin, China
- Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, China
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12
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Nafe R, Porto L, Samp PF, You SJ, Hattingen E. Adult-type and Pediatric-type Diffuse Gliomas : What the Neuroradiologist Should Know. Clin Neuroradiol 2023; 33:611-624. [PMID: 36941392 PMCID: PMC10449995 DOI: 10.1007/s00062-023-01277-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/03/2023] [Indexed: 03/22/2023]
Abstract
The classification of diffuse gliomas into the adult type and the pediatric type is the new basis for the diagnosis and clinical evaluation. The knowledge for the neuroradiologist should not remain limited to radiological aspects but should be based additionally on the current edition of the World Health Organization (WHO) classification of tumors of the central nervous system (CNS). This classification defines the 11 entities of diffuse gliomas, which are included in the 3 large groups of adult-type diffuse gliomas, pediatric-type diffuse low-grade gliomas, and pediatric-type diffuse high-grade gliomas. This article provides a detailed overview of important molecular, morphological, and clinical aspects for all 11 entities, such as typical genetic alterations, age distribution, variability of the tumor localization, variability of histopathological and radiological findings within each entity, as well as currently available statistical information on prognosis and outcome. Important differential diagnoses are also discussed.
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Affiliation(s)
- Reinhold Nafe
- Dept. Neuroradiology, Clinics of Johann Wolfgang-Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.
| | - Luciana Porto
- Dept. Neuroradiology, Clinics of Johann Wolfgang-Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Patrick-Felix Samp
- Dept. Neuroradiology, Clinics of Johann Wolfgang-Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Se-Jong You
- Dept. Neuroradiology, Clinics of Johann Wolfgang-Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Elke Hattingen
- Dept. Neuroradiology, Clinics of Johann Wolfgang-Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
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13
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Storz C, Sankowski R, Roelz R, Prinz M, Urbach H, Erny D, Taschner CA. Freiburg Neuropathology Case Conference : Recurrent Speech Arrest, Neologistic Jargon Aphasia, and Impaired Memory Function in a 39-year-old Patient. Clin Neuroradiol 2023; 33:869-876. [PMID: 37462746 PMCID: PMC10450002 DOI: 10.1007/s00062-023-01335-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/26/2023]
Affiliation(s)
- C Storz
- Department of Neuroradiology, Medical Centre-University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - R Sankowski
- Department of Neuropathology, Medical Centre-University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - R Roelz
- Department of Neurosurgery, Medical Centre-University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M Prinz
- Department of Neuropathology, Medical Centre-University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, Medical Centre-University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - D Erny
- Department of Neuropathology, Medical Centre-University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - C A Taschner
- Department of Neuroradiology, Medical Centre-University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany.
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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14
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Furuta T, Moritsubo M, Muta H, Shimamoto H, Ohshima K, Sugita Y. Pediatric and elderly polymorphous low-grade neuroepithelial tumor of the young: Typical and unusual case reports and literature review. Neuropathology 2023; 43:319-325. [PMID: 36545913 DOI: 10.1111/neup.12889] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/29/2022] [Accepted: 11/29/2022] [Indexed: 08/03/2023]
Abstract
Polymorphous low-grade neuroepithelial tumor of the young (PLNTY), one of the pediatric-type diffuse low-grade gliomas, is characterized by a diffuse infiltrating pattern of oligodendroglioma-like tumor cells showing CD34 positivity and harbors mitogen-activated protein kinase (MAPK) alteration, such as vRAF murine sarcoma viral oncogene homolog B1 (BRAF) p.V600E or fibroblast growth factor fusion genetically. It occurs mainly in pediatric and adolescents with seizures due to the dominant location of the temporal lobe. However, there have been a few cases of PLNTY in adult patients, suggesting the wide range of this tumor spectrum. Here, we describe two cases of PLNTY, one in a 14-year-old female and the other in a 66-year-old female. The pediatric tumor showed typical clinical course and histopathology with BRAF p.V600E mutation, whereas the elderly tumor was unusual because of non-epileptic onset clinically and ependymal differentiation histopathologically harboring KIAA1549-BRAF fusion. There might be unusual but possible PLNTY, as in our elderly case. We also compared typical pediatric and unusual elderly tumors by reviewing the literature.
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Affiliation(s)
- Takuya Furuta
- Department of Pathology, Kurume University School of Medicine, Fukuoka, Japan
| | - Mayuko Moritsubo
- Department of Pathology, Kurume University School of Medicine, Fukuoka, Japan
| | - Hiroko Muta
- Department of Pathology, Kurume University School of Medicine, Fukuoka, Japan
| | | | - Koichi Ohshima
- Department of Pathology, Kurume University School of Medicine, Fukuoka, Japan
| | - Yasuo Sugita
- Department of Neuropathology, St. Mary's Hospital, Fukuoka, Japan
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15
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Dang DD, Rosenblum JS, Shah AH, Zhuang Z, Doucet-O’Hare TT. Epigenetic Regulation in Primary CNS Tumors: An Opportunity to Bridge Old and New WHO Classifications. Cancers (Basel) 2023; 15:2511. [PMID: 37173979 PMCID: PMC10177493 DOI: 10.3390/cancers15092511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/22/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
Originally approved in 1979, a specific grading classification for central nervous system (CNS) tumors was devised by the World Health Organization (WHO) in an effort to guide cancer treatment and better understand prognosis. These "blue books" have since undergone several iterations based on tumor location, advancements in histopathology, and most recently, diagnostic molecular pathology in its fifth edition. As new research methods have evolved to elucidate complex molecular mechanisms of tumorigenesis, a need to update and integrate these findings into the WHO grading scheme has become apparent. Epigenetic tools represent an area of burgeoning interest that encompasses all non-Mendelian inherited genetic features affecting gene expression, including but not limited to chromatin remodeling complexes, DNA methylation, and histone regulating enzymes. The SWItch/Sucrose non-fermenting (SWI/SNF) chromatin remodeling complex is the largest mammalian family of chromatin remodeling proteins and is estimated to be altered in 20-25% of all human malignancies; however, the ways in which it contributes to tumorigenesis are not fully understood. We recently discovered that CNS tumors with SWI/SNF mutations have revealed an oncogenic role for endogenous retroviruses (ERVs), remnants of exogenous retroviruses that integrated into the germline and are inherited like Mendelian genes, several of which retain open reading frames for proteins whose expression putatively contributes to tumor formation. Herein, we analyzed the latest WHO classification scheme for all CNS tumors with documented SWI/SNF mutations and/or aberrant ERV expression, and we summarize this information to highlight potential research opportunities that could be integrated into the grading scheme to better delineate diagnostic criteria and therapeutic targets.
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Affiliation(s)
- Danielle D. Dang
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jared S. Rosenblum
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ashish H. Shah
- Section of Virology and Immunotherapy, Department of Neurosurgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Zhengping Zhuang
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Tara T. Doucet-O’Hare
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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16
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Changes to pediatric brain tumors in 2021 World Health Organization classification of tumors of the central nervous system. Pediatr Radiol 2023; 53:523-543. [PMID: 36348014 DOI: 10.1007/s00247-022-05546-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/12/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022]
Abstract
New tumor types are continuously being described with advances in molecular testing and genomic analysis resulting in better prognostics, new targeted therapy options and improved patient outcomes. As a result of these advances, pathological classification of tumors is periodically updated with new editions of the World Health Organization (WHO) Classification of Tumors books. In 2021, WHO Classification of Tumors of the Central Nervous System, 5th edition (CNS5), was published with major changes in pediatric brain tumors officially recognized including pediatric gliomas being separated from adult gliomas, ependymomas being categorized based on anatomical compartment and many new tumor types, most of them seen in children. Additional general changes, such as tumor grading now being done within tumor types rather than across entities and changes in definition of glioblastoma, are also relevant to pediatric neuro-oncology practice. The purpose of this manuscript is to highlight the major changes in pediatric brain tumors in CNS5 most relevant to radiologists. Additionally, brief descriptions of newly recognized entities will be presented with a focus on imaging findings.
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17
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Atypical presentation of polymorphous low-grade neuroepithelial tumor of young (PLNTY): a case report. EGYPTIAN JOURNAL OF NEUROSURGERY 2023. [DOI: 10.1186/s41984-023-00192-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
AbstractThe polymorphous low-grade neuroepithelial tumor of young (PLNTY) is considered as one among the low-grade neuroepithelial tumor; as per WHO-2021 classification of Brain Tumors in the fifth edition. The term PLNTY was first coined by Huse in 2016. These morphologically variable tumors are characterized by their oligodendroglioma-like cellular components, infiltrative growth pattern, and Cluster of Differentiation 34 (CD34) immunopositivity. Frequent genetic abnormalities involving mitogen-activated protein kinase pathway constituents like the BRAF proto-oncogene or fibroblast growth receptor 2/3 are harbored by PLNTYs. Radiologically, these are found to be well-circumscribed lesions with calcified and cystic components, affecting primarily temporal lobes. Clinically, they present with seizures/epilepsy in young adults (< 30 years). In the present manuscript we are reporting a case of 37-year-old male, presenting with a gradually progressive headache for 6 months, found to have a left frontal multiloculated cystic lesion with dystrophic calcifications. Based on the distinctive histopathological feature of the oligodendroglioma-like infiltrative lesion showing CD34 immunopositivity, a diagnosis of a polymorphous low-grade neuroepithelial tumor of young was made.
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18
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Métais A, Tauziède-Espariat A, Garcia J, Appay R, Uro-Coste E, Meyronet D, Maurage CA, Vandenbos F, Rigau V, Chiforeanu DC, Pallud J, Senova S, Saffroy R, Colin C, Edjlali M, Varlet P, Figarella-Branger D, Godfraind C, Gauchotte G, Mokhtari K, Bielle F, Escande F, Fina F. Clinico-pathological and epigenetic heterogeneity of diffuse gliomas with FGFR3::TACC3 fusion. Acta Neuropathol Commun 2023; 11:14. [PMID: 36647073 PMCID: PMC9843943 DOI: 10.1186/s40478-023-01506-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/03/2023] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Gliomas with FGFR3::TACC3 fusion mainly occur in adults, display pathological features of glioblastomas (GB) and are usually classified as glioblastoma, IDH-wildtype. However, cases demonstrating pathological features of low-grade glioma (LGG) lead to difficulties in classification and clinical management. We report a series of 8 GB and 14 LGG with FGFR3:TACC3 fusion in order to better characterize them. METHODS Centralized pathological examination, search for TERT promoter mutation and DNA-methylation profiling were performed in all cases. Search for prognostic factors was done by the Kaplan-Meir method. RESULTS TERT promoter mutation was recorded in all GB and 6/14 LGG. Among the 7 cases with a methylation score > 0.9 in the classifier (v12.5), 2 were classified as glioblastoma, 4 as ganglioglioma (GG) and 1 as dysembryoplastic neuroepithelial tumor (DNET). t-SNE analysis showed that the 22 cases clustered into three groups: one included 12 cases close to glioblastoma, IDH-wildtype methylation class (MC), 5 cases each clustered with GG or DNET MC but none with PLNTY MC. Unsupervised clustering analysis revealed four groups, two of them being clearly distinct: 5 cases shared age (< 40), pathological features of LGG, lack of TERT promoter mutation, FGFR3(Exon 17)::TACC3(Exon 10) fusion type and LGG MC. In contrast, 4 cases shared age (> 40), pathological features of glioblastoma, and were TERT-mutated. Relevant factors associated with a better prognosis were age < 40 and lack of TERT promoter mutation. CONCLUSION Among gliomas with FGFR3::TACC3 fusion, age, TERT promoter mutation, pathological features, DNA-methylation profiling and fusion subtype are of interest to determine patients' risk.
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Affiliation(s)
- Alice Métais
- GHU Psychiatrie et Neurosciences, Site Sainte-Anne, service de Neuropathologie, Paris, France ,grid.5842.b0000 0001 2171 2558Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Equipe IMA-BRAIN (Imaging Biomarkers for Brain Development and Disorders), Université de Paris, Paris, France
| | - Arnault Tauziède-Espariat
- GHU Psychiatrie et Neurosciences, Site Sainte-Anne, service de Neuropathologie, Paris, France ,grid.5842.b0000 0001 2171 2558Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Equipe IMA-BRAIN (Imaging Biomarkers for Brain Development and Disorders), Université de Paris, Paris, France
| | - Jeremy Garcia
- grid.411266.60000 0001 0404 1115APHM, CHU Timone, Service d’Anatomie Pathologique et de Neuropathologie, Marseille, France
| | - Romain Appay
- grid.411266.60000 0001 0404 1115APHM, CHU Timone, Service d’Anatomie Pathologique et de Neuropathologie, Marseille, France ,grid.464051.20000 0004 0385 4984Aix-Marseille Univ, CNRS, INP, Inst Neurophysiopathol, Marseille, France
| | - Emmanuelle Uro-Coste
- grid.411175.70000 0001 1457 2980Department of Pathology, Toulouse University Hospital, Toulouse, France
| | - David Meyronet
- grid.413852.90000 0001 2163 3825Groupe Hospitalier Est, Département de Neuropathologie, Hospices Civils de Lyon, Bron, France ,grid.7849.20000 0001 2150 7757Claude Bernard University Lyon 1, Lyon, France ,grid.462282.80000 0004 0384 0005Department of Cancer cell plasticity – INSERM U1052, Cancer Research Center of Lyon, Lyon, France
| | - Claude-Alain Maurage
- grid.410463.40000 0004 0471 8845Department of Pathology, Lille University Hospital, Lille, France
| | - Fanny Vandenbos
- grid.464719.90000 0004 0639 4696Department of Neuropathology, Hôpital Pasteur, Nice, France
| | - Valérie Rigau
- grid.121334.60000 0001 2097 0141Department of Pathology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Dan Christian Chiforeanu
- grid.414271.5Service d’Anatomie et Cytologie Pathologiques, Pontchaillou University Hospital, Rennes, France
| | - Johan Pallud
- grid.5842.b0000 0001 2171 2558Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Equipe IMA-BRAIN (Imaging Biomarkers for Brain Development and Disorders), Université de Paris, Paris, France ,Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Suhan Senova
- grid.50550.350000 0001 2175 4109Departments of Neurosurgery and Psychiatry, Assistance Publique-Hôpitaux de Paris (APHP) Groupe Henri-Mondor Albert-Chenevier, Créteil, France
| | - Raphaël Saffroy
- grid.413133.70000 0001 0206 8146Department of Biochemistry and Oncogenetic, APHP, Paul-Brousse Hospital, Villejuif, France
| | - Carole Colin
- grid.464051.20000 0004 0385 4984Aix-Marseille Univ, CNRS, INP, Inst Neurophysiopathol, Marseille, France
| | - Myriam Edjlali
- grid.460789.40000 0004 4910 6535Department of Radiology, APHP, Hôpitaux Raymond-Poincaré and Ambroise Paré, DMU Smart Imaging, U 1179 UVSQ/Paris-Saclay, GH Université Paris-Saclay, Paris, France ,grid.503243.3Laboratoire d’imagerie Biomédicale Multimodale (BioMaps), CEA, CNRS, Inserm, Service Hospitalier Frédéric Joliot, Université Paris-Saclay, Orsay, France
| | - Pascale Varlet
- GHU Psychiatrie et Neurosciences, Site Sainte-Anne, service de Neuropathologie, Paris, France ,grid.5842.b0000 0001 2171 2558Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Equipe IMA-BRAIN (Imaging Biomarkers for Brain Development and Disorders), Université de Paris, Paris, France
| | - Dominique Figarella-Branger
- grid.411266.60000 0001 0404 1115APHM, CHU Timone, Service d’Anatomie Pathologique et de Neuropathologie, Marseille, France ,grid.464051.20000 0004 0385 4984Aix-Marseille Univ, CNRS, INP, Inst Neurophysiopathol, Marseille, France
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Halfpenny AM, Wood MD. Review of the Recent Changes in the WHO Classification for Pediatric Brain and Spinal Cord Tumors. Pediatr Neurosurg 2023; 58:337-355. [PMID: 36617415 PMCID: PMC10664345 DOI: 10.1159/000528957] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 12/15/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Periodic updates to the World Health Organization (WHO) classification system for central nervous system (CNS) tumors reflect advances in the pathological diagnosis, categorization, and molecular underpinnings of primary brain, spinal cord, and peripheral nerve tumors. The 5th edition of the WHO Classification of CNS Tumors was published in 2021. This review discusses the guiding principles of the revision, introduces the more common new diagnostic entities, and describes tumor classification and nomenclature changes that are relevant for pediatric neurological surgeons. SUMMARY Revisions to the WHO CNS tumor classification system introduced new diagnostic entities, restructured and renamed other entities with particular impact in the diffuse gliomas and CNS embryonal tumors, and expanded the requirements for incorporating both molecular and histological features of CNS tumors into a unified integrated diagnosis. Many of the new diagnostic entities occur at least occasionally in pediatric patients and will thus be encountered by pediatric neurosurgeons. New nomenclature impacts the terminology that is applied in communication between pathologists, surgeons, clinicians, and patients. Requirements for molecular information in tumor diagnosis are expected to refine diagnostic categories while also introducing practical considerations for intraoperative consultation, preliminary histological evaluation, and triaging of neurosurgical tissue samples for histology, molecular testing, and clinical trial requirements. KEY MESSAGES Pediatric brain tumor diagnosis and clinical management are a multidisciplinary effort that is rapidly advancing in the molecular era. Interdisciplinary collaboration is critical for providing the best care for pediatric CNS tumor patients. Pediatric neurosurgeons and their local neuropathologists and neuro-oncologists must work collaboratively to put the most current CNS tumor diagnostic guidelines into standard practice.
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Affiliation(s)
| | - Matthew D. Wood
- Department of Pathology and Laboratory Medicine, Oregon Health & Science University, Portland, Oregon, USA
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20
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Jesus-Ribeiro J, Rebelo O, Ribeiro IP, Pires LM, Melo JD, Sales F, Santana I, Freire A, Melo JB. The landscape of common genetic drivers and DNA methylation in low-grade (epilepsy-associated) neuroepithelial tumors: A review. Neuropathology 2022; 42:467-482. [PMID: 35844095 DOI: 10.1111/neup.12846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/05/2022] [Accepted: 06/05/2022] [Indexed: 12/15/2022]
Abstract
Low-grade neuroepithelial tumors (LNETs) represent an important group of central nervous system neoplasms, some of which may be associated to epilepsy. The concept of long-term epilepsy-associated tumors (LEATs) includes a heterogenous group of low-grade, cortically based tumors, associated to drug-resistant epilepsy, often requiring surgical treatment. LEATs entities can sometimes be poorly discriminated by histological features, precluding a confident classification in the absence of additional diagnostic tools. This study aimed to provide an updated review on the genomic findings and DNA methylation profiling advances in LNETs, including histological entities of LEATs. A comprehensive search strategy was conducted on PubMed, Embase, and Web of Science Core Collection. High-quality peer-reviewed original manuscripts and review articles with full-text in English, published between 2003 and 2022, were included. Results were screened based on titles and abstracts to determine suitability for inclusion, and when addressed the topic of the review was screened by full-text reading. Data extraction was performed through a qualitative content analysis approach. Most LNETs appear to be driven mainly by a single genomic abnormality and respective affected signaling pathway, including BRAF p.V600E mutations in ganglioglioma, FGFR1 abnormalities in dysembryoplastic neuroepithelial tumor, MYB alterations in angiocentric glioma, BRAF fusions in pilocytic astrocytoma, PRKCA fusions in papillary glioneuronal tumor, between others. However, these molecular alterations are not exclusive, with some overlap amongst different tumor histologies. Also, clustering analysis of DNA methylation profiles allowed the identification of biologically similar molecular groups that sometimes transcend conventional histopathological classification. The exciting developments on the molecular basis of these tumors reinforce the importance of an integrative histopathological and (epi)genetic classification, which can be translated into precision medicine approaches.
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Affiliation(s)
- Joana Jesus-Ribeiro
- Neurology Department, Centro Hospitalar de Leiria, Leiria, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR) and Center of Investigation on Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Olinda Rebelo
- Neuropathology Laboratory, Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ilda Patrícia Ribeiro
- Coimbra Institute for Clinical and Biomedical Research (iCBR) and Center of Investigation on Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Laboratory of Cytogenetics and Genomics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Luís Miguel Pires
- Coimbra Institute for Clinical and Biomedical Research (iCBR) and Center of Investigation on Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Laboratory of Cytogenetics and Genomics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - João Daniel Melo
- Internal Medicine Department, CUF Coimbra Hospital, Coimbra, Portugal
| | - Francisco Sales
- Epilepsy and Sleep Monitoring Unit, Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Isabel Santana
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - António Freire
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Neurology Department, Coimbra Luz Hospital, Coimbra, Portugal
| | - Joana Barbosa Melo
- Coimbra Institute for Clinical and Biomedical Research (iCBR) and Center of Investigation on Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Laboratory of Cytogenetics and Genomics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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21
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Fabbri VP, Caporalini C, Asioli S, Buccoliero A. Paediatric-type diffuse low-grade gliomas: a clinically and biologically distinct group of tumours with a favourable outcome. Pathologica 2022; 114:410-421. [PMID: 36534420 PMCID: PMC9763978 DOI: 10.32074/1591-951x-828] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/12/2022] [Indexed: 12/23/2022] Open
Abstract
The WHO 2021 classification of central nervous system cancers distinguishes diffuse gliomas that arise in adults (referred to as the "adult type") and those that arise in children (defined as "paediatric") based on clinical and molecular characteristics."). However, paediatric-type gliomas may occasionally be present in younger adults and occasionally adult-type gliomas may occur in children. Diffuse low-grade paediatric glioma includes diffuse astrocytoma altered by MYB or MYBL1, low-grade polymorphic juvenile neuroepithelial tumour, angiocentric glioma, and diffuse low-grade glioma with an altered MAPK pathway. Here, we examine these newly recognised entities according to WHO diagnostic criteria and propose an integrated diagnostic approach that can be used to separate these clinically and biologically distinct tumor groups.
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Affiliation(s)
- Viscardo Paolo Fabbri
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Azienda Ospedaliero Universitaria Policlinico Modena, Modena, Italy
| | | | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Programma Neurochirurgia Ipofisi- Pituitary Unit, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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22
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Kleinschmidt-DeMasters BK, Gilani A. Extra-CNS and dural metastases in FGFR3::TACC3 fusion+ adult glioblastoma, IDH-wildtype. Neurooncol Pract 2022; 9:449-455. [PMID: 36134017 PMCID: PMC9476975 DOI: 10.1093/nop/npac042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Adult glioblastomas (GBMs), IDH-wildtype, WHO grade 4 with FGFR3::TACC3 fusion have a better prognosis than standard GBMs. Whether this extended survival leads to late biological consequences is unknown. Although constituting only 4% of all GBMs, FGFR3::TACC3 fusion-positive GBMs manifest recurrent morphological features that allow prediction of this subtype, possibly affecting trial eligibility and/or targeted therapies. However, we have previously shown that an identical histological pattern can be present in wildtype examples, and conversely, occasional FGFR3::TACC3 fusion-positive tumors lack this stereotypic morphology; thus, ultimately molecular characterization is required. We now report for the first time an adult with FGFR3::TACC3 fusion-positive GBM showing archetypal histological features who developed extracranial metastases to provide further insight into potential behavior of the GBM type. METHODS Report of a 70-year-old man with left parietal GBM who developed 2 subsequent metastases, all 3 of which were assessed by next-generation sequencing (NGS) and DNA methylation. RESULTS Biopsy-proven dural metastases occurred at 8 months and cervical lymph node metastasis at 12-month post-diagnosis before the patient succumbed at 23 months. By NGS, all 3 tumors showed FGFR3::TACC3 fusion as well as an additional PDZD2::TERT fusion of uncertain significance. DNA methylation profiling demonstrated mesenchymal subtype in the initial biopsy and RTKII subtype in subsequent dural and lymph node metastases, indicating intratumor spatial heterogeneity or temporal evolution. CONCLUSION Rarely, FGFR3::TACC3 fusion-positive GBM patients may develop dural and extracranial metastatic spread, the latter with subclass switching on epigenomic analysis.
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Affiliation(s)
- B K Kleinschmidt-DeMasters
- Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ahmed Gilani
- Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Pathology, Children’s Hospital Colorado, Aurora, Colorado, USA
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23
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Palejwala AH, O’Neal CM, Quinton MR, Battiste JD, Peterson JEG, Dunn IF. Polymorphous low-grade neuroepithelial tumor of the young: Rare tumor and review of the literature. Rare Tumors 2022; 14:20363613221083360. [PMID: 35371417 PMCID: PMC8966082 DOI: 10.1177/20363613221083360] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Polymorphous low-grade neuroepithelial tumor of the young (PLNTY) is a recently described low-grade neuroepithelial tumor with an infiltrative growth pattern and oligodendrocyte-like cells that are CD34 immunopositive. Correlating histology and results from molecular testing is critical to correctly diagnosing PLNTY, as its histologic appearance is similar to oligodendrogliomas and shares genetic abnormalities common to other low-grade epilepsy associated tumors (LEATs). In this case report, we describe a 31-year-old female with intractable epilepsy found to have a temporal mass and diagnosed with PLNTY after histopathologic and molecular testing. We describe the radiographic, histologic, and genetic features in relation to the epileptic and oncologic outcomes for this patient. Then, we compare these features and outcomes to other cases of PLNTY described in the literature.
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Affiliation(s)
- Ali H Palejwala
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Ok, USA
| | - Christen M O’Neal
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Ok, USA
| | - Michael R Quinton
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Ok, USA
| | - James D Battiste
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Ok, USA
| | - Jo Elle G Peterson
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Ok, USA
| | - Ian F Dunn
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Ok, USA
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Fei X, Zhao J, Wei W, Wang W, Kong X, Qian R, Niu C, Yao Y. Clinical, Radiological, Pathological Features and Seizure Outcome With Surgical Management of Polymorphous Low-Grade Neuroepithelial Tumor of the Young Associated With Epilepsy. Front Oncol 2022; 12:863373. [PMID: 35372027 PMCID: PMC8971723 DOI: 10.3389/fonc.2022.863373] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivePolymorphous low-grade neuroepithelial tumor of the young (PLNTY) is a novel distinct epileptogenic neoplasm, and its clinical, imaging, histopathological, and molecular features were already known in the existing literature. We aimed to analyze the surgical management of PLNTY combined with these known characteristics.MethodsEight patients underwent surgical treatment in our center between December 2017 and December 2020, and the postoperative pathology was diagnosed as PLNTY. Their clinical data, imaging, pathological, molecular characteristics, and seizure outcome were retrospectively analyzed. Follow-up evaluations and a literature review were performed.ResultsThe 8 patients included 1 woman and 7 men, aged between 5 and 51 years old (mean = 31.6, median = 29). The preoperative symptoms of all 8 cases were seizures. Four tumors were situated in the temporal lobes, and one of the four extratemporal tumors was in the occipital lobe and three were in the frontal lobe. Enlarged and gross total resections were performed in 2 cases and the other 6 cases, respectively. All cases exhibited intense labeling of CD34, and absence of 1p/19q codeletion and IDH1 or IDH2 mutation. B-Raf proto-oncogene (BRAF) V600E mutation was presented in 4 (66.7%) of 6 detected cases. The postoperative seizure outcome of Engel class I was achieved in 6 cases (75%).ConclusionPLNTY represents distinctive histologic, immunophenotypic and biomolecular features, and has high epileptogenicity. Early surgical intervention and enlarged resection of PLNTY associated with epilepsy will help to improve the postoperative seizure-free rate.
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Affiliation(s)
- Xiaorui Fei
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Jing Zhao
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Wei Wei
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Wei Wang
- Department of Pathology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Intelligent Pathology Institute, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xue Kong
- Department of Pathology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Intelligent Pathology Institute, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Ruobing Qian
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Chaoshi Niu
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Yang Yao
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- *Correspondence: Yang Yao,
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Bale TA, Rosenblum MK. The 2021 WHO Classification of Tumors of the Central Nervous System: An update on pediatric low-grade gliomas and glioneuronal tumors. Brain Pathol 2022; 32:e13060. [PMID: 35218102 PMCID: PMC9245930 DOI: 10.1111/bpa.13060] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 12/13/2022] Open
Abstract
The 2021 5th edition of the WHO Classification of Tumors of the Central Nervous System reflects the discovery of genetic alterations underlying many central nervous system (CNS) neoplasms. Insights gained from technologic advances and novel applications in molecular diagnostics, including next‐generation sequencing and DNA methylation‐based profiling, coupled with the recognition of clinicopathologic correlates, have prompted substantial changes to CNS tumor classification; this is particularly true for pediatric low‐grade gliomas and glioneuronal tumors (pLGG/GNTs). The 2021 WHO now classifies gliomas, glioneuronal tumors and neuronal tumors into 6 families, three of which encompass pLGG/LGNTs: “Pediatric type diffuse low‐grade gliomas,” “circumscribed astrocytic gliomas,” and “glioneuronal and neuronal tumors.” Among these are six newly recognized tumor types: “diffuse astrocytoma, MYB or MYBL1‐altered”; “polymorphous low grade neuroepithelial tumor of the young (PLNTY)”; “diffuse low‐grade glioma‐MAPK altered”; “Diffuse glioneuronal tumor with oligodendroglioma‐like features and nuclear clusters (DGONC)”; “myxoid glioneuronal tumor (MGT)”; and “multinodular and vacuolating neuronal tumor (MVNT).” We review these newly recognized entities in the context of general changes to the WHO schema, discuss implications of the new classification for treatment of pLGG/LGNT, and consider strategies for molecular testing and interpretation.
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Affiliation(s)
- Tejus A Bale
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Marc K Rosenblum
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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26
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Kurokawa M, Kurokawa R, Capizzano AA, Baba A, Ota Y, Pinarbasi E, Johnson T, Srinivasan A, Moritani T. Neuroradiological features of the polymorphous low-grade neuroepithelial tumor of the young: five new cases with a systematic review of the literature. Neuroradiology 2022; 64:1255-1264. [PMID: 35001164 DOI: 10.1007/s00234-021-02879-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/06/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE Polymorphous low-grade neuroepithelial tumors of the young (PLNTY) is a newly recognized brain tumor with genetic abnormalities frequently involving either BRAF or FGFR2/FGFR3. There are few publications available about the neuroradiological features of PLNTY. In this systematic review, we assessed the demographic, clinical, and neuroradiological features of PLNTY. METHODS Literature data were extracted from database searches in MEDLINE and SCOPUS databases up to June 10, 2021. Studies reporting on pathologically proven PLNTY with neuroradiological findings were included. After reviewing 103 abstracts, 9 articles encompassing 19 cases met the inclusion criteria. We also added five patients from our hospital. The correlations between the presence of "transmantle-like sign" and the following three factors: duration of seizures; tumor size; and pathologically proven cortical dysplasia, were examined. RESULTS The median patient age was 15.5 years (range, 5-57 years), and 15/24 (62.5%) were female. All tumors were localized supratentorialy. The main radiological features included cortical or subcortical masses (95.8%) in the temporal lobe (66.7%), calcification (83.3%), well-defined margins (72.7%), solid and cystic components (66.6%), and T2-weighted imaging (T2WI) hyperintensity (50.0%). The duration of seizure was significantly longer (positive vs. negative (median [range]), 24 months [6 - 96 months] vs. 5 months [1 - 12 months], p = 0.042), and the presence of the cortical dysplasia was significantly more frequent (3/8 vs 0/16, p = 0.042) in the patients with transmantle-like sign. CONCLUSION PLNTY typically represents a calcified, well-defined mass in the supratentorial cortical or subcortical regions. The radiological findings defined here could facilitate the diagnosis of PLNTY.
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Affiliation(s)
- Mariko Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI, 48109, USA
| | - Ryo Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI, 48109, USA.
| | - Aristides A Capizzano
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI, 48109, USA
| | - Akira Baba
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI, 48109, USA
| | - Yoshiaki Ota
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI, 48109, USA
| | - Emile Pinarbasi
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Timothy Johnson
- Department of Biostatistics, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Ashok Srinivasan
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI, 48109, USA
| | - Toshio Moritani
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI, 48109, USA
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Métais A, Appay R, Pagès M, Gallardo C, Silva K, Siegfried A, Perbet R, Maurage CA, Scavarda D, Fina F, Uro-Coste E, Riffaud L, Colin C, Figarella-Branger D. Low-grade epilepsy-associated neuroepithelial tumours with a prominent oligodendroglioma-like component: The diagnostic challenges. Neuropathol Appl Neurobiol 2021; 48:e12769. [PMID: 34551121 DOI: 10.1111/nan.12769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/23/2021] [Accepted: 09/12/2021] [Indexed: 12/24/2022]
Abstract
AIMS We searched for recurrent pathological features and molecular alterations in a retrospective series of 72 low-grade epilepsy-associated neuroepithelial tumours (LEATs) with a prominent oligodendroglioma-like component, in order to classify them according to the 2021 World Health Organization (WHO) classification of central nervous system (CNS) tumours. METHODS Centralised pathological examination was performed as well as targeted molecular analysis of v-Raf murine sarcoma viral oncogene homologue B (BRAF) and fibroblast growth factor receptor 1 (FGFR1) by multiplexed digital polymerase chain reaction (mdPCR). DNA methylation profiling was performed in cases with sufficient DNA. In cases with no genetic alteration by mdPCR and sufficient material, RNA sequencing was done. RESULTS We first reclassified our cohort into three groups: ganglioglioma (GG, n = 14), dysembryoplastic neuroepithelial tumours (DNTs, n = 19) and glioneuronal tumours/paediatric-type low-grade glioma (LGG) not otherwise specified (GNT/PLGG NOS, n = 39). mdPCR found an alteration in 38/72 cases. Subsequent RNA sequencing revealed a fusion transcript involving BRAF, FGFR1/2/3 or neurotrophic tyrosine kinase receptor type 2 [NTRK2] in 9/25 cases. DNA methylation profiling found 12/46 cases with a calibrated score ≥0.9. Unsupervised hierarchical clustering revealed two clusters: Cluster 1 was enriched with cases classified as DNT at histology, belonging to the LGG-DNT methylation class (MC), with haematopoietic progenitor cell antigen (CD34) negativity and FGRF1 alterations; Cluster 2 was enriched with cases classified at histology as GG, belonging to the LGG-GG MC MC, with BRAF V600E mutation and CD34 positivity. The tumours reclassified as GNT/PLGG NOS were equally distributed across both clusters. Interestingly, all polymorphous low-grade neuroepithelial tumour of the young belonged to Cluster 2, whereas diffuse LGG mitogen-activated protein kinase (MAPK) pathway-altered were equally distributed among the two clusters. This led us to build an algorithm to classify LEATs with a prominent oligodendroglioma-like component. CONCLUSIONS Integrated histomolecular diagnosis of LEATs with a prominent oligodendroglioma-like component remains challenging. Because these tumours can be split into two major clusters of biological significance, the clinicopathological relevance of the four types recognised by the WHO CNS5 within this spectrum of tumours is questionable.
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Affiliation(s)
- Alice Métais
- AP-HM, CHU Timone, Service d'Anatomie Pathologique et de Neuropathologie, Marseille, France.,Service d'Anatomie et Cytologie Pathologiques, CHU Pontchaillou, Rennes, France
| | - Romain Appay
- AP-HM, CHU Timone, Service d'Anatomie Pathologique et de Neuropathologie, Marseille, France.,Aix-Marseille Univ, CNRS, INP, Inst Neurophysiopathol, Marseille, France
| | - Mélanie Pagès
- GHU-Paris Sainte-Anne Hospital, Paris University, Paris, France.,Department of Genetics, Institut Curie, Paris, France.,SIREDO Paediatric Cancer Center, Institut Curie, Paris, France.,INSERM U830, Laboratory of Translational Research in Paediatric Oncology, Institut Curie, Paris, France
| | - Catherine Gallardo
- AP-HM, CHU Timone, Service d'Anatomie Pathologique et de Neuropathologie, Marseille, France
| | - Karen Silva
- Groupe Hospitalier Est, Département de Neuropathologie, Hospices Civils de Lyon, Bron, France
| | - Aurore Siegfried
- Department of Pathology, Toulouse University Hospital, Toulouse, France.,INSERM U1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France.,Université Paul Sabatier, Toulouse III, Toulouse, France
| | - Romain Perbet
- Univ. Lille, Inserm, CHU Lille, Alzheimer and Tauopathies, Lille Neuroscience & Cognition, UMR-S1172, Lille, France
| | - Claude-Alain Maurage
- Univ. Lille, Inserm, CHU Lille, Laboratory of Development and Plasticity of the Neuroendocrine Brain, Lille Neuroscience & Cognition, UMR-S1172, Lille, France
| | - Didier Scavarda
- Aix-Marseille Univ, AP-HM, Institut de Neurosciences des Systèmes, CHU Timone, Service de Neurochirurgie infantile, Marseille, France
| | - Frédéric Fina
- AP-HM, CHU Timone, Service d'Anatomie Pathologique et de Neuropathologie, Marseille, France.,ID Solutions, Research and Development, Grabels, France
| | - Emmanuelle Uro-Coste
- Department of Pathology, Toulouse University Hospital, Toulouse, France.,INSERM U1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France.,Université Paul Sabatier, Toulouse III, Toulouse, France
| | - Laurent Riffaud
- Department of Pediatric Neurosurgery, Rennes University Hospital, Rennes, France.,INSERM MediCIS, unit U1099 LTSI, Rennes 1 University, Rennes, France
| | - Carole Colin
- Aix-Marseille Univ, CNRS, INP, Inst Neurophysiopathol, Marseille, France
| | - Dominique Figarella-Branger
- AP-HM, CHU Timone, Service d'Anatomie Pathologique et de Neuropathologie, Marseille, France.,Aix-Marseille Univ, CNRS, INP, Inst Neurophysiopathol, Marseille, France
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Ida CM, Johnson DR, Nair AA, Davila J, Kollmeyer TM, Minn K, Fadra NM, Balcom JR, Fung KMA, Kim DK, Kaufmann TJ, Kipp BR, Halling KC, Jenkins RB, Giannini C. Polymorphous Low-Grade Neuroepithelial Tumor of the Young (PLNTY): Molecular Profiling Confirms Frequent MAPK Pathway Activation. J Neuropathol Exp Neurol 2021; 80:821-829. [PMID: 34363682 DOI: 10.1093/jnen/nlab075] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Polymorphous low-grade neuroepithelial tumor of the young (PLNTY) is a recently described epileptogenic tumor characterized by oligodendroglioma-like components, aberrant CD34 expression, and frequent mitogen-activated protein kinase (MAPK) pathway activation. We molecularly profiled 13 cases with diagnostic histopathological features of PLNTY (10 female; median age, 16 years; range, 5-52). Patients frequently presented with seizures (9 of 12 with available history) and temporal lobe tumors (9 of 13). MAPK pathway activating alterations were identified in all 13 cases. Fusions were present in the 7 youngest patients: FGFR2-CTNNA3 (n = 2), FGFR2-KIAA1598 (FGFR2-SHTN1) (n = 1), FGFR2-INA (n = 1), FGFR2-MPRIP (n = 1), QKI-NTRK2 (n = 1), and KIAA1549-BRAF (n = 1). BRAF V600E mutation was present in 6 patients (17 years or older). Two fusion-positive cases additionally harbored TP53/RB1 abnormalities suggesting biallelic inactivation. Copy number changes predominantly involving whole chromosomes were observed in all 10 evaluated cases, with losses of chromosome 10q occurring with FGFR2-KIAA1598 (SHTN1)/CTNNA3 fusions. The KIAA1549-BRAF and QKI-NTRK2 fusions were associated respectively with a 7q34 deletion and 9q21 duplication. This study shows that despite its name, PLNTY also occurs in older adults, who frequently show BRAF V600E mutation. It also expands the spectrum of the MAPK pathway activating alterations associated with PLNTY and demonstrates recurrent chromosomal copy number changes consistent with chromosomal instability.
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Affiliation(s)
- Cristiane M Ida
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA (CMI, TMK, KM, JRB, BRK, KCH, RBJ, CG)
| | - Derek R Johnson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA (DRJ, DKK, TJK)
| | - Asha A Nair
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA (AAN, JD, NMF)
| | - Jaime Davila
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA (AAN, JD, NMF).,Department of Mathematics, Statistics and Computer Science, St Olaf College, Northfield, Minnesota, USA (JD)
| | - Thomas M Kollmeyer
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA (CMI, TMK, KM, JRB, BRK, KCH, RBJ, CG)
| | - Kay Minn
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA (CMI, TMK, KM, JRB, BRK, KCH, RBJ, CG)
| | - Numrah M Fadra
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA (AAN, JD, NMF)
| | - Jessica R Balcom
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA (CMI, TMK, KM, JRB, BRK, KCH, RBJ, CG)
| | - Kar-Ming A Fung
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA (KMAF)
| | - Dong Kun Kim
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA (DRJ, DKK, TJK)
| | - Timothy J Kaufmann
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA (DRJ, DKK, TJK)
| | - Benjamin R Kipp
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA (CMI, TMK, KM, JRB, BRK, KCH, RBJ, CG)
| | - Kevin C Halling
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA (CMI, TMK, KM, JRB, BRK, KCH, RBJ, CG)
| | - Robert B Jenkins
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA (CMI, TMK, KM, JRB, BRK, KCH, RBJ, CG)
| | - Caterina Giannini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA (CMI, TMK, KM, JRB, BRK, KCH, RBJ, CG)
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