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Tauziède‐Espariat A, Beccaria K, Dangouloff‐Ros V, Sievers P, Meurgey A, Pissaloux D, Appay R, Saffroy R, Grill J, Mariet C, Bourdeaut F, Hasty L, Métais A, Chrétien F, Blauwblomme T, Puget S, Boddaert N, Varlet P. A comprehensive analysis of infantile central nervous system tumors to improve distinctive criteria for infant-type hemispheric glioma versus desmoplastic infantile ganglioglioma/astrocytoma. Brain Pathol 2023; 33:e13182. [PMID: 37349135 PMCID: PMC10467037 DOI: 10.1111/bpa.13182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/12/2023] [Indexed: 06/24/2023] Open
Abstract
Recent epigenomic analyses have revealed the existence of a new DNA methylation class (MC) of infant-type hemispheric glioma (IHG). Like desmoplastic infantile ganglioglioma/astrocytoma (DIG/DIA), these tumors mainly affect infants and are supratentorial. While DIG/DIA is characterized by BRAF or RAF1 alterations, IHG has been shown to have receptor tyrosine kinase (RTK) gene fusions (ALK, ROS1, NTRK1/2/3, and MET). However, in this rapidly evolving field, a more comprehensive analysis of infantile glial/glioneuronal tumors including clinical, radiological, histopathological, and molecular data is needed. Here, we retrospectively investigated data from 30 infantile glial/glioneuronal tumors, consecutively compiled from our center. They were analyzed by two experienced pediatric neuroradiologists in consensus, without former knowledge of the molecular data. We also performed a comprehensive clinical, and histopathological examination (including molecular evaluation by next-generation sequencing, RNA sequencing, and fluorescence in situ hybridization [FISH] analyses), as well as DNA methylation profiling for the samples having sufficient material available. The integrative histopathological, genetic, and epigenetic analyses, including t-distributed stochastic neighbor embedding (t-SNE) analyses segregated tumors into 10 DIG/DIA (33.3%), six IHG (20.0%), three gangliogliomas (10.0%), two pleomorphic xanthoastrocytomas (6.7%), two pilocytic astrocytomas (6.7%), two supratentorial ependymomas, ZFTA fusion-positive (6.7%), two supratentorial ependymomas, YAP1 fusion-positive (6.7%), two embryonal tumors with PLAGL2-family amplification (6.7%), and one diffuse low-grade glioma, MAPK-pathway altered. This study highlights the significant differential features, in terms of histopathology (leptomeningeal infiltration, intense desmoplasia and ganglion cells in DIG/DIA and necrosis, microvascular proliferation, and siderophages in IHG), and radiology between DIG/DIA and IHG. Moreover, these results are consistent with the literature data concerning the molecular dichotomy (BRAF/RAF1 alterations vs. RTK genes' fusions) between DIG/DIA and IHG. This study characterized histopathologically and radiologically two additional cases of the novel embryonal tumor characterized by PLAGL2 gene amplification.
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Affiliation(s)
- Arnault Tauziède‐Espariat
- Department of Neuropathology, GHU Paris‐Psychiatrie et NeurosciencesSainte‐Anne HospitalParisFrance
- Inserm, UMR 1266, IMA‐BrainInstitut de Psychiatrie et Neurosciences de ParisParisFrance
| | - Kévin Beccaria
- Department of Pediatric Neurosurgery, Necker Hospital, APHPUniversité Paris Descartes, Sorbonne Paris CitéParisFrance
| | - Volodia Dangouloff‐Ros
- Pediatric Radiology DepartmentHôpital Necker Enfants Malades, AP‐HPParisFrance
- Université Paris Cité, UMR 1163Institut Imagine and INSERM U1299ParisFrance
| | - Philipp Sievers
- Department of Neuropathology, Institute of PathologyUniversity Hospital HeidelbergHeidelbergGermany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK)German Cancer Research Center DKFZHeidelbergGermany
| | - Alexandra Meurgey
- Department of BiopathologyLéon Bérard Cancer CenterLyonFrance
- INSERM 1052, CNRS 5286Cancer Research Center of Lyon (CRCL)LyonFrance
| | - Daniel Pissaloux
- Department of BiopathologyLéon Bérard Cancer CenterLyonFrance
- INSERM 1052, CNRS 5286Cancer Research Center of Lyon (CRCL)LyonFrance
| | - Romain Appay
- APHM, CHU TimoneService d'Anatomie Pathologique et de NeuropathologieMarseilleFrance
- Aix‐Marseille University, CNRS, INP, Institute of NeurophysiopathologyMarseilleFrance
| | - Raphaël Saffroy
- Department of Biochemistry and OncogeneticsPaul Brousse HospitalVillejuifFrance
| | - Jacques Grill
- U981, Molecular Predictors and New Targets in Oncology, INSERM, Gustave RoussyUniversité Paris‐SaclayVillejuifFrance
- Department of Pediatric Oncology, Gustave RoussyUniversité Paris‐SaclayVillejuifFrance
| | - Cassandra Mariet
- Department of Pediatric Oncology, Gustave RoussyUniversité Paris‐SaclayVillejuifFrance
| | - Franck Bourdeaut
- INSERMU830Laboratory of Translational Research in Pediatric OncologyParisFrance
- Institut Curie, SIREDO Center Care, Innovation, Research in Pediatric, Adolescent and Young Adult OncologyParis Sciences Lettres Research UniversityParisFrance
| | - Lauren Hasty
- Department of Neuropathology, GHU Paris‐Psychiatrie et NeurosciencesSainte‐Anne HospitalParisFrance
| | - Alice Métais
- Department of Neuropathology, GHU Paris‐Psychiatrie et NeurosciencesSainte‐Anne HospitalParisFrance
- Inserm, UMR 1266, IMA‐BrainInstitut de Psychiatrie et Neurosciences de ParisParisFrance
| | - Fabrice Chrétien
- Department of Neuropathology, GHU Paris‐Psychiatrie et NeurosciencesSainte‐Anne HospitalParisFrance
| | - Thomas Blauwblomme
- Pediatric Radiology DepartmentHôpital Necker Enfants Malades, AP‐HPParisFrance
| | - Stéphanie Puget
- Pediatric Radiology DepartmentHôpital Necker Enfants Malades, AP‐HPParisFrance
| | - Nathalie Boddaert
- Pediatric Radiology DepartmentHôpital Necker Enfants Malades, AP‐HPParisFrance
- Université Paris Cité, UMR 1163Institut Imagine and INSERM U1299ParisFrance
| | - Pascale Varlet
- Department of Neuropathology, GHU Paris‐Psychiatrie et NeurosciencesSainte‐Anne HospitalParisFrance
- Inserm, UMR 1266, IMA‐BrainInstitut de Psychiatrie et Neurosciences de ParisParisFrance
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Tauziède-Espariat A, Figarella-Branger D, Uro-Coste E, Nicaise Y, André N, Scavarda D, Testud B, Girard N, Rousseau A, Basset L, Chotard G, Jecko V, le Loarer F, Hostein I, Machet MC, Tallegas M, Listrat A, Hasty L, Métais A, Chrétien F, Boddaert N, Varlet P. Clinicopathological and molecular characterization of three cases classified by DNA-methylation profiling as "Glioneuronal Tumors, NOS, Subtype A". Acta Neuropathol 2022; 144:1179-1183. [PMID: 36121478 DOI: 10.1007/s00401-022-02490-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Arnault Tauziède-Espariat
- Department of Neuropathology, GHU Paris-Psychiatrie et Neurosciences, Sainte-Anne Hospital, 1, rue Cabanis, 75014, Paris, France.
- Inserm, UMR 1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.
| | - Dominique Figarella-Branger
- Department of Anatomopathology and Neuropathology, Inst Neurophysiopathol, and APHM, La Timone Hospital, Aix-Marseille Univ, CNRS, INP, 13385, Marseille, France
| | - Emmanuelle Uro-Coste
- Cancer Research Center of Toulouse (CRCT), INSERM U1037, Toulouse, France
- Université Paul Sabatier, Toulouse III, Toulouse, France
- Department of Pathology, Toulouse University Hospital, Toulouse, France
| | - Yvan Nicaise
- Cancer Research Center of Toulouse (CRCT), INSERM U1037, Toulouse, France
| | - Nicolas André
- Department of Pediatric Oncology, AP-HM La Timone, Marseille, France
- SMARTc, Centre de Recherche en Cancérologie de Marseille, Inserm U1068, Aix Marseille University, Marseille, France
| | - Didier Scavarda
- Department of Pediatric Neurosurgery, AP-HM La Timone, Marseille, France
| | - Benoît Testud
- Department of Radiology, AP-HM La Timone, Marseille, France
| | - Nadine Girard
- Department of Radiology, AP-HM La Timone, Marseille, France
| | - Audrey Rousseau
- Department of Pathology, Angers Hospital, Angers, France
- Université d'Angers, Inserm UMR 1307, CNRS UMR 6075, Nantes Université, CRCI2NA, 49000, Angers, France
| | - Laetitia Basset
- Department of Pathology, Angers Hospital, Angers, France
- Université d'Angers, Inserm UMR 1307, CNRS UMR 6075, Nantes Université, CRCI2NA, 49000, Angers, France
| | | | - Vincent Jecko
- Department of Pediatric Neurosurgery, Pellegrin Hospital, Bordeaux, France
| | - François le Loarer
- Université de Bordeaux, Talence, France
- Institut Bergonié, INSERM U1218, ACTION, Bordeaux, France
| | - Isabelle Hostein
- Université de Bordeaux, Talence, France
- Institut Bergonié, INSERM U1218, ACTION, Bordeaux, France
| | | | | | - Antoine Listrat
- Department of Pediatric Neurosurgery, Tours Hospital, Tours, France
| | - Lauren Hasty
- Department of Neuropathology, GHU Paris-Psychiatrie et Neurosciences, Sainte-Anne Hospital, 1, rue Cabanis, 75014, Paris, France
| | - Alice Métais
- Department of Neuropathology, GHU Paris-Psychiatrie et Neurosciences, Sainte-Anne Hospital, 1, rue Cabanis, 75014, Paris, France
- Inserm, UMR 1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Fabrice Chrétien
- Department of Neuropathology, GHU Paris-Psychiatrie et Neurosciences, Sainte-Anne Hospital, 1, rue Cabanis, 75014, Paris, France
| | - Nathalie Boddaert
- Pediatric Radiology Department, Hôpital Necker Enfants Malades, AP-HP, Paris, France
- Institut Imagine and INSERM U1299, Université Paris Cité, UMR 1163, Paris, France
| | - Pascale Varlet
- Department of Neuropathology, GHU Paris-Psychiatrie et Neurosciences, Sainte-Anne Hospital, 1, rue Cabanis, 75014, Paris, France
- Inserm, UMR 1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
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3
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Tran S, Bielle F. WHO 2021 and beyond: new types, molecular markers and tools for brain tumor classification. Curr Opin Oncol 2022; 34:670-675. [PMID: 36093875 DOI: 10.1097/cco.0000000000000903] [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: 11/26/2022]
Abstract
PURPOSE OF REVIEW The fifth edition of the WHO classification of central nervous system tumors was published in 2021. It implemented major advances in the current diagnostic practice such as DNA methylation profiling. The review addresses how our understanding of the diversity of brain tumors has recently much improved through omics analysis and derived molecular biomarkers. RECENT FINDINGS Latest impactful studies identifying new diagnostic or prognostic biomarkers in frequent tumors and describing new rare tumor types are summarized about adult and pediatric gliomas, rare neuroepithelial tumors, ependymomas, medulloblastomas and meningiomas. Some controversies are debated. The role of methylation classes and surrogate immunohistochemical markers is highlighted. SUMMARY New diagnostic criteria and better definitions of tumor types aim at improving the management of brain tumor patients and at better evaluating new treatments in clinical trials. The rapidly evolving field of brain tumor classification opens exciting perspectives and many challenges to integrate clinical, radiological, histological and molecular information into a framework relevant for care and research.
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Affiliation(s)
- Suzanne Tran
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital Universitaire La Pitié Salpêtrière, DMU Neurosciences, Department of Neuropathology
| | - Franck Bielle
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital Universitaire La Pitié Salpêtrière, DMU Neurosciences, Department of Neuropathology
- Sorbonne Université, AP-HP, SIRIC CURAMUS, Paris, France
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4
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Lucas CHG, Davidson CJ, Alashari M, Putnam AR, Whipple NS, Bruggers CS, Mendez JS, Cheshier SH, Walker JB, Ramani B, Cadwell CR, Sullivan DV, Lu R, Mirchia K, Van Ziffle J, Devine P, Goldschmidt E, Hervey-Jumper SL, Gupta N, Oberheim Bush NA, Raleigh DR, Bollen A, Tihan T, Pekmezci M, Solomon DA, Phillips JJ, Perry A. Targeted Next-Generation Sequencing Reveals Divergent Clonal Evolution in Components of Composite Pleomorphic Xanthoastrocytoma-Ganglioglioma. J Neuropathol Exp Neurol 2022; 81:650-657. [PMID: 35703914 PMCID: PMC9297094 DOI: 10.1093/jnen/nlac044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Composite pleomorphic xanthoastrocytoma-ganglioglioma (PXA-GG) is an extremely rare central nervous system neoplasm with 2 distinct but intermingled components. Whether this tumor represents a "collision tumor" of separate neoplasms or a monoclonal neoplasm with divergent evolution is poorly understood. Clinicopathologic studies and capture-based next generation sequencing were performed on extracted DNA from all available PXA-GG at 2 medical centers. Five PXA-GG were diagnosed in 1 male and 4 female patients ranging from 13 to 25 years in age. Four arose within the cerebral hemispheres; 1 presented in the cerebellar vermis. DNA was sufficient for analysis in 4 PXA components and 3 GG components. Four paired PXA and GG components harbored BRAF p.V600E hotspot mutations. The 4 sequenced PXA components demonstrated CDKN2A homozygous deletion by sequencing with loss of p16 (protein product of CDKN2A) expression by immunohistochemistry, which was intact in all assessed GG components. The PXA components also demonstrated more frequent copy number alterations relative to paired GG components. In one PXA-GG, shared chromosomal copy number alterations were identified in both components. Our findings support divergent evolution of the PXA and GG components from a common BRAF p.V600E-mutant precursor lesion, with additional acquisition of CDKN2A homozygous deletion in the PXA component as is typically seen in conventional PXA.
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Affiliation(s)
- Calixto-Hope G Lucas
- From the Department of Pathology, University of California, San Francisco, San Francisco, California, USA
| | | | - Mouied Alashari
- Division of Pediatric Pathology, Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Angelica R Putnam
- Division of Pediatric Pathology, Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Nicholas S Whipple
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Carol S Bruggers
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Joe S Mendez
- Department of Neurosurgery, University of Utah/Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Samuel H Cheshier
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Intermountain Primary Children's Hospital, Salt Lake City, Utah, USA
| | | | - Biswarathan Ramani
- From the Department of Pathology, University of California, San Francisco, San Francisco, California, USA
| | - Cathryn R Cadwell
- From the Department of Pathology, University of California, San Francisco, San Francisco, California, USA
| | - Daniel V Sullivan
- From the Department of Pathology, University of California, San Francisco, San Francisco, California, USA
| | - Rufei Lu
- From the Department of Pathology, University of California, San Francisco, San Francisco, California, USA
| | - Kanish Mirchia
- From the Department of Pathology, University of California, San Francisco, San Francisco, California, USA
| | - Jessica Van Ziffle
- From the Department of Pathology, University of California, San Francisco, San Francisco, California, USA
- Clinical Cancer Genomics Laboratory, University of California, San Francisco, San Francisco, California, USA
| | - Patrick Devine
- From the Department of Pathology, University of California, San Francisco, San Francisco, California, USA
- Clinical Cancer Genomics Laboratory, University of California, San Francisco, San Francisco, California, USA
| | - Ezequiel Goldschmidt
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Shawn L Hervey-Jumper
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Nalin Gupta
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
- Department of Pediatrics, University of California, San Francisco, San Francisco, USA
| | - Nancy Ann Oberheim Bush
- Division of Neuro-Oncology, Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
| | - David R Raleigh
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California, USA
| | - Andrew Bollen
- From the Department of Pathology, University of California, San Francisco, San Francisco, California, USA
| | - Tarik Tihan
- From the Department of Pathology, University of California, San Francisco, San Francisco, California, USA
| | - Melike Pekmezci
- From the Department of Pathology, University of California, San Francisco, San Francisco, California, USA
| | - David A Solomon
- From the Department of Pathology, University of California, San Francisco, San Francisco, California, USA
| | - Joanna J Phillips
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
- From the Department of Pathology, University of California, San Francisco, San Francisco, California, USA
| | - Arie Perry
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
- From the Department of Pathology, University of California, San Francisco, San Francisco, California, USA
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5
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Pratt D, Abdullaev Z, Papanicolau-Sengos A, Ketchum C, Selvam PP, Chung HJ, Lee I, Raffeld M, Gilbert MR, Armstrong TS, Pytel P, Borys E, Klonoski JM, McCord M, Horbinski C, Brat D, Perry A, Solomon D, Eberhart C, Giannini C, Quezado M, Aldape K. High-grade glioma with pleomorphic and pseudopapillary features (HPAP): a proposed type of circumscribed glioma in adults harboring frequent TP53 mutations and recurrent monosomy 13. Acta Neuropathol 2022; 143:403-414. [PMID: 35103816 PMCID: PMC9844519 DOI: 10.1007/s00401-022-02404-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/28/2022] [Accepted: 01/29/2022] [Indexed: 01/19/2023]
Abstract
Tumors of the central nervous system (CNS) often display a wide morphologic spectrum that has, until recently, been the sole basis for tumor classification. The introduction of the integrated histomolecular diagnostic approach in CNS tumors has facilitated a classification system that is increasingly data-driven and with improved alignment to clinical outcome. Here, we report a previously uncharacterized glioma type (n = 31) using unsupervised clustering analysis of DNA methylation array data from approximately 14,000 CNS tumor samples. Histologic examination revealed circumscribed growth and morphologic similarities to pleomorphic xanthoastrocytoma (PXA), astroblastoma, ependymoma, polymorphous neuroepithelial tumor of the young (PLNTY), and IDH-wildtype glioblastoma (GBM). Median age (46.5 years) was significantly older than other circumscribed gliomas and younger than GBM. Dimensionality reduction with uniform manifold approximation and projection (UMAP) and hierarchical clustering confirmed a methylation signature distinct from known tumor types and methylation classes. DNA sequencing revealed recurrent mutations in TP53 (57%), RB1 (26%), NF1 (26%), and NF2 (14%). BRAF V600E mutations were detected in 3/27 sequenced cases (12%). Copy number analysis showed increased whole chromosome aneuploidy with recurrent loss of chromosome 13 (28/31 cases, 90%). CDKN2A/B deletion (2/31, 6%) and MGMT promoter methylation (1/31, 3%) were notably rare events. Most tumors showed features of a high-grade glioma, yet survival data showed significantly better overall survival compared to GBM (p < 0.0001). In summary, we describe a previously uncharacterized glioma of adults identified by a distinct DNA methylation signature and recurrent loss of chromosome 13.
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Affiliation(s)
- Drew Pratt
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, 20814, USA.
| | - Zied Abdullaev
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20814, USA
| | | | - Courtney Ketchum
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20814, USA
| | - Pavalan Panneer Selvam
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20814, USA
| | - Hye-Jung Chung
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20814, USA
| | - Ina Lee
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20814, USA
| | - Mark Raffeld
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20814, USA
| | - Mark R. Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Terri S. Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Peter Pytel
- Department of Pathology, University of Chicago Medicine, Chicago, IL, USA
| | - Ewa Borys
- Department of Pathology, Loyola University Medical Center, Maywood, IL, USA
| | - Joshua M. Klonoski
- Department of Pathology and ARUP Laboratories, University of Utah Health Sciences Center, Salt Lake City, USA
| | - Matthew McCord
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Craig Horbinski
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Daniel Brat
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Arie Perry
- Department of Pathology, University of California, San Francisco, CA, USA
| | - David Solomon
- Department of Pathology, University of California, San Francisco, CA, USA
| | - Charles Eberhart
- Department of Neuropathology and Ophthalmic Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Caterina Giannini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Martha Quezado
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20814, USA
| | - Kenneth Aldape
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, 20814, USA.
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