1
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Sharma AE, Dermawan JK, Chiang S, Wexler LH, Antonescu CR. Botryoid-type Embryonal Rhabdomyosarcoma: A Comprehensive Clinicopathologic and Molecular Appraisal With Cross-comparison to its Conventional-type Counterpart. Am J Surg Pathol 2024:00000478-990000000-00408. [PMID: 39210566 DOI: 10.1097/pas.0000000000002300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Embryonal rhabdomyosarcoma (ERMS) is the most common subtype of RMS, occurring in soft tissue and visceral sites of young children, and is associated with favorable outcomes. A subset occurs in mucosal-lined luminal structures, displaying a unique grape-like growth termed as "botryoid-type." To further delineate the differences between conventional (cERMS) and botryoid-type (bERMS) RMS, we performed a comparative histologic review and comprehensive molecular profiling of 48 cases (25 bERMS and 23 cERMS). All tumors were subjected to a hybridization capture-based targeted matched tumor-normal DNA NGS assay. The mean age was 17 and 7 years for bERMS and cERMS, respectively. Most bERMS were female with a predilection for the gynecologic tract (75%), while cERMS had a slight male predominance and were preferentially located in abdominopelvic and paratesticular sites (30%, each). All bERMS exhibited an exophytic, bulbous architecture accompanied by a subepithelial "cambium layer." Distinctive germline alterations were detected, with DICER1 (18%) and FH (6%) mutations only in bERMS, and rare TP53, VHL, and APC mutations in cERMS. Similarly, contrasting somatic genomic landscapes were observed, with frequent DICER1 (52%, P**<0.0001) and TP53 (36%, P*<0.05) alterations exclusively in bERMS. Cartilaginous differentiation was only observed in DICER1-mutated bERMS. All patients had longitudinal follow-up. bERMS patients with somatic/germline DICER1 mutations showed significantly improved recurrence-free survival compared with that of DICER1-wild type patients (P*<0.05). Moreover, bERMS showed improved disease-specific survival compared with that of cERMS, with 8% versus 30% (P*<0.05) dead of disease, respectively. In summary, we compare the molecular underpinnings of the largest cohort of bERMS and cERMS with targeted DNA sequencing and long-term follow-up data. Our findings reveal divergent genomic topographies between the 2 groups, with bERMS showing unique germline and somatic abnormalities, including enrichment in DICER1 and TP53 alterations, and a trend towards improved survival.
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Affiliation(s)
- Aarti E Sharma
- Department of Pathology & Laboratory Medicine, Memorial Sloan Kettering Cancer Center
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery
| | - Josephine K Dermawan
- Department of Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Sarah Chiang
- Department of Pathology & Laboratory Medicine, Memorial Sloan Kettering Cancer Center
| | - Leonard H Wexler
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Cristina R Antonescu
- Department of Pathology & Laboratory Medicine, Memorial Sloan Kettering Cancer Center
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2
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Lachance A, Dimentberg E, Huang S, Bergeron-Gravel S, Bouffet É, Fonseca A, Crevier L, Saikali S, Bourget C, Giannakouros P, Faury D, Jabado N, Foulkes WD, Larouche V, Renzi S. Recurrent primary intracranial sarcoma, DICER1-mutant in a pediatric patient with DICER1 syndrome: the importance of molecular testing. Childs Nerv Syst 2024; 40:1965-1969. [PMID: 38478067 DOI: 10.1007/s00381-024-06356-1] [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: 01/27/2024] [Accepted: 03/01/2024] [Indexed: 05/23/2024]
Abstract
Pediatric intracranial sarcomas are rare, aggressive tumors with a poor prognosis in general. Here we report the case of a child who was initially diagnosed with a primary intracranial sarcoma, DICER1-mutant; subsequent genetic analyses confirmed a pathogenic germline DICER1 mutation. She received multimodal standard treatments consisting of surgery, radiotherapy and chemotherapy. The tumor recurred 2.5 years later within the surgical cavity. Following the gross tumor resection of this new lesion, the same multimodal standard approach was used. From a molecular perspective, evidence of hyperactivation of the MAPK-kinase pathway with a pathogenic KRAS mutation at both diagnosis and recurrence was present. The patient is currently in remission, 18 months post-end of treatment.
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Affiliation(s)
| | | | - Sidong Huang
- Department of Biochemistry, McGill University, Montreal, Canada
- Rosalind & Morris Goodman Cancer Institute, McGill University, Montreal, Canada
| | | | - Éric Bouffet
- Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Adriana Fonseca
- Brain Tumor Institute, Children's National Hospital, Washington, USA
| | - Louis Crevier
- Division of Neurosurgery, Department of Surgery, CHU de Québec - Université Laval, Quebec, Canada
| | - Stephan Saikali
- Division of Molecular Biology, Medical Biochemistry and Pathology, CHU de Québec - Université Laval, Quebec, Canada
| | - Catherine Bourget
- Department of Diagnostic Radiology, CHU de Québec - Université Laval, Quebec, Canada
| | - Panagiota Giannakouros
- Department of Pediatrics, Division of Hemato-Oncology, CHU de Québec-Université Laval, Quebec, Canada
| | - Damien Faury
- Department of Pediatrics, McGill University and The Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Nada Jabado
- Department of Pediatrics, McGill University and The Research Institute of the McGill University Health Centre, Montreal, Canada
| | - William D Foulkes
- Lady Davis Institute and Segal Cancer Centre, Jewish General Hospital, Montreal, Canada
- Department of Human Genetics, McGill University, Montreal, Canada
| | - Valérie Larouche
- Department of Pediatrics, Division of Hemato-Oncology, CHU de Québec-Université Laval, Quebec, Canada
| | - Samuele Renzi
- Department of Pediatrics, Division of Hemato-Oncology, CHU de Québec-Université Laval, Quebec, Canada.
- CHU de Québec - Université Laval, 2705, Boulevard Laurier, Sainte-Foy, Quebec, G1V 4G2, Canada.
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3
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A. Jacobo J. Central nervous system tumors of uncertain differentiation. World Neurosurg X 2024; 22:100349. [PMID: 38455248 PMCID: PMC10918257 DOI: 10.1016/j.wnsx.2024.100349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 12/05/2023] [Accepted: 02/21/2024] [Indexed: 03/09/2024] Open
Abstract
Background The 2021 World Health Organization classification for brain tumors introduced several new entities and categories.Tumors of uncertain differentiation are a new subcategory that includes the intracranial mesenchymal tumor, FET-CREB fusion-positive; the CIC-rearranged sarcoma; and the Primary intracranial sarcoma, DICER1-mutant. Methods A search was made in Pubmed and Google Scholar to include all articles with the term "uncertain differentiation", "Mesenchymal, non-meningothelial", "FET-CREB fusion positive", "DICER1-mutant sarcoma" and "CIC-Rearranged sarcoma" in their title. These articles were reviewed to draft a concise review on this subject. Results This review on CNS non-meningothelial mesenchymal tumors is meant to provide an update with diagnostic, prognostic, and therapeutic implications. Conclusion Tumors of uncertain differentiation include a variety of mesenchymal, non-meningothelial tumors that have distinct molecular characteristics and consequently behave in a very particular matter.Given that these tumors have been described only recently, there is still an important lack of information regarding the most appropriate treatment and prognosis.
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Affiliation(s)
- Javier A. Jacobo
- Neuro-Oncology Unit, Center for the Treatment and Investigation About Cancer (CTIC), Bogotá, Colombia
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4
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Cardona AF, Chamorro Ortiz DF, Ruíz-Patiño A, Gomez D, Muñoz Á, Ardila DV, Garcia-Robledo JE, Ordóñez-Reyes C, Sussmann L, Mosquera A, Forero Y, Rojas L, Hakim F, Jimenez E, Ramón JF, Cifuentes H, Pineda D, Mejía JA, Rodríguez J, Archila P, Sotelo C, Moreno-Pérez DA, Arrieta O. DICER1-associated central nervous system sarcoma: A comprehensive clinical and genomic characterization of case series of young adult patients. Neurooncol Pract 2023; 10:381-390. [PMID: 37457227 PMCID: PMC10346402 DOI: 10.1093/nop/npad014] [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] [Indexed: 07/18/2023] Open
Abstract
Background DICER1 alterations are associated with intracranial tumors in the pediatric population, including pineoblastoma, pituitary blastoma, and the recently described "primary DICER1-associated CNS sarcoma" (DCS). DCS is an extremely aggressive tumor with a distinct methylation signature and a high frequency of co-occurring mutations. However, little is known about its treatment approach and the genomic changes occurring after exposure to chemoradiotherapy. Methods We collected clinical, histological, and molecular data from eight young adults with DCS. Genomic analysis was performed by Next-generation Sequencing (NGS). Subsequently, an additional germline variants analysis was completed. In addition, an NGS analysis on post-progression tumor tissue or liquid biopsy was performed when available. Multiple clinicopathological characteristics, treatment variables, and survival outcomes were assessed. Results Median age was 20 years. Most lesions were supratentorial. Histology was classified as fusiform cell sarcomas (50%), undifferentiated (unclassified) sarcoma (37.5%), and chondrosarcoma (12.5%). Germline pathogenic DICER1 variants were present in two patients, 75% of cases had more than one somatic alteration in DICER1, and the most frequent commutation was TP53. Seven patients were treated with surgery, Ifosfamide, Cisplatin, and Etoposide (ICE) chemotherapy and radiotherapy. The objective response was 75%, and the median time to progression (TTP) was 14.5 months. At progression, the most common mutations were in KRAS and NF1. Overall survival was 30.8 months. Conclusions DCS is an aggressive tumor with limited therapeutic options that requires a comprehensive diagnostic approach, including molecular characterization. Most cases had mutations in TP53, NF1, and PTEN, and most alterations at progression were related to MAPK, RAS and PI3K signaling pathways.
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Affiliation(s)
- Andrés F Cardona
- Direction of Research, Science and Education, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia
| | - Diego Fernando Chamorro Ortiz
- Foundation for Clinical and Applied Cancer Research, FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Alejandro Ruíz-Patiño
- Foundation for Clinical and Applied Cancer Research, FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Diego Gomez
- Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Álvaro Muñoz
- Radiotherapy Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Dora V Ardila
- Foundation for Clinical and Applied Cancer Research, FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | | | - Camila Ordóñez-Reyes
- Foundation for Clinical and Applied Cancer Research, FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Liliana Sussmann
- Foundation for Clinical and Applied Cancer Research, FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Andrés Mosquera
- Foundation for Clinical and Applied Cancer Research, FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Yency Forero
- Foundation for Clinical and Applied Cancer Research, FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Leonardo Rojas
- Direction of Research, Science and Education, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia
| | - Fernando Hakim
- Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Enrique Jimenez
- Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | | | | | - Diego Pineda
- Neuro-Radiology Section, Radiology Department, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center, CTIC, Bogotá, Colombia
| | | | - July Rodríguez
- Foundation for Clinical and Applied Cancer Research, FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Pilar Archila
- Foundation for Clinical and Applied Cancer Research, FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Carolina Sotelo
- Foundation for Clinical and Applied Cancer Research, FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Darwin A Moreno-Pérez
- Foundation for Clinical and Applied Cancer Research, FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - Oscar Arrieta
- Personalized Oncology Laboratory, National Cancer Institute (INCan), México City, México
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5
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Guerin JB, Kaufmann TJ, Eckel LJ, Morris JM, Vaubel RA, Giannini C, Johnson DR. A Radiologist's Guide to the 2021 WHO Central Nervous System Tumor Classification: Part 2-Newly Described and Revised Tumor Types. Radiology 2023; 307:e221885. [PMID: 37191486 DOI: 10.1148/radiol.221885] [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: 05/17/2023]
Abstract
The fifth edition of the World Health Organization classification of tumors of the central nervous system (CNS), published in 2021, introduces major shifts in the classification of brain and spine tumors. These changes were necessitated by rapidly increasing knowledge of CNS tumor biology and therapies, much of which is based on molecular methods in tumor diagnosis. The growing complexity of CNS tumor genetics has required reorganization of tumor groups and acknowledgment of new tumor entities. For radiologists interpreting neuroimaging studies, proficiency with these updates is critical in providing excellent patient care. This review will focus on new or revised CNS tumor types and subtypes, beyond infiltrating glioma (described in part 1 of this series), with an emphasis on imaging features.
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Affiliation(s)
- Julie B Guerin
- From the Departments of Radiology (J.B.G., T.J.K., L.J.E., J.M.M., D.R.J.), Laboratory Medicine and Pathology (R.A.V., C.G.), and Neurology (D.R.J.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy (C.G.)
| | - Timothy J Kaufmann
- From the Departments of Radiology (J.B.G., T.J.K., L.J.E., J.M.M., D.R.J.), Laboratory Medicine and Pathology (R.A.V., C.G.), and Neurology (D.R.J.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy (C.G.)
| | - Laurence J Eckel
- From the Departments of Radiology (J.B.G., T.J.K., L.J.E., J.M.M., D.R.J.), Laboratory Medicine and Pathology (R.A.V., C.G.), and Neurology (D.R.J.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy (C.G.)
| | - Jonathan M Morris
- From the Departments of Radiology (J.B.G., T.J.K., L.J.E., J.M.M., D.R.J.), Laboratory Medicine and Pathology (R.A.V., C.G.), and Neurology (D.R.J.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy (C.G.)
| | - Rachael A Vaubel
- From the Departments of Radiology (J.B.G., T.J.K., L.J.E., J.M.M., D.R.J.), Laboratory Medicine and Pathology (R.A.V., C.G.), and Neurology (D.R.J.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy (C.G.)
| | - Caterina Giannini
- From the Departments of Radiology (J.B.G., T.J.K., L.J.E., J.M.M., D.R.J.), Laboratory Medicine and Pathology (R.A.V., C.G.), and Neurology (D.R.J.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy (C.G.)
| | - Derek R Johnson
- From the Departments of Radiology (J.B.G., T.J.K., L.J.E., J.M.M., D.R.J.), Laboratory Medicine and Pathology (R.A.V., C.G.), and Neurology (D.R.J.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy (C.G.)
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6
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Tauziède-Espariat A, Hasty L, Métais A, Varlet P. Mesenchymal non-meningothelial tumors of the central nervous system: a literature review and diagnostic update of novelties and emerging entities. Acta Neuropathol Commun 2023; 11:22. [PMID: 36737790 PMCID: PMC9896826 DOI: 10.1186/s40478-023-01522-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/25/2023] [Indexed: 02/05/2023] Open
Abstract
The fifth edition of the World Health Organization Classification of Tumors of the Central Nervous System (CNS) now includes mesenchymal tumors that occur uniquely or frequently in the CNS. Moreover, this version has aligned the terminology of mesenchymal tumors with their soft tissue counterparts. New tumor types have been added, such as the "intracranial mesenchymal tumor, FET-CREB fusion-positive", the "CIC-rearranged sarcoma", and the "Primary intracranial sarcoma, DICER1-mutant". Other entities (such as rhabdomyosarcoma) have remained in the current WHO classification because these tumor types may present specificities in the CNS as compared to their soft tissue counterparts. Based on an extensive literature review, herein, we will discuss these newly recognized entities in terms of clinical observation, radiology, histopathology, genetics and outcome, and consider strategies for an accurate diagnosis. In light of this literature analysis, we will also introduce some potentially novel tumor types.
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Affiliation(s)
- Arnault Tauziède-Espariat
- Department of Neuropathology, Sainte-Anne Hospital, 1, rue Cabanis, 75014, Paris, France. .,Inserm, UMR 1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.
| | - Lauren Hasty
- grid.414435.30000 0001 2200 9055Department of Neuropathology, Sainte-Anne Hospital, 1, rue Cabanis, 75014 Paris, France ,grid.512035.0Inserm, UMR 1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Alice Métais
- grid.414435.30000 0001 2200 9055Department of Neuropathology, Sainte-Anne Hospital, 1, rue Cabanis, 75014 Paris, France ,grid.512035.0Inserm, UMR 1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Pascale Varlet
- grid.414435.30000 0001 2200 9055Department of Neuropathology, Sainte-Anne Hospital, 1, rue Cabanis, 75014 Paris, France ,grid.512035.0Inserm, UMR 1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
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7
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Pizzimenti C, Gianno F, Gessi M. Expanding the spectrum of "mesenchymal" tumors of the central nervous system. Pathologica 2022; 114:455-464. [PMID: 36534424 PMCID: PMC9763981 DOI: 10.32074/1591-951x-826] [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] [Received: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 12/23/2022] Open
Abstract
In this review, we summarize the clinical, histopathological, and molecular features of central nervous system (CNS) tumors with BCOR internal tandem duplication, intracranial mesenchymal tumor with FET/CREB fusion, CNS CIC-rearranged sarcomas and primary intracranial sarcoma DICER1-mutant, now included in the 2021 WHO classification of CNS tumors. Possible relationships between tumors occurring in the CNS and their systemic counterparts are discussed.
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Affiliation(s)
- Cristina Pizzimenti
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Italy
| | - Francesca Gianno
- Department of Radiological, Oncological and Pathological sciences, University of Rome “la Sapienza”Rome Italy
| | - Marco Gessi
- Neuropathology Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy,Correspondence Marco Gessi Neuropathology Unit, Div. of Pathology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore Largo A. Gemelli 8, 00168 Roma, Italy Tel.: +39-06-30154433 E-mail: ;
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8
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Vuong HG, Le MK, Dunn IF. A systematic review of the clinicopathological features and prognostic outcomes of DICER1-mutant malignant brain neoplasms. J Neurosurg Pediatr 2022; 30:308-315. [PMID: 35901678 PMCID: PMC10193506 DOI: 10.3171/2022.6.peds22119] [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: 04/04/2022] [Accepted: 06/13/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE DICER1-mutant malignant brain neoplasms are very rare tumors, and published data have relied on case reports or small case series. In this review, the authors aimed to systematically summarize the types and distribution patterns of DICER1 mutations, clinicopathological characteristics, and prognostic outcomes of these tumors. METHODS The authors searched PubMed and Web of Science for relevant studies. They included studies if they provided individual patient data of primary malignant brain tumors carrying DICER1 mutations. RESULTS The authors found 16 studies consisting of 9 embryonal tumors with multilayered rosettes (ETMRs), 30 pineoblastomas, 52 primary intracranial sarcomas, and 27 pituitary blastomas. Pineoblastoma, ETMR, and pituitary blastoma were more likely to carry DICER1 germline mutations, while only a small subset of primary intracranial sarcomas harbored these mutations (p < 0.001). Nearly 80% of tumors with germline mutations also had another somatic mutation in DICER1. ETMR and primary intracranial sarcoma were associated with an increased risk for tumor progression and relapse compared with pituitary blastoma and pineoblastoma (p = 0.0025), but overall survival (OS) was not significantly different. Gross-total resection (GTR) and radiotherapy administration were associated with prolonged OS. CONCLUSIONS ETMR, pineoblastoma, primary intracranial sarcoma, and pituitary blastoma should be considered rare phenotypes of the DICER1 syndrome, and families should be counseled and screened for associated tumors. ETMR and primary intracranial sarcoma had a higher risk of relapse. GTR and radiotherapy appeared to improve the OS of patients with DICER1-mutant malignant intracranial tumors.
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Affiliation(s)
- Huy Gia Vuong
- Department of Neurosurgery, The University of Oklahoma Health Sciences Center, Oklahoma University, Oklahoma City, Oklahoma; and
| | - Minh-Khang Le
- Department of Pathology, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Ian F. Dunn
- Department of Neurosurgery, The University of Oklahoma Health Sciences Center, Oklahoma University, Oklahoma City, Oklahoma; and
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9
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Mondragón-Soto MG, Del Valle L, González-Soto JA, De Leo-Vargas RA. Metastatic primary brain rhabdomyosarcoma in a pediatric patient: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 4:CASE22189. [PMID: 36046269 PMCID: PMC9329863 DOI: 10.3171/case22189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/19/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Primary intracranial rhabdomyosarcoma is an extraordinarily rare malignant tumor, with even fewer presenting with distant metastasis. To date, only five cases, including the one presented here, have been reported to present metastatic activity.
OBSERVATIONS
A 12-year-old boy presented with a few days of headache, nausea, vomiting, but no neurological deficit. Brain computed tomography and magnetic resonance imaging demonstrated hydrocephalus and a cystic lesion with left parieto-occipital extension. After resection, pathology reported primary rhabdomyosarcoma, with positive desmin and myogenin on immunohistochemistry. The patient presented with pulmonary metastasis. The patient had an overall survival of 21 months after diagnosis with optimal treatment.
LESSONS
Rhabdomyosarcoma is a malignant neoplasm arising from undifferentiated skeletal muscle cells, with morphological, immunohistochemical, ultrastructural, or molecular genetic evidence of primary skeletal muscle differentiation. It presents with a rapidly worsening clinical course and the final outcome is poor. Treatment is widely based on protocols that have been proven to be effective in extracranial versions of these tumors, although repeatedly ineffective. Primary brain rhabdomyosarcoma poses a diagnostic challenge because of its infrequent presentation, grade of undifferentiation and tumor heterogeneity. Immunohistochemical and genetic testing have proven to be useful tools for diagnosis.
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Affiliation(s)
| | - Luis Del Valle
- Molecular Histopathology & Microscopy Core, Stanley S. Scott Cancer Center Louisiana State University Health, New Orleans, Louisiana
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10
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Leelatian N, Goss J, Pastakia D, Dewan MC, Snuderl M, Mobley BC. Primary Intracranial Sarcoma, DICER1-Mutant Presenting as a Pineal Region Tumor Mimicking Pineoblastoma: Case Report and Review of the Literature. J Neuropathol Exp Neurol 2022; 81:762-764. [PMID: 35789272 DOI: 10.1093/jnen/nlac053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nalin Leelatian
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James Goss
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Devang Pastakia
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael C Dewan
- Department of Neurological Surgery, Vanderbilt University Medical Center, Medical Center North, Nashville, Tennessee, USA
| | - Matija Snuderl
- Department of Pathology, NYU Langone Health and School of Medicine, New York, New York, USA
| | - Bret C Mobley
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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11
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McCluggage WG, Fu L, Mohler K, de Kock L, Sabbaghian N, Mindlin A, Stewart CJR, Gilks CB, Foulkes WD. An Unusual Enteric Yolk Sac Tumor: First Report of an Ovarian Germ Cell Tumor Associated With a Germline Pathogenic Variant in DICER1. Int J Gynecol Pathol 2022; 41:349-355. [PMID: 34380971 DOI: 10.1097/pgp.0000000000000818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A variety of unusual tumors are associated with both germline and somatic DICER1 pathogenic variants (PVs), including, in the female genital tract, embryonal rhabdomyosarcoma at various sites and ovarian Sertoli-Leydig cell tumor. There have been occasional reported cases of ovarian germ cell tumors [mainly yolk sac tumor (YST)] harboring DICER1 PVs but, as far as we are aware, none of these has been proven to have a germline provenance. We report an unusual enteric variant of ovarian YST in a 28-yr-old woman associated with a germline PV c.901C>T (p.Gln301Ter) in exon 7 of DICER1, accompanied by a somatic (YST-only) hotspot mutation: c.5437G>A, p.E1813K. To our knowledge, this is the first report of an ovarian germ cell tumor associated with a germline DICER1 PV. We review other reported cases of ovarian germ cell tumor with DICER1 PVs and discuss the differential diagnosis of this unusual variant of YST which was originally diagnosed as a mucinous adenocarcinoma.
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12
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Hiemcke-Jiwa L, van Belle S, Eijkelenboom A, Merks J, van Noesel M, Kaal S, Pijnenborg J, Bulten J, Tops B, van de Ven C, van Gorp J, de Krijger R, Cheesman E, Kelsey A, Kester L, Flucke U. Pleuropulmonary blastoma (PPB) and other DICER1-associated high-grade malignancies are morphologically, genetically and epigenetically related – A comparative study of 4 PPBs and 6 sarcomas. Ann Diagn Pathol 2022; 60:152002. [DOI: 10.1016/j.anndiagpath.2022.152002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/20/2022] [Accepted: 06/20/2022] [Indexed: 11/01/2022]
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13
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McCluggage WG, Stewart CJR, Belcijan NL, Mourad S, Goudie C, Chan JC, Liu A, Alaggio R, Foulkes WD. NEUROECTODERMAL ELEMENTS ARE PART OF THE MORPHOLOGICAL SPECTRUM OF DICER1-ASSOCIATED NEOPLASMS. Hum Pathol 2022; 123:46-58. [PMID: 35245609 DOI: 10.1016/j.humpath.2022.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 11/04/2022]
Abstract
Many sarcomas with DICER1 pathogenic variants (PVs) exhibit a characteristic morphology, including a subepithelial layer of malignant mesenchymal cells, areas of rhabdomyoblastic differentiation and cartilaginous and/ or osseous elements. We report 5 DICER1-associated neoplasms (1 moderately to poorly differentiated Sertoli Leydig cell tumour and 4 sarcomas) containing variable amounts of neuroectodermal elements. The neoplasms predominantly involved or were in close proximity to the female genital tract (ovary, uterine corpus, abdominal and pelvic cavity) and occurred in females aged 14 months to 54 years. The neuroectodermal elements were characterised by solid and tubular/ rosette-like patterns and variable immunoreactivity with SALL4 and neuroendocrine markers. In some cases, the neuroectodermal component was focal while in others it was exclusive. In one case, the focal neuroectodermal component within an ovarian Sertoli Leydig cell tumour resulted in extraovarian metastasis. In reporting these cases, we suggest that neuroectodermal elements, including pure neuroectodermal tumours, are part of the morphological spectrum of DICER1-associated neoplasms. It is important that pathologists recognize that a neuroectodermal component (often admixed with other elements) may be a feature of such neoplasms. This will facilitate appropriate tumour and/ or germline testing which could lead to the identification of germline DICER1 PVs (DICER1 syndrome). Three of the patients we report were subsequently shown to have a germline DICER1 PV.
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Affiliation(s)
- W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom.
| | - Colin J R Stewart
- School for Women's and Infants' Health, University of Western Australia, Perth, WA, Australia
| | - Neza Lebic Belcijan
- University Medical Center Ljubljana, Division of Gynecology and Obstetrics, Department of Gynecological Pathology, Ljubljana, Slovenia
| | - Stephanie Mourad
- Department of Paediatrics, Division of Haematology-Oncology, Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| | - Catherine Goudie
- Department of Paediatrics, Division of Haematology-Oncology, Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| | - Joshua Ck Chan
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong and Hong Kong Children's Hospital, Hong Kong SAR
| | - Anthony Liu
- Pathology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rita Alaggio
- Pathology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - William D Foulkes
- Departments of Human Genetics, Medicine and Oncology, McGill University, Montréal, Québec, Canada; Cancer Axis, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada H3T 1E2
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14
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González IA, Stewart DR, Schultz KAP, Field AP, Hill DA, Dehner LP. DICER1 tumor predisposition syndrome: an evolving story initiated with the pleuropulmonary blastoma. Mod Pathol 2022; 35:4-22. [PMID: 34599283 PMCID: PMC8695383 DOI: 10.1038/s41379-021-00905-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/09/2021] [Accepted: 08/09/2021] [Indexed: 02/06/2023]
Abstract
DICER1 syndrome (OMIM 606241, 601200) is a rare autosomal dominant familial tumor predisposition disorder with a heterozygous DICER1 germline mutation. The most common tumor seen clinically is the pleuropulmonary blastoma (PPB), a lung neoplasm of early childhood which is classified on its morphologic features into four types (IR, I, II and III) with tumor progression over time within the first 4-5 years of life from the prognostically favorable cystic type I to the unfavorable solid type III. Following the initial report of PPB, its association with other cystic neoplasms was demonstrated in family studies. The detection of the germline mutation in DICER1 provided the opportunity to identify and continue to recognize a number seemingly unrelated extrapulmonary neoplasms: Sertoli-Leydig cell tumor, gynandroblastoma, embryonal rhabdomyosarcomas of the cervix and other sites, multinodular goiter, differentiated and poorly differentiated thyroid carcinoma, cervical-thyroid teratoma, cystic nephroma-anaplastic sarcoma of kidney, nasal chondromesenchymal hamartoma, intestinal juvenile-like hamartomatous polyp, ciliary body medulloepithelioma, pituitary blastoma, pineoblastoma, primary central nervous system sarcoma, embryonal tumor with multilayered rosettes-like cerebellar tumor, PPB-like peritoneal sarcoma, DICER1-associated presacral malignant teratoid neoplasm and other non-neoplastic associations. Each of these neoplasms is characterized by a second somatic mutation in DICER1. In this review, we have summarized the salient clinicopathologic aspects of these tumors whose histopathologic features have several overlapping morphologic attributes particularly the primitive mesenchyme often with rhabdomyoblastic and chondroid differentiation and an uncommitted spindle cell pattern. Several of these tumors have an initial cystic stage from which there is progression to a high grade, complex patterned neoplasm. These pathologic findings in the appropriate clinical setting should serve to alert the pathologist to the possibility of a DICER1-associated neoplasm and initiate appropriate testing on the neoplasm and to alert the clinician about the concern for a DICER1 mutation.
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Affiliation(s)
- Iván A. González
- grid.239552.a0000 0001 0680 8770Department of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Douglas R. Stewart
- grid.48336.3a0000 0004 1936 8075Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD USA
| | - Kris Ann P. Schultz
- International Pleuropulmonary Blastoma/DICER1 Registry, Children’s Minnesota, Minneapolis, MN USA ,Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN USA
| | | | - D. Ashley Hill
- International Pleuropulmonary Blastoma/DICER1 Registry, Children’s Minnesota, Minneapolis, MN USA ,ResourcePath LLC, Sterling, VA USA ,grid.253615.60000 0004 1936 9510Division of Pathology, Children’s National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC USA
| | - Louis P. Dehner
- International Pleuropulmonary Blastoma/DICER1 Registry, Children’s Minnesota, Minneapolis, MN USA ,grid.411019.cThe Lauren V. Ackerman Laboratory of Surgical Pathology, Barnes-Jewish and St. Louis Children’s Hospitals, Washington University Medical Center, St. Louis, MO USA
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15
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Chong AS, Han H, Albrecht S, Weon YC, Park SK, Foulkes WD. DICER1 syndrome in a young adult with pituitary blastoma. Acta Neuropathol 2021; 142:1071-1076. [PMID: 34677675 DOI: 10.1007/s00401-021-02378-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 12/23/2022]
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16
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Diaz Coronado RY, Mynarek M, Koelsche C, Mora Alferez P, Casavilca Zambrano S, Wachtel Aptowitzer A, Sahm F, von Deimling A, Schüller U, Spohn M, Sturm D, Pfister SM, Morales La Madrid A, Sernaque Quintana R, Sarria Bardales G, Negreiros Chinchihuara T, Ojeda Medina L, Garcia-Corrochano Medina P, Campos Sanchez DA, Ponce Farfan J, Rutkowski S, Garcia Leon JL. Primary central nervous system sarcoma with DICER1 mutation-treatment results of a novel molecular entity in pediatric Peruvian patients. Cancer 2021; 128:697-707. [PMID: 34674226 DOI: 10.1002/cncr.33977] [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] [Received: 03/21/2021] [Revised: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND A high frequency of primary central nervous system (CNS) sarcomas was observed in Peru. This article describes the clinical characteristics, biological characteristics, and outcome of 70 pediatric patients. METHODS Data from 70 pediatric patients with primary CNS sarcomas diagnosed between January 2005 and June 2018 were analyzed. DNA methylation profiling from 28 tumors and gene panel sequencing from 27 tumors were available. RESULTS The median age of the patients was 6 years (range, 2-17.5 years), and 66 of 70 patients had supratentorial tumors. DNA methylation profiling classified 28 of 28 tumors as primary CNS sarcoma, DICER1 mutant. DICER1 mutations were found in 26 of 27 cases, TP53 mutations were found in 22 of 27 cases, and RAS-pathway gene mutations (NF1, KRAS, and NRAS) were found in 19 of 27 tumors, all of which were somatic (germline control available in 19 cases). The estimated incidence in Peru was 0.19 cases per 100,000 children (<18 years old) per year, which is significantly higher than the estimated incidence in Germany (0.007 cases per 100,000 children [<18 years] per year; P < .001). Patients with nonmetastatic disease (n = 46) that were treated with a combination therapy had a 2-year progression-free survival (PFS) rate of 58% (95% CI, 44%-76%) and a 2-year overall survival rate of 71% (95% CI, 57%-87%). PFS was the highest in patients treated with chemotherapy with ifosfamide, carboplatin, and etoposide (ICE) after upfront surgery followed by radiotherapy and ICE (2-year PFS, 79% [59%-100%], n = 18). CONCLUSIONS Primary CNS sarcoma with DICER1 mutation has an aggressive clinical course. A combination of surgery, chemotherapy, and radiotherapy seems beneficial. An underlying cancer predisposition syndrome explaining the increased incidence in Peruvian patients has not been identified so far. LAY SUMMARY A high incidence of primary pediatric central nervous system sarcomas in the Peruvian population is described. Using sequencing technologies and DNA methylation profiling, it is confirmed that these tumors molecularly belong to the recently proposed entity "primary central nervous system sarcomas, DICER1 mutant." Unexpectedly, DICER1 mutations as well as all other defining tumor mutations (TP53 mutations and RAS-pathway mutations) were not inherited in all 19 patients where analyzation was possible. These tumors have an aggressive clinical course. Multimodal combination therapy based on surgery, ifosfamide, carboplatin, and etoposide chemotherapy, and local radiotherapy leads to superior outcomes.
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Affiliation(s)
- Rosdali Y Diaz Coronado
- Pediatric Oncology Department, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru.,Delgado Clinic, Auna, Lima, Peru
| | - Martin Mynarek
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Koelsche
- Department of Pathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Pamela Mora Alferez
- Genetics Department, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | | | | | - Felix Sahm
- Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center, Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center, Heidelberg, Germany
| | - Ulrich Schüller
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Research Institute Children's Cancer Center, Hamburg, Germany.,Institute of Neuropathology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Michael Spohn
- Research Institute Children's Cancer Center, Hamburg, Germany.,Bioinformatics Core Facility and Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dominik Sturm
- University Medical Center, Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg, Heidelberg, Germany.,Pediatric Glioma Research Group, German Cancer Research Center, Heidelberg, Germany
| | - Stefan M Pfister
- University Medical Center, Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg, Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Consortium and German Cancer Research Center, Heidelberg, Germany
| | | | | | - Gustavo Sarria Bardales
- Delgado Clinic, Auna, Lima, Peru.,Radiotherapy Department, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | | | - Luis Ojeda Medina
- Neurosurgery Department, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | | | | | | | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Juan L Garcia Leon
- Pediatric Oncology Department, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru.,Delgado Clinic, Auna, Lima, Peru.,Pediatric Oncology Service, Anglo Americana Clinic, Lima, Peru
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17
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Tanaka R, Inoue K, Yamada Y, Yoshida M, Shima H, Ito J, Okita H, Miwa T, Kato M, Shimada H. A case of primary CNS embryonal rhabdomyosarcoma with PAX3-NCOA2 fusion and systematic meta-review. J Neurooncol 2021; 154:247-256. [PMID: 34398431 DOI: 10.1007/s11060-021-03823-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/06/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Primary central nervous system (CNS) rhabdomyosarcoma is a rare mesenchymal tumor predominantly seen in children and associated with a poor outcome. We report a case of primary CNS rhabdomyosarcoma with PAX3-NCOA2 fusion and present a systematic meta-review of primary CNS rhabdomyosarcoma to characterize this rare tumor. METHODS We present the case of a 6-year-old boy with primary CNS rhabdomyosarcoma in the posterior fossa. In a systematic meta-review, we compare the demographic data of primary CNS rhabdomyosarcoma with data of rhabdomyosarcoma at all sites from the SEER database and analyze clinical factors associated with survival outcome. RESULTS Our patient underwent gross total resection and received vincristine, actinomycin-D, cyclophosphamide with early introduction of concurrent focal radiation and remained alive with no evidence of disease for 2 years after the end of therapy. Histopathological review revealed embryonal-type rhabdomyosarcoma, and whole-transcriptome analysis revealed PAX3 (EX6)-NCOA2 (EX12) fusion. In all, 77 cases of primary CNS rhabdomyosarcoma were identified through the meta-review. The demographic data of primary CNS rhabdomyosarcoma were similar to data of rhabdomyosarcoma at all sites. Overall and event-free survival outcomes were available for 64 and 56 patients, respectively, with a 3-year OS of 29.0% and a 3-year EFS of 25.7%. The group that received trimodal treatment exhibited better survival outcomes, with a 3-year OS of 57.4% and a 3-year EFS of 46.3%. CONCLUSIONS Primary CNS rhabdomyosarcoma shares common histological, molecular, and demographic features with non-CNS rhabdomyosarcoma. A trimodal treatment approach with early introduction of radiation therapy may result in favorable survival outcomes.
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Affiliation(s)
- Ryuma Tanaka
- Division of Hem/Onc/BMT, Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Road, MFRC3018, Milwaukee, WI, 53226, USA. .,Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan.
| | - Kyohei Inoue
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Yuji Yamada
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan.,Department of Pediatric Hematology and Oncology Research, National Center for Child Health and Development, Tokyo, Japan
| | - Masanori Yoshida
- Department of Pediatric Hematology and Oncology Research, National Center for Child Health and Development, Tokyo, Japan.,Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Haruko Shima
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Jumpei Ito
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Hajime Okita
- Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Tomoru Miwa
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Motohiro Kato
- Department of Pediatric Hematology and Oncology Research, National Center for Child Health and Development, Tokyo, Japan.,Department of Pediatrics, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Shimada
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
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18
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McCluggage WG, Foulkes WD. DICER1-associated sarcomas: towards a unified nomenclature. Mod Pathol 2021; 34:1226-1228. [PMID: 32572152 DOI: 10.1038/s41379-020-0602-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/10/2020] [Accepted: 06/10/2020] [Indexed: 12/16/2022]
Affiliation(s)
- W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, UK.
| | - William D Foulkes
- Department of Human Genetics, McGill University, Montréal, QC, Canada
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19
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Kamihara J, Paulson V, Breen MA, Laetsch TW, Rakheja D, Shulman DS, Schoettler ML, Clinton CM, Ward A, Reidy D, Pinches RS, Weiser DA, Mullen EA, Schienda J, Meyers PA, DuBois SG, Nowak JA, Foulkes WD, Schultz KAP, Janeway KA, Vargas SO, Church AJ. DICER1-associated central nervous system sarcoma in children: comprehensive clinicopathologic and genetic analysis of a newly described rare tumor. Mod Pathol 2020; 33:1910-1921. [PMID: 32291395 DOI: 10.1038/s41379-020-0516-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 12/16/2022]
Abstract
The spectrum of neoplasms associated with DICER1 variants continues to expand, with the recent addition of primary "DICER1-associated central nervous system sarcoma" (DCS). DCS is a high-grade malignancy predominantly affecting pediatric patients. Six pediatric DCS were identified through a combination of clinical diagnostic studies, archival inquiry, and interinstitutional collaboration. Clinical, histologic, immunohistologic, and molecular features were examined. Genomic findings in the 6 DCS were compared with those in 14 additional DICER1-associated tumors sequenced with the same assay. The six patients presented at ages 3-15 years with CNS tumors located in the temporal (n = 2), parietal (n = 1), fronto-parietal (n = 1), and frontal (n = 2) lobes. All underwent surgical resection. Histologic examination demonstrated high-grade malignant spindle cell tumors with pleuropulmonary blastoma-like embryonic "organoid" features and focal rhabdomyoblastic differentiation; immature cartilage was seen in one case. Immunohistochemically, there was patchy desmin and myogenin staining, and patchy loss of H3K27me3, and within eosinophilic cytoplasmic globules, alfa-fetoprotein staining. Biallelic DICER1 variants were identified in all cases, with germline variants in two of five patients tested. DCS demonstrated genomic alterations enriched for Ras pathway activation and TP53 inactivation. Tumor mutational burden was significantly higher in the 6 DCS tumors than in 14 other DICER1-associated tumors examined (mean 12.9 vs. 6.8 mutations/Mb, p = 0.035). Postoperative care included radiation (n = 5) and chemotherapy (n = 3); at the last follow-up, three patients were alive without DCS, and three had died of disease. Our analysis expands the clinical, histologic, immunohistological, and molecular spectrum of DCS, identifying distinctive features that can aid in the diagnosis, multidisciplinary evaluation, and treatment of DCS.
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Affiliation(s)
- Junne Kamihara
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Vera Paulson
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Laboratory Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Micheál A Breen
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Theodore W Laetsch
- Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Health, Dallas, TX, USA
| | - Dinesh Rakheja
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David S Shulman
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Michelle L Schoettler
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Catherine M Clinton
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Abigail Ward
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Deirdre Reidy
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - R Seth Pinches
- Department of Pathology, Boston Children's Hospital, Boston, MA, USA
| | - Daniel A Weiser
- Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Elizabeth A Mullen
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Jaclyn Schienda
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Paul A Meyers
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - Steven G DuBois
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Jonathan A Nowak
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - William D Foulkes
- Department of Human Genetics, McGill University Health Centre/Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Kris Ann P Schultz
- Cancer and Blood Disorders and International Pleuropulmonary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, MN, USA
| | - Katherine A Janeway
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Sara O Vargas
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alanna J Church
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
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20
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Rashidi A, Luna LP, Rodriguez F, Tekes A. Teaching NeuroImages: Intracranial DICER1-associated spindle cell sarcoma in a child. Neurology 2020; 95:e2176-e2177. [PMID: 32680948 DOI: 10.1212/wnl.0000000000010374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Ali Rashidi
- From the Russell H. Morgan Department of Radiology and Radiological Science (A.R., L.P.L., A.T.) and Pathology Department (F.R.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Licia P Luna
- From the Russell H. Morgan Department of Radiology and Radiological Science (A.R., L.P.L., A.T.) and Pathology Department (F.R.), Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Fausto Rodriguez
- From the Russell H. Morgan Department of Radiology and Radiological Science (A.R., L.P.L., A.T.) and Pathology Department (F.R.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Aylin Tekes
- From the Russell H. Morgan Department of Radiology and Radiological Science (A.R., L.P.L., A.T.) and Pathology Department (F.R.), Johns Hopkins University School of Medicine, Baltimore, MD
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21
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de Kock L, Rivera B, Foulkes WD. Pineoblastoma is uniquely tolerant of mutually exclusive loss of DICER1, DROSHA or DGCR8. Acta Neuropathol 2020; 139:1115-1118. [PMID: 32124011 DOI: 10.1007/s00401-020-02139-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
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22
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Eulo V, Lesmana H, Doyle LA, Nichols KE, Hirbe AC. Secondary Sarcomas: Biology, Presentation, and Clinical Care. Am Soc Clin Oncol Educ Book 2020; 40:1-12. [PMID: 32213089 DOI: 10.1200/edbk_280985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Secondary sarcomas are a subset of sarcomas that occur in patients with prior cancer diagnoses and are associated with environmental or genetic factors. Although secondary sarcomas are rare in general, there are predisposing factors that can substantially increase this risk in certain populations. Herein, we review the environmental factors with the strongest association of sarcoma risk, including chemical exposure, certain viruses, cytotoxic and immunosuppressive agents, chronic edema, and radiation exposure. Additionally, the most common genetic disorders that carry a predisposition for sarcoma development will be discussed, including hereditary retinoblastoma (RB), Li-Fraumeni syndrome (LFS), neurofibromatosis type 1 (NF1), and DICER1 syndrome. Although treatment does not generally differ for sporadic versus secondary sarcomas, awareness of the risk factors can alter therapeutic strategies to minimize risk, aid prompt diagnosis by increasing clinical suspicion, and allow for appropriate surveillance and genetic counseling for those patients with cancer predisposition syndromes.
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Affiliation(s)
- Vanessa Eulo
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Harry Lesmana
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Leona A Doyle
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
| | - Kim E Nichols
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Angela C Hirbe
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
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