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Poletti N, Marques LL, Deigendesch N, Soleman J, Mariani L, Guzman R, Rychen J. Fulminant hemorrhagic course of a thalamic H3 K27-altered diffuse midline glioma in an adult patient: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2024; 7:CASE23598. [PMID: 38252930 PMCID: PMC10805590 DOI: 10.3171/case23598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 11/29/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND H3 K27-altered diffuse midline gliomas (DMGs) are rare tumors, which are, regardless of their histological appearance, classified as World Health Organization grade 4 tumors. They are characterized by a diffuse growth pattern, midline anatomical location, and poor prognosis. Although DMGs occur predominantly in childhood, these tumors can also be found in young adults. OBSERVATIONS The authors present a case of a 29-year-old patient who was found unconscious with a Glasgow Coma Scale score of 4, along with abnormal extensor movements and bilateral middilated nonreactive pupils. Computed tomography revealed obstructive hydrocephalus due to an acute hemorrhage in a right thalamic lesion. To drain the hydrocephalus and relieve the ongoing central herniation, emergent placement of a right-sided, and later a left-sided, extraventricular drain was performed. Despite the postoperative resolution of hydrocephalus, the patient died shortly after because of the central brain herniation that had occurred. Brain autopsy revealed a H3 K27-altered DMG in the right thalamus. LESSONS Although typically described in the pediatric population and located in the pons, H3 K27-altered DMG should also be considered in young adult patients with midline lesions, particularly if they are located in the thalamus or brainstem. In rare cases, H3 K27-altered DMG may present with an acute tumor-related hemorrhage, leading to a fulminant clinical course.
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Affiliation(s)
| | | | | | - Jehuda Soleman
- Departments of Neurosurgery and
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Luigi Mariani
- Departments of Neurosurgery and
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Raphael Guzman
- Departments of Neurosurgery and
- Faculty of Medicine, University of Basel, Basel, Switzerland
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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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Peng Y, Ren Y, Huang B, Tang J, Jv Y, Mao Q, Liu Y, Lei Y, Zhang Y. A validated prognostic nomogram for patients with H3 K27M-mutant diffuse midline glioma. Sci Rep 2023; 13:9970. [PMID: 37340065 DOI: 10.1038/s41598-023-37078-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/15/2023] [Indexed: 06/22/2023] Open
Abstract
H3 K27M-mutant diffuse midline glioma (H3 K27M-mt DMG) is a rare, highly invasive tumor with a poor prognosis. The prognostic factors of H3 K27M-mt DMG have not been fully identified, and there is no clinical prediction model for it. This study aimed to develop and validate a prognostic model for predicting the probability of survival in patients with H3 K27M-mt DMG. Patients diagnosed with H3 K27M-mt DMG in the West China Hospital from January 2016 to August 2021 were included. Cox proportional hazard regression was used for survival assessment, with adjustment for known prognostic factors. The final model was established using the patient data of our center as the training cohort and data from other centers for external independent verification. One hundred and five patients were ultimately included in the training cohort, and 43 cases from another institution were used as the validation cohort. The factors influencing survival probability in the prediction model included age, preoperative KPS score, radiotherapy and Ki-67 expression level. The adjusted consistency indices of the Cox regression model in internal bootstrap validation at 6, 12, and 18 months were 0.776, 0.766, and 0.764, respectively. The calibration chart showed high consistency between the predicted and observed results. The discrimination in external verification was 0.785, and the calibration curve showed good calibration ability. We identified the risk factors that affect the prognosis of H3 K27M-mt DMG patients and then established and validated a diagnostic model for predicting the survival probability of these patients.
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Affiliation(s)
- Youheng Peng
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yanming Ren
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Bowen Huang
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jun Tang
- College of Electronics and Information Engineering, Sichuan University, No. 24, South Section 1, First Ring Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yan Jv
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Qing Mao
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yanhui Liu
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yinjie Lei
- College of Electronics and Information Engineering, Sichuan University, No. 24, South Section 1, First Ring Road, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Yuekang Zhang
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China.
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Zhao Y, Chen Y, Wang L, Gao Y, Xu J. The clinicopathological features and prognosis of multifocal high-grade gliomas in adults with H3F3A mutation. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2023; 28:42-47. [PMID: 36617452 PMCID: PMC9987625 DOI: 10.17712/nsj.2023.1.20220080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/23/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To explore the clinicopathological features and prognosis of multifocal high-grade gliomas (M-HGGs) with H3F3A mutation in adults. METHODS Four adult patients with H3F3A-mutant M-HGGs who were treated at our institution from August 2020 to December 2021 were reviewed, including clinical, pathological and radiologic data. A series of 16 adult patients with M-HGGs without H3F3A mutation was used as a comparative group. Progression-free survival (PFS) and overall survival (OS) were compared between the groups using the Kaplan-Meier method. RESULTS All patients were IDH wild-type and TERT wild-type, and P53 was overexpressed. A patient with the H3 G34R mutation and 1 of 3 patients with the H3 K27 M mutation had MGMT promoter methylation. The lesions with the H3 G34R mutation were located in the cerebral hemisphere; the lesions with H3 K27 alterations were mainly in the midline structure, and the cerebral hemisphere could also be involved. One patient underwent subtotal resection (STR), and 3 patients underwent biopsy. All patients received radiotherapy, and the median PFS and OS were 9.5 months and 14.5 months, respectively. The clinical outcomes were similar to those of non-H3F3A-mutated M-HGGs patients (median PFS and OS were 7.0 months and 18.0 months, respectively). CONCLUSION We describe the clinicopathological features and outcomes of 4 adult M-HGGs patients with H3F3A mutation, and found this mutation doesn't appear to have a negative outcome with the administration of current therapies.
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Affiliation(s)
- Yongrui Zhao
- From the Department of Radiation Oncology (Zhao, Chen, Gao, Xu), Department of Pathology (Wang), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yidong Chen
- From the Department of Radiation Oncology (Zhao, Chen, Gao, Xu), Department of Pathology (Wang), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Leiming Wang
- From the Department of Radiation Oncology (Zhao, Chen, Gao, Xu), Department of Pathology (Wang), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ying Gao
- From the Department of Radiation Oncology (Zhao, Chen, Gao, Xu), Department of Pathology (Wang), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiankun Xu
- From the Department of Radiation Oncology (Zhao, Chen, Gao, Xu), Department of Pathology (Wang), Xuanwu Hospital, Capital Medical University, Beijing, China
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Valentino WL, Okada D, Bhanu S. A curious case of T2-FLAIR mismatch in H3K27M mutant glioma. Radiol Case Rep 2022; 17:2930-2935. [PMID: 35755103 PMCID: PMC9218295 DOI: 10.1016/j.radcr.2022.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/04/2022] [Accepted: 05/11/2022] [Indexed: 11/19/2022] Open
Abstract
Diffuse midline gliomas are a rare relatively new classification of primary central nervous system tumors which include astrocytomas, oligodendrogliomas, and glioblastomas. The T2-FLAIR mismatch sign is regarded as a highly specific imaging feature of IDH-mutant, 1p/19q non-codeleted astrocytomas. The case presented herein demonstrates this sign, however, in a non-IDH mutated diffuse midline glioma with a H3K27M mutation, a World Health Organization Grade IV neoplasm. Although preoperative diagnosis can provide important treatment and prognostic information, it is often quite difficult particularly in primary central nervous system tumors.
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Affiliation(s)
- William L. Valentino
- Riverside Community Hospital, 4445 Magnolia Avenue, Riverside, CA, 92501 USA
- HCA Healthcare, Nashville, TN, USA
- Corresponding author.
| | - Darren Okada
- Riverside Community Hospital, 4445 Magnolia Avenue, Riverside, CA, 92501 USA
- HCA Healthcare, Nashville, TN, USA
| | - Shiv Bhanu
- Riverside Community Hospital, 4445 Magnolia Avenue, Riverside, CA, 92501 USA
- HCA Healthcare, Nashville, TN, USA
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Osborn AG, Louis DN, Poussaint TY, Linscott LL, Salzman KL. The 2021 World Health Organization Classification of Tumors of the Central Nervous System: What Neuroradiologists Need to Know. AJNR Am J Neuroradiol 2022; 43:928-937. [PMID: 35710121 DOI: 10.3174/ajnr.a7462] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/08/2021] [Indexed: 12/12/2022]
Abstract
Neuroradiologists play a key role in brain tumor diagnosis and management. Staying current with the latest classification systems and diagnostic markers is important to provide optimal patient care. Publication of the 2016 World Health Organization Classification of Tumors of the Central Nervous System introduced a paradigm shift in the diagnosis of CNS neoplasms. For the first time, both histologic features and genetic alterations were incorporated into the diagnostic framework, classifying and grading brain tumors. The newly published 2021 World Health Organization Classification of Tumors of the Central Nervous System, May 2021, 5th edition, has added even more molecular features and updated pathologic diagnoses. We present, summarize, and illustrate the most salient aspects of the new 5th edition. We have selected the key "must know" topics for practicing neuroradiologists.
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Affiliation(s)
- A G Osborn
- From the Department of Radiology and Imaging Sciences (A.G.O., K.L.S.), University of Utah School of Medicine, Salt Lake City, Utah
| | - D N Louis
- Department of Pathology (D.N.L.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - T Y Poussaint
- Department of Radiology (T.Y.P.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - L L Linscott
- Intermountain Pediatric Imaging (L.L.L.), Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | - K L Salzman
- From the Department of Radiology and Imaging Sciences (A.G.O., K.L.S.), University of Utah School of Medicine, Salt Lake City, Utah
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7
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Bhattarai AM, Mainali G, Jha P, Karki P, Adhikari A, Pandit A, Bhattarai AM. Diffuse midline glioma H3K27M mutation in adult: A case report. Ann Med Surg (Lond) 2022; 76:103567. [PMID: 35495373 PMCID: PMC9052283 DOI: 10.1016/j.amsu.2022.103567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ayush Mohan Bhattarai
- Shree Birendra Hospital, Chaunni, Kathmandu, Nepal
- Corresponding author. Shree Birendra Hospital, 44600, Kathmandu, Nepal.
| | - Gaurab Mainali
- Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
| | - Pinky Jha
- Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
| | - Pearlbiga Karki
- Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
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8
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Neth BJ, Balakrishnan SN, Carabenciov ID, Uhm JH, Daniels DJ, Kizilbash SH, Ruff MW. Panobinostat in adults with H3 K27M-mutant diffuse midline glioma: a single-center experience. J Neurooncol 2022; 157:91-100. [PMID: 35076860 DOI: 10.1007/s11060-022-03950-8] [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] [Received: 12/14/2021] [Accepted: 01/18/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Diffuse midline gliomas (DMG) with the H3 K27M-mutation are a well-described entity with most DMG harboring this mutation, with notable heterogeneity in adults. No therapy has been proven to improve survival in this tumor type. Panobinostat is a histone deacetylase inhibitor that may have therapeutic benefit. METHODS We report our retrospective experience with use of panobinostat in adults (> 18 years) with H3 K27M-mutant DMG treated at Mayo Clinic (Rochester) from January 2016 to August 2020, with follow-up until October 2021. Survival was calculated using the Kaplan-Meier method. RESULTS 4 patients with H3 K27M-mutant glioma were treated with panobinostat as compassionate use. Patients had a median age of 40 years (range 22-62 years) and 2 were female. Tumor location was midline for all patients, spinal cord (n = 2), brainstem (n = 1), and thalamus (n = 1). All tumors were IDH1/IDH2 wildtype. 3 patients received radiotherapy followed by adjuvant panobinostat. All patients had no other pharmacologic therapy utilized prior to or during panobinostat therapy aside from concurrent dexamethasone utilized in 3 patients. No patient experienced a grade 2 or higher (per CTCAE grade) adverse effect. The median overall survival was 42 months, median progression free survival of 19 months, 2 patients were alive at last follow up (both with spinal cord tumors and received radiation). The best response was stable disease in 2 patients and a partial response in 1 patient. CONCLUSIONS This is the first report of clinical outcomes of panobinostat in adults with H3 K27M-mutant DMG. We showed that it is well-tolerated at the dosage schedule that we describe, with no serious adverse effects throughout the study period.
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Affiliation(s)
- Bryan J Neth
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | | | - Ivan D Carabenciov
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Joon H Uhm
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - David J Daniels
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Michael W Ruff
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
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Li H, Shan C, Wu S, Cheng B, Fan C, Cai L, Chen Y, Shi Y, Liu K, Shao Y, Zhu D, Li Z. Genomic Profiling Identified Novel Prognostic Biomarkers in Chinese Midline Glioma Patients. Front Oncol 2021; 10:607429. [PMID: 33747896 PMCID: PMC7968371 DOI: 10.3389/fonc.2020.607429] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/26/2020] [Indexed: 12/21/2022] Open
Abstract
Background Molecular characteristics are essential for the classification and grading of gliomas. However, diagnostic classification of midline glioma is still debatable and substantial molecular and clinical heterogeneity within each subgroup suggested that they should be further stratified. Here, we studied the mutation landscape of Chinese midline glioma patients in hope to provide new insights for glioma prognosis and treatment. Methods Tissue samples from 112 midline glioma patients underwent next-generation sequencing targeting 425 cancer-relevant genes. Gene mutations and copy number variations were investigated for their somatic interactions and prognostic effect using overall survival data. Pathway-based survival analysis was performed for ten canonical oncogenic pathways. Results We identified several currently established diagnostic and prognostic biomarkers of glioma, including TP53 (33%), EGFR (26%), TERT (24%), PTEN (21%), PIK3CA (14%), ATRX (14%), BRAF (13%), and IDH1/2 (6%). Among all genetic aberrations with more than 5% occurrence rate, six mutations and three copy number gains were greatly associated with poor overall survival (univariate, P < 0.1). Of these, TERT mutations (hazard ratio [HR], 3.00; 95% confidence interval [CI], 1.37–6.61; P = 0.01) and PIK3CA mutations (HR, 2.04; 95% CI, 1.08–3.84; P = 0.02) remained significant in multivariate analyses. Additionally, we have also identified a novel MCL1 amplification (found in 31% patients) as a potential independent biomarker for glioma (multivariate HR, 2.78; 95% CI, 1.53–5.08; P < 0.001), which was seldom reported in public databases. Pathway analyses revealed significantly worse prognosis with abnormal PI3K (HR, 1.81; 95% CI, 1.12–2.95; P = 0.01) and cell cycle pathways (HR, 1.97; 95% CI, 1.15–3.37; P = 0.01), both of which stayed meaningful after multivariate adjustment. Conclusions In this study, we discovered shorter survival in midline glioma patients with PIK3CA and TERT mutations and with abnormal PI3K and cell cycle pathways. We also revealed a novel prognostic marker, MCL1 amplification that collectively provided new insights and opportunities in understanding and treating midline gliomas.
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Affiliation(s)
- Hainan Li
- Department of Pathology, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Changguo Shan
- Department of Pathology, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Shengnan Wu
- Department of Pathology, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Baijie Cheng
- Department of Pathology, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Chongzu Fan
- Department of Pathology, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Linbo Cai
- Department of Pathology, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Yedan Chen
- Medical Department, Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Yuqian Shi
- Medical Department, Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Kaihua Liu
- Medical Department, Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Yang Shao
- Medical Department, Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Dan Zhu
- Department of Pathology, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Zhi Li
- Department of Pathology, Guangdong Provincial People's Hospital, Guangzhou, China
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10
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Takahashi M, Tomita Y, Yamada SM, Yamazaki K, Yokoo H, Aso T, Kawamoto M. Cerebellar high-grade glioma with H3 K27M mutation: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE20112. [PMID: 36045933 PMCID: PMC9394179 DOI: 10.3171/case20112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/07/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Diffuse midline glioma H3 K27M-mutant is a distinct subtype of glial tumors newly introduced in the revised fourth edition of the World Health Organization Classification of Tumours of the Central Nervous System. They are aggressive pediatric tumors with a poor prognosis but have also been reported in adults. OBSERVATIONS The authors present the case of a man in his 60s who presented with rotatory vertigo, taste disorder, and right facial paralysis. Magnetic resonance imaging showed a tumor expanding from the cerebellum to the pons, which was histologically identified as glioblastoma, grade IV, IDH wild type. After tumor resection, the patient received chemoradiotherapy but showed only a partial response. His condition gradually worsened, and he died of progressive disease 12 months postoperation, after which an autopsy was performed. Tumor cells with a high nuclear-to-cytoplasm ratio were immunohistochemically analyzed and found to test positive for H3 K27M and negative for H3 K27me3. Furthermore, mutational analysis revealed HIST1H3B K27M mutation, and the tumor was finally identified as a high-grade glioma H3 K27M-mutant. The tumor invaded widely along the cerebral ventricle and disseminated to the spinal cord. LESSONS When a glioblastoma shows localization or dissemination patterns different from those of typical glioblastoma, an H3 K27M-mutant glioma should be suspected.
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Affiliation(s)
| | - Yusuke Tomita
- Neurosurgery, Teikyo University Hospital, Mizonokuchi, Kawasaki, Kanagawa, Japan
| | - Shoko Merrit Yamada
- Neurosurgery, Teikyo University Hospital, Mizonokuchi, Kawasaki, Kanagawa, Japan
| | - Kazuto Yamazaki
- Department of Pathology, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan; and
| | - Hideaki Yokoo
- Department of Human Pathology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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11
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Khandwala K, Mubarak F, Minhas K. The many faces of glioblastoma: Pictorial review of atypical imaging features. Neuroradiol J 2021; 34:33-41. [PMID: 33081585 PMCID: PMC7868590 DOI: 10.1177/1971400920965970] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Glioblastoma is an aggressive primary central nervous system tumour that usually has a poor prognosis. Generally, the typical imaging features are easily recognisable, but the behaviour of glioblastoma multiforme (GBM) can often be unusual. Several variations and heterogeneity in GBM appearance have been known to occur. In this pictorial essay, we present cases of pathologically confirmed GBM that illustrate unusual locations and atypical features on neuroimaging, and review the relevant literature. Even innocuous-looking foci, cystic lesions, meningeal-based pathology, intraventricular and infra-tentorial masses, multifocal/multicentric lesions and spinal cord abnormalities may represent GBM. We aim to highlight the atypical characteristics of glioblastoma, clarify their importance and list the potential mimickers. Although a definitive diagnosis in these rare cases of GBM warrants histopathological confirmation, an overview of the many imaging aspects may help make an early diagnosis.
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Affiliation(s)
| | | | - Khurram Minhas
- Department of Pathology and Laboratory Medicine, Aga Khan University, Pakistan
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12
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Li S, Lai M, Zhen J, Deng G, Li H, Cheng L, Liu X, Li J, Zhou J, Hu Q, Ye M, Wen L, Zhou C, Zhou Z, Shan C, Hong W, Xiao X, Wang H, Yang Y, Ai R, Cai L. Bone metastases in an adult patient with diffuse midline glioma: a case report. Neurooncol Adv 2020; 3:vdaa156. [PMID: 33543143 PMCID: PMC7846091 DOI: 10.1093/noajnl/vdaa156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Shaoqun Li
- Department of Neuro-Oncology, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Mingyao Lai
- Department of Neuro-Oncology, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Junjie Zhen
- Department of Neuro-Oncology, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Guanhua Deng
- Department of Neuro-Oncology, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Hainan Li
- Department of Pathology, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Lina Cheng
- Department of Neuro-Oncology, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Xuchen Liu
- Department of Orthopedics, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Juan Li
- Department of Neuro-Oncology, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Jiangfen Zhou
- Department of Neuro-Oncology, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Qingjun Hu
- Department of Neuro-Oncology, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Minting Ye
- Department of Neuro-Oncology, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Lei Wen
- Department of Neuro-Oncology, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Cheng Zhou
- Department of Neuro-Oncology, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Zhaoming Zhou
- Department of Neuro-Oncology, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Changguo Shan
- Department of Neuro-Oncology, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Weiping Hong
- Department of Neuro-Oncology, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Xiao Xiao
- Department of Neuro-Oncology, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Hui Wang
- Department of Neuro-Oncology, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Yanying Yang
- Department of Neuro-Oncology, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Ruyu Ai
- Department of Neuro-Oncology, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Linbo Cai
- Department of Neuro-Oncology, Guangdong Sanjiu Brain Hospital, Guangzhou, China.,Department of Medical Imaging, Guangdong Sanjiu Brain Hospital, Guangzhou, China
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