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Das AK, Mani SK, Singh SK, Kumar S. Management and outcome of unusual pediatric brain tumors: challenges experienced at a tertiary care center of a developing country. Childs Nerv Syst 2023; 39:169-183. [PMID: 36198891 DOI: 10.1007/s00381-022-05694-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/27/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE Primary brain tumors are the most frequent solid pediatric tumors, accounting for 40-50% of all cancers in children. Eighty to ninety percent of the 250,000 new cases of pediatric cancer each year are discovered in low and middle-income nations, where nearly 88 percent of the world's children reside. This article aims to emphasize the unusual presentation, management, and surgical outcome of complex pediatric brain tumors. METHODS We performed a retrospective study of patients who were admitted to the neurosurgery department with unusual pediatric brain tumors between March 1, 2019, and March 1, 2022. The study included pediatric patients up to age 18 years. We included those pediatric brain tumors whose (i) location was uncommon, or (ii) presented with unusual clinical presentation, or (iii) histopathology suggested to be a rare tumor, or (iv) radiological features were atypical. RESULTS We included 9 cases of rare unusual pediatric brain tumors. Three out of 9 cases required preoperative embolization due to its hypervascular nature on digital subtraction angiography (DSA). All patients underwent surgical excision within 24-48 h of tumor devascularization. One out of 9 cases died in follow-up period due to pleural effusion and distant metastasis to lungs. CONCLUSION Treatment considerations for unusual pediatric brain tumors include a comprehensive multidisciplinary approach, including community-based screening and proper referral system for early treatment, a variety of treatment modalities, and sophisticated follow-up strategy. Government shall work in coherence with tertiary centers to spread social awareness and provide various financial scheme to prevent treatment dropouts.
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Affiliation(s)
- Anand Kumar Das
- All India Institute of Medical Sciences, Phulwari Sharif, Bihar, Patna, 801507, India
| | - Suraj Kant Mani
- All India Institute of Medical Sciences, Phulwari Sharif, Bihar, Patna, 801507, India
| | - Saraj Kumar Singh
- All India Institute of Medical Sciences, Phulwari Sharif, Bihar, Patna, 801507, India.
| | - Subhash Kumar
- All India Institute of Medical Sciences, Phulwari Sharif, Bihar, Patna, 801507, India
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Kraus TFJ, Schwartz C, Machegger L, Zellinger B, Hölzl D, Schlicker HU, Pöppe J, Ladisich B, Spendel M, Kral M, Sotlar K. A patient with two gliomas with independent oligodendroglioma and glioblastoma biology proved by DNA-methylation profiling: a case report and review of the literature. Brain Tumor Pathol 2022; 39:111-119. [PMID: 35018523 PMCID: PMC9090705 DOI: 10.1007/s10014-021-00423-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/12/2021] [Indexed: 12/21/2022]
Abstract
AbstractHere, we report on a patient presenting with two histopathologically distinct gliomas. At the age of 42, the patient underwent initial resection of a right temporal oligodendroglioma IDH mutated 1p/19q co-deleted WHO Grade II followed by adjuvant radiochemotherapy with temozolomide. 15 months after initial diagnosis, the patient showed right hemispheric tumor progression and an additional new left frontal contrast enhancement in the subsequent imaging. A re-resection of the right-sided tumor and resection of the left frontal tumor were conducted. Neuropathological work-up showed recurrence of the right-sided oligodendroglioma with features of an anaplastic oligodendroglioma WHO Grade III, but a glioblastoma WHO grade IV for the left frontal lesion. In depth molecular profiling revealed two independent brain tumors with distinct molecular profiles of anaplastic oligodendroglioma IDH mutated 1p/19q co-deleted WHO Grade III and glioblastoma IDH wildtype WHO grade IV. This unique and rare case of a patient with two independent brain tumors revealed by in-depth molecular work-up and epigenomic profiling emphasizes the importance of integrated work-up of brain tumors including methylome profiling for advanced patient care.
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Affiliation(s)
- Theo F J Kraus
- Institute of Pathology, University Hospital Salzburg, Paracelsus Medical University, Müllner Hauptstr. 48, 5020, Salzburg, Austria.
| | - Christoph Schwartz
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria
| | - Lukas Machegger
- Institute of Neuroradiology, University Hospital Salzburg, Paracelsus Medical University, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria
| | - Barbara Zellinger
- Institute of Pathology, University Hospital Salzburg, Paracelsus Medical University, Müllner Hauptstr. 48, 5020, Salzburg, Austria
| | - Dorothee Hölzl
- Institute of Pathology, University Hospital Salzburg, Paracelsus Medical University, Müllner Hauptstr. 48, 5020, Salzburg, Austria
| | - Hans U Schlicker
- Institute of Pathology, University Hospital Salzburg, Paracelsus Medical University, Müllner Hauptstr. 48, 5020, Salzburg, Austria
| | - Johannes Pöppe
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria
| | - Barbara Ladisich
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria
| | - Mathias Spendel
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria
| | - Michael Kral
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria
| | - Karl Sotlar
- Institute of Pathology, University Hospital Salzburg, Paracelsus Medical University, Müllner Hauptstr. 48, 5020, Salzburg, Austria.
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Kraus TFJ, Pöppe J, Machegger L, Zellinger B, Dovjak E, Schlicker HU, Schwartz C, Ladisich B, Spendel M, Al‐Schameri AR, Winkler PA, Sotlar K. Genotypical glioblastoma of the frontal lobe mimicking ganglioglioma: A case report and review of the literature. Clin Case Rep 2021; 9:e04544. [PMID: 34484744 PMCID: PMC8405366 DOI: 10.1002/ccr3.4544] [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: 05/04/2021] [Accepted: 06/16/2021] [Indexed: 11/18/2022] Open
Abstract
This case of severe phenotype-genotype mismatch brain tumor morphologically mimicking benign ganglioglioma emphasizes the urgent need for advanced molecular profiling in brain tumor diagnosis in the era of sophisticated molecular profiling.
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Affiliation(s)
- Theo F. J. Kraus
- Institute of PathologyUniversity Hospital SalzburgParacelsus Medical UniversitySalzburgAustria
| | - Johannes Pöppe
- Department of NeurosurgeryUniversity Hospital SalzburgParacelsus Medical UniversitySalzburgAustria
| | - Lukas Machegger
- Institute of NeuroradiologyUniversity Hospital SalzburgParacelsus Medical UniversitySalzburgAustria
| | - Barbara Zellinger
- Institute of PathologyUniversity Hospital SalzburgParacelsus Medical UniversitySalzburgAustria
| | - Eva Dovjak
- Institute of PathologyUniversity Hospital SalzburgParacelsus Medical UniversitySalzburgAustria
| | - Hans U. Schlicker
- Institute of PathologyUniversity Hospital SalzburgParacelsus Medical UniversitySalzburgAustria
| | - Christoph Schwartz
- Department of NeurosurgeryUniversity Hospital SalzburgParacelsus Medical UniversitySalzburgAustria
| | - Barbara Ladisich
- Department of NeurosurgeryUniversity Hospital SalzburgParacelsus Medical UniversitySalzburgAustria
| | - Mathias Spendel
- Department of NeurosurgeryUniversity Hospital SalzburgParacelsus Medical UniversitySalzburgAustria
| | - Abdul R. Al‐Schameri
- Department of NeurosurgeryUniversity Hospital SalzburgParacelsus Medical UniversitySalzburgAustria
| | - Peter A. Winkler
- Department of NeurosurgeryUniversity Hospital SalzburgParacelsus Medical UniversitySalzburgAustria
| | - Karl Sotlar
- Institute of PathologyUniversity Hospital SalzburgParacelsus Medical UniversitySalzburgAustria
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Diffuse midline glioma of the cervical spinal cord with H3 K27M genotype phenotypically mimicking anaplastic ganglioglioma: a case report and review of the literature. Brain Tumor Pathol 2020; 37:89-94. [PMID: 32451719 PMCID: PMC7324431 DOI: 10.1007/s10014-020-00365-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/08/2020] [Indexed: 02/07/2023]
Abstract
Here, we report on a 28-year old male patient presenting with neck and shoulder pain, dysesthesia of all four limbs and hypesthesia of both hands, without motor deficits. Magnetic resonance imaging showed an intradural, intramedullary mass of the cervical spinal cord of 6.4 cm length and 1.7 cm diameter. The patient underwent surgical resection. Histological and immunohistochemical evaluation showed pleomorphic glial tumor cells, mitoses, calcifications, and atypical ganglioid cells compatible with the morphology of anaplastic ganglioglioma (WHO Grade III). Extensive molecular workup revealed H3F3A K27M, TERT C228T and PDGFRα Y849C mutations indicating poor prognosis. The H3F3A K27M mutation assigned the tumor to the molecular group of diffuse midline glioma (WHO Grade IV). Epigenome-wide methylation profiling confirmed the methylation class of diffuse midline glioma. Thus, this is a very rare case of malignant glioma with H3 K27M genotype phenotypically mimicking anaplastic ganglioglioma. This case emphasizes the importance of comprehensive morphological and molecular workup including methylome profiling for advanced patient care.
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Bhimani AD, Ryoo JS, Reddy AK, Denyer S, McGuire LS, Alonso M, Mehta AI. Differentiation of Outcomes by Treatment Regimen and Histology in Central Nervous System Primary Embryonal Tumors. World Neurosurg 2020; 141:e289-e306. [PMID: 32434022 DOI: 10.1016/j.wneu.2020.05.103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Central nervous system (CNS) embryonal tumors are malignant neoplasms of undifferentiated embryonic cells that typically occur in the pediatric population. They are further divided into many subgroups by distinct histologic and genetic profiles. We present the largest study to date to identify differential survival outcomes within each subgroup by treatment regimen. METHODS The SEER (Surveillance Epidemiology and End Results) database was queried from 1973 to 2015 for embryonal tumors of primary CNS origin (n = 3900). The effects of patient demographics, tumor characteristics, and treatment regimen were analyzed using a multivariate Cox proportional hazard model in CNS embryonal tumor subtypes divided into medulloblastoma, atypical teratoid/rhabdoid tumor, and primitive neuroectodermal tumor. RESULTS No significant patient demographic factors were found to be associated with increased mortality. In all 3 CNS embryonal tumor subtypes, most monotherapy and combinatorial treatment paradigms showed a higher hazard ratio compared with gross total resection with adjuvant chemoradiotherapy (hazard ratio, 1.72-22.94; P < 0.05 for all). In a subgroup analysis of patients with medulloblastoma ≤3 years of age, patients who did not receive radiation showed lower survival probabilities at 1, 5, and 10 years (odds ratio [OR], 0.37, P < 0.0001; OR, 0.39, P < 0.0001; OR, 0.34, P < 0.0001, respectively). Kaplan-Meier analysis of medulloblastoma histologic subtypes showed that use of radiation imparted a higher survival probability in the desmoplastic/nodular medulloblastoma and medulloblastoma not otherwise specified groups (P < 0.001 for both). CONCLUSIONS CNS embryonal tumors are highly malignant in all populations and the best survival is seen with aggressive combination therapies. Radiation therapy may have a role in prolonging survival in patients with medulloblastoma ≤3 years of age.
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Affiliation(s)
- Abhiraj D Bhimani
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - James S Ryoo
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Abhinav K Reddy
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Steven Denyer
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Laura S McGuire
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Matthew Alonso
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
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Abstract
Embryonal tumors of the central nervous system (CNS) are rare, high-grade neoplasms predominantly affecting the pediatric population. Well-defined embryonal tumors include medulloblastoma, atypical teratoid/rhabdoid tumor, embryonal tumor with multilayered rosettes, C19MC-altered and embryonal tumor with multilayered rosettes, not otherwise specified, pineoblastoma, pituitary blastoma, CNS neuroblastoma, and ganglioneuroblastoma. Although their prognosis is nearly uniformly poor, the rapidly evolving understanding of their molecular biology contributes to diagnosis, prognosis, treatment, and clinical trial participation. Knowledge of current tumor stratification and diagnostic techniques will help pathologists guide care and preserve tissue for necessary or desired additional testing.
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Affiliation(s)
- Melissa M Blessing
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Sanda Alexandrescu
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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