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Lehman NL, Hattab EM, Mobley BC, Usubalieva A, Schniederjan MJ, McLendon RE, Paulus W, Rushing EJ, Georgescu MM, Couce M, Dulai MS, Cohen ML, Pierson CR, Raisanen JM, Martin SE, Lehman TD, Lipp ES, Bonnin JM, Al-Abbadi MA, Kenworthy K, Zhao K, Mohamed N, Zhang G, Zhao W. Morphological and molecular features of astroblastoma, including BRAFV600E mutations, suggest an ontological relationship to other cortical-based gliomas of children and young adults. Neuro Oncol 2016; 19:31-42. [PMID: 27416954 DOI: 10.1093/neuonc/now118] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Astroblastomas (ABs) are rare glial tumors showing overlapping features with astrocytomas, ependymomas, and sometimes other glial neoplasms, and may be challenging to diagnose. METHODS We examined clinical, histopathological, and molecular features in 28 archival formalin-fixed, paraffin-embedded AB cases and performed survival analyses using Cox proportional hazards and Kaplan-Meier methods. RESULTS Unlike ependymomas and angiocentric gliomas, ABs demonstrate abundant distinctive astroblastic pseudorosettes and are usually Olig2 immunopositive. They also frequently exhibit rhabdoid cells, multinucleated cells, and eosinophilic granular material. They retain immunoreactivity to alpha thalassemia/mental retardation syndrome X-linked, are immunonegative to isocitrate dehydrogenase-1 R132H mutation, and only occasionally show MGMT promoter hypermethylation differentiating them from many diffuse gliomas. Like pleomorphic xanthoastrocytoma, ganglioglioma, supratentorial pilocytic astrocytoma, and other predominantly cortical-based glial tumors, ABs often harbor the BRAFV600E mutation, present in 38% of cases tested (n = 21), further distinguishing those tumors from ependymomas and angiocentric gliomas. Factors correlating with longer patient survival included age less than 30 years, female gender, absent BRAFV600E , and mitotic index less than 5 mitoses/10 high-power fields; however, only the latter was significant by Cox and Kaplan-Meier analyses (n = 24; P = .024 and .012, respectively). This mitotic cutoff is therefore currently the best criterion to stratify tumors into low-grade ABs and higher-grade anaplastic ABs. CONCLUSIONS In addition to their own characteristic histological features, ABs share some molecular and histological findings with other, possibly ontologically related, cortical-based gliomas of mostly children and young adults. Importantly, the presence of BRAFV600E mutations in a subset of ABs suggests potential clinical utility of targeted anti-BRAF therapy.
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Affiliation(s)
- Norman L Lehman
- Department of Pathology, The Ohio State University, Columbus, Ohio (N.L.L., A.U., C.R.P., K.K., K.Z., N.M., G.Z., W.Z.); Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana (E.M.H., J.M.B.); Department of Pathology, Vanderbilt University, Nashville, Tennessee (B.C.M.); Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia (M.J.S.); Department of Pathology, Duke University, Durham, North Carolina (R.E.M., E.S.L.); Institute of Neuropathology, University Hospital Münster, Germany (W.P.); Institute for Neuropathology, University Hospital of Zurich, Switzerland (E.J.R.); Department of Pathology, The University of Texas Southwestern, Dallas, Texas (M.-M.G., J.M.R.); Department of Pathology, Case Western Reserve University, Cleveland, Ohio (M.C., M.L.C.); Department of Anatomic Pathology, Beaumont Hospital, Royal Oak, Michigan (M.S.D.); Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (C.R.P.); Department of Pathology, University of Illinois, Peoria, Illinois (S.E.M.); Department of Pathology, Sheikh Khalifa Medical City, Abu Dhabi, UAE (M.A.A.-A.); Department of Family and Community Medicine, Contra Costa Regional Medical Center, Martinez, California (T.D.L.)
| | - Eyas M Hattab
- Department of Pathology, The Ohio State University, Columbus, Ohio (N.L.L., A.U., C.R.P., K.K., K.Z., N.M., G.Z., W.Z.); Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana (E.M.H., J.M.B.); Department of Pathology, Vanderbilt University, Nashville, Tennessee (B.C.M.); Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia (M.J.S.); Department of Pathology, Duke University, Durham, North Carolina (R.E.M., E.S.L.); Institute of Neuropathology, University Hospital Münster, Germany (W.P.); Institute for Neuropathology, University Hospital of Zurich, Switzerland (E.J.R.); Department of Pathology, The University of Texas Southwestern, Dallas, Texas (M.-M.G., J.M.R.); Department of Pathology, Case Western Reserve University, Cleveland, Ohio (M.C., M.L.C.); Department of Anatomic Pathology, Beaumont Hospital, Royal Oak, Michigan (M.S.D.); Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (C.R.P.); Department of Pathology, University of Illinois, Peoria, Illinois (S.E.M.); Department of Pathology, Sheikh Khalifa Medical City, Abu Dhabi, UAE (M.A.A.-A.); Department of Family and Community Medicine, Contra Costa Regional Medical Center, Martinez, California (T.D.L.)
| | - Bret C Mobley
- Department of Pathology, The Ohio State University, Columbus, Ohio (N.L.L., A.U., C.R.P., K.K., K.Z., N.M., G.Z., W.Z.); Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana (E.M.H., J.M.B.); Department of Pathology, Vanderbilt University, Nashville, Tennessee (B.C.M.); Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia (M.J.S.); Department of Pathology, Duke University, Durham, North Carolina (R.E.M., E.S.L.); Institute of Neuropathology, University Hospital Münster, Germany (W.P.); Institute for Neuropathology, University Hospital of Zurich, Switzerland (E.J.R.); Department of Pathology, The University of Texas Southwestern, Dallas, Texas (M.-M.G., J.M.R.); Department of Pathology, Case Western Reserve University, Cleveland, Ohio (M.C., M.L.C.); Department of Anatomic Pathology, Beaumont Hospital, Royal Oak, Michigan (M.S.D.); Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (C.R.P.); Department of Pathology, University of Illinois, Peoria, Illinois (S.E.M.); Department of Pathology, Sheikh Khalifa Medical City, Abu Dhabi, UAE (M.A.A.-A.); Department of Family and Community Medicine, Contra Costa Regional Medical Center, Martinez, California (T.D.L.)
| | - Aisulu Usubalieva
- Department of Pathology, The Ohio State University, Columbus, Ohio (N.L.L., A.U., C.R.P., K.K., K.Z., N.M., G.Z., W.Z.); Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana (E.M.H., J.M.B.); Department of Pathology, Vanderbilt University, Nashville, Tennessee (B.C.M.); Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia (M.J.S.); Department of Pathology, Duke University, Durham, North Carolina (R.E.M., E.S.L.); Institute of Neuropathology, University Hospital Münster, Germany (W.P.); Institute for Neuropathology, University Hospital of Zurich, Switzerland (E.J.R.); Department of Pathology, The University of Texas Southwestern, Dallas, Texas (M.-M.G., J.M.R.); Department of Pathology, Case Western Reserve University, Cleveland, Ohio (M.C., M.L.C.); Department of Anatomic Pathology, Beaumont Hospital, Royal Oak, Michigan (M.S.D.); Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (C.R.P.); Department of Pathology, University of Illinois, Peoria, Illinois (S.E.M.); Department of Pathology, Sheikh Khalifa Medical City, Abu Dhabi, UAE (M.A.A.-A.); Department of Family and Community Medicine, Contra Costa Regional Medical Center, Martinez, California (T.D.L.)
| | - Matthew J Schniederjan
- Department of Pathology, The Ohio State University, Columbus, Ohio (N.L.L., A.U., C.R.P., K.K., K.Z., N.M., G.Z., W.Z.); Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana (E.M.H., J.M.B.); Department of Pathology, Vanderbilt University, Nashville, Tennessee (B.C.M.); Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia (M.J.S.); Department of Pathology, Duke University, Durham, North Carolina (R.E.M., E.S.L.); Institute of Neuropathology, University Hospital Münster, Germany (W.P.); Institute for Neuropathology, University Hospital of Zurich, Switzerland (E.J.R.); Department of Pathology, The University of Texas Southwestern, Dallas, Texas (M.-M.G., J.M.R.); Department of Pathology, Case Western Reserve University, Cleveland, Ohio (M.C., M.L.C.); Department of Anatomic Pathology, Beaumont Hospital, Royal Oak, Michigan (M.S.D.); Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (C.R.P.); Department of Pathology, University of Illinois, Peoria, Illinois (S.E.M.); Department of Pathology, Sheikh Khalifa Medical City, Abu Dhabi, UAE (M.A.A.-A.); Department of Family and Community Medicine, Contra Costa Regional Medical Center, Martinez, California (T.D.L.)
| | - Roger E McLendon
- Department of Pathology, The Ohio State University, Columbus, Ohio (N.L.L., A.U., C.R.P., K.K., K.Z., N.M., G.Z., W.Z.); Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana (E.M.H., J.M.B.); Department of Pathology, Vanderbilt University, Nashville, Tennessee (B.C.M.); Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia (M.J.S.); Department of Pathology, Duke University, Durham, North Carolina (R.E.M., E.S.L.); Institute of Neuropathology, University Hospital Münster, Germany (W.P.); Institute for Neuropathology, University Hospital of Zurich, Switzerland (E.J.R.); Department of Pathology, The University of Texas Southwestern, Dallas, Texas (M.-M.G., J.M.R.); Department of Pathology, Case Western Reserve University, Cleveland, Ohio (M.C., M.L.C.); Department of Anatomic Pathology, Beaumont Hospital, Royal Oak, Michigan (M.S.D.); Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (C.R.P.); Department of Pathology, University of Illinois, Peoria, Illinois (S.E.M.); Department of Pathology, Sheikh Khalifa Medical City, Abu Dhabi, UAE (M.A.A.-A.); Department of Family and Community Medicine, Contra Costa Regional Medical Center, Martinez, California (T.D.L.)
| | - Werner Paulus
- Department of Pathology, The Ohio State University, Columbus, Ohio (N.L.L., A.U., C.R.P., K.K., K.Z., N.M., G.Z., W.Z.); Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana (E.M.H., J.M.B.); Department of Pathology, Vanderbilt University, Nashville, Tennessee (B.C.M.); Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia (M.J.S.); Department of Pathology, Duke University, Durham, North Carolina (R.E.M., E.S.L.); Institute of Neuropathology, University Hospital Münster, Germany (W.P.); Institute for Neuropathology, University Hospital of Zurich, Switzerland (E.J.R.); Department of Pathology, The University of Texas Southwestern, Dallas, Texas (M.-M.G., J.M.R.); Department of Pathology, Case Western Reserve University, Cleveland, Ohio (M.C., M.L.C.); Department of Anatomic Pathology, Beaumont Hospital, Royal Oak, Michigan (M.S.D.); Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (C.R.P.); Department of Pathology, University of Illinois, Peoria, Illinois (S.E.M.); Department of Pathology, Sheikh Khalifa Medical City, Abu Dhabi, UAE (M.A.A.-A.); Department of Family and Community Medicine, Contra Costa Regional Medical Center, Martinez, California (T.D.L.)
| | - Elisabeth J Rushing
- Department of Pathology, The Ohio State University, Columbus, Ohio (N.L.L., A.U., C.R.P., K.K., K.Z., N.M., G.Z., W.Z.); Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana (E.M.H., J.M.B.); Department of Pathology, Vanderbilt University, Nashville, Tennessee (B.C.M.); Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia (M.J.S.); Department of Pathology, Duke University, Durham, North Carolina (R.E.M., E.S.L.); Institute of Neuropathology, University Hospital Münster, Germany (W.P.); Institute for Neuropathology, University Hospital of Zurich, Switzerland (E.J.R.); Department of Pathology, The University of Texas Southwestern, Dallas, Texas (M.-M.G., J.M.R.); Department of Pathology, Case Western Reserve University, Cleveland, Ohio (M.C., M.L.C.); Department of Anatomic Pathology, Beaumont Hospital, Royal Oak, Michigan (M.S.D.); Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (C.R.P.); Department of Pathology, University of Illinois, Peoria, Illinois (S.E.M.); Department of Pathology, Sheikh Khalifa Medical City, Abu Dhabi, UAE (M.A.A.-A.); Department of Family and Community Medicine, Contra Costa Regional Medical Center, Martinez, California (T.D.L.)
| | - Maria-Magdalena Georgescu
- Department of Pathology, The Ohio State University, Columbus, Ohio (N.L.L., A.U., C.R.P., K.K., K.Z., N.M., G.Z., W.Z.); Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana (E.M.H., J.M.B.); Department of Pathology, Vanderbilt University, Nashville, Tennessee (B.C.M.); Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia (M.J.S.); Department of Pathology, Duke University, Durham, North Carolina (R.E.M., E.S.L.); Institute of Neuropathology, University Hospital Münster, Germany (W.P.); Institute for Neuropathology, University Hospital of Zurich, Switzerland (E.J.R.); Department of Pathology, The University of Texas Southwestern, Dallas, Texas (M.-M.G., J.M.R.); Department of Pathology, Case Western Reserve University, Cleveland, Ohio (M.C., M.L.C.); Department of Anatomic Pathology, Beaumont Hospital, Royal Oak, Michigan (M.S.D.); Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (C.R.P.); Department of Pathology, University of Illinois, Peoria, Illinois (S.E.M.); Department of Pathology, Sheikh Khalifa Medical City, Abu Dhabi, UAE (M.A.A.-A.); Department of Family and Community Medicine, Contra Costa Regional Medical Center, Martinez, California (T.D.L.)
| | - Marta Couce
- Department of Pathology, The Ohio State University, Columbus, Ohio (N.L.L., A.U., C.R.P., K.K., K.Z., N.M., G.Z., W.Z.); Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana (E.M.H., J.M.B.); Department of Pathology, Vanderbilt University, Nashville, Tennessee (B.C.M.); Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia (M.J.S.); Department of Pathology, Duke University, Durham, North Carolina (R.E.M., E.S.L.); Institute of Neuropathology, University Hospital Münster, Germany (W.P.); Institute for Neuropathology, University Hospital of Zurich, Switzerland (E.J.R.); Department of Pathology, The University of Texas Southwestern, Dallas, Texas (M.-M.G., J.M.R.); Department of Pathology, Case Western Reserve University, Cleveland, Ohio (M.C., M.L.C.); Department of Anatomic Pathology, Beaumont Hospital, Royal Oak, Michigan (M.S.D.); Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (C.R.P.); Department of Pathology, University of Illinois, Peoria, Illinois (S.E.M.); Department of Pathology, Sheikh Khalifa Medical City, Abu Dhabi, UAE (M.A.A.-A.); Department of Family and Community Medicine, Contra Costa Regional Medical Center, Martinez, California (T.D.L.)
| | - Mohanpal S Dulai
- Department of Pathology, The Ohio State University, Columbus, Ohio (N.L.L., A.U., C.R.P., K.K., K.Z., N.M., G.Z., W.Z.); Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana (E.M.H., J.M.B.); Department of Pathology, Vanderbilt University, Nashville, Tennessee (B.C.M.); Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia (M.J.S.); Department of Pathology, Duke University, Durham, North Carolina (R.E.M., E.S.L.); Institute of Neuropathology, University Hospital Münster, Germany (W.P.); Institute for Neuropathology, University Hospital of Zurich, Switzerland (E.J.R.); Department of Pathology, The University of Texas Southwestern, Dallas, Texas (M.-M.G., J.M.R.); Department of Pathology, Case Western Reserve University, Cleveland, Ohio (M.C., M.L.C.); Department of Anatomic Pathology, Beaumont Hospital, Royal Oak, Michigan (M.S.D.); Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (C.R.P.); Department of Pathology, University of Illinois, Peoria, Illinois (S.E.M.); Department of Pathology, Sheikh Khalifa Medical City, Abu Dhabi, UAE (M.A.A.-A.); Department of Family and Community Medicine, Contra Costa Regional Medical Center, Martinez, California (T.D.L.)
| | - Mark L Cohen
- Department of Pathology, The Ohio State University, Columbus, Ohio (N.L.L., A.U., C.R.P., K.K., K.Z., N.M., G.Z., W.Z.); Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana (E.M.H., J.M.B.); Department of Pathology, Vanderbilt University, Nashville, Tennessee (B.C.M.); Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia (M.J.S.); Department of Pathology, Duke University, Durham, North Carolina (R.E.M., E.S.L.); Institute of Neuropathology, University Hospital Münster, Germany (W.P.); Institute for Neuropathology, University Hospital of Zurich, Switzerland (E.J.R.); Department of Pathology, The University of Texas Southwestern, Dallas, Texas (M.-M.G., J.M.R.); Department of Pathology, Case Western Reserve University, Cleveland, Ohio (M.C., M.L.C.); Department of Anatomic Pathology, Beaumont Hospital, Royal Oak, Michigan (M.S.D.); Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (C.R.P.); Department of Pathology, University of Illinois, Peoria, Illinois (S.E.M.); Department of Pathology, Sheikh Khalifa Medical City, Abu Dhabi, UAE (M.A.A.-A.); Department of Family and Community Medicine, Contra Costa Regional Medical Center, Martinez, California (T.D.L.)
| | - Christopher R Pierson
- Department of Pathology, The Ohio State University, Columbus, Ohio (N.L.L., A.U., C.R.P., K.K., K.Z., N.M., G.Z., W.Z.); Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana (E.M.H., J.M.B.); Department of Pathology, Vanderbilt University, Nashville, Tennessee (B.C.M.); Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia (M.J.S.); Department of Pathology, Duke University, Durham, North Carolina (R.E.M., E.S.L.); Institute of Neuropathology, University Hospital Münster, Germany (W.P.); Institute for Neuropathology, University Hospital of Zurich, Switzerland (E.J.R.); Department of Pathology, The University of Texas Southwestern, Dallas, Texas (M.-M.G., J.M.R.); Department of Pathology, Case Western Reserve University, Cleveland, Ohio (M.C., M.L.C.); Department of Anatomic Pathology, Beaumont Hospital, Royal Oak, Michigan (M.S.D.); Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (C.R.P.); Department of Pathology, University of Illinois, Peoria, Illinois (S.E.M.); Department of Pathology, Sheikh Khalifa Medical City, Abu Dhabi, UAE (M.A.A.-A.); Department of Family and Community Medicine, Contra Costa Regional Medical Center, Martinez, California (T.D.L.)
| | - Jack M Raisanen
- Department of Pathology, The Ohio State University, Columbus, Ohio (N.L.L., A.U., C.R.P., K.K., K.Z., N.M., G.Z., W.Z.); Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana (E.M.H., J.M.B.); Department of Pathology, Vanderbilt University, Nashville, Tennessee (B.C.M.); Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia (M.J.S.); Department of Pathology, Duke University, Durham, North Carolina (R.E.M., E.S.L.); Institute of Neuropathology, University Hospital Münster, Germany (W.P.); Institute for Neuropathology, University Hospital of Zurich, Switzerland (E.J.R.); Department of Pathology, The University of Texas Southwestern, Dallas, Texas (M.-M.G., J.M.R.); Department of Pathology, Case Western Reserve University, Cleveland, Ohio (M.C., M.L.C.); Department of Anatomic Pathology, Beaumont Hospital, Royal Oak, Michigan (M.S.D.); Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (C.R.P.); Department of Pathology, University of Illinois, Peoria, Illinois (S.E.M.); Department of Pathology, Sheikh Khalifa Medical City, Abu Dhabi, UAE (M.A.A.-A.); Department of Family and Community Medicine, Contra Costa Regional Medical Center, Martinez, California (T.D.L.)
| | - Sarah E Martin
- Department of Pathology, The Ohio State University, Columbus, Ohio (N.L.L., A.U., C.R.P., K.K., K.Z., N.M., G.Z., W.Z.); Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana (E.M.H., J.M.B.); Department of Pathology, Vanderbilt University, Nashville, Tennessee (B.C.M.); Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia (M.J.S.); Department of Pathology, Duke University, Durham, North Carolina (R.E.M., E.S.L.); Institute of Neuropathology, University Hospital Münster, Germany (W.P.); Institute for Neuropathology, University Hospital of Zurich, Switzerland (E.J.R.); Department of Pathology, The University of Texas Southwestern, Dallas, Texas (M.-M.G., J.M.R.); Department of Pathology, Case Western Reserve University, Cleveland, Ohio (M.C., M.L.C.); Department of Anatomic Pathology, Beaumont Hospital, Royal Oak, Michigan (M.S.D.); Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (C.R.P.); Department of Pathology, University of Illinois, Peoria, Illinois (S.E.M.); Department of Pathology, Sheikh Khalifa Medical City, Abu Dhabi, UAE (M.A.A.-A.); Department of Family and Community Medicine, Contra Costa Regional Medical Center, Martinez, California (T.D.L.)
| | - Trang D Lehman
- Department of Pathology, The Ohio State University, Columbus, Ohio (N.L.L., A.U., C.R.P., K.K., K.Z., N.M., G.Z., W.Z.); Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana (E.M.H., J.M.B.); Department of Pathology, Vanderbilt University, Nashville, Tennessee (B.C.M.); Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia (M.J.S.); Department of Pathology, Duke University, Durham, North Carolina (R.E.M., E.S.L.); Institute of Neuropathology, University Hospital Münster, Germany (W.P.); Institute for Neuropathology, University Hospital of Zurich, Switzerland (E.J.R.); Department of Pathology, The University of Texas Southwestern, Dallas, Texas (M.-M.G., J.M.R.); Department of Pathology, Case Western Reserve University, Cleveland, Ohio (M.C., M.L.C.); Department of Anatomic Pathology, Beaumont Hospital, Royal Oak, Michigan (M.S.D.); Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (C.R.P.); Department of Pathology, University of Illinois, Peoria, Illinois (S.E.M.); Department of Pathology, Sheikh Khalifa Medical City, Abu Dhabi, UAE (M.A.A.-A.); Department of Family and Community Medicine, Contra Costa Regional Medical Center, Martinez, California (T.D.L.)
| | - Eric S Lipp
- Department of Pathology, The Ohio State University, Columbus, Ohio (N.L.L., A.U., C.R.P., K.K., K.Z., N.M., G.Z., W.Z.); Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana (E.M.H., J.M.B.); Department of Pathology, Vanderbilt University, Nashville, Tennessee (B.C.M.); Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia (M.J.S.); Department of Pathology, Duke University, Durham, North Carolina (R.E.M., E.S.L.); Institute of Neuropathology, University Hospital Münster, Germany (W.P.); Institute for Neuropathology, University Hospital of Zurich, Switzerland (E.J.R.); Department of Pathology, The University of Texas Southwestern, Dallas, Texas (M.-M.G., J.M.R.); Department of Pathology, Case Western Reserve University, Cleveland, Ohio (M.C., M.L.C.); Department of Anatomic Pathology, Beaumont Hospital, Royal Oak, Michigan (M.S.D.); Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (C.R.P.); Department of Pathology, University of Illinois, Peoria, Illinois (S.E.M.); Department of Pathology, Sheikh Khalifa Medical City, Abu Dhabi, UAE (M.A.A.-A.); Department of Family and Community Medicine, Contra Costa Regional Medical Center, Martinez, California (T.D.L.)
| | - Jose M Bonnin
- Department of Pathology, The Ohio State University, Columbus, Ohio (N.L.L., A.U., C.R.P., K.K., K.Z., N.M., G.Z., W.Z.); Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana (E.M.H., J.M.B.); Department of Pathology, Vanderbilt University, Nashville, Tennessee (B.C.M.); Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia (M.J.S.); Department of Pathology, Duke University, Durham, North Carolina (R.E.M., E.S.L.); Institute of Neuropathology, University Hospital Münster, Germany (W.P.); Institute for Neuropathology, University Hospital of Zurich, Switzerland (E.J.R.); Department of Pathology, The University of Texas Southwestern, Dallas, Texas (M.-M.G., J.M.R.); Department of Pathology, Case Western Reserve University, Cleveland, Ohio (M.C., M.L.C.); Department of Anatomic Pathology, Beaumont Hospital, Royal Oak, Michigan (M.S.D.); Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (C.R.P.); Department of Pathology, University of Illinois, Peoria, Illinois (S.E.M.); Department of Pathology, Sheikh Khalifa Medical City, Abu Dhabi, UAE (M.A.A.-A.); Department of Family and Community Medicine, Contra Costa Regional Medical Center, Martinez, California (T.D.L.)
| | - Mousa A Al-Abbadi
- Department of Pathology, The Ohio State University, Columbus, Ohio (N.L.L., A.U., C.R.P., K.K., K.Z., N.M., G.Z., W.Z.); Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana (E.M.H., J.M.B.); Department of Pathology, Vanderbilt University, Nashville, Tennessee (B.C.M.); Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia (M.J.S.); Department of Pathology, Duke University, Durham, North Carolina (R.E.M., E.S.L.); Institute of Neuropathology, University Hospital Münster, Germany (W.P.); Institute for Neuropathology, University Hospital of Zurich, Switzerland (E.J.R.); Department of Pathology, The University of Texas Southwestern, Dallas, Texas (M.-M.G., J.M.R.); Department of Pathology, Case Western Reserve University, Cleveland, Ohio (M.C., M.L.C.); Department of Anatomic Pathology, Beaumont Hospital, Royal Oak, Michigan (M.S.D.); Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (C.R.P.); Department of Pathology, University of Illinois, Peoria, Illinois (S.E.M.); Department of Pathology, Sheikh Khalifa Medical City, Abu Dhabi, UAE (M.A.A.-A.); Department of Family and Community Medicine, Contra Costa Regional Medical Center, Martinez, California (T.D.L.)
| | - Kara Kenworthy
- Department of Pathology, The Ohio State University, Columbus, Ohio (N.L.L., A.U., C.R.P., K.K., K.Z., N.M., G.Z., W.Z.); Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana (E.M.H., J.M.B.); Department of Pathology, Vanderbilt University, Nashville, Tennessee (B.C.M.); Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia (M.J.S.); Department of Pathology, Duke University, Durham, North Carolina (R.E.M., E.S.L.); Institute of Neuropathology, University Hospital Münster, Germany (W.P.); Institute for Neuropathology, University Hospital of Zurich, Switzerland (E.J.R.); Department of Pathology, The University of Texas Southwestern, Dallas, Texas (M.-M.G., J.M.R.); Department of Pathology, Case Western Reserve University, Cleveland, Ohio (M.C., M.L.C.); Department of Anatomic Pathology, Beaumont Hospital, Royal Oak, Michigan (M.S.D.); Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (C.R.P.); Department of Pathology, University of Illinois, Peoria, Illinois (S.E.M.); Department of Pathology, Sheikh Khalifa Medical City, Abu Dhabi, UAE (M.A.A.-A.); Department of Family and Community Medicine, Contra Costa Regional Medical Center, Martinez, California (T.D.L.)
| | - Kevin Zhao
- Department of Pathology, The Ohio State University, Columbus, Ohio (N.L.L., A.U., C.R.P., K.K., K.Z., N.M., G.Z., W.Z.); Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana (E.M.H., J.M.B.); Department of Pathology, Vanderbilt University, Nashville, Tennessee (B.C.M.); Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia (M.J.S.); Department of Pathology, Duke University, Durham, North Carolina (R.E.M., E.S.L.); Institute of Neuropathology, University Hospital Münster, Germany (W.P.); Institute for Neuropathology, University Hospital of Zurich, Switzerland (E.J.R.); Department of Pathology, The University of Texas Southwestern, Dallas, Texas (M.-M.G., J.M.R.); Department of Pathology, Case Western Reserve University, Cleveland, Ohio (M.C., M.L.C.); Department of Anatomic Pathology, Beaumont Hospital, Royal Oak, Michigan (M.S.D.); Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (C.R.P.); Department of Pathology, University of Illinois, Peoria, Illinois (S.E.M.); Department of Pathology, Sheikh Khalifa Medical City, Abu Dhabi, UAE (M.A.A.-A.); Department of Family and Community Medicine, Contra Costa Regional Medical Center, Martinez, California (T.D.L.)
| | - Nehad Mohamed
- Department of Pathology, The Ohio State University, Columbus, Ohio (N.L.L., A.U., C.R.P., K.K., K.Z., N.M., G.Z., W.Z.); Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana (E.M.H., J.M.B.); Department of Pathology, Vanderbilt University, Nashville, Tennessee (B.C.M.); Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia (M.J.S.); Department of Pathology, Duke University, Durham, North Carolina (R.E.M., E.S.L.); Institute of Neuropathology, University Hospital Münster, Germany (W.P.); Institute for Neuropathology, University Hospital of Zurich, Switzerland (E.J.R.); Department of Pathology, The University of Texas Southwestern, Dallas, Texas (M.-M.G., J.M.R.); Department of Pathology, Case Western Reserve University, Cleveland, Ohio (M.C., M.L.C.); Department of Anatomic Pathology, Beaumont Hospital, Royal Oak, Michigan (M.S.D.); Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (C.R.P.); Department of Pathology, University of Illinois, Peoria, Illinois (S.E.M.); Department of Pathology, Sheikh Khalifa Medical City, Abu Dhabi, UAE (M.A.A.-A.); Department of Family and Community Medicine, Contra Costa Regional Medical Center, Martinez, California (T.D.L.)
| | - Guojuan Zhang
- Department of Pathology, The Ohio State University, Columbus, Ohio (N.L.L., A.U., C.R.P., K.K., K.Z., N.M., G.Z., W.Z.); Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana (E.M.H., J.M.B.); Department of Pathology, Vanderbilt University, Nashville, Tennessee (B.C.M.); Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia (M.J.S.); Department of Pathology, Duke University, Durham, North Carolina (R.E.M., E.S.L.); Institute of Neuropathology, University Hospital Münster, Germany (W.P.); Institute for Neuropathology, University Hospital of Zurich, Switzerland (E.J.R.); Department of Pathology, The University of Texas Southwestern, Dallas, Texas (M.-M.G., J.M.R.); Department of Pathology, Case Western Reserve University, Cleveland, Ohio (M.C., M.L.C.); Department of Anatomic Pathology, Beaumont Hospital, Royal Oak, Michigan (M.S.D.); Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (C.R.P.); Department of Pathology, University of Illinois, Peoria, Illinois (S.E.M.); Department of Pathology, Sheikh Khalifa Medical City, Abu Dhabi, UAE (M.A.A.-A.); Department of Family and Community Medicine, Contra Costa Regional Medical Center, Martinez, California (T.D.L.)
| | - Weiqiang Zhao
- Department of Pathology, The Ohio State University, Columbus, Ohio (N.L.L., A.U., C.R.P., K.K., K.Z., N.M., G.Z., W.Z.); Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana (E.M.H., J.M.B.); Department of Pathology, Vanderbilt University, Nashville, Tennessee (B.C.M.); Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia (M.J.S.); Department of Pathology, Duke University, Durham, North Carolina (R.E.M., E.S.L.); Institute of Neuropathology, University Hospital Münster, Germany (W.P.); Institute for Neuropathology, University Hospital of Zurich, Switzerland (E.J.R.); Department of Pathology, The University of Texas Southwestern, Dallas, Texas (M.-M.G., J.M.R.); Department of Pathology, Case Western Reserve University, Cleveland, Ohio (M.C., M.L.C.); Department of Anatomic Pathology, Beaumont Hospital, Royal Oak, Michigan (M.S.D.); Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (C.R.P.); Department of Pathology, University of Illinois, Peoria, Illinois (S.E.M.); Department of Pathology, Sheikh Khalifa Medical City, Abu Dhabi, UAE (M.A.A.-A.); Department of Family and Community Medicine, Contra Costa Regional Medical Center, Martinez, California (T.D.L.)
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