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Cuoco JA, Williams S, Klein BJ, Borowicz VM, Ho H, Stump MS, Rogers CM. Astroblastoma With a Novel YAP1::BEND2 Fusion: A Case Report. J Pediatr Hematol Oncol 2024; 46:e313-e316. [PMID: 38857191 DOI: 10.1097/mph.0000000000002885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 04/23/2024] [Indexed: 06/12/2024]
Abstract
In the most recent fifth edition of the World Health Organization Classification of Tumors of the Central Nervous System, astroblastoma has been defined by molecular rearrangements involving the MN1 gene, with common partners being BEND2 or CXXC5 . Accordingly, this tumor entity is now known as "astroblastoma, MN1 -altered." However, gliomas with EWSR1::BEND2 fusions, devoid of MN1 fusion alterations, have recently been shown to exhibit astroblastoma-like histomorphologic features and reside in a distinct epigenetic subgroup based on DNA methylation studies similar to high-grade neuroepithelial tumor with MN1 alteration, which includes astroblastoma, MN1 altered tumors. This new epigenetically distinct subtype of astroblastoma containing EWSR1::BEND2 fusions lacks the required MN1 alteration and, thus, does not satisfy the current molecular classification of these lesions. Here, we describe a case of glioma with histologic features and DNA methylation profiling consistent with astroblastoma with a novel YAP1: : BEND2 fusion. This case and others further expand the molecular findings observable in astroblastoma-like tumors outside the constraints of MN1 alteration. Such cases of astroblastoma with EWSR1::BEND2 and YAP1::BEND2 fusions challenge the current molecular classification of astroblastoma based solely on an MN1 alteration.
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Affiliation(s)
- Joshua A Cuoco
- Virginia Tech Carilion School of Medicine, 2 Riverside Circle
- Department of Neurosurgery
- School of Neuroscience, Virginia Polytechnic Institute and State University, 635 Prices Fork Road, Blacksburg, VA
| | - Serina Williams
- Virginia Tech Carilion School of Medicine, 2 Riverside Circle
| | - Brendan J Klein
- Virginia Tech Carilion School of Medicine, 2 Riverside Circle
- Department of Neurosurgery
- School of Neuroscience, Virginia Polytechnic Institute and State University, 635 Prices Fork Road, Blacksburg, VA
| | - Violet M Borowicz
- Virginia Tech Carilion School of Medicine, 2 Riverside Circle
- Department of Pediatric Hematology Oncology
| | - Hao Ho
- NeoGenomics Laboratories, Inc, 31 Columbia, Aliso Viejo, CA
| | - Michael S Stump
- Virginia Tech Carilion School of Medicine, 2 Riverside Circle
- Department of Pathology, Carilion Clinic, 1906 Belleview Ave, Roanoke
| | - Cara M Rogers
- Virginia Tech Carilion School of Medicine, 2 Riverside Circle
- Department of Neurosurgery
- School of Neuroscience, Virginia Polytechnic Institute and State University, 635 Prices Fork Road, Blacksburg, VA
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2
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Allison CM, Scoones D, Batra A, Sinclair G. Thirteen-year long-term follow-up in a rare case of anaplastic astroblastoma: What makes the difference? Surg Neurol Int 2022; 13:221. [PMID: 35673675 PMCID: PMC9168415 DOI: 10.25259/sni_1065_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 05/02/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Astroblastomas are uncommon neuroepithelial tumors of the central nervous system with a distinct, yet, controversial radiological, histological, and molecular profile. Debatable differences between low- and high-grade astroblastoma have been reported in the medical literature; indeed, despite the increasing relevance of molecular genetic profiling in the realm of astroblastoma, its application is still in its early stages. As a result, the diagnostic criteria for astroblastoma remain undecided with yet no real consensus on the most ideal management. Case Description: This report describes a case of astroblastoma diagnosed 13 years ago in a young woman who despite six episodes of recurrence, transformation, and progression was able to retain a perfomace status of 0 by World Health Organization standard, throughout. Conclusion: This report discusses the clinical, radiological, histological features, and management of this rare tumor with an extraordinarily long survival, with an aim to strengthen the literature on management options. To the best of our knowledge, this is the longest surviving case of anaplastic astroblastoma reported in the available medical literature.
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Affiliation(s)
| | - David Scoones
- Department of Neuropathology, James Cook University Hospital, Middlesbrough, UK
| | - Arun Batra
- Department of Radiology James Cook University Hospital, Middlesbrough, UK
| | - Georges Sinclair
- Department of Oncology, James Cook University Hospital, Middlesbrough, UK.,Department of Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.,Department of Neurosurgery, Bezmialem Vakif University Hospital, Istanbul, Turkey
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3
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Jeon C, Kim B, Choi JW. Clinicoradiological and histopathological characteristics and treatment outcomes of cerebral astroblastoma in children: a single-institution experience. J Neurosurg Pediatr 2022; 29:513-519. [PMID: 35180693 DOI: 10.3171/2022.1.peds21389] [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: 07/31/2021] [Accepted: 01/03/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Astroblastoma (AB) is a rare glial tumor. The optimal treatment and prognosis of this tumor remain unclear. The authors retrospectively analyzed the clinical characteristics, neuroimaging findings, histopathological results, and treatment outcomes of 7 patients with AB. METHODS The study comprised 7 patients with pathologically proven AB who were surgically treated at Samsung Medical Center from November 1994 to January 2019. Clinicoradiological, histopathological, and surgical records were reviewed. RESULTS The patients included 5 girls (71.4%) and 2 boys (28.6%), with a median age of 13 years. All patients showed contrast enhancement on preoperative MRI: 5 ABs (71.4%) showed a concomitant solid and cystic appearance, and 2 (28.6%) demonstrated a solid appearance. ABs in 6 patients (85.7%) showed a well-circumscribed, characteristic "bubbly" appearance on T2-weighted MRI. Gross-total resection (GTR) was achieved in all cases (100%). Six patients (85.7%) were diagnosed with high-grade AB and 1 (14.3%) with low-grade AB. Six (85.7%) of the 7 patients received adjuvant treatment after resection, including 5 (83.3%) with AB who received chemotherapy and radiotherapy and 1 (16.7%) who received proton therapy alone. The median clinical follow-up duration was 96 months (range 48-189 months). Two patients experienced recurrence, and all patients in this series were alive at the last follow-up. CONCLUSIONS In this study, the clinicoradiological and histopathological features of AB were described. Based on the authors' limited experience with 7 cases, resection with the goal of GTR is currently the mainstream treatment for AB, and adjuvant radiation treatment should be considered after surgery.
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Affiliation(s)
- Chiman Jeon
- 1Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; and
| | - Binnari Kim
- 2Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jung Won Choi
- 1Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; and
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Dey B, Dutta S, Saurabh A, Raphael V, Khonglah Y. Cerebral Astroblastoma: A Rare Tumor. Cureus 2021; 13:e16323. [PMID: 34395111 PMCID: PMC8355865 DOI: 10.7759/cureus.16323] [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] [Accepted: 07/11/2021] [Indexed: 11/24/2022] Open
Abstract
Astroblastoma is a rare neuroepithelial tumor of the central nervous system, which accounts for only 0.45-2.8% of all neuroglial tumors. These tumors have distinct radiological, histopathological, immunohistochemical, and molecular features. We describe a case of astroblastoma of the left temporal lobe in a 38-year-old female, who presented with complaints of headache and occasional episodes of vomiting.
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Affiliation(s)
- Biswajit Dey
- Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND
| | - Satya Dutta
- Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND
| | - Animesh Saurabh
- Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND
| | - Vandana Raphael
- Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND
| | - Yookarin Khonglah
- Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND
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Yapıcıer Ö, Demir MK, Özdamarlar U, Kılıç D, Akakın A, Kılıç T. Posterior fossa astroblastoma in a child: a case report and a review of the literature. Childs Nerv Syst 2019; 35:1251-1255. [PMID: 30859299 DOI: 10.1007/s00381-019-04113-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 03/05/2019] [Indexed: 01/13/2023]
Abstract
A 4-year-old girl presented to the hospital with a progressive headache, difficulty walking, and persistent daily vomiting for 3 weeks. Papilledema was observed on fundoscopic examination. A large left cerebellovermian tumor with "bubbly" appearance was discovered. Total removal of the tumor mass was performed, and a diagnosis of low-grade astroblastoma was made. Adjuvant radiotherapy was performed due to the risk of recurrence. The patient is disease-free and has been kept on close follow-up for 6 months. The occurrence of posterior fossa astroblastoma has been rarely reported in the literature. Thus, when a "bubby" appearance enhancing cystic solid tumor is located on the cerebellar hemisphere in a child, an astroblastoma should also be included in the differential diagnosis.
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Affiliation(s)
- Özlem Yapıcıer
- Department of Pathology, Bahçeşehir University School of Medicine, Göztepe Medical Park Training and Education Hospital, Istanbul, Turkey
| | - Mustafa Kemal Demir
- Department of Radiology,, Bahçeşehir University School of Medicine, Göztepe Medical Park Training and Education Hospital, 11. kisim, Yasemin Apt, D blok. Daire 35 Ataköy, 34158, Istanbul, Turkey.
| | - Umut Özdamarlar
- Department of Radiology,, Bahçeşehir University School of Medicine, Göztepe Medical Park Training and Education Hospital, 11. kisim, Yasemin Apt, D blok. Daire 35 Ataköy, 34158, Istanbul, Turkey
| | - Deniz Kılıç
- Bahçeşehir University School of Medicine, Istanbul, Turkey
| | - Akın Akakın
- Department of Neurosurgery, Bahçeşehir University School of Medicine, Göztepe Medical Park Training and Education Hospital, Istanbul, Turkey
| | - Türker Kılıç
- Department of Neurosurgery, Bahçeşehir University School of Medicine, Göztepe Medical Park Training and Education Hospital, Istanbul, Turkey
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Hammas N, Senhaji N, Alaoui Lamrani MY, Bennis S, Chaoui EM, El Fatemi H, Chbani L. Astroblastoma - a rare and challenging tumor: a case report and review of the literature. J Med Case Rep 2018; 12:102. [PMID: 29678196 PMCID: PMC5910607 DOI: 10.1186/s13256-018-1623-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 02/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background Astroblastoma is a controversial and an extremely rare central nervous system neoplasm. Although its histogenesis has been clarified recently, controversies exist regarding its cellular origin and validity as a distinct entity. Because of its extreme rarity and because its common features are shared with other glial neoplasms, this tumor is prone to misdiagnosis and remains challenging not only in terms of diagnosis and classification but also in the subsequent management. This case report describes a new case of astroblastoma. It discusses clinical, radiologic, pathological, and therapeutic features and differential diagnosis of this rare neoplasm, with a review of the recent literature. Case presentation We report the case of an 8-year-old Moroccan girl who presented with a 1-year history of epileptic seizure, headache, and decreased visual acuity. Cranial magnetic resonance imaging revealed a right occipito-temporal mass. A tumor resection was performed and histological examination combined with immunohistochemical study confirmed the diagnosis of low-grade astroblastoma. Conclusions Astroblastoma is a very rare primary brain tumor. Its diagnosis is often challenging because of the astroblastic aspects that can be found in astrocytic tumors, in ependymomas, and in non-neuroepithelial tumors. Considerable confusion surrounds its histogenesis and classification. The low incidence rate makes it difficult to conduct studies to examine tumor characteristics.
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Affiliation(s)
- Nawal Hammas
- Department of Pathology, Hassan II University Hospital, 30000, Fez, Morocco. .,Biomedical and Translational Research Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco.
| | - Nadia Senhaji
- Bioactive Molecules Laboratory, Faculty of Science and Technology, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - My Youssef Alaoui Lamrani
- Department of Radiology, Hassan II University Hospital, Fez, Morocco.,Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Sanae Bennis
- Biomedical and Translational Research Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco.,Oncogenetic/pathology Unit, Hassan II University Hospital, Fez, Morocco
| | - Elfaiz Mohamed Chaoui
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco.,Department of Neurosurgery, Hassan II University Hospital, Fez, Morocco
| | - Hind El Fatemi
- Department of Pathology, Hassan II University Hospital, 30000, Fez, Morocco.,Biomedical and Translational Research Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Laila Chbani
- Department of Pathology, Hassan II University Hospital, 30000, Fez, Morocco.,Biomedical and Translational Research Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
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Sadiq M, Ahmad I, Shuja J, Ahmad Z, Ahmed R, Ahmad K. Astroblastoma in a Young Female Patient: A Case Report and Literature Review of Clinicopathological, Radiological and Prognostic Characteristics and Current Treatment Strategies. Brain Tumor Res Treat 2017; 5:120-126. [PMID: 29188215 PMCID: PMC5700025 DOI: 10.14791/btrt.2017.5.2.120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/03/2017] [Accepted: 09/19/2017] [Indexed: 01/26/2023] Open
Abstract
Astroblastoma is an uncommon glial tumor with predominant manifestation in the young age. Herein, we report a case of 18-year-old astroblastoma female patient who presented with history of two months headache. Magnetic resonance imaging (MRI) of the brain demonstrated well circumscribed, intra-axial abnormal signal intensity lesion (size=5×4 cm2) in the right parieto-occipital region of the brain. The patient underwent complete surgical resection of the gross tumor, as confirmed by an early post-surgical MRI (i.e., within 24 hours of surgery). Histopathological examination revealed neoplastic lesion exhibiting perivascular pseudo-rosettes with centrally hyalinized blood vessel and focal nuclear pleomorphism. Immunohistochemistry staining illustrated reactivity for glial fibrillary acidic protein and integrase interactor 1 (INI-1). These features rendered the diagnosis of astroblastoma. A comprehensive review of the current literature to summarize the clinicopathological and radiological characteristics, prognostic factors and current treatment strategies of astroblastomas is also presented. Our study would expand the pool of this uncommon tumor towards its better understanding and optimal treatment.
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Affiliation(s)
- Muhammad Sadiq
- Center for Nuclear Medicine and Radiotherapy, Quetta, Pakistan
| | - Iftikhar Ahmad
- Institute of Radiotherapy and Nuclear Medicine, Peshawar, Pakistan
| | - Jamila Shuja
- Center for Nuclear Medicine and Radiotherapy, Quetta, Pakistan
| | - Zubair Ahmad
- Agha Khan University Hospital, Karachi, Pakistan
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Samples DC, Henry J, Yu FF, Bazan C, Tarasiewicz I. A case of astroblastoma: Radiological and histopathological characteristics and a review of current treatment options. Surg Neurol Int 2016; 7:S1008-S1012. [PMID: 28144474 PMCID: PMC5234270 DOI: 10.4103/2152-7806.195583] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 10/17/2016] [Indexed: 11/30/2022] Open
Abstract
Background: Astroblastoma is a rare neuroepithelial tumor that often originates in the cerebral hemisphere of children and young adults. Diagnosis of this obscure neoplasm can be difficult because these tumors are so infrequently encountered and share common radiological and neuropathological features of other glial neoplasms. As such, it should be included in the differential diagnosis of astrocytoma and ependymoma if the clinical and radiographic features suggest it. Standardized treatment of astroblastomas remains under dispute because of the lack of knowledge regarding the tumor and a paucity of studies in the literature. Case Description: We present a case of a low-grade astroblastoma diagnosed in a 30-year-old female with seizures, headache, and vision changes. She underwent gross total resection and, without evidence of high-grade features, adjuvant therapy was not planned postoperatively. Post-operative surveillance suggested early recurrence, warranting referral to radiation therapy. Patient ended up expiring despite adjuvant therapy secondary to extensive recurrence and tumor metastasis. Conclusions: Astroblastoma must be considered in the differential of supratentorial tumors in children and young adults. Treatment of such, as suggested by most recent literature, includes gross total resection and adjuvant radiotherapy for lesions exhibiting high-grade features.
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Affiliation(s)
- Derek C Samples
- Department of Neurological Surgery, University of Texas Health Science Center, San Antonio, Texas, USA
| | - James Henry
- Department of Pathology, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Fang Frank Yu
- Department of Radiology, Massachusetts General Hospital, Boston
| | - Carlos Bazan
- Department of Radiology, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Izabela Tarasiewicz
- Department of Neurological Surgery, University of Texas Health Science Center, San Antonio, Texas, USA
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Cunningham DA, Lowe LH, Shao L, Acosta NR. Neuroradiologic characteristics of astroblastoma and systematic review of the literature: 2 new cases and 125 cases reported in 59 publications. Pediatr Radiol 2016; 46:1301-8. [PMID: 27048363 DOI: 10.1007/s00247-016-3607-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 01/30/2016] [Accepted: 03/03/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Astroblastoma is a rare tumor of uncertain origin most commonly presenting in the cerebrum of children and young adults. The literature contains only case reports and small series regarding its radiologic features. This systematic review is the largest study of imaging findings of astroblastoma to date and serves to identify features that might differentiate it from other neoplasms. OBJECTIVE This study describes the imaging features of astroblastoma based on a systematic review of the literature and two new cases. MATERIALS AND METHODS We conducted a PubMed and Google Scholar database search that identified 59 publications containing 125 cases of pathology-confirmed astroblastoma, and we also added two new cases from our own institution. Data collected include patient age, gender, tumor location, morphology, calcifications and calvarial changes. We recorded findings on CT, MRI, diffusion-weighted imaging (DWI), MR spectroscopy, positron emission tomography (PET) and catheter angiography. RESULTS Age at diagnosis ranged 0-70 years (mean 18 years; median 14 years). Female-to-male ratio was 8:1. Of 127 cases, 66 reported CT, 78 reported MRI and 47 reported both findings. Not all authors reported all features, but the tumor features reported included supratentorial in 96% (122/127), superficial in 72% (48/67), well-demarcated in 96% (79/82), mixed cystic-solid in 93% (79/85), and enhancing in 99% (78/79). On CT, 84% (26/31) of astroblastomas were hyperattenuated, 73% (27/37) had calcifications and 7 cases reported adjacent calvarial erosion. Astroblastomas were hypointense on T1-W in 58% (26/45) and on T2-W in 50% (23/46) of MRI sequences. Peritumoral edema was present in 80% (40/50) of cases but was typically described as slight. Six cases included DWI findings, with 100% showing restricted diffusion. On MR spectroscopy, 100% (5/5) showed nonspecific tumor spectra with elevated choline and decreased N-acetylaspartate (NAA). PET revealed nonspecific reduced uptake of [F-18] 2-fluoro-2-deoxyglucose ((18)F-FDG) and increased uptake of [11C]-Methionine in 100% (3/3) of cases. Catheter angiography findings (n=12) were variable, including hypervascularity in 67%, arteriovenous shunting in 33% and avascular areas in 25%. CONCLUSION Astroblastomas occur most often in adolescent girls. Imaging often shows a supratentorial, superficial, well-defined, cystic-solid enhancing mass. On CT, most are hyperattenuated, have calcifications, and may remodel adjacent bone if superficial. MRI characteristically reveals a hypointense mass on T1-W and T2-W sequences with restricted diffusion. MR spectroscopy, PET and catheter angiography findings are nonspecific.
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Affiliation(s)
- Danielle A Cunningham
- University of Missouri-Kansas City School of Medicine, 2411 Holmes St., Kansas City, MO, 64108, USA.
| | - Lisa H Lowe
- University of Missouri-Kansas City School of Medicine, 2411 Holmes St., Kansas City, MO, 64108, USA
- Department of Radiology, Children's Mercy Hospital and Clinics, Kansas City, MO, USA
| | - Lei Shao
- University of Missouri-Kansas City School of Medicine, 2411 Holmes St., Kansas City, MO, 64108, USA
- Department of Pathology, Children's Mercy Hospital and Clinics, Kansas City, MO, USA
| | - Natasha R Acosta
- University of Missouri-Kansas City School of Medicine, 2411 Holmes St., Kansas City, MO, 64108, USA
- Department of Radiology, Truman Medical Center, Kansas City, MO, USA
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