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Mangum R, Varga E, Boué DR, Capper D, Benesch M, Leonard J, Osorio DS, Pierson CR, Zumberge N, Sahm F, Schrimpf D, Pfister SM, Finlay JL. SHH desmoplastic/nodular medulloblastoma and Gorlin syndrome in the setting of Down syndrome: case report, molecular profiling, and review of the literature. Childs Nerv Syst 2016; 32:2439-2446. [PMID: 27444290 DOI: 10.1007/s00381-016-3185-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 07/07/2016] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Individuals with Down syndrome (DS) have an increased risk of acute leukemia compared to a markedly decreased incidence of solid tumors. Medulloblastoma, the most common malignant brain tumor of childhood, is particularly rare in the DS population, with only one published case. As demonstrated in a mouse model, DS is associated with cerebellar hypoplasia and a decreased number of cerebellar granule neuron progenitor cells (CGNPs) in the external granule cell layer (EGL). Treatment of these mice with sonic hedgehog signaling pathway (Shh) agonists promote normalization of CGNPs and improved cognitive functioning. CASE REPORT We describe a 21-month-old male with DS and concurrent desmoplastic/nodular medulloblastoma (DNMB)-a tumor derived from Shh dysregulation and over-activation of CGNPs. Molecular profiling further classified the tumor into the new consensus SHH molecular subgroup. Additional testing revealed a de novo heterozygous germ line mutation in the PTCH1 gene encoding a tumor suppressor protein in the Shh pathway. DISCUSSION The developmental failure of CGNPs in DS patients offers a plausible explanation for the rarity of medulloblastoma in this population. Conversely, patients with PTCH1 germline mutations experience Shh overstimulation resulting in Gorlin (Nevoid Basal Cell Carcinoma) syndrome and an increased incidence of malignant transformation of CGNPs leading to medulloblastoma formation. This represents the first documented report of an individual with DS simultaneously carrying PTCH1 germline mutation. CONCLUSION We have observed a highly unusual circumstance in which the PTCH1 mutation appears to "trump" the effects of DS in causation of Shh-activated medulloblastoma.
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Affiliation(s)
- Ross Mangum
- The Divisions of Hematology/Oncology/BMT, Neurosurgery and Neuropathology, the Departments of Pediatrics, Surgery and Pathology, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA.
| | - Elizabeth Varga
- The Divisions of Hematology/Oncology/BMT, Neurosurgery and Neuropathology, the Departments of Pediatrics, Surgery and Pathology, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Daniel R Boué
- The Divisions of Hematology/Oncology/BMT, Neurosurgery and Neuropathology, the Departments of Pediatrics, Surgery and Pathology, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - David Capper
- German Cancer Consortium (DKTK), Core Center Heidelberg, Heidelberg, Germany.,Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Martin Benesch
- Division of Pediatric Hematology/Oncology, Medical University of Graz, Graz, Austria
| | - Jeffrey Leonard
- The Divisions of Hematology/Oncology/BMT, Neurosurgery and Neuropathology, the Departments of Pediatrics, Surgery and Pathology, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Diana S Osorio
- The Divisions of Hematology/Oncology/BMT, Neurosurgery and Neuropathology, the Departments of Pediatrics, Surgery and Pathology, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Christopher R Pierson
- The Divisions of Hematology/Oncology/BMT, Neurosurgery and Neuropathology, the Departments of Pediatrics, Surgery and Pathology, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Nicholas Zumberge
- The Divisions of Hematology/Oncology/BMT, Neurosurgery and Neuropathology, the Departments of Pediatrics, Surgery and Pathology, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Felix Sahm
- German Cancer Consortium (DKTK), Core Center Heidelberg, Heidelberg, Germany.,Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Daniel Schrimpf
- German Cancer Consortium (DKTK), Core Center Heidelberg, Heidelberg, Germany.,Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan M Pfister
- German Cancer Consortium (DKTK), Core Center Heidelberg, Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jonathan L Finlay
- The Divisions of Hematology/Oncology/BMT, Neurosurgery and Neuropathology, the Departments of Pediatrics, Surgery and Pathology, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
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Tan HW, Ty A, Goh SGN, Wong MC, Hong A, Chuah KL. Pineal yolk sac tumour with a solid pattern: a case report in a Chinese adult man with Down's syndrome. J Clin Pathol 2004; 57:882-4. [PMID: 15280413 PMCID: PMC1770394 DOI: 10.1136/jcp.2004.016659] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Intracranial germ cell tumours are rare. The incidence of primary intracranial yolk sac tumour is even more uncommon, with only two reported cases being associated with Down's syndrome in the English literature. This report details the findings of yolk sac tumour in the pineal region affecting a 22 year old Chinese man with Down's syndrome. Histology revealed yolk sac tumour with only a solid pattern, potentially mimicking the more common germinoma in the pineal region. No other germ cell components were identified. This is the third report of intracranial yolk sac tumour manifesting in a patient with trisomy 21. The pathology of this tumour and its differential diagnoses are discussed.
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Affiliation(s)
- H W Tan
- Department of Pathology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
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Abstract
Choroid plexus tumors are rare intraventricular papillary neoplasms derived from choroid plexus epithelium, which account for only between 0.4-0.6% of all intracranial and 2-3% of pediatric neoplasms. Plexus papillomas outnumber choroid plexus carcinomas by a ratio of 5:1 and around 80% of choroid plexus carcinomas arise in children. Plexus tumors are most common in the lateral and fourth ventricles; while 80% of lateral ventricle tumors present in children, fourth ventricle tumors are evenly distributed in all age groups. Clinically, choroid plexus tumors tend to cause hydrocephalus and increased intracranial pressure. Histologically, choroid plexus papillomas correspond to WHO grade I, choroid plexus carcinomas to WHO grade III. Immunohistochemically, cytokeratins and vimentin are expressed by virtually all choroid plexus papillomas and most choroid plexus carcinomas while transthyretin and S-100 protein are present in 80-90% of cases, less frequently, though, in choroid plexus carcinomas. Glial fibrillary acidic protein can be found focally in about 25-55% of choroid plexus papillomas and 20% of choroid plexus carcinomas. The mean Ki67/MIB1 labeling index for choroid plexus papillomas is 1.9%, for choroid plexus carcinomas 13. 8%. Choroid plexus papillomas typically show hyperdiploidy with gains particularly on chromosomes 7, 9, 12, 15, 17, and 18 while one choroid plexus carcinoma showed rearrangements of chromosomes 7p11-12, 9q11-12, 15q22, and 19q13.4. Choroid plexus papillomas can usually be cured by surgery alone with a 5-year survival rate of up to 100% with occasional recurrences while choroid plexus carcinomas grow more rapidly and have a less favorable outcome with a 5-year survival rate of 26-40%.
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Affiliation(s)
- C H Rickert
- Institute of Neuropathology, Westfälische Wilhelms-Universität, Domagkstrasse 19, Münster, Germany.
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Tanabe M, Mizushima M, Anno Y, Kondou S, Dejima S, Hirao DJ, Kamitani H, Watanabe T, Hori T. Intracranial germinoma with Down's syndrome: a case report and review of the literature. SURGICAL NEUROLOGY 1997; 47:28-31. [PMID: 8986161 DOI: 10.1016/s0090-3019(96)00152-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Down's syndrome's association with malignancies such as leukemia is well known, but its association with brain tumor appears to be rare. We reviewed such rare cases of Down's syndrome and intracranial germ-cell tumor. CASE REPORT A 10-year-old boy with Down's syndrome and intracranial germinoma located in the left basal ganglia is reported. The patient presented with right hemiparesis and was treated with a combination of surgery, chemotherapy with cisplatin and etoposide, and irradiation. CONCLUSIONS We speculate that the percentage of germ-cell tumors is high among Down syndrome patients with brain tumors and that the most common site is the basal ganglia.
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Affiliation(s)
- M Tanabe
- Division of Neurosurgery, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, Yonago, Japan
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Satge D, Van Den Berghe H. Aspects of the neoplasms observed in patients with constitutional autosomal trisomy. CANCER GENETICS AND CYTOGENETICS 1996; 87:63-70. [PMID: 8646744 DOI: 10.1016/0165-4608(95)00249-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A review of the literature reveals numerous clinical case reports, systematic histologic analyses, epidemiologic studies, and large series of tumors showing that subjects with trisomy 8, 9, 13, 18, and 21 have an excess of hematologic and various solid tumors compared to the general population. These tumors more frequently affect particular organs for a given type of trisomy. A large proportion of tumors are observed during fetal and neonatal life, are incompletely developed, and subsequently regress. In older children or even adults, tumors are less frequent, are often found on the same organs as earlier in life, are more aggressive, and do not involute. The mechanism responsible for the development of these neoplasms could be similar to that which generates the malformations in these children and may result from cooperation of the chromosomal abnormality with physiologic growth phenomena, which are particularly active early in life. Trisomic subjects must be carefully followed in order to detect tumors as early as possible and to allow treatment under optimal conditions.
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Affiliation(s)
- D Satge
- Laboratoire d'Anatomie Pathologique, Tulle, France
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