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Bielle F, Ducray F, Mokhtari K, Dehais C, Adle-Biassette H, Carpentier C, Chanut A, Polivka M, Poggioli S, Rosenberg S, Giry M, Marie Y, Duyckaerts C, Sanson M, Figarella-Branger D, Idbaih A. Tumor cells with neuronal intermediate progenitor features define a subgroup of 1p/19q co-deleted anaplastic gliomas. Brain Pathol 2016; 27:567-579. [PMID: 27543943 DOI: 10.1111/bpa.12434] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/15/2016] [Indexed: 02/01/2023] Open
Abstract
The integrated diagnosis of anaplastic oligodendroglioma, IDH mutant and 1p/19q co-deleted, grade III (O3id ) is a histomolecular entity that WHO 2016 classification distinguished from other diffuse gliomas by specific molecular alterations. In contrast, its cell portrait is less well known. The present study is focused on intertumor and intratumor, cell lineage-oriented, heterogeneity in O3id . Based on pathological, transcriptomic and immunophenotypic studies, a novel subgroup of newly diagnosed O3id overexpressing neuronal intermediate progenitor (NIP) genes was identified. This NIP overexpression pattern in O3id is associated with: (i) morphological and immunohistochemical similarities with embryonic subventricular zone, (ii) proliferating tumor cell subpopulation with NIP features including expression of INSM1 and no expression of SOX9, (iii) mutations in critical genes involved in NIP biology and, (iv) increased tumor necrosis. Interestingly, NIP tumor cell subpopulation increases in O3id recurrence compared with paired newly diagnosed tumors. Our results, validated in an independent cohort, emphasize intertumor and intratumor heterogeneity in O3id and identified a tumor cell subpopulation exhibiting NIP characteristics that is potentially critical in oncogenesis of O3id . A better understanding of spatial and temporal intratumor cell heterogeneity in O3id will open new therapeutic avenues overcoming resistance to current antitumor treatments.
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Affiliation(s)
- Franck Bielle
- Service de Neuropathologie Raymond Escourolle, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Paris, F-75013, France.,Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, F-75013, France
| | - François Ducray
- Service de Neuro-oncologie, Hospices Civils de Lyon, Hôpital Neurologique, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Cancer Research Centre of Lyon, INSERM U1052, CNRS UMR5286, Lyon, France
| | - Karima Mokhtari
- Service de Neuropathologie Raymond Escourolle, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Paris, F-75013, France.,Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, F-75013, France.,OncoNeuroTek, Institut du Cerveau et de la Moelle épinière, ICM, Paris, F-75013, France
| | - Caroline Dehais
- AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, F-75013, France
| | | | - Catherine Carpentier
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, F-75013, France
| | - Anaïs Chanut
- Service de Neuropathologie Raymond Escourolle, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Paris, F-75013, France
| | - Marc Polivka
- Hôpital Lariboisière, Département de Pathologie, AP-HP, Paris, France
| | - Sylvie Poggioli
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, F-75013, France
| | - Shai Rosenberg
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, F-75013, France
| | - Marine Giry
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, F-75013, France
| | - Yannick Marie
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, F-75013, France.,OncoNeuroTek, Institut du Cerveau et de la Moelle épinière, ICM, Paris, F-75013, France
| | - Charles Duyckaerts
- Service de Neuropathologie Raymond Escourolle, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Paris, F-75013, France.,Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, F-75013, France
| | - Marc Sanson
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, F-75013, France.,AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, F-75013, France
| | - Dominique Figarella-Branger
- Département de Pathologie et Neuropathologie, Assistance Publique-Hôpitaux de Marseille, CHU Timone, Marseille, France.,Université Aix-Marseille, INSERM U911, Marseille, France
| | - Ahmed Idbaih
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, F-75013, France.,AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, F-75013, France
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- POLA Network investigators: Amiens: Christine Desenclos, Henri Sevestre; Angers: Philippe Menei, Audrey Rousseau; Besançon: Joel Godard, Gabriel Viennet; Bobigny: Antoine Carpentier; Bordeaux: Sandrine Eimer, Hugues Loiseau; Brest: Phong Dam-Hieu, Isabelle Quintin-Roué; Caen: Jean-Sebastien Guillamo, Emmanuelle Lechapt-Zalcman; Clermont-Ferrand:Jean-Louis Kemeny, Toufik Khallil; Clichy: Dominique Cazals-Hatem, Thierry Faillot; Cornebarrieu: Ioana Carpiuc, Pomone Richard; Créteil: Caroline Le Guerinel; Colmar: Claude Gaultier, Marie-Christine Tortel; Dijon: Marie-Hélène Aubriot-Lorton, François Ghiringhelli; Kremlin-Bicêtre: Clovis Adam, Fabrice Parker; Lille: Claude-Alain Maurage, Carole Ramirez; Limoges: Edouard Marcel Gueye, François Labrousse; Lyon: Anne Jouvet; Marseille: Olivier Chinot; Montpellier: Luc Bauchet, Valérie Rigau; Nancy: Patrick Beauchesne, Dr Guillaume Gauchotte; Nantes: Mario Campone, Delphine Loussouarn; Nice: Denys Fontaine, Fanny Vandenbos; Orléans: Claire Blechet, Mélanie Fesneau; Paris: Jean Yves Delattre (national coordinator of the network), Selma Elouadhani-Hamdi, Damien Ricard; Poitiers: Delphine Larrieu-Ciron, Pierre-Marie Levillain; Reims: Philippe Colin, Marie-Danièle Diebold; Rennes: Danchristian Chiforeanu, Elodie Vauléon; Rouen: Olivier Langlois, Annie Laquerrière; Saint-Etienne: Marie Janette Motsuo Fotso, Michel Peoc'h; Saint-Pierre de la réunion: Marie Andraud, Gwenaelle Runavot; Strasbourg: Marie-Pierre Chenard, Georges Noel; Suresnes: Dr Stéphane Gaillard, Dr Chiara Villa; Toulon: Nicolas Desse; Toulouse: Elisabeth Cohen-Moyal, Emmanuelle Uro-Coste; Villejuif: Frédéric Dhermain
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2
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Choudhri O, Razavi SM, Vogel H, Li G. Atypical and Rare Variants of Central Neurocytomas. Neurosurg Clin N Am 2015; 26:91-8. [DOI: 10.1016/j.nec.2014.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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3
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Canova CH, Riet FG, Idbaih A, Mokhtari K, Mazeron JJ, Feuvret L. [Radiotherapy in central neurocytoma and review of literature]. Cancer Radiother 2014; 18:222-8; quiz 245, 248. [PMID: 24708940 DOI: 10.1016/j.canrad.2013.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 12/11/2013] [Accepted: 12/13/2013] [Indexed: 11/29/2022]
Abstract
Central neurocytoma is a rare primary central nervous system tumour of young adults with good prognosis. Typical and atypical forms are described according to various histologic and histopathologic parameters. Central neurocytoma develops in the periventricular areas and is revealed by increased intracranial pressure. The tumour exhibits typical characteristics on CT scan and MRI and a characteristic peak of glycine on spectroscopy-MRI. The main treatment is total resection, which is achievable only in half of the cases. External beam therapy improves local control of partially resected and/or atypical central neurocytoma. Many studies show that stereotactic radiotherapy can be used in the therapeutic management as exclusive treatment, in postoperatives residues and in case of distant recurrence. Chemotherapy is the last line of treatment in refractory forms, especially in the forms with extracranial and/or neuromeningeal spread and in recurrent forms after treatment with surgery and/or radiotherapy.
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Affiliation(s)
- C-H Canova
- Service de radiothérapie, groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - F-G Riet
- Service de radiothérapie, groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - A Idbaih
- Service de neurologie 2 - Mazarin, groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - K Mokhtari
- Département de neuropathologie, groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - J-J Mazeron
- Service de radiothérapie, groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - L Feuvret
- Service de radiothérapie, groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
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4
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Li Y, Ye XF, Qian G, Yin Y, Pan QG. Pathologic features and clinical outcome of central neurocytoma: analysis of 15 cases. Chin J Cancer Res 2013. [DOI: 10.1007/s11670-012-0265-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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5
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Li Y, Ye XF, Qian G, Yin Y, Pan QG. Pathologic features and clinical outcome of central neurocytoma: analysis of 15 cases. Chin J Cancer Res 2013; 24:284-90. [PMID: 23358787 DOI: 10.3978/j.issn.1000-9604.2012.08.02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 08/15/2012] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To get better recognition of central neurocytoma and diminish misdiagnosis. METHODS A retrospective review identified 15 cases of central neurocytoma. All cases of central neurocytoma were analyzed for their clinical symptoms, pathologic changes, immunohistochemical staining, prognosis and differential diagnosis. Clinical follow up was performed. RESULTS There were 8 males and 7 females aged 10-64 years (median 32.93 years). The most common presenting symptoms were those related to increased intracranial pressure (ICP), including headache (100%), papilledema (93%) and vomiting (80%). All tumors were located in the ventricular system. The tumors were composed of uniform cells with round nuclei and a fine chromatin pattern, and in some areas, small cells with perinuclear halo could be seen. In particular, the anuclear areas may have a fine fibrillary matrix (neuropil). Nuclear atypia and vascular proliferation appeared in two cases, respectively. Focal necrosis could be seen in one case. Immunohistochemical findings included expression of synaptophysin (15/15), neuron specific enolase (12/15) and glial fibrillary acidic protein (GFAP) (3/15). MIB-1 proliferation index ranged from 0.8-12.5%, and was more than 2% in 3 of 15 cases assessed. Follow-up information of 11 patients was available. CONCLUSIONS Central neurocytoma has a favorable prognosis in general, but in some cases, the clinical course could be aggressive. Increase of GFAP positivity, proliferation index and vascular proliferation might suggest a more malignant process.
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Affiliation(s)
- Yu Li
- Institute of Neuroscience, Department of Pathology, Chongqing Medical University, Chongqing 400016, China
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6
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Qian H, Lin S, Zhang M, Cao Y. Surgical management of intraventricular central neurocytoma: 92 cases. Acta Neurochir (Wien) 2012; 154:1951-60. [PMID: 22941394 DOI: 10.1007/s00701-012-1446-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 07/04/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To analyse the clinical characteristics of intraventricular central neurocytomas and gain a better understanding of the surgical management and treatment strategies. METHODS A total of 92 cases of intraventricular central neurocytomas with initial treatment using surgical resection were studied retrospectively. RESULTS Among 48 male and 44 female patients, 65 underwent gross total resection and 27 underwent subtotal resection. Transcortical or transcallosal approaches were performed, and there was no significant difference between the two approaches in terms of effects and complications. Tumours with calcification or adhesion had a significant lower gross total resection rate. Three patients died after surgery. During follow-up, 55 patients underwent postoperative radiotherapy and four patients had a recurrence of the tumour. CONCLUSION Central neurocytomas mostly occur in the lateral ventricle system near the foramen of Monro. Therefore, total resection is the best treatment. Two surgical approaches are possible as treatment. Calcifications or adhesions affect the gross total resection of the tumour. Radiation therapy or radiosurgery therapy can be chosen as a salvage treatment in case of recurrence.
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7
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Shravan Kumar C, Sharma DN, Sharma K, Haresh KP, Rath GK. Youngest case of third ventricular anaplastic neurocytoma. Indian J Med Paediatr Oncol 2011; 31:69-71. [PMID: 21209769 PMCID: PMC2970939 DOI: 10.4103/0971-5851.71660] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 6-year-old child presented to us with on and off headache and vomiting for 4 months. On examination, there was bilateral papilledema with mild intracranial hypertension but with no neurological deficits. Magnetic resonance imaging (MRI) showed third ventricular mass with obstructive hydrocephalus with possibility of glioma. The patient underwent gross tumor excision and histopathology confirmed anaplastic neurocytoma. The postoperative MRI showed residual disease. The patient treated with adjuvant radiotherapy and temozolamide chemotherapy.
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Affiliation(s)
- Chinnikatti Shravan Kumar
- Department of Radiation Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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8
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Ogiwara H, Dubner S, Bigio E, Chandler J. Neurocytoma of the cerebellum. Surg Neurol Int 2011; 2:36. [PMID: 21541206 PMCID: PMC3086174 DOI: 10.4103/2152-7806.78246] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Accepted: 02/03/2011] [Indexed: 11/17/2022] Open
Abstract
Background: Neurocytomas are benign central nervous system tumor composed of small cells with characteristics of neuronal differentiation; they are usually located in the supratentorial periventricular region, in close relation to the septum pellucidum and the foramen of Monro. Case Description: Herein we report a rare case of a neurocytoma located in the cerebellar hemisphere. To date there are only four such reported cases. Conclusion: Neurocytomas should be considered in the differential diagnosis of mass lesions in the cerebellum.
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Affiliation(s)
- Hideki Ogiwara
- Division of Neurosurgery, Northwestern University, Feinberg, School of Medicine, Chicago, IL, USA
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9
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Mutation-specific IDH1 antibody differentiates oligodendrogliomas and oligoastrocytomas from other brain tumors with oligodendroglioma-like morphology. Acta Neuropathol 2011; 121:241-52. [PMID: 21069360 DOI: 10.1007/s00401-010-0770-2] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 10/26/2010] [Accepted: 10/26/2010] [Indexed: 02/01/2023]
Abstract
Isocitrate dehydrogenase 1 (IDH1) mutations are frequent in astrocytomas, oligoastrocytomas and oligodendrogliomas. We previously reported the generation of a mutation-specific antibody that specifically detects R132H mutated IDH1 protein (clone H09). Here, we investigate the feasibility of H09 immunohistochemistry to differentiate between oligodendrogliomas/oligoastrocytomas and other tumors with similar morphology. A total of 274 brain tumors presenting with focal or extensive clear cell morphology were investigated. High numbers of H09-positive cases were observed in adult grade II oligodendrogliomas (67 of 74, 91%), grade III oligodendrogliomas (65 of 69, 94%), grade II oligoastrocytomas (11 of 14, 79%) and grade III oligoastrocytomas (10 of 11, 91%). All cases of pediatric oligodendrogliomas (n = 7), neurocytomas (n = 41, 35 central, 4 extraventricular, 2 cerebellar liponeurocytomas), dysembryoplastic neuroepithelial tumors (n = 21), clear cell ependymomas (n = 8), clear cell meningiomas (n = 9) as well as 12 primary glioblastomas with oligodendroglial differentiation and 5 pilocytic astrocytomas with oligodendroglial-like differentiation were negative for H09 immunohistochemistry. Three oligodendrogliomas with neurocytic differentiation had evidence of IDH1/IDH2 mutations either by H09 immunohistochemistry or direct sequencing. We conclude that in tumors with an oligodendroglioma-like morphology, binding of H09 is highly specific for oligodendrogliomas or oligoastrocytomas and substantially helps in the discrimination from other clear cell tumors. Negative H09 immunohistochemistry of an adult oligodendroglioma or oligoastrocytoma should prompt the consideration of other clear cell neoplasms. Further, our observations firmly assign oligodendrogliomas with neurocytic differentiation to the group of oligodendrogliomas and demonstrate that H09 is especially helpful for the difficult discrimination of such lesions from extraventricular neurocytomas.
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10
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Choudhari KA, Kaliaperumal C, Jain A, Sarkar C, Soo MYS, Rades D, Singh J. Central neurocytoma: A multi-disciplinary review. Br J Neurosurg 2009; 23:585-95. [DOI: 10.3109/02688690903254350] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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11
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Wong J, Teo C, Kwok B. Central neurocytoma in third and fourth ventricles with aqueductal involvement. Br J Neurosurg 2009; 20:57-62. [PMID: 16698614 DOI: 10.1080/02688690600598463] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Central neurocytomas are characterized by their intraventricular locations, usually arising from the lateral ventricles and their benign clinical course. Variations in location, histology and clinical behaviour have been reported in recent years. The authors present two cases of central neurocytomas arising in the third and fourth ventricles with aqueductal involvement. The atypical features in their location and behaviour are discussed. The cases represent the extended spectrum of central neurocytomas.
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Affiliation(s)
- J Wong
- Department of Neurosurgery, Prince of Wales Hospital, Sydney, New South Wales, Australia.
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12
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Sharma MC, Deb P, Sharma S, Sarkar C. Neurocytoma: a comprehensive review. Neurosurg Rev 2006; 29:270-85; discussion 285. [PMID: 16941163 DOI: 10.1007/s10143-006-0030-z] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2005] [Revised: 01/12/2006] [Accepted: 02/27/2006] [Indexed: 11/24/2022]
Abstract
Central neurocytomas (CN) are uncommon tumors of the central nervous system, most descriptions of which available in the literature are in the form of isolated case reports and small series. Owing to this rare incidence, diagnosis and management of this neoplasm remain controversial. Usually, these tumors affect lateral ventricles of young adults and display characteristic neuroimaging and histomorphologic findings. Neurocytomas often mimic oligodendrogliomas when confirmation of diagnosis rests on immunohistochemistry, ultrastructure, and genetic studies. Extraventricular neurocytomas, situated entirely within the brain parenchyma and spinal cord, have also been reported. Typically, CN are associated with a favorable outcome although cases with more aggressive clinical course with recurrences are not unknown. MIB-1 labeling index (LI) of >2% often heralds poor prognosis and tumour recurrence. Safe maximal resection is presently considered the ideal therapeutic option, with best long-term prognosis in terms of local control and survival. The role of adjuvant radiotherapy apparently seems to benefit patients with incomplete resection and in atypical neurocytoma. Utility of other therapeutic regimen, however, remains shrouded in controversy. Epidemiology, histogenesis, clinical profile, histology, neuroimaging and therapeutic modalities of neurocytomas have been comprehensively reviewed, with special emphasis on CN and extraventricular neurocytomas and their atypical counterparts.
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Affiliation(s)
- Mehar Chand Sharma
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
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Abstract
Abstract
OBJECTIVE AND IMPORTANCE:
Neurocytomas are typically located within the supratentorial ventricular system. Extraventricular neurocytomas are very rare, and this is only the second reported case of a pontine neurocytoma. We discuss the clinical presentation, histology, and treatment of these rare tumors.
CLINICAL PRESENTATION:
A 58-year-old man presented with a 4-month history of headache and unilateral facial and distal extremity paresthesia. Magnetic resonance imaging (MRI) scans demonstrated a 2.6 × 2.2-cm ring-enhancing cystic mass in the right pons.
INTERVENTION:
MRI-guided stereotactic biopsy yielded a diagnosis of atypical neurocytoma. Because of the location and malignant histological features of the tumor, the patient was initially treated with external beam radiation therapy. Several months later, MRI scans demonstrated tumor progression. The patient then underwent three rounds of temozolomide chemotherapy, during and after which his symptoms worsened. Aggressive subtotal resection of the tumor was achieved via a right suboccipital craniectomy.
CONCLUSION:
Twenty-eight months postoperatively, the patient is symptom free, and MRI scans demonstrate no evidence of residual or recurrent tumor.
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Affiliation(s)
- Bradley M Swinson
- Department of Neurosurgery, University of Florida, Gainesville 32610, USA
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14
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Lenzi J, Salvati M, Raco A, Frati A, Piccirilli M, Delfini R. Central neurocytoma: a novel appraisal of a polymorphic pathology. Our experience and a review of the literature. Neurosurg Rev 2006; 29:286-92; discussion 292. [PMID: 16604374 DOI: 10.1007/s10143-006-0024-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Revised: 12/01/2005] [Accepted: 12/28/2005] [Indexed: 11/30/2022]
Abstract
Central neurocytoma should be considered in the differential diagnosis of intraventricular tumours. The records of 20 patients operated on between 1975 and 2000 for central neurocytoma were retrospectively reviewed, and the histological gradings and clinical outcomes were compared. On the basis of our previous cases, in the latter five of this series, the following therapeutic protocol was adopted. In those cases in which total removal was achieved, no further treatment was given if the MIB-1 index was <4%; vice versa, if it was >4%, a course of conformational radiotherapy was delivered. In subtotally removed cases, radiosurgery with linac was also performed (median dose 20 Gy) as well as conformational radiotherapy whenever there was a recurrence of the lesion (median dose 45 Gy). In cases in which there was only partial cytoreduction, conformational radiotherapy was administered with the adjunct of polychemotherapy if the MIB-1 was >4%. Twenty patients were surgically treated: 11 men and nine women, with an average age of 26 years (range 17 years to 42 years).Total, subtotal and partial removals were achieved in, respectively, ten, three and seven cases. At average follow-up of 7 years, 16 patients had been cured, had significantly improved or were at least stable [Karnofsky performance status score (KPS)] >70 or more)]. On the other hand, four patients had worsened; of these, two had died and two had a KPS=50 and an unfavourable prognosis. The presence of histological atypia has proved to be a significantly negative risk factor for survival (P=0.02) while an MIB score >4% was significantly correlated with an unfavourable outcome (death or worsening of neurological status). The "atypical" neurocytoma seems to be a distinct entity, with a less favourable prognosis and a higher tendency to recur.
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Affiliation(s)
- Jacopo Lenzi
- Department of Neurosurgery, University of Rome La Sapienza, Rome, Italy
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15
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Ogawa Y, Sugawara T, Seki H, Sakuma T. Central neurocytomas with MIB-1 labeling index over 10% showing rapid tumor growth and dissemination. J Neurooncol 2006; 79:211-6. [PMID: 16552620 DOI: 10.1007/s11060-006-9129-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Accepted: 01/23/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVE AND IMPORTANCE Central neurocytoma is recognized as a indolent intraventricular tumor arising from the ependyma around the foramen of Monro and anterior part of the lateral ventricles, and well demarcated from the brain parenchyma. Surgical removal can be curative without postoperative therapy. However, malignant central neurocytoma refractory to even aggressive treatment is known. CLINICAL PRESENTATION We report two cases of extraventricular central neurocytomas with significant vascular proliferation, mitoses, and MIB-1 labeling index of more than 10%. INTERVENTION Subtotal removal for the one patient and open biopsy for other followed by radiotherapy with chemotherapy were performed. However, the disease progressed and dissemination occurred. Both patients subsequently died 23 and 18 month after the histological diagnosis was established. CONCLUSION Extraventricular central neurocytoma may present with frequent vascular proliferation and high MIB-1 labeling index. Even if they lack malignant histological findings like frequent mitosis and/or necrosis, the prognosis for such patients is very poor.
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Affiliation(s)
- Yoshikazu Ogawa
- Department of Neurosurgery, Iwate Prefectural Central Hospital, Morioka, Japan.
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16
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Bertalanffy A, Roessler K, Koperek O, Gelpi E, Prayer D, Knosp E. Recurrent central neurocytomas. Cancer 2005; 104:135-42. [PMID: 15880432 DOI: 10.1002/cncr.21109] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Since the first description of Central neurocytomas (CNs) as a benign tumor entity in 1982, there has been great enthusiasm regarding the benign course and the curative surgical approach to this disease. The current study was performed to investigate the frequency of disease recurrence during long-term follow-up. METHODS A retrospective analysis of the medical files with emphasis on clinicoradiologic findings and histologic and immunohistochemical features was performed. RESULTS Between 1985-2003. surgical resection was performed in 14 patients with CNs ages 16-43 years (7 were female and 7 were male). Two patients (14%) died postoperatively and one patient had a malignant disease course (7%). In the remaining 11 patients, one patient with an incompletely resected CN had disease progression after 37 months but at the time of last follow-up had had stable disease for 10 years. In addition, the authors reported 5 patients with disease recurrence occurring at a median of 67 months after surgery (range, 51-79 months after surgery), all of which occurred after complete surgical resection was performed. The observation period for the remaining 5 patients was short (median of 34 months [range, 5-44 months]). Extensive histologic and immunohistochemical workup did not identify any significant prognostic parameters. The MIB-1 proliferation index ranged from 0.8-11% (median of 4.6%), but was reported to be 46.8% in the malignant transformed tumor. All patients with disease recurrence responded well to different forms of focal radiation therapy (gamma knife radiosurgery in three patients and interstitial irradiation in one patient) and for one patient with a recently detected recurrence, gamma knife radiosurgery was planned. CONCLUSIONS CNs appear to have a higher tendency to recur during long-term follow-up than previously reported, even after complete resection. Therefore, periodic neuroradiologic follow-up examinations should be considered mandatory in all patients, even after several years.
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Mrak RE, Yasargil MG, Mohapatra G, Earel J, Louis DN. Atypical extraventricular neurocytoma with oligodendroglioma-like spread and an unusual pattern of chromosome 1p and 19q loss. Hum Pathol 2004; 35:1156-9. [PMID: 15343519 DOI: 10.1016/j.humpath.2004.05.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
An insular cortex tumor in a 54-year-old woman showed unequivocal neurocytic features, including open nuclei, distinct nucleoli, and strong synaptophysin immunoreactivity. Ultrastructurally, there were neuritic-type processes with microtubules and hillock-like attachments, and there were dense-core granules. Atypical features were mitotic activity, prominent vasculature, and small foci of necrosis. Peripherally, there was oligodendroglia-like histology with single-cell infiltration of white matter and perineuronal spread in cortex. Fluorescence in situ hybridization analysis with chromosome 1 and 19 probes showed 3 copies of 1q and 2 copies of 1p and showed 2 copies of 19q and 4 copies of 19p. This yielded a 1p-19q loss of heterozygosity pattern similar to that seen in oligodendrogliomas, although the actual chromosomal abnormality is distinct. This tumor, best classified as an atypical neurocytoma with oligodendroglia-like spread, supports suggestions of a close histogenic relationship between oligodendroglial and neurocytic tumors. This case also illustrates the limitations of relying exclusively on loss of heterozygosity analysis for tumor classification.
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Affiliation(s)
- Robert E Mrak
- Department of Pathology, University of Arkansas for Medical Sciences, Littlle Rock, AR 72205, USA
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Rodríguez De Lope A, De La Lama A, López-Ariztegui N, Martínez R, Conde C, Fiaño C, Vázquez F. Tratamiento del neurocitoma central. Experiencia en nuestro centro. Neurocirugia (Astur) 2004; 15:128-36; discussion 136-7. [PMID: 15159790 DOI: 10.1016/s1130-1473(04)70491-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Central neurocytomas are classically considered as a rare, intraventricular benign tumours with neuronal differentiation derived from precursor cells of subventricular matrix. However some patients with neoplasms with histologic atypia and elevated proliferation potential may have a poor outcome. Treatment of choice is complete surgical excision. Adjuvant therapy is reserved for patients with residual or recurrent lesions including reoperation, radiotherapy or chemotherapy. We review our experience with the treatment of this neoplasm. Five patients with an intraventricular mass studied with magnetic resonance imaging underwent craniotomy for tumour resection. All cases were reviewed retrospectively. Histopathological analysis confirmed central neurocytoma in all cases. Proliferation index was assessed by Ki-67 immunohistochemistry. Complete radiological tumor resection through transcortical approach was achieved in all except one patient. In this case adjuvant therapy with radiosurgery was given with important reduction in tumor size. All the tumours had a proliferation index below 2% except one with 5%. Follow-up in four patients ranged from 12 to 36 months. There were no tumour recurrences in this period. Complete surgical excision of central neurocytoma provides better local control and survival compared with other treatments. Radiosurgery as adjuvant therapy in incomplete resections may eliminate the need of reoperation and avoid long-term side effects from conventional radiotherapy.
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Affiliation(s)
- A Rodríguez De Lope
- Servicio de Neurocirugía, Hospital Universitario Xeral-Cíes, Vigo, Pontevedra
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Buccoliero AM, Caldarella A, Ammannati F, Mennonna P, Taddei A, Taddei GL. Extraventricular neurocytoma: morphological and immunohistochemical considerations on differential diagnosis. Pathol Res Pract 2003; 198:627-33; discussion 635-8. [PMID: 12440786 DOI: 10.1078/0344-0338-00312] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Neurocytoma is an unusual neuronal tumor especially affecting young people. It commonly arises in the ventricles and has a benign outcome. Herein, we report on a rare case of extraventricular neurocytomas (right parietal lobe) in a young girl admitted to hospital for a cranial trauma subsequent to a seizure. The tumor, radiologically well-circumscribed, cystic and enhancing, was surgically excised. The patient, who received no post surgical treatment, is alive and well after 18 months of follow-up. Pathological examination showed a well-differentiated lesion composed of uniform, round cells with perinuclear halos in a neuropil background and immunohistochemically positive for neuronal markers (synaptophysin, neuron-specific enolase, neurofilaments). The authors emphasize the role of the morphological and immunohistochemical evaluations to recognize this rare tumor.
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Affiliation(s)
- Anna Maria Buccoliero
- Dipartimento di Patologia Umana e Oncologia, Università degli Studi di Firenze, Italy
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20
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Kim CY, Paek SH, Kim DG. Linear accelerator radiosurgery for central neurocytoma: a case report. J Neurooncol 2003; 61:249-54. [PMID: 12675318 DOI: 10.1023/a:1022540929253] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study presents a case of central neurocytoma successfully treated with linear accelerator (LINAC)stereotactic radiosurgery. Originally, the tumor in the left lateral ventricle was removed by craniotomy, but a small residual mass was detected in follow-up magnetic resonance imagery 6 months after the operation. A further 6 months later, additional radiographic studies revealed that the residual mass had grown. LINAC radiosurgery was then performed, in which 1750 cGy doses were delivered at the 70% level with 3 isocenters (collimator size, 2 cm). The mass was completely absent over the duration of follow-up, including the final MR imagery examination 51 months after radiosurgery. LINAC radiosurgery is suggested to be a good treatment modality for residual or recurrent central neurocytoma.
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Affiliation(s)
- Chae-Yong Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
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Fujisawa H, Marukawa K, Hasegawa M, Tohma Y, Hayashi Y, Uchiyama N, Tachibana O, Yamashita J. Genetic differences between neurocytoma and dysembryoplastic neuroepithelial tumor and oligodendroglial tumors. J Neurosurg 2002; 97:1350-5. [PMID: 12507133 DOI: 10.3171/jns.2002.97.6.1350] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Because of their histological similarities, it is occasionally difficult to differentiate neurocytoma and dysembryoplastic neuroepithelial tumor (DNT) from oligodendroglial tumors. This study was conducted to investigate genetic differences among these tumor types in terms of loss of heterozygosity on chromosomes 1p and 19q, and p53 gene mutation. METHODS A total of 24 tumors were analyzed, consisting of eight central neurocytomas, three DNTs, seven oligodendrogliomas, four oligoastrocytomas, and two undetermined extraventricular tumors with neurocytoma features (ETNFs). Allelic loss was determined using microsatellite markers that cover the common deletions on chromosomes 1p and 19q in oligodendrogliomas. A p53 gene mutation was identified using polymerase chain reaction-single-strand conformation polymorphism analysis and subsequent direct sequencing. Immunohistochemical studies with synaptophysin and electron microscopy investigations were also conducted. Allelic loss on 1p and 19q was detected in six oligodendrogliomas (86%) and in three oligoastrocytomas (75%), but in none of the central neurocytomas or DNTs. A p53 missense mutation was detected at codon 161 (GCC-->ACC, Ala-->Thr) in only one oligoastrocytoma without allelic loss. Synaptophysin was expressed in all central neurocytomas and DNTs, in three oligodendrogliomas (43%), and in three oligoastrocytomas (75%). Of the ETNFs, one demonstrated synaptophysin expression and neural ultrastructures but lacked genetic alterations, whereas the other showed allelic loss on 1p and 19q but was negative immunohistochemically and ultrastructurally. The former was diagnosed as a potential intraparenchymal neurocytoma and the latter as an oligodendroglioma. CONCLUSIONS Despite histological similarities, central neurocytomas and DNTs are genetically distinct from oligodendroglial tumors. Examination for allelic loss on 1p and 19q and for p53 mutation can be useful for making this distinction.
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Affiliation(s)
- Hironori Fujisawa
- Department of Neurosurgery, Division of Neuroscience, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
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Schiffer D. Critical Commentary to: Extraventricular Neurocytoma: Morphological and Immunohistochemical Considerations on Differential Diagnosis. Pathol Res Pract 2002. [DOI: 10.1078/0344-0338-00314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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23
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Brat DJ, Scheithauer BW, Eberhart CG, Burger PC. Extraventricular neurocytomas: pathologic features and clinical outcome. Am J Surg Pathol 2001; 25:1252-60. [PMID: 11688459 DOI: 10.1097/00000478-200110000-00005] [Citation(s) in RCA: 169] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neurocytic neoplasms usually arise within the lateral ventricles, generally as circumscribed, slowly growing masses curable by total resection. Both subtotal resection and histologic atypia are associated with an increased risk of recurrence. In contrast, neurocytic neoplasms situated within brain parenchyma, so-called "extraventricular neurocytomas" (EVNs), are not as well characterized. The relationships between histologic features and extent of resection versus clinical behavior have not been defined. We evaluated pathologic features, clinical data, and neuroimaging of 35 examples. The tumors occurred in 18 males and 17 females, age 5-76 years (median 34 years). All tumors involved the cerebrum. On imaging, EVNs were solitary, variably contrast-enhancing, and often (57%) cystic. Tumor cells were arranged in sheets, clusters, ribbons, or rosettes, in association with fine neuropil dispersed in broad zones that separated cell aggregates. Ganglion cell differentiation was seen in 66%. All tumors showed strong synaptophysin immunoreactivity. Despite the lack of apparent astrocytes in hematoxylin and eosin-stained sections, focal glial fibrillary acidic protein reactivity was seen in 46%. Eleven EVNs were designated "atypical" based on the presence of necrosis, vascular proliferation, or elevated mitotic activity (> or = 3 mitoses/10 high power fields). Nineteen tumors were subtotally resected or biopsied, whereas 14 were totally resected grossly. Seventeen patients underwent radiotherapy (mean 55 Gy). In 30 cases with follow-up, 10 tumors recurred, 3 causing death at 6, 14, and 43 months. All 10 recurrences followed subtotal resection. No totally resected tumors recurred. Thus, the majority of EVNs are well differentiated and appear unlikely to recur after gross total resection. Subtotal resection, atypical histologic features, and high cell proliferation rates correlate with recurrence.
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Affiliation(s)
- D J Brat
- Department of Pathology, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
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