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Imperato A, Spennato P, Mazio F, Arcas E, Ozgural O, Quaglietta L, Errico ME, Cinalli G. Desmoplastic infantile astrocytoma and ganglioglioma: a series of 12 patients treated at a single institution. Childs Nerv Syst 2021; 37:2187-2195. [PMID: 33507362 DOI: 10.1007/s00381-021-05057-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/19/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Desmoplastic infantile astrocytomas and gangliogliomas (DIA/DIG) usually present with a large size, large cystic component, large dural implant, encasement of big vessels, clinical presentation within 18 months of life, high incidence of seizures and overall good prognosis, even if tumour surgery can be very challenging at first procedure. METHODS We retrospectively reviewed clinical and radiological data of patients diagnosed with desmoplastic infantile tumours who were surgically treated between 2008 and 2019. RESULTS The series included 12 patients. The median age at surgery was 91 days. The average tumour volume was 212 cm3. Cystic components were predominant ranging from 0 to 295 cm3. Active hydrocephalus was pre-operatively evident in 5 cases. Eight patients (66.6%) received total or subtotal removal, three of them (25%) underwent partial removal, and one patient (8.3%) received a biopsy. One patient died within 24 h after surgery due to severe hypotension, as a consequence of significant intraoperative blood loss. Overall, seven (58.3%) patients were reoperated on the tumour after the first procedure: 4 patients were operated twice; 3 patients were operated 3 times. Two patients presented remote localizations and underwent chemotherapy. At last follow-up, 7 patients were tumour-free, 2 are alive with stable disease, and 2 are alive with progressive disease (leptomeningeal seeding). CONCLUSION Desmoplastic infantile tumours are rare giant neonatal tumours. Total removal is the goal of treatment, but prognosis remains good even if total removal is not achieved. In case of tumour progression or epilepsy from residual tumour, reoperation is the first option, with chemotherapy reserved to unresectable or disseminated cases with mixed results, while, to date, radiotherapy still plays no role.
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Affiliation(s)
- Alessia Imperato
- Division of Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy
| | - Pietro Spennato
- Division of Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy.
| | - Federica Mazio
- Division of Pediatric Neuroradiology, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy
| | - Esperanza Arcas
- Division of Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy
- Department of Neurosurgery, University Hospital Virgen de las Nieves, Granada, Spain
| | - Onur Ozgural
- Division of Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy
- Department of Neurosurgery, University of Ankara, Ankara, Turkey
| | - Lucia Quaglietta
- Division of Pediatric Oncology, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy
| | - Maria Elena Errico
- Division of Pathology, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy
| | - Giuseppe Cinalli
- Division of Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy
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Wang AC, Jones DTW, Abecassis IJ, Cole BL, Leary SES, Lockwood CM, Chavez L, Capper D, Korshunov A, Fallah A, Wang S, Ene C, Olson JM, Geyer JR, Holland EC, Lee A, Ellenbogen RG, Ojemann JG. Desmoplastic Infantile Ganglioglioma/Astrocytoma (DIG/DIA) Are Distinct Entities with Frequent BRAFV600 Mutations. Mol Cancer Res 2018; 16:1491-1498. [PMID: 30006355 PMCID: PMC7269191 DOI: 10.1158/1541-7786.mcr-17-0507] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 01/02/2018] [Accepted: 06/25/2018] [Indexed: 11/16/2022]
Abstract
Desmoplastic infantile ganglioglioma (DIG) and desmoplastic infantile astrocytoma (DIA) are extremely rare tumors that typically arise in infancy; however, these entities have not been well characterized in terms of genetic alterations or clinical outcomes. Here, through a multi-institutional collaboration, the largest cohort of DIG/DIA to date is examined using advanced laboratory and data processing techniques. Targeted DNA exome sequencing and DNA methylation profiling were performed on tumor specimens obtained from different patients (n = 8) diagnosed histologically as DIG/DIGA. Two of these cases clustered with other tumor entities, and were excluded from analysis. The remaining 16 cases were confirmed to be DIG/DIA by histology and by DNA methylation profiling. Somatic BRAF gene mutations were discovered in 7 instances (43.8%); 4 were BRAFV600E mutations, and 3 were BRAFV600D mutations. Three instances of malignant transformation were found, and sequencing of the recurrence demonstrated a new TP53 mutation in one case, new ATRX deletion in one case, and in the third case, the original tumor harbored an EML4-ALK fusion, also present at recurrence. DIG/DIA are distinct pathologic entities that frequently harbor BRAFV600 mutations. Complete surgical resection is the ideal treatment, and overall prognosis is excellent. While, the small sample size and incomplete surgical records limit a definitive conclusion about the risk of tumor recurrence, the risk appears quite low. In rare cases with wild-type BRAF, malignant progression can be observed, frequently with the acquisition of other genetic alterations.Implications: DIG/DIA are a distinct molecular entity, with a subset frequently harboring either BRAF V600E or BRAF V600D mutations. Mol Cancer Res; 16(10); 1491-8. ©2018 AACR.
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Affiliation(s)
- Anthony C Wang
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California
| | - David T W Jones
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg University, Heidelberg, Germany
| | - Isaac Joshua Abecassis
- Department of Neurological Surgery, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - Bonnie L Cole
- Department of Anatomic Pathology, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - Sarah E S Leary
- Department of Pediatrics, Division of Hematology/Oncology, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - Christina M Lockwood
- Department of Laboratory Medicine, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - Lukas Chavez
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg University, Heidelberg, Germany
| | - David Capper
- Department of Neuropathology, German Cancer Research Center (DKFZ), Heidelberg University, Heidelberg, Germany
| | - Andrey Korshunov
- Department of Neuropathology, German Cancer Research Center (DKFZ), Heidelberg University, Heidelberg, Germany
| | - Aria Fallah
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California
| | - Shelly Wang
- Division of Neurosurgery, Hospital for Sick Children and Toronto Western Hospital, Toronto, Ontario, Canada
| | - Chibawanye Ene
- Department of Neurological Surgery, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - James M Olson
- Department of Pediatrics, Division of Hematology/Oncology, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - J Russell Geyer
- Department of Pediatrics, Division of Hematology/Oncology, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - Eric C Holland
- Department of Neurological Surgery, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - Amy Lee
- Department of Neurological Surgery, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - Richard G Ellenbogen
- Department of Neurological Surgery, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - Jeffrey G Ojemann
- Department of Neurological Surgery, University of Washington and Seattle Children's Hospital, Seattle, Washington
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Phi JH, Koh EJ, Kim SK, Park SH, Cho BK, Wang KC. Desmoplastic infantile astrocytoma: recurrence with malignant transformation into glioblastoma: a case report. Childs Nerv Syst 2011; 27:2177-81. [PMID: 21947035 DOI: 10.1007/s00381-011-1587-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 09/07/2011] [Indexed: 11/29/2022]
Abstract
Desmoplastic infantile astrocytoma (DIA) is an uncommon brain tumor of early infancy. The tumor is characterized by a lobar location, glial histology, and excellent prognosis after surgical removal. DIA and a similar tumor, desmoplastic infantile ganglioglioma (DIG) have been considered to be benign neoplasms, but the prognosis of DIA and DIG is currently under question as atypical and aggressive clinical features of the tumors have been reported. We encountered a patient who was diagnosed with DIA at the age of 22 months and exhibited tumor recurrence 8 years later. Surgical removal of the recurred tumor revealed that the tumor had transformed to overt glioblastoma. This case demonstrates that DIA is not an absolutely benign tumor and that careful clinical surveillance is needed during the follow-up period.
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Affiliation(s)
- Ji Hoon Phi
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, 101 Daehakro, Jongno-gu, Seoul 110-744, Republic of Korea.
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Beppu T, Sato Y, Uesugi N, Kuzu Y, Ogasawara K, Ogawa A. Desmoplastic infantile astrocytoma and characteristics of the accompanying cyst. Case report. J Neurosurg Pediatr 2008; 1:148-51. [PMID: 18352787 DOI: 10.3171/ped/2008/1/2/148] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A desmoplastic infantile astrocytoma (DIA) is an extremely rare tumor that comprises a solid astrocytic tumor accompanied by a large cyst and involves the superficial cerebral cortex and leptomeninges in infants. The solid part of this type of tumor has been well described in various reports and books, but characteristics of the cystic portion have remained unclear. Because adequate resection is required to ensure a favorable prognosis, information about the cyst is very important for diagnostic purposes and surgical planning. The authors report on the clinical and histological features of the cyst in a case of a DIA. A 12-month-old boy presented with vomiting. Contrast-enhanced magnetic resonance imaging revealed a strongly enhancing single-lobed large cyst located in the deep white matter, under the solid part of the tumor attached to the dura mater of the left frontal lobe. Both the solid and cystic portions of the tumor were surgically removed. The border between the cyst wall and surrounding white matter was unclear. Histologically, the cyst wall was composed of gliosis representing a rough accumulation of reactive astrocytes, lymphocytes, and small capillary vessels in edematous parenchyma, but no tumor cells. The present case and previous reports suggest that the cyst does not contain tumor cells, even if strongly depicted on contrast-enhanced neuroimaging, and that a thickly enhancing cyst wall indicates gliosis with accumulation of numerous small vessels.
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Affiliation(s)
- Takaaki Beppu
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
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