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Sepulveda F, Scotto Opipari R, Coppola F, Ramaglia A, Mankad K, Alves CAP, Bison B, Löbel U. Approaches to supratentorial brain tumours in children. Neuroradiology 2024:10.1007/s00234-024-03398-9. [PMID: 38953989 DOI: 10.1007/s00234-024-03398-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 06/01/2024] [Indexed: 07/04/2024]
Abstract
The differential diagnosis of supratentorial brain tumours in children can be challenging, especially considering the recent changes to the WHO classification of CNS tumours published in 2021. Many new tumour types have been proposed which frequently present in children and young adults and their imaging features are currently being described by the neuroradiology community. The purpose of this article is to provide guidance to residents and fellows new to the field of paediatric neuroradiology on how to evaluate an MRI of a patient with a newly diagnosed supratentorial tumour. Six different approaches are discussed including: 1. Tumour types, briefly discussing the main changes to the recent WHO classification of CNS tumours, 2. Patient age and its influence on incidence rates of specific tumour types, 3. Growth patterns, 4. Tumour location and how defining the correct location helps in narrowing down the differential diagnoses and 5. Imaging features of the tumour on DWI, SWI, FLAIR and post contrast sequences.
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Affiliation(s)
- Francisco Sepulveda
- Departamento de Imagenología, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | | | - Fiorenza Coppola
- Department of Diagnostic and Interventional Radiology, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - Antonia Ramaglia
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK
| | - Cesar A P Alves
- Radiology Department, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brigitte Bison
- Diagnostic and Interventional Neuroradiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Ulrike Löbel
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK.
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2
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Gonçalves FG, Mahecha-Carvajal ME, Desa A, Yildiz H, Talbeya JK, Moreno LA, Viaene AN, Vossough A. Imaging of supratentorial intraventricular masses in children:a pictorial review- part 1. Neuroradiology 2024; 66:677-698. [PMID: 38466393 PMCID: PMC11031501 DOI: 10.1007/s00234-024-03314-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 02/12/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE This article is the first in a two-part series designed to provide a comprehensive overview of the range of supratentorial intraventricular masses observed in children. Our primary objective is to discuss the diverse types of intraventricular masses that originate not only from cells within the choroid plexus but also from other sources. METHODS In this article, we review relevant epidemiological data, the current genetics/molecular classification as outlined in the fifth edition of the World Health Organization's Classification of tumours of the Central Nervous System and noteworthy imaging findings. We conduct an exhaustive analysis of primary choroid plexus tumours as well as other conditions such as choroid plexus hyperplasia, choroid plexus cyst, choroid plexus xanthogranuloma, atypical teratoid rhabdoid tumour, meningioma, arteriovenous malformation and metastasis. RESULTS We comprehensively evaluated each supratentorial intraventricular mass, providing an in-depth analysis of their unique clinical and histological characteristics. The fifth edition of the World Health Organization Classification of Tumours of the Central Nervous System introduces major modifications. These important changes could potentially have a profound impact on the management strategies and subsequent outcomes of these tumours. CONCLUSION Intraventricular masses in children can arise from various sources. Surgical intervention is key for certain supratentorial intraventricular masses in paediatric patients, with preoperative neuroimaging essential to decide the best treatment approach, surgical or otherwise, as some cases may not require surgery.
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Affiliation(s)
| | | | - Aishwary Desa
- Drexel University College of Medicine Philadelphia, Philadelphia, PA, USA
| | - Harun Yildiz
- Department of Radiology, Dortcelik Children's Hospital, Bursa, Turkey
| | | | - Luz Angela Moreno
- Pediatric Imaging, Department of Radiology, Fundación Hospital La Misericordia, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Angela N Viaene
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Pathology Department, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Arastoo Vossough
- Radiology Department, Children's Hospital of Philadelphia, Philadelphia, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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3
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Corvino S, Del Basso De Caro M, Franca RA, Corazzelli G, Della Monica R, Chiariotti L, Maiuri F. Atypical Teratoid/Rhabdoid Tumor of the Nervous System in Adults: Location-Related Features and Outcome. World Neurosurg 2023; 179:e404-e415. [PMID: 37659753 DOI: 10.1016/j.wneu.2023.08.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Atypical teratoid/rhabdoid tumor (AT/RT) of the nervous system is a rare and highly malignant neoplasm, mainly affecting children, first recognized as a pathologic entity in 1996 and added to the World Health Organization Classification of the Tumors of the Central Nervous System in 2000. AT/RT is even rarer among adults and is associated with a worse prognosis. The aim of the present study was to analyze the different tumor features according to the location in adults. METHODS A comprehensive and detailed literature review of AT/RTs in adults was made. The demographic, management, and outcome data associated with tumor location were analyzed and compared; histopathologic and molecular features were also discussed. Furthermore, we added our personal case with brain hemispheric localization and reported a progression-free survival of 103 months after gross total resection and adjuvant radiotherapy showing a peculiar histopathologic pattern. RESULTS Female sex is mainly affected by AT/RT on median localizations, both intracranial and spinal, and by all sellar region cases. Gross total resection is mainly achieved among lateral compared with median localizations. Combined radiotherapy and chemotherapy is the most adopted adjuvant treatment in all tumor localizations and is related to better outcome. Postoperative death is reported only among sellar region localizations, whereas brain hemispheric cases show the best overall survival. CONCLUSIONS AT/RTs show different and peculiar features according to their location, which significantly affects the outcome; precise knowledge of them helps the neurosurgeon in planning the best strategy for treatment.
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Affiliation(s)
- Sergio Corvino
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University of Naples "Federico II", Naples, Italy
| | - Marialaura Del Basso De Caro
- Department of Advanced Biomedical Sciences, Section of Pathology, University of Naples "Federico II", Naples, Italy
| | - Raduan Ahmed Franca
- Department of Advanced Biomedical Sciences, Section of Pathology, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Corazzelli
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University of Naples "Federico II", Naples, Italy
| | - Rosa Della Monica
- Department of Molecular Medicine and Medical Biotechnology, University "Federico II" of Naples, Naples, Italy
| | - Lorenzo Chiariotti
- Department of Molecular Medicine and Medical Biotechnology, University "Federico II" of Naples, Naples, Italy
| | - Francesco Maiuri
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University of Naples "Federico II", Naples, Italy.
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4
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Lobón-Iglesias MJ, Andrianteranagna M, Han ZY, Chauvin C, Masliah-Planchon J, Manriquez V, Tauziede-Espariat A, Turczynski S, Bouarich-Bourimi R, Frah M, Dufour C, Blauwblomme T, Cardoen L, Pierron G, Maillot L, Guillemot D, Reynaud S, Bourneix C, Pouponnot C, Surdez D, Bohec M, Baulande S, Delattre O, Piaggio E, Ayrault O, Waterfall JJ, Servant N, Beccaria K, Dangouloff-Ros V, Bourdeaut F. Imaging and multi-omics datasets converge to define different neural progenitor origins for ATRT-SHH subgroups. Nat Commun 2023; 14:6669. [PMID: 37863903 PMCID: PMC10589300 DOI: 10.1038/s41467-023-42371-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/09/2023] [Indexed: 10/22/2023] Open
Abstract
Atypical teratoid rhabdoid tumors (ATRT) are divided into MYC, TYR and SHH subgroups, suggesting diverse lineages of origin. Here, we investigate the imaging of human ATRT at diagnosis and the precise anatomic origin of brain tumors in the Rosa26-CreERT2::Smarcb1flox/flox model. This cross-species analysis points to an extra-cerebral origin for MYC tumors. Additionally, we clearly distinguish SHH ATRT emerging from the cerebellar anterior lobe (CAL) from those emerging from the basal ganglia (BG) and intra-ventricular (IV) regions. Molecular characteristics point to the midbrain-hindbrain boundary as the origin of CAL SHH ATRT, and to the ganglionic eminence as the origin of BG/IV SHH ATRT. Single-cell RNA sequencing on SHH ATRT supports these hypotheses. Trajectory analyses suggest that SMARCB1 loss induces a de-differentiation process mediated by repressors of the neuronal program such as REST, ID and the NOTCH pathway.
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Affiliation(s)
- María-Jesús Lobón-Iglesias
- INSERM U830, Laboratory of Translational Research In Pediatric Oncology, PSL Research University, SIREDO Oncology center, Institut Curie Research Center, Paris, France
| | - Mamy Andrianteranagna
- INSERM U830, Laboratory of Translational Research In Pediatric Oncology, PSL Research University, SIREDO Oncology center, Institut Curie Research Center, Paris, France
- INSERM U900, Bioinformatics, Biostatistics, Epidemiology and Computational Systems Unit, Institut Curie, Mines Paris Tech, PSL Research University, Institut Curie Research Center, Paris, France
| | - Zhi-Yan Han
- INSERM U830, Laboratory of Translational Research In Pediatric Oncology, PSL Research University, SIREDO Oncology center, Institut Curie Research Center, Paris, France
| | - Céline Chauvin
- INSERM U830, Laboratory of Translational Research In Pediatric Oncology, PSL Research University, SIREDO Oncology center, Institut Curie Research Center, Paris, France
| | - Julien Masliah-Planchon
- Somatic Genetic Unit, Department of Pathology and Diagnostic and Theranostic Medecine, Institut Curie Hospital, Paris, France
| | - Valeria Manriquez
- INSERM U932, Immunity and Cancer, PSL Research University, Institut Curie Research Center, Paris, France
| | - Arnault Tauziede-Espariat
- Department of Neuropathology, GHU Paris-Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Paris Psychiatry and Neurosciences Institute (IPNP), UMR S1266, INSERM, IMA-BRAIN, Paris, France
| | - Sandrina Turczynski
- INSERM U830, Laboratory of Translational Research In Pediatric Oncology, PSL Research University, SIREDO Oncology center, Institut Curie Research Center, Paris, France
| | - Rachida Bouarich-Bourimi
- INSERM U830, Laboratory of Translational Research In Pediatric Oncology, PSL Research University, SIREDO Oncology center, Institut Curie Research Center, Paris, France
| | - Magali Frah
- INSERM U830, Laboratory of Translational Research In Pediatric Oncology, PSL Research University, SIREDO Oncology center, Institut Curie Research Center, Paris, France
| | - Christelle Dufour
- Department of Children and Adolescents Oncology, Gustave Roussy, Paris Saclay University, Villejuif, France
| | - Thomas Blauwblomme
- Department of Pediatric Neurosurgery-AP-HP, Necker Sick Kids Hospital, Université de Paris, Paris, France
| | | | - Gaelle Pierron
- Somatic Genetic Unit, Department of Pathology and Diagnostic and Theranostic Medecine, Institut Curie Hospital, Paris, France
| | - Laetitia Maillot
- Somatic Genetic Unit, Department of Pathology and Diagnostic and Theranostic Medecine, Institut Curie Hospital, Paris, France
| | - Delphine Guillemot
- Somatic Genetic Unit, Department of Pathology and Diagnostic and Theranostic Medecine, Institut Curie Hospital, Paris, France
| | - Stéphanie Reynaud
- Somatic Genetic Unit, Department of Pathology and Diagnostic and Theranostic Medecine, Institut Curie Hospital, Paris, France
| | - Christine Bourneix
- Somatic Genetic Unit, Department of Pathology and Diagnostic and Theranostic Medecine, Institut Curie Hospital, Paris, France
| | - Célio Pouponnot
- CNRS UMR 3347, INSERM U1021, Institut Curie, PSL Research University, Université Paris-Saclay, Orsay, France
| | - Didier Surdez
- INSERM U830, Diversity and Plasticity of Childhood Tumors Lab, PSL Research University, SIREDO Oncology Center, Institut Curie Research Center, Paris, France
- Balgrist University Hospital, Faculty of Medicine, University of Zurich (UZH), Zurich, Switzerland
| | - Mylene Bohec
- Institut Curie, PSL University, Single Cell Initiative, ICGex Next-Generation Sequencing Platform, PSL University, 75005, Paris, France
| | - Sylvain Baulande
- Institut Curie, PSL University, Single Cell Initiative, ICGex Next-Generation Sequencing Platform, PSL University, 75005, Paris, France
| | - Olivier Delattre
- Somatic Genetic Unit, Department of Pathology and Diagnostic and Theranostic Medecine, Institut Curie Hospital, Paris, France
- INSERM U830, Diversity and Plasticity of Childhood Tumors Lab, PSL Research University, SIREDO Oncology Center, Institut Curie Research Center, Paris, France
| | - Eliane Piaggio
- INSERM U932, Immunity and Cancer, PSL Research University, Institut Curie Research Center, Paris, France
| | - Olivier Ayrault
- CNRS UMR 3347, INSERM U1021, Institut Curie, PSL Research University, Université Paris-Saclay, Orsay, France
| | - Joshua J Waterfall
- INSERM U830, Integrative Functional Genomics of Cancer Lab, PSL Research University, Institut Curie Research Center, Paris, France
- Department of Translational Research, PSL Research University, Institut Curie Research Center, Paris, France
| | - Nicolas Servant
- INSERM U900, Bioinformatics, Biostatistics, Epidemiology and Computational Systems Unit, Institut Curie, Mines Paris Tech, PSL Research University, Institut Curie Research Center, Paris, France
| | - Kevin Beccaria
- Department of Pediatric Neurosurgery-AP-HP, Necker Sick Kids Hospital, Université de Paris, Paris, France
| | - Volodia Dangouloff-Ros
- Pediatric Radiology Department, AP-HP, Necker Sick Kids Hospital and Paris Cite Universiy INSERM 1299 and UMR 1163, Institut Imagine, Paris, France
| | - Franck Bourdeaut
- INSERM U830, Laboratory of Translational Research In Pediatric Oncology, PSL Research University, SIREDO Oncology center, Institut Curie Research Center, Paris, France.
- Department of Pediatric Oncology, SIREDO Oncology Center, Institut Curie Hospital, Paris, and Université de Paris, Paris, France.
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5
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Paun L, Lavé A, Jannelli G, Egervari K, Janssen I, Schaller K, von Bueren AO, Bartoli A. Pediatric Posterior Fossa ATRT: A Case Report, New Treatment Strategies and Perspectives. Brain Sci 2023; 13:brainsci13050712. [PMID: 37239184 DOI: 10.3390/brainsci13050712] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/17/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
Posterior fossa atypical teratoid rhabdoid tumor (ATRT) is a rare childhood tumor usually associated with a dismal prognosis. Although upfront surgical gross total resection (GTR) has classically been the first line of treatment, new multimodal treatments, including two-stage surgery, are showing promising results in terms of overall survival (OS) and complication rate. We present a case of a 9-month-old child treated with two-staged surgery and chemotherapy. When deemed risky, multimodal treatments, including staged surgeries, can be a safe alternative to reduce surgical mortality and morbidity. At 23 months old, the patient had normal global development and no major impact on quality of life. We, therefore, discuss the most recent advancements from a treatment perspective, including molecular targeting.
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Affiliation(s)
- Luca Paun
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals and University of Geneva Faculty of Medicine, 1205 Geneva, Switzerland
- Department of Neurosurgery, Site Sainte-Anne, Groupe Hospitalier Universitaire Paris Psychiatrie et Neurosciences, Université Paris Cité, 75014 Paris, France
| | - Alexandre Lavé
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals and University of Geneva Faculty of Medicine, 1205 Geneva, Switzerland
- Department of Neurosurgery, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France
| | - Gianpaolo Jannelli
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals and University of Geneva Faculty of Medicine, 1205 Geneva, Switzerland
- Department of Spine and Spinal Cord Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, 69002 Lyon, France
| | - Kristof Egervari
- Department of Pathology and Immunology, University of Geneva, 1211 Geneva, Switzerland
- Division of Clinical Pathology, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Insa Janssen
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals and University of Geneva Faculty of Medicine, 1205 Geneva, Switzerland
| | - Karl Schaller
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals and University of Geneva Faculty of Medicine, 1205 Geneva, Switzerland
| | - André O von Bueren
- Department of Pediatrics, Obstetrics and Gynecology, Division of Pediatric Hematology and Oncology, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Andrea Bartoli
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals and University of Geneva Faculty of Medicine, 1205 Geneva, Switzerland
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6
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Calandrelli R, Massimi L, Pilato F, Verdolotti T, Ruggiero A, Attinà G, Gessi M, Colosimo C. Atypical Teratoid Rhabdoid Tumor: Proposal of a Diagnostic Pathway Based on Clinical Features and Neuroimaging Findings. Diagnostics (Basel) 2023; 13:diagnostics13030475. [PMID: 36766580 PMCID: PMC9914341 DOI: 10.3390/diagnostics13030475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/17/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To assess the main imaging and clinical features in adult- and pediatric-onset atypical teratoid rhabdoid tumor (ATRT) in order to build a predefined pathway useful for the diagnosis. METHODS We enrolled 11 ATRT patients (10 children, one adult) and we conducted a literature search on PubMed Central using the key terms "adult" or "pediatric" and "atypical teratoid/rhabdoid tumor". We collected clinical and neuroradiological data reported in previous studies and combined them with those from our case series. A three step process was built to reach diagnosis by identifying the main distinctive clinical and imaging features. RESULTS Clinical evaluation: neurological symptoms were nonspecific. ATRT was more frequent in children under 3 years of age (7 out of 10 children) and infratentorial localization was reported more frequently in children under the age of 24 months. Midline/off-midline localization was influenced by the age. IMAGING FINDINGS Preferential location near the ventricles and liquor spaces and the presence of eccentric cysts were hallmark for ATRT; higher frequency of peripheral cysts was detected in children and in the supratentorial compartment (five out of eight patients with solid-cystic ATRT). Leptomeningeal dissemination at diagnosis was common (5 out of 10 children), while intratumoral hemorrhage, calcifications, and high cellularity were non-specific findings. Histopathological analysis: specific immunohistochemical markers were essential to confirm the diagnosis. CONCLUSION In younger children, a bulky, heterogeneous mass with eccentric cystic components and development near ventricles or cisternal spaces may be suggestive of ATRT. ATRT diagnosis is more challenging in adults and relies exclusively on neuropathological examination.
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Affiliation(s)
- Rosalinda Calandrelli
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 1, 00168 Rome, Italy
- Correspondence:
| | - Luca Massimi
- Pediatric Neurosurgery, Neurosurgery Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 1, 00168 Rome, Italy
| | - Fabio Pilato
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Campus Bio-Medico University, 00128 Rome, Italy
| | - Tommaso Verdolotti
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 1, 00168 Rome, Italy
| | - Antonio Ruggiero
- UOSD di Oncologia Pediatrica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Largo F.sco Vito 1, 00168 Rome, Italy
| | - Giorgio Attinà
- UOSD di Oncologia Pediatrica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Marco Gessi
- Neuropathology Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Cesare Colosimo
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 1, 00168 Rome, Italy
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7
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AlRayahi J, Alwalid O, Mubarak W, Maaz AUR, Mifsud W. Pediatric Brain Tumors in the Molecular Era: Updates for the Radiologist. Semin Roentgenol 2023; 58:47-66. [PMID: 36732011 DOI: 10.1053/j.ro.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/28/2022] [Accepted: 09/30/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Jehan AlRayahi
- Department of Pediatric Radiology, Sidra Medicine, Doha, Qatar.
| | - Osamah Alwalid
- Department of Pediatric Radiology, Sidra Medicine, Doha, Qatar
| | - Walid Mubarak
- Department of Pediatric Radiology, Sidra Medicine, Doha, Qatar
| | - Ata Ur Rehman Maaz
- Department of Pediatric Hematology-Oncology, Sidra Medicine, Doha, Qatar
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8
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Kang X, Xia H, Skudder-Hill L, Yin Y, Wang X. Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET)/Computed Tomography Features of Atypical Teratoid/Rhabdoid Tumors: Case Series and Review. J Child Neurol 2022; 37:1003-1009. [PMID: 36417494 DOI: 10.1177/08830738221129968] [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] [Indexed: 11/25/2022]
Abstract
Purpose: The purpose of this article is to explore the clinical and neuroradiologic properties of atypical teratoid/rhabdoid tumors. Methods: Data from 6 pediatric patients with atypical teratoid/rhabdoid tumors, which mainly contained the features of magnetic resonance imaging (MRI) and positron emission tomography (PET)/computed tomography (CT), was retrospectively analyzed. Follow-up was conducted in all patients through clinic services and/or telephone consultation. Results: The patients included 4 males and 2 females, aged from 3.2 to 83.1 months at the initial diagnosis. All patients had MRI scans. Two patients underwent 18F-fluorodeoxyglucose PET/CT scintigraphy preoperatively and 4 postoperatively. All primary lesions were located in the cranial cavity and the average diameter of lesions was 37.2 mm. Cerebrospinal fluid spread on enhanced T1-weighted images were found in 2 patients. Multiple metastases were found on MRI and PET/CT scans, which were located at cranial cavity, spinal cord, lung and lymph node. The primary and metastatic lesions showed evident uptake of 18F-fluorodeoxyglucose. Two patients underwent total tumor removal, and 4 patients underwent subtotal removal. None of the patients received shunt surgery. Follow-up was performed in all 6 patients. One patient survived event-free 38.4 months after resection. The mean overall survival of the remaining 5 patients was 5.1 months. Conclusion: We identified specific PET/CT and MRI features that can facilitate the recognition of atypical teratoid/rhabdoid tumors prior to biopsy.
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Affiliation(s)
- Xu Kang
- Department of Pediatric Neurosurgery, Xinhua Hospital, 91603Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hongping Xia
- Department of Neonatology, Xinhua Hospital, 91603Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Loren Skudder-Hill
- Department of Pediatric Neurosurgery, 191612The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Yafu Yin
- Department of Nuclear Medicine, 91603Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaoqiang Wang
- Department of Pediatric Neurosurgery, Xinhua Hospital, 91603Shanghai Jiaotong University School of Medicine, Shanghai, China
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9
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Benesch M, Perwein T, Apfaltrer G, Langer T, Neumann A, Brecht IB, Schuhmann MU, Cario H, Frühwald MC, Vollert K, van Buiren M, Deng MY, Seitz A, Haberler C, Mynarek M, Kramm C, Sahm F, Robe PA, Dankbaar JW, Hoff KV, Warmuth-Metz M, Bison B. MR Imaging and Clinical Characteristics of Diffuse Glioneuronal Tumor with Oligodendroglioma-like Features and Nuclear Clusters. AJNR Am J Neuroradiol 2022; 43:1523-1529. [PMID: 36137663 PMCID: PMC9575520 DOI: 10.3174/ajnr.a7647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/28/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Diffuse glioneuronal tumor with oligodendroglioma-like features and nuclear clusters (DGONC) is a new, molecularly defined glioneuronal CNS tumor type. The objective of the present study was to describe MR imaging and clinical characteristics of patients with DGONC. MATERIALS AND METHODS Preoperative MR images of 9 patients with DGONC (median age at diagnosis, 9.9 years; range, 4.2-21.8 years) were reviewed. RESULTS All tumors were located superficially in the frontal/temporal lobes and sharply delineated, displaying little mass effect. Near the circle of Willis, the tumors encompassed the arteries. All except one demonstrated characteristics of low-to-intermediate aggressiveness with high-to-intermediate T2WI and ADC signals and bone remodeling. Most tumors (n = 7) showed a homogeneous ground-glass aspect on T2-weighted and FLAIR images. On the basis of the original histopathologic diagnosis, 6 patients received postsurgical chemo-/radiotherapy, 2 were irradiated after surgery, and 1 patient underwent tumor resection only. At a median follow-up of 61 months (range, 10-154 months), 6 patients were alive in a first complete remission and 2 with stable disease 10 and 21 months after diagnosis. The only patient with progressive disease was lost to follow-up. Five-year overall and event-free survival was 100% and 86±13%, respectively. CONCLUSIONS This case series presents radiomorphologic characteristics highly predictive of DGONC that contrast with the typical aspects of the original histopathologic diagnoses. This presentation underlines the definition of DGONC as a separate entity, from a clinical perspective. Complete resection may be favorable for long-term disease control in patients with DGONC. The efficacy of nonsurgical treatment modalities should be evaluated in larger series.
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Affiliation(s)
- M Benesch
- From the Division of Pediatric Hematology and Oncology (M.B., T.P.), Department of Pediatrics and Adolescent Medicine
| | - T Perwein
- From the Division of Pediatric Hematology and Oncology (M.B., T.P.), Department of Pediatrics and Adolescent Medicine
| | - G Apfaltrer
- Division of Pediatric Radiology (G.A.), Department of Radiology, Medical University Graz, Graz, Austria
| | - T Langer
- Departments of Pediatrics (T.L.)
| | - A Neumann
- Neuroradiology (A.N.), University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - I B Brecht
- Pediatric Hematology and Oncology (I.B.B.), Children's Hospital
| | - M U Schuhmann
- Division of Pediatric Neurosurgery (M.U.S.), Department of Neurosurgery, Eberhard-Karls University Tübingen, Tübingen, Germany
| | - H Cario
- Department of Pediatrics and Adolescent Medicine (H.C.), Ulm University Medical Center, Ulm, Germany
| | | | - K Vollert
- Pediatric and Adolescent Medicine and Departments of Diagnostic and Interventional Radiology and Neuroradiology (K.V., B.B.), University Medical Center Augsburg, Augsburg, Germany
| | - M van Buiren
- Department of Pediatric Hematology and Oncology (M.v.B.), Center for Pediatrics, Medical Center-University of Freiburg, Freiburg, Germany
| | - M Y Deng
- Hopp Children's Cancer Center Heidelberg (M.Y.D., F.S.)
| | - A Seitz
- German Cancer Research Center and Department of Neuroradiology (A.S.)
| | - C Haberler
- Division of Neuropathology and Neurochemistry (C.H.), Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - M Mynarek
- Department of Pediatric Hematology and Oncology (M.M.)
- Mildred Scheel Cancer Career Center (M.M.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Kramm
- Division of Pediatric Hematology and Oncology (C.K.), University Medical Center Göttingen, Göttingen, Germany
| | - F Sahm
- Hopp Children's Cancer Center Heidelberg (M.Y.D., F.S.)
- Department of Neuropathology (F.S.), Institute of Pathology
- Clinical Cooperation Unit Neuropathology (F.S.), German Cancer Consortium, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany
| | - P A Robe
- Department of Neurology and Neurosurgery (P.A.R.)
| | - J W Dankbaar
- Department of Radiology (J.W.D.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - K V Hoff
- Department of Pediatric Oncology and Hematology (K.V.H.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - M Warmuth-Metz
- Institute of Diagnostic and Interventional Neuroradiology (M.W.-M.), University Hospital Würzburg, Würzburg, Germany
| | - B Bison
- Pediatric and Adolescent Medicine and Departments of Diagnostic and Interventional Radiology and Neuroradiology (K.V., B.B.), University Medical Center Augsburg, Augsburg, Germany
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10
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2021 WHO classification of tumours of the central nervous system: a review for the neuroradiologist. Neuroradiology 2022; 64:1919-1950. [DOI: 10.1007/s00234-022-03008-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/01/2022] [Indexed: 10/17/2022]
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11
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ATRT-SHH comprises three molecular subgroups with characteristic clinical and histopathological features and prognostic significance. Acta Neuropathol 2022; 143:697-711. [PMID: 35501487 PMCID: PMC9107423 DOI: 10.1007/s00401-022-02424-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 11/16/2022]
Abstract
Atypical teratoid/rhabdoid tumor (ATRT) is an aggressive central nervous system tumor characterized by loss of SMARCB1/INI1 protein expression and comprises three distinct molecular groups, ATRT–TYR, ATRT–MYC and ATRT–SHH. ATRT–SHH represents the largest molecular group and is heterogeneous with regard to age, tumor location and epigenetic profile. We, therefore, aimed to investigate if heterogeneity within ATRT–SHH might also have biological and clinical importance. Consensus clustering of DNA methylation profiles and confirmatory t-SNE analysis of 65 ATRT–SHH yielded three robust molecular subgroups, i.e., SHH-1A, SHH-1B and SHH-2. These subgroups differed by median age of onset (SHH-1A: 18 months, SHH-1B: 107 months, SHH-2: 13 months) and tumor location (SHH-1A: 88% supratentorial; SHH-1B: 85% supratentorial; SHH-2: 93% infratentorial, often extending to the pineal region). Subgroups showed comparable SMARCB1 mutational profiles, but pathogenic/likely pathogenic SMARCB1 germline variants were over-represented in SHH-2 (63%) as compared to SHH-1A (20%) and SHH-1B (0%). Protein expression of proneural marker ASCL1 (enriched in SHH-1B) and glial markers OLIG2 and GFAP (absent in SHH-2) as well as global mRNA expression patterns differed, but all subgroups were characterized by overexpression of SHH as well as Notch pathway members. In a Drosophila model, knockdown of Snr1 (the fly homologue of SMARCB1) in hedgehog activated cells not only altered hedgehog signaling, but also caused aberrant Notch signaling and formation of tumor-like structures. Finally, on survival analysis, molecular subgroup and age of onset (but not ASCL1 staining status) were independently associated with overall survival, older patients (> 3 years) harboring SHH-1B experiencing relatively favorable outcome. In conclusion, ATRT–SHH comprises three subgroups characterized by SHH and Notch pathway activation, but divergent molecular and clinical features. Our data suggest that molecular subgrouping of ATRT–SHH has prognostic relevance and might aid to stratify patients within future clinical trials.
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12
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Guo G, Zhuang J, Zhang K, Zhou Z, Wang Y, Zhang Z. Atypical Teratoid/Rhabdoid Tumor of the Central Nervous System in Children: Case Reports and Literature Review. Front Surg 2022; 9:864518. [PMID: 36034392 PMCID: PMC9406290 DOI: 10.3389/fsurg.2022.864518] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/25/2022] [Indexed: 11/15/2022] Open
Abstract
Atypical teratoid/rhabdoid tumor (AT/RT) of the central nervous system is a highly malignant tumor that mainly occurs in children under the age of 3 and has only been rarely described in adults. The fact that AT/RT patients have such a terrible prognosis is even more regrettable. Herein, we reported two special cases of AT/RT, both of which were under 3 years. Symptoms at presentation included increased intracranial pressure and cerebellar symptoms such as headache, altered gait, and ataxia. As for the tumor location, one was infratentorial in the posterior fossa, and the other was the right lateral ventricle. Preoperative magnetic resonance imaging scans showed calcification and heterogeneous contrast enhancement in the lesions. The mass was excised surgically for the progression of symptoms. Postoperative pathologies of the tumors, combined with immunohistochemistry, revealed AT/RT. AT/RTs are often misdiagnosed as other types of brain tumors due to the lack of specific radiological features and other key characteristics. To improve awareness of AT/RT on the differential diagnosis of intracranial lesions among clinicians, we present this report and briefly summarize previous cases.
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Affiliation(s)
- Gengyin Guo
- Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jianfeng Zhuang
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, China
| | - Keke Zhang
- Department of Otolaryngology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Zhizhen Zhou
- Department of Neurosurgery, Weishan People’s Hospital, Jining, Shandong, China
| | - Yanjun Wang
- Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Zhen Zhang
- Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- State Key Laboratory of Translational Medicine and Innovative Drug Development, Jiangsu Simcere Pharmaceutical Co., Ltd.,Nanjing, China
- Shandong University of Traditional Chinese Medicine, First Clinical College, Jinan, China
- Correspondence: Zhen Zhang
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13
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Baiano C, Della Monica R, Franca RA, Del Basso De Caro ML, Cavallo LM, Chiariotti L, Ius T, Jouanneau E, Somma T. Atypical Teratoid Rhabdoid Tumor: A Possible Oriented Female Pathology? Front Oncol 2022; 12:854437. [PMID: 35433419 PMCID: PMC9010824 DOI: 10.3389/fonc.2022.854437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/08/2022] [Indexed: 11/29/2022] Open
Abstract
Atypical teratoid rhabdoid tumor is a rare lesion that occurs mainly in children can be supratentorial or infratentorial and it accounts for 1-2% of pediatric brain tumors and over 10% of central nervous system (CNS) tumors in infants, with a male preponderance up to 3 years of age, more than 50% of these occur in the cerebellum. In this report we describe four new cases of sellar AT/RTs underwent endoscopic endonasal approach and different adjuvant therapies. Our aim is to report the clinical, radiological and pathological features of these rare lesions, focusing on the possibility to perform an early diagnosis and appropriate therapeutic strategy.
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Affiliation(s)
- Cinzia Baiano
- Division of Neurosurgery, Università degli Studi di Napoli “Federico II”, Naples, Italy
- *Correspondence: Cinzia Baiano,
| | - Rosa Della Monica
- Department of Molecular Medicine and Medical Biotechnology, University of Naples “Federico II”, Naples, Italy
| | | | | | - Luigi Maria Cavallo
- Division of Neurosurgery, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Lorenzo Chiariotti
- Department of Molecular Medicine and Medical Biotechnology, University of Naples “Federico II”, Naples, Italy
| | - Tamara Ius
- Division of Neurosurgery, Ospedale Santa Maria della Misericordia, Udine, Italy
| | - Emmanuel Jouanneau
- Division of Neurosurgery, Hopital Neurologique “Pierre Wertheimer”, Lyon, France
| | - Teresa Somma
- Division of Neurosurgery, Università degli Studi di Napoli “Federico II”, Naples, Italy
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14
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The impact of surgical resection and adjuvant therapy on survival in paediatric patients with Atypical Teratoid Rhabdoid Tumour: Systematic review and pooled survival analysis. World Neurosurg 2022; 164:216-227. [DOI: 10.1016/j.wneu.2022.04.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 11/17/2022]
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15
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Graf M, Interlandi M, Moreno N, Holdhof D, Göbel C, Melcher V, Mertins J, Albert TK, Kastrati D, Alfert A, Holsten T, de Faria F, Meisterernst M, Rossig C, Warmuth-Metz M, Nowak J, Meyer Zu Hörste G, Mayère C, Nef S, Johann P, Frühwald MC, Dugas M, Schüller U, Kerl K. Single-cell transcriptomics identifies potential cells of origin of MYC rhabdoid tumors. Nat Commun 2022; 13:1544. [PMID: 35318328 PMCID: PMC8941154 DOI: 10.1038/s41467-022-29152-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/26/2022] [Indexed: 11/30/2022] Open
Abstract
Rhabdoid tumors (RT) are rare and highly aggressive pediatric neoplasms. Their epigenetically-driven intertumoral heterogeneity is well described; however, the cellular origin of RT remains an enigma. Here, we establish and characterize different genetically engineered mouse models driven under the control of distinct promoters and being active in early progenitor cell types with diverse embryonic onsets. From all models only Sox2-positive progenitor cells give rise to murine RT. Using single-cell analyses, we identify distinct cells of origin for the SHH and MYC subgroups of RT, rooting in early stages of embryogenesis. Intra- and extracranial MYC tumors harbor common genetic programs and potentially originate from fetal primordial germ cells (PGCs). Using PGC specific Smarcb1 knockout mouse models we validate that MYC RT originate from these progenitor cells. We uncover an epigenetic imbalance in MYC tumors compared to PGCs being sustained by epigenetically-driven subpopulations. Importantly, treatments with the DNA demethylating agent decitabine successfully impair tumor growth in vitro and in vivo. In summary, our work sheds light on the origin of RT and supports the clinical relevance of DNA methyltransferase inhibitors against this disease. Rhabdoid tumors (RT) are aggressive paediatric cancers with yet unknown cells of origin. Here, the authors establish genetically engineered mouse models of RT and, using single-cell RNA-seq and epigenomics, identify potential cells of origin for the SHH and MYC subtypes.
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Affiliation(s)
- Monika Graf
- Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, 48149, Münster, Germany
| | - Marta Interlandi
- Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, 48149, Münster, Germany.,Institute of Medical Informatics, University of Münster, 48149, Münster, Germany
| | - Natalia Moreno
- Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, 48149, Münster, Germany
| | - Dörthe Holdhof
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, 20251, Hamburg, Germany.,Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, 20251, Hamburg, Germany
| | - Carolin Göbel
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, 20251, Hamburg, Germany.,Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, 20251, Hamburg, Germany
| | - Viktoria Melcher
- Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, 48149, Münster, Germany
| | - Julius Mertins
- Department of Neurology, Schlosspark-Klinik, 14059, Berlin, Germany.,Institute of Molecular Tumor Biology, University of Münster, 48149, Münster, Germany
| | - Thomas K Albert
- Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, 48149, Münster, Germany
| | - Dennis Kastrati
- Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, 48149, Münster, Germany
| | - Amelie Alfert
- Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, 48149, Münster, Germany
| | - Till Holsten
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, 20251, Hamburg, Germany.,Institute of Molecular Tumor Biology, University of Münster, 48149, Münster, Germany
| | - Flavia de Faria
- Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, 48149, Münster, Germany.,Department of Pediatric Hematology and Oncology, Children's Hospital of Brasìlia, 70684-831, Brasìlia, Brazil
| | - Michael Meisterernst
- Institute of Molecular Tumor Biology, University of Münster, 48149, Münster, Germany
| | - Claudia Rossig
- Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, 48149, Münster, Germany
| | - Monika Warmuth-Metz
- Neuroradiological Reference Center, University Hospital Würzburg, Würzburg, Germany
| | - Johannes Nowak
- Neuroradiological Reference Center, University Hospital Würzburg, Würzburg, Germany.,SRH Poliklinik Gera GmbH, Radiological Practice Gotha, Gotha, Germany
| | - Gerd Meyer Zu Hörste
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, 48149, Münster, Germany
| | - Chloe Mayère
- Department of Genetic Medicine and Development, University of Geneva, 1211, Geneva, Switzerland.,iGE3, Institute of Genetics and Genomics of Geneva, University of Geneva, 1211, Geneva, Switzerland
| | - Serge Nef
- Department of Genetic Medicine and Development, University of Geneva, 1211, Geneva, Switzerland.,iGE3, Institute of Genetics and Genomics of Geneva, University of Geneva, 1211, Geneva, Switzerland
| | - Pascal Johann
- Swabian Children's Cancer Center, Paediatric and Adolescent Medicine, University Medical Center Augsburg, 86156, Augsburg, Germany.,Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael C Frühwald
- Swabian Children's Cancer Center, Paediatric and Adolescent Medicine, University Medical Center Augsburg, 86156, Augsburg, Germany
| | - Martin Dugas
- Institute of Medical Informatics, University of Münster, 48149, Münster, Germany.,Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Ulrich Schüller
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, 20251, Hamburg, Germany.,Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, 20251, Hamburg, Germany.,Research Institute Children's Cancer Center, 20251, Hamburg, Germany
| | - Kornelius Kerl
- Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, 48149, Münster, Germany.
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16
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Atypical teratoid/rhabdoid tumor in adults: a systematic review of the literature with meta-analysis and additional reports of 4 cases. J Neurooncol 2022; 157:1-14. [PMID: 35217948 DOI: 10.1007/s11060-022-03959-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/01/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Atypical teratoid/rhabdoid tumor (AT/RT) is a highly aggressive embryonal CNS neoplasm, characterized by inactivation of SMARCB1 (INI1) or rarely of SMARCA4 (BRG1). While it is predominantly a childhood tumor, AT/RT is rare in adults. METHODS We provide a comprehensive systematic review of literature with meta-analysis; 92 adult cases were found from 74 articles. We additionally present 4 cases of adult AT/RTs (age ranging from 19 to 29 years), located to cerebellum in 2 cases, to ponto-cerebellar angle in 1 case and to spinal cord in the remaining case. RESULTS Microscopic features of our 4 cases showed a highly cellular tumor with rhabdoid morphology and high mitotic activity. All tumor cells lacked nuclear SMARCB1/INI1 protein expression. In case no. 3 we also performed methylation profiling which clustered the tumor with pediatric AT/RT-MYC subgroup. Prognosis remains poor in both pediatric and adult population with a median overall survival of 11 months. Our review demonstrated median overall survival of 15 months among the adult populations. However, consistent with a recent review, adult AT/RT seems to have highly variable prognosis and some patients reach long term survival with 22.9% of 5-year survival without evidence of disease and mean follow up time of 35.9 months (SD = 36.5). 27.1% of dissemination was also reported among the adult population. CONCLUSIONS Adult AT/RTs predominantly arise in female patients and in supratentorial location. Midline structures, including the sellar region, are the most affected sites, especially among females aged > 40 years. Male gender is more prevalent between the age of 18 and 40 years and more frequently associated with non-midline tumors. Factors significantly associated with better prognosis are patient's age (< 40 years), combined radio-chemotherapy adjuvant approach and Ki-67 score < 40%.
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17
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Pringle C, Kilday JP, Kamaly-Asl I, Stivaros SM. The role of artificial intelligence in paediatric neuroradiology. Pediatr Radiol 2022; 52:2159-2172. [PMID: 35347371 PMCID: PMC9537195 DOI: 10.1007/s00247-022-05322-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/22/2021] [Accepted: 02/11/2022] [Indexed: 01/17/2023]
Abstract
Imaging plays a fundamental role in the managing childhood neurologic, neurosurgical and neuro-oncological disease. Employing multi-parametric MRI techniques, such as spectroscopy and diffusion- and perfusion-weighted imaging, to the radiophenotyping of neuroradiologic conditions is becoming increasingly prevalent, particularly with radiogenomic analyses correlating imaging characteristics with molecular biomarkers of disease. However, integration into routine clinical practice remains elusive. With modern multi-parametric MRI now providing additional data beyond anatomy, informing on histology, biology and physiology, such metric-rich information can present as information overload to the treating radiologist and, as such, information relevant to an individual case can become lost. Artificial intelligence techniques are capable of modelling the vast radiologic, biological and clinical datasets that accompany childhood neurologic disease, such that this information can become incorporated in upfront prognostic modelling systems, with artificial intelligence techniques providing a plausible approach to this solution. This review examines machine learning approaches than can be used to underpin such artificial intelligence applications, with exemplars for each machine learning approach from the world literature. Then, within the specific use case of paediatric neuro-oncology, we examine the potential future contribution for such artificial intelligence machine learning techniques to offer solutions for patient care in the form of decision support systems, potentially enabling personalised medicine within this domain of paediatric radiologic practice.
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Affiliation(s)
- Catherine Pringle
- Children’s Brain Tumour Research Network (CBTRN), Royal Manchester Children’s Hospital, Manchester, UK ,Division of Informatics, Imaging, and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK
| | - John-Paul Kilday
- Children’s Brain Tumour Research Network (CBTRN), Royal Manchester Children’s Hospital, Manchester, UK ,The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, University of Manchester, Manchester, UK
| | - Ian Kamaly-Asl
- Children’s Brain Tumour Research Network (CBTRN), Royal Manchester Children’s Hospital, Manchester, UK ,The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, University of Manchester, Manchester, UK
| | - Stavros Michael Stivaros
- Division of Informatics, Imaging, and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK. .,Department of Paediatric Radiology, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK. .,The Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
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18
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Molecular diagnostic challenges in a case with atypical teratoid tumor: Case report. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2021. [DOI: 10.1016/j.cpccr.2021.100122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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19
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Meng L, Wang L, Shao G. Relapsing cerebral atypical teratoid/rhabdoid tumor after trimodality therapy: A case report. Medicine (Baltimore) 2021; 100:e27986. [PMID: 34964793 PMCID: PMC8615398 DOI: 10.1097/md.0000000000027986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/11/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Atypical teratoid rhabdoid tumor (AT/RT) is a high-grade embryonal malignant neoplasm of the central nervous system. It is rare and most often diagnosed in children <4 years of age. The biological manifestations of AT/RTs are highly malignant and have a very poor prognosis. Here, we present the case of a 16-year-old boy with AT/RT in the right parietal lobe and with a dismal outcome. PATIENT CONCERNS A 16-year-old male boy presented with a headache after waking up for 1 year without obvious cause. The pain was persistent and dull, mainly in the right orbital, and was slightly relieved after pressing the orbital. Occasionally, nausea and vomiting occurred, and the vomiting was gastric contents. Examination and head computed tomography performed at a local hospital revealed a space-occupying lesion in the right parietal lobe. The patient was then transferred to our hospital for further diagnosis and treatment. DIAGNOSIS The patient underwent craniotomy and gross total excision of the tumor. Further histologic examination of the tumor was identified (space-occupying lesion in the right parietal lobe) AT/RT, World Health Organization grade IV. INTERVENTIONS The patient was transferred to the oncology department for radiotherapy and chemotherapy after surgery recovery. OUTCOMES The patient did not comply with the advice for adjuvant chemotherapy regularly and the tumor recurred rapidly. Finally, the patient died after 18 months after the definitive surgery. CONCLUSION In conclusion, in the presence of a tumor with peripheral cystic components or hemorrhage in young children, a diagnosis of AT/RT must always be considered. Patients must follow the doctor's advice for active treatment. All relevant data are within the paper and its Supporting Information files.
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20
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Alves CAPF, Löbel U, Martin-Saavedra JS, Toescu S, Tsunemi MH, Teixeira SR, Mankad K, Hargrave D, Jacques TS, da Costa Leite C, Gonçalves FG, Vossough A, D'Arco F. A Diagnostic Algorithm for Posterior Fossa Tumors in Children: A Validation Study. AJNR Am J Neuroradiol 2021; 42:961-968. [PMID: 33664107 DOI: 10.3174/ajnr.a7057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Primary posterior fossa tumors comprise a large group of neoplasias with variable aggressiveness and short and long-term outcomes. This study aimed to validate the clinical usefulness of a radiologic decision flow chart based on previously published neuroradiologic knowledge for the diagnosis of posterior fossa tumors in children. MATERIALS AND METHODS A retrospective study was conducted (from January 2013 to October 2019) at 2 pediatric referral centers, Children's Hospital of Philadelphia, United States, and Great Ormond Street Hospital, United Kingdom. Inclusion criteria were younger than 18 years of age and histologically and molecularly confirmed posterior fossa tumors. Subjects with no available preoperative MR imaging and tumors located primarily in the brain stem were excluded. Imaging characteristics of the tumors were evaluated following a predesigned, step-by-step flow chart. Agreement between readers was tested with the Cohen κ, and each diagnosis was analyzed for accuracy. RESULTS A total of 148 cases were included, with a median age of 3.4 years (interquartile range, 2.1-6.1 years), and a male/female ratio of 1.24. The predesigned flow chart facilitated identification of pilocytic astrocytoma, ependymoma, and medulloblastoma sonic hedgehog tumors with high sensitivity and specificity. On the basis of the results, the flow chart was adjusted so that it would also be able to better discriminate atypical teratoid/rhabdoid tumors and medulloblastoma groups 3 or 4 (sensitivity = 75%-79%; specificity = 92%-99%). Moreover, our adjusted flow chart was useful in ruling out ependymoma, pilocytic astrocytomas, and medulloblastoma sonic hedgehog tumors. CONCLUSIONS The modified flow chart offers a structured tool to aid in the adjunct diagnosis of pediatric posterior fossa tumors. Our results also establish a useful starting point for prospective clinical studies and for the development of automated algorithms, which may provide precise and adequate diagnostic tools for these tumors in clinical practice.
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Affiliation(s)
- C A P F Alves
- From the Division of Neuroradiology (C.A.P.F.A., J.S.M.-S. S.R.T., F.G.G., A.V.), Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Radiology (C.d.C.L.), Hospital das Clinicas, Faculdade de Medicina de Sao Paulo, Sao Paulo
| | - U Löbel
- Radiology Department (U.L., K.M., F.D.), UCL Great Ormond Street Hospital for Children, London, UK
| | - J S Martin-Saavedra
- From the Division of Neuroradiology (C.A.P.F.A., J.S.M.-S. S.R.T., F.G.G., A.V.), Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - S Toescu
- Department of Neurosurgery (S.T.), UCL Great Ormond Street Hospital for Children, London, UK
| | - M H Tsunemi
- Department of Biostatistics (M.H.T.), Instituto de Biociências, São Paulo State University, São Paul, Brazil
| | - S R Teixeira
- From the Division of Neuroradiology (C.A.P.F.A., J.S.M.-S. S.R.T., F.G.G., A.V.), Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - K Mankad
- Radiology Department (U.L., K.M., F.D.), UCL Great Ormond Street Hospital for Children, London, UK
| | - D Hargrave
- Pediatric Oncology Unit (D.H.), UCL Great Ormond Street Institute of Child Health, London, UK
| | - T S Jacques
- Developmental Biology and Cancer Programme (T.S.J.), UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - C da Costa Leite
- Department of Radiology (C.d.C.L.), Hospital das Clinicas, Faculdade de Medicina de Sao Paulo, Sao Paulo
| | - F G Gonçalves
- From the Division of Neuroradiology (C.A.P.F.A., J.S.M.-S. S.R.T., F.G.G., A.V.), Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - A Vossough
- From the Division of Neuroradiology (C.A.P.F.A., J.S.M.-S. S.R.T., F.G.G., A.V.), Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - F D'Arco
- Radiology Department (U.L., K.M., F.D.), UCL Great Ormond Street Hospital for Children, London, UK
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21
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Ho B, Johann PD, Grabovska Y, De Dieu Andrianteranagna MJ, Yao F, Frühwald M, Hasselblatt M, Bourdeaut F, Williamson D, Huang A, Kool M. Molecular subgrouping of atypical teratoid/rhabdoid tumors-a reinvestigation and current consensus. Neuro Oncol 2021; 22:613-624. [PMID: 31889194 PMCID: PMC7229260 DOI: 10.1093/neuonc/noz235] [Citation(s) in RCA: 114] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Atypical teratoid/rhabdoid tumors (ATRTs) are known to exhibit molecular and clinical heterogeneity even though SMARCB1 inactivation is the sole recurrent genetic event present in nearly all cases. Indeed, recent studies demonstrated 3 molecular subgroups of ATRTs that are genetically, epigenetically, and clinically distinct. As these studies included different numbers of tumors, various subgrouping techniques, and naming, an international working group sought to align previous findings and to reach a consensus on nomenclature and clinicopathological significance of ATRT subgroups. Methods We integrated various methods to perform a meta-analysis on published and unpublished DNA methylation and gene expression datasets of ATRTs and associated clinicopathological data. Results In concordance with previous studies, the analyses identified 3 main molecular subgroups of ATRTs, for which a consensus was reached to name them ATRT-TYR, ATRT-SHH, and ATRT-MYC. The ATRT-SHH subgroup exhibited further heterogeneity, segregating further into 2 subtypes associated with a predominant supratentorial (ATRT-SHH-1) or infratentorial (ATRT-SHH-2) location. For each ATRT subgroup we provide an overview of its main molecular and clinical characteristics, including SMARCB1 alterations and pathway activation. Conclusions The introduction of a common classification, characterization, and nomenclature of ATRT subgroups will facilitate future research and serve as a common ground for subgrouping patient samples and ATRT models, which will aid in refining subgroup-based therapies for ATRT patients.
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Affiliation(s)
- Ben Ho
- Division of Hematology and Oncology, Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Pascal D Johann
- Hopp Children's Cancer Center, Heidelberg, Germany.,Division of Pediatric Neuro-oncology, German Cancer Research Center and German Cancer Research Consortium, Heidelberg, Germany.,Department of Pediatric Hematology and Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Yura Grabovska
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Mamy Jean De Dieu Andrianteranagna
- Departments of Genetics and of Oncopediatry and Young Adults, Curie Institute, Paris, France.,INSERM U830, Laboratory of Translational Research in Pediatric Oncology, SIREDO Pediatric Oncology Center, Curie Institute, Paris, France
| | - Fupan Yao
- Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael Frühwald
- University Children's Hospital Augsburg, Swabian Children's Cancer Center, Augsburg, Germany
| | - Martin Hasselblatt
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Franck Bourdeaut
- Departments of Genetics and of Oncopediatry and Young Adults, Curie Institute, Paris, France.,INSERM U830, Laboratory of Translational Research in Pediatric Oncology, SIREDO Pediatric Oncology Center, Curie Institute, Paris, France
| | - Daniel Williamson
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Annie Huang
- Division of Hematology and Oncology, Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marcel Kool
- Hopp Children's Cancer Center, Heidelberg, Germany.,Division of Pediatric Neuro-oncology, German Cancer Research Center and German Cancer Research Consortium, Heidelberg, Germany
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22
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Frühwald MC, Hasselblatt M, Nemes K, Bens S, Steinbügl M, Johann PD, Kerl K, Hauser P, Quiroga E, Solano-Paez P, Biassoni V, Gil-da-Costa MJ, Perek-Polnik M, van de Wetering M, Sumerauer D, Pears J, Stabell N, Holm S, Hengartner H, Gerber NU, Grotzer M, Boos J, Ebinger M, Tippelt S, Paulus W, Furtwängler R, Hernáiz-Driever P, Reinhard H, Rutkowski S, Schlegel PG, Schmid I, Kortmann RD, Timmermann B, Warmuth-Metz M, Kordes U, Gerss J, Nysom K, Schneppenheim R, Siebert R, Kool M, Graf N. Age and DNA methylation subgroup as potential independent risk factors for treatment stratification in children with atypical teratoid/rhabdoid tumors. Neuro Oncol 2021; 22:1006-1017. [PMID: 31883020 DOI: 10.1093/neuonc/noz244] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Controversy exists as to what may be defined as standard of care (including markers for stratification) for patients with atypical teratoid/rhabdoid tumors (ATRTs). The European Rhabdoid Registry (EU-RHAB) recruits uniformly treated patients and offers standardized genetic and DNA methylation analyses. METHODS Clinical, genetic, and treatment data of 143 patients from 13 European countries were analyzed (2009-2017). Therapy consisted of surgery, anthracycline-based induction, and either radiotherapy or high dose chemotherapy following a consensus among European experts. Fluorescence in situ hybridization, multiplex ligation-dependent probe amplification, and sequencing were employed for assessment of somatic and germline mutations in SWItch/sucrose nonfermentable related, matrix associated, actin dependent regulator of chromatin, subfamily B (SMARCB1). Molecular subgroups (ATRT-SHH, ATRT-TYR, and ATRT-MYC) were determined using DNA methylation arrays, resulting in profiles of 84 tumors. RESULTS Median age at diagnosis of 67 girls and 76 boys was 29.5 months. Five-year overall survival (OS) and event-free survival (EFS) were 34.7 ± 4.5% and 30.5 ± 4.2%, respectively. Tumors displayed allelic partial/whole gene deletions (66%; 122/186 alleles) or single nucleotide variants (34%; 64/186 alleles) of SMARCB1. Germline mutations were detected in 26% of ATRTs (30/117). The patient cohort consisted of 47% ATRT-SHH (39/84), 33% ATRT-TYR (28/84), and 20% ATRT-MYC (17/84). Age <1 year, non-TYR signature (ATRT-SHH or -MYC), metastatic or synchronous tumors, germline mutation, incomplete remission, and omission of radiotherapy were negative prognostic factors in univariate analyses (P < 0.05). An adjusted multivariate model identified age <1 year and a non-TYR signature as independent negative predictors of OS: high risk (<1 y + non-TYR; 5-y OS = 0%), intermediate risk (<1 y + ATRT-TYR or ≥1 y + non-TYR; 5-y OS = 32.5 ± 8.7%), and standard risk (≥1 y + ATRT-TYR, 5-y OS = 71.5 ± 12.2%). CONCLUSIONS Age and molecular subgroup status are independent risk factors for survival in children with ATRT. Our model warrants validation within future clinical trials.
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Affiliation(s)
- Michael C Frühwald
- University Children's Hospital Augsburg, Swabian Children's Cancer Center, Augsburg, Germany
| | - Martin Hasselblatt
- University Children's Hospital Augsburg, Swabian Children's Cancer Center, Augsburg, Germany
| | - Karolina Nemes
- University Children's Hospital Augsburg, Swabian Children's Cancer Center, Augsburg, Germany.,Department of Pediatrics and Adolescent Medicine, Neuroscience Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Susanne Bens
- Institute of Human Genetics, University of Ulm & University Hospital of Ulm, Ulm, Germany
| | - Mona Steinbügl
- University Children's Hospital Augsburg, Swabian Children's Cancer Center, Augsburg, Germany
| | - Pascal D Johann
- Hopp Children's Cancer Center, German Cancer Research Center and German Cancer Consortium, Heidelberg, Germany.,Department of Pediatric Oncology, Hematology, and Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Kornelius Kerl
- Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany
| | - Peter Hauser
- Second Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Eduardo Quiroga
- Department of Pediatric Oncology, Hospital Infantil Virgen del Rocio, Sevilla, Spain
| | - Palma Solano-Paez
- Department of Pediatric Oncology, Hospital Infantil Virgen del Rocio, Sevilla, Spain
| | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS National Tumor Institute, Milan, Italy
| | - Maria Joao Gil-da-Costa
- Pediatric Hematology and Oncology Division, University Hospital S João Alameda Hernani Monteiro, Porto, Portugal
| | - Martha Perek-Polnik
- Department of Oncology, The Children's Memorial Health Institute, Warsaw, Poland
| | | | - David Sumerauer
- Department of Pediatric Hematology and Oncology, University Hospital Motol, Prague, Czech Republic
| | - Jane Pears
- Department of Pediatric Haematology and Oncology Our Lady's Children's Hospital, Dublin, Ireland
| | - Niklas Stabell
- Pediatric Department, Oncology Unit, University Hospital of North Norway, Tromso, Norway
| | - Stefan Holm
- Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | - Joachim Boos
- Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany
| | - Martin Ebinger
- Department of General Pediatrics, Hematology, and Oncology, Children's University Hospital Tübingen, Tübingen, Germany
| | - Stefan Tippelt
- Department of Pediatric Hematology/Oncology, Pediatrics III, University Hospital of Essen, Essen, Germany
| | - Werner Paulus
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Rhoikos Furtwängler
- Department of Pediatric Hematology and Oncology, University of Saarland, Homburg, Germany
| | - Pablo Hernáiz-Driever
- Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, corporate member of the Free University Berlin, Humboldt University Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Harald Reinhard
- Pediatrics, Asklepios Kinderklinik Sankt Augustin, Sankt Augustin, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paul-Gerhardt Schlegel
- Department of Pediatric Hematology and Oncology, University of Würzburg, Würzburg, Germany
| | - Irene Schmid
- Department of Pediatric Hematology and Oncology, Ludwig-Maximilian-University, Munich, Germany
| | | | - Beate Timmermann
- Particle Therapy Clinics at West German Proton Therapy, University Hospital Essen, Essen, Germany
| | - Monika Warmuth-Metz
- Department of Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Uwe Kordes
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joachim Gerss
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Karsten Nysom
- University Children's Hospital Augsburg, Swabian Children's Cancer Center, Augsburg, Germany.,Department of Pediatrics and Adolescent Medicine, Neuroscience Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Reinhard Schneppenheim
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Reiner Siebert
- Institute of Human Genetics, University of Ulm & University Hospital of Ulm, Ulm, Germany
| | - Marcel Kool
- Hopp Children's Cancer Center, German Cancer Research Center and German Cancer Consortium, Heidelberg, Germany
| | - Norbert Graf
- Hopp Children's Cancer Center, German Cancer Research Center and German Cancer Consortium, Heidelberg, Germany
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23
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Zhu X, Lazow MA, Schafer A, Bartlett A, Senthil Kumar S, Mishra DK, Dexheimer P, DeWire M, Fuller C, Leach JL, Fouladi M, Drissi R. A pilot radiogenomic study of DIPG reveals distinct subgroups with unique clinical trajectories and therapeutic targets. Acta Neuropathol Commun 2021; 9:14. [PMID: 33431066 PMCID: PMC7798248 DOI: 10.1186/s40478-020-01107-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/14/2020] [Indexed: 01/03/2023] Open
Abstract
An adequate understanding of the relationships between radiographic and genomic features in diffuse intrinsic pontine glioma (DIPG) is essential, especially in the absence of universal biopsy, to further characterize the molecular heterogeneity of this disease and determine which patients are most likely to respond to biologically-driven therapies. Here, a radiogenomics analytic approach was applied to a cohort of 28 patients with DIPG. Tumor size and imaging characteristics from all available serial MRIs were evaluated by a neuro-radiologist, and patients were divided into three radiographic response groups (partial response [PR], stable disease [SD], progressive disease [PD]) based on MRI within 2 months of radiotherapy (RT) completion. Whole genome and RNA sequencing were performed on autopsy tumor specimens. We report several key, therapeutically-relevant findings: (1) Certain radiologic features on first and subsequent post-RT MRIs are associated with worse overall survival, including PD following irradiation as well as present, new, and/or increasing peripheral ring enhancement, necrosis, and diffusion restriction. (2) Upregulation of EMT-related genes and distant tumor spread at autopsy are observed in a subset of DIPG patients who exhibit poorer radiographic response to irradiation and/or higher likelihood of harboring H3F3A mutations, suggesting possible benefit of upfront craniospinal irradiation. (3) Additional genetic aberrations were identified, including DYNC1LI1 mutations in a subgroup of patients with PR on post-RT MRI; further investigation into potential roles in DIPG tumorigenesis and/or treatment sensitivity is necessary. (4) Whereas most DIPG tumors have an immunologically “cold” microenvironment, there appears to be a subset which harbor a more inflammatory genomic profile and/or higher mutational burden, with a trend toward improved overall survival and more favorable radiographic response to irradiation, in whom immunotherapy should be considered. This study has begun elucidating relationships between post-RT radiographic response with DIPG molecular profiles, revealing radiogenomically distinct subgroups with unique clinical trajectories and therapeutic targets.
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24
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Atypical teratoid rhabdoid tumor: molecular insights and translation to novel therapeutics. J Neurooncol 2020; 150:47-56. [PMID: 33021733 DOI: 10.1007/s11060-020-03639-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 09/28/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Atypical teratoid rhabdoid tumor (ATRT) is a rare, often lethal brain tumor of childhood characterized by a complex epigenetic landscape amongst a simple genetic background. Recent molecular studies have defined key biologic events that contribute to tumorigenesis and molecular subtypes of ATRT. METHODS Seminal studies on ATRT are reviewed with an emphasis on molecular pathogenesis and its relevance to novel therapeutics. RESULTS In this review, we summarize the key clinicopathologic and molecular features of ATRT, completed and ongoing clinical trials and outline the translational potential of novel insights into the molecular pathogenesis of this tumor. CONCLUSIONS SMARCB1 loss is the key genetic event in ATRT pathogenesis that leads to widespread epigenetic dysregulation and loss of lineage-specific enhancers. Current work is defining subtype-specific treatments that target underlying molecular derangements that drive tumorigenesis.
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25
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Buch K. Invited Commentary: A Framework for the Differential Diagnosis of Benign and Malignant Intramedullary Tumors. Radiographics 2020; 40:1146-1147. [DOI: 10.1148/rg.2020200059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Karen Buch
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
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26
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Alzoubi H, Gianno F, Giangaspero F, Bartolini D, Riccioni L, Miele E, Antonelli M. Dural-based atypical teratoid/rhabdoid tumor in an adult: DNA methylation profiling as a tool for the diagnosis. CNS Oncol 2020; 9:CNS54. [PMID: 32602741 PMCID: PMC7341157 DOI: 10.2217/cns-2020-0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Atypical teratoid/rhabdoid tumor (ATRT) is a malignant CNS embryonal tumor that mostly occurs in childhood, adult cases are rare. We report a case of a 23-year-old male with an extra-axial dura-based lesion in the left frontal area, previously diagnosed as gliosarcoma. After 6 years, the patient had a recurrence and the previous slides were reviewed. Tumor was positive for vimentin and negative for INI1. The differential diagnosis for this extra-axial tumor with long survival was rhabdoid meningioma with INI1 loss or ATRT. DNA methylation profiling was performed to reach the final and the most definitive diagnosis; the result was ATRT. Our case suggests the usefulness of DNA methylation profiling for diagnosing challenging CNS tumors.
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Affiliation(s)
- Hiba Alzoubi
- Department of Basic Medical Sciences, Faculty of medicine, Yarmouk University, Irbid, Jordan.,Department of Radiological, Oncological & Anatomopathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Francesca Gianno
- Department of Radiological, Oncological & Anatomopathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Felice Giangaspero
- Department of Radiological, Oncological & Anatomopathological Sciences, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed-Mediterranean Neurological Institute, Pozzilli, Italy
| | | | - Luca Riccioni
- Department of Pathology, Bufalini Hospital, Cesena, Italy
| | - Evelina Miele
- Department of Paediatric Haematology/Oncology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Manila Antonelli
- Department of Radiological, Oncological & Anatomopathological Sciences, Sapienza University of Rome, Rome, Italy
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27
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Jaimes C, Vajapeyam S, Brown D, Kao PC, Ma C, Greenspan L, Gupta N, Goumnerova L, Bandopahayay P, Dubois F, Greenwald NF, Zack T, Shapira O, Beroukhim R, Ligon KL, Chi S, Kieran MW, Wright KD, Poussaint TY. MR Imaging Correlates for Molecular and Mutational Analyses in Children with Diffuse Intrinsic Pontine Glioma. AJNR Am J Neuroradiol 2020; 41:874-881. [PMID: 32381545 DOI: 10.3174/ajnr.a6546] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 03/16/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE Recent advances in molecular techniques have characterized distinct subtypes of diffuse intrinsic pontine gliomas. Our aim was the identification of MR imaging correlates of these subtypes. MATERIALS AND METHODS Initial MRIs from subjects with diffuse intrinsic pontine gliomas recruited for a prospective clinical trial before treatment were analyzed. Retrospective imaging analyses included FLAIR/T2 tumor volume, tumor volume enhancing, the presence of cyst and/or necrosis, median, mean, mode, skewness, kurtosis of ADC tumor volume based on FLAIR, and enhancement at baseline. Molecular subgroups based on EGFR and MGMT mutations were established. Histone mutations were also determined (H3F3A, HIST1H3B, HIST1H3C). Univariate Cox proportional hazards regression was used to test the association of imaging predictors with overall and progression-free survival. Wilcoxon rank sum, Kruskal-Wallis, and Fisher exact tests were used to compare imaging measures among groups. RESULTS Fifty patients had biopsy and MR imaging. The median age at trial registration was 6 years (range, 3.3-17.5 years); 52% were female. On the basis of immunohistochemical results, 48 patients were assigned to 1 of 4 subgroups: 28 in MGMT-/epidermal growth factor receptor (EGFR)-, 14 in MGMT-/EGFR+, 3 in MGMT+/EGFR-, and 3 in MGMT+/EGFR+. Twenty-three patients had histone mutations in H3F3A, 8 in HIST1H3B, and 3 in HIST1H3C. Enhancing tumor volume was near-significantly different across molecular subgroups (P = .04), after accounting for the false discovery rate. Tumor volume enhancing, median, mode, skewness, and kurtosis ADC T2-FLAIR/T2 were significantly different (P ≤ .048) between patients with H3F3A and HIST1H3B/C mutations. CONCLUSIONS MR imaging features including enhancement and ADC histogram parameters are correlated with molecular subgroups and mutations in children with diffuse intrinsic pontine gliomas.
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Affiliation(s)
- C Jaimes
- From the Departments of Radiology (C.J., S.V., T.Y.P.).,Fetal-Neonatal Neuroimaging and Developmental Science Center (C.J.), Division of Newborn Medicine; Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School (C.J., S.V., C.M., P.B., F.D., R.B., K.L.L., S.C., K.D.W., T.Y.P.), Boston, Massachusetts
| | - S Vajapeyam
- From the Departments of Radiology (C.J., S.V., T.Y.P.).,Harvard Medical School (C.J., S.V., C.M., P.B., F.D., R.B., K.L.L., S.C., K.D.W., T.Y.P.), Boston, Massachusetts
| | - D Brown
- Tumor Imaging Metrics Core (D.B.), Massachusetts General Hospital, Boston, Massachusetts
| | - P-C Kao
- Pediatrics, Division of Oncology (P.-C.K., C.M., L.G., P.B., R.B., S.C., K.D.W.).,Dana Farber Cancer Institute (P.-C.K., C.M., L.G., P.B., F.D., O.S., R.B., K.L.L., S.C., K.D.W.), Boston, Massachusetts
| | - C Ma
- Pediatrics, Division of Oncology (P.-C.K., C.M., L.G., P.B., R.B., S.C., K.D.W.).,Dana Farber Cancer Institute (P.-C.K., C.M., L.G., P.B., F.D., O.S., R.B., K.L.L., S.C., K.D.W.), Boston, Massachusetts.,Harvard Medical School (C.J., S.V., C.M., P.B., F.D., R.B., K.L.L., S.C., K.D.W., T.Y.P.), Boston, Massachusetts
| | - L Greenspan
- Pediatrics, Division of Oncology (P.-C.K., C.M., L.G., P.B., R.B., S.C., K.D.W.).,Dana Farber Cancer Institute (P.-C.K., C.M., L.G., P.B., F.D., O.S., R.B., K.L.L., S.C., K.D.W.), Boston, Massachusetts
| | - N Gupta
- Department of Pediatric Neurosurgery (N.G.), University of California San Francisco Benioff Children's Hospital, San Francisco, California.,University of California San Francisco School of Medicine (N.G., T.Z.), San Francisco, California
| | | | - P Bandopahayay
- Pediatrics, Division of Oncology (P.-C.K., C.M., L.G., P.B., R.B., S.C., K.D.W.).,Dana Farber Cancer Institute (P.-C.K., C.M., L.G., P.B., F.D., O.S., R.B., K.L.L., S.C., K.D.W.), Boston, Massachusetts.,Harvard Medical School (C.J., S.V., C.M., P.B., F.D., R.B., K.L.L., S.C., K.D.W., T.Y.P.), Boston, Massachusetts
| | - F Dubois
- Dana Farber Cancer Institute (P.-C.K., C.M., L.G., P.B., F.D., O.S., R.B., K.L.L., S.C., K.D.W.), Boston, Massachusetts.,Harvard Medical School (C.J., S.V., C.M., P.B., F.D., R.B., K.L.L., S.C., K.D.W., T.Y.P.), Boston, Massachusetts
| | - N F Greenwald
- Stanford University School of Medicine (N.F.G.), Palo Alto, California
| | - T Zack
- University of California San Francisco School of Medicine (N.G., T.Z.), San Francisco, California
| | - O Shapira
- Dana Farber Cancer Institute (P.-C.K., C.M., L.G., P.B., F.D., O.S., R.B., K.L.L., S.C., K.D.W.), Boston, Massachusetts.,Broad Institute of Massachusetts Institute of Technology and Harvard University (O.S.), Cambridge, Massachusetts
| | - R Beroukhim
- Pediatrics, Division of Oncology (P.-C.K., C.M., L.G., P.B., R.B., S.C., K.D.W.).,Dana Farber Cancer Institute (P.-C.K., C.M., L.G., P.B., F.D., O.S., R.B., K.L.L., S.C., K.D.W.), Boston, Massachusetts.,Harvard Medical School (C.J., S.V., C.M., P.B., F.D., R.B., K.L.L., S.C., K.D.W., T.Y.P.), Boston, Massachusetts
| | - K L Ligon
- Dana Farber Cancer Institute (P.-C.K., C.M., L.G., P.B., F.D., O.S., R.B., K.L.L., S.C., K.D.W.), Boston, Massachusetts.,Department of Pathology (K.L.L.), Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School (C.J., S.V., C.M., P.B., F.D., R.B., K.L.L., S.C., K.D.W., T.Y.P.), Boston, Massachusetts
| | - S Chi
- Pediatrics, Division of Oncology (P.-C.K., C.M., L.G., P.B., R.B., S.C., K.D.W.).,Dana Farber Cancer Institute (P.-C.K., C.M., L.G., P.B., F.D., O.S., R.B., K.L.L., S.C., K.D.W.), Boston, Massachusetts.,Harvard Medical School (C.J., S.V., C.M., P.B., F.D., R.B., K.L.L., S.C., K.D.W., T.Y.P.), Boston, Massachusetts
| | - M W Kieran
- Clinical Trials Division (M.W.K.), Bristol-Myers-Squibb, New York, New York
| | - K D Wright
- Pediatrics, Division of Oncology (P.-C.K., C.M., L.G., P.B., R.B., S.C., K.D.W.).,Dana Farber Cancer Institute (P.-C.K., C.M., L.G., P.B., F.D., O.S., R.B., K.L.L., S.C., K.D.W.), Boston, Massachusetts.,Harvard Medical School (C.J., S.V., C.M., P.B., F.D., R.B., K.L.L., S.C., K.D.W., T.Y.P.), Boston, Massachusetts
| | - T Y Poussaint
- From the Departments of Radiology (C.J., S.V., T.Y.P.) .,Harvard Medical School (C.J., S.V., C.M., P.B., F.D., R.B., K.L.L., S.C., K.D.W., T.Y.P.), Boston, Massachusetts
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28
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Chen F, Mei W, Lu W, Zeng T, Kang D, Wu X, You H. Atypical Teratoid/Rhabdoid Tumor Originated From the Trigeminal Nerve in a Young Male Adult: Case Report and Review of the Literature. Front Neurol 2020; 11:265. [PMID: 32373048 PMCID: PMC7186469 DOI: 10.3389/fneur.2020.00265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/20/2020] [Indexed: 11/17/2022] Open
Abstract
Atypical teratoid/rhabdoid tumor (AT/RT) is a highly malignant central nervous system neoplasm predominantly found in children under the age of 3 years, and is extremely rare in adults. There is no specific clinical presentations or radiological features in reported cases of AT/RT. Diagnosis of brain AT/RT is mainly dependent on the classical pathological characteristics. We report a rare case of AT/RT arising from the trigeminal nerve and leading to progressively multiple cranial nerve palsies in a 25-year-old male patient. Microsurgical resection of the tumor has been performed and confirmed the diagnosis by postoperative pathology. To our knowledge, this is the second case of adult-onset AT/RT originating from the trigeminal nerve.
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Affiliation(s)
- Fuxiang Chen
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Wenzhong Mei
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Wen Lu
- Department of Disease Prevention and Healthcare, Fujian Provincial Hospital, Fuzhou, China
| | - Tiefa Zeng
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Dezhi Kang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xiyue Wu
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Honghai You
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Thomas C, Wefers A, Bens S, Nemes K, Agaimy A, Oyen F, Vogelgesang S, Rodriguez FJ, Brett FM, McLendon R, Bodi I, Burel-Vandenbos F, Keyvani K, Tippelt S, Poulsen FR, Lipp ES, Giannini C, Reifenberger G, Kuchelmeister K, Pietsch T, Kordes U, Siebert R, Frühwald MC, Johann PD, Sill M, Kool M, von Deimling A, Paulus W, Hasselblatt M. Desmoplastic myxoid tumor, SMARCB1-mutant: clinical, histopathological and molecular characterization of a pineal region tumor encountered in adolescents and adults. Acta Neuropathol 2020; 139:277-286. [PMID: 31732806 DOI: 10.1007/s00401-019-02094-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 02/07/2023]
Abstract
Atypical teratoid/rhabdoid tumor (ATRT) is a highly malignant brain tumor predominantly occurring in infants. Mutations of the SMARCB1 gene are the characteristic genetic lesion. SMARCB1-mutant tumors in adolescents and adults are rare and may show uncommon histopathological and clinical features. Here we report seven SMARCB1-deficient intracranial tumors sharing distinct clinical, histopathological and molecular features. Median age of the four females and three males was 40 years (range 15-61 years). All tumors were located in the pineal region. Histopathologically, these tumors displayed spindled and epithelioid cells embedded in a desmoplastic stroma alternating with a variable extent of a loose myxoid matrix. All cases showed loss of nuclear SMARCB1/INI1 protein expression, expression of EMA and CD34 was frequent and the Ki67/MIB1 proliferation index was low in the majority of cases (median 3%). Three cases displayed heterozygous SMARCB1 deletions and two cases a homozygous SMARCB1 deletion. On sequencing, one tumor showed a 2 bp deletion in exon 4 (c.369_370del) and one a short duplication in exon 3 (c.237_276dup) both resulting in frameshift mutations. Most DNA methylation profiles were not classifiable using the Heidelberg Brain Tumor Classifier (version v11b4). By unsupervised t-SNE analysis and hierarchical clustering analysis, however, all tumors grouped closely together and showed similarities with ATRT-MYC. After a median observation period of 48 months, three patients were alive with stable disease, whereas one patient experienced tumor progression and three patients had succumbed to disease. In conclusion, our series represents an entity with distinct clinical, histopathological and molecular features showing epigenetic similarities with ATRT-MYC. We propose the designation desmoplastic myxoid tumor (DMT), SMARCB1-mutant, for these tumors.
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Affiliation(s)
- Christian Thomas
- Institute of Neuropathology, University Hospital Münster, Pottkamp 2, Münster, Germany
| | - Annika Wefers
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Susanne Bens
- Institute of Human Genetics, University of Ulm and Ulm University Hospital, Ulm, Germany
| | - Karolina Nemes
- Swabian Childrens' Cancer Center, University Childrens' Hospital Augsburg and EU-RHAB Registry, Augsburg, Germany
| | - Abbas Agaimy
- Institute of Pathology, University of Erlangen, Erlangen, Germany
| | - Florian Oyen
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Silke Vogelgesang
- Institute of Pathology, Department of Neuropathology, University Medicine Greifswald, Greifswald, Germany
| | | | - Francesca M Brett
- Department of Neuropathology, Beaumont Hospital, Beaumont Road, Dublin, Ireland
| | - Roger McLendon
- Department of Pathology, Duke University, Durham, NC, USA
| | - Istvan Bodi
- Department of Clinical Neuropathology, King's College Hospital NHS Foundation Trust, London, UK
| | - Fanny Burel-Vandenbos
- Central Laboratory of Pathology, Nice University Hospital, Hôpital Pasteur, Nice, France
| | - Kathy Keyvani
- Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany
| | - Stefan Tippelt
- Department of Pediatric Oncology and Hematology, Pediatrics III, University Hospital Essen, Essen, Germany
| | - Frantz R Poulsen
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark
| | - Eric S Lipp
- Preston Robert Tisch Brain Tumor Center, Duke University, Durham, NC, USA
| | - Caterina Giannini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Guido Reifenberger
- Department of Neuropathology, Heinrich Heine University, Düsseldorf, Germany
- German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, German Cancer Research Center (DKFZ), Düsseldorf, Germany
| | - Klaus Kuchelmeister
- Institute of Neuropathology and DGNN Brain Tumor Reference Centre, University of Bonn, Bonn, Germany
| | - Torsten Pietsch
- Institute of Neuropathology and DGNN Brain Tumor Reference Centre, University of Bonn, Bonn, Germany
| | - Uwe Kordes
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Reiner Siebert
- Institute of Human Genetics, University of Ulm and Ulm University Hospital, Ulm, Germany
| | - Michael C Frühwald
- Swabian Childrens' Cancer Center, University Childrens' Hospital Augsburg and EU-RHAB Registry, Augsburg, Germany
| | - Pascal D Johann
- Hopp-Children's Cancer Center (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Martin Sill
- Hopp-Children's Cancer Center (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Marcel Kool
- Hopp-Children's Cancer Center (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Andreas von Deimling
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Werner Paulus
- Institute of Neuropathology, University Hospital Münster, Pottkamp 2, Münster, Germany
| | - Martin Hasselblatt
- Institute of Neuropathology, University Hospital Münster, Pottkamp 2, Münster, Germany.
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30
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Vomiting – a symptom easy to be misdiagnosed in children. PEDIATRU.RO 2020. [DOI: 10.26416/pedi.58.2.2020.3577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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31
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Jaju A, Hwang EI, Kool M, Capper D, Chavez L, Brabetz S, Billups C, Li Y, Fouladi M, Packer RJ, Pfister SM, Olson JM, Heier LA. MRI Features of Histologically Diagnosed Supratentorial Primitive Neuroectodermal Tumors and Pineoblastomas in Correlation with Molecular Diagnoses and Outcomes: A Report from the Children's Oncology Group ACNS0332 Trial. AJNR Am J Neuroradiol 2019; 40:1796-1803. [PMID: 31601576 DOI: 10.3174/ajnr.a6253] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/21/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Supratentorial primitive neuroectodermal tumors and pineoblastomas have traditionally been grouped together for treatment purposes. Molecular profiling of these tumors has revealed a number of distinct entities and has led to the term "CNS-primitive neuroectodermal tumors" being removed from the 2016 World Health Organization classification. The purpose of this study was to describe the MR imaging findings of histologically diagnosed primitive neuroectodermal tumors and pineoblastomas and correlate them with molecular diagnoses and outcomes. MATERIALS AND METHODS Histologically diagnosed primitive neuroectodermal tumors and pineoblastomas were enrolled in this Children's Oncology Group Phase III trial, and molecular classification was retrospectively completed using DNA methylation profiling. MR imaging features were systematically studied and correlated with molecular diagnoses and survival. RESULTS Of the 85 patients enrolled, 56 met the inclusion criteria, in whom 28 tumors were in pineal and 28 in nonpineal locations. Methylation profiling revealed a variety of diagnoses, including pineoblastomas (n = 27), high-grade gliomas (n = 17), embryonal tumors (n = 7), atypical teratoid/rhabdoid tumors (n = 3), and ependymomas (n = 2). Thus, 39% overall and 71% of nonpineal tumor diagnoses were discrepant with histopathology. Tumor location, size, margins, and edema were predictors of embryonal-versus-nonembryonal tumors. Larger size and ill-defined margins correlated with poor event-free survival, while metastatic disease by MR imaging did not. CONCLUSIONS In nonpineal locations, only a minority of histologically diagnosed primitive neuroectodermal tumors are embryonal tumors; therefore, high-grade glioma or ependymoma should be high on the radiographic differential. An understanding of molecularly defined tumor entities and their relative frequencies and locations will help the radiologist make more accurate predictions of the tumor types.
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Affiliation(s)
- A Jaju
- From the Department of Radiology (A.J.), Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois .,Northwestern University Feinberg School of Medicine (A.J.), Chicago, Illinois
| | - E I Hwang
- Brain Tumor Institute (E.I.H., R.J.P.), Children's National Health System, Washington, DC
| | - M Kool
- Department of Pediatric Neurooncology (M.K., S.B., S.M.P.), German Cancer Research Center, Heidelberg, Baden-Württemberg, Germany
| | - D Capper
- Department of Pediatric Neuropathology (D.C.), University Hospital Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - L Chavez
- Department of Medicine (L.C.), University of California San Diego, La Jolla, California
| | - S Brabetz
- Department of Pediatric Neurooncology (M.K., S.B., S.M.P.), German Cancer Research Center, Heidelberg, Baden-Württemberg, Germany
| | - C Billups
- Department of Biostatistics (C.B., Y.L.), St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Y Li
- Department of Biostatistics (C.B., Y.L.), St. Jude Children's Research Hospital, Memphis, Tennessee
| | - M Fouladi
- Brain Tumor Center (M.F.), Cincinnati Children's Hospital, Cincinnati, Ohio
| | - R J Packer
- Brain Tumor Institute (E.I.H., R.J.P.), Children's National Health System, Washington, DC
| | - S M Pfister
- Department of Pediatric Neurooncology (M.K., S.B., S.M.P.), German Cancer Research Center, Heidelberg, Baden-Württemberg, Germany
| | - J M Olson
- Fred Hurtchinson Cancer Research Center (J.M.O.), Seattle Children's Hospital, Seattle, Washington
| | - L A Heier
- Department of Radiology (L.A.H.), New York Presbyterian Hospital, New York, New York
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Hasselblatt M, Thomas C, Nemes K, Monoranu CM, Riemenschneider MJ, Koch A, Sumerauer D, Hauser P, Paulus W, Johann PD, Kool M, Frühwald MC. Tyrosinase immunohistochemistry can be employed for the diagnosis of atypical teratoid/rhabdoid tumours of the tyrosinase subgroup (ATRT-TYR). Neuropathol Appl Neurobiol 2019; 46:186-189. [PMID: 31077608 DOI: 10.1111/nan.12560] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- M Hasselblatt
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - C Thomas
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - K Nemes
- Swabian Childrens' Cancer Center, University Childrens' Hospital Augsburg and EU-RHAB Registry, Augsburg, Germany
| | - C-M Monoranu
- Department of Neuropathology, Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - M J Riemenschneider
- Department of Neuropathology, Regensburg University Hospital, Regensburg, Germany
| | - A Koch
- Department of Neuropathology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - D Sumerauer
- Department of Pediatric Hematology and Oncology, University Hospital Motol, Charles University, 2nd Medical School, Prague, Czech Republic
| | - P Hauser
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - W Paulus
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - P D Johann
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany.,Division of Paediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany
| | - M Kool
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany.,Division of Paediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany
| | - M C Frühwald
- Swabian Childrens' Cancer Center, University Childrens' Hospital Augsburg and EU-RHAB Registry, Augsburg, Germany
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33
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Thomas C, Knerlich-Lukoschus F, Reinhard H, Johann PD, Sturm D, Sahm F, Bens S, Vogt J, Nemes K, Oyen F, Kordes U, Siebert R, Schneppenheim R, Messing-Jünger M, Pietsch T, von Deimling A, Paulus W, Pfister SM, Kool M, Frühwald MC, Hasselblatt M. Two molecularly distinct atypical teratoid/rhabdoid tumors (or tumor components) occurring in an infant with rhabdoid tumor predisposition syndrome 1. Acta Neuropathol 2019; 137:847-850. [PMID: 30945057 DOI: 10.1007/s00401-019-02001-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 03/30/2019] [Accepted: 03/30/2019] [Indexed: 01/27/2023]
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34
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Tamrazi B, Venneti S, Margol A, Hawes D, Cen SY, Nelson M, Judkins A, Biegel J, Blüml S. Pediatric Atypical Teratoid/Rhabdoid Tumors of the Brain: Identification of Metabolic Subgroups Using In Vivo 1H-MR Spectroscopy. AJNR Am J Neuroradiol 2019; 40:872-877. [PMID: 30948375 DOI: 10.3174/ajnr.a6024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/27/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Atypical teratoid/rhabdoid tumors are rare, aggressive central nervous system tumors that are predominantly encountered in very young children. Our aim was to determine whether in vivo metabolic profiles correlate with molecular features of central nervous system pediatric atypical teratoid/rhabdoid tumors. MATERIALS AND METHODS Twenty confirmed patients with atypical teratoid/rhabdoid tumors who underwent MR spectroscopy were included in this study. In vivo metabolite levels of atypical teratoid/rhabdoid tumors were compared with molecular subtypes assessed by achaete-scute homolog 1 expression. Additionally, brain-specific creatine kinase levels were determined in tissue samples. RESULTS In vivo creatine concentrations were higher in tumors that demonstrated achaete-scute homolog 1 expression compared with those without achaete-scute homolog 1 expression (3.42 ± 1.1 versus 1.8 ± 0.8 IU, P < .01). Additionally, levels of myo-inositol (mI) (9.0 ± 1.5 versus 4.7 ± 3.6 IU, P < .05) were significantly different, whereas lipids approached significance (44 ± 20 versus 80 ± 30 IU, P = .07) in these 2 cohorts. Higher brain-specific creatine kinase levels were observed in the cohort with achaete-scute homolog 1 expression (P < .05). Pearson correlation analysis showed a significant positive correlation of brain-specific creatine kinase with absolute creatine (P < .05) and myo-inositol (P < .05) concentrations. CONCLUSIONS In vivo MR spectroscopy may predict key molecular features of atypical teratoid/rhabdoid tumors at initial diagnosis, leading to timely patient risk stratification and accelerating the development of targeted therapies.
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Affiliation(s)
- B Tamrazi
- From the Departments of Radiology (B.T., M.N., S.B.)
| | - S Venneti
- Department of Pathology (S.V.), University of Michigan, Ann Arbor, Michigan
| | - A Margol
- Pediatrics (A.M.) and Division of Hematology Oncology
| | - D Hawes
- Pathology (D.H., A.J., J.B.), Children's Hospital Los Angeles, Los Angeles, California
| | - S Y Cen
- Department of Radiology and Neurology (S.Y.C.), University of Southern California, Los Angeles, California
| | - M Nelson
- From the Departments of Radiology (B.T., M.N., S.B.)
| | - A Judkins
- Pathology (D.H., A.J., J.B.), Children's Hospital Los Angeles, Los Angeles, California
| | - J Biegel
- Pathology (D.H., A.J., J.B.), Children's Hospital Los Angeles, Los Angeles, California
| | - S Blüml
- From the Departments of Radiology (B.T., M.N., S.B.).,Rudi Schulte Research Institute (S.B.), Santa Barbara, California
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Embryonal Tumors of the Central Nervous System in Children: The Era of Targeted Therapeutics. Bioengineering (Basel) 2018; 5:bioengineering5040078. [PMID: 30249036 PMCID: PMC6315657 DOI: 10.3390/bioengineering5040078] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 09/12/2018] [Accepted: 09/12/2018] [Indexed: 02/07/2023] Open
Abstract
Embryonal tumors (ET) of the central nervous system (CNS) in children encompass a wide clinical spectrum of aggressive malignancies. Until recently, the overlapping morphological features of these lesions posed a diagnostic challenge and undermined discovery of optimal treatment strategies. However, with the advances in genomic technology and the outpouring of biological data over the last decade, clear insights into the molecular heterogeneity of these tumors are now well delineated. The major subtypes of ETs of the CNS in children include medulloblastoma, atypical teratoid rhabdoid tumor (ATRT), and embryonal tumors with multilayered rosettes (ETMR), which are now biologically and clinically characterized as different entities. These important developments have paved the way for treatments guided by risk stratification as well as novel targeted therapies in efforts to improve survival and reduce treatment burden.
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