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Rufus P, Chatterjee S. Second-look surgery in postoperative pediatric low-grade glioma. Childs Nerv Syst 2024:10.1007/s00381-024-06516-3. [PMID: 38970692 DOI: 10.1007/s00381-024-06516-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 06/20/2024] [Indexed: 07/08/2024]
Abstract
OBJECTIVE To review the literature on second-look surgery in pediatric low-grade gliomas (LGG) with a view to presenting both sides of the picture of re-exploration. METHODS Collection of material from recent literature on pediatric LGG. This was a retrospective review of these publications. RESULTS There are a number of publications recommending second-look surgery in selected cases, provided morbidity of the second surgery is minimum, and indeed some in which there is improvement in the neurodeficit after the second resection. CONCLUSION There seems a fair balance of articles recommending and dissuading the practice of second-look surgery, but in our limited experience we have found it useful in selected patients.
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2
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Bale TA, Rosenblum MK. The 2021 WHO Classification of Tumors of the Central Nervous System: An update on pediatric low-grade gliomas and glioneuronal tumors. Brain Pathol 2022; 32:e13060. [PMID: 35218102 PMCID: PMC9245930 DOI: 10.1111/bpa.13060] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 12/13/2022] Open
Abstract
The 2021 5th edition of the WHO Classification of Tumors of the Central Nervous System reflects the discovery of genetic alterations underlying many central nervous system (CNS) neoplasms. Insights gained from technologic advances and novel applications in molecular diagnostics, including next‐generation sequencing and DNA methylation‐based profiling, coupled with the recognition of clinicopathologic correlates, have prompted substantial changes to CNS tumor classification; this is particularly true for pediatric low‐grade gliomas and glioneuronal tumors (pLGG/GNTs). The 2021 WHO now classifies gliomas, glioneuronal tumors and neuronal tumors into 6 families, three of which encompass pLGG/LGNTs: “Pediatric type diffuse low‐grade gliomas,” “circumscribed astrocytic gliomas,” and “glioneuronal and neuronal tumors.” Among these are six newly recognized tumor types: “diffuse astrocytoma, MYB or MYBL1‐altered”; “polymorphous low grade neuroepithelial tumor of the young (PLNTY)”; “diffuse low‐grade glioma‐MAPK altered”; “Diffuse glioneuronal tumor with oligodendroglioma‐like features and nuclear clusters (DGONC)”; “myxoid glioneuronal tumor (MGT)”; and “multinodular and vacuolating neuronal tumor (MVNT).” We review these newly recognized entities in the context of general changes to the WHO schema, discuss implications of the new classification for treatment of pLGG/LGNT, and consider strategies for molecular testing and interpretation.
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Affiliation(s)
- Tejus A Bale
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Marc K Rosenblum
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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3
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Pérez-Serrano C, Bartolomé Á, Bargalló N, Sebastià C, Nadal A, Gómez O, Oleaga L. Perinatal post-mortem magnetic resonance imaging (MRI) of the central nervous system (CNS): a pictorial review. Insights Imaging 2021; 12:104. [PMID: 34292413 PMCID: PMC8298710 DOI: 10.1186/s13244-021-01051-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/30/2021] [Indexed: 11/28/2022] Open
Abstract
Central nervous system (CNS) abnormalities cause approximately 32–37.7% of terminations of pregnancy (TOP). Autopsy is currently the gold standard for assessing dead foetuses and stillborn. However, it has limitations and is sometimes subject to parental rejection. Recent studies have described post-mortem foetal magnetic resonance imaging (MRI) as an alternative and even complementary to autopsy for CNS assessment. Radiologists now play a key role in the evaluation of perinatal deaths. Assessment of foetal CNS abnormalities is difficult, and interpretation of foetal studies requires familiarisation with normal and abnormal findings in post-mortem MRI studies as well as the strengths and limitations of the imaging studies. The purpose of this pictorial review is to report our experience in the post-mortem MRI evaluation of the CNS system, including a description of the protocol used, normal CNS findings related to post-mortem status, abnormal CNS findings in our sample, and the correlation of these findings with histopathological results.
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Affiliation(s)
- Carlos Pérez-Serrano
- Radiology Department, CDIC, Hospital Clínic de Barcelona, C/Villarroel no. 170, 08036, Barcelona, Spain.
| | - Álvaro Bartolomé
- Radiology Department, CDIC, Hospital Clínic de Barcelona, C/Villarroel no. 170, 08036, Barcelona, Spain
| | - Núria Bargalló
- Radiology Department, CDIC, Hospital Clínic de Barcelona, C/Villarroel no. 170, 08036, Barcelona, Spain
| | - Carmen Sebastià
- Radiology Department, CDIC, Hospital Clínic de Barcelona, C/Villarroel no. 170, 08036, Barcelona, Spain
| | - Alfons Nadal
- Pathology Department, CDB, Hospital Clínic de Barcelona, C/Villarroel no. 170, 08036, Barcelona, Spain
| | - Olga Gómez
- Gynecology Department, ICGON, Hospital Clínic de Barcelona, C/Villarroel no. 170, 08036, Barcelona, Spain
| | - Laura Oleaga
- Radiology Department, CDIC, Hospital Clínic de Barcelona, C/Villarroel no. 170, 08036, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
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4
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Chiang JCH, Harreld JH, Tanaka R, Li X, Wen J, Zhang C, Boué DR, Rauch TM, Boyd JT, Chen J, Corbo JC, Bouldin TW, Elton SW, Liu LWL, Schofield D, Lee SC, Bouffard JP, Georgescu MM, Dossani RH, Aguiar MA, Sances RA, Saad AG, Boop FA, Qaddoumi I, Ellison DW. Septal dysembryoplastic neuroepithelial tumor: a comprehensive clinical, imaging, histopathologic, and molecular analysis. Neuro Oncol 2020; 21:800-808. [PMID: 30726976 DOI: 10.1093/neuonc/noz037] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Dysembryoplastic neuroepithelial tumors (DNETs) are uncommon neural tumors presenting most often in children and young adults and associated with intractable seizures. Rare midline neoplasms with similar histological features to those found in DNETs have been described near the septum pellucidum and termed "DNET-like neoplasms of the septum pellucidum." Due to their rarity, these tumors have been described in just a few reports and their genetic alterations sought only in small series. METHODS We collected 20 of these tumors for a comprehensive study of their clinical, radiological, and pathological features. RNA sequencing or targeted DNA sequencing was undertaken on 18 tumors, and genome-wide DNA methylation profiling was possible with 11 tumors. Published cases (n = 22) were also reviewed for comparative purposes. RESULTS The commonest presenting symptoms and signs were related to raised intracranial pressure; 40% of cases required cerebrospinal fluid diversion. Epilepsy was seen in approximately one third of cases. All patients had an indolent disease course, despite metastasis within the neuraxis in a few cases. Radiologically, the septum verum/septal nuclei were involved in all cases and are the proposed site of origin for septal DNET (sDNET). Septal DNET showed a high frequency (~80%) of mutations of platelet derived growth factor receptor A (PDGFRA), and alterations in fibroblast growth factor receptor 1 (FGFR1) and neurofibromatosis type 1 (NF1) were also identified. In a genomic DNA methylation analysis alongside other neural tumors, sDNETs formed a separate molecular group. CONCLUSIONS Genetic alterations that are different from those of cerebral DNETs and a distinct methylome profile support the proposal that sDNET is a distinct disease entity.
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Affiliation(s)
- Jason C H Chiang
- Department of Pathology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Julie H Harreld
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Ryuma Tanaka
- Department of Oncology, Division of Neuro-Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Xiaoyu Li
- Department of Pathology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Ji Wen
- Department of Pathology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Chenran Zhang
- Department of Pediatric Neurosurgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Department of Surgery, Division of Pediatric Neurosurgery, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Daniel R Boué
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Tracy M Rauch
- Pathology Group of Louisiana, Baton Rouge, Louisiana, USA
| | - J Todd Boyd
- Clinical and Anatomic Pathology Laboratory, Dayton Children's, Dayton, Ohio, USA
| | - Jie Chen
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joseph C Corbo
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Thomas W Bouldin
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Scott W Elton
- Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Deborah Schofield
- Department of Pathology, Children's Hospital of The King's Daughters, Norfolk, Virginia, USA
| | - Sunhee C Lee
- Department of Surgical Pathology, Montefiore Medical Center/Moses Campus, Bronx, New York, USA
| | | | - Maria-Magdalena Georgescu
- Department of Pathology, Louisiana State University Health Science Center, Shreveport, Louisiana, USA
| | - Rimal H Dossani
- Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana, USA
| | - Maria A Aguiar
- Department of Pathology, Children's Hospital of The King's Daughters, Norfolk, Virginia, USA
| | - Richard A Sances
- Department of Pathology, East Tennessee Children's Hospital, Knoxville, Tennessee, USA
| | - Ali G Saad
- Department of Pathology, Methodist University Hospital, Memphis, Tennessee, USA
| | - Frederick A Boop
- Department of Surgery, Division of Pediatric Neurosurgery, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Ibrahim Qaddoumi
- Department of Pathology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - David W Ellison
- Department of Oncology, Division of Neuro-Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
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5
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Lucas CHG, Villanueva-Meyer JE, Whipple N, Oberheim Bush NA, Cooney T, Chang S, McDermott M, Berger M, Cham E, Sun PP, Putnam A, Zhou H, Bollo R, Cheshier S, Poppe MM, Fung KM, Sung S, Glenn C, Fan X, Bannykh S, Hu J, Danielpour M, Li R, Alva E, Johnston J, Van Ziffle J, Onodera C, Devine P, Grenert JP, Lee JC, Pekmezci M, Tihan T, Bollen AW, Perry A, Solomon DA. Myxoid glioneuronal tumor, PDGFRA p.K385-mutant: clinical, radiologic, and histopathologic features. Brain Pathol 2019; 30:479-494. [PMID: 31609499 DOI: 10.1111/bpa.12797] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/07/2019] [Indexed: 02/06/2023] Open
Abstract
"Myxoid glioneuronal tumor, PDGFRA p.K385-mutant" is a recently described tumor entity of the central nervous system with a predilection for origin in the septum pellucidum and a defining dinucleotide mutation at codon 385 of the PDGFRA oncogene replacing lysine with either leucine or isoleucine (p.K385L/I). Clinical outcomes and optimal treatment for this new tumor entity have yet to be defined. Here, we report a comprehensive clinical, radiologic, and histopathologic assessment of eight cases. In addition to its stereotypic location in the septum pellucidum, we identify that this tumor can also occur in the corpus callosum and periventricular white matter of the lateral ventricle. Tumors centered in the septum pellucidum uniformly were associated with obstructive hydrocephalus, whereas tumors centered in the corpus callosum and periventricular white matter did not demonstrate hydrocephalus. While multiple patients were found to have ventricular dissemination or local recurrence/progression, all patients in this series remain alive at last clinical follow-up despite only biopsy or subtotal resection without adjuvant therapy in most cases. Our study further supports "myxoid glioneuronal tumor, PDGFRA p.K385-mutant" as a distinct CNS tumor entity and expands the spectrum of clinicopathologic and radiologic features of this neoplasm.
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Affiliation(s)
| | | | - Nicholas Whipple
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Nancy Ann Oberheim Bush
- Division of Neuro-Oncology, Department of Neurological Surgery, University of California, San Francisco, CA.,Department of Neurology, University of California, San Francisco, CA
| | - Tabitha Cooney
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, CA
| | - Susan Chang
- Division of Neuro-Oncology, Department of Neurological Surgery, University of California, San Francisco, CA.,Department of Neurology, University of California, San Francisco, CA
| | - Michael McDermott
- Department of Neurological Surgery, University of California, San Francisco, CA
| | - Mitchel Berger
- Department of Neurological Surgery, University of California, San Francisco, CA
| | - Elaine Cham
- Department of Pathology, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | - Peter P Sun
- Department of Neurosurgery, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | - Angelica Putnam
- Department of Pathology, University of Utah, Salt Lake City, UT
| | - Hong Zhou
- Department of Pathology, University of Utah, Salt Lake City, UT
| | - Robert Bollo
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah, Salt Lake City, UT
| | - Samuel Cheshier
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah, Salt Lake City, UT
| | - Matthew M Poppe
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Kar-Ming Fung
- Department of Pathology, University of Oklahoma, Oklahoma City, OK
| | - Sarah Sung
- Department of Neurology, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Chad Glenn
- Department of Neurosurgery, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Xuemo Fan
- Department of Pathology, Cedars Sinai Medical Center, Los Angeles, CA
| | - Serguei Bannykh
- Department of Pathology, Cedars Sinai Medical Center, Los Angeles, CA
| | - Jethro Hu
- Department of Neurology, Cedars Sinai Medical Center, Los Angeles, CA
| | - Moise Danielpour
- Department of Neurosurgery, Cedars Sinai Medical Center, Los Angeles, CA
| | - Rong Li
- Department of Pathology, Children's Hospital of Alabama, Birmingham, AL
| | - Elizabeth Alva
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Children's Hospital of Alabama, Birmingham, AL
| | - James Johnston
- Department of Neurosurgery, Children's Hospital of Alabama, Birmingham, AL
| | - Jessica Van Ziffle
- Department of Pathology, University of California, San Francisco, CA.,Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA
| | - Courtney Onodera
- Department of Pathology, University of California, San Francisco, CA.,Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA
| | - Patrick Devine
- Department of Pathology, University of California, San Francisco, CA.,Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA
| | - James P Grenert
- Department of Pathology, University of California, San Francisco, CA.,Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA
| | - Julieann C Lee
- Department of Pathology, University of California, San Francisco, CA
| | - Melike Pekmezci
- Department of Pathology, University of California, San Francisco, CA
| | - Tarik Tihan
- Department of Pathology, University of California, San Francisco, CA
| | - Andrew W Bollen
- Department of Pathology, University of California, San Francisco, CA
| | - Arie Perry
- Department of Pathology, University of California, San Francisco, CA.,Department of Neurological Surgery, University of California, San Francisco, CA
| | - David A Solomon
- Department of Pathology, University of California, San Francisco, CA.,Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA
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6
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Luzzi S, Elia A, Del Maestro M, Elbabaa SK, Carnevale S, Guerrini F, Caulo M, Morbini P, Galzio R. Dysembryoplastic Neuroepithelial Tumors: What You Need to Know. World Neurosurg 2019; 127:255-265. [PMID: 30981794 DOI: 10.1016/j.wneu.2019.04.056] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE An updated and comprehensive review on dysembryoplastic neuroepithelial tumor (DNET) focusing on differential diagnosis, atypical presentation, seizure outcome, and risk of malignant transformation. METHODS A PubMed/MEDLINE-based literature search has been performed using "dysembryoplastic neuroepithelial tumor" as a keyword. Two treated cases characterized by an atypical presentation have been reviewed. RESULTS Of 1162 articles, 200 relevant studies have been selected. DNET is a benign mixed neuronal-glial tumor causing drug-resistant epilepsy primarily in children and young adults. The typical radiological pattern is a magnetic resonance imaging (MRI) T1-hypointense, T2-, and fluid-attenuated inversion-recovery hyperintense multicystic lesion involving the cerebral cortex with no edema. Contrast enhancement may be present and a focal cortical dysplasia is commonly associated with it. MRI diffusion, perfusion, and spectroscopy have a paramount role in the differential diagnosis. The "specific glioneuronal elements" are pathognomonic. They are positive for S100 protein, synaptofisin, neuronal nuclei, oligodendrocyte transcription factor, neurite outgrowth inhibitor, and microtubule-associated protein 2, but negative for glial fibrillary acidic protein. As opposed to v-myb avian myeloblastosis viral oncogene homolog, isocitrate dehydrogenase-1/isocitrate dehydrogenase-2 mutation and codeletion 1p-19q, fibroblast growth factor receptor 1 and BRAF V600E mutations are present. The effectiveness of surgery on seizure outcome has been established. Rare malignant transformations have been reported, especially in extra-temporal and complex forms. CONCLUSIONS Advanced MRI techniques are fundamental in the differential diagnosis for DNET versus other low-grade gliomas. Immuno-phenotype assessment and search for fibroblast growth factor receptor 1 and BRAF V600E mutations limit the risk of misdiagnoses. A gross total tumor removal is generally associated with a seizure-free outcome. Recurrences and malignant transformations may rarely follow, legitimizing MRI surveillance in cases of subtotal tumor resection.
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Affiliation(s)
- Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; D.E.O.T. Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy.
| | - Angela Elia
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Mattia Del Maestro
- PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Samer K Elbabaa
- Pediatric Neurosurgery Department, Pediatric Neuroscience Center of Excellence, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Sergio Carnevale
- Unit of Pathological Anatomy, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Francesco Guerrini
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
| | - Patrizia Morbini
- Unit of Pathological Anatomy, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Renato Galzio
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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7
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Gessi M, Hattingen E, Dörner E, Goschzik T, Dreschmann V, Waha A, Pietsch T. Dysembryoplastic Neuroepithelial Tumor of the Septum Pellucidum and the Supratentorial Midline: Histopathologic, Neuroradiologic, and Molecular Features of 7 Cases. Am J Surg Pathol 2017; 40:806-11. [PMID: 26796505 DOI: 10.1097/pas.0000000000000600] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Dysembryoplastic neuroepithelial tumors (DNTs) are one of the most common epilepsy-associated low-grade glioneuronal tumors of the central nervous system. Although most DNTs occur in the cerebral cortex, DNT-like tumors with unusual intraventricular or periventricular localizations have been reported. Most of them involve the septum pellucidum and the foramen of Monro. In this study, we have described the neuroradiologic, histopathologic, and molecular features of 7 cases (4 female and 3 male; patient age range, 3 to 34 y; mean age, 16.7 y). The tumors, all localized near the supratentorial midline structures in proximity to the foramen of Monro and septum pellucidum, appeared in magnetic resonance imaging as well-delimited cystic lesions with cerebrospinal fluid-like signal on T1-weighted and T2-weighted images, some of them with typical fluid-attenuated inversion recovery ring sign. Histologically, they shared features with classic cortical DNTs but did not display aspects of multinodularity. From a molecular point of view the cases investigated did not show KIAA1549-BRAF fusions or FGFR1 mutations, alterations otherwise observed in pilocytic astrocytomas, or MYB and MYBL1 alterations that have been identified in a large group of pediatric low-grade gliomas. Moreover, BRAF mutations, which so far represent the most common molecular alteration found in cortical DNTs, were absent in this group of rare periventricular tumors.
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Affiliation(s)
- Marco Gessi
- *Institute of Neuropathology †Department of Neuroradiology, Institute of Radiology, University of Bonn Medical Center, Bonn, Germany
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9
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Abstract
Dysembryoplastic neuroepithelial tumor (DNT) is a benign glioneuronal neoplasm that most commonly occurs in children and young adults and may present with medically intractable, chronic seizures. Radiologically, this tumor is characterized by a cortical topography and lack of mass effect or perilesional edema. Partial complex seizures are the most common presentation. Three histologic subtypes of DNTs have been described. Histologically, the recognition of a unique, specific glioneuronal element in brain tumor samples from patients with medically intractable, chronic epilepsy serves as a diagnostic feature for complex or simple DNT types. However, nonspecific DNT has diagnostic difficulty because its histology is indistinguishable from conventional gliomas and because a specific glioneuronal element and/or multinodularity are absent. This review will focus on the clinical, radiographic, histopathological, and immunohistochemical features as well as the molecular genetics of all three variants of DNTs. The histological and cytological differential diagnoses for this lesion, especially the nonspecific variant, will be discussed.
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Affiliation(s)
- Yeon-Lim Suh
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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10
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Chen SY, Wang YJ, Lu DH, Yang XP, Bao YH, Piao YS. A 6-year-old girl presenting with paroxysmal binocular blindness. Neuropathology 2014; 35:192-6. [PMID: 25263516 DOI: 10.1111/neup.12157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 08/18/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Shi-Yun Chen
- Department of Neuropathology, Xuanwu Hospital, Capital Medical University, Beijing, China
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11
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Paudel K, Borofsky S, Jones RV, Levy LM. Dysembryoplastic neuroepithelial tumor with atypical presentation: MRI and diffusion tensor characteristics. J Radiol Case Rep 2013; 7:7-14. [PMID: 24421925 DOI: 10.3941/jrcr.v7i11.1559] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We report the neuroimaging findings of a 26-year-old female patient with a biopsy-proven dysembryoplastic neuroepithelial tumor (DNET). DNETs are an uncommon, usually benign, glial-neural cortical neoplasm of children and young adults who typically present with intractable seizures. DNETs may occur in any region of the supratentorial cortex, but have a predilection for the temporal lobes. Accurate neuroimaging diagnosis is essential since patients with DNET benefit from complete resection. However, accurate differentiation from other cortical lesions may be challenging. Typical conventional Magnetic Resonance Imaging (MRI) features can help in the differentiation from other similar cortical tumors. Diffusion tensor imaging can also provide important additional diagnostic information regarding the degree of involvement of adjacent parenchyma and white matter tracts. In this case, tractography and fractional anisotropy maps demonstrated that fiber tracts surrounding the lesion were displaced, but fiber integrity was maintained, which is more suggestive of a DNET rather than a more aggressive neoplasm. Accurate identification of DNETs is essential for the purpose of rendering a timely diagnosis and start appropriate treatment.
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Affiliation(s)
- Kalyan Paudel
- Department of Radiology, the George Washington University Hospital, Washington, DC, USA
| | - Samuel Borofsky
- Department of Radiology, the George Washington University Hospital, Washington, DC, USA
| | - Robert V Jones
- Department of Pathology, the George Washington University Hospital, Washington, DC, USA
| | - Lucien M Levy
- Department of Radiology, the George Washington University Hospital, Washington, DC, USA
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12
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Komori T, Arai N. Dysembryoplastic neuroepithelial tumor, a pure glial tumor? Immunohistochemical and morphometric studies. Neuropathology 2013; 33:459-68. [PMID: 23530928 DOI: 10.1111/neup.12033] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Accepted: 02/27/2013] [Indexed: 11/30/2022]
Abstract
Dysembryoplastic neuroepithelial tumor (DNT) is a benign glioneuronal tumor, occurring in children and adolescents, typically associated with drug-resistant partial seizures. Pathologically, DNT is characterized by a specific glioneuronal element that is comprised of oligodendroglia-like cells (OLC) and floating neurons. The definition of DNT is currently controversial and the incidence of DNT varies among institutions. In this study we characterize the morphologic profiles of OLC and floating neurons by performing immunohistochemical and morphometric studies on seven cases of a simple form of DNT. While a majority of OLC was positive for oligodendrocyte transcription factor 2 (Olig2), only floating neurons and a few small cells were positive for neuronal nuclear antigens (NeuN). Double immunofluorescence studies revealed co-localization of Olig2 and galectin 3 in OLC, but no co-localization of Olig2 and NeuN. The distribution pattern of NeuN-positive nuclei within the tumor tissue was not different from that in the adjacent neural tissue. A section cut perpendicular to the cortex stained with NeuN showed a continuous laminar arrangement with the adjacent cortex. Densities of NeuN-positive nuclei from tumors embedded in the white matter were significantly lower than those from tumors in the gray matter. Our results suggest that the NeuN-positive small and large cells observed within the specific glioneuronal element are in fact entrapped granular and pyramidal cells within the cortex and that OLCs are essentially glial and not neuronal in nature. DNT is thus a pure glial tumor rather than a glioneuronal tumor, that is, the equivalent of non-infiltrating oligodendroglioma, grade I.
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Affiliation(s)
- Takashi Komori
- Department of Laboratory Medicine and Pathology, Neuropathology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan.
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13
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Daghistani R, Miller E, Kulkarni AV, Widjaja E. Atypical characteristics and behavior of dysembryoplastic neuroepithelial tumors. Neuroradiology 2013; 55:217-24. [DOI: 10.1007/s00234-013-1135-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 01/03/2013] [Indexed: 11/30/2022]
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14
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Giulioni M, Rubboli G, Marucci G, Martinoni M, Marliani AF, Riguzzi P, Calbucci F. Focal epilepsy associated with dysembryoplastic neuroepithelial tumor in the area of the caudate nucleus. Clin Neurol Neurosurg 2012; 114:1119-22. [PMID: 22809555 DOI: 10.1016/j.clineuro.2012.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Revised: 05/31/2012] [Accepted: 06/02/2012] [Indexed: 02/08/2023]
Abstract
Dysembryoplastic neuroepithelial tumors (DNTs) are usually located within the supratentorial cortex, often in the temporal lobe and they are frequently associated with intractable complex partial seizures. DNTs in extracortical sites are rare. Thus far, 21 cases of 36 DNT-lesions occurring in these areas have been reported; only 8 out of them had epilepsy. We report a case of a 39-year-old woman who had pharmacoresistant epilepsy associated to a DNT in the caudate nucleus-periventricular area treated by lesionectomy. During a 4-year follow-up period, the patient was seizure free and the tumor did not recur. We discuss the hypothetical epileptogenic mechanism involved and we review the pertinent literature.
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Affiliation(s)
- Marco Giulioni
- Division of Neurosurgery, Department of Neurosciences, Bellaria Hospital, Bologna IRCCS Istituto delle Scienze Neurologiche, Italy.
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15
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Kim SK, Jeong MY, Jung TY, Kang HK, Yoon W. Diffuse ependymal dysembryoplastic neuroepithelial tumor causing spinal drop metastases: a case report. Korean J Radiol 2012; 13:492-5. [PMID: 22778572 PMCID: PMC3384832 DOI: 10.3348/kjr.2012.13.4.492] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 10/05/2011] [Indexed: 12/02/2022] Open
Abstract
Dysembryoplastic neuroepithelial tumors (DNETs) arise mostly in the supratentorial cerebral cortex. A very rare case of intraventricular DNET with diffuse ependymal involvement, which causes spinal drop metastasis, is presented.
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Affiliation(s)
- Seul Kee Kim
- Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju 501-757, Korea
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16
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Abstract
Dysembryoplastic neuroepithelial tumour (DNT) is located in the cerebral cortex with very few exceptions. In this article, an extremely rare case of intraventricular DNT originating from the septum pellucidum is reported. A 25-year-old woman presented with 5-month history of headache. Cranial magnetic resonance imaging (MRI) scans revealed a mass in the right lateral and third ventricle which was hypointense on T1-weighted image, and hyperintense on T2-weighted images. No contrast enhancement was detected. The lesion was excised totally using a transcallosal-transventricular approach. Immunohistochemical examination revealed DNT. The patient was discharged without any neurological deficits. Intraventricular DNT presents with symptoms of increased intracranial pressure rather than seizures. Distinguishing DNT from other intraventricular tumours is essential as DNT is characterized by benign clinical course and does not require adjuvant therapy.
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17
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Yuan J, Sharma N, Choudhri H, Figueroa R, Sharma S. Intraventricular dysembryoplastic neuroepithelial tumor in a pediatric patient: is it the most common extracortical location for DNT? Childs Nerv Syst 2011; 27:485-90. [PMID: 20959995 DOI: 10.1007/s00381-010-1307-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Accepted: 10/04/2010] [Indexed: 11/26/2022]
Abstract
Dysembryoplastic neuroepithelial tumor (DNT) is commonly located in the supratentorial cortex. Extracortical localization of DNT is extremely rare. A 15-year-old female presented with loss of consciousness after head trauma. MRI demonstrated hydrocephalus secondary to a small non-enhancing T1 hypointense and T2 hyperintense mass lesion in the foramen of Monro; with radiologic impression of low-grade astrocytoma or colloid cyst. Tumor was gross totally resected. Histologic examination showed partly microcystic architecture with oligodendroglia-like neurocytic cells, glioneuronal element, and floating neurons, with synaptophysin reactivity mainly in cell processes, consistent with DNT. Focal subependymoma-like pattern was noted. The low tumor cellularity and morphologic pattern did not support a central neurocytoma. Patient was asymptomatic and was radiologically stable 9 months post-surgery. Literature review of previously reported supratentorial extracortical DNT cases demonstrate that 24 of 25 cases involved the ventricular system (as in our case) of which eight additionally involved periventricular deep gray or white matter. None of the cases recurred following surgery. Clinico-pathologically, extracortical DNTs were similar to the cerebral cortical simple DNTs and differed only in their presentation related to their location. The novel aspects of this report are the radiologic resemblance of DNT to colloid cyst and focal subependymoma-like pattern on histology. Importantly, intra-/periventricular region appears to be the most common extracortical location of cerebral DNT with a 100% disease-free survival reported in the literature.
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Affiliation(s)
- Ji Yuan
- Department of Pathology, Medical College of Georgia, Augusta, GA 30912, USA
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18
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Kawataki T, Sato E, Kato T, Sato T, Horikoshi T, Kinouchi H. A cortical dysembryoplastic neuroepithelial tumor initially occurring in the periventricular white matter. J Neurosurg Pediatr 2010; 6:600-3. [PMID: 21121739 DOI: 10.3171/2010.10.peds10391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this report, a rare case of dysembryoplastic neuroepithelial tumor (DNET) initially presented as a small white matter lesion with calcification adjacent to the lateral ventricle and extending to the frontal cortex after 7 years. This 1-year-old boy initially suffered from partial seizures. Initial CT revealed a small, low-density area surrounding a tiny calcified mass in the deep white matter of the left frontal lobe. Seven years later, his seizures had become intractable to antiepileptic agents, and MR imaging demonstrated a relatively large mass extending from the calcified lesion up to the adjacent cortical surface. He underwent surgery and the tumor was subtotally removed. Histological examination of the tumor verified it as a DNET consisting of clusters of small oligodendrocytes with floating neurons in the mucoid background. The pattern of the tumor progression in this case suggests that a DNET in the cortex originates from the subependymal germinal layer near the ventricle.
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Affiliation(s)
- Tomoyuki Kawataki
- Department of Neurosurgery, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan.
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19
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Cataltepe O, Marshall P, Smith TW. Dysembryoplastic neuroepithelial tumor located in pericallosal and intraventricular area in a child. Case report. J Neurosurg Pediatr 2009; 3:456-60. [PMID: 19485727 DOI: 10.3171/2009.1.peds0823] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Dysembryoplastic neuroepithelial tumors (DNETs) are frequently seen in children and young adults with intractable epilepsy, and are typically located in the temporal cortex. Extracortical location of DNET is a very rare occurrence. The authors report on a child with a unique extracortical location of DNET with an extensive involvement to the supracallosal cistern and callosum, septum pellucidum, and lateral ventricle ependyma. The authors discuss the radiological and pathological characteristics of the lesion and reiterate the difficulty in differentiating the histological characteristics of central neurocytoma and DNET in extracortical locations and its significance for further management planning.
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Affiliation(s)
- Oguz Cataltepe
- Division of Neurosurgery, Department of Surgery, University of Massachusetts Medical Center, Worcester, MA 01655, USA.
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20
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Lu JQ, Scheithauer BW, Sharma P, Scott JN, Parney IF, Hader W, Burger PC, Clark AW. MULTIFOCAL COMPLEX GLIONEURONAL TUMOR IN AN ELDERLY MAN. Neurosurgery 2009; 64:E1193-5; discussion E1195. [DOI: 10.1227/01.neu.0000345640.40566.48] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
The clinicopathological spectra of a dysembryoplastic neuroepithelial tumor (DNT) and a rosette-forming glioneuronal tumor (RGNT) are expanding. We report here the autopsy findings of a case of complex glioneuronal tumor with combined histological features of both a DNT and an RGNT.
CLINICAL PRESENTATION
A 79-year-old man presented with a 1-month history of confusion and gait difficulties. A magnetic resonance imaging scan revealed obstructive hydrocephalus attributed to a mass in the posterior third ventricle.
INTERVENTION
A third ventriculostomy was performed. Postoperatively, the mass remained unchanged in size for more than 14 months. Thirty-eight months after his initial manifestations, he experienced minor head trauma and was then hospitalized. Despite placement of an external ventricular drain and other supportive treatment, he deteriorated and died. A full autopsy was performed, with emphasis on the brain. The mass lesion and a few independent microfoci situated primarily around the third ventricle showed histological features of pilocytic astrocytoma with recurrent hemorrhage. Far more numerous were microfoci with histological features of a DNT, including floating neurons, as well as typical RGNT-associated, synaptophysin-positive rosettes and perivascular pseudorosettes.
CONCLUSION
The advanced age of the patient, the coexisting histological features of the DNT and RGNT, and the distinctive anatomic distribution of the lesions, being centered on the third ventricle, may lend insight into the histogenetic relationship of a DNT, an RGNT, and mixed glioneuronal tumors.
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Affiliation(s)
- Jian-Qiang Lu
- Department of Pathology, Foothills Medical Centre, University of Calgary, Calgary, Canada
| | - Bernd W. Scheithauer
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Pranshu Sharma
- Department of Radiology, Foothills Medical Centre, University of Calgary, Calgary, Canada
| | - James N. Scott
- Department of Radiology, Foothills Medical Centre, University of Calgary, Calgary, Canada
| | - Ian F. Parney
- Department of Clinical Neurosciences, Foothills Medical Centre, University of Calgary, Calgary, Canada
| | - Walter Hader
- Department of Clinical Neurosciences, Foothills Medical Centre, University of Calgary, Calgary, Canada
| | - Peter C. Burger
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Arthur W. Clark
- Department of Pathology, Foothills Medical Centre, University of Calgary, Calgary, Canada
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21
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Saito T, Sugiyama K, Yamasaki F, Tominaga A, Kurisu K, Takeshima Y, Hirose T. Familial occurrence of dysembryoplastic neuroepithelial tumor-like neoplasm of the septum pellucidum: case report. Neurosurgery 2009; 63:E370-2; discussion E372. [PMID: 18797318 DOI: 10.1227/01.neu.0000320421.82255.63] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Dysembryoplastic neuroepithelial tumor (DNT)-like neoplasms of the septum pellucidum are extremely rare. In this article, we report the familial occurrence of these neoplasms. CLINICAL PRESENTATION We report two cases of such neoplasms: Patient 1, a 42-year-old woman, and Patient 2, the 20-year-old nephew of Patient 1. Patient 1 experienced headache and worsening dizziness; Patient 2 experienced headache and worsening dizziness and also had partial seizures. In both cases, magnetic resonance imaging (MRI) revealed an intraventricular tumor adjacent to the septum pellucidum. Both tumors appeared as a hypointense region on T1-weighted MRI, and both appeared as a hyperintense region on T2-weighted MRI without gadolinium enhancement. Interestingly, both tumors had a high apparent diffusion coefficient. INTERVENTION Both tumors were subtotally removed and had common histological findings, such as alveolar structures with oligodendroglia-like cells and "specific glioneuronal element." These findings are consistent with a dysembryoplastic neuroepithelial tumor-like neoplasm. After tumor removal, the symptoms disappeared. The postoperative course was uneventful, and the patients did not require adjuvant therapy. MRI showed no regrowth of residual tumors at 4 years (Patient 1) and 2 years (Patient 2) postoperatively. CONCLUSION The familial occurrence of this rare tumor suggests that both of these cases arose from a common germline mutation. Identification of this rare tumor in this rare location is important to avoid unnecessary adjuvant therapy. A markedly high apparent diffusion coefficient and histological findings of specific glioneuronal element can facilitate the differential diagnosis of dysembryoplastic neuroepithelial tumor-like neoplasms. Genetic study of affected patients in this family may provide clues to its molecular pathogenesis.
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Affiliation(s)
- Taiichi Saito
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
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22
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Dysembryoplastic neuroepithelial tumor: a clinicopathological study of 32 cases. Neurosurg Rev 2009; 32:161-9; discussion 169-70. [DOI: 10.1007/s10143-008-0181-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2008] [Revised: 10/04/2008] [Accepted: 10/26/2008] [Indexed: 11/25/2022]
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23
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Altinörs N, Calisaneller T, Gülşen S, Ozen O, Ongürü O. Intraventricular dysembryoplastic neuroepithelial tumor: case report. Neurosurgery 2008; 61:E1332-3; discussion E1333. [PMID: 18162864 DOI: 10.1227/01.neu.0000306114.08540.aa] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The most common localization of dysembryoplastic neuroepithelial tumors (DNTs) is the supratentorial cortex, often in the temporal lobe. However, intraventricular localization of a DNT is extremely rare. CLINICAL PRESENTATION A 30-year-old woman presented with a 1-year history of epileptic seizures. The seizures had not been controlled despite standard doses of antiepileptics. INTERVENTION Neuroimaging results demonstrated a lesion located in the occipital horn of the right lateral ventricle. The lesion was totally removed. Based on histopathological and immunohistochemical evaluation, a DNT was diagnosed. Over the course of the next 8 months, the patient's epileptic seizures were under control. The most recent neuroimaging examinations revealed neither residual nor recurrent tumor. CONCLUSION Because DNTs are surgically curable and neither radiotherapy nor chemotherapy is required after surgery, recognition of an intraventricular DNT in this location is extremely important.
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Affiliation(s)
- Nur Altinörs
- Department of Neurosurgery, Baskent University School of Medicine, Ankara, Turkey
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24
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Schittenhelm J, Mittelbronn M, Wolff M, Truebenbach J, Will BE, Meyermann R, Beschorner R. Multifocal dysembryoplastic neuroepithelial tumor with signs of atypia after regrowth. Neuropathology 2007; 27:383-9. [PMID: 17899694 DOI: 10.1111/j.1440-1789.2007.00780.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report the case of a multifocal dysembryoplastic neuroepithelial tumor (DNT) in a 7-year-old girl with local tumor regrowth 6 years later. The tumor was localized in the right parietal lobe extending from the cortex into the periventricular white matter. After subtotal resection of a histopathologically confirmed DNT we observed unexpected tumor progression in long-term follow-up. Therefore, a second surgery was performed when the patient was 14 years of age. In neuropathological examination of the second specimen the tumor showed an increased cellularity and pleomorphism, microvascular proliferations, an elevated proliferative activity (MIB1-index focally up to 10%) and cellular atypia not typical for WHO grade I DNT. Furthermore, MRI studies showed additional supratentorial and infratentorial lesions which remained stable over years and are also well consistent with DNTs. Thus, an unusual form of a DNT with multifocal lesions, local regrowth and morphological transformation is supposed.
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Affiliation(s)
- Jens Schittenhelm
- Institute of Brain Research, University of Tuebingen, Calwerstr. 3, D-72076 Tuebingen, Germany.
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25
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Wang F, Qiao G, Li X, Gui Q. A DYSEMBRYOPLASTIC NEUROEPITHELIAL TUMOR IN THE AREA OF THE CAUDATE NUCLEUS IN A 57-YEAR-OLD WOMAN. Neurosurgery 2007; 61:E420; discussion E420. [PMID: 17762726 DOI: 10.1227/01.neu.0000255530.46092.aa] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
Dysembryoplastic neuroepithelial tumors (DNTs) are clinicopathologically unique tumors. They are usually located within the supratentorial cortex, most often in the temporal lobe. These lesions are frequently associated with intractable complex partial seizures in children and young adults. DNTs may also arise outside of the cerebral cortex. We report a case of a 57-year-old woman who had a DNT in the caudate nucleus. During a 7-year follow-up period, the tumor did not recur. The literature on DNTs with atypical “ectopic” localizations is summarized.
CLINICAL PRESENTATION
A patient presented with a 1-year history of headaches, nausea and vomiting, and progressive visual disturbances.
INTERVENTION
Gross subtotal removal of the lesion was accomplished without further treatment.
CONCLUSION
Unlike diffuse gliomas, such as oligodendrogliomas and central neurocytomas, DNTs are benign lesions with a favorable prognosis after surgical resection. Therefore, recognition of DNTs at atypical ectopic locations is essential for predicting the clinical course and for making the right therapeutic decisions.
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Affiliation(s)
- Fulin Wang
- Department of Pathology, People's Liberation Army General Hospital, Beijing, China.
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26
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Bulakbasi N, Kocaoglu M, Sanal TH, Tayfun C. Dysembryoplastic neuroepithelial tumors: proton MR spectroscopy, diffusion and perfusion characteristics. Neuroradiology 2007; 49:805-12. [PMID: 17632714 DOI: 10.1007/s00234-007-0263-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Accepted: 05/29/2007] [Indexed: 10/23/2022]
Abstract
INTRODUCTION We describe the magnetic resonance (MR) imaging characteristics of dysembryoplastic neuroepithelial tumors (DNT) and discuss their differential diagnosis. MATERIAL AND METHODS Proton MR spectroscopy (TE 30 and 136 ms), diffusion-weighted and perfusion images were retrospectively evaluated in 22 patients with pathologically proven DNT (17 male and 5 female, mean age 18.7 years) and 14 control subjects (10 male and 4 female, mean age 16.9 years). The results from the DNT patients and from the control subjects were compared using an independent sample t-test and the degree of correlation was tested by Pearson's correlation. RESULTS All DNTs were solitary and in a supratentorial cortical or subcortical location (ten temporal, eight frontal and four parietal). They had low-signal on T1-weighted images and high-signal on T2-weighted images without a prominent mass effect. Additionally a cystic appearance (six patients, 27.3%), cortical dysplasia (six patients, 27.3%) and contrast enhancement (four patients, 18.2%) were also noted. No significant differences were detected in NAA/Cho, NAA/Cr, NAA/Cho+Cr or Cho/Cr ratios between DNT and normal brain. DNTs had a significantly higher mI/Cr ratio and apparent diffusion coefficient (ADC) values and lower cerebral blood values than normal parenchyma (P < 0.001). ADC had the highest correlation with the diagnosis of DNT (r = 0.996) followed by relative cerebral blood volume (rCBV) (r = -0.883) and mI/Cr ratio (r = 0.663). CONCLUSION Proton MR spectroscopy, diffusion-weighted and perfusion imaging characteristics of DNTs provide additional information to their MR imaging findings. The MR spectrum showing a slight increase in mI/Cr ratio, and higher ADC and lower rCBV values than normal parenchyma help to differentiate DNTs from other cortical tumors, which had higher rCBV and lower ADC values than DNTs.
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Affiliation(s)
- Nail Bulakbasi
- Department of Radiology, Military Medical Faculty, Gulhane Military Medical Academy, Etlik, 06018 Ankara, Turkey.
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27
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Josan V, Smith P, Kornberg A, Rickert C, Maixner W. Development of a pilocytic astrocytoma in a dysembryoplastic neuroepithelial tumor. Case report. J Neurosurg 2007; 106:509-12. [PMID: 17566412 DOI: 10.3171/ped.2007.106.6.509] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Dysembryoplastic neuroepithelial tumors (DNETs) are benign supratentorial tumors based in the cerebral cortex. They usually are found in children and young adults with seizures that tend to become refractory to medical treatment. In the vast majority of cases resection results in good seizure control, and adjuvant therapy is not required. When tumors thought to be DNETs are not resected due to their proximity to eloquent cortex, lack of change in the clinical and neuroimaging features over time supports the diagnosis of DNET. The authors report on a patient in whom a pilocytic astrocytoma developed within a DNET, raising questions regarding the classification of these lesions and the need for lifelong clinical and imaging surveillance. This paper adds to the growing body of literature about the biological behavior of these lesions.
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Affiliation(s)
- Vivek Josan
- Department of Neurosurgery, Royal Children's Hospital, Melbourne, Victoria, Australia
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28
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Chan CH, Bittar RG, Davis GA, Kalnins RM, Fabinyi GCA. Long-term seizure outcome following surgery for dysembryoplastic neuroepithelial tumor. J Neurosurg 2006; 104:62-9. [PMID: 16509148 DOI: 10.3171/jns.2006.104.1.62] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECT Resection of dysembryoplastic neuroepithelial tumor (DNET) is thought to result in favorable seizure outcome, but long-term follow-up data are scarce. The authors present a review of 18 patients who underwent surgical removal of a DNET: 12 via temporal lobectomy and six via lesionectomy. METHODS The mean long-term follow up was 10.8 years (median 10.4 years, range 7.8 to 14.8 years), and results obtained during this time period were compared with previously reported short-term (mean 2.7 years) seizure outcome data. In the current study, 66.7% patients had an Engel Class I outcome and 55.6% had an Engel Class IA outcome compared with 77.8% and 55.6%, respectively. Temporal lobectomy (Engel Class I, 83.3%; Engel Class IA, 66.7%) led to a better seizure outcome than lesionectomy (Engel Classes I and IA, 33.3%). Two patients (11.1%) required repeated operation and both had an incomplete lesionectomy initially. CONCLUSIONS Results indicated that complete resection of a DNET leads to a favorable seizure outcome, with epilepsy cure in those who had experienced early postoperative seizure relief. Long-term seizure outcome after surgery is predictable based on the result of short-term follow up.
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Affiliation(s)
- Chow Huat Chan
- Neurosurgical Department, Austin Hospital, Heidelberg, Victoria, Australia
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29
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Cenacchi G, Giangaspero F. Emerging Tumor Entities and Variants of CNS Neoplasms. J Neuropathol Exp Neurol 2004; 63:185-92. [PMID: 15055442 DOI: 10.1093/jnen/63.3.185] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Since the appearance in 2000 of the World Health Organization (WHO) classification for central nervous system (CNS) neoplasms, numerous descriptions of new entities or variants have appeared in the literature. In the group of neuronal and mixed glioneuronal neoplasms are lesions with distinctive morphological features that are still not included in a precise classification, including extraventricular neurocytoma, papillary glioneuronal tumor, rosette-forming glioneuronal of the fourth ventricle, glioneuronal with neuropil-like rosette, and DNT-like tumor of the septum pellucidum. The glioneuronal tumor with neuropil-like rosette and oligodendroglioma with neurocytic differentiation represent morphological variants of genetically proven diffuse gliomas. The lipoastrocytoma and the pilomixoid astrocytoma enlarge the group of astrocytic lesions. Rare, low-grade gliomas of the spinal cord with extensive leptomeningeal dissemination associated with unusual neuroimaging are described. The chordoid glioma of the third ventricle and the papillary tumor of the pineal region seem to be correlated by a common histogenesis from the specialized ependyma of the subcommissural organ. An embryonal tumor with neuropil and true rosettes combining features of neuroblastoma and ependymoblastoma is discussed. These new, recently described lesions indicate that the complex morphologic spectrum of CNS tumors is far from being completely delineated.
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Affiliation(s)
- Giovanna Cenacchi
- Department of Radiology and Pathology, University of Bologna, Bologna, Italy
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30
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Sisodiya SM. Malformations of cortical development: burdens and insights from important causes of human epilepsy. Lancet Neurol 2004; 3:29-38. [PMID: 14693109 DOI: 10.1016/s1474-4422(03)00620-3] [Citation(s) in RCA: 129] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Malformations of cortical development (MCD) are important causes of chronic epilepsy in human beings. A blanket term, MCD encompasses many varied developmental disorders with diverse clinical manifestations in patients that neurologists, paediatricians, and learning disability psychiatrists will encounter. Advances in imaging and genetics have led to a significant increase in our understanding of MCD, which has in turn enriched our knowledge of human epileptogenesis and normal brain development and function. In this review, I discuss some of the most common or enlightening MCD: focal cortical dysplasia, periventricular heterotopia, polymicrogyria, band heterotopia and lissencephaly, dysembryoplastic neuroepithelial tumours, and microdysgenesis. Clinical and imaging features, genetic aetiologies, treatments, and the insights that have resulted from MCD study are covered. The burden of epilepsy due to MCD is significant and there is still much to learn about MCD.
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Affiliation(s)
- Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, UK.
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31
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Rushing EJ, Thompson LD, Mena H. Malignant transformation of a dysembryoplastic neuroepithelial tumor after radiation and chemotherapy. Ann Diagn Pathol 2003; 7:240-4. [PMID: 12913847 DOI: 10.1016/s1092-9134(03)00070-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We describe a case of anaplastic astrocytoma in a 14-year-old boy arising at the site of a dysembryoplastic neuroepithelial tumor (DNT) 3 years after combined radiation and chemotherapy. The subtotally excised superficial right temporoparietal tumor was originally diagnosed as mixed oligoastrocytoma in 1974; the patient was treated with radiation therapy postoperatively. One year later he underwent a craniotomy to remove cyst fluid and no change was reported in the size of the residual tumor. Postoperatively, he received a 6-week course of chemotherapy (lovustine, CCNU). He remained clinically and radiographically stable until 3 years later, when seizure activity returned and imaging studies were consistent with tumor recurrence. He was lost to follow-up until 1986, when records showed that he had died. Review of the initial biopsy showed cortical fragments containing abundant calcifications and multinodular structures typical of the complex form of DNT, in addition to specific glioneuronal elements. The Ki-67 labeling index ranged from 0.1% to 3% focally. The specimen from the third surgery showed an anaplastic astrocytoma (Ki-67 up to 12%) and morphologic features characteristic of radiation effect. This is the first documented case of malignant transformation of DNT following radiation and adjuvant chemotherapy. The implications of malignant transformation in subtotally excised complex DNTs and the intriguing issue of the contribution of radiation/chemotherapy are discussed.
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Affiliation(s)
- Elisabeth J Rushing
- Department of Neuropathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA
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Kurtkaya-Yapicier O, Elmaci I, Boran B, Kiliç T, Sav A, Pamir MN. Dysembryoplastic neuroepithelial tumor of the midbrain tectum: a case report. Brain Tumor Pathol 2003; 19:97-100. [PMID: 12622140 DOI: 10.1007/bf02478934] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Dysembryoplastic neuroepithelial tumor (DNT) is a relatively new nosologic entity. First described in 1988, it is now included in the "neuronal and mixed neuronal-glial tumours" category in the revised 2000 World Health Organization (WHO) Classification of Tumours of the Nervous System. The collective experience of more than 300 reported cases indicates that, with only rare exceptions, DNTs are cerebral cortical lesions. At present, the actual incidence of extracortical DNT is unknown. We describe, the clinicopathologic features of the first tectal DNT. The patient was a 51-year-old man with a 2-month history of pulsatile headaches. On neurologic examination, the only abnormality was gait ataxia. Magnetic resonance imaging (MRI) demonstrated a midbrain tumor involving the tectum. It was hypointense on T1-weighted images and featured an iso- to hyperintense nodule at its center. The nodule showed enhancement upon contrast administration. No aqueductal obstruction or intraventricular extension of tumor was detected. The tumor was approached supratentorially and removed completely. The mucoid tumor was well demarcated from neural tissue. Histopathologically, it was a typical DNT, exhibiting a nodular pattern of growth with a "specific glioneuronal component." This case report documents the first DNT to arise in the midbrain tectum and focuses on the problem of diagnosing this uncommon tumor at extracortical sites.
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Affiliation(s)
- Ozlem Kurtkaya-Yapicier
- Department of Neurosurgery and Neuropathology, Marmara University, PK 53, 81532, Basibüyük-Maltepe, Istanbul, Turkey.
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Tatke M, Suri VS, Malhotra V, Sharma A, Sinha S, Kumar S. Dysembryoplastic neuroepithelial tumors: report of 10 cases from a center where epilepsy surgery is not done. Pathol Res Pract 2002; 197:769-74. [PMID: 11770021 DOI: 10.1078/0344-0338-00157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Dysembryoplastic neuroepithelial tumor (DNT) is a recently recognized tumor entity with distinctive clinicopathological features and an excellent long-term prognosis. We report 10 cases of DNT out of neurosurgical specimens sent for histopathological examination since 1994. Epilepsy surgery is not done at our center, and all the cases were sent with a clinical diagnosis of glioma. On histopathological examination, all the 10 cases contained the specific glioneuronal element. In 6 cases, glial nodules were noted in addition. This study therefore reports 4 cases of simple DNT and 6 cases of complex DNT. There was no nuclear atypia or mitosis in any of the cases. Proliferative index by PCNA varied from negative to <1%. It is very important to recognize this entity, as surgery cures the patient, and radiotherapy or chemotherapy is not required.
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Affiliation(s)
- M Tatke
- Department of Pathology, G.B Pant Hospital, New Delhi, India.
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Komori T, Scheithauer BW, Hirose T. A rosette-forming glioneuronal tumor of the fourth ventricle: infratentorial form of dysembryoplastic neuroepithelial tumor? Am J Surg Pathol 2002; 26:582-91. [PMID: 11979088 DOI: 10.1097/00000478-200205000-00004] [Citation(s) in RCA: 191] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Eleven cases of a distinctive tumor of the posterior fossa are described. The patients (age range 12-59 years) presented with headache and/or ataxia. Neuroimaging revealed a relatively discrete, focally enhancing mass(es) primarily involving the aqueduct, fourth ventricle, and cerebellar vermis. Hydrocephalus was present in seven cases, and two lesions were multicentric. In two cases a significant increase in tumor size was documented. Gross total or subtotal resections were achieved in 10 cases. One patient underwent biopsy alone and another received postoperative irradiation. Histologically, two components were identified in all cases. One consisted of neurocytes forming neurocytic and/or perivascular pseudorosettes in a fibrillary, partly microcystic matrix. The second, astrocytic component resembled pilocytic astrocytoma in 10 cases and consisted of fibrillated spindle cells with oval nuclei associated with occasional Rosenthal fibers, granular bodies, glomeruloid capillaries, and microcalcifications. Regionally, this component was more diffuse and patternless, consisting of sheets of round to oval, oligodendrocyte-like cells. Rare ganglion cells were seen in four cases. The rosettes were consistently synaptophysin and MAP-2 immunoreactive, whereas the spindle cells were positive for S-100 protein and glial fibrillary acidic protein. Overall, atypia was minimal; no mitoses were found, and Ki67 labeling indices were low. Ultrastructurally, the neurocytic cells featured processes containing microtubules and occasional dense core granules. Mature synapses were found in one of the four cases studied. Although the histologic features of this unique tumor superficially resemble those of dysembryoplastic neuroepithelial tumor, rosette formation by neuronal cells, the frequent presence of a pilocytic astrocytoma component, and the growing nature of the lesion argue against that diagnosis, as does occasional multifocality.
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Affiliation(s)
- Takashi Komori
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
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Valenti MP, Froelich S, Armspach JP, Chenard MP, Dietemann JL, Kerhli P, Marescaux C, Hirsch E, Namer IJ. Contribution of SISCOM imaging in the presurgical evaluation of temporal lobe epilepsy related to dysembryoplastic neuroepithelial tumors. Epilepsia 2002; 43:270-6. [PMID: 11906512 DOI: 10.1046/j.1528-1157.2002.25101.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Dysembryoplastic neuroepithelial tumors (DNTs) are a group of glioneuronal supratentorial and intracortical lesions often associated with the early onset of intractable and crippling partial seizures. They are characterized by their location, multinodular architecture, and heterogeneous cell composition, with a specific glioneuronal element in the specific form. Foci of cortical dysplasia may be associated with the tumoral lesion, and identifying the presence and the extent of cortical dysplasia is not always easy on magnetic resonance images (MRIs). The purpose of this article is to evaluate, retrospectively, the usefulness of ictal single-photon emission computed tomography (SPECT) imaging to assess the presence and the extent of cortical dysplasia associated with DNTs in nine patients with intractable temporal lobe epilepsy related to histopathologically confirmed DNTs. METHODS The results of the subtraction of ictal and interictal SPECT coregistered to MRI (SISCOM) were compared with the results of the examinations of pathological material after surgery. RESULTS SISCOM showed a strongly hyperperfused area corresponding anatomically to electroclinical abnormalities and to the location of DNTs on MRI. A circumscribed hyperperfusion was present in DNTs without cortical dysplasia, limited to the location of the tumor on MRI. In cases of associated cortical dysplasia, a widespread hyperperfusion including areas corresponding to normal perilesional regions on MRI was found. CONCLUSIONS SISCOM, used among presurgical investigations, contributes to detecting cortical dysplasia associated with DNTs. Concordance between the symptomatogenic zone (defined from the medical history and electroclinical data), MRI scans, SISCOM pattern, and complete resection of the epileptic zone was predictive of a good postsurgical outcome.
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Affiliation(s)
- M P Valenti
- Unité d'Explorations Fonctionnelles des Epilepsies, Clinique Neurologique, Hopitaux Universitaires de Strasbourg, France
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Koeller KK, Henry JM. From the archives of the AFIP: superficial gliomas: radiologic-pathologic correlation. Armed Forces Institute of Pathology. Radiographics 2001; 21:1533-56. [PMID: 11706224 DOI: 10.1148/radiographics.21.6.g01nv051533] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Glial neoplasms that are peripherally located and involve the cortical gray matter are noteworthy because of their predilection to serve as a seizure locus, their amenability to surgical resection, their generally favorable prognosis, and their characteristic imaging features, which facilitate diagnosis before surgery. The smaller lesions include ganglioglioma and dysembryoplastic neuroepithelial tumor. Gangliogliomas contain both neuronal and glial components and occur most commonly in the temporal lobe. Variant forms of gangliogliomas may occur and are related to the different compositions of the underlying cellular population. Gangliocytomas lack glial cells and are located both in the cerebral hemispheres and the cerebellum. Lhermitte-Duclos disease represents a specific type of cerebellar gangliocytoma with dysplastic features and is characterized by a laminar pattern at imaging. Dysembryoplastic neuroepithelial tumors occur predominantly in children and young adults with partial seizures and most commonly arise in the temporal lobe, frequently in combination with cortical dysplasia. Surrounding vasogenic edema is conspicuously absent in both gangliogliomas and dysembryoplastic neuroepithelial tumors. The larger masses in this group include desmoplastic infantile ganglioglioma and pleomorphic xanthoastrocytoma and tend to involve the leptomeninges and cortical territory. Both invoke an intense desmoplastic reaction, which appears as an enhancing soft-tissue component at imaging.
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Affiliation(s)
- K K Koeller
- Department of Radiologic Pathology, Armed Forces Institute of Pathology, Bldg 54, Rm M-121, 14th St at Alaska Ave, Washington, DC 20306-6000, USA.
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Richardson MP, Hammers A, Brooks DJ, Duncan JS. Benzodiazepine-GABA(A) receptor binding is very low in dysembryoplastic neuroepithelial tumor: a PET study. Epilepsia 2001; 42:1327-34. [PMID: 11737168 DOI: 10.1046/j.1528-1157.2001.44100.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the nature of abnormalities of gamma-aminobutyric acid (GABA)A-central benzodiazepine (BZD) receptor binding in patients with dysembryoplastic neuroepithelial tumor (DNET) in comparison with normal controls. METHODS Five patients with DNET and 24 normal controls underwent (11C)flumazenil positron emission tomography (PET) to measure (11C)flumazenil volume of distribution (FMZVD) at the voxel level. Patients were compared with normal controls by using statistical parametric mapping (SPM) and also a partial-volume effect (PVE) corrected volume-of-interest (VOI) analysis covering the entire brain. First, using SPM, the highest Z-score for the entire image representing FMZVD decreases in comparison with the normals was found. Second, regions of abnormal FMZVD were located using SPM, p < 0.001 uncorrected, corrected p < 0.05. Finally, PVE-corrected measures of FMZVD were calculated for each patient VOI and compared wih those of normals, using significance levels of >2.5 standard deviations (SD) for the DNET and >3 SD for all other regions. RESULTS In all cases, the highest Z-score across the whole image representing decreased FMZVD was within the DNET. In three cases SPM revealed a single region of significantly reduced FMZVD, within the DNET in all three. VOI analysis showed PVE-corrected FMZVD was significantly low in the DNET in four cases. VOI analysis also showed seven other regions of abnormal FMZVD; three were adjacent to a DNET, and two were in mesial temporal areas not affected by DNET. CONCLUSIONS FMZVD is low in DNET, probably contributing to epileptogenicity.
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Abstract
Given current prognostic and therapeutic implications, the accurate classification and grading of oligodendroglial neoplasms has become critical. However, the prevalence of morphologically ambiguous gliomas, subjective histologic criteria, personal biases, oligodendroglioma mimics, and the lack of specific oligodendroglioma markers has led to high interobserver variability and created a contentious problem encountered daily in active surgical neuropathology practices. Since histologic assessment is still a powerful prognosticator, it appropriately remains the diagnostic gold standard. However, recent efforts have focused on identifying the most reproducible and clinically relevant criteria, standardizing classification and grading schemes, and searching for useful ancillary biologic and genetic markers capable of further stratifying an otherwise heterogeneous patient population. This paper reviews the morphologic and genetic spectrum of oligodendroglial neoplasms, recent diagnostic and prognostic developments, and potential future directions.
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Affiliation(s)
- A Perry
- Washington University School of Medicine, St Louis, Missouri 63110-1093, USA.
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Baisden BL, Brat DJ, Melhem ER, Rosenblum MK, King AP, Burger PC. Dysembryoplastic neuroepithelial tumor-like neoplasm of the septum pellucidum: a lesion often misdiagnosed as glioma: report of 10 cases. Am J Surg Pathol 2001; 25:494-9. [PMID: 11257624 DOI: 10.1097/00000478-200104000-00009] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The authors report a series of 10 low-grade neoplasms arising in the midline anteriorly in the region of the septum pellucidum with many of the histologic features of dysembryoplastic neuroepithelial tumor (DNT). The patients (five female, five male) ranged in age from 6 to 35 years (mean age, 21.5 years). The most common presenting symptoms were headache, nausea and vomiting, and visual disturbances. Radiographically, the tumors extended into the lateral ventricles from the septal region and obstructed the foramen of Monro. Varying degrees of hydrocephalus were present. The lesions were lobular, well-delineated, hypointense to brain on T1-weighted magnetic resonance imaging, and hyperintense on T2-weighted images. They were uniformly nonenhancing or showed only minimal peripheral enhancement. The tumors, in aggregate, had the histologic features of DNT. These included a mucin-rich background, oligodendrocyte-like cells, "floating neurons," and a "specific glioneuronal element." Seven patients underwent gross total resection and two underwent subtotal resection. No patients received adjuvant chemotherapy or radiotherapy. On follow-up (n = 6; median, 14 months), all tumors had either not recurred or were radiologically stable. On the basis of both neuroimaging and histopathology, DNT-like lesions should be considered in the differential diagnosis of midline intraventricular tumors in children and young adults. Distinction from more aggressive neoplasms is essential because these tumors appear to behave in a benign fashion.
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Affiliation(s)
- B L Baisden
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
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Fujimoto K, Ohnishi H, Tsujimoto M, Hoshida T, Nakazato Y. Dysembryoplastic neuroepithelial tumor of the cerebellum and brainstem. Case report. J Neurosurg 2000; 93:487-9. [PMID: 10969950 DOI: 10.3171/jns.2000.93.3.0487] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors present a case in which dysembryoplastic neuroepithelial tumors (DNETs) occurred in the cerebellum and brainstem of a 44-year-old woman. A magnetic resonance image of the brain revealed multiple cystic lesions in the right cerebellar hemisphere, vermis, tonsil, and brainstem. Partial removal of the tumors was performed. There were gray multinodular gelatinous lesions on the cerebellar hemisphere. Histologically, the tumors exhibited areas of multiple microcystic nodules in the cerebellar white matter, which were composed of oligodendroglia-like cells (OLCs), astrocytes, and neurons. There were multiple, variable nodules in the lesions, lined by OLCs. The adjacent cerebellar cortex displayed dysplastic features. Reduction of granule neurons and dislocation of Purkinje cells into the molecular layer were observed. The pathological profile of this patient agrees with that described by Daumas-Duport, et al., as a "dysembryoplastic neuroepithelial tumor."
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Affiliation(s)
- K Fujimoto
- Department of Neurosurgery, Osaka Police Hospital, Japan
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Gyure KA, Sandberg GD, Prayson RA, Morrison AL, Armstrong RC, Wong K. Dysembryoplastic neuroepithelial tumor: an immunohistochemical study with myelin oligodendrocyte glycoprotein. Arch Pathol Lab Med 2000; 124:123-6. [PMID: 10629143 DOI: 10.5858/2000-124-0123-dnt] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT The dysembryoplastic neuroepithelial tumor (DNT) is an uncommon lesion characterized by a heterogeneous population of neurons, astrocytes, and oligodendroglia-like cells (OLCs). The basic nature of the DNT and its constituent cells, particularly the OLCs, remains unresolved; some authors favor a neuronal origin, and others propose a glial or mixed origin for these cells. DESIGN We examined 11 DNTs with antibodies to myelin oligodendrocyte glycoprotein, a marker of mature oligodendrocytes. RESULTS All DNTs studied (7 from males, 4 from females; age range of patients, 2-37 years) were composed of varying proportions of neurons, astrocytes, and OLCs. Membrane or cytoplasmic immunoreactivity for myelin oligodendrocyte glycoprotein was found in many OLCs in 9 of 11 cases. The number of myelin oligodendrocyte glycoprotein-positive OLCs was variable: >75% of the OLCs were positive in 5 cases, 25% to 75% of the OLCs were positive in 2 cases, and <25% of the OLCs were positive in 2 cases. CONCLUSION These findings suggest that many of the OLCs represent mature oligodendrocytes and support the notion that DNTs are heterogenous lesions composed of multiple, mature cell types.
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Affiliation(s)
- K A Gyure
- Armed Forces Institute of Pathology, Washington, DC 20306, USA
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Kaplan AM, Lawson MA, Spataro J, Bandy DJ, Bonstelle CT, Moss SD, Manwaring KH, Reiman EM. Positron emission tomography using [18F] fluorodeoxyglucose and [11C] l-methionine to metabolically characterize dysembryoplastic neuroepithelial tumors. J Child Neurol 1999; 14:673-7. [PMID: 10511341 DOI: 10.1177/088307389901401009] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Dysembryoplastic neuroepithelial tumors are unique and benign congenital tumors occurring frequently in children and adolescents. Differentiation from other low-grade tumors is important for management. Five patients with confirmed dysembryoplastic neuroepithelial tumors were studied with positron emission tomography using glucose and protein metabolic uptake in an attempt to categorize these tumors metabolically. Functional brain mapping also was obtained to aid in operative management. Results of the study conclude that dysembryoplastic neuroepithelial tumors, although having similar neuroimgaing characteristics to other low-grade tumors, are distinguished by a unique metabolic profile. They are inactive tumors with no significant glucose or protein metabolic activity. The combination of preoperative positron emission tomographic metabolic studies with functional brain mapping allowed for prediction of tumor type, defined eloquent areas of cortical function, and improved approach and resection of the tumors with minimal risk of neurologic impairment.
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Affiliation(s)
- A M Kaplan
- Division of Neurology, Phoenix Children's Hospital/Good Samaritan Regional Medical Center, AZ 85006, USA
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Honavar M, Janota I, Polkey CE. Histological heterogeneity of dysembryoplastic neuroepithelial tumour: identification and differential diagnosis in a series of 74 cases. Histopathology 1999; 34:342-56. [PMID: 10231402 DOI: 10.1046/j.1365-2559.1999.00576.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS In a retrospective study of resected specimens from 416 patients being treated for long-standing epilepsy, 74 cases of dysembryoplastic neuroepithelial tumour (DNT) were encountered that were all characteristically composed of small round oligodendroglia-like cells (OLC), astrocytes and mature neurones in varying proportions. The architectural patterns, histological, immunohistochemical and ultrastructural features and results of cell proliferation studies and postoperative follow-up are described to facilitate the identification of DNT and to differentiate it from other intrinsic neoplasms that commonly present with seizures. METHODS AND RESULTS The tumours presented with early onset of seizures, at a median age of 7 years, without the signs of raised intracranial pressure. A majority of the lesions were located in the temporal lobe (n = 59), with fewer cases in the frontal (n = 8), parietal (n = 6) and occipital lobes (n = 1), and ranged in size from 10 to 70 mm; 33 were cystic. Histologically three types could be distinguished, multinodular, solitary nodular and diffuse. The first type (37.8%) had the features of a typical DNT with multinodular architecture and mixed cellular composition. The second type (33.8%) consisted of a solitary nodule, while the third (28.4%) was a diffuse tumour, both composed of a similar mixture of cells as the multinodular DNT. The lesions were seen in the neocortex and white matter and tumours in the temporal lobe often involved the amygdala and hippocampus. The presence of myxoid matrix, microcystic change, calcification and leptomeningeal involvement were common. Dysplastic neurones at the periphery of the tumour and abnormalities in cortical lamination in the adjacent neocortex were found in about one-third of the resections. Rare mitotic figures were encountered in eight of the tumours and necrosis was found in two. Immunocytochemistry for glial fibrillary acidic protein (GFAP) and neuronal markers neuron-specific enolase, synaptophysin and neurofilament (RT 97) assists in establishing the diagnosis, highlighting the astrocytic and neuronal components, and the OLC, by the absence of expression of GFAP. Electron microscopy showed that in some cases OLC show neuronal differentiation. Although the proliferating cell nuclear antigen labelling index varied between 0 and 45.5%, 20 of the 51 tumours stained failed to express the antigen, in keeping with the indolent nature of this neoplasm. The response to surgery was excellent; none of the tumours have recurred, and the control of seizures remained good. CONCLUSIONS Despite some histological heterogeneity, the clinical and pathological features and indolent biological behaviour indicate that these tumours constitute a single distinct entity. The spectrum of morphological appearances of DNT is broader than has been previously reported, the recognition of which is needed to avoid unnecessary neoadjuvant therapy.
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Affiliation(s)
- M Honavar
- Department of Neuropathology, Institute of Psychiatry, King's Heath Trust, London, UK
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Daumas-Duport C, Varlet P, Bacha S, Beuvon F, Cervera-Pierot P, Chodkiewicz JP. Dysembryoplastic neuroepithelial tumors: nonspecific histological forms -- a study of 40 cases. J Neurooncol 1999; 41:267-80. [PMID: 10359147 DOI: 10.1023/a:1006193018140] [Citation(s) in RCA: 175] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To demonstrate that DNTs include a large morphological spectrum of tumors that cannot be histologically distinguished from conventional categories of gliomas. METHODS All tumors from patients who underwent epilepsy surgery in Sainte-Anne hospital (Paris) that histologically resembled gliomas and did not conform to current histological criteria for DNTs or gangliogliomas were entered in the study. RESULTS According to the WHO histological classification, the 40 tumors resembled: pilocytic astrocytomas (4 cases), astrocytomas (16 cases), anaplastic astrocytoma (1 case), oligodendrogliomas (10 cases), oligo-astrocytomas (8 cases) or anaplastic oligo-astrocytomas (1 case). However foci of cortical dysplasia could be observed in 47% of the cases. Clinical presentation and imaging features were strikingly similar to that observed in typical DNTs. Although surgical removal was incomplete in 28% of the cases and none of the patients underwent chemo or radiotherapy, none of the tumors recurred (mean follow-up: 7 years). Moreover, serial preoperative imaging in 26 patients (mean follow-up: 4.5 years) demonstrated that these lesions were perfectly stable. CONCLUSIONS Whatever the histological appearance of a glial tumor, the diagnosis of DNT must be considered when all the following criteria are associated: (1) partial seizures, with or without secondary generalization, beginning before the age 20 years, (2) no neurological deficit or stable congenital deficit, (3) cortical topography of the lesion as better demonstrated by MRI and (4) no mass effect on imaging.
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MESH Headings
- Adolescent
- Adult
- Age of Onset
- Brain Neoplasms/classification
- Brain Neoplasms/diagnostic imaging
- Brain Neoplasms/pathology
- Brain Neoplasms/surgery
- Child
- Child, Preschool
- Epilepsy/complications
- Epilepsy/surgery
- Female
- Follow-Up Studies
- Humans
- Infant
- Male
- Neoplasms, Germ Cell and Embryonal/classification
- Neoplasms, Germ Cell and Embryonal/diagnostic imaging
- Neoplasms, Germ Cell and Embryonal/pathology
- Neoplasms, Germ Cell and Embryonal/surgery
- Neoplasms, Neuroepithelial/classification
- Neoplasms, Neuroepithelial/diagnostic imaging
- Neoplasms, Neuroepithelial/pathology
- Neoplasms, Neuroepithelial/surgery
- Retrospective Studies
- Tomography, X-Ray Computed
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Affiliation(s)
- C Daumas-Duport
- Department of Pathology, Sainte-Anne Hospital, Cochin Port-Royal University, Paris, France.
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