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Pateras IS, Igea A, Nikas IP, Leventakou D, Koufopoulos NI, Ieronimaki AI, Bergonzini A, Ryu HS, Chatzigeorgiou A, Frisan T, Kittas C, Panayiotides IG. Diagnostic Challenges during Inflammation and Cancer: Current Biomarkers and Future Perspectives in Navigating through the Minefield of Reactive versus Dysplastic and Cancerous Lesions in the Digestive System. Int J Mol Sci 2024; 25:1251. [PMID: 38279253 PMCID: PMC10816510 DOI: 10.3390/ijms25021251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 01/28/2024] Open
Abstract
In the setting of pronounced inflammation, changes in the epithelium may overlap with neoplasia, often rendering it impossible to establish a diagnosis with certainty in daily clinical practice. Here, we discuss the underlying molecular mechanisms driving tissue response during persistent inflammatory signaling along with the potential association with cancer in the gastrointestinal tract, pancreas, extrahepatic bile ducts, and liver. We highlight the histopathological challenges encountered in the diagnosis of chronic inflammation in routine practice and pinpoint tissue-based biomarkers that could complement morphology to differentiate reactive from dysplastic or cancerous lesions. We refer to the advantages and limitations of existing biomarkers employing immunohistochemistry and point to promising new markers, including the generation of novel antibodies targeting mutant proteins, miRNAs, and array assays. Advancements in experimental models, including mouse and 3D models, have improved our understanding of tissue response. The integration of digital pathology along with artificial intelligence may also complement routine visual inspections. Navigating through tissue responses in various chronic inflammatory contexts will help us develop novel and reliable biomarkers that will improve diagnostic decisions and ultimately patient treatment.
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Affiliation(s)
- Ioannis S. Pateras
- 2nd Department of Pathology, “Attikon” University Hospital, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (D.L.); (N.I.K.); (A.I.I.); (I.G.P.)
| | - Ana Igea
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain;
- Mobile Genomes, Centre for Research in Molecular Medicine and Chronic Diseases (CiMUS), University of Santiago de Compostela (USC), 15706 Santiago de Compostela, Spain
| | - Ilias P. Nikas
- Medical School, University of Cyprus, 2029 Nicosia, Cyprus
| | - Danai Leventakou
- 2nd Department of Pathology, “Attikon” University Hospital, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (D.L.); (N.I.K.); (A.I.I.); (I.G.P.)
| | - Nektarios I. Koufopoulos
- 2nd Department of Pathology, “Attikon” University Hospital, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (D.L.); (N.I.K.); (A.I.I.); (I.G.P.)
| | - Argyro Ioanna Ieronimaki
- 2nd Department of Pathology, “Attikon” University Hospital, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (D.L.); (N.I.K.); (A.I.I.); (I.G.P.)
| | - Anna Bergonzini
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Alfred Nobels Allé 8, 141 52 Stockholm, Sweden;
- Department of Molecular Biology and Umeå Centre for Microbial Research (UCMR), Umeå University, 901 87 Umeå, Sweden;
| | - Han Suk Ryu
- Department of Pathology, Seoul National University Hospital, Seoul 03080, Republic of Korea;
| | - Antonios Chatzigeorgiou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece;
| | - Teresa Frisan
- Department of Molecular Biology and Umeå Centre for Microbial Research (UCMR), Umeå University, 901 87 Umeå, Sweden;
| | - Christos Kittas
- Department of Histopathology, Biomedicine Group of Health Company, 156 26 Athens, Greece;
| | - Ioannis G. Panayiotides
- 2nd Department of Pathology, “Attikon” University Hospital, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (D.L.); (N.I.K.); (A.I.I.); (I.G.P.)
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Sporikova Z, Slavkovsky R, Tuckova L, Kalita O, Megova Houdova M, Ehrmann J, Hajduch M, Hrabalek L, Vaverka M. IDH1/2 Mutations in Patients With Diffuse Gliomas: A Single Centre Retrospective Massively Parallel Sequencing Analysis. Appl Immunohistochem Mol Morphol 2022; 30:178-183. [PMID: 35262523 PMCID: PMC8920008 DOI: 10.1097/pai.0000000000000997] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 10/26/2021] [Indexed: 12/05/2022]
Abstract
Patients below 55 years were genetically studied because the prevalence of isocitrate dehydrogenase 1 (IDH1) decreases in older patients and on grounds of cost-effectiveness, as suggested by the World Health Organization (WHO) in 2016. The aim of our study was to use novel massively parallel sequencing (MPS) approaches to examine rare variants of IDH1/2 in Czech diffuse astrocytic and oligodendroglial tumors (gliomas) patients below 55 years of age who had been immunohistochemically (IHC) diagnosed as IDH1 R132H negative. The IHC IDH1 status (wild type or mutant) of 275 tissue samples was analyzed using antibodies against the IDH1 R132H protein. Sixty-three samples of 55 years old patients with IHC IDH1 WT status were genotyped using two different MPS technologies to detect rare IDH1 and IDH2 variants. The tiered IHC (60 positive) and molecular (10 positive) approach thus revealed that 70 of the 275 samples (25%) bore IDH1/IDH2 mutations. The combined molecular and IHC approach thus revealed that 70 of the 275 samples (25%) considered in the study bore IDH1/IDH2 mutations. IHC detection of the IDH1 R132H variant should be routinely complemented with MPS to detect rare IDH1/2 variants in glioma patients below 55 years of age with negative IHC result of IDH R132H variant.
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Affiliation(s)
| | | | | | - Ondrej Kalita
- Neurosurgery, Faculty of Medicine and Dentistry, Palacky University and University Hospital, Olomouc
- Department of Health Care Science, Faculty of Humanities, T. Bata University in Zlin, the Czech Republic
| | | | | | | | - Lumir Hrabalek
- Neurosurgery, Faculty of Medicine and Dentistry, Palacky University and University Hospital, Olomouc
| | - Miroslav Vaverka
- Neurosurgery, Faculty of Medicine and Dentistry, Palacky University and University Hospital, Olomouc
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Clinical and Molecular Features of Patients with Gliomas Harboring IDH1 Non-canonical Mutations: A Systematic Review and Meta-Analysis. Adv Ther 2022; 39:165-177. [PMID: 34853984 DOI: 10.1007/s12325-021-01977-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 10/26/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The canonical isocitrate dehydrogenase 1 R132 mutation (IDH1 R132) is the most frequent mutation among IDH-mutated gliomas. Non-canonical IDH1 mutations or IDH2 mutations are unusual and their clinical and biological role is still unclear. METHODS We performed a systematic review and meta-analysis to assess the clinical role of IDH non-canonical mutations. RESULTS Overall, we selected 13 of 3513 studies reporting data of 4007 patients with a diagnosis of grade 2 and grade 3 glioma including 3091 patients with a molecularly proven IDH1 or IDH2 mutation. Patients with non-canonical IDH1 mutations were younger and presented a higher DNA methylation level as compared to those with canonical IDH1 R132H alteration. The overall incidence of non-canonical IDH1 mutations was 7.9% (95% CI 5.4-10.7%) in patients with IDH-mutated gliomas. There was no statistical difference in terms of incidence between patients with grade 2 or grade 3 glioma. Patients with non-canonical IDH mutations had a lower rate of 1p19q codeletion (risk difference 31%, 95% CI 23-38%) and presented a significantly prolonged survival (pooled HR 0.47, 95% CI 0.28-0.81) as compared to those with IDH1 R132H mutation. CONCLUSION Non-canonical IDH1 mutations occur in 7.9% of IDH-mutated gliomas and identify a specific subgroup of patients with an improved survival despite a lower rate of 1p19q codeletion. Data about the type of IDH mutation should be collected in clinical practice and within interventional trials as this could be a critical variable for improved stratification and selection of patients.
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Central Nervous System Tumor Classification: An Update on the Integration of Tumor Genetics. Hematol Oncol Clin North Am 2021; 36:1-21. [PMID: 34763992 DOI: 10.1016/j.hoc.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In 2016, the World Health Organization Classification of CNS Tumors introduced molecular abnormalities that refined tumor diagnoses. Around this time, the introduction of large scale genetic mutational analyses quickly advanced our knowledge of recurrent abnormalities in disease. In 2017, the C-IMPACT group was established to render expert consensus opinions regarding the application of molecular findings into central nervous system tumor diagnoses. C-IMPACT have presented their recommendations in 7 peer-reviewed publications; this article details those recommendations that are expected to be incorporated into the upcoming fifth edition of the World Health Organization classification.
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Pekmezci M, Morshed RA, Chunduru P, Pandian B, Young J, Villanueva-Meyer JE, Tihan T, Sloan EA, Aghi MK, Molinaro AM, Berger MS, Hervey-Jumper SL. Detection of glioma infiltration at the tumor margin using quantitative stimulated Raman scattering histology. Sci Rep 2021; 11:12162. [PMID: 34108566 PMCID: PMC8190264 DOI: 10.1038/s41598-021-91648-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/10/2021] [Indexed: 11/23/2022] Open
Abstract
In the management of diffuse gliomas, the identification and removal of tumor at the infiltrative margin remains a central challenge. Prior work has demonstrated that fluorescence labeling tools and radiographic imaging are useful surgical adjuvants with macroscopic resolution. However, they lose sensitivity at the tumor margin and have limited clinical utility for lower grade histologies. Fiber-laser based stimulated Raman histology (SRH) is an optical imaging technique that provides microscopic tissue characterization of unprocessed tissues. It remains unknown whether SRH of tissues taken from the infiltrative glioma margin will identify microscopic residual disease. Here we acquired glioma margin specimens for SRH, histology, and tumor specific tissue characterization. Generalized linear mixed models were used to evaluate agreement. We find that SRH identified residual tumor in 82 of 167 margin specimens (49%), compared to IHC confirming residual tumor in 72 of 128 samples (56%), and H&E confirming residual tumor in 82 of 169 samples (49%). Intraobserver agreements between all 3 modalities were confirmed. These data demonstrate that SRH detects residual microscopic tumor at the infiltrative glioma margin and may be a promising tool to enhance extent of resection.
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Affiliation(s)
- Melike Pekmezci
- Department of Pathology, University of California, San Francisco, CA, USA
| | - Ramin A Morshed
- Department of Neurological Surgery, University of California, 505 Parnassus Ave., Rm. M-779, San Francisco, CA, 94143-0112, USA
| | - Pranathi Chunduru
- Department of Neurological Surgery, University of California, 505 Parnassus Ave., Rm. M-779, San Francisco, CA, 94143-0112, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Balaji Pandian
- Department of Neurological Surgery, University of California, 505 Parnassus Ave., Rm. M-779, San Francisco, CA, 94143-0112, USA.,Invenio Imaging, Inc, Santa Clara, CA, USA
| | - Jacob Young
- Department of Neurological Surgery, University of California, 505 Parnassus Ave., Rm. M-779, San Francisco, CA, 94143-0112, USA
| | | | - Tarik Tihan
- Department of Pathology, University of California, San Francisco, CA, USA
| | - Emily A Sloan
- Department of Pathology, University of California, San Francisco, CA, USA
| | - Manish K Aghi
- Department of Neurological Surgery, University of California, 505 Parnassus Ave., Rm. M-779, San Francisco, CA, 94143-0112, USA
| | - Annette M Molinaro
- Department of Neurological Surgery, University of California, 505 Parnassus Ave., Rm. M-779, San Francisco, CA, 94143-0112, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Mitchel S Berger
- Department of Neurological Surgery, University of California, 505 Parnassus Ave., Rm. M-779, San Francisco, CA, 94143-0112, USA
| | - Shawn L Hervey-Jumper
- Department of Neurological Surgery, University of California, 505 Parnassus Ave., Rm. M-779, San Francisco, CA, 94143-0112, USA.
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Franceschi E, De Biase D, Di Nunno V, Pession A, Tosoni A, Gatto L, Tallini G, Visani M, Lodi R, Bartolini S, Brandes AA. IDH1 Non-Canonical Mutations and Survival in Patients with Glioma. Diagnostics (Basel) 2021; 11:diagnostics11020342. [PMID: 33669525 PMCID: PMC7922632 DOI: 10.3390/diagnostics11020342] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/08/2021] [Accepted: 02/18/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Non-canonical mutations of the isocitrate dehydrogenase (IDH) genes have been described in about 20-25% and 5-12% of patients with WHO grade II and III gliomas, respectively. To date, the prognostic value of these rare mutations is still a topic of debate. METHODS We selected patients with WHO grade II and III gliomas and IDH1 mutations with available tissue samples for next-generation sequencing. The clinical outcomes and baseline behaviors of patients with canonical IDH1 R132H and non-canonical IDH1 mutations were compared. RESULTS We evaluated 433 patients harboring IDH1 mutations. Three hundred and ninety patients (90.1%) had a canonical IDH1 R132H mutation while 43 patients (9.9%) had a non-canonical IDH1 mutation. Compared to those with the IDH1 canonical mutation, patients with non-canonical mutations were younger (p < 0.001) and less frequently presented the 1p19q codeletion (p = 0.017). Multivariate analysis confirmed that the extension of surgery (p = 0.003), the presence of the 1p19q codeletion (p = 0.001), and the presence of a non-canonical mutation (p = 0.041) were variables correlated with improved overall survival. CONCLUSION the presence of non-canonical IDH1 mutations could be associated with improved survival among patients with IDH1 mutated grade II-III glioma.
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Affiliation(s)
- Enrico Franceschi
- Department of Oncology, AUSL Bologna, 40139 Bologna, Italy; (V.D.N.); (A.T.); (L.G.); (S.B.); (A.A.B.)
- Correspondence: ; Tel.: +39-05-1622-5697
| | - Dario De Biase
- Department of Pharmacy and Biotechnology (Dipartimento di Farmacia e Biotecnologie)-Molecular Diagnostic Unit, Azienda USL di Bologna, University of Bologna, 40126 Bologna, Italy; (D.D.B.); (A.P.)
| | - Vincenzo Di Nunno
- Department of Oncology, AUSL Bologna, 40139 Bologna, Italy; (V.D.N.); (A.T.); (L.G.); (S.B.); (A.A.B.)
| | - Annalisa Pession
- Department of Pharmacy and Biotechnology (Dipartimento di Farmacia e Biotecnologie)-Molecular Diagnostic Unit, Azienda USL di Bologna, University of Bologna, 40126 Bologna, Italy; (D.D.B.); (A.P.)
| | - Alicia Tosoni
- Department of Oncology, AUSL Bologna, 40139 Bologna, Italy; (V.D.N.); (A.T.); (L.G.); (S.B.); (A.A.B.)
| | - Lidia Gatto
- Department of Oncology, AUSL Bologna, 40139 Bologna, Italy; (V.D.N.); (A.T.); (L.G.); (S.B.); (A.A.B.)
| | - Giovanni Tallini
- Department of Medicine (Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale)-Molecular Diagnostic Unit, Azienda USL di Bologna, University of Bologna School of Medicine, 40126 Bologna, Italy; (G.T.); (M.V.)
| | - Michela Visani
- Department of Medicine (Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale)-Molecular Diagnostic Unit, Azienda USL di Bologna, University of Bologna School of Medicine, 40126 Bologna, Italy; (G.T.); (M.V.)
| | - Raffaele Lodi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy;
| | - Stefania Bartolini
- Department of Oncology, AUSL Bologna, 40139 Bologna, Italy; (V.D.N.); (A.T.); (L.G.); (S.B.); (A.A.B.)
| | - Alba Ariela Brandes
- Department of Oncology, AUSL Bologna, 40139 Bologna, Italy; (V.D.N.); (A.T.); (L.G.); (S.B.); (A.A.B.)
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Geramizadeh B, Kohandel-Shirazi M, Soltani A. A Simple Panel of IDH1 and P53 in Differential Diagnosis Between Low-Grade Astrocytoma and Reactive Gliosis. CLINICAL PATHOLOGY 2021; 14:2632010X20986168. [PMID: 33634261 PMCID: PMC7887675 DOI: 10.1177/2632010x20986168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 12/09/2020] [Indexed: 11/16/2022]
Abstract
Background Reactive gliosis is a response of glial tissue to different types of injury such as brain abscess, trauma, hemorrhage, or even neoplastic process. In some circumstances, especially when the tissue biopsy is small, there may be difficulty to discriminate this reactive condition with low-grade diffuse astrocytoma (World Health Organization [WHO] grade II) by conventional hematoxylin and eosin (H&E) slides, so some immunohistochemical and molecular markers have been introduced for this differential diagnosis. One of the important aspects of updated WHO classification in 2016 has been dividing some of the glial tumor according to IDH1 (isocitrate dehydrogenase 1) mutation. Objectives In this study, we tried to evaluate IDH1 and P53 mutation by immunohistochemistry as a simple and highly specific and sensitive method to differentiate low-grade astrocytoma and reactive gliosis. Material and methods For 5 years (2013-2018), 50 cases of clinically documented reactive gliosis and 50 cases of low-grade astrocytoma were evaluated for the presence or absence of IDH1 and P53 mutation by immunohistochemistry. Results Isocitrate dehydrogenase 1 was positive in 92% and 4% of the astrocytoma and reactive gliosis cases and P53 was positive in 90% and 4% of the cases with the final diagnosis of astrocytoma and reactive gliosis, respectively. Discussion and conclusion Combination of P53 and IDH1 as an immunohistochemical panel showed specificity of 96% and sensitivity of 91% for differential diagnosis of reactive gliosis and low-grade astrocytoma. These 2 markers can be extremely helpful for this differential diagnosis.
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Affiliation(s)
- Bita Geramizadeh
- Department of Pathology, Medical School of Shiraz University, Shiraz University of Medical Sciences, Shiraz, Iran.,Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahsa Kohandel-Shirazi
- Department of Pathology, Medical School of Shiraz University, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Soltani
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
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Alshoabi SA, Alareqi AA, Omer AM, Suliman AG, Daqqaq TS. Diffuse astrocytoma and the diagnostic dilemma of an unusual phenotype: A case report. Radiol Case Rep 2020; 16:319-326. [PMID: 33304444 PMCID: PMC7718471 DOI: 10.1016/j.radcr.2020.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/06/2020] [Accepted: 11/11/2020] [Indexed: 11/30/2022] Open
Abstract
Diffuse astrocytoma is an infiltrating type of glioma (World Health Organization grade II), which even with histopathology, is difficult to diagnose. Magnetic resonance imaging (MRI) is the cornerstone for diagnoses and follow-up of brain gliomas. This report describes a case of diffuse astrocytoma in a 48-year-old man who presented with sudden right-sided weakness and repeated convulsive attacks. On brain computed tomography, the case was diagnosed and treated as an acute infarction. Ten days later, the patient returned with a total loss of consciousness. Brain MRI images revealed an irregularly outlined lesion involving the splenium of the corpus callosum that extended into the left periventricular parietal lobe of the brain with cystic foci in the septum pellucidum. Contrast-enhanced and new sequences of MRI was helpful in approach to diagnosis because of its superior tissue characterization. The histopathology results ultimately confirmed the diagnosis of diffuse astrocytoma. The patient died postoperatively.
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Affiliation(s)
- Sultan A. Alshoabi
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah, 42312, Kingdom of Saudi Arabia
- Corresponding author.
| | - Amal A. Alareqi
- Department of Radiology, University of Science and Technology Hospital (USTH), Sana'a, Republic of Yemen
- Radiology department, 21 September university of medical and applied sciences, Sana'a, Republic of Yemen
| | - Awatef M. Omer
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah, 42312, Kingdom of Saudi Arabia
| | - Awadia G. Suliman
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah, 42312, Kingdom of Saudi Arabia
| | - Tareef S. Daqqaq
- Department of Radiology, Faculty of Medicine, Taibah University, Almadinah Almunawwarah, Kingdom of Saudi Arabia
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Hewer E, Phour J, Gutt-Will M, Schucht P, Dettmer MS, Vassella E. TERT Promoter Mutation Analysis to Distinguish Glioma From Gliosis. J Neuropathol Exp Neurol 2020; 79:430-436. [PMID: 32068851 DOI: 10.1093/jnen/nlaa004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/12/2019] [Accepted: 01/21/2020] [Indexed: 12/14/2022] Open
Abstract
Among the most challenging diagnostic issues in surgical neuropathology is the distinction between scant infiltration by diffuse gliomas and reactive gliosis. The best documented ancillary marker to establish a definitive diagnosis of glioma in this setting is the identification of hotspot mutations in the isocitrate dehydrogenase 1 and 2 (IDH1/IDH2) genes, which is limited, however, by the low prevalence of these mutations in gliomas of elderly adults. Since telomerase reverse transcriptase (TERT) promoter mutations are present in the vast majority of IDH-wildtype diffuse gliomas, we hypothesized that combined analysis of IDH and TERT might overcome these limitations. For this purpose, we analyzed a series of non-neoplastic and neoplastic CNS samples for the prevalence of TERT hotspot mutations. TERT mutations were identified in none out of 58 (0%) reactive gliosis samples, and in 91 out of 117 (78%) IDH-wildtype gliomas. Based on a series of 200 consecutive diffuse gliomas, we found that IDH mutation analysis alone had a sensitivity of 28% (63% and 12%, respectively, in patients below and above age of 50) for detection of gliomas, whereas a combined analysis of IDH and TERT was 85% sensitive (87% and 84%, respectively, below and above age of 50). In sum, our findings suggest that TERT promoter mutation analysis contributes favorably to a molecular panel in cases equivocal for glioma versus gliosis on morphological grounds, especially in patients above age of 50, in which IDH analysis alone performs poorly.
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Affiliation(s)
| | | | - Marielena Gutt-Will
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philippe Schucht
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Abstract
Isocitrate dehydrogenase 1 (IDH1) encodes a protein which catalyses the oxidative decarboxylation of isocitrate to α-ketoglutarate. Mutant IDH1 favours the production of 2-hydroxyglutarate, an oncometabolite with multiple downstream effects which promote tumourigenesis. IDH1 mutations have been described in a number of neoplasms most notably low-grade diffuse gliomas, conventional central and periosteal cartilaginous tumours and cytogenetically normal acute myeloid leukaemia. Post zygotic somatic mutations of IDH1 characterise the majority of cases of Ollier disease and Maffucci syndrome. IDH1 mutations are uncommon in epithelial neoplasia but have been described in cholangiocarcinoma.
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Affiliation(s)
- Cassandra Bruce-Brand
- Division of Anatomical Pathology, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa .,Anatomical Pathology, National Health Laboratory Service, Tygerberg Hospital, Cape Town, Western Cape, South Africa
| | - Dhirendra Govender
- Anatomical Pathology, Pathcare Cape Town, Cape Town, South Africa.,Division of Anatomical Pathology, University of Cape Town, Cape Town, Western Cape, South Africa
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11
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Shen X, Voets NL, Larkin SJ, de Pennington N, Plaha P, Stacey R, McCullagh JSO, Schofield CJ, Clare S, Jezzard P, Cadoux-Hudson T, Ansorge O, Emir UE. A Noninvasive Comparison Study between Human Gliomas with IDH1 and IDH2 Mutations by MR Spectroscopy. Metabolites 2019; 9:E35. [PMID: 30791611 PMCID: PMC6409728 DOI: 10.3390/metabo9020035] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/05/2019] [Accepted: 02/15/2019] [Indexed: 12/29/2022] Open
Abstract
The oncogenes that are expressed in gliomas reprogram particular pathways of glucose, amino acids, and fatty acid metabolism. Mutations in isocitrate dehydrogenase genes (IDH1/2) in diffuse gliomas are associated with abnormally high levels of 2-hydroxyglutarate (2-HG) levels. The aim of this study was to determine whether metabolic reprogramming associated with IDH mutant gliomas leads to additional ¹H MRS-detectable differences between IDH1 and IDH2 mutations, and to identify metabolites correlated with 2-HG. A total of 21 glioma patients (age= 37 ± 11, 13 males) were recruited for magnetic resonance spectroscopy (MRS) using semi-localization by adiabatic selective refocusing pulse sequence at an ultra-high-field (7T). For 20 patients, the tumor mutation subtype was confirmed by immunohistochemistry and DNA sequencing. LCModel analysis was applied for metabolite quantification. A two-sample t-test was used for metabolite comparisons between IDH1 (n = 15) and IDH2 (n = 5) mutant gliomas. The Pearson correlation coefficients between 2-HG and associated metabolites were calculated. A Bonferroni correction was applied for multiple comparison. IDH2 mutant gliomas have a higher level of 2-HG/tCho (total choline=phosphocholine+glycerylphosphorylcholine) (2.48 ± 1.01vs.0.72 ± 0.38, Pc < 0.001) and myo-Inositol/tCho (2.70 ± 0.90 vs. 1.46 ± 0.51, Pc = 0.011) compared to IDH1 mutation gliomas. Associated metabolites, myo-Inositol and glucose+taurine were correlated with 2-HG levels. These results show the improved characterization of the metabolic pathways in IDH1 and IDH2 gliomas for precision medicine.
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Affiliation(s)
- Xin Shen
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA.
| | - Natalie L Voets
- Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK.
| | - Sarah J Larkin
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK.
| | - Nick de Pennington
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK.
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK.
| | - Puneet Plaha
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK.
| | - Richard Stacey
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK.
| | - James S O McCullagh
- Chemistry Research Laboratory, Department of Chemistry, University of Oxford, Oxford OX1 3TA, UK.
| | - Christopher J Schofield
- Chemistry Research Laboratory, Department of Chemistry, University of Oxford, Oxford OX1 3TA, UK.
| | - Stuart Clare
- Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK.
| | - Peter Jezzard
- Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK.
| | - Tom Cadoux-Hudson
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK.
| | - Olaf Ansorge
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK.
| | - Uzay E Emir
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA.
- Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK.
- School of Health Sciences, Purdue University, West Lafayette, IN 47907, USA.
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12
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Manasson J, Howard J, Nowatzky J. Brainstem astrocytoma as a neuro-Behçet's disease mimic. BMJ Case Rep 2018; 11:11/1/e226945. [PMID: 30567204 DOI: 10.1136/bcr-2018-226945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 58-year-old man with a history of recurrent aphthous ulcers since childhood was admitted to the hospital with acute neurological decline characterised by loss of motor dexterity, dysarthria, dysphagia and unsteady gait. MRI brain was significant for symmetrical hyperintense T2 fluid attenuated inversion recovery (FLAIR) in the corticospinal tracts, including parts of the pons and the mesodiencephalic junction. Though initial concern was for neuro-Behçet's disease, brain biopsy ultimately revealed a diagnosis of astrocytoma. This report demonstrates a mimic of neuro-Behçet's disease and the importance of confirming the correct diagnosis prior to initiating therapy.
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Affiliation(s)
- Julia Manasson
- Internal Medicine, Division of Rheumatology, New York University, New York City, New York, USA
| | - Jonathan Howard
- Neurology and Psychiatry, New York University, New York City, New York, USA
| | - Johannes Nowatzky
- Internal Medicine, Division of Rheumatology, New York University, New York City, New York, USA
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13
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Yoshida A, Satomi K, Ohno M, Matsushita Y, Takahashi M, Miyakita Y, Hiraoka N, Narita Y, Ichimura K. Frequent false-negative immunohistochemical staining with IDH1 (R132H)-specific H09 antibody on frozen section control slides: a potential pitfall in glioma diagnosis. Histopathology 2018; 74:350-354. [DOI: 10.1111/his.13756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 09/13/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Akihiko Yoshida
- Department of Pathology and Clinical Laboratories; National Cancer Centre Hospital; Tokyo Japan
- Rare Cancer Centre; National Cancer Centre Hospital; Tokyo Japan
| | - Kaishi Satomi
- Department of Pathology and Clinical Laboratories; National Cancer Centre Hospital; Tokyo Japan
| | - Makoto Ohno
- Department of Neurosurgery and Neuro-Oncology; National Cancer Centre Hospital; Tokyo Japan
| | - Yuko Matsushita
- Department of Neurosurgery and Neuro-Oncology; National Cancer Centre Hospital; Tokyo Japan
- Division of Brain Tumour Translational Research; National Cancer Centre Research Institute; Tokyo Japan
| | - Masamichi Takahashi
- Department of Neurosurgery and Neuro-Oncology; National Cancer Centre Hospital; Tokyo Japan
| | - Yasuji Miyakita
- Department of Neurosurgery and Neuro-Oncology; National Cancer Centre Hospital; Tokyo Japan
| | - Nobuyoshi Hiraoka
- Department of Pathology and Clinical Laboratories; National Cancer Centre Hospital; Tokyo Japan
| | - Yoshitaka Narita
- Rare Cancer Centre; National Cancer Centre Hospital; Tokyo Japan
- Department of Neurosurgery and Neuro-Oncology; National Cancer Centre Hospital; Tokyo Japan
| | - Koichi Ichimura
- Rare Cancer Centre; National Cancer Centre Hospital; Tokyo Japan
- Division of Brain Tumour Translational Research; National Cancer Centre Research Institute; Tokyo Japan
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14
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Abstract
OBJECTIVE To explain several biomarkers used in primary adult brain tumor diagnosis and the methodologies for their application. DATA SOURCES Peer-reviewed literature. CONCLUSION In the past few years, several biomarkers have been touted as providing reliable and objective assays of histogenesis, prognosis, and therapeutic sensitivity. A number of these markers have failed the test of time and rigorous practice applications. More recently, assays with diagnostic applications have been reported and validated from multiple laboratories using large numbers of patients in routine clinical practices. IMPLICATIONS FOR NURSING PRACTICE This article provides a reference for biomarker tests for gliomas. There is a greater need for nurses to understand the translational interface between basic science and clinical medicine to determine the applications of these biomarkers for the best interests of their patients.
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15
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DeWitt JC, Jordan JT, Frosch MP, Samore WR, Iafrate AJ, Louis DN, Lennerz JK. Cost-effectiveness of IDH testing in diffuse gliomas according to the 2016 WHO classification of tumors of the central nervous system recommendations. Neuro Oncol 2018; 19:1640-1650. [PMID: 29016871 DOI: 10.1093/neuonc/nox120] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Due to the decreasing prevalence of IDH1 mutations in older patients, the 2016 World Health Organization (WHO) classification of brain tumors proposed not to perform sequencing for isocitrate dehydrogenase (IDH) in glioblastoma patients ≥55 years old. We present a cost-effectiveness analysis to estimate the financial impact of these guidelines. Methods From 2010 to 2015 we performed 1023 IDH tests in gliomas, amounting to ~$1.09 million in direct laboratory test costs. Samples were tested using R132H-specific immunohistochemistry, DNA sequencing validated for detection of noncanonical IDH1/2 mutations, or both methods. Results In cases tested by DNA sequencing, the fraction of non-R132H mutations was 5.4%, which included only 2 high-grade gliomas in patients ≥55 years (0.9%). When remodeling the optimal age cutoff in our patient population using 5-year age-binning, we found a 10-times higher pretest probability for the presence of a noncanonical IDH1 mutation in the setting of a negative IDH1-R132H immunohistochemistry result in patients <55 years. Applying the independently confirmed age cutoff of 55 years to glioblastoma patients (64%) would result in $403200 saved (43%). By not performing sequencing in patients ≥55 years, the turn-around time to final integrated neuropathological diagnosis is reduced by 53%, allowing these patients to gain earlier benefits from personalized genomic medicine. Conclusion The negligible prevalence of noncanonical IDH mutations in glioblastoma patients ≥55 years argues against universal IDH sequencing in this population. We predict that adoption of this age-based sequencing cutoff recommendation from the 2016 WHO guidelines will result in significant cost and time savings throughout the global health care system.
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Affiliation(s)
- John C DeWitt
- Department of Pathology; Department of Neurology, Division of Neuro-Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Justin T Jordan
- Department of Pathology; Department of Neurology, Division of Neuro-Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Matthew P Frosch
- Department of Pathology; Department of Neurology, Division of Neuro-Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Wesley R Samore
- Department of Pathology; Department of Neurology, Division of Neuro-Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - A John Iafrate
- Department of Pathology; Department of Neurology, Division of Neuro-Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - David N Louis
- Department of Pathology; Department of Neurology, Division of Neuro-Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jochen K Lennerz
- Department of Pathology; Department of Neurology, Division of Neuro-Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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16
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Hammas N, Senhaji N, Alaoui Lamrani MY, Bennis S, Chaoui EM, El Fatemi H, Chbani L. Astroblastoma - a rare and challenging tumor: a case report and review of the literature. J Med Case Rep 2018; 12:102. [PMID: 29678196 PMCID: PMC5910607 DOI: 10.1186/s13256-018-1623-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 02/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background Astroblastoma is a controversial and an extremely rare central nervous system neoplasm. Although its histogenesis has been clarified recently, controversies exist regarding its cellular origin and validity as a distinct entity. Because of its extreme rarity and because its common features are shared with other glial neoplasms, this tumor is prone to misdiagnosis and remains challenging not only in terms of diagnosis and classification but also in the subsequent management. This case report describes a new case of astroblastoma. It discusses clinical, radiologic, pathological, and therapeutic features and differential diagnosis of this rare neoplasm, with a review of the recent literature. Case presentation We report the case of an 8-year-old Moroccan girl who presented with a 1-year history of epileptic seizure, headache, and decreased visual acuity. Cranial magnetic resonance imaging revealed a right occipito-temporal mass. A tumor resection was performed and histological examination combined with immunohistochemical study confirmed the diagnosis of low-grade astroblastoma. Conclusions Astroblastoma is a very rare primary brain tumor. Its diagnosis is often challenging because of the astroblastic aspects that can be found in astrocytic tumors, in ependymomas, and in non-neuroepithelial tumors. Considerable confusion surrounds its histogenesis and classification. The low incidence rate makes it difficult to conduct studies to examine tumor characteristics.
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Affiliation(s)
- Nawal Hammas
- Department of Pathology, Hassan II University Hospital, 30000, Fez, Morocco. .,Biomedical and Translational Research Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco.
| | - Nadia Senhaji
- Bioactive Molecules Laboratory, Faculty of Science and Technology, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - My Youssef Alaoui Lamrani
- Department of Radiology, Hassan II University Hospital, Fez, Morocco.,Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Sanae Bennis
- Biomedical and Translational Research Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco.,Oncogenetic/pathology Unit, Hassan II University Hospital, Fez, Morocco
| | - Elfaiz Mohamed Chaoui
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco.,Department of Neurosurgery, Hassan II University Hospital, Fez, Morocco
| | - Hind El Fatemi
- Department of Pathology, Hassan II University Hospital, 30000, Fez, Morocco.,Biomedical and Translational Research Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Laila Chbani
- Department of Pathology, Hassan II University Hospital, 30000, Fez, Morocco.,Biomedical and Translational Research Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
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17
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Visani M, Acquaviva G, Marucci G, Paccapelo A, Mura A, Franceschi E, Grifoni D, Pession A, Tallini G, Brandes AA, de Biase D. Non-canonical IDH1 and IDH2 mutations: a clonal and relevant event in an Italian cohort of gliomas classified according to the 2016 World Health Organization (WHO) criteria. J Neurooncol 2017; 135:245-254. [PMID: 28748342 DOI: 10.1007/s11060-017-2571-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 07/13/2017] [Indexed: 02/05/2023]
Abstract
According to the 2016 World Health Organization (WHO) classification of tumors of the central nervous system, assessment of exon 4 mutations in isocitrate dehydrogenase 1 or 2 genes (IDH1 or IDH2) is an essential step in the characterization of gliomas. The p.R132H mutation is the most frequent alteration in IDH genes, however other non-canonical IDH mutations can be identified. The aim of this study is to investigate in depth the prevalence of non-R132H IDH ("non-canonical") mutations in brain tumors classified according to the 2016 WHO scheme and their clonal distribution in neoplastic cells. A total of 288 consecutive cases of brain gliomas (grade II-IV) were analyzed for exon 4 IDH1 and IDH2 mutations. IDH1 and IDH2 analysis was performed using next generation sequencing. Non-canonical IDH mutations were identified in 13/52 (25.0%) grade II gliomas (astrocytomas: 8/31, 25.8%; oligodendrogliomas: 5/21, 23.8%) and in 5/40 (12.5%) grade III gliomas (astrocytomas: 3/25, 12.0%; oligodendrogliomas: 2/15, 13.3%). They were not identified in 196 grade IV gliomas (192 glioblastomas, 4 gliosarcomas). In the large majority (>80%) of tumors IDH mutations, both IDH1-R132H and the non-canonical ones, were present in the large majority (>80%) of neoplastic cells. Our data highlight the importance of investigating not only the IDH1-R132H mutation but also the non-canonical ones. These mutations are clonally distributed, with proportions of mutated neoplastic cells overlapping with those of p.R132H, a finding consistent with their driver role in gliomagenesis.
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Affiliation(s)
- Michela Visani
- Department of Medicine (Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale) - Molecular Diagnostic Unit, Azienda USL di Bologna, University of Bologna School of Medicine, Bologna, Italy
| | - Giorgia Acquaviva
- Department of Medicine (Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale) - Molecular Diagnostic Unit, Azienda USL di Bologna, University of Bologna School of Medicine, Bologna, Italy
| | - Gianluca Marucci
- Anatomic Pathology Unit, AUSL of Bologna, Via Altura 3, 40139, Bologna, Italy
- Department of Neuropathology, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Alexandro Paccapelo
- Department of Oncology, AUSL Bologna - IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Antonella Mura
- Department of Oncology, AUSL Bologna - IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Enrico Franceschi
- Department of Oncology, AUSL Bologna - IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Daniela Grifoni
- Department of Pharmacy and Biotechnology (Dipartimento di Farmacia e Biotecnologie) - Molecular Diagnostic Unit, Azienda USL di Bologna, University of Bologna, Bologna, Italy
| | - Annalisa Pession
- Department of Pharmacy and Biotechnology (Dipartimento di Farmacia e Biotecnologie) - Molecular Diagnostic Unit, Azienda USL di Bologna, University of Bologna, Bologna, Italy
| | - Giovanni Tallini
- Department of Medicine (Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale) - Molecular Diagnostic Unit, Azienda USL di Bologna, University of Bologna School of Medicine, Bologna, Italy.
- Anatomia Patologica, ASL Bologna, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Scuola di Medicina e Chirurgia, Università di Bologna, Via Altura 3, 40139, Bologna, Italy.
| | - Alba A Brandes
- Department of Oncology, AUSL Bologna - IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Dario de Biase
- Department of Pharmacy and Biotechnology (Dipartimento di Farmacia e Biotecnologie) - Molecular Diagnostic Unit, Azienda USL di Bologna, University of Bologna, Bologna, Italy
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18
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Heras FL, Diocares G. NEUROPATOLOGÍA: DIAGNÓSTICO CON BIOLOGÍA MOLECULAR. REVISTA MÉDICA CLÍNICA LAS CONDES 2017. [DOI: 10.1016/j.rmclc.2017.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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19
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Abstract
CONTEXT -Molecular genetics is playing an increasingly important role in patient care and pathology practice. Immunohistochemistry (IHC) is a valuable and practical tool employed by most pathologists on a regular basis. OBJECTIVE -To highlight select examples of how IHC may be used in the realm of molecular diagnostics. DATA SOURCES -Select sources on IHC relating to tumor subtyping, hereditary cancer screening, and treatment-response prediction are reviewed. These represent some of the areas in which IHC can be employed by anatomic pathologists to optimize patient care and further inform molecular testing. CONCLUSION -In the emerging era of personalized medicine, IHC continues to serve a valuable function, complementing and enhancing other molecular techniques.
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Affiliation(s)
- Brandon S Sheffield
- From the Department of Pathology, Vancouver General Hospital, Vancouver, Canada
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20
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Abstract
Gliomas form a heterogeneous group of tumors of the central nervous system (CNS) and are traditionally classified based on histologic type and malignancy grade. Most gliomas, the diffuse gliomas, show extensive infiltration in the CNS parenchyma. Diffuse gliomas can be further typed as astrocytic, oligodendroglial, or rare mixed oligodendroglial-astrocytic of World Health Organization (WHO) grade II (low grade), III (anaplastic), or IV (glioblastoma). Other gliomas generally have a more circumscribed growth pattern, with pilocytic astrocytomas (WHO grade I) and ependymal tumors (WHO grade I, II, or III) as the most frequent representatives. This chapter provides an overview of the histology of all glial neoplasms listed in the WHO 2016 classification, including the less frequent "nondiffuse" gliomas and mixed neuronal-glial tumors. For multiple decades the histologic diagnosis of these tumors formed a useful basis for assessment of prognosis and therapeutic management. However, it is now fully clear that information on the molecular underpinnings often allows for a more robust classification of (glial) neoplasms. Indeed, in the WHO 2016 classification, histologic and molecular findings are integrated in the definition of several gliomas. As such, this chapter and Chapter 6 are highly interrelated and neither should be considered in isolation.
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21
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Tanboon J, Williams EA, Louis DN. The Diagnostic Use of Immunohistochemical Surrogates for Signature Molecular Genetic Alterations in Gliomas. J Neuropathol Exp Neurol 2016; 75:4-18. [PMID: 26671986 DOI: 10.1093/jnen/nlv009] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
A number of key mutations that affect treatment and prognosis have been identified in human gliomas. Two major ways to identify these mutations in a tumor sample are direct interrogation of the mutated DNA itself and immunohistochemistry to assess the effects of the mutated genes on proteins. Immunohistochemistry is an affordable, robust, and widely available technology that has been in place for decades. For this reason, the use of immunohistochemical approaches to assess molecular genetic changes has become an essential component of state-of-the-art practice. In contrast, even though DNA sequencing technologies are undergoing rapid development, many medical centers do not have access to such methodologies and may be thwarted by the relatively high costs of sending out such tests to reference laboratories. This review summarizes the current experience using immunohistochemistry of glioma samples to identify mutations in IDH1, TP53, ATRX, histone H3 genes, BRAF, EGFR, MGMT, CIC, and FUBP1 as well as guidelines for prudent use of DNA sequencing as a supplemental method.
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22
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Filbin MG, Suvà ML. Gliomas Genomics and Epigenomics: Arriving at the Start and Knowing It for the First Time. ANNUAL REVIEW OF PATHOLOGY-MECHANISMS OF DISEASE 2016; 11:497-521. [DOI: 10.1146/annurev-pathol-012615-044208] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Mariella G. Filbin
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114;
- Center for Cancer Research, Massachusetts General Hospital, Boston, Massachusetts 02114;
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts 02142
- Cancer and Blood Disorders Center, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, Massachusetts 02215
| | - Mario L. Suvà
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114;
- Center for Cancer Research, Massachusetts General Hospital, Boston, Massachusetts 02114;
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts 02142
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23
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Nikiforova MN, Wald AI, Melan MA, Roy S, Zhong S, Hamilton RL, Lieberman FS, Drappatz J, Amankulor NM, Pollack IF, Nikiforov YE, Horbinski C. Targeted next-generation sequencing panel (GlioSeq) provides comprehensive genetic profiling of central nervous system tumors. Neuro Oncol 2016; 18:379-87. [PMID: 26681766 PMCID: PMC4767245 DOI: 10.1093/neuonc/nov289] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 09/25/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Identification of genetic changes in CNS tumors is important for the appropriate clinical management of patients. Our objective was to develop a next-generation sequencing (NGS) assay for simultaneously detecting the various types of genetic alterations characteristic for adult and pediatric CNS tumors that can be applied to small brain biopsies. METHODS We report an amplification-based targeted NGS assay (GlioSeq) that analyzes 30 genes for single nucleotide variants (SNVs) and indels, 24 genes for copy number variations (CNVs), and 14 types of structural alterations in BRAF, EGFR, and FGFR3 genes in a single workflow. GlioSeq performance was evaluated in 54 adult and pediatric CNS tumors, and the results were compared with fluorescence in-situ hybridization, Sanger sequencing, and reverse transcription PCR. RESULTS GlioSeq correctly identified 71/71 (100%) genetic alterations known to be present by conventional techniques, including 56 SNVs/indels, 9 CNVs, 3 EGFRvIII, and 3 KIAA1549-BRAF fusions. Only 20 ng of DNA and 10 ng of RNA were required for successful sequencing of 100% frozen and 96% formalin-fixed, paraffin-embedded tissue specimens. The assay sensitivity was 3%-5% of mutant alleles for SNVs and 1%-5% for gene fusions. The most commonly detected alterations were IDH1, TP53, TERT, ATRX. CDKN2A, and PTEN in high-grade gliomas, followed by BRAF fusions in low-grade gliomas and H3F3A mutations in pediatric gliomas. CONCLUSIONS GlioSeq NGS assay offers accurate and sensitive detection of a wide range of genetic alterations in a single workflow. It allows rapid and cost-effective profiling of brain tumor specimens and thus provides valuable information for patient management.
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Affiliation(s)
- Marina N Nikiforova
- Department of Pathology, Division of Molecular & Genomic Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (M.N.N, A.I.W., M.A.M., S.R., S.Z., Y.E.N.); Department of Pathology, Division of Neuropathology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, Pennsylvania (R.L.H.); Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (F.S.L., J.D.); Department of Neurological Surgery, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (N.M.A., I.F.P.); Departments of Pathology and Neurosurgery, Northwestern University, Chicago, Illinois (C.H.)
| | - Abigail I Wald
- Department of Pathology, Division of Molecular & Genomic Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (M.N.N, A.I.W., M.A.M., S.R., S.Z., Y.E.N.); Department of Pathology, Division of Neuropathology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, Pennsylvania (R.L.H.); Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (F.S.L., J.D.); Department of Neurological Surgery, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (N.M.A., I.F.P.); Departments of Pathology and Neurosurgery, Northwestern University, Chicago, Illinois (C.H.)
| | - Melissa A Melan
- Department of Pathology, Division of Molecular & Genomic Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (M.N.N, A.I.W., M.A.M., S.R., S.Z., Y.E.N.); Department of Pathology, Division of Neuropathology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, Pennsylvania (R.L.H.); Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (F.S.L., J.D.); Department of Neurological Surgery, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (N.M.A., I.F.P.); Departments of Pathology and Neurosurgery, Northwestern University, Chicago, Illinois (C.H.)
| | - Somak Roy
- Department of Pathology, Division of Molecular & Genomic Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (M.N.N, A.I.W., M.A.M., S.R., S.Z., Y.E.N.); Department of Pathology, Division of Neuropathology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, Pennsylvania (R.L.H.); Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (F.S.L., J.D.); Department of Neurological Surgery, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (N.M.A., I.F.P.); Departments of Pathology and Neurosurgery, Northwestern University, Chicago, Illinois (C.H.)
| | - Shan Zhong
- Department of Pathology, Division of Molecular & Genomic Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (M.N.N, A.I.W., M.A.M., S.R., S.Z., Y.E.N.); Department of Pathology, Division of Neuropathology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, Pennsylvania (R.L.H.); Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (F.S.L., J.D.); Department of Neurological Surgery, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (N.M.A., I.F.P.); Departments of Pathology and Neurosurgery, Northwestern University, Chicago, Illinois (C.H.)
| | - Ronald L Hamilton
- Department of Pathology, Division of Molecular & Genomic Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (M.N.N, A.I.W., M.A.M., S.R., S.Z., Y.E.N.); Department of Pathology, Division of Neuropathology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, Pennsylvania (R.L.H.); Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (F.S.L., J.D.); Department of Neurological Surgery, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (N.M.A., I.F.P.); Departments of Pathology and Neurosurgery, Northwestern University, Chicago, Illinois (C.H.)
| | - Frank S Lieberman
- Department of Pathology, Division of Molecular & Genomic Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (M.N.N, A.I.W., M.A.M., S.R., S.Z., Y.E.N.); Department of Pathology, Division of Neuropathology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, Pennsylvania (R.L.H.); Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (F.S.L., J.D.); Department of Neurological Surgery, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (N.M.A., I.F.P.); Departments of Pathology and Neurosurgery, Northwestern University, Chicago, Illinois (C.H.)
| | - Jan Drappatz
- Department of Pathology, Division of Molecular & Genomic Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (M.N.N, A.I.W., M.A.M., S.R., S.Z., Y.E.N.); Department of Pathology, Division of Neuropathology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, Pennsylvania (R.L.H.); Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (F.S.L., J.D.); Department of Neurological Surgery, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (N.M.A., I.F.P.); Departments of Pathology and Neurosurgery, Northwestern University, Chicago, Illinois (C.H.)
| | - Nduka M Amankulor
- Department of Pathology, Division of Molecular & Genomic Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (M.N.N, A.I.W., M.A.M., S.R., S.Z., Y.E.N.); Department of Pathology, Division of Neuropathology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, Pennsylvania (R.L.H.); Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (F.S.L., J.D.); Department of Neurological Surgery, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (N.M.A., I.F.P.); Departments of Pathology and Neurosurgery, Northwestern University, Chicago, Illinois (C.H.)
| | - Ian F Pollack
- Department of Pathology, Division of Molecular & Genomic Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (M.N.N, A.I.W., M.A.M., S.R., S.Z., Y.E.N.); Department of Pathology, Division of Neuropathology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, Pennsylvania (R.L.H.); Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (F.S.L., J.D.); Department of Neurological Surgery, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (N.M.A., I.F.P.); Departments of Pathology and Neurosurgery, Northwestern University, Chicago, Illinois (C.H.)
| | - Yuri E Nikiforov
- Department of Pathology, Division of Molecular & Genomic Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (M.N.N, A.I.W., M.A.M., S.R., S.Z., Y.E.N.); Department of Pathology, Division of Neuropathology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, Pennsylvania (R.L.H.); Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (F.S.L., J.D.); Department of Neurological Surgery, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (N.M.A., I.F.P.); Departments of Pathology and Neurosurgery, Northwestern University, Chicago, Illinois (C.H.)
| | - Craig Horbinski
- Department of Pathology, Division of Molecular & Genomic Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (M.N.N, A.I.W., M.A.M., S.R., S.Z., Y.E.N.); Department of Pathology, Division of Neuropathology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, Pennsylvania (R.L.H.); Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (F.S.L., J.D.); Department of Neurological Surgery, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (N.M.A., I.F.P.); Departments of Pathology and Neurosurgery, Northwestern University, Chicago, Illinois (C.H.)
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Liu A, Hou C, Chen H, Zong X, Zong P. Genetics and Epigenetics of Glioblastoma: Applications and Overall Incidence of IDH1 Mutation. Front Oncol 2016; 6:16. [PMID: 26858939 PMCID: PMC4731485 DOI: 10.3389/fonc.2016.00016] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 01/16/2016] [Indexed: 12/02/2022] Open
Abstract
Glioblastoma is the most fatal brain cancer found in humans. Patients suffering from glioblastoma have a dismal prognosis, with a median survival of 15 months. The tumor may develop rapidly de novo in older patients or through progression from anaplastic astrocytomas in younger patients if glioblastoma is primary or secondary, respectively. During the past decade, significant advances have been made in the understanding of processes leading to glioblastoma, and several important genetic defects that appear to be important for the development and progression of this tumor have been identified. Particularly, the discovery of recurrent mutations in the isocitrate dehydrogenase 1 (IDH1) gene has shed new light on the molecular landscape in glioblastoma. Indeed, emerging research on the consequences of mutant IDH1 protein expression suggests that its neomorphic enzymatic activity catalyzing the production of the oncometabolite 2-hydroxyglutarate influences a range of cellular programs that affect the epigenome and contribute to glioblastoma development. One of the exciting observations is the presence of IDH1 mutation in the vast majority of secondary glioblastoma, while it is almost absent in primary glioblastoma. Growing data indicate that this particular mutation has clinical and prognostic importance and will become a critical early distinction in diagnosis of glioblastoma.
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Affiliation(s)
- Aizhen Liu
- Department of Oncology, Yidu Central Hospital , Jinan , China
| | - Chunfeng Hou
- Department of Oncology Nursing, Yidu Central Hospital , Jinan , China
| | - Hongfang Chen
- Department of Oncology, Yidu Central Hospital , Jinan , China
| | - Xuan Zong
- Department of Oncology, Shandong University School of Medicine , Jinan , China
| | - Peijun Zong
- Department of Oncology, Yidu Central Hospital , Jinan , China
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25
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Cahill DP, Louis DN, Cairncross JG. Molecular background of oligodendroglioma: 1p/19q, IDH, TERT, CIC and FUBP1. CNS Oncol 2015; 4:287-94. [PMID: 26545048 DOI: 10.2217/cns.15.32] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Oligodendroglioma is the quintessential molecularly-defined brain tumor. The characteristic whole-arm loss of the long arm of chromosome 1 and the short arm of chromosome 19 (1p/19q-codeletion) within the genome of these tumors facilitated the reproducible molecular identification of this subcategory of gliomas. More recently, recurrent molecular genetic alterations have been identified to occur concurrently with 1p/19q-codeletion, and definitively identify these tumors, including mutations in IDH1/2, CIC, FUBP1, and the TERT promoter, as well as the absence of ATRX and TP53 alterations. These findings provide a foundation for the consistent diagnosis of this tumor type, upon which a generation of clinical investigators have assembled a strong evidence base for the effective treatment of this disease with radiation and chemotherapy.
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Affiliation(s)
- Daniel P Cahill
- Department of Neurosurgery & Translational Neuro-Oncology Laboratory, Harvard Medical School, Boston, MA 02115, USA.,Massachusetts General Hospital Cancer Center, Harvard Medical School, 32 Fruit Street - Yawkey 9E, Boston, MA 02114, USA
| | - David N Louis
- Massachusetts General Hospital Cancer Center, Harvard Medical School, 32 Fruit Street - Yawkey 9E, Boston, MA 02114, USA.,Department of Pathology, Harvard Medical School, Boston, MA 02115, USA
| | - John Gregory Cairncross
- Southern Alberta Cancer Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
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26
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van Vuurden DG, Aronica E, Hulleman E, Wedekind LE, Biesmans D, Malekzadeh A, Bugiani M, Geerts D, Noske DP, Vandertop WP, Kaspers GJL, Cloos J, Würdinger T, van der Stoop PPM. Pre-B-cell leukemia homeobox interacting protein 1 is overexpressed in astrocytoma and promotes tumor cell growth and migration. Neuro Oncol 2015; 16:946-59. [PMID: 24470547 DOI: 10.1093/neuonc/not308] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Glial brain tumors cause considerable mortality and morbidity in children and adults. Innovative targets for therapy are needed to improve survival and reduce long-term sequelae. The aim of this study was to find a candidate tumor-promoting protein, abundantly expressed in tumor cells but not in normal brain tissues, as a potential target for therapy. METHODS In silico proteomics and genomics, immunohistochemistry, and immunofluorescence microscopy validation were performed. RNA interference was used to ascertain the functional role of the overexpressed candidate target protein. RESULTS In silico proteomics and genomics revealed pre-B-cell leukemia homeobox (PBX) interacting protein 1 (PBXIP1) overexpression in adult and childhood high-grade glioma and ependymoma compared with normal brain. PBXIP1 is a PBX-family interacting microtubule-binding protein with a putative role in migration and proliferation of cancer cells. Immunohistochemical studies in glial tumors validated PBXIP1 expression in astrocytoma and ependymoma but not in oligodendroglioma. RNAi-mediated PBXIP1-knockdown in glioblastoma cell lines strongly reduced proliferation and migration and induced morphological changes, indicating that PBXIP1 knockdown decreases glioma cell viability and motility through rearrangements of the actin cytoskeleton. Furthermore, expression of PBXIP1 was observed in radial glia and astrocytic progenitor cells in human fetal tissues, suggesting that PBXIP1 is an astroglial progenitor cell marker during human embryonic development. CONCLUSION PBXIP1 is a novel protein overexpressed in astrocytoma and ependymoma, involved in tumor cell proliferation and migration, that warrants further exploration as a novel therapeutic target in these tumors.
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27
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Hayashi S, Sasaki H, Kimura T, Abe T, Nakamura T, Kitamura Y, Miwa T, Kameyama K, Hirose Y, Yoshida K. Molecular-genetic and clinical characteristics of gliomas with astrocytic appearance and total 1p19q loss in a single institutional consecutive cohort. Oncotarget 2015; 6:15871-81. [PMID: 25991674 PMCID: PMC4599243 DOI: 10.18632/oncotarget.3869] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 04/02/2015] [Indexed: 12/18/2022] Open
Abstract
The prognostic significance of 1p19q loss in astrocytic gliomas has been inconclusive.We collected 57 gliomas with total 1p19q loss from among 218 cases of WHO grade-II/III gliomas operated at Keio University Hospital between 1990 and 2010. These tumors were classified as oligodendroglial or "astrocytic" by a WHO-criteria-based institutional diagnosis. Chromosomal copy number aberrations (CNAs), IDH 1/2 mutations, MGMT promoter methylation, and expression of p53 and ATRX were assessed. Survival outcome was compared between the two histological groups.Of the 57 codeleted gliomas, 37, 16, and four were classified as oligodendroglial, "astrocytic", and unclassified, respectively. Comparative genomic hybridization revealed that although chromosome 7q/7 gain was more frequent in "astrocytic" gliomas, other CNAs occurred at a similar frequency in both groups. None of the "astrocytic" gliomas showed p53 accumulation, and ATRX loss was found in three of the 15 "astrocytic" gliomas. The estimated overall survival (OS) curves in the patients with codeleted oligodendroglial and "astrocytic" gliomas overlapped, and the median OS was 187 and 184 months, respectively. Histopathological re-assessment by a single pathologist showed consistent results.Gliomas with total 1p19q loss with "astrocytic" features have molecular and biological characteristics comparable to those of oligodendroglial tumors.
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Affiliation(s)
- Saeko Hayashi
- Department of Neurosurgery, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Hikaru Sasaki
- Department of Neurosurgery, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Tokuhiro Kimura
- Department of Pathology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
- Present address: Department of Pathology, Yamaguchi University Graduate, School of Medicine, Minami-kogushi, Ube, Yamaguchi, Japan
| | - Takayuki Abe
- Center for Clinical Research, Department of Preventive Medicine and Public Health, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Takumi Nakamura
- Department of Neurosurgery, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Yohei Kitamura
- Department of Neurosurgery, Saiseikai Utsunomiya Hospital, Takebayashi, Utsunomiya, Tochigi, Japan
| | - Tomoru Miwa
- Department of Neurosurgery, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Kaori Kameyama
- Division of Diagnostic Pathology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Yuichi Hirose
- Department of Neurosurgery, Fujita Health University School of Medicine, Kutsukake-cho, Toyoake, Aichi, Japan
| | - Kazunari Yoshida
- Department of Neurosurgery, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
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28
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Tsai WC, Hueng DY, Lin CK. Nuclear overexpression of urocortin discriminates primary brain tumors from reactive gliosis. APMIS 2015; 123:465-72. [PMID: 25904177 DOI: 10.1111/apm.12374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 01/13/2015] [Indexed: 11/26/2022]
Abstract
The role of urocortin (UCN) is still ambiguous in human cancers. We tested the hypothesis that using UCN expression discriminates reactive gliosis from primary brain tumors (PBTs). Immunohistochemical analysis of UCN was performed in six reactive gliosis and 99 PBTs. The immunostain scores of UCN were calculated as the degree of intensity multiplied by the percentage of expressed tumor cells. Nuclear staining of UCN revealed weak intensity and small portion of positively stained cells in reactive gliosis. However, comparing with non-neoplastic tissues, higher immunostain scores of UCN were identified in each WHO grade of astrocytomas and meningiomas. Finally, neither WHO grade nor overall survival rate did not significantly correlate with UCN expression in astrocytomas and meningiomas. Our findings demonstrate for the first time that the application of UCN might be a novel biomarker for not only discriminating reactive gliosis from PBTs, but also deciding where the clear surgical margin was.
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Affiliation(s)
- Wen-Chiuan Tsai
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Dueng-Yuan Hueng
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Kung Lin
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Abstract
Recent advances in molecular diagnostics have led to better understanding of glioma tumorigenesis and biology. Numerous glioma biomarkers with diagnostic, prognostic, and predictive value have been identified. Although some of these markers are already part of the routine clinical management of glioma patients, data regarding others are limited and difficult to apply routinely. In addition, multiple methods for molecular subclassification have been proposed either together with or as an alternative to the current morphologic classification and grading scheme. This article reviews the literature regarding glioma biomarkers and offers a few practical suggestions.
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Affiliation(s)
- Melike Pekmezci
- Division of Neuropathology, Department of Pathology, University of California, San Francisco, 505 Parnassus Avenue, #M551, Box 0102, San Francisco, CA 94143, USA
| | - Arie Perry
- Division of Neuropathology, Department of Pathology, University of California, San Francisco, 505 Parnassus Avenue, #M551, Box 0102, San Francisco, CA 94143, USA; Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
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Abstract
Low-grade gliomas (LGG) constitute grades I and II tumors of astrocytic and grade II tumors of oligodendroglial lineage. Although these tumors are typically slow growing, they may be associated with significant morbidity and mortality because of recurrence and malignant progression, even in the setting of optimal resection. LGG in pediatric and adult age groups are currently classified by morphologic criteria. Recent years have heralded a molecular revolution in understanding brain tumors, including LGG. Next-generation sequencing has definitively demonstrated that pediatric and adult LGG fundamentally differ in their underlying molecular characteristics, despite being histologically similar. Pediatric LGG show alterations in FGFR1 and BRAF in pilocytic astrocytomas and FGFR1 alterations in diffuse astrocytomas, each converging on the mitogen-activated protein kinase signaling pathway. Adult LGG are characterized by IDH1/2 mutations and ATRX mutations in astrocytic tumors and IDH1/2 mutations and 1p/19q codeletions in oligodendroglial tumors. TERT promoter mutations are also noted in LGG and are mainly associated with oligodendrogliomas. These findings have considerably refined approaches to classifying these tumors. Moreover, many of the molecular alterations identified in LGG directly impact on prognosis, tumor biology, and the development of novel therapies.
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31
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Dunn GP, Andronesi OC, Cahill DP. From genomics to the clinic: biological and translational insights of mutant IDH1/2 in glioma. Neurosurg Focus 2015; 34:E2. [PMID: 23373447 DOI: 10.3171/2012.12.focus12355] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The characterization of the genomic alterations across all human cancers is changing the way that malignant disease is defined and treated. This paradigm is extending to glioma, where the discovery of recurrent mutations in the isocitrate dehydrogenase 1 (IDH1) gene has shed new light on the molecular landscape in glioma and other IDH-mutant cancers. The IDH1 mutations are present in the vast majority of low-grade gliomas and secondary glioblastomas. Rapidly emerging work on the consequences of mutant IDH1 protein expression suggests that its neomorphic enzymatic activity catalyzing the production of the oncometabolite 2-hydroxyglutarate influences a range of cellular programs that affect the epigenome, transcriptional programs, hypoxia-inducible factor biology, and development. In the brief time since its discovery, knowledge of the IDH mutation status has had significant translational implications, and diagnostic tools are being used to monitor its expression and function. The concept of IDH1-mutant versus IDH1-wild type will become a critical early distinction in diagnostic and treatment algorithms.
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Affiliation(s)
- Gavin P Dunn
- Departments of Neurosurgery, Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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32
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Kato Y. Specific monoclonal antibodies against IDH1/2 mutations as diagnostic tools for gliomas. Brain Tumor Pathol 2014; 32:3-11. [DOI: 10.1007/s10014-014-0202-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 09/29/2014] [Indexed: 12/19/2022]
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Abstract
Oligodendrogliomas are an important adult form of diffuse gliomas with a distinctive clinical and genetic profile. Histologically similar tumors occurring rarely in children are incompletely characterized. We studied 50 patients with oligodendrogliomas (median age at diagnosis 8 y, range 7 mo to 20 y). Tumors resembling dysembryoplastic neuroepithelial tumors or pilocytic astrocytomas or those having a "mixed" histology were excluded. Tumors at first diagnosis were low grade (n=38) or anaplastic (n=12). Histologic features included uniform round cells with perinuclear halos (100%), secondary structures (predominantly perineuronal satellitosis) (90%), calcifications (46%), and microcysts (44%). Sequential surgical specimens were obtained in 8 low-grade oligodendroglioma patients, with only 1 progressing to anaplasia. Studies for 1p19q performed in 40 cases demonstrated intact 1p19q loci in 29 (73%), 1p19q codeletion in 10 (25%), and 1p deletion with intact 19q in 1 (2%). Except for 2 young patients (3 and 11 y of age), patients with 1p19q codeletion were older than 16 years at diagnosis. Mutant IDH1 (R132H) protein immunohistochemistry was positive in 4 (of 22) (18%) cases, 3 of which also had 1p19q codeletion, whereas 1p19q status was not available on the fourth case. There was a nonsignificant trend for worse overall survival in grade III tumors, but no significant association with age, extent of resection, or 1p19q status. In summary, oligodendrogliomas with classic histology occur in the pediatric population but lack 1p19q codeletion and IDH1 (R132H) mutations in most instances. They are predominantly low grade, recur/clinically progress in a subset, but demonstrate a relatively low frequency of histologic progression.
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34
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Inano R, Oishi N, Kunieda T, Arakawa Y, Yamao Y, Shibata S, Kikuchi T, Fukuyama H, Miyamoto S. Voxel-based clustered imaging by multiparameter diffusion tensor images for glioma grading. NEUROIMAGE-CLINICAL 2014; 5:396-407. [PMID: 25180159 PMCID: PMC4145535 DOI: 10.1016/j.nicl.2014.08.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 07/15/2014] [Accepted: 08/05/2014] [Indexed: 11/26/2022]
Abstract
Gliomas are the most common intra-axial primary brain tumour; therefore, predicting glioma grade would influence therapeutic strategies. Although several methods based on single or multiple parameters from diagnostic images exist, a definitive method for pre-operatively determining glioma grade remains unknown. We aimed to develop an unsupervised method using multiple parameters from pre-operative diffusion tensor images for obtaining a clustered image that could enable visual grading of gliomas. Fourteen patients with low-grade gliomas and 19 with high-grade gliomas underwent diffusion tensor imaging and three-dimensional T1-weighted magnetic resonance imaging before tumour resection. Seven features including diffusion-weighted imaging, fractional anisotropy, first eigenvalue, second eigenvalue, third eigenvalue, mean diffusivity and raw T2 signal with no diffusion weighting, were extracted as multiple parameters from diffusion tensor imaging. We developed a two-level clustering approach for a self-organizing map followed by the K-means algorithm to enable unsupervised clustering of a large number of input vectors with the seven features for the whole brain. The vectors were grouped by the self-organizing map as protoclusters, which were classified into the smaller number of clusters by K-means to make a voxel-based diffusion tensor-based clustered image. Furthermore, we also determined if the diffusion tensor-based clustered image was really helpful for predicting pre-operative glioma grade in a supervised manner. The ratio of each class in the diffusion tensor-based clustered images was calculated from the regions of interest manually traced on the diffusion tensor imaging space, and the common logarithmic ratio scales were calculated. We then applied support vector machine as a classifier for distinguishing between low- and high-grade gliomas. Consequently, the sensitivity, specificity, accuracy and area under the curve of receiver operating characteristic curves from the 16-class diffusion tensor-based clustered images that showed the best performance for differentiating high- and low-grade gliomas were 0.848, 0.745, 0.804 and 0.912, respectively. Furthermore, the log-ratio value of each class of the 16-class diffusion tensor-based clustered images was compared between low- and high-grade gliomas, and the log-ratio values of classes 14, 15 and 16 in the high-grade gliomas were significantly higher than those in the low-grade gliomas (p < 0.005, p < 0.001 and p < 0.001, respectively). These classes comprised different patterns of the seven diffusion tensor imaging-based parameters. The results suggest that the multiple diffusion tensor imaging-based parameters from the voxel-based diffusion tensor-based clustered images can help differentiate between low- and high-grade gliomas. We have developed a novel unsupervised method for voxel-based clustered imaging. Each class ratio in clustered images differentiated high from low-grade gliomas. The 16-class clustered images showed the best performance for the differentiation. Each class comprised different patterns of the seven diffusion tensor-based features. Multiple parameters from diffusion tensor images are useful for glioma grading.
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Key Words
- ADC, apparent diffusion coefficient
- AUC, area under the curve
- BET, FSL's Brain extraction Tool
- BLSOM, batch-learning self-organizing map
- CI, confidence interval
- CNS, central nervous system
- DTI, diffusion tensor imaging
- DTcI, diffusion tensor-based clustered image
- DWI, diffusion-weighted imaging
- Diffusion tensor imaging
- EPI, echo planar image
- FA, fractional anisotropy
- FDT, FMRIB's diffusion toolbox
- FLAIR, fluid-attenuated inversion-recovery
- FSL, FMRIB Software Library
- Glioma grading
- HGG, high-grade glioma
- K-means
- KM++, K-means++
- KM, K-means
- L1, first eigenvalue
- L2, second eigenvalue
- L3, third eigenvalue
- LGG, low-grade glioma
- LOOCV, leave-one-out cross-validation
- MD, mean diffusivity
- MP-RAGE, magnetization-prepared rapid gradient-echo
- MRI, magnetic resonance imaging
- PET, positron emission tomography
- ROC, receiver operating characteristic
- ROI, region of interest
- S0, raw T2 signal with no diffusion weighting
- SOM, self-organizing map
- SVM, support vector machine
- Self-organizing map
- Support vector machine
- T1WI, T1-weighted image
- T1WIce, contrast-enhanced T1-weighted image
- T2WI, T2-weighted image
- Voxel-based clustering
- WHO, World Health Organization
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Affiliation(s)
- Rika Inano
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan ; Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naoya Oishi
- Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeharu Kunieda
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshiki Arakawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yukihiro Yamao
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan ; Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sumiya Shibata
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan ; Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takayuki Kikuchi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hidenao Fukuyama
- Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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35
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Collins V. Pathology of Gliomas and Developments in Molecular Testing. Clin Oncol (R Coll Radiol) 2014; 26:377-84. [DOI: 10.1016/j.clon.2014.04.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 04/08/2014] [Indexed: 01/14/2023]
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36
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Chen L, Voronovich Z, Clark K, Hands I, Mannas J, Walsh M, Nikiforova MN, Durbin EB, Weiss H, Horbinski C. Predicting the likelihood of an isocitrate dehydrogenase 1 or 2 mutation in diagnoses of infiltrative glioma. Neuro Oncol 2014; 16:1478-83. [PMID: 24860178 DOI: 10.1093/neuonc/nou097] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Several variables are associated with the likelihood of isocitrate dehydrogenase 1 or 2 (IDH1/2) mutation in gliomas, though no guidelines yet exist for when testing is warranted, especially when an R132H IDH1 immunostain is negative. METHODS A cohort of 89 patients was used to build IDH1/2 mutation prediction models in World Health Organization grades II-IV gliomas, and an external cohort of 100 patients was used for validation. Logistic regression and backward model selection with the Akaike information criterion were used to develop prediction models. RESULTS A multivariable model, incorporating patient age, glioblastoma multiforme diagnosis, and prior history of grade II or III glioma, was developed to predict IDH1/2 mutation probability. This model generated an area under the curve (AUC) of 0.934 (95% CI: 0.878, 0.978) in the external validation cohort and 0.941 (95% CI: 0.918, 0.962) in the cohort of The Cancer Genome Atlas. When R132H IDH1 immunostain information was added, AUC increased to 0.986 (95% CI: 0.967, 0.998). This model had an AUC of 0.947 (95% CI: 0.891, 0.995) in predicting whether an R132H IDH1 immunonegative case harbored a less common IDH1 or IDH2 mutation. The models were also 94% accurate in predicting IDH1/2 mutation status in gliomas from The Cancer Genome Atlas. An interactive web-based application for calculating the probability of an IDH1/2 mutation is now available using these models. CONCLUSIONS We have integrated multiple variables to generate a probability of an IDH1/2 mutation. The associated web-based application can help triage diffuse gliomas that would benefit from mutation testing in both clinical and research settings.
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Affiliation(s)
- Li Chen
- Biostatistics Shared Resource Facility, Markey Cancer Center, University of Kentucky, Lexington, Kentucky (L.C., H.W.); Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky (L.C., H.W.); Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Z.V., K.C., M.N.N.); Cancer Research Informatics Shared Resource Facility, Markey Cancer Center, University of Kentucky, Lexington, Kentucky (I.H., E.B.D.); Department of Neurosurgery, University of Kentucky, Lexington, Kentucky (J.M.); Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, Kentucky (M.W.); Division of Biomedical Informatics, Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky (E.B.D.)
| | - Zoya Voronovich
- Biostatistics Shared Resource Facility, Markey Cancer Center, University of Kentucky, Lexington, Kentucky (L.C., H.W.); Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky (L.C., H.W.); Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Z.V., K.C., M.N.N.); Cancer Research Informatics Shared Resource Facility, Markey Cancer Center, University of Kentucky, Lexington, Kentucky (I.H., E.B.D.); Department of Neurosurgery, University of Kentucky, Lexington, Kentucky (J.M.); Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, Kentucky (M.W.); Division of Biomedical Informatics, Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky (E.B.D.)
| | - Kenneth Clark
- Biostatistics Shared Resource Facility, Markey Cancer Center, University of Kentucky, Lexington, Kentucky (L.C., H.W.); Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky (L.C., H.W.); Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Z.V., K.C., M.N.N.); Cancer Research Informatics Shared Resource Facility, Markey Cancer Center, University of Kentucky, Lexington, Kentucky (I.H., E.B.D.); Department of Neurosurgery, University of Kentucky, Lexington, Kentucky (J.M.); Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, Kentucky (M.W.); Division of Biomedical Informatics, Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky (E.B.D.)
| | - Isaac Hands
- Biostatistics Shared Resource Facility, Markey Cancer Center, University of Kentucky, Lexington, Kentucky (L.C., H.W.); Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky (L.C., H.W.); Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Z.V., K.C., M.N.N.); Cancer Research Informatics Shared Resource Facility, Markey Cancer Center, University of Kentucky, Lexington, Kentucky (I.H., E.B.D.); Department of Neurosurgery, University of Kentucky, Lexington, Kentucky (J.M.); Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, Kentucky (M.W.); Division of Biomedical Informatics, Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky (E.B.D.)
| | - Jonathan Mannas
- Biostatistics Shared Resource Facility, Markey Cancer Center, University of Kentucky, Lexington, Kentucky (L.C., H.W.); Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky (L.C., H.W.); Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Z.V., K.C., M.N.N.); Cancer Research Informatics Shared Resource Facility, Markey Cancer Center, University of Kentucky, Lexington, Kentucky (I.H., E.B.D.); Department of Neurosurgery, University of Kentucky, Lexington, Kentucky (J.M.); Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, Kentucky (M.W.); Division of Biomedical Informatics, Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky (E.B.D.)
| | - Meggen Walsh
- Biostatistics Shared Resource Facility, Markey Cancer Center, University of Kentucky, Lexington, Kentucky (L.C., H.W.); Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky (L.C., H.W.); Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Z.V., K.C., M.N.N.); Cancer Research Informatics Shared Resource Facility, Markey Cancer Center, University of Kentucky, Lexington, Kentucky (I.H., E.B.D.); Department of Neurosurgery, University of Kentucky, Lexington, Kentucky (J.M.); Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, Kentucky (M.W.); Division of Biomedical Informatics, Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky (E.B.D.)
| | - Marina N Nikiforova
- Biostatistics Shared Resource Facility, Markey Cancer Center, University of Kentucky, Lexington, Kentucky (L.C., H.W.); Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky (L.C., H.W.); Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Z.V., K.C., M.N.N.); Cancer Research Informatics Shared Resource Facility, Markey Cancer Center, University of Kentucky, Lexington, Kentucky (I.H., E.B.D.); Department of Neurosurgery, University of Kentucky, Lexington, Kentucky (J.M.); Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, Kentucky (M.W.); Division of Biomedical Informatics, Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky (E.B.D.)
| | - Eric B Durbin
- Biostatistics Shared Resource Facility, Markey Cancer Center, University of Kentucky, Lexington, Kentucky (L.C., H.W.); Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky (L.C., H.W.); Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Z.V., K.C., M.N.N.); Cancer Research Informatics Shared Resource Facility, Markey Cancer Center, University of Kentucky, Lexington, Kentucky (I.H., E.B.D.); Department of Neurosurgery, University of Kentucky, Lexington, Kentucky (J.M.); Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, Kentucky (M.W.); Division of Biomedical Informatics, Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky (E.B.D.)
| | - Heidi Weiss
- Biostatistics Shared Resource Facility, Markey Cancer Center, University of Kentucky, Lexington, Kentucky (L.C., H.W.); Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky (L.C., H.W.); Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Z.V., K.C., M.N.N.); Cancer Research Informatics Shared Resource Facility, Markey Cancer Center, University of Kentucky, Lexington, Kentucky (I.H., E.B.D.); Department of Neurosurgery, University of Kentucky, Lexington, Kentucky (J.M.); Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, Kentucky (M.W.); Division of Biomedical Informatics, Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky (E.B.D.)
| | - Craig Horbinski
- Biostatistics Shared Resource Facility, Markey Cancer Center, University of Kentucky, Lexington, Kentucky (L.C., H.W.); Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky (L.C., H.W.); Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Z.V., K.C., M.N.N.); Cancer Research Informatics Shared Resource Facility, Markey Cancer Center, University of Kentucky, Lexington, Kentucky (I.H., E.B.D.); Department of Neurosurgery, University of Kentucky, Lexington, Kentucky (J.M.); Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, Kentucky (M.W.); Division of Biomedical Informatics, Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky (E.B.D.)
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Brat DJ, Ryken TC, Kalkanis SN, Olson JJ. The role of neuropathology in the management of progressive glioblastoma : a systematic review and evidence-based clinical practice guideline. J Neurooncol 2014; 118:461-78. [PMID: 24733643 DOI: 10.1007/s11060-013-1331-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 12/28/2013] [Indexed: 11/27/2022]
Abstract
QUESTION 1. What are the most important diagnostic considerations in reporting progressive glioblastoma? TARGET POPULATION These recommendations apply to adults with progressive glioblastoma RECOMMENDATIONS LEVEL III For patients who undergo biopsy or neurosurgical resection at the time of radiologic or clinical progression, it is recommended that the pathologist report the presence and extent of progressive neoplasm as well as the presence and extent of necrosis within the pathologic material examined. Furthermore, to ensure the proper interpretation of progressive glioblastoma, it is recommended that the pathologist take into account the patient's previous diagnosis and treatment, as well as the current clinical and neuroimaging features that have led to a second biopsy or resection. QUESTION 2. What techniques and ancillary studies are most useful in separating malignant progression from treatment effect? TARGET POPULATION These recommendations apply to adults with progressive glioblastoma RECOMMENDATIONS LEVEL III In the setting of prior radiation and chemotherapy, it is recommended to adhere to strict histologic criteria for microvascular proliferation and necrosis in order to establish a diagnosis of a glioblastoma. Immunohistochemistry and genetic studies are selectively recommended for distinguishing neoplastic cells from atypical reactive cells in progressive glioblastoma.
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Affiliation(s)
- Daniel J Brat
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA,
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Shen F, Chen LC, Yao Y, Zhou LF. Astroblastoma: rare incidence and challenges in the pattern of care. World Neurosurg 2014; 82:e125-7. [PMID: 24607547 DOI: 10.1016/j.wneu.2014.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 03/04/2014] [Indexed: 11/24/2022]
Affiliation(s)
- Fang Shen
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Ling-Chao Chen
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yu Yao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Liang-Fu Zhou
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.
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Johnson GC, Coates JR, Wininger F. Diagnostic immunohistochemistry of canine and feline intracalvarial tumors in the age of brain biopsies. Vet Pathol 2013; 51:146-60. [PMID: 24280940 DOI: 10.1177/0300985813509387] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The focus of immunohistochemistry as applied to nervous system tumors is in identifying the neoplasm present and evaluating margins between normal and neoplastic tissue. Although not always utilized by specialists in neuropathology, immunohistochemistry remains useful to resolve concerns about the differentiation and rate of tumor growth. The aims of this review are to discuss the utility of immunohistochemical reagents currently used in diagnosis of canine and feline intracalvarial tumors, to indicate the applicability of some tests currently used in human nervous system tumors for domestic species, and to evaluate a few less commonly used reagents. A panel of biomarkers is usually needed to confirm a diagnosis, with groups of reagents for leptomeningeal, intraparenchymal, and ventricular neoplasms. In the future, signature genetic alterations found among feline and canine brain tumors--as correlated prospectively with diagnosis, rate of enlargement, or response to treatment--may result in new immunohistochemical reagents to simplify the task of diagnosis. Prospective studies determining the type and proportion of stem cell marker expression on patient longevity are likely to be fruitful and suggest new therapies. Due to increased frequency of biopsy or partial resection of tumors from the living patient, biomarkers are needed to serve as accurate prognostic indicators and assist in determining the efficacy of developing therapeutic options in nervous system tumors of dogs and cats.
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Affiliation(s)
- G C Johnson
- Department of Veterinary Pathobiology, Veterinary Medical Diagnostic Laboratory, University of Missouri, 1600 East Rollins Street, Columbia MO 65211, USA.
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The differential diagnosis of pilocytic astrocytoma with atypical features and malignant glioma: an analysis of 16 cases with emphasis on distinguishing molecular features. J Neurooncol 2013; 115:477-86. [PMID: 24057326 DOI: 10.1007/s11060-013-1249-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 09/05/2013] [Indexed: 10/26/2022]
Abstract
Rare pilocytic astrocytomas (PA) have atypical histologic and clinicoradiologic features that raise the differential diagnosis of glioblastoma. Whether ancillary studies can supplement histopathologic examination in placing these cases accurately on the spectrum of WHO Grade I PA to higher-grade glioma is not always clear, partly because these cases are not common. Here, ten PAs with atypical clinicoradiologic and histologic features and six pediatric glioblastoma multiforme (pGBMs) were analyzed for BRAF V600E, IDH1, IDH2, and TP53 mutations. Ki-67, p53, and p16 protein expression were also examined by immunohistochemistry. BRAF-KIAA1549 fusion status was assessed in the PA subgroup. The rate of BRAF-KIAA1549 fusion was high in these PAs (5/7 tumors) including four extracerebellar examples. A single BRAF V600E mutation was identified in the fusion-negative extracerebellar PA of a very young child who succumbed to the disease. TP53 mutations were present only in malignant gliomas, including three pGBMs and one case designated as PA with anaplastic features (with consultation opinion of pGBM). IDH1 and IDH2 were wild type in all cases, consistent with earlier findings that IDH mutations are not typical in high-grade gliomas of patients ≤14 years of age. Immunohistochemical studies showed substantial overlap in Ki-67 labeling indices, an imperfect correlation between p53 labeling and TP53 mutation status, and complete p16 loss in only two pGBMs but in no PAs. These results suggest that (a) BRAF-KIAA1549 fusion may be common in PAs with atypical clinicoradiologic and histologic features, including those at extracerebellar sites, (b) BRAF V600E mutation is uncommon in extracerebellar PAs, and (c) TP53 mutation analysis remains a valuable tool in identifying childhood gliomas that will likely behave in a malignant fashion.
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Burel-Vandenbos F, Turchi L, Benchetrit M, Fontas E, Pedeutour Z, Rigau V, Almairac F, Ambrosetti D, Michiels JF, Virolle T. Cells with intense EGFR staining and a high nuclear to cytoplasmic ratio are specific for infiltrative glioma: a useful marker in neuropathological practice. Neuro Oncol 2013; 15:1278-88. [PMID: 23935154 DOI: 10.1093/neuonc/not094] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The differential diagnosis between infiltrative glioma (IG) and benign or curable glial lesions, such as gliosis, pilocytic astrocytoma, dysembryoplastic neuroepithelial tumor, ganglioglioma, or demyelinating disease, may be challenging for the pathologist because specific markers are lacking. Recently, we described a strong EGFR immunolabelling pattern in cells with a high nuclear to cytoplasmic ratio that enables the discrimination of low-grade IG from gliosis. The aim of this study was to extend our observation to high-grade glioma to assess whether EGFR expression pattern is of value in the discrimination of all IG from noninfiltrative glial lesions (NIG), including gliosis, benign tumors, and demyelinating disease. METHODS One hundred one IG and 58 NIG were compared for immunohistochemical expression of EGFR with use of an antibody that recognizes an epitope in the extracellular domain of both EGFRwt and EGFRvIII. Highly EGFR-positive cells with a high nuclear to cytoplasmic ratio were isolated and further characterized. RESULTS Cells with intense EGFR staining and a high nuclear to cytoplasmic ratio were significantly associated with the diagnosis of IG (P < .0001). The sensitivity and specificity of this staining pattern for the diagnosis of IG were 95% and 100%, respectively. EGFR expression was independent of IDH1 mutations and EGFR amplification. Finally, we showed that these particular cells displayed the phenotype and properties of glial progenitors and coexpressed CXCR4, a marker of invasiveness. CONCLUSIONS We demonstrate that cells with intense EGFR staining and a high nuclear to cytoplasmic ratio are specific criteria for the diagnosis of IG, irrespective of grade, histological subtype, and progression pathway, and their identification represents a tool to discriminate IG from benign or curable glial lesions.
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Affiliation(s)
- Fanny Burel-Vandenbos
- Corresponding Author: Fanny Burel-Vandenbos, MD, Laboratoire Central d'Anatomie Pathologique, Hopital Pasteur, 30 avenue de la Voie Romaine, 06000 Nice, France.
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Promoter methylation of WNT inhibitory factor-1 and expression pattern of WNT/β-catenin pathway in human astrocytoma: pathologic and prognostic correlations. Mod Pathol 2013; 26:626-39. [PMID: 23328978 DOI: 10.1038/modpathol.2012.215] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
WNT inhibitory factor-1 (WIF1) is an antagonist of the WNT signaling pathway. We investigated the relationship between WIF1 promoter methylation and regulation of the WNT/β-catenin signaling pathway, tumor grade, and survival in patients with astrocytoma. This study included 86 cases of astrocytoma, comprising 20 diffuse astrocytomas and 66 glioblastomas. In addition, 17 temporal lobectomy specimens from patients with epilepsy were included as controls. The ratio of methylated DNA to total methylated and unmethylated DNA (% methylation) was measured by methylation- and unmethylation-specific PCR. Representative tumor tissue was immunostained for WIF1, β-catenin, cyclin D1, c-myc, and isocitrate dehydrogenase 1. Levels of WIF1 promoter methylation, mRNA expression, and protein expression in a glioblastoma cell line were compared before and after demethylation treatment. The mean percent methylation of the WIF1 promoter in astrocytomas was higher than that in control brain tissue. WIF1 protein expression was lower in the tumor group with >5% methylation than in the group with <5% methylation. Cytoplasmic β-catenin staining was more frequently observed in tumors with a low WIF1 protein expression level. Demethylation treatment of a glioblastoma cell line increased WIF1 mRNA and protein expression. Increased WIF1 promoter methylation and decreased WIF1 protein expression were not related to patient survival. In conclusion, WIF1 expression is downregulated by promoter methylation and is an important mechanism of aberrant WNT/β-catenin pathway activation in astrocytoma pathogenesis.
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Choi J, Lee EY, Shin KJ, Minn YK, Kim J, Kim SH. IDH1 mutation analysis in low cellularity specimen: a limitation of diagnostic accuracy and a proposal for the diagnostic procedure. Pathol Res Pract 2013; 209:284-90. [PMID: 23561624 DOI: 10.1016/j.prp.2013.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 02/02/2013] [Accepted: 02/03/2013] [Indexed: 11/16/2022]
Abstract
Recently, new techniques for detecting IDH1 mutations have been developed. Most studies assessed the mutation status in glioma tissue without consideration of the size of the samples. We assessed the mutation status of IDH1 in simulated small biopsied tissue from 5 low grade gliomas, prepared by grid cutting procedure with direct sequencing, IDH1 immunohistochemistry (IHC), multiplex PCR with single base extension (SBE) assay and PNA-clamping method, and then analyzed the agreement between the methods. Kappa values were 0.53 (direct sequencing), 0.59 (multiplex PCR with SBE assay), and 0.69 (PNA-clamping method). Discrepant results between the methods were observed in lower cellularity samples. Twelve out of 25 cases were classified as wild type by direct sequencing, even with IDH1 IHC-positive cells, whereas 6, 8, and 11 of IHC-negative cases were classified as mutant cases by other 3 methods. In conclusion, newly developed sensitive methods, such as the PNA-clamping method and multiplex PCR with SBE assay, are practically useful in addition to the conventional IDH1 IHC in small biopsied samples.
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Affiliation(s)
- Junjeong Choi
- Department of Pathology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
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Abstract
Progress in our understanding of the molecular biology of neoplasms has been driven by remarkable improvements in molecular biology techniques. This has created a rapidly moving field in which even subspecialists struggle to keep abreast of the current literature. Nowhere is this more clearly demonstrated than in neuro-oncology, wherein molecular diagnostics can now wring more clinically useful information out of very small biopsies than ever before. Herein the biologic and practical aspects of four key molecular biomarkers in gliomas are discussed, including two that have been known for some time (1p/19q codeletion and EGFR amplification) as well as two whose relevance was discovered via advanced whole-genome assays (IDH1/2 mutations and BRAF alterations).
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Abstract
Glioblastomas are heterogeneous neoplasms that are driven by complex signalling pathways, and are among the most aggressive and challenging cancers to treat. Despite standard treatment with resection, radiation and chemotherapy, the prognosis of patients with glioblastomas remains poor. An increasing understanding of the molecular pathogenesis of glioblastomas has stimulated the development of novel therapies, including the use of molecular-targeted agents. Identification and validation of diagnostic, prognostic and predictive biomarkers has led to the advancement of clinical trial design, and identification of glioblastoma subgroups with a more-favourable prognosis and response to therapy. In this Review, we discuss common molecular alterations relevant to the biology of glioblastomas, targeted, antiangiogenic and immunotherapies that have impacted on the treatment of this disease, and the challenges and pitfalls associated with these therapies. In addition, we emphasize current biomarkers relevant to the management of patients with glioblastoma.
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Yang H, Ye D, Guan KL, Xiong Y. IDH1 and IDH2 mutations in tumorigenesis: mechanistic insights and clinical perspectives. Clin Cancer Res 2012; 18:5562-71. [PMID: 23071358 PMCID: PMC3897211 DOI: 10.1158/1078-0432.ccr-12-1773] [Citation(s) in RCA: 317] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Genes encoding for isocitrate dehydrogenases 1 and 2, IDH1 and IDH2, are frequently mutated in multiple types of human cancer. Mutations targeting IDH1 and IDH2 result in simultaneous loss of their normal catalytic activity, the production of α-ketoglutarate (α-KG), and gain of a new function, the production of 2-hydroxyglutarate (2-HG). 2-HG is structurally similar to α-KG, and acts as an α-KG antagonist to competitively inhibit multiple α-KG-dependent dioxygenases, including both lysine histone demethylases and the ten-eleven translocation family of DNA hydroxylases. Abnormal histone and DNA methylation are emerging as a common feature of tumors with IDH1 and IDH2 mutations and may cause altered stem cell differentiation and eventual tumorigenesis. Therapeutically, unique features of IDH1 and IDH2 mutations make them good biomarkers and potential drug targets.
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Affiliation(s)
- Hui Yang
- Molecular and Cell Biology Lab, Institutes of Biomedical Sciences and School of Life Sciences, Fudan University, Shanghai, P R China
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Usefulness of immunohistochemical expression analysis of metabolic-related molecules to differentiate between intracranial neoplastic and non-neoplastic lesions. Brain Tumor Pathol 2012; 30:144-50. [DOI: 10.1007/s10014-012-0120-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 09/23/2012] [Indexed: 12/22/2022]
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Fu YJ, Taniguchi Y, Takeuchi S, Shiga A, Okamoto K, Hirato J, Nobusawa S, Nakazato Y, Kakita A, Takahashi H. Cerebral astroblastoma in an adult: An immunohistochemical, ultrastructural and genetic study. Neuropathology 2012; 33:312-9. [DOI: 10.1111/j.1440-1789.2012.01351.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 08/23/2012] [Indexed: 12/27/2022]
Affiliation(s)
- Yong-Juan Fu
- Department of Pathology; University of Niigata; Niigata; Japan
| | | | - Shigekazu Takeuchi
- Department of Neurosurgery; Nagaoka Chuo General Hospital; Nagaoka; Japan
| | - Atsushi Shiga
- Department of Pathology; University of Niigata; Niigata; Japan
| | - Kouichirou Okamoto
- Department of Neurosurgery; Brain Research Institute; University of Niigata; Niigata; Japan
| | - Junko Hirato
- Department of Pathology; Gunma University Hospital; Japan
| | - Sumihito Nobusawa
- Department of Human Pathology; Gunma University Graduate School of Medicine; Maebashi; Japan
| | - Yoichi Nakazato
- Department of Human Pathology; Gunma University Graduate School of Medicine; Maebashi; Japan
| | - Akiyoshi Kakita
- Department of Pathology; University of Niigata; Niigata; Japan
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Low rate of R132H IDH1 mutation in infratentorial and spinal cord grade II and III diffuse gliomas. Acta Neuropathol 2012; 124:449-51. [PMID: 22772980 DOI: 10.1007/s00401-012-1011-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 06/11/2012] [Accepted: 06/29/2012] [Indexed: 10/28/2022]
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