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Alturkustani M, Walker AD, Castañeda EA, Cotter JA. Utility of OLIG2 immunostaining in pediatric brain tumors with embryonal morphology. J Neuropathol Exp Neurol 2024:nlae082. [PMID: 39067019 DOI: 10.1093/jnen/nlae082] [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: 07/30/2024] Open
Abstract
This study evaluates the diagnostic utility of OLIG2 immunohistochemistry for distinguishing between pediatric high-grade gliomas (pHGG) and embryonal tumors (ETs) of the CNS. Utilizing a retrospective pediatric cohort (1990-2021) of 56 CNS tumors, classified initially as primitive neuroectodermal tumors or CNS ET, we reclassified the cases based on WHO CNS5 criteria after comprehensive review and additional molecular testing that included next-generation sequencing and DNA methylation profiling. Our results indicate that OLIG2 immunopositivity was negative or minimal in a significant subset of pHGG cases (6 out of 11). At the same time, it showed diffuse expression in all cases of CNS neuroblastomas with FOXR2 activation (5/5), demonstrating its limited specificity in differentiating between pHGG and ET. Variable OLIG2 expression in other ETs, ATRT, and ETMR suggests the broader diagnostic implications of the marker. Furthermore, incidental findings of OLIG2 positivity in cases traditionally expected to be negative, such as medulloblastoma and ependymoma, introduce an additional layer of complexity. Together, these findings highlight the challenges of relying solely on OLIG2 immunostaining for accurate tumor classification in pediatric CNS neoplasms and underscore the importance of an integrated diagnostic approach.
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Affiliation(s)
- Murad Alturkustani
- Department of Pathology, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Pathology, University of Western Ontario, London, ON, Canada
| | - Adam D Walker
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Everardo A Castañeda
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Jennifer A Cotter
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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2
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Pagliuca F, Carraturo E, De Chiara A, Vallese S, Giovannoni I, Alaggio R, Cannella L, Tafuto S, Franco R. Synovial Sarcoma of the Kidney: Diagnostic Pitfalls in a Case with Myxoid Monophasic Differentiation and No Epithelial Biomarkers Expression. Int J Mol Sci 2024; 25:7382. [PMID: 39000489 PMCID: PMC11242046 DOI: 10.3390/ijms25137382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 06/28/2024] [Accepted: 06/30/2024] [Indexed: 07/16/2024] Open
Abstract
Synovial sarcomas are soft tissue tumours of uncertain origin, most commonly found in the upper or lower extremities. They are characterised by distinctive chromosomal rearrangements involving the gene SS18. Synovial sarcomas can occasionally arise also in visceral sites, but retroperitoneal SSs are very unusual. Among them, a few primary renal synovial sarcomas have been described in the scientific literature. Primary renal synovial sarcomas tend to be monophasic and often show cystic changes. Histologically, they can closely resemble other primary kidney tumours, mainly paediatric tumours such as nephroblastoma and clear cell sarcoma of the kidney. In the current work, a primary synovial sarcoma of the kidney with unusual morphological features (extensively myxoid stroma and immunohistochemical positivity for BCOR) is described. Molecular analysis, through targeted RNA sequencing, was of invaluable help in reaching the correct diagnosis. Despite locally advanced disease at presentation, the patient showed an unexpectedly brilliant response to chemotherapy.
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Affiliation(s)
| | - Emma Carraturo
- Pathology Unit, Vanvitelli University Hospital, 80138 Naples, Italy
| | - Anna De Chiara
- Histopathology of Lymphomas and Sarcomas SSD, Istituto Nazionale Tumori-IRCCS-Fondazione "G. Pascale", 80131 Naples, Italy
| | - Silvia Vallese
- Pathology Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | | | - Rita Alaggio
- Pathology Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Lucia Cannella
- S.C. Sarcomas and Rare Tumors, Istituto Nazionale Tumori-IRCCS-Fondazione "G. Pascale", 80131 Naples, Italy
| | - Salvatore Tafuto
- S.C. Sarcomas and Rare Tumors, Istituto Nazionale Tumori-IRCCS-Fondazione "G. Pascale", 80131 Naples, Italy
| | - Renato Franco
- Pathology Unit, Vanvitelli University Hospital, 80138 Naples, Italy
- Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
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3
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Wang W, Zhang A, Li Y, Wang D, Chen L, Li Q, Chen J, Li H, Sun S, Pan M, Zhou W, Wu H. Clinical, pathological, and molecular features of central nervous system tumors with BCOR internal tandem duplication. Pathol Res Pract 2024; 259:155367. [PMID: 38797130 DOI: 10.1016/j.prp.2024.155367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/09/2024] [Accepted: 05/23/2024] [Indexed: 05/29/2024]
Abstract
Central nervous system tumor with BCOR internal tandem duplication (CNS tumor with BCOR-ITD) constitutes a molecularly distinct entity, characterized by internal tandem duplication within exon 15 of the BCOR transcriptional co-repressor gene (BCOR-ITD). The current study aimed to elucidate the clinical, pathological, and molecular attributes of CNS tumors with BCOR-ITD and explore their putative cellular origin. This study cohort comprised four pediatric cases, aged 23 months to 13 years at initial presentation. Magnetic resonance imaging revealed large, well-circumscribed intra-CNS masses localized heterogeneously throughout the CNS. Microscopically, tumors were composed of spindle to ovoid cells, exhibiting perivascular pseudorosettes and palisading necrosis, but lacking microvascular proliferation. Immunohistochemical staining showed diffuse tumor cell expression of BCOR, CD56, CD99, vimentin, and the stem cell markers PAX6, SOX2, CD133 and Nestin, alongside focal positivity for Olig-2, S100, SOX10, Syn and NeuN. Molecularly, all cases harbored BCOR-ITDs ranging from 87 to 119 base pairs in length, including one case with two distinct ITDs. Notably, the ITDs were interrupted by unique 1-3 bp insertions in all cases. In summary, CNS tumors with BCOR-ITD exhibit characteristic clinical, pathological, and molecular features detectable through BCOR immunohistochemistry and confirmatory molecular analyses. Their expression of stem cell markers raises the possibility of an origin from neuroepithelial stem cells rather than representing true embryonal neoplasms.
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Affiliation(s)
- Wei Wang
- Department of Pathology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China; Intelligent Pathology Institute, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Anli Zhang
- Department of Pathology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China; Intelligent Pathology Institute, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Yujie Li
- Department of Pathology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China; Intelligent Pathology Institute, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Daizhong Wang
- Department of Pathology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Lian Chen
- Department of Pathology, Children's Hospital of Fudan University, Shanghai, China
| | - Qianqian Li
- Department of Pathology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China; Intelligent Pathology Institute, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Jingjing Chen
- Department of Pathology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China; Intelligent Pathology Institute, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Heng Li
- Department of Pathology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China; Intelligent Pathology Institute, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Sibai Sun
- Department of Pathology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China; Intelligent Pathology Institute, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Minhong Pan
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Wenchao Zhou
- Intelligent Pathology Institute, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
| | - Haibo Wu
- Department of Pathology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China; Intelligent Pathology Institute, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
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4
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Ahuja S, Khan AA, Zaheer S. BCOR Positive Central Nervous System Neuroepithelial Tumor Masquerading as a Meningioma. Indian J Surg Oncol 2024; 15:359-363. [PMID: 38741634 PMCID: PMC11088582 DOI: 10.1007/s13193-024-01894-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 01/31/2024] [Indexed: 05/16/2024] Open
Abstract
The central nervous system tumor with BCL-6 interacting corepressor internal tandem duplication (BCOR-ITD) is a molecularly defined entity with an internal tandem duplication in exon 15 of the BCOR gene. It is histologically characterized by a solid pattern with spindle-shaped cells and a dense capillary network. Very few cases of this rare entity have been reported till date. We present a case of BCOR-positive CNS tumor in a 3-year-old child who presented with scalp swelling. A differential diagnosis of CNS tumor with BCOR expression should be considered whenever high-grade tumors with histopathological features of glial or ependymal tumors do not express the classical glial markers.
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Affiliation(s)
- Sana Ahuja
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Adil Aziz Khan
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sufian Zaheer
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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5
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Medina-Ceballos E, Niveiro M, Ureña-Horno L, Sesé M, Tasso M, Navarro S, Garrido-Pontnou M. Decoding BCOR-ITD Sarcomas: Case Report of a Rare Pediatric Tumor With Challenges in Diagnosis. Pediatr Dev Pathol 2024:10935266241249344. [PMID: 38762770 DOI: 10.1177/10935266241249344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2024]
Abstract
Sarcomas characterized by BCOR gene alterations, are a distinct clinico-pathological group of high-grade tumors, that represent 5% of small round cell tumors without EWSR or FUS fusion. Diverse genetic alterations characterize this group, including BCOR-CCNB3 gene fusion being the most common alteration and less frequently internal tandem duplications (ITDs). We present a compelling case of a 3-year-old girl diagnosed with a high-grade nasoethmoidal sarcoma exhibiting BCOR-ITD. The diagnostic process illustrates the histological and immunophenotypic spectrum, requiring an extensive immunohistochemical panel and diverse molecular tests for accurate classification. Additionally, this case highlights the challenges in detecting BCOR-ITDs using different NGS panels, advocating for alternative molecular approaches. Our patient after 10 months since diagnosis is alive with progressive disease. This emphasizes the urgency for ongoing research to refine diagnostic methods and develop effective therapeutic strategies for these rare and aggressive tumors.
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Affiliation(s)
| | - María Niveiro
- Pathology Department, General University Hospital of Alicante, Alicante, Spain
- Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Laura Ureña-Horno
- Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Pediatric Oncology Department, General University Hospital of Alicante, Alicante, Spain
| | - Marta Sesé
- Pathology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - María Tasso
- Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Pediatric Oncology Department, General University Hospital of Alicante, Alicante, Spain
| | - Samuel Navarro
- Pathology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Pathology Department, University of Valencia, Valencia, Spain
- Cancer CIBER (CIBERONC), Madrid, Spain
- University of Valencia-INCLIVA, Valencia, Spain
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6
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Dehner CA, Lazar AJ, Chrisinger JSA. Updates on WHO classification for small round cell tumors: Ewing sarcoma vs. everything else. Hum Pathol 2024; 147:101-113. [PMID: 38280658 DOI: 10.1016/j.humpath.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/16/2024] [Accepted: 01/22/2024] [Indexed: 01/29/2024]
Abstract
The WHO Classification of Soft Tissue and Bone Tumours currently recognizes four categories of undifferentiated small round cell sarcoma: Ewing sarcoma, round cell sarcoma with EWSR1-non-ETS fusions including NFATc2 and PATZ1, CIC-rearranged sarcoma, and sarcoma with BCOR genetic alterations. These neoplasms frequently pose significant diagnostic challenges due to rarity and overlapping morphologic and immunohistochemical findings. Further, molecular testing, with accompanying pitfalls, may be needed to establish a definitive diagnosis. This review summarizes the clinical, histologic, immunohistochemical, and molecular features of these neoplasms. In addition, differential diagnosis and areas of uncertainty and ongoing investigation are discussed.
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MESH Headings
- Humans
- Sarcoma, Ewing/genetics
- Sarcoma, Ewing/pathology
- Sarcoma, Ewing/classification
- Sarcoma, Ewing/chemistry
- Bone Neoplasms/pathology
- Bone Neoplasms/genetics
- Bone Neoplasms/classification
- Sarcoma, Small Cell/genetics
- Sarcoma, Small Cell/pathology
- Sarcoma, Small Cell/classification
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/analysis
- World Health Organization
- Diagnosis, Differential
- Immunohistochemistry
- Soft Tissue Neoplasms/pathology
- Soft Tissue Neoplasms/genetics
- Soft Tissue Neoplasms/classification
- RNA-Binding Protein EWS/genetics
- Repressor Proteins/genetics
- Gene Rearrangement
- Proto-Oncogene Proteins/genetics
- Predictive Value of Tests
- Phenotype
- Genetic Predisposition to Disease
- Oncogene Proteins, Fusion/genetics
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Affiliation(s)
- Carina A Dehner
- Department of Anatomic Pathology and Laboratory Medicine, Indiana University, 635 Barnhill Drive, Indianapolis, IN, 46202, USA.
| | - Alexander J Lazar
- Department of Pathology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA; Department of Genomic Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - John S A Chrisinger
- Department of Pathology and Immunology, Division of Anatomic and Molecular Pathology, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA.
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7
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Tauziède-Espariat A, Nicaise Y, Sievers P, Sahm F, von Deimling A, Guillemot D, Pierron G, Duchesne M, Edjlali M, Dangouloff-Ros V, Boddaert N, Roux A, Dezamis E, Hasty L, Lhermitte B, Hirsch E, Hirsch MPV, Ardellier FD, Karnoub MA, Csanyi M, Maurage CA, Mokhtari K, Bielle F, Rigau V, Roujeau T, Abad M, Klein S, Bernier M, Horodyckid C, Adam C, Brandal P, Niehusmann P, Vannod-Michel Q, Provost C, de Champfleur NM, Nichelli L, Métais A, Mariet C, Chrétien F, Blauwblomme T, Beccaria K, Pallud J, Puget S, Uro-Coste E, Varlet P. CNS tumors with PLAGL1-fusion: beyond ZFTA and YAP1 in the genetic spectrum of supratentorial ependymomas. Acta Neuropathol Commun 2024; 12:55. [PMID: 38581034 PMCID: PMC10998316 DOI: 10.1186/s40478-023-01695-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/22/2023] [Indexed: 04/07/2024] Open
Abstract
A novel methylation class, "neuroepithelial tumor, with PLAGL1 fusion" (NET-PLAGL1), has recently been described, based on epigenetic features, as a supratentorial pediatric brain tumor with recurrent histopathological features suggesting an ependymal differentiation. Because of the recent identification of this neoplastic entity, few histopathological, radiological and clinical data are available. Herein, we present a detailed series of nine cases of PLAGL1-fused supratentorial tumors, reclassified from a series of supratentorial ependymomas, non-ZFTA/non-YAP1 fusion-positive and subependymomas of the young. This study included extensive clinical, radiological, histopathological, ultrastructural, immunohistochemical, genetic and epigenetic (DNA methylation profiling) data for characterization. An important aim of this work was to evaluate the sensitivity and specificity of a novel fluorescent in situ hybridization (FISH) targeting the PLAGL1 gene. Using histopathology, immunohistochemistry and electron microscopy, we confirmed the ependymal differentiation of this new neoplastic entity. Indeed, the cases histopathologically presented as "mixed subependymomas-ependymomas" with well-circumscribed tumors exhibiting a diffuse immunoreactivity for GFAP, without expression of Olig2 or SOX10. Ultrastructurally, they also harbored features reminiscent of ependymal differentiation, such as cilia. Different gene partners were fused with PLAGL1: FOXO1, EWSR1 and for the first time MAML2. The PLAGL1 FISH presented a 100% sensitivity and specificity according to RNA sequencing and DNA methylation profiling results. This cohort of supratentorial PLAGL1-fused tumors highlights: 1/ the ependymal cell origin of this new neoplastic entity; 2/ benefit of looking for a PLAGL1 fusion in supratentorial cases of non-ZFTA/non-YAP1 ependymomas; and 3/ the usefulness of PLAGL1 FISH.
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Affiliation(s)
- Arnault Tauziède-Espariat
- Department of Neuropathology, GHU Paris-Psychiatrie Et Neurosciences, Sainte-Anne Hospital, 1, Rue Cabanis, 75014, Paris, France.
| | - Yvan Nicaise
- Department of Pathology, Toulouse University Hospital, Toulouse, France
- Cancer Research Center of Toulouse (CRCT), INSERM U1037, Toulouse, France
| | - Philipp Sievers
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center DKFZ, German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center DKFZ, German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center DKFZ, German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany
| | - Delphine Guillemot
- Paris-Sciences-Lettres, Curie Institute Research Center, INSERMU830, Paris, France
- Laboratory of Somatic Genetics, Curie Institute Hospital, Paris, France
| | - Gaëlle Pierron
- Paris-Sciences-Lettres, Curie Institute Research Center, INSERMU830, Paris, France
- Laboratory of Somatic Genetics, Curie Institute Hospital, Paris, France
| | - Mathilde Duchesne
- Department of Pathology, Dupuytren University Hospital, Limoges, France
| | - Myriam Edjlali
- Radiology Department, AP-HP, Raymond Poincaré Hospital, 92380, Garches, France
| | - Volodia Dangouloff-Ros
- Pediatric Radiology Department, AP-HP, Hôpital Universitaire Necker-Enfants Malades, France, and Université de Paris, INSERM ERL UA10, INSERM U1163, Institut Imagine, F-75015, Paris, France
| | - Nathalie Boddaert
- Pediatric Radiology Department, AP-HP, Hôpital Universitaire Necker-Enfants Malades, France, and Université de Paris, INSERM ERL UA10, INSERM U1163, Institut Imagine, F-75015, Paris, France
| | - Alexandre Roux
- Department of Neurosurgery, GHU Paris-Psychiatrie Et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Edouard Dezamis
- Department of Neurosurgery, GHU Paris-Psychiatrie Et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Lauren Hasty
- Department of Neuropathology, GHU Paris-Psychiatrie Et Neurosciences, Sainte-Anne Hospital, 1, Rue Cabanis, 75014, Paris, France
| | - Benoît Lhermitte
- Department of Pathology, Strasbourg Hospital, Strasbourg, France
| | - Edouard Hirsch
- Department of Neurology, Strasbourg Hospital, Strasbourg, France
| | | | - François-Daniel Ardellier
- Radiology 2 Department, Strasbourg University Hospital, Hautepierre Hospital, Strasbourg, France
- Engineering Science, Computer Science and Imaging Laboratory (ICube), Integrative Multimodal Imaging in Healthcare, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France
| | - Mélodie-Anne Karnoub
- Department of Pediatric Neurosurgery, Lille University Hospital, 59000, Lille, France
| | - Marie Csanyi
- Institute of Pathology, Centre de Biologie Pathologie, Lille University Hospital, 59000, Lille, France
| | - Claude-Alain Maurage
- Institute of Pathology, Centre de Biologie Pathologie, Lille University Hospital, 59000, Lille, France
| | - Karima Mokhtari
- Sorbonne Université, AP-HP, Institut du Cerveau - Paris Brain Institute - ICM, Inserm,, CNRS, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neuropathologie, 75013, Paris, France
| | - Franck Bielle
- Sorbonne Université, AP-HP, Institut du Cerveau - Paris Brain Institute - ICM, Inserm,, CNRS, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neuropathologie, 75013, Paris, France
| | - Valérie Rigau
- Department of Pathology, Gui de Chauliac Hospital, 34295, Montpellier, France
| | - Thomas Roujeau
- Department of Neurosurgery, Gui de Chauliac Hospital, 34295, Montpellier, France
| | - Marine Abad
- Department of Pathology, Jean Minjoz Hospital, Besançon, France
| | - Sébastien Klein
- Department of Pediatric Oncology, Jean Minjoz Hospital, Besançon, France
| | | | | | - Clovis Adam
- Department of Pathology, Bicêtre Hospital, 94275, Le Kremlin-Bicêtre, France
| | - Petter Brandal
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway
- Department of Oncology, Oslo University Hospital-The Norwegian Radium Hospital, Oslo, Norway
| | - Pitt Niehusmann
- Devision of Cancer Medicine, Oslo University Hospital, Oslo, Norway
- Department of Pathology, Oslo University Hospital, Oslo, Norway
| | | | - Corentin Provost
- Department of Radiology, GHU-Paris-Psychiatrie Et Neurosciences, Hôpital Sainte Anne, 75014, Paris, France
| | | | - Lucia Nichelli
- Department of Neuroradiology, Sorbonne Université, AP-HP, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, 75013, Paris, France
| | - Alice Métais
- Department of Neuropathology, GHU Paris-Psychiatrie Et Neurosciences, Sainte-Anne Hospital, 1, Rue Cabanis, 75014, Paris, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, Imabrain Team, 75014, Paris, France
| | - Cassandra Mariet
- Department of Neuropathology, GHU Paris-Psychiatrie Et Neurosciences, Sainte-Anne Hospital, 1, Rue Cabanis, 75014, Paris, France
| | - Fabrice Chrétien
- Department of Neuropathology, GHU Paris-Psychiatrie Et Neurosciences, Sainte-Anne Hospital, 1, Rue Cabanis, 75014, Paris, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, Imabrain Team, 75014, Paris, France
| | - Thomas Blauwblomme
- Department of Pediatric Neurosurgery, Necker Hospital, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Kévin Beccaria
- Department of Pediatric Neurosurgery, Necker Hospital, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Johan Pallud
- Department of Neurosurgery, GHU Paris-Psychiatrie Et Neurosciences, Sainte-Anne Hospital, Paris, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, Imabrain Team, 75014, Paris, France
| | - Stéphanie Puget
- Department of Neurosurgery, La Martinique Hospital, Fort-de-France, France
| | - Emmanuelle Uro-Coste
- Department of Pathology, Toulouse University Hospital, Toulouse, France
- Cancer Research Center of Toulouse (CRCT), INSERM U1037, Toulouse, France
- Université Paul Sabatier, Toulouse III, Toulouse, France
| | - Pascale Varlet
- Department of Neuropathology, GHU Paris-Psychiatrie Et Neurosciences, Sainte-Anne Hospital, 1, Rue Cabanis, 75014, Paris, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, Imabrain Team, 75014, Paris, France
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8
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Barresi V, Cardoni A, Miele E, Pedace L, Masotto B, Nardini C, Barresi S, Rossi S. CNS tumor with CREBBP::BCORL1 Fusion and pathogenic mutations in BCOR and CREBBP: expanding the spectrum of BCOR-altered tumors. Acta Neuropathol Commun 2024; 12:8. [PMID: 38216991 PMCID: PMC10785472 DOI: 10.1186/s40478-024-01726-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/24/2023] [Indexed: 01/14/2024] Open
Abstract
The fifth edition of the World Health Organization (WHO) classification of central nervous system (CNS) tumors introduced the new tumor type CNS tumor with BCOR internal tandem duplication (ITD), characterized by a distinct DNA methylation profile and peculiar histopathological features, including a circumscribed growth pattern, ependymoma-like perivascular pseudorosettes, microcystic pattern, absent or focal GFAP immunostaining, OLIG2 positivity, and BCOR immunoreactivity. We describe a rare case of a CNS tumor in a 45-year-old man with histopathological and immunohistochemical features overlapping the CNS tumor with BCOR internal tandem duplication (ITD) but lacking BCOR immunostaining and BCOR ITD. Instead, the tumor showed CREBBP::BCORL1 fusion and pathogenic mutations in BCOR and CREBBP, along with a DNA methylation profile matching the "CNS tumor with EP300:BCOR(L1) fusion" methylation class. Two CNS tumors with fusions between CREBBP, or its paralog EP300, and BCORL1, and approximately twenty CNS tumors with CREBBP/EP300::BCOR fusions have been reported to date. They exhibited similar ependymoma-like features or a microcystic pattern, along with focal or absent GFAP immunostaining, and shared the same DNA methylation profile. Given their morphological and epigenetic similarities, circumscribed CNS tumors with EP300/CREBBP::BCOR(L1) fusions and CNS tumors with BCOR ITD may represent variants of the same tumor type. The ependymoma-like aspect coupled with the lack of diffuse GFAP immunostaining and the presence of OLIG2 positivity are useful clues for recognizing these tumors in histopathological practice. The diagnosis should be confirmed after testing for BCOR(L1) gene fusions and BCOR ITD.
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Affiliation(s)
- Valeria Barresi
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
- Department of Diagnostics and Public Health, Policlinico G.B. Rossi, P.le L.A. Scuro, 10, Verona, 37138, Italy.
| | - Antonello Cardoni
- Pathology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Evelina Miele
- Oncohematology Research Area, Genetics and Epigenetics of tumors, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Lucia Pedace
- Oncohematology Research Area, Genetics and Epigenetics of tumors, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Barbara Masotto
- Unit of Cranial Posterior Fossa Surgery, University and Hospital Trust of Verona, Verona, Italy
| | - Claudia Nardini
- Oncohematology Research Area, Genetics and Epigenetics of tumors, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Sabina Barresi
- Oncohematology Research Area, Genetics and Epigenetics of tumors, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Sabrina Rossi
- Pathology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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9
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Nakata S, Arai Y, Fukuoka K, Shirakura T, Yamazaki A, Osawa S, Hama N, Shibata T, Miyagishima T, Horiguchi K, Tosaka M, Yokoo H, Yoshimoto Y, Nobusawa S. Pediatric diffuse glioma with EP300::BCOR fusion manifesting as low-grade epilepsy-associated neuroepithelial tumor: a case presentation. Brain Tumor Pathol 2024; 41:35-39. [PMID: 38133797 DOI: 10.1007/s10014-023-00475-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Satoshi Nakata
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yasuhito Arai
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Kohei Fukuoka
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Takahiro Shirakura
- Department of Human Pathology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Ayako Yamazaki
- Department of Human Pathology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Sho Osawa
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Japan
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Natsuko Hama
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Tatsuhiro Shibata
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Takaaki Miyagishima
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Keishi Horiguchi
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masahiko Tosaka
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hideaki Yokoo
- Department of Human Pathology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Yuhei Yoshimoto
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Sumihito Nobusawa
- Department of Human Pathology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.
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10
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Mizuno R, Sasaki A, Suzuki T, Adachi JI, Shirahata M, Nishikawa R, Mishima K. Successful Treatment of a CNS Tumor with BCOR Internal Tandem Duplication: A Case Report. NMC Case Rep J 2023; 10:343-348. [PMID: 38249434 PMCID: PMC10796265 DOI: 10.2176/jns-nmc.2023-0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/14/2023] [Indexed: 01/23/2024] Open
Abstract
A central nervous system (CNS) tumor with BCL-6 co-repressor (BCOR) internal tandem duplication (CNS tumor with BCOR ITD) is a rare tumor classified as an embryonal tumor by the World Health Organization classification (5th edition), and the prognosis is generally poor. A successfully treated case is reported, and its treatment is discussed. A five-year-old boy presented with a one-month history of headache and vomiting. Magnetic resonance imaging showed a well-demarcated, left-frontal tumor without perifocal edema. The patient underwent complete resection without a neurological deficit. Anti-BCOR antibody showed strong immunoreactivity in tumor nuclei, and the tumor was diagnosed as a CNS tumor with BCOR ITD. The patient received craniospinal irradiation (CSI) comprising 23.4 Gy, followed by a boost to the primary site to a total dose of 30.6 Gy in daily fractions of 1.8 Gy. The chemotherapy comprised four cycles of vincristine, cyclophosphamide, and cisplatin with peripheral blood stem cell rescue. The clinical course was uneventful throughout the treatment, the tumor has not recurred for four years, and no neurological impairment was reported. CSI and multiagent chemotherapy were effective for a CNS tumor with BCOR ITD.
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Affiliation(s)
- Reina Mizuno
- Department of Neuro-Oncology/Neurosurgery, Saitama International Medical Center, Hidaka, Saitama, Japan
| | - Atsushi Sasaki
- Department of Pathology, Saitama Medical University, Moroyama, Saitama, Japan
| | - Tomonari Suzuki
- Department of Neuro-Oncology/Neurosurgery, Saitama International Medical Center, Hidaka, Saitama, Japan
| | - Jun-Ichi Adachi
- Department of Neuro-Oncology/Neurosurgery, Saitama International Medical Center, Hidaka, Saitama, Japan
| | - Mitsuaki Shirahata
- Department of Neuro-Oncology/Neurosurgery, Saitama International Medical Center, Hidaka, Saitama, Japan
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama International Medical Center, Hidaka, Saitama, Japan
| | - Kazuhiko Mishima
- Department of Neuro-Oncology/Neurosurgery, Saitama International Medical Center, Hidaka, Saitama, Japan
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11
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Gharbaran R. Insights into the molecular roles of FOXR2 in the pathology of primary pediatric brain tumors. Crit Rev Oncol Hematol 2023; 192:104188. [PMID: 37879492 DOI: 10.1016/j.critrevonc.2023.104188] [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: 03/13/2023] [Revised: 08/23/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023] Open
Abstract
Forkhead box gene R2 (FOXR2) belongs to the family of FOX genes which codes for highly conserved transcription factors (TFs) with critical roles in biological processes ranging from development to organogenesis to metabolic and immune regulation to cellular homeostasis. A number of FOX genes are associated with cancer development and progression and poor prognosis. A growing body of evidence suggests that FOXR2 is an oncogene. Studies suggested important roles for FOXR2 in cancer cell growth, metastasis, and drug resistance. Recent studies showed that FOXR2 is overexpressed by a subset of newly identified entities of embryonal tumors. This review discusses the role(s) FOXR2 plays in the pathology of pediatric brain cancers and its potential as a therapeutic target.
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Affiliation(s)
- Rajendra Gharbaran
- Biological Sciences Department, Bronx Community College/City University of New York, 2155 University Avenue, Bronx, NY 10453, USA.
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12
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Motoi T, Hirata M, Kukita Y, Satomi K, Tamura H, Adachi S, Matsushita Y, Horiguchi SI, Hishima T, Ikegami M, Okuma T, Tao K, Arakawa A, Ogawa C, Matsuda K, Ichimura K, Nakamura H, Mori T, Yoshida A. KDM2B-Rearranged Soft Tissue Sarcomas Expand the Concept of BCOR-Associated Sarcoma. Mod Pathol 2023; 36:100317. [PMID: 37634866 DOI: 10.1016/j.modpat.2023.100317] [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: 05/04/2023] [Revised: 08/02/2023] [Accepted: 08/16/2023] [Indexed: 08/29/2023]
Abstract
Sarcomas with BCOR genetic alterations (BCOR-associated sarcomas) represent a recently recognized family of soft tissue and bone tumors characterized by BCOR fusion, BCOR internal tandem duplication, or YWHAE::NUTM2B fusion. Histologically, the tumors demonstrate oval to spindle cell proliferation in a variably vascular stroma and overexpression of BCOR and SATB2. Herein, we describe 3 soft tissue sarcomas with KDM2B fusions that phenotypically and epigenetically match BCOR-associated sarcomas. The cases included 1 infant, 1 adolescent, and 1 older patient. All tumors showed histologic findings indistinguishable from those of BCOR-associated sarcomas and were originally diagnosed as such based on the phenotype. However, none of the tumors had BCOR or YWHAE genetic alterations. Instead, targeted RNA sequencing identified in-frame KDM2B::NUTM2B, KDM2B::CREBBP, and KDM2B::DUX4 fusions. KDM2B fusions were validated using reverse-transcription PCR, Sanger sequencing, and in situ hybridization assays. Genome-wide DNA methylation analysis matched all 3 tumors with BCOR-associated sarcomas using the Deutsches Krebsforschungszentrum (DKFZ) classifier and t-distributed stochastic neighbor embedding analysis. One localized tumor showed a flat genome-wide copy number profile, and the patient remained disease-free after treatment. The other tumors showed multiple copy number alterations, including MDM2/CDK4 amplification and/or CDKN2A/B loss, and both tumors metastasized, leading to the patient's death in one of the cases. When tested using KDM2B immunohistochemistry, all 3 KDM2B-rearranged sarcomas showed diffuse strong staining, and all 13 sarcomas with BCOR genetic alterations also demonstrated diffuse, strong, or weak staining. By contrast, among 72 mimicking tumors, only a subset of synovial sarcomas showed focal or diffuse weak KDM2B expression. In conclusion, our study suggests that KDM2B-rearranged soft tissue sarcomas belong to the BCOR-associated sarcoma family and expand its molecular spectrum. This may be related to the known molecular relationship between KDM2B and BCOR in the polycomb repressive complex 1.1. Immunohistochemical analysis of KDM2B is a potentially valuable diagnostic tool for BCOR-associated sarcomas, including those with KDM2B rearrangement.
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Affiliation(s)
- Toru Motoi
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
| | - Makoto Hirata
- Laboratory of Genome Technology, Institute of Medical Science, University of Tokyo, Tokyo, Japan; Department of Genetic Medicine and Services, National Cancer Center Hospital, Tokyo, Japan
| | - Yoji Kukita
- Laboratory of Genomic Pathology, Osaka International Cancer Institute, Osaka, Japan
| | - Kaishi Satomi
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan; Department of Pathology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Hiromi Tamura
- Department of Pathology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Shiro Adachi
- Department of Pathology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Yuko Matsushita
- Department of Brain Disease Translational Research, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shin-Ichiro Horiguchi
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Tsunekazu Hishima
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Masachika Ikegami
- Department of Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Tomotake Okuma
- Department of Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Kayoko Tao
- Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Ayumu Arakawa
- Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan; Rare Cancer Center, National Cancer Center, Tokyo, Japan
| | - Chitose Ogawa
- Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan; Rare Cancer Center, National Cancer Center, Tokyo, Japan
| | - Koichi Matsuda
- Laboratory of Clinical Genome Sequencing, Graduate School of Frontier Sciences, University of Tokyo, Tokyo, Japan
| | - Koichi Ichimura
- Department of Brain Disease Translational Research, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Harumi Nakamura
- Laboratory of Genomic Pathology, Osaka International Cancer Institute, Osaka, Japan
| | - Taisuke Mori
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Akihiko Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan; Rare Cancer Center, National Cancer Center, Tokyo, Japan.
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13
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Schieffer KM, Moccia A, Bucknor BA, Stonerock E, Jayaraman V, Jenkins H, McKinney A, Koo SC, Mathew MT, Mardis ER, Lee K, Reshmi SC, Cottrell CE. Expanding the Clinical Utility of Targeted RNA Sequencing Panels beyond Gene Fusions to Complex, Intragenic Structural Rearrangements. Cancers (Basel) 2023; 15:4394. [PMID: 37686670 PMCID: PMC10486946 DOI: 10.3390/cancers15174394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023] Open
Abstract
Gene fusions are a form of structural rearrangement well established as driver events in pediatric and adult cancers. The identification of such events holds clinical significance in the refinement, prognostication, and provision of treatment in cancer. Structural rearrangements also extend beyond fusions to include intragenic rearrangements, such as internal tandem duplications (ITDs) or exon-level deletions. These intragenic events have been increasingly implicated as cancer-promoting events. However, the detection of intragenic rearrangements may be challenging to resolve bioinformatically with short-read sequencing technologies and therefore may not be routinely assessed in panel-based testing. Within an academic clinical laboratory, over three years, a total of 608 disease-involved samples (522 hematologic malignancy, 86 solid tumors) underwent clinical testing using Anchored Multiplex PCR (AMP)-based RNA sequencing. Hematologic malignancies were evaluated using a custom Pan-Heme 154 gene panel, while solid tumors were assessed using a custom Pan-Solid 115 gene panel. Gene fusions, ITDs, and intragenic deletions were assessed for diagnostic, prognostic, or therapeutic significance. When considering gene fusions alone, we report an overall diagnostic yield of 36% (37% hematologic malignancy, 41% solid tumors). When including intragenic structural rearrangements, the overall diagnostic yield increased to 48% (48% hematologic malignancy, 45% solid tumor). We demonstrate the clinical utility of reporting structural rearrangements, including gene fusions and intragenic structural rearrangements, using an AMP-based RNA sequencing panel.
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Affiliation(s)
- Kathleen M. Schieffer
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children’s Hospital, Columbus, OH 43215, USA
- Department of Pathology, The Ohio State University, Columbus, OH 43210, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH 43210, USA
| | - Amanda Moccia
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children’s Hospital, Columbus, OH 43215, USA
| | - Brianna A. Bucknor
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children’s Hospital, Columbus, OH 43215, USA
| | - Eileen Stonerock
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children’s Hospital, Columbus, OH 43215, USA
| | - Vijayakumar Jayaraman
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children’s Hospital, Columbus, OH 43215, USA
| | - Heather Jenkins
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children’s Hospital, Columbus, OH 43215, USA
| | - Aimee McKinney
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children’s Hospital, Columbus, OH 43215, USA
| | - Selene C. Koo
- Department of Pathology, The Ohio State University, Columbus, OH 43210, USA
- Department of Pathology and Laboratory Medicine, Nationwide Children’s Hospital, Columbus, OH 43205, USA
| | - Mariam T. Mathew
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children’s Hospital, Columbus, OH 43215, USA
- Department of Pathology, The Ohio State University, Columbus, OH 43210, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH 43210, USA
| | - Elaine R. Mardis
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children’s Hospital, Columbus, OH 43215, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH 43210, USA
| | - Kristy Lee
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children’s Hospital, Columbus, OH 43215, USA
- Department of Pathology, The Ohio State University, Columbus, OH 43210, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH 43210, USA
| | - Shalini C. Reshmi
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children’s Hospital, Columbus, OH 43215, USA
- Department of Pathology, The Ohio State University, Columbus, OH 43210, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH 43210, USA
| | - Catherine E. Cottrell
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children’s Hospital, Columbus, OH 43215, USA
- Department of Pathology, The Ohio State University, Columbus, OH 43210, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH 43210, USA
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14
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Bakkar M, Altinok D, Kupsky WJ, Marupudi NI, Chiang J, Gorsi HS. Central Nervous System Tumor With BCL6 Corepressor Internal Tandem Duplication: Treatment Course of a Long-term Survivor. J Pediatr Hematol Oncol 2023; 45:352-355. [PMID: 37314948 DOI: 10.1097/mph.0000000000002695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 04/26/2023] [Indexed: 06/16/2023]
Abstract
Central nervous system (CNS) tumor with BCL6 corepressor (BCOR) internal tandem duplication (ITD) is a newly described CNS tumor, characterized by in-frame ITDs of the BCOR gene. There is no standard practice regarding the management of this tumor. We report the clinical course of a 6-year-old boy who presented to the hospital with worsening headaches. Computed tomography scan showed a large right-sided parietal supratentorial mass and brain magnetic resonance imaging confirmed a 6×8×6.7 cm lobulated, solid but heterogeneous mass in the right parieto-occipital region. While initial pathology suggested a WHO grade 3 anaplastic meningioma, additional investigation with molecular analysis confirmed the diagnosis of high-grade neuroepithelial tumor with BCOR exon 15 ITD. This diagnosis was renamed CNS tumor with BCOR ITD in the 2021 WHO CNS tumor classification. The patient received 54 Gy of focal radiation and has no evidence of disease recurrence after 48 months from the end of treatment. As this is a newly discovered entity with only a few previous reports in the scientific literature, this report presents a unique treatment for this CNS tumor compared with those previously described.
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Affiliation(s)
- Mohamad Bakkar
- Pediatrics, Children's Hospital of Michigan, Detroit, MI
| | - Deniz Altinok
- Department of Radiology, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI
| | - William J Kupsky
- Department of Pathology, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI
| | - Neena I Marupudi
- Department of Pediatric Neurosurgery, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI
| | - Jason Chiang
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Hamza S Gorsi
- Pediatrics, Children's Hospital of Michigan, Detroit, MI
- Department of Hematology/Oncology, Children's Hospital of Michigan, Central Michigan University School of Medicine, Mount Pleasant, MI
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15
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Yu SH, Kan ANC, To KF, Lam YL, Yan CLS, Liu APY, Ku DTL. Durable disease control with apatinib, irinotecan and temozolomide in a case of metastatic primitive myxoid mesenchymal tumour of infancy. Pediatr Blood Cancer 2023; 70:e30026. [PMID: 36441598 DOI: 10.1002/pbc.30026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/17/2022] [Accepted: 09/08/2022] [Indexed: 11/30/2022]
Affiliation(s)
- S H Yu
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Kowloon, Hong Kong SAR
| | - Amanda N C Kan
- Department of Pathology, Hong Kong Children's Hospital, Kowloon, Hong Kong SAR
| | - K F To
- Department of Anatomical and Cellular Pathology, Chinese University of Hong Kong, Kowloon, Hong Kong SAR
| | - Y L Lam
- Department of Orthopaediacs and Traumatology, Queen Mary Hospital, Kowloon, Hong Kong SAR
| | - Carol L S Yan
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Kowloon, Hong Kong SAR
| | - Anthony P Y Liu
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Kowloon, Hong Kong SAR.,Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Kowloon, Hong Kong SAR
| | - Dennis T L Ku
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Kowloon, Hong Kong SAR
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16
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High-grade neuroepithelial tumor with EP300::BCOR fusion and negative BCOR immunohistochemical expression: a case report. Brain Tumor Pathol 2023; 40:133-141. [PMID: 36811792 DOI: 10.1007/s10014-023-00451-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/05/2023] [Indexed: 02/24/2023]
Abstract
In the World Health Organization tumor classification (fifth edition), central nervous system (CNS) tumors with BCOR internal tandem duplications have been recognized as a new tumor type. Some recent studies have reported CNS tumors with EP300::BCOR fusions, predominantly in children and young adults, expanding the spectrum of BCOR-altered CNS tumors. This study reports a new case of high-grade neuroepithelial tumor (HGNET) with an EP300::BCOR fusion in the occipital lobe of a 32-year-old female. The tumor displayed anaplastic ependymoma-like morphologies characterized by a relatively well-circumscribed solid growth with perivascular pseudorosettes and branching capillaries. Immunohistochemically, OLIG2 was focally positive and BCOR was negative. RNA sequencing revealed an EP300::BCOR fusion. The Deutsches Krebsforschungszentrum DNA methylation classifier (v12.5) classified the tumor as CNS tumor with BCOR/BCORL1 fusion. The t-distributed stochastic neighbor embedding analysis plotted the tumor close to the HGNET with BCOR alteration reference samples. BCOR/BCORL1-altered tumors should be included in the differential diagnosis of supratentorial CNS tumors with ependymoma-like histological features, especially when they lack ZFTA fusion or express OLIG2 even in the absence of BCOR expression. Analysis of published CNS tumors with BCOR/BCORL1 fusions revealed partly overlapping but not identical phenotypes. Further studies of additional cases are required to establish their classification.
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17
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Tauziède-Espariat A, Uro-Coste E, Sievers P, Nicaise Y, Mariet C, Siegfried A, Pierron G, Guillemot D, Benzakoun J, Pallud J, Roques M, Bonneville F, Larrieu-Ciron D, Chaynes P, Saffroy R, Hamelin J, Hasty L, Métais A, Chrétien F, Kool M, Gojo J, Varlet P. CNS tumor with EP300::BCOR fusion: discussing its prevalence in adult population. Acta Neuropathol Commun 2023; 11:26. [PMID: 36782314 PMCID: PMC9926824 DOI: 10.1186/s40478-023-01523-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/24/2023] [Indexed: 02/15/2023] Open
Abstract
The Central Nervous System (CNS) tumor with BCOR internal tandem duplication (ITD) has recently been added as a novel embryonal histomolecular tumor type to the 2021 World Health Organization (WHO) Classification of CNS Tumors. In addition, other CNS tumors harboring a BCOR/BCORL1 fusion, which are defined by a distinct DNA-methylation profile, have been recently identified in the literature but clinical, radiological and histopathological data remain scarce. Herein, we present two adult cases of CNS tumors with EP300::BCOR fusion. These two cases presented radiological, histopathological, and immunohistochemical homologies with CNS tumors having BCOR ITD in children. To compare these tumors with different BCOR alterations, we performed a literature review with a meta-analysis. CNS tumors with EP300::BCOR fusion seem to be distinct from their BCOR ITD counterparts in terms of age, location, progression-free survival, tumor growth pattern, and immunopositivity for the BCOR protein. CNS tumors from the EP300::BCOR fusion methylation class in adults may be added to the future WHO classification.
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Affiliation(s)
- Arnault Tauziède-Espariat
- Department of Neuropathology, GHU Paris - Psychiatry and Neuroscience, Sainte-Anne Hospital, 1, Rue Cabanis, 75014, Paris, France. .,Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, INSERM, IMA-BRAIN, Paris, France. .,Université de Paris, Paris, France.
| | - Emmanuelle Uro-Coste
- grid.411175.70000 0001 1457 2980Department of Pathology, Toulouse University Hospital, Toulouse, France ,grid.468186.5Cancer Research Center of Toulouse (CRCT), INSERM U1037, Toulouse, France ,grid.15781.3a0000 0001 0723 035XUniversité Paul Sabatier, Toulouse III, Toulouse, France
| | - Philipp Sievers
- grid.5253.10000 0001 0328 4908Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany ,grid.7497.d0000 0004 0492 0584Clinical Cooperation Unit Neuropathology, German Cancer Research Center DKFZ), German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany
| | - Yvan Nicaise
- grid.411175.70000 0001 1457 2980Department of Pathology, Toulouse University Hospital, Toulouse, France ,grid.468186.5Cancer Research Center of Toulouse (CRCT), INSERM U1037, Toulouse, France ,grid.15781.3a0000 0001 0723 035XUniversité Paul Sabatier, Toulouse III, Toulouse, France
| | - Cassandra Mariet
- grid.414435.30000 0001 2200 9055Department of Neuropathology, GHU Paris - Psychiatry and Neuroscience, Sainte-Anne Hospital, 1, Rue Cabanis, 75014 Paris, France ,grid.5842.b0000 0001 2171 2558Université de Paris, Paris, France
| | - Aurore Siegfried
- grid.411175.70000 0001 1457 2980Department of Pathology, Toulouse University Hospital, Toulouse, France ,grid.468186.5Cancer Research Center of Toulouse (CRCT), INSERM U1037, Toulouse, France ,grid.15781.3a0000 0001 0723 035XUniversité Paul Sabatier, Toulouse III, Toulouse, France
| | - Gaëlle Pierron
- grid.418596.70000 0004 0639 6384Paris-Sciences-Lettres, Curie Institute Research Center, INSERMU830 Paris, France ,grid.418596.70000 0004 0639 6384Laboratory of Somatic Genetics, Curie Institute Hospital, Paris, France
| | - Delphine Guillemot
- grid.418596.70000 0004 0639 6384Paris-Sciences-Lettres, Curie Institute Research Center, INSERMU830 Paris, France
| | - Joseph Benzakoun
- grid.7429.80000000121866389Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, INSERM, IMA-BRAIN, Paris, France ,grid.414435.30000 0001 2200 9055Department of Radiology, GHU Paris-Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Johan Pallud
- grid.7429.80000000121866389Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, INSERM, IMA-BRAIN, Paris, France ,grid.5842.b0000 0001 2171 2558Université de Paris, Paris, France ,grid.414435.30000 0001 2200 9055Department of Neurosurgery, GHU Paris-Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Margaux Roques
- grid.414282.90000 0004 0639 4960Department of Radiology, Purpan University Hospital, Toulouse, France
| | - Fabrice Bonneville
- grid.414282.90000 0004 0639 4960Department of Radiology, Purpan University Hospital, Toulouse, France
| | - Delphine Larrieu-Ciron
- grid.411175.70000 0001 1457 2980Department of Neurology, Toulouse University Hospital, Toulouse, France ,grid.488470.7Department of Medical Oncology, IUCT-Oncopole, Toulouse, France
| | - Patrick Chaynes
- grid.411175.70000 0001 1457 2980Department of Neurosurgery, Toulouse University Hospital, Toulouse, France
| | - Raphaël Saffroy
- grid.413133.70000 0001 0206 8146Department of Biochemistry and Oncogenetic, Paul Brousse Hospital, Villejuif, France
| | - Jocelyne Hamelin
- grid.413133.70000 0001 0206 8146Department of Biochemistry and Oncogenetic, Paul Brousse Hospital, Villejuif, France
| | - Lauren Hasty
- grid.414435.30000 0001 2200 9055Department of Neuropathology, GHU Paris - Psychiatry and Neuroscience, Sainte-Anne Hospital, 1, Rue Cabanis, 75014 Paris, France
| | - Alice Métais
- grid.414435.30000 0001 2200 9055Department of Neuropathology, GHU Paris - Psychiatry and Neuroscience, Sainte-Anne Hospital, 1, Rue Cabanis, 75014 Paris, France ,grid.7429.80000000121866389Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, INSERM, IMA-BRAIN, Paris, France ,grid.5842.b0000 0001 2171 2558Université de Paris, Paris, France
| | - Fabrice Chrétien
- grid.414435.30000 0001 2200 9055Department of Neuropathology, GHU Paris - Psychiatry and Neuroscience, Sainte-Anne Hospital, 1, Rue Cabanis, 75014 Paris, France ,grid.5842.b0000 0001 2171 2558Université de Paris, Paris, France
| | - Marcel Kool
- grid.510964.fHopp Children’s Cancer Center (KiTZ), Heidelberg, Germany ,grid.7497.d0000 0004 0492 0584Division of Pediatric Oncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany ,grid.487647.ePrincess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Johannes Gojo
- grid.22937.3d0000 0000 9259 8492Department of Pediatric and Adolescent Medicine, Comprehensive Center for Pediatrics and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Pascale Varlet
- grid.414435.30000 0001 2200 9055Department of Neuropathology, GHU Paris - Psychiatry and Neuroscience, Sainte-Anne Hospital, 1, Rue Cabanis, 75014 Paris, France ,grid.7429.80000000121866389Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, INSERM, IMA-BRAIN, Paris, France ,grid.5842.b0000 0001 2171 2558Université de Paris, Paris, France
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18
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Kamenova M, Kaneva R, Genova K, Gabrovsky N. Embryonal Tumors of the Central Nervous System with Multilayered Rosettes and Atypical Teratoid/Rhabdoid Tumors. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:225-252. [PMID: 37452940 DOI: 10.1007/978-3-031-23705-8_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
The 2016 WHO classification of tumors of the central nervous system affected importantly the group of CNS embryonal tumors. Molecular analysis on methylome, genome, and transcriptome levels allowed better classification, identification of specific molecular hallmarks of the different subtypes of CNS embryonal tumors, and their more precise diagnosis. Routine application of appropriate molecular testing and standardized reporting are of pivotal importance for adequate prognosis and treatment, but also for epidemiology studies and search for efficient targeted therapies. As a result of this approach, the term primitive neuroectodermal tumor-PNET was removed and a new clinic-pathological entity was introduced-Embryonal tumor with multilayered rosettes (ETMR). The group of CNS embryonal tumors include also medulloblastoma, medulloepithelioma, CNS neuroblastoma, CNS ganglioneuroblastoma, atypical teratoid/rhabdoid tumor (ATRT) and their subtypes. This chapter will focus mainly on ETMR and ATRT. Embryonal tumors with multilayered rosettes and the atypical teratoid/rhabdoid tumors are undifferentiated or poorly differentiated tumors of the nervous system that originate from primitive brain cells, develop exclusively in childhood or adolescence, and are characterized by a high degree of malignancy, aggressive evolution and a tendency to metastasize to the cerebrospinal fluid. Their clinical presentation is similar to other malignant, intracranial, neoplastic lesions and depends mainly on the localization of the tumor, the rise of the intracranial pressure, and eventually the obstruction of the cerebrospinal fluid pathways. The MRI image characteristics of these tumors are largely overlappingintra-axial, hypercellular, heterogeneous tumors, frequently with intratumoral necrosis and/or hemorrhages. Treatment options for ETMR and ATRT are very restricted. Surgery can seldom achieve radical excision. The rarity of the disease hampers the establishment of a chemotherapy protocol and the usual age of the patients limits severely the application of radiotherapy as a therapeutic option. Consequently, the prognosis of these undifferentiated, malignant, aggressive tumors remains dismal with a 5-year survival between 0 and 30%.
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Affiliation(s)
| | - Radka Kaneva
- Molecular Medicine Center, Department of Medical Chemistry and Biochemistry, Medical University, Sofia, Bulgaria
| | - Kamelia Genova
- Department of Image Diagnostic, University Hospital "Pirogov", Sofia, Bulgaria
| | - Nikolay Gabrovsky
- Department of Neurosurgery, University Hospital "Pirogov", Sofia, Bulgaria.
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19
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Gojo J, Kjaersgaard M, Zezschwitz BV, Capper D, Tietze A, Kool M, Haberler C, Pizer B, Hoff KV. Rare embryonal and sarcomatous central nervous system tumours: State-of-the art and future directions. Eur J Med Genet 2023; 66:104660. [PMID: 36356895 DOI: 10.1016/j.ejmg.2022.104660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 10/06/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022]
Abstract
The introduction of molecular methods into the diagnostics of central nervous system (CNS) tumours and the subsequent deciphering of their molecular heterogeneity has resulted in a significant impact on paediatric neurooncology. Particularly in the field of rare embryonal and sarcomatous CNS tumours, novel tumour types have been delineated and introduced in the recent 5th edition of the WHO classification of CNS tumours. The rarity and novelty of these tumour types result in diagnostic and therapeutic challenges. Apart from distinct histopathological and molecular features, these tumour types exhibit characteristic clinical properties and require different therapeutic approaches for optimal patient management. However, based on the limited availability of clinical data, current therapeutic recommendations have to be based on data from small, predominantly retrospective patient cohorts. Within this article, we provide guidance for diagnostic work-up and clinical management of rare CNS embryonal tumours ('embryonal tumour with multi-layered rosettes', ETMR; 'CNS neuroblastoma, FOXR2-activated', CNS NB-FOXR2; 'CNS tumour with BCOR-ITD, CNS BCOR-ITD) and rare CNS sarcomatous tumours ('primary intracranial sarcoma, DICER1-mutant', CNS DICER1; 'CIC-rearranged sarcoma', CNS CIC). By emphasizing the significant consequences on patient management in paediatric CNS tumours, we want to encourage wide implementation of comprehensive molecular diagnostics and stress the importance for joint international efforts to further collect and study these rare tumour types.
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Affiliation(s)
- Johannes Gojo
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany; Division of Pediatric Oncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany.
| | - Mimi Kjaersgaard
- Department of Paediatrics and Adolescent Medicine, Children and Adolescents with Cancer and Hematological Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Barbara V Zezschwitz
- Department of Paediatric Oncology and Haematology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Germany
| | - David Capper
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Anna Tietze
- Institute of Neuroradiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marcel Kool
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany; Division of Pediatric Oncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Christine Haberler
- Division of Neuropathology and Neurochemistry, Department of Neurology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | | | - Katja V Hoff
- Department of Paediatric Oncology and Haematology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Germany; Department of Paediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.
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20
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Yoshida A. Ewing and Ewing-like sarcomas: A morphological guide through genetically-defined entities. Pathol Int 2023; 73:12-26. [PMID: 36484765 PMCID: PMC10107474 DOI: 10.1111/pin.13293] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/15/2022] [Indexed: 12/14/2022]
Abstract
The fifth edition of the World Health Organization classification of soft tissue and bone tumors redefined Ewing sarcoma by fusions between EWSR1/FUS and ETS family of transcription factors, and recognized three tumor groups among Ewing-like sarcoma: CIC-rearranged sarcoma, sarcoma with BCOR genetic alterations, and round cell sarcoma with EWSR1::non-ETS fusions. Although this classification underscores the critical role of molecular genetics in the diagnosis of small round cell sarcoma, each entry is recognized as a specific entity not only because they have different genetics but because their phenotypes are distinct and reasonably robust to support the diagnosis. This review focuses on the morphological aspects of Ewing sarcoma and a subset of Ewing-like sarcomas (CIC-rearranged sarcoma, BCOR-associated sarcoma, and EWSR1::NFATC2 sarcoma) for which phenotypic characteristics have been well established. Classic histological findings, uncommon variations, and recurrent diagnostic pitfalls are addressed, along with the utility of recently developed immunohistochemical markers (NKX2.2, PAX7, ETV4, BCOR, CCNB3, and NKX3.1). Phenotypic expertise would significantly expedite the diagnostic process and complement (or sometimes outperform) genetic testing, even in well-resourced settings. Morphological knowledge plays an even more substantial role in facilities that do not have easy access to molecular testing.
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Affiliation(s)
- Akihiko Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan.,Rare Cancer Center, National Cancer Center, Tokyo, Japan
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21
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McLachlan T, Matthews WC, Jackson ER, Staudt DE, Douglas AM, Findlay IJ, Persson ML, Duchatel RJ, Mannan A, Germon ZP, Dun MD. B-cell Lymphoma 6 (BCL6): From Master Regulator of Humoral Immunity to Oncogenic Driver in Pediatric Cancers. Mol Cancer Res 2022; 20:1711-1723. [PMID: 36166198 PMCID: PMC9716245 DOI: 10.1158/1541-7786.mcr-22-0567] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 01/15/2023]
Abstract
B-cell lymphoma 6 (BCL6) is a protooncogene in adult and pediatric cancers, first identified in diffuse large B-cell lymphoma (DLBCL) where it acts as a repressor of the tumor suppressor TP53, conferring survival, protection, and maintenance of lymphoma cells. BCL6 expression in normal B cells is fundamental in the regulation of humoral immunity, via initiation and maintenance of the germinal centers (GC). Its role in B cells during the production of high affinity immunoglobins (that recognize and bind specific antigens) is believed to underpin its function as an oncogene. BCL6 is known to drive the self-renewal capacity of leukemia-initiating cells (LIC), with high BCL6 expression in acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), and glioblastoma (GBM) associated with disease progression and treatment resistance. The mechanisms underpinning BCL6-driven therapy resistance are yet to be uncovered; however, high activity is considered to confer poor prognosis in the clinical setting. BCL6's key binding partner, BCL6 corepressor (BCOR), is frequently mutated in pediatric cancers and appears to act in concert with BCL6. Using publicly available data, here we show that BCL6 is ubiquitously overexpressed in pediatric brain tumors, inversely to BCOR, highlighting the potential for targeting BCL6 in these often lethal and untreatable cancers. In this review, we summarize what is known of BCL6 (role, effect, mechanisms) in pediatric cancers, highlighting the two sides of BCL6 function, humoral immunity, and tumorigenesis, as well as to review BCL6 inhibitors and highlight areas of opportunity to improve the outcomes of patients with pediatric cancer.
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Affiliation(s)
- Tabitha McLachlan
- University of Newcastle, Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine & Wellbeing, Callaghan, New South Wales, Australia.,Precision Medicine Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - William C. Matthews
- University of Newcastle, Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine & Wellbeing, Callaghan, New South Wales, Australia.,Precision Medicine Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Evangeline R. Jackson
- University of Newcastle, Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine & Wellbeing, Callaghan, New South Wales, Australia.,Precision Medicine Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Dilana E. Staudt
- University of Newcastle, Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine & Wellbeing, Callaghan, New South Wales, Australia.,Precision Medicine Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Alicia M. Douglas
- University of Newcastle, Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine & Wellbeing, Callaghan, New South Wales, Australia.,Precision Medicine Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Izac J. Findlay
- University of Newcastle, Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine & Wellbeing, Callaghan, New South Wales, Australia.,Precision Medicine Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Mika L. Persson
- University of Newcastle, Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine & Wellbeing, Callaghan, New South Wales, Australia.,Precision Medicine Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Ryan J. Duchatel
- University of Newcastle, Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine & Wellbeing, Callaghan, New South Wales, Australia.,Precision Medicine Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Abdul Mannan
- University of Newcastle, Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine & Wellbeing, Callaghan, New South Wales, Australia.,Precision Medicine Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Zacary P. Germon
- University of Newcastle, Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine & Wellbeing, Callaghan, New South Wales, Australia.,Precision Medicine Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Matthew D. Dun
- University of Newcastle, Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine & Wellbeing, Callaghan, New South Wales, Australia.,Precision Medicine Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Corresponding Author: Matthew D. Dun, Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, The University of Newcastle, Level 3, Life Sciences Bldg, Callaghan, NSW 2308, Australia. Phone: 612-4921-5693; E-mail:
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22
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Pizzimenti C, Gianno F, Gessi M. Expanding the spectrum of "mesenchymal" tumors of the central nervous system. Pathologica 2022; 114:455-464. [PMID: 36534424 PMCID: PMC9763981 DOI: 10.32074/1591-951x-826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 12/23/2022] Open
Abstract
In this review, we summarize the clinical, histopathological, and molecular features of central nervous system (CNS) tumors with BCOR internal tandem duplication, intracranial mesenchymal tumor with FET/CREB fusion, CNS CIC-rearranged sarcomas and primary intracranial sarcoma DICER1-mutant, now included in the 2021 WHO classification of CNS tumors. Possible relationships between tumors occurring in the CNS and their systemic counterparts are discussed.
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Affiliation(s)
- Cristina Pizzimenti
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Italy
| | - Francesca Gianno
- Department of Radiological, Oncological and Pathological sciences, University of Rome “la Sapienza”Rome Italy
| | - Marco Gessi
- Neuropathology Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy,Correspondence Marco Gessi Neuropathology Unit, Div. of Pathology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore Largo A. Gemelli 8, 00168 Roma, Italy Tel.: +39-06-30154433 E-mail: ;
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23
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Maehara T, Yamazaki A, Nakano Y, Nakata S, Fukuoka K, Deguchi S, Mitsuya K, Hayashi N, Oishi T, Kakuda Y, Sugino T, Ichimura K, Yokoo H, Nobusawa S. Exophytic cerebellopontine angle tumor showing mostly an embryonal appearance with H3-3A K27M. Neuropathology 2022; 43:200-206. [PMID: 36221932 DOI: 10.1111/neup.12873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/22/2022] [Accepted: 09/25/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Tatsuro Maehara
- Department of Human Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Ayako Yamazaki
- Department of Human Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoshiko Nakano
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan.,Department of Pediatrics, The University of Tokyo, Tokyo, Japan
| | - Satoshi Nakata
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kohei Fukuoka
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Shoichi Deguchi
- Division of Neurosurgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Koichi Mitsuya
- Division of Neurosurgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Nakamasa Hayashi
- Division of Neurosurgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Takuma Oishi
- Division of Pathology, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Yuko Kakuda
- Division of Pathology, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Takashi Sugino
- Division of Pathology, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Koichi Ichimura
- Department of Brain Disease Translational Research, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hideaki Yokoo
- Department of Human Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Sumihito Nobusawa
- Department of Human Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
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24
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Goh JY, Kuick CH, Sugiura M, Aw SJ, Zhao M, Tang H, Gunaratne S, Zhu F, Cai L, Teh BT, Thorner PS, Chang KTE. Paediatric
BCOR
‐associated sarcomas with a novel long spliced internal tandem duplication of
BCOR
exon 15. J Pathol Clin Res 2022; 8:470-480. [PMID: 35836306 PMCID: PMC9353662 DOI: 10.1002/cjp2.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/14/2022] [Accepted: 06/22/2022] [Indexed: 11/08/2022]
Abstract
Clear cell sarcoma of the kidney (CCSK) and primitive myxoid mesenchymal tumour of infancy (PMMTI) are paediatric sarcomas that most commonly harbour internal tandem duplications (ITDs) of exon 15 of the BCOR gene, in the range of 87–114 base pairs (bp). Some cases, instead, have BCOR‐CCNB3 or YWHAE‐NUTM2 gene fusions. About 10% of cases lack any of these genetic alterations when tested by standard methods. Two cases of CCSK and one PMMTI lacking the aforementioned mutations were analysed using Archer FusionPlex technology. Two related BCOR exon 15 RNA transcripts with ITDs of lengths 388 and 96 bp were detected in each case; only the 388 bp transcript was identified when genomic DNA was sequenced. In silico analysis of this transcript revealed acceptor and donor splice sites indicating that, at the RNA level, the 388‐bp transcript was likely spliced to form the 96‐bp transcript. The results were confirmed by Sanger sequencing using primers targeting the ITD breakpoint. This novel and unusually long ITD segment is difficult to identify by DNA sequencing using typical primer design strategies flanking entire duplicated segments because it exceeds the typical read lengths of most sequencing platforms as well as the usual fragment lengths obtained from formalin‐fixed paraffin‐embedded material. As diagnosis of CCSK and PMMTI may be challenging by morphology and immunohistochemistry alone, it is important to identify mutations in these cases. Knowledge of this novel BCOR ITD is important in relation to primer design for detection by sequencing, and using RNA versus DNA for sequencing.
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Affiliation(s)
- Jian Yuan Goh
- Department of Pathology and Laboratory Medicine KK Women's and Children's Hospital Singapore
- Pathology Academic Clinical Programme SingHealth Duke‐NUS Medical School Singapore
| | - Chik Hong Kuick
- Department of Pathology and Laboratory Medicine KK Women's and Children's Hospital Singapore
| | - Masahiro Sugiura
- Department of Pathology and Laboratory Medicine KK Women's and Children's Hospital Singapore
| | - Sze Jet Aw
- Department of Pathology and Laboratory Medicine KK Women's and Children's Hospital Singapore
| | - Manli Zhao
- Department of Pathology The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health Hangzhou PR China
| | - Hongfeng Tang
- Department of Pathology The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health Hangzhou PR China
| | - Sandini Gunaratne
- Department of Pathology Lady Ridgeway Hospital for Children Colombo Sri Lanka
| | - Fucun Zhu
- Department of Pathology Fuzhou Children's Hospital of Fujian Province Fuzhou PR China
| | - Lin Cai
- Department of Pathology Fuzhou Children's Hospital of Fujian Province Fuzhou PR China
| | - Bin Tean Teh
- Laboratory of Cancer Epigenome National Cancer Centre Singapore Singapore
- Cancer and Stem Cell Biology Programme Duke‐NUS Medical School Singapore
| | - Paul S Thorner
- Department of Laboratory Medicine and Pathobiology University of Toronto Toronto ON Canada
| | - Kenneth Tou En Chang
- Department of Pathology and Laboratory Medicine KK Women's and Children's Hospital Singapore
- Pathology Academic Clinical Programme SingHealth Duke‐NUS Medical School Singapore
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25
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2021 WHO classification of tumours of the central nervous system: a review for the neuroradiologist. Neuroradiology 2022; 64:1919-1950. [DOI: 10.1007/s00234-022-03008-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/01/2022] [Indexed: 10/17/2022]
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26
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Kurokawa R, Kurokawa M, Baba A, Ota Y, Pinarbasi E, Camelo-Piragua S, Capizzano AA, Liao E, Srinivasan A, Moritani T. Major Changes in 2021 World Health Organization Classification of Central Nervous System Tumors. Radiographics 2022; 42:1474-1493. [PMID: 35802502 DOI: 10.1148/rg.210236] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The World Health Organization (WHO) published the fifth edition of the WHO Classification of Tumors of the Central Nervous System (WHO CNS5) in 2021, as an update of the WHO central nervous system (CNS) classification system published in 2016. WHO CNS5 was drafted on the basis of recommendations from the Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy (cIMPACT-NOW) and expounds the classification scheme of the previous edition, which emphasized the importance of genetic and molecular changes in the characteristics of CNS tumors. Multiple newly recognized tumor types, including those for which there is limited knowledge regarding neuroimaging features, are detailed in WHO CNS5. The authors describe the major changes introduced in WHO CNS5, including revisions to tumor nomenclature. For example, WHO grade IV tumors in the fourth edition are equivalent to CNS WHO grade 4 tumors in the fifth edition, and diffuse midline glioma, H3 K27M-mutant, is equivalent to midline glioma, H3 K27-altered. With regard to tumor typing, isocitrate dehydrogenase (IDH)-mutant glioblastoma has been modified to IDH-mutant astrocytoma. In tumor grading, IDH-mutant astrocytomas are now graded according to the presence or absence of homozygous CDKN2A/B deletion. Moreover, the molecular mechanisms of tumorigenesis, as well as the clinical characteristics and imaging features of the tumor types newly recognized in WHO CNS5, are summarized. Given that WHO CNS5 has become the foundation for daily practice, radiologists need to be familiar with this new edition of the WHO CNS tumor classification system. Online supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article. ©RSNA, 2022.
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Affiliation(s)
- Ryo Kurokawa
- From the Division of Neuroradiology, Department of Radiology (R.K., M.K., A.B., Y.O., A.A.C., E.L., A.S., T.M.) and Department of Pathology (E.P., S.C.P.), Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (R.K., M.K.)
| | - Mariko Kurokawa
- From the Division of Neuroradiology, Department of Radiology (R.K., M.K., A.B., Y.O., A.A.C., E.L., A.S., T.M.) and Department of Pathology (E.P., S.C.P.), Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (R.K., M.K.)
| | - Akira Baba
- From the Division of Neuroradiology, Department of Radiology (R.K., M.K., A.B., Y.O., A.A.C., E.L., A.S., T.M.) and Department of Pathology (E.P., S.C.P.), Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (R.K., M.K.)
| | - Yoshiaki Ota
- From the Division of Neuroradiology, Department of Radiology (R.K., M.K., A.B., Y.O., A.A.C., E.L., A.S., T.M.) and Department of Pathology (E.P., S.C.P.), Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (R.K., M.K.)
| | - Emile Pinarbasi
- From the Division of Neuroradiology, Department of Radiology (R.K., M.K., A.B., Y.O., A.A.C., E.L., A.S., T.M.) and Department of Pathology (E.P., S.C.P.), Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (R.K., M.K.)
| | - Sandra Camelo-Piragua
- From the Division of Neuroradiology, Department of Radiology (R.K., M.K., A.B., Y.O., A.A.C., E.L., A.S., T.M.) and Department of Pathology (E.P., S.C.P.), Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (R.K., M.K.)
| | - Aristides A Capizzano
- From the Division of Neuroradiology, Department of Radiology (R.K., M.K., A.B., Y.O., A.A.C., E.L., A.S., T.M.) and Department of Pathology (E.P., S.C.P.), Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (R.K., M.K.)
| | - Eric Liao
- From the Division of Neuroradiology, Department of Radiology (R.K., M.K., A.B., Y.O., A.A.C., E.L., A.S., T.M.) and Department of Pathology (E.P., S.C.P.), Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (R.K., M.K.)
| | - Ashok Srinivasan
- From the Division of Neuroradiology, Department of Radiology (R.K., M.K., A.B., Y.O., A.A.C., E.L., A.S., T.M.) and Department of Pathology (E.P., S.C.P.), Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (R.K., M.K.)
| | - Toshio Moritani
- From the Division of Neuroradiology, Department of Radiology (R.K., M.K., A.B., Y.O., A.A.C., E.L., A.S., T.M.) and Department of Pathology (E.P., S.C.P.), Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (R.K., M.K.)
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Wang R, Guan W, Qiao M, Zhang Y, Zhang M, Wang K, Wang Y, Wang L. CNS tumor with BCOR internal tandem duplication: clinicopathologic, molecular characteristics and prognosis factors. Pathol Res Pract 2022; 236:153995. [DOI: 10.1016/j.prp.2022.153995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/19/2022] [Accepted: 06/22/2022] [Indexed: 12/01/2022]
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Bouchoucha Y, Tauziède-Espariat A, Gauthier A, Guillemot D, Bochaton D, Vibert J, Carton M, Watson S, Grossetête S, Quignot C, Orbach D, Corradini N, Schleiermacher G, Bourdeaut F, Simbozel M, Dufour C, Minard-Colin V, Brahmi M, Tirode F, Pissaloux D, Karanian M, Machet MC, Masliah-Planchon J, Delattre O, Cardoen L, Pierron G, Doz F. Intra- and extra-cranial BCOR-ITD tumours are separate entities within the BCOR-rearranged family. JOURNAL OF PATHOLOGY CLINICAL RESEARCH 2022; 8:217-232. [PMID: 35174661 PMCID: PMC8977275 DOI: 10.1002/cjp2.255] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 12/03/2021] [Accepted: 12/09/2021] [Indexed: 01/07/2023]
Abstract
BCOR-ITD tumours form an emerging family of aggressive entities with an internal tandem duplication (ITD) in the last exon of the BCOR gene. The family includes cerebral tumours, termed central nervous system BCOR-ITD (CNS BCOR-ITD), and sarcomatous types described in the kidney as clear cell sarcoma of the kidney (CCSK), in the endometrium as high-grade endometrial stromal sarcoma, and in the bone and soft tissue as undifferentiated round cell sarcoma or primitive myxoid mesenchymal tumour of infancy. Based on a series of 33 retrospective cases, including 10 CNS BCOR-ITD and 23 BCOR-ITD sarcomas, we interrogated the homogeneity of the entity regarding clinical, radiological, and histopathological findings, and molecular signatures. Whole-transcriptomic sequencing and DNA methylation profiling were used for unsupervised clustering. BCOR-ITD tumours mostly affected young children with a median age at diagnosis of 2.1 years (range 0-62.4). Median overall survival was 3.9 years and progression-free survival was 1.4 years. This dismal prognosis is shared among tumours in all locations except CCSK. Histopathological review revealed marked differences between CNS BCOR-ITD and BCOR-ITD sarcomas. These two groups were consistently segregated by unsupervised clustering of expression (n = 22) and DNA methylation (n = 21) data. Proximity between the two groups may result from common somatic changes within key pathways directly related to the novel activity of the ITD itself. Conversely, comparison of gene signatures with single-cell RNA-Seq atlases suggests that the distinction between BCOR-ITD sarcomas and CNS BCOR-ITD may result from differences in cells of origin.
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Affiliation(s)
- Yassine Bouchoucha
- SIREDO Oncology Center of Care, Innovation and Research for Children, Adolescent and Young Adults with Cancer, Institut Curie, Paris, France.,Université de Paris, Paris, France
| | - Arnault Tauziède-Espariat
- Université de Paris, Paris, France.,Department of Neuropathology, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France.,Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, INSERM, IMA-BRAIN, Paris, France
| | | | | | - Dorian Bochaton
- Laboratory of Genetics and Biology of Cancer, INSERM U830, Paris, France
| | - Julien Vibert
- Laboratory of Genetics and Biology of Cancer, INSERM U830, Paris, France
| | | | - Sarah Watson
- Laboratory of Genetics and Biology of Cancer, INSERM U830, Paris, France.,Medical Oncology Department, Institut Curie, Paris, France
| | | | - Chloé Quignot
- Laboratory of Genetics and Biology of Cancer, INSERM U830, Paris, France
| | - Daniel Orbach
- SIREDO Oncology Center of Care, Innovation and Research for Children, Adolescent and Young Adults with Cancer, Institut Curie, Paris, France
| | - Nadège Corradini
- Institute of Pediatric Hematology and Oncology IHOPE, Centre Leon Berard, Lyon, France
| | - Gudrun Schleiermacher
- SIREDO Oncology Center of Care, Innovation and Research for Children, Adolescent and Young Adults with Cancer, Institut Curie, Paris, France.,Laboratory of Genetics and Biology of Cancer, INSERM U830, Paris, France
| | - Franck Bourdeaut
- SIREDO Oncology Center of Care, Innovation and Research for Children, Adolescent and Young Adults with Cancer, Institut Curie, Paris, France.,Laboratory of Genetics and Biology of Cancer, INSERM U830, Paris, France
| | - Marie Simbozel
- Department of Pediatric and Adolescent Oncology, INSERM 1015, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Christelle Dufour
- Department of Pediatric and Adolescent Oncology, INSERM 1015, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Véronique Minard-Colin
- Department of Pediatric and Adolescent Oncology, INSERM 1015, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Mehdi Brahmi
- Genetics Epigenetics and Biology of Sarcomas Team, Claude Bernard University Lyon 1, INSERM 1052, CNRS 5286, Cancer Research Center of Lyon, Centre Léon Bérard, Lyon, France.,Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Franck Tirode
- Genetics Epigenetics and Biology of Sarcomas Team, Claude Bernard University Lyon 1, INSERM 1052, CNRS 5286, Cancer Research Center of Lyon, Centre Léon Bérard, Lyon, France
| | - Daniel Pissaloux
- Genetics Epigenetics and Biology of Sarcomas Team, Claude Bernard University Lyon 1, INSERM 1052, CNRS 5286, Cancer Research Center of Lyon, Centre Léon Bérard, Lyon, France.,Department of Biopathology, Centre Léon Bérard, Lyon, France
| | - Marie Karanian
- Genetics Epigenetics and Biology of Sarcomas Team, Claude Bernard University Lyon 1, INSERM 1052, CNRS 5286, Cancer Research Center of Lyon, Centre Léon Bérard, Lyon, France.,Department of Biopathology, Centre Léon Bérard, Lyon, France
| | | | | | - Olivier Delattre
- SIREDO Oncology Center of Care, Innovation and Research for Children, Adolescent and Young Adults with Cancer, Institut Curie, Paris, France.,Department of Somatic Genetics, Institut Curie, Paris, France.,Laboratory of Genetics and Biology of Cancer, INSERM U830, Paris, France
| | | | - Gaëlle Pierron
- Department of Somatic Genetics, Institut Curie, Paris, France
| | - François Doz
- SIREDO Oncology Center of Care, Innovation and Research for Children, Adolescent and Young Adults with Cancer, Institut Curie, Paris, France.,Université de Paris, Paris, France
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Molecular Markers of Pediatric Solid Tumors—Diagnosis, Optimizing Treatments, and Determining Susceptibility: Current State and Future Directions. Cells 2022; 11:cells11071238. [PMID: 35406801 PMCID: PMC8997439 DOI: 10.3390/cells11071238] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/26/2022] [Accepted: 03/29/2022] [Indexed: 02/04/2023] Open
Abstract
Advances in molecular technologies, from genomics and transcriptomics to epigenetics, are providing unprecedented insight into the molecular landscape of pediatric tumors. Multi-omics approaches provide an opportunity to identify a wide spectrum of molecular alterations that account for the initiation of the neoplastic process in children, response to treatment and disease progression. The detection of molecular markers is crucial to assist clinicians in accurate tumor diagnosis, risk stratification, disease subtyping, prediction of treatment response, and surveillance, allowing also for personalized cancer management. This review summarizes the most recent developments in genomics research and their relevance to the field of pediatric oncology with the aim of generating an overview of the most important, from the clinical perspective, molecular markers for pediatric solid tumors. We present an overview of the molecular markers selected based on therapeutic protocols, guidelines from international committees and scientific societies, and published data.
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30
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Meredith DM, Alexandrescu S. Embryonal and non-meningothelial mesenchymal tumors of the central nervous system - Advances in diagnosis and prognostication. Brain Pathol 2022; 32:e13059. [PMID: 35266242 PMCID: PMC9245947 DOI: 10.1111/bpa.13059] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/08/2022] [Accepted: 02/16/2022] [Indexed: 12/31/2022] Open
Abstract
The 5th edition of the WHO Classification of Tumours of the Central Nervous System introduces new entities, and provides updated guidance regarding the diagnostic criteria for tumors of the central nervous system (CNS). CNS embryonal tumors and CNS non‐meningothelial mesenchymal tumors can be challenging for practicing pathologists, as the histologic features are not always specific to a particular entity, and integration of microscopic and molecular findings is necessary. This review on CNS embryonal and non‐meningothelial mesenchymal tumors is meant to provide an update with a focus on WHO changes and additions and on recent discoveries with diagnostic, prognostic, and therapeutic implications.
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Affiliation(s)
- David M Meredith
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sanda Alexandrescu
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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31
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Cotter JA, Judkins AR. Evaluation and Diagnosis of Central Nervous System Embryonal Tumors (Non-Medulloblastoma). Pediatr Dev Pathol 2022; 25:34-45. [PMID: 35168419 DOI: 10.1177/10935266211018554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Since the 1990s, the sheer number of defined central nervous system (CNS) embryonal tumor entities has continuously increased, with the trend accelerating in the most recent editions of the World Health Organization (WHO) Classification of Tumours of the CNS. The introduction of increasingly specific tumor groups is an effort to create more internally homogeneous categories, to allow more precise prognostication, and potentially to develop targeted therapies. However, these ever-smaller categories within an already rare group of tumors pose a challenge for pediatric pathologists. In this article we review the current categorization of non-medulloblastoma CNS embryonal tumors (including atypical teratoid/rhabdoid tumor, cribriform neuroepithelial tumor, embryonal tumor with multilayered rosettes, CNS neuroblastoma, FOXR2-activated, and CNS tumor with BCOR internal tandem duplication) and provide an overview of available ancillary techniques to characterize these tumors. We provide a practical approach to workup and development of an integrated diagnosis for CNS embryonal tumors.
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Affiliation(s)
- Jennifer A Cotter
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Alexander R Judkins
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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32
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Cardoen L, Tauziède-Espariat A, Dangouloff-Ros V, Moalla S, Nicolas N, Roux CJ, Bouchoucha Y, Bourdeaut F, Beccaria K, Bolle S, Pierron G, Dufour C, Doz F, Boddaert N, Brisse H. Imaging Features with Histopathologic Correlation of CNS High-Grade Neuroepithelial Tumors with a BCOR Internal Tandem Duplication. AJNR Am J Neuroradiol 2022; 43:151-156. [PMID: 34887247 PMCID: PMC8757552 DOI: 10.3174/ajnr.a7367] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/27/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE A new brain tumor entity occurring in early childhood characterized by a somatic BCL6 corepressor gene internal tandem duplication was recently described. The aim of this study was to describe the radiologic pattern of these tumors and correlate this pattern with histopathologic findings. MATERIALS AND METHODS This retrospective, noninterventional study included 10 children diagnosed with a CNS tumor, either by ribonucleic acid-sequencing analysis or deoxyribonucleic acid methylation analysis. Clinical, radiologic, and histopathologic data were collected. A neuropathologist reviewed 9 tumor samples. Preoperative images were analyzed in consensus by 7 pediatric radiologists. RESULTS All tumors were relatively large (range, 4.7-9.2 cm) intra-axial peripheral masses with well-defined borders and no peritumoral edema. All tumors showed mild and heterogeneous enhancement and marked restriction on DWI of the solid portions. Perfusion imaging showed a relatively lower CBF in the tumor than in the adjacent normal parenchyma. Nine of 10 tumors showed areas of necrosis, with the presence of hemorrhage in 8/10 and calcifications in 4/7. Large intratumoral macroscopic veins were observed in 9/10 patients. No intracranial or spinal leptomeningeal dissemination was noted at diagnosis. CONCLUSIONS CNS tumors with a BCL6 corepressor gene internal tandem duplication present as large intra-axial peripheral masses with well-defined borders, no edema, restricted diffusion, weak contrast enhancement, frequent central necrosis, hemorrhage and calcifications, intratumoral veins, and no leptomeningeal dissemination at the time of diagnosis. Knowledge of these imaging characteristics may aid in histologic, genomic, and molecular profiling of brain tumors in young children.
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Affiliation(s)
- L. Cardoen
- From the Imaging Department (L.C., N.N., H.J.B.)
| | - A. Tauziède-Espariat
- Department of Neuropathology (A.T.-E.), Centre Hospitalier Sainte Anne, Paris, France
| | - V. Dangouloff-Ros
- Pediatric Radiology Department (V.D.-R., C.-J.R., N.B.), Assistance Publique–Hôpitaux de Paris, Hôpital Universitaire Necker-Enfants Malades, Paris, France,Institut Imagine (V.D.-R., N.B.), Université de Paris, Unité Médicale de Recherche (UMR) 1163, Paris, France,Université de Paris (V.D.-R., K.B., F.D., N.B.), Institut National de la Santé et de la Recherche Médicale, ERL UA10, Paris, France
| | | | - N. Nicolas
- From the Imaging Department (L.C., N.N., H.J.B.)
| | - C.-J. Roux
- Pediatric Radiology Department (V.D.-R., C.-J.R., N.B.), Assistance Publique–Hôpitaux de Paris, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Y. Bouchoucha
- SIREDO Oncology Center Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer (Y.B., F.B., F.D.)
| | - F. Bourdeaut
- SIREDO Oncology Center Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer (Y.B., F.B., F.D.)
| | - K. Beccaria
- Department of Neurosurgery (K.B.),Université de Paris (V.D.-R., K.B., F.D., N.B.), Institut National de la Santé et de la Recherche Médicale, ERL UA10, Paris, France
| | | | - G. Pierron
- Department of Biopathology and Genetics (G.P.), Institut Curie, Paris, France
| | - C. Dufour
- Paediatric and Adolescent Oncology (C.D.), Gustave Roussy, Villejuif, France
| | - F. Doz
- SIREDO Oncology Center Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer (Y.B., F.B., F.D.),Université de Paris (V.D.-R., K.B., F.D., N.B.), Institut National de la Santé et de la Recherche Médicale, ERL UA10, Paris, France
| | - N. Boddaert
- Pediatric Radiology Department (V.D.-R., C.-J.R., N.B.), Assistance Publique–Hôpitaux de Paris, Hôpital Universitaire Necker-Enfants Malades, Paris, France,Institut Imagine (V.D.-R., N.B.), Université de Paris, Unité Médicale de Recherche (UMR) 1163, Paris, France,Université de Paris (V.D.-R., K.B., F.D., N.B.), Institut National de la Santé et de la Recherche Médicale, ERL UA10, Paris, France
| | - H.J. Brisse
- From the Imaging Department (L.C., N.N., H.J.B.),Université Paris Saclay (H.J.B.), Institut National de la Santé et de la Recherche Médicale, LITO U1288, Orsay, France
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Pratt D, Sahm F, Aldape K. DNA methylation profiling as a model for discovery and precision diagnostics in neuro-oncology. Neuro Oncol 2021; 23:S16-S29. [PMID: 34725697 PMCID: PMC8561128 DOI: 10.1093/neuonc/noab143] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Recent years have witnessed a shift to more objective and biologically-driven methods for central nervous system (CNS) tumor classification. The 2016 world health organization (WHO) classification update ("blue book") introduced molecular diagnostic criteria into the definitions of specific entities as a response to the plethora of evidence that key molecular alterations define distinct tumor types and are clinically meaningful. While in the past such diagnostic alterations included specific mutations, copy number changes, or gene fusions, the emergence of DNA methylation arrays in recent years has similarly resulted in improved diagnostic precision, increased reliability, and has provided an effective framework for the discovery of new tumor types. In many instances, there is an intimate relationship between these mutations/fusions and DNA methylation signatures. The adoption of methylation data into neuro-oncology nosology has been greatly aided by the availability of technology compatible with clinical diagnostics, along with the development of a freely accessible machine learning-based classifier. In this review, we highlight the utility of DNA methylation profiling in CNS tumor classification with a focus on recently described novel and rare tumor types, as well as its contribution to refining existing types.
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Affiliation(s)
- Drew Pratt
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Felix Sahm
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Kenneth Aldape
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
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34
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Tauziède-Espariat A, Pierron G, Guillemot D, Bochaton D, Watson S, Masliah-Planchon J, Vasiljevic A, Meurgey A, Chotard G, Hasty L, Wahler E, Lechapt E, Chrétien F, Grill J, Bourdeaut F, Bouchoucha Y, Puget S, Icher-de-Bouyn C, Jecko V, Cardoen L, Dangouloff-Ros V, Boddaert N, Varlet P. CNS tumors with YWHAE:NUTM2 and KDM2B-fusions present molecular similarities to extra-CNS tumors having BCOR internal tandem duplication or alternative fusions. Acta Neuropathol Commun 2021; 9:176. [PMID: 34717763 PMCID: PMC8557563 DOI: 10.1186/s40478-021-01279-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/17/2021] [Indexed: 05/31/2023] Open
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35
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Tauziède-Espariat A, Siegfried A, Nicaise Y, Kergrohen T, Sievers P, Vasiljevic A, Roux A, Dezamis E, Benevello C, Machet MC, Michalak S, Puiseux C, Llamas-Gutierrez F, Leblond P, Bourdeaut F, Grill J, Dufour C, Guerrini-Rousseau L, Abbou S, Dangouloff-Ros V, Boddaert N, Saffroy R, Hasty L, Wahler E, Pagès M, Andreiuolo F, Lechapt E, Chrétien F, Blauwblomme T, Beccaria K, Pallud J, Puget S, Uro-Coste E, Varlet P. Supratentorial non-RELA, ZFTA-fused ependymomas: a comprehensive phenotype genotype correlation highlighting the number of zinc fingers in ZFTA-NCOA1/2 fusions. Acta Neuropathol Commun 2021; 9:135. [PMID: 34389065 PMCID: PMC8362233 DOI: 10.1186/s40478-021-01238-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/05/2021] [Indexed: 12/11/2022] Open
Abstract
The cIMPACT-NOW Update 7 has replaced the WHO nosology of “ependymoma, RELA fusion positive” by “Supratentorial-ependymoma, C11orf95-fusion positive”. This modification reinforces the idea that supratentorial-ependymomas exhibiting fusion that implicates the C11orf95 (now called ZFTA) gene with or without the RELA gene, represent the same histomolecular entity. A hot off the press molecular study has identified distinct clusters of the DNA methylation class of ZFTA fusion-positive tumors. Interestingly, clusters 2 and 4 comprised tumors of different morphologies, with various ZFTA fusions without involvement of RELA. In this paper, we present a detailed series of thirteen cases of non-RELA ZFTA-fused supratentorial tumors with extensive clinical, radiological, histopathological, immunohistochemical, genetic and epigenetic (DNA methylation profiling) characterization. Contrary to the age of onset and MRI aspects similar to RELA fusion-positive EPN, we noted significant histopathological heterogeneity (pleomorphic xanthoastrocytoma-like, astroblastoma-like, ependymoma-like, and even sarcoma-like patterns) in this cohort. Immunophenotypically, these NFκB immunonegative tumors expressed GFAP variably, but EMA constantly and L1CAM frequently. Different gene partners were fused with ZFTA: NCOA1/2, MAML2 and for the first time MN1. These tumors had epigenetic homologies within the DNA methylation class of ependymomas-RELA and were classified as satellite clusters 2 and 4. Cluster 2 (n = 9) corresponded to tumors with classic ependymal histological features (n = 4) but also had astroblastic features (n = 5). Various types of ZFTA fusions were associated with cluster 2, but as in the original report, ZFTA:MAML2 fusion was frequent. Cluster 4 was enriched with sarcoma-like tumors. Moreover, we reported a novel anatomy of three ZFTA:NCOA1/2 fusions with only 1 ZFTA zinc finger domain in the putative fusion protein, whereas all previously reported non-RELA ZFTA fusions have 4 ZFTA zinc fingers. All three cases presented a sarcoma-like morphology. This genotype/phenotype association requires further studies for confirmation. Our series is the first to extensively characterize this new subset of supratentorial ZFTA-fused ependymomas and highlights the usefulness of ZFTA FISH analysis to confirm the existence of a rearrangement without RELA abnormality.
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Al-Ibraheemi A, Putra J, Tsai HK, Cano S, Lip V, Pinches RS, Restrepo T, Alexandrescu S, Janeway KA, Duraisamy S, Harris MH, Church AJ. Assessment of BCOR Internal Tandem Duplications in Pediatric Cancers by Targeted RNA Sequencing. J Mol Diagn 2021; 23:1269-1278. [PMID: 34325058 DOI: 10.1016/j.jmoldx.2021.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/02/2021] [Accepted: 07/01/2021] [Indexed: 01/07/2023] Open
Abstract
Alterations in the BCOR gene, including internal tandem duplications (ITDs) of exon 15 have emerged as important oncogenic changes that define several diagnostic entities. In pediatric cancers, BCOR ITDs have recurrently been described in clear cell sarcoma of kidney (CCSK), primitive myxoid mesenchymal tumor of infancy (PMMTI), and central nervous system high-grade neuroepithelial tumor with BCOR ITD in exon 15 (HGNET-BCOR ITDex15). In adults, BCOR ITDs are also reported in endometrial and other sarcomas. The utility of multiplex targeted RNA sequencing for the identification of BCOR ITD in pediatric cancers was investigated. All available archival cases of CCSK, PMMTI, and HGNET-BCOR ITDex15 were collected. Each case underwent anchored multiplex PCR library preparation with a custom-designed panel, with BCOR targeted for both fusions and ITDs. BCOR ITD was detected in all cases across three histologic subtypes using the RNA panel, with no other fusions identified in any of the cases. All BCOR ITDs occurred in the final exon, within 16 codons from the stop sequence. Multiplex targeted RNA sequencing from formalin-fixed, paraffin-embedded tissue is successful at identifying BCOR internal tandem duplications. This analysis supports the use of anchored multiplex PCR targeted RNA next-generation sequencing panels for identification of BCOR ITDs in pediatric tumors. The use of post-analytic algorithms to improve the detection of BCOR ITD using DNA panels was also explored.
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Affiliation(s)
- Alyaa Al-Ibraheemi
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Juan Putra
- Division of Pathology, Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Harrison K Tsai
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Samantha Cano
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Va Lip
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - R Seth Pinches
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Tamara Restrepo
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sanda Alexandrescu
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Katherine A Janeway
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Sekhar Duraisamy
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Marian H Harris
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Alanna J Church
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
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Mardi L, Tauziède-Espariat A, Guillemot D, Pierron G, Gigant P, Mehdi L, Berthaud C, Pucelle N, Lacombe J, Hasty L, Wahler E, Chrétien F, Lechapt E, Varlet P. Bcor Immunohistochemistry, And Not SATB2, Is A Sensitive And Specific Diagnostic Biomarker For Cns Tumors With BCOR Internal Tandem Duplication. Histopathology 2021; 79:891-894. [PMID: 34196010 DOI: 10.1111/his.14439] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/24/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022]
Abstract
Central nervous system (CNS) tumors with the BCOR (BCL6 Corepressor) internal tandem duplication (ITD) were recently isolated by a DNA-methylation profile from a series of primitive neuroectodermal tumors [1]. They are mainly characterized by a recurrent BCOR ITD and express BCOR by immunohistochemistry (IHC) [2]. In rare cases, they present an EP300-BCOR fusion inducing the absence of expression of BCOR by IHC [3]. In soft tissue and kidney tumors with different types of BCOR alterations, SATB2 has been considered a diagnostic hallmark and BCOR IHC is not highly specific in some other contexts (soft tissue and uterine tumors) [4]. In a recent paper, SATB2 immunoexpression has been evidenced in one CNS-tumor with proven BCOR ITD [5]. The aim of our study was to evaluate the sensitivity and specificity of the BCOR and SATB2 immunostainings in a large cohort of pediatric CNS tumors.
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Affiliation(s)
- L Mardi
- Department of Neuropathology, GHU Paris-Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
| | - A Tauziède-Espariat
- Department of Neuropathology, GHU Paris-Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France.,Institute of Psychiatry and Neurosciences de Paris (IPNP), UMR S1266, INSERM, IMA-BRAIN, Paris, France.,Université de Paris, Paris, France
| | - D Guillemot
- Curie Institute Hospital, Laboratory of Somatic Genetics, Paris, France
| | - G Pierron
- Curie Institute Hospital, Laboratory of Somatic Genetics, Paris, France.,Paris-Sciences-Lettres, Curie Institute Research Center, INSERMU830, Paris, France
| | - P Gigant
- Department of Neuropathology, GHU Paris-Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
| | - L Mehdi
- Department of Neuropathology, GHU Paris-Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
| | - C Berthaud
- Department of Neuropathology, GHU Paris-Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
| | - N Pucelle
- Department of Neuropathology, GHU Paris-Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
| | - J Lacombe
- Department of Neuropathology, GHU Paris-Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
| | - L Hasty
- Department of Neuropathology, GHU Paris-Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
| | - E Wahler
- Department of Neuropathology, GHU Paris-Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
| | - F Chrétien
- Department of Neuropathology, GHU Paris-Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France.,Université de Paris, Paris, France
| | - E Lechapt
- Department of Neuropathology, GHU Paris-Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France.,Université de Paris, Paris, France
| | - P Varlet
- Department of Neuropathology, GHU Paris-Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France.,Institute of Psychiatry and Neurosciences de Paris (IPNP), UMR S1266, INSERM, IMA-BRAIN, Paris, France.,Université de Paris, Paris, France
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38
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Targeted RNA expression profiling identifies high-grade endometrial stromal sarcoma as a clinically relevant molecular subtype of uterine sarcoma. Mod Pathol 2021; 34:1008-1016. [PMID: 33077922 DOI: 10.1038/s41379-020-00705-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 12/13/2022]
Abstract
High-grade endometrial stromal sarcoma (HGESS) may harbor YWHAE-NUTM2A/B fusion, ZC3H7B-BCOR fusion, and BCOR internal tandem duplication (ITD). NTRK3 upregulation and pan-Trk expression were reported in soft tissue lesions that share similar morphology and genetic abnormalities. To confirm these findings in HGESS, differential expression analysis was performed at gene level comparing 11 HGESS with 48 other uterine sarcomas, including 9 low-grade endometrial stromal sarcomas, 23 undifferentiated uterine sarcomas, and 16 leiomyosarcomas, using targeted RNA sequencing data. Pan-Trk immunohistochemistry was performed on 35 HGESS, including 10 tumors with RNA expression data, with genotypes previously confirmed by targeted RNA sequencing, fluorescence in situ hybridization, and/or genomic PCR. Unsupervised hierarchical clustering of the top 25% of differentially expressed probes identified three molecular groups: (1) high NTRK3, FGFR3, RET, BCOR, GLI1, and PTCH1 and low ESR1 expression; (2) low NTRK3, FGFR3, RET, BCOR, GLI1, and PTCH1 and high ESR1 expression; and (3) low NTRK3, FGFR3, RET, BCOR, GLI1, PTCH1, and ESR1 expression. Among HGESS, 64% of tumors clustered in group 1, while 27% clustered in group 2. Cytoplasmic and/or nuclear pan-Trk staining of variable extent and intensity was seen in 91% of HGESS regardless of cyclin D1 and/or BCOR positivity. ER and PR expression was seen in 44% of HGESS despite ESR1 downregulation. Two patients with ER and PR positive but ESR1 downregulated stage I HGESS were treated with endocrine therapy, and both recurred at 12 and 36 months after primary resection. By RNA expression, HGESS appear homogenous and distinct from other uterine sarcomas by activation of kinases, including NTRK3, and sonic hedgehog pathway genes along with downregulation of ESR1. Most HGESS demonstrate pan-Trk staining which may serve as a diagnostic biomarker. ESR1 downregulation is seen in some HGESS that express ER and PR which raises implications in the utility of endocrine therapy in these patients.
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Cai Z, Duncan D, Li R, Thomas J, Zhu H. BCOR-CCNB3 Sarcoma with Prominent Rhabdoid Cells Mimicking Rhabdomyoblasts: Expanding the Morphologic spectrum of BCOR-CCNB3 Sarcoma. Int J Surg Pathol 2021; 29:915-919. [PMID: 33909519 DOI: 10.1177/10668969211013891] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BCOR-CCNB3 sarcoma (BCS) is a rare recently defined undifferentiated sarcoma that predominantly affects children and young adults. The diagnosis of this tumor is difficult due to the highly variable morphology and nonspecific immunophenotype. Emerging data suggest that patients with BCS show response to Ewing sarcoma-based treatment regimen, thus correct diagnosis is of clinical relevance. In this study, we report a case of BCS arising from the big toe of a 15-year-old male patient. The tumor had a prominent population of rhabdoid cells with bright eosinophilic cytoplasm mimicking rhabdomyosarcoma. The tumor cells were focally positive for desmin and myogenin, and negative for CD99. Next-generation sequencing showed the presence of BCOR-CCNB3 gene fusion. BCS with prominent rhabdoid cells has not been described before. This study further expands the morphologic spectrum of BCS.
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Affiliation(s)
- Zhenjian Cai
- 12340University of Texas Health Science Center, McGovern Medical Center, Houston, TX, USA
| | - Darryl Duncan
- 12340University of Texas Health Science Center, McGovern Medical Center, Houston, TX, USA
| | - Rongying Li
- 12340University of Texas Health Science Center, McGovern Medical Center, Houston, TX, USA
| | - Jaiyeola Thomas
- 12340University of Texas Health Science Center, McGovern Medical Center, Houston, TX, USA
| | - Hui Zhu
- 12340University of Texas Health Science Center, McGovern Medical Center, Houston, TX, USA
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40
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Nakata S, Yuan M, Rubens JA, Kahlert UD, Maciaczyk J, Raabe EH, Eberhart CG. BCOR Internal Tandem Duplication Expression in Neural Stem Cells Promotes Growth, Invasion, and Expression of PRC2 Targets. Int J Mol Sci 2021; 22:ijms22083913. [PMID: 33920124 PMCID: PMC8070097 DOI: 10.3390/ijms22083913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/02/2021] [Accepted: 04/06/2021] [Indexed: 11/24/2022] Open
Abstract
Central nervous system tumor with BCL6-corepressor internal tandem duplication (CNS-BCOR ITD) is a malignant entity characterized by recurrent alterations in exon 15 encoding the essential binding domain for the polycomb repressive complex (PRC). In contrast to deletion or truncating mutations seen in other tumors, BCOR expression is upregulated in CNS-BCOR ITD, and a distinct oncogenic mechanism has been suggested. However, the effects of this change on the biology of neuroepithelial cells is poorly understood. In this study, we introduced either wildtype BCOR or BCOR-ITD into human and murine neural stem cells and analyzed them with quantitative RT-PCR and RNA-sequencing, as well as growth, clonogenicity, and invasion assays. In human cells, BCOR-ITD promoted derepression of PRC2-target genes compared to wildtype BCOR. A similar effect was found in clinical specimens from previous studies. However, no growth advantage was seen in the human neural stem cells expressing BCOR-ITD, and long-term models could not be established. In the murine cells, both wildtype BCOR and BCOR-ITD overexpression affected cellular differentiation and histone methylation, but only BCOR-ITD increased cellular growth, invasion, and migration. BCOR-ITD overexpression drives transcriptional changes, possibly due to altered PRC function, and contributes to the oncogenic transformation of neural precursors.
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Affiliation(s)
- Satoshi Nakata
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (S.N.); (M.Y.)
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (J.A.R.); (E.H.R.)
| | - Ming Yuan
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (S.N.); (M.Y.)
| | - Jeffrey A. Rubens
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (J.A.R.); (E.H.R.)
| | - Ulf D. Kahlert
- Neurosurgical Clinic, Medical Faculty, Heinrich-Heine University Duesseldorf, D-40225 Dusseldorf, Germany;
| | - Jarek Maciaczyk
- Department of Neurosurgery, University of Bonn, D-53127 Bonn, Germany;
| | - Eric H. Raabe
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (J.A.R.); (E.H.R.)
| | - Charles G. Eberhart
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (S.N.); (M.Y.)
- Correspondence:
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41
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Abstract
PURPOSE OF REVIEW This review aims to give an update on histopathological, molecular and clinical features of central nervous system (CNS) 'embryonal' tumors. RECENT FINDINGS The taxonomy of previously called 'CNS primitive neuroectodermal tumor' (CNS PNET) has been deeply modified since the discovery of specific molecular profiles for each various sub-entity of these rare, mainly pediatric, tumors. The term 'embryonal tumors' now refers to medulloblastomas, atypical teratoid rhabdoid tumors (AT/RT) and other rare entities, defined by their specific histopathological features together with expression-based or methylation-based profiling; specific gene mutations or fusions characterize some tumor types. In addition, the compilation of large series of molecular data has allowed to dissecting several of these tumor types in molecular subgroups, increasing the number of tumor entities, and leading to an amazingly complex nosology of rare-to-extremely rare malignancies. This rarity precludes from having strong evidence-based therapeutic recommendations, although international efforts are conducted to define the best treatment strategies. SUMMARY Embryonal tumors now correspond to molecularly well defined entities, which deserve further international collaborations to specify their biology and the appropriate burden of treatment, in order to minimize the long-term side-effects of treatment of these overall rare and severe diseases of childhood.
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42
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Ishi Y, Shimizu A, Takakuwa E, Sugiyama M, Okamoto M, Motegi H, Hirabayashi S, Cho Y, Iguchi A, Manabe A, Nobusawa S, Tanaka S, Yamaguchi S. High-grade neuroepithelial tumor with BCL6 corepressor-alteration presenting pathological and radiological calcification: A case report. Pathol Int 2021; 71:348-354. [PMID: 33713516 DOI: 10.1111/pin.13083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/24/2021] [Indexed: 11/30/2022]
Abstract
A 5-year-old girl presented with headache and vomiting. Head computed tomography and magnetic resonance imaging showed a right frontal lobe tumor with marked calcification. The patient underwent resection surgery with suspicion of anaplastic ependymoma, and the tumor was gross totally removed. Pathological examination revealed areas of dense tumor cells with a high nucleocytoplasmic ratio and myxoid areas consisting of tumor cells with a round-shaped nucleus and eosinophilic cytoplasm. Perivascular pseudorosette, necrosis, circumscribed growth, and microcalcification were also observed. Immunohistochemistry demonstrated negative staining for glial fibrillary protein and epithelial membrane antigen. Diagnosis of a high-grade neuroepithelial tumor (HGNET) with BCL6 corepressor (BCOR) alteration was made based on pathological findings and internal tandem duplication in the exon 15 of BCOR. Although calcification on radiological and pathological examination is not typical, it would be essential to recognize that calcification could appear in HGNET-BCOR.
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Affiliation(s)
- Yukitomo Ishi
- Department of Neurosurgery, Faculty of Medicine, Hokkaido University, Hokkaido, Japan
| | - Ai Shimizu
- Department of Surgical Pathology, Hokkaido University Hospital, Hokkaido, Japan
| | - Emi Takakuwa
- Department of Surgical Pathology, Hokkaido University Hospital, Hokkaido, Japan
| | - Minako Sugiyama
- Department of Pediatrics, Faculty of Medicine, Hokkaido University, Hokkaido, Japan
| | - Michinari Okamoto
- Department of Neurosurgery, Faculty of Medicine, Hokkaido University, Hokkaido, Japan
| | - Hiroaki Motegi
- Department of Neurosurgery, Faculty of Medicine, Hokkaido University, Hokkaido, Japan
| | - Shinsuke Hirabayashi
- Department of Pediatrics, Faculty of Medicine, Hokkaido University, Hokkaido, Japan
| | - Yuko Cho
- Department of Pediatrics, Faculty of Medicine, Hokkaido University, Hokkaido, Japan
| | - Akihiro Iguchi
- Department of Pediatrics, Faculty of Medicine, Hokkaido University, Hokkaido, Japan
| | - Atsushi Manabe
- Department of Pediatrics, Faculty of Medicine, Hokkaido University, Hokkaido, Japan
| | - Sumihito Nobusawa
- Department of Surgical Pathology and Department of Human Pathology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Shinya Tanaka
- Department of Cancer Pathology, Faculty of Medicine, Hokkaido University, Hokkaido, Japan.,WPI-ICReDD, Hokkaido University, Hokkaido, Japan
| | - Shigeru Yamaguchi
- Department of Neurosurgery, Faculty of Medicine, Hokkaido University, Hokkaido, Japan
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Hamline MY, Corcoran CM, Wamstad JA, Miletich I, Feng J, Lohr JL, Hemberger M, Sharpe PT, Gearhart MD, Bardwell VJ. OFCD syndrome and extraembryonic defects are revealed by conditional mutation of the Polycomb-group repressive complex 1.1 (PRC1.1) gene BCOR. Dev Biol 2020; 468:110-132. [PMID: 32692983 PMCID: PMC9583620 DOI: 10.1016/j.ydbio.2020.06.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/16/2020] [Accepted: 06/26/2020] [Indexed: 12/15/2022]
Abstract
BCOR is a critical regulator of human development. Heterozygous mutations of BCOR in females cause the X-linked developmental disorder Oculofaciocardiodental syndrome (OFCD), and hemizygous mutations of BCOR in males cause gestational lethality. BCOR associates with Polycomb group proteins to form one subfamily of the diverse Polycomb repressive complex 1 (PRC1) complexes, designated PRC1.1. Currently there is limited understanding of differing developmental roles of the various PRC1 complexes. We therefore generated a conditional exon 9-10 knockout Bcor allele and a transgenic conditional Bcor expression allele and used these to define multiple roles of Bcor, and by implication PRC1.1, in mouse development. Females heterozygous for Bcor exhibiting mosaic expression due to the X-linkage of the gene showed reduced postnatal viability and had OFCD-like defects. By contrast, Bcor hemizygosity in the entire male embryo resulted in embryonic lethality by E9.5. We further dissected the roles of Bcor, focusing on some of the tissues affected in OFCD through use of cell type specific Cre alleles. Mutation of Bcor in neural crest cells caused cleft palate, shortening of the mandible and tympanic bone, ectopic salivary glands and abnormal tongue musculature. We found that defects in the mandibular region, rather than in the palate itself, led to palatal clefting. Mutation of Bcor in hindlimb progenitor cells of the lateral mesoderm resulted in 2/3 syndactyly. Mutation of Bcor in Isl1-expressing lineages that contribute to the heart caused defects including persistent truncus arteriosus, ventricular septal defect and fetal lethality. Mutation of Bcor in extraembryonic lineages resulted in placental defects and midgestation lethality. Ubiquitous over expression of transgenic Bcor isoform A during development resulted in embryonic defects and midgestation lethality. The defects we have found in Bcor mutants provide insights into the etiology of the OFCD syndrome and how BCOR-containing PRC1 complexes function in development.
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Affiliation(s)
- Michelle Y Hamline
- The Molecular, Cellular, Developmental Biology and Genetics Graduate Program, University of Minnesota, Minneapolis, MN, 55455, USA; University of Minnesota Medical Scientist Training Program, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Connie M Corcoran
- Department of Genetics, Cell Biology and Development, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Joseph A Wamstad
- The Molecular, Cellular, Developmental Biology and Genetics Graduate Program, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Isabelle Miletich
- Centre for Craniofacial and Regenerative Biology, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, SE1 9RT, UK
| | - Jifan Feng
- Centre for Craniofacial and Regenerative Biology, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, SE1 9RT, UK
| | - Jamie L Lohr
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Myriam Hemberger
- Department of Biochemistry and Molecular Biology, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Paul T Sharpe
- Centre for Craniofacial and Regenerative Biology, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, SE1 9RT, UK; Medical Research Council Centre for Transplantation, King's College London, London, SE1 9RT, UK
| | - Micah D Gearhart
- Department of Genetics, Cell Biology and Development, University of Minnesota, Minneapolis, MN, 55455, USA; Developmental Biology Center, University of Minnesota, Minneapolis, MN, 55455, USA.
| | - Vivian J Bardwell
- Department of Genetics, Cell Biology and Development, University of Minnesota, Minneapolis, MN, 55455, USA; Developmental Biology Center, University of Minnesota, Minneapolis, MN, 55455, USA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN, 55455, USA.
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44
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Micci F, Heim S, Panagopoulos I. Molecular pathogenesis and prognostication of "low-grade'' and "high-grade" endometrial stromal sarcoma. Genes Chromosomes Cancer 2020; 60:160-167. [PMID: 33099834 PMCID: PMC7894482 DOI: 10.1002/gcc.22907] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/21/2020] [Indexed: 12/11/2022] Open
Abstract
Endometrial stromal sarcomas (ESS) are a heterogeneous group of rare mesenchymal cancers. Considerable knowledge has been gained in recent years about the molecular characteristics of these cancers, which helps to classify them in a more meaningful manner leading to improved diagnosis, prognostication, and treatment. According to this classification, ESS is now grouped as low‐ or high‐grade. ESS may have overlapping clinical presentation, morphology, and immunohistochemical profile. Their genetic characteristics allow subdivision of many of them depending on which pathogenetically important fusion genes they carry, but clearly much more needs to be unraveled in this regard. We here provide an overview of the molecular pathogenetic knowledge gained so far on low‐ and high‐grade ESS.
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Affiliation(s)
- Francesca Micci
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, Oslo, Norway
| | - Sverre Heim
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ioannis Panagopoulos
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, Oslo, Norway
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45
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Lopez-Nunez O, Cafferata B, Santi M, Ranganathan S, Pearce TM, Kulich SM, Bailey KM, Broniscer A, Rossi S, Zin A, Nasrallah MP, Li MM, Zhong Y, Miele E, Alaggio R, Surrey LF. The spectrum of rare central nervous system (CNS) tumors with EWSR1-non-ETS fusions: experience from three pediatric institutions with review of the literature. Brain Pathol 2020; 31:70-83. [PMID: 32997853 PMCID: PMC8018079 DOI: 10.1111/bpa.12900] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/02/2020] [Accepted: 09/14/2020] [Indexed: 12/11/2022] Open
Abstract
The group of CNS mesenchymal (non‐meningothelial) and primary glial/neuronal tumors in association with EWSR1‐non‐ETS rearrangements comprises a growing spectrum of entities, mostly reported in isolation with incomplete molecular profiling. Archival files from three pediatric institutions were queried for unusual cases of pediatric (≤21 years) CNS EWSR1‐rearranged tumors confirmed by at least one molecular technique. Extra‐axial tumors and cases with a diagnosis of Ewing sarcoma (EWSR1‐ETS family fusions) were excluded. Additional studies, including anchored multiplex‐PCR with next‐generation sequencing and DNA methylation profiling, were performed as needed to determine fusion partner status and brain tumor methylation class, respectively. Five cases (median 17 years) were identified (M:F of 3:2). Location was parenchymal (n = 3) and undetermined (n = 2) with topographic distributions including posterior fossa (n = 1), frontal (n = 1), temporal (n = 1), parietal (n = 1) and occipital (n = 1) lobes. Final designation with fusion findings included desmoplastic small round cell tumor (EWSR1‐WT1; n = 1) and tumors of uncertain histogenesis (EWSR1‐CREM, n = 1; EWSR1‐CREB1, n = 1; EWSR1‐PLAGL1, n = 1; and EWSR1‐PATZ1, n = 1). Tumors showed a wide spectrum of morphology and biologic behavior. For EWSR1‐CREM, EWSR1‐PLAGL1 and EWSR1‐PATZ1 tumors, no significant methylation scores were reached in the known brain tumor classes. Available outcome (4/5) was reported as favorable (n = 2) and unfavorable (n = 2) with a median follow‐up of 30 months. In conclusion, we describe five primary EWSR1‐non‐ETS fused CNS tumors exhibiting morphologic and biologic heterogeneity and we highlight the clinical importance of determining specific fusion partners to improve diagnostic accuracy, treatment and monitoring. Larger prospective clinicopathological and molecular studies are needed to determine the prognostic implications of histotypes, anatomical location, fusion partners, breakpoints and methylation profiles in patients with these rare tumors.
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Affiliation(s)
- Oscar Lopez-Nunez
- Department of Pathology and Laboratory Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.,Department of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Barbara Cafferata
- General Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Mariarita Santi
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Sarangarajan Ranganathan
- Department of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Thomas M Pearce
- Division of Neuropathology, Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Scott M Kulich
- Division of Neuropathology, Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Kelly M Bailey
- Division of Pediatric Hematology/Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Alberto Broniscer
- Division of Pediatric Hematology/Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Sabrina Rossi
- Department of Pathology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Angelica Zin
- Institute of Pediatric Research (IRP), Fondazione Città della Speranza, Padova, Italy
| | - MacLean P Nasrallah
- General Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Marilyn M Li
- General Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Yiming Zhong
- General Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Evelina Miele
- Department of Pediatric Onco-Hematology and Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rita Alaggio
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.,Department of Pathology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Lea F Surrey
- General Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
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Tauziède-Espariat A, Pierron G, Siegfried A, Guillemot D, Uro-Coste E, Nicaise Y, Castel D, Catalaa I, Larrieu-Ciron D, Chaynes P, de Barros A, Nicolau J, Gareton A, Lechapt E, Chrétien F, Bourdeaut F, Doz F, Bouchoucha Y, Grill J, Beccaria K, Boddaert N, Saffroy R, Pagès M, Varlet P. The EP300:BCOR fusion extends the genetic alteration spectrum defining the new tumoral entity of "CNS tumors with BCOR internal tandem duplication". Acta Neuropathol Commun 2020; 8:178. [PMID: 33138864 PMCID: PMC7607816 DOI: 10.1186/s40478-020-01064-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/17/2020] [Indexed: 11/10/2022] Open
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47
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Salgado CM, Zin A, Garrido M, Kletskaya I, DeVito R, Reyes-Múgica M, Bisogno G, Donofrio V, Alaggio R. Pediatric Soft Tissue Tumors With BCOR ITD Express EGFR but Not OLIG2. Pediatr Dev Pathol 2020; 23:424-430. [PMID: 32790583 DOI: 10.1177/1093526620945528] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Somatic internal tandem duplication of 3' of BCOR (BCOR ITD) has been found in clear cell sarcomas of the kidney (CCSK), soft tissue undifferentiated round cell sarcomas/primitive myxoid mesenchymal tumors of infancy (URCS/PMMTI), and a subgroup of central nervous system high-grade neuroepithelial tumors (CNS-HGNET). BCOR ITD+ tumors share morphologic features. Expression of OLIG2 and epidermal growth factor receptor (EGFR) has been reported in CNS-HGNET with BCOR ITD. Here, we characterize OLIG2 and EGFR expression in URCS/PMMTI with BCOR ITD. METHODS Paraffin blocks of 9 polymerase chain reaction-confirmed soft tissue BCOR ITD+ tumors (URCS/PMMTI) were immunophenotyped for OLIG2 and EGFR expression and scored semiquantitatively by percentage of positive cells and intensity of staining as negative, 1+, 2+, and 3+. Fluorescence in situ hybridization (FISH) for EGFR amplification was performed (amplification EGFR/CEP7 ratio ≥2.0). RESULTS All 9 tumors showed membrane/cytoplasmic expression of EGFR, strong and diffuse (3+) in 8 cases; weak (+2) in 1. FISH detected no EGFR amplification. OLIG2 was negative in all. CONCLUSIONS EGFR is overexpressed in pediatric URCS/PMMTI with BCOR ITD and may be related to transcriptional upregulation of EGFR by BCOR ITD. OLIG2 negative staining differentiates URCS/PMMTI from CNS-HGNET. This finding may further support the possibility that these tumors have a different stem cell of origin.
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Affiliation(s)
- Claudia M Salgado
- Department of Pathology, UPMC Children's Hospital of Pittsburgh. University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Angelica Zin
- Clinica di Oncoematologia Pediatrica Azienda Ospedaliera, Università di Padova, Padua, Italy
| | - Marta Garrido
- Unidad de Anatomía Patológica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Irina Kletskaya
- Russian Children's Clinical Hospital of Pirogov Russian National Research Medical University of the Ministry of Healthcare, Russian Federation, Moscow, Russia
| | - Rita DeVito
- Ospedale Pediatrico Bambino Gesu, Istituto Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Miguel Reyes-Múgica
- Department of Pathology, UPMC Children's Hospital of Pittsburgh. University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Gianni Bisogno
- Dipartimento Salute della Donna e Del Bambino, Università di Padova, Padua, Italy
| | - Vittoria Donofrio
- Pathology Unit Department of Pathology, Santobono-Pausilipon Children's Hospital, Via Posillipo, Naples, Italy
| | - Rita Alaggio
- Ospedale Pediatrico Bambino Gesu, Istituto Ricovero e Cura a Carattere Scientifico, Rome, Italy
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48
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Cole BL, Pierson CR. Histopathologic and Molecular Features of Central Nervous System Embryonal Tumors for Integrated Diagnosis Reporting. Surg Pathol Clin 2020; 13:783-800. [PMID: 33183733 DOI: 10.1016/j.path.2020.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Embryonal tumors of the pediatric central nervous system are challenging clinically and diagnostically. These tumors are aggressive, and patients often have poor outcomes even with intense therapy. Proper tumor classification is essential to patient care, and this process has undergone significant changes with the World Health Organization recommending histopathologic and molecular features be integrated in diagnostic reporting. This has especially impacted the workup of embryonal tumors because molecular testing has resulted in the identification of clinically relevant tumor subgroups and new entities. This review summarizes recent developments and provides a framework to workup embryonal tumors in diagnostic practice.
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Affiliation(s)
- Bonnie L Cole
- Department of Laboratories, Seattle Children's Hospital, OC.8.720, 4800 Sand Point Way Northeast, 1959 NE Pacific St., Box 357470, Seattle, WA 98105, USA; Department of Anatomic Pathology, University of Washington School of Medicine, 1959 NE Pacific St., Box 357470, Seattle, WA 98195, USA
| | - Christopher R Pierson
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, J0359, 700 Children's Drive, Columbus, OH 43205, USA; Department of Pathology, The Ohio State University, 129 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210, USA; Department of Biomedical Education & Anatomy, The Ohio State University, 1645 Neil Avenue, Columbus, OH 43210, USA.
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Abstract
Molecular characterization has led to advances in the understanding of pediatric renal tumors, including the association of pediatric cystic nephromas with DICER1 tumor syndrome, the metanephric family of tumors with somatic BRAF mutations, the characterization of ETV6-NTRK3-negative congenital mesoblastic nephromas, the expanded spectrum of gene fusions in translocation renal cell carcinoma, the relationship of clear cell sarcoma of the kidney with other BCOR-altered tumors, and the pathways affected by SMARCB1 alterations in rhabdoid tumors of the kidney. These advances have implications for diagnosis, classification, and treatment of pediatric renal tumors.
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50
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Central nervous system high grade neuroepithelial tumor with BCOR immunopositivity: Is there a molecular heterogeneity? Brain Tumor Pathol 2020; 38:41-49. [PMID: 32980923 DOI: 10.1007/s10014-020-00381-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 09/17/2020] [Indexed: 01/05/2023]
Abstract
Central nervous system high grade neuroepithelial tumor - BCOR altered is a newly defined entity which is characterised by internal tandem duplication (ITD) in exon 15 of BCOR. These tumors resemble high grade glioma histologically and exhibit BCOR immunopositivity. However, recently fusions of BCOR are also described in CNS lower grade gliomas, thus questioning the sensitivity and specificity of BCOR immunohistochemistry for identification of BCOR-ITD. We describe four cases of high grade neuroepithelial tumor with BCOR immunopositivity which were diagnosed over a period of one year at our institute. Amongst these, only one tumor revealed BCOR-ITD on sequencing. SATB2 immunopositivity which is a sensitive marker of BCOR-ITD, BCOR fusions and YWHAE fusions was noted in three out of four cases. Our study suggests that BCOR immunopositive CNS high grade tumors are molecularly heterogeneous and could harbour genetic alterations other than BCOR-ITD.
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