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Nowosławska E, Zakrzewska M, Sikorska B, Zakrzewski J, Polis B. A 13-Year-Old Girl Affected by Melanocytic Tumors of the Central Nervous System-The Case. Int J Mol Sci 2024; 25:9628. [PMID: 39273574 PMCID: PMC11395317 DOI: 10.3390/ijms25179628] [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: 07/23/2024] [Revised: 08/28/2024] [Accepted: 09/03/2024] [Indexed: 09/15/2024] Open
Abstract
Primary intracranial melanoma is a very rare brain tumor, especially when accompanied by benign intramedullary melanocytoma. Distinguishing between a primary central nervous system (CNS) lesion and metastatic melanoma is extremely difficult, especially when the primary cutaneous lesion is not visible. Here we report a 13-year-old girl admitted to the Neurosurgery Department of the Institute of Polish Mother's Health Centre in Lodz due to upper limb paresis. An intramedullary tumor of the cervical C3-C4 and an accompanying syringomyelic cavity C1-C7 were revealed. The child underwent partial removal of the tumor due to the risk of damage to spinal cord motor centers. The removed part of the tumor was diagnosed as melanocytoma. Eight months later, a neurological examination revealed paresis of the right sixth cranial nerve, accompanied by bilateral optic disc edema. Diagnostic imaging revealed a brain tumor. The girl underwent resection of both detected the tumors and an additional satellite lesion revealed during the surgery. The removed tumors were diagnosed as malignant melanomas in pathomorphological examination. Molecular analysis revealed NRASQ61K mutation in both the intracranial and the intramedullary tumor. It should be noted that in cases where available evidence is inconclusive, an integrative diagnostic process is essential to reach a definitive diagnosis.
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Affiliation(s)
- Emilia Nowosławska
- Department of Neurosurgery, Institute of Polish Mother's Health Centre in Lodz, Rzgowska 281/289, 93-338 Lodz, Poland
| | - Magdalena Zakrzewska
- Department of Molecular Pathology and Neuropathology, Medical University of Lodz, Pomorska 251, 92-213 Lodz, Poland
| | - Beata Sikorska
- Department of Molecular Pathology and Neuropathology, Medical University of Lodz, Pomorska 251, 92-213 Lodz, Poland
| | - Jakub Zakrzewski
- Faculty of Medicine, Medical University of Lodz, Kosciuszki 4, 90-419 Lodz, Poland
| | - Bartosz Polis
- Department of Neurosurgery, Institute of Polish Mother's Health Centre in Lodz, Rzgowska 281/289, 93-338 Lodz, Poland
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Pellerino A, Verdijk RM, Nichelli L, Andratschke NH, Idbaih A, Goldbrunner R. Primary Meningeal Melanocytic Tumors of the Central Nervous System: A Review from the Ultra-Rare Brain Tumors Task Force of the European Network for Rare Cancers (EURACAN). Cancers (Basel) 2024; 16:2508. [PMID: 39061148 PMCID: PMC11274408 DOI: 10.3390/cancers16142508] [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: 06/02/2024] [Revised: 07/04/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Primary meningeal melanocytic tumors are ultra-rare entities with distinct histological and molecular features compared with other melanocytic or pigmented lesions, such as brain and leptomeningeal metastases from metastatic melanoma. METHODS The European Network for Rare Cancers (EURACAN) Task Force on Ultra-Rare Brain Tumors (domain 10, subdomain 10) performed a literature review from January 1985 to December 2023 regarding the epidemiologic and clinical characteristics, histological and molecular features, radiological findings, and efficacy of local treatments (surgery and radiotherapy) and systemic treatments for these entities. RESULTS Molecular analysis can detect specific mutations, including GNAQ, GNA11, SF3B1, EIF1AX, BAP1, that are typically found in circumscribed primary meningeal melanocytic tumors and not in other melanocytic lesions, whereas NRAS and BRAF mutations are typical for diffuse primary meningeal melanocytic tumors. The neuroimaging of the whole neuroaxis suggests a melanocytic nature of a lesion, depicts its circumscribed or diffuse nature, but cannot predict the tumor's aggressiveness. Gross-total resection is the first choice in the case of circumscribed meningeal melanocytoma and melanoma; conversely, meningeal biopsy may be reserved for patients with diffuse and multinodular leptomeningeal spread to achieve a definitive diagnosis. High-dose radiotherapy is rarely indicated in diffuse melanocytic tumors except as palliative treatment to alleviate symptoms. Last, a definitive advantage of a specific systemic treatment could not be concluded, as most of the data available derive from case reports or small cohorts. CONCLUSIONS As primary meningeal melanocytic tumors are extremely rare, the correlations between the clinical characteristics, molecular profile, radiological findings at diagnosis and progression are weak, and poor evidence on the best therapeutic approach is available. There is a need to develop shared platforms and registries to capture more knowledge regarding these ultra-rare entities.
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Affiliation(s)
- Alessia Pellerino
- Division of Neuro-Oncology, Department of Neuroscience “Rita Levi Montalcini”, University and City of Health and Science Hospital, 10126 Torino, Italy
| | - Robert M. Verdijk
- Department of Pathology, Section Ophthalmic Pathology, Erasmus MC University Medical Center, 3015 Rotterdam, The Netherlands;
- Department of Pathology, Leiden University Medical Center, 2333 Leiden, The Netherlands
| | - Lucia Nichelli
- Department of Neuroradiology, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, 75013 Paris, France;
| | - Nicolaus H. Andratschke
- Department of Radiation Oncology, University of Zurich, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Ahmed Idbaih
- CNRS, Inserm, DMU Neurosciences, Service de Neuro-Oncologie-Institut de Neurologie, Sorbonne Université, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, F-75013 Paris, France;
| | - Roland Goldbrunner
- Center for Neurosurgery, Department of General Neurosurgery, University of Cologne, 50923 Cologne, Germany;
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Lv JJ, Yao QL, Jiang XB, Ren M, Cai X, Dai B, Kong YY. Primary leptomeningeal melanocytic neoplasms: A clinicopathologic, immunohistochemical, and molecular study of 12 cases. Hum Pathol 2024; 148:32-40. [PMID: 38670237 DOI: 10.1016/j.humpath.2024.04.014] [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: 02/07/2024] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 04/28/2024]
Abstract
This study investigated the clinicopathological, immunohistochemical, and molecular features of primary leptomeningeal melanocytic neoplasms (LMNs). Twelve LMN cases were retrospectively reviewed. We performed Fluorescence in-situ hybridization (including a 4-probe FISH assay with CDKN2A and MYC assay) and Next-Generation sequencing analyses on available cases. Histologically, 2 tumours were classified as melanocytomas (MC), 2 as intermediate-grade melanocytomas (IMC), and 8 as leptomeningeal melanomas (LMM). Two rare cases of LMM were associated with large plaque-like blue nevus. One MC case was associated with Ota. Ten cases (83.3%) showed melanocytic cells with benign features diffusely proliferating within the meninges. The Ki-67 in three categories differed (MC 0-1%, IMC 0-3%, LMM 3-10%). 57.1% of LMM cases (4/7) were positive for FISH. Nine of 10 tumours harboured activating hotspot mutations in GNAQ, GNA11, or PLCB4. Additional mutations of EIF1AX, SF3B1, or BAP1 were found in 40%, 30%, and 10% of tumours, respectively. During the follow-up (median = 43 months), 5 LMM patients experienced recurrence and/or metastasis, 3 of them died of the disease and the other 2 are alive with the tumour. Our study is by far the first cohort of LMN cases tested by FISH. In addition to morphological indicators including necrosis and mitotic figures, using a combination of Ki-67 and FISH helps to differentiate between IMC and LMM, especially in LMM cases with less pleomorphic features. SF3B1 mutation is first described in 2 cases of plaque-type blue nevus associated with LMM. Patients with SF3B1 mutation might be related to poor prognosis in LMN.
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Affiliation(s)
- Jiao-Jie Lv
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Qian-Lan Yao
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Xue-Bing Jiang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China; Department of Pathology, Minhang Hospital, Fudan University, Shanghai, 201100, People's Republic of China
| | - Min Ren
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Xu Cai
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Bo Dai
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China; Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China.
| | - Yun-Yi Kong
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
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Moser PO, Favier V, Raingeard I, Crampette L, Rigau V, Boetto J. Primitive pituitary perivascascular epithelioid cell tumor: A challenging diagnosis of melanocytic pituitary lesion. Neurochirurgie 2023; 69:101394. [PMID: 36502879 DOI: 10.1016/j.neuchi.2022.101394] [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: 08/12/2022] [Revised: 09/24/2022] [Accepted: 09/28/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Perivascular Epithelioid cell tumors (PEComa) are rare mesenchymal tumors. They generally occur in the gynecologic or digestive tract. The diagnosis of Central Nervous System PEComa is exceptional and challenging. CASE DESCRIPTION We report the case of a 46-year-old woman, with no particular medical history, who presented a secondary amenorrhea and a slight hyperprolactinemia. She was diagnosed on MRI with a pituitary tumor showing spontaneous hypersignal in T1-weighted images. After failure of medical treatment with cabergoline, surgical resection was required due to progressive tumor growth. Macroscopic aspect and initial immunohistochemical features were in favor of a primitive hypophyseal melanocytoma. However, molecular and transcriptional study through targeted exome- and RNA-sequencing led to the exceptional diagnosis of pituitary Perivascular Epithelioid Cell Tumor (PEComa). Three-years of postoperative radio-clinical follow-up showed an asymptomatic non-evolutive small remnant. CONCLUSION PEComa is an exceptional diagnosis among pituitary tumors. It should be evoked as a potential differential diagnosis in case of primitive melanocytic lesion of the pituitary gland. Specific molecular analysis is mandatory to confirm the diagnosis and exclude differential diagnosis.
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Affiliation(s)
- P-O Moser
- Department of neurosurgery, Montpellier University medical center, Gui-De-Chauliac Hospital, Montpellier, France.
| | - V Favier
- Department of ENT, Montpellier University medical center, Gui-De-Chauliac Hospital, Montpellier, France
| | - I Raingeard
- Department of endocrinology, Montpellier University medical center, Lapeyronie Hospital, Montpellier, France
| | - L Crampette
- Department of ENT, Montpellier University medical center, Gui-De-Chauliac Hospital, Montpellier, France
| | - V Rigau
- Department of pathology, Montpellier University medical center, Gui-De-Chauliac Hospital, Montpellier, France
| | - J Boetto
- Department of neurosurgery, Montpellier University medical center, Gui-De-Chauliac Hospital, Montpellier, France
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Deng SL, Wang YB, Wang DH, Zhan S, Jing Y, Guan Y. Malignant Transformation and Metastatic Spread of Dumbbell-Shaped Meningeal Melanocytoma of the Cervical Spine: A Case Report and Literature Review. Front Surg 2022; 9:789256. [PMID: 35402475 PMCID: PMC8983910 DOI: 10.3389/fsurg.2022.789256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/25/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMeningeal melanocytoma is a rare disease that originates from leptomeningeal melanocytes in the central nervous system. Meningeal melanocytoma is generally considered benign, and has a good prognosis following complete surgical resection. Reports of the malignant transformation and spread of these tumors are scarce.Case PresentationA 19 year old female presented with headache, progressive limb weakness, and dyspnea. Magnetic resonance imaging showed a dumbbell-shaped lesion at C1–C2 that was hyperintense on T1 weighted images and showed strong contrast enhancement. Total resection was achieved using a posterior midline approach. Post-operative pathology showed meningeal melanocytoma. The tumor recurred 9 months later with intracranial spread. Resection of the lesion revealed malignant transformation to meningeal melanoma.ConclusionMeningeal melanocytoma harbors malignant potential even with total resection. Radiotherapy could be considered to prevent disease recurrence and progression.
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Affiliation(s)
- Shuang-lin Deng
- Department of Oncological Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Yu-bo Wang
- Department of Oncological Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Dan-hua Wang
- Department of Pathology, First Hospital of Jilin University, Changchun, China
| | - Shuang Zhan
- Department of Oncological Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Yi Jing
- Department of Oncological Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Yi Guan
- Department of Oncological Neurosurgery, First Hospital of Jilin University, Changchun, China
- *Correspondence: Yi Guan
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Zhou HW, Tran AQ, North VS, Zagzag D, Sen C, Kazim M. GNA11 Mutation in an Intracranial Melanocytoma with Orbital Involvement and Nevus of Ota. Ophthalmic Plast Reconstr Surg 2022; 38:e47-e49. [PMID: 34750314 DOI: 10.1097/iop.0000000000002081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The prognostic value of mutations in G-protein genes GNAQ and GNA11 in patients with intracranial and orbital melanocytomas is unknown. The authors present a case of GNA11 mutation (GNA11Q209L) in a 32-year-old male suffering from a meningeal melanocytoma with orbital involvement and ipsilateral Nevus of Ota. The patient underwent gamma knife stereotactic radiosurgery without biopsy and later partial transcranial resection of the melanocytic tumor that was subject to immunohistochemical and molecular analysis. A 50-gene next-generation sequencing panel revealed a 626A>T mutation in the GNA11 gene. One year later, intracranial extension of the melanocytoma necessitated a ventriculoperitoneal shunt and immunotherapy. Future work is needed to determine how GNA11 mutations in melanocytomas influence prognosis and monitoring strategies.
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Affiliation(s)
- Henry W Zhou
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, U.S.A
| | - Ann Q Tran
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, U.S.A
- Department of Ophthalmology, Illinois Eye and Ear Infirmary, Chicago, Illinois, U.S.A
| | - Victoria S North
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, U.S.A
| | - David Zagzag
- Department of Pathology, New York University Langone Medical Center, New York, U.S.A
- Department of Neurosurgery, New York University Langone Medical Center, New York, U.S.A
| | - Chandranath Sen
- Department of Neurosurgery, New York University Langone Medical Center, New York, U.S.A
| | - Michael Kazim
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, U.S.A
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Donofrio CA, Roncaroli F, Riccio L, Pereira M, O'Sullivan J, Mayers H, Potter GM, Djoukhadar I, Rutherford SA. A CHALLENGING CASE OF SPORADIC MELANOCYTOMA OF THE JUGULAR FORAMEN. Neurochirurgie 2021; 68:453-457. [PMID: 34157339 DOI: 10.1016/j.neuchi.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/30/2021] [Accepted: 06/06/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The jugular foramen (JF) can be the site of several tumours. Paragangliomas, schwannomas and meningiomas are the most commonly reported. We describe a case of melanocytoma originating from the JF and presenting with an accessory nerve palsy. Illustrative case: A 48-year-old woman presented with a 6-month history of cervical and left shoulder pain with wasting and weakness of the left trapezius. A Magnetic Resonance Imaging (MRI) showed a T1-hyperintense, T2-isointense, heterogeneously enhancing lesion involving the left JF and extending into the cerebello-medullary and cerebello-pontine cisterns. A retrosigmoid craniotomy was performed and a near total removal achieved. The accessory nerve was involved by tumour and could not be preserved. Given the diagnostic uncertainty between melanotic schwannoma, metastatic melanoma and meningeal melanocytoma, next generation sequencing and genome-wide DNA methylation arrays were performed, documenting a mutation in GNA11 (c.6226A>T, p. Gln209Leu) and a methylation profile consistent with melanocytoma. The patient underwent adjuvant fractionated radiotherapy of the tumour remnant. A follow-up MRI 4 years after surgery did not show any tumour recurrence. CONCLUSIONS The differential diagnosis of skull base pigmented tumours can be challenging, particularly when they occur in unusual locations such as the JF. They can be misdiagnosed given their similar clinical, neuroradiological and pathological features if anatomy of the site of origin is not carefully considered and molecular tests are not performed, leading to erroneous treatment and follow up planning.
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Affiliation(s)
- Carmine Antonio Donofrio
- Geoffrey Jefferson Brain Research and Division of Neuroscience and Experimental Psychology, Faculty of Biology, University of Manchester, Manchester, UK; Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
| | - Federico Roncaroli
- Geoffrey Jefferson Brain Research and Division of Neuroscience and Experimental Psychology, Faculty of Biology, University of Manchester, Manchester, UK; Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Lucia Riccio
- Vita-Salute San Raffaele University, Milan, Italy
| | - Marta Pereira
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Division of Evolution and Genomic Science, University of Manchester, Manchester, UK
| | - James O'Sullivan
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Division of Evolution and Genomic Science, University of Manchester, Manchester, UK
| | - Helen Mayers
- Department of Cellular Pathology, Salford Royal Foundation Trust, Northern Care Alliance, Salford, UK
| | - Gillian Margaret Potter
- Department of Neuroradiology, Manchester Centre for Clinical Neurosciences, Salford Royal Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Ibrahim Djoukhadar
- Department of Neuroradiology, Manchester Centre for Clinical Neurosciences, Salford Royal Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Scott A Rutherford
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Hean V, Bouleftour W, Ramirez C, Forest F, Boutet C, Rivoirard R. Nivolumab as adjuvant treatment for a spinal melanocytoma: A case report. Medicine (Baltimore) 2021; 100:e25862. [PMID: 34106633 PMCID: PMC8133133 DOI: 10.1097/md.0000000000025862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/13/2021] [Accepted: 04/21/2021] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Meningeal melanocytoma is a rare benign melanocytic tumor of the central nervous system. We report for the first time a case of meningeal melanocytoma treated with immunotherapy. PATIENT CONCERNS A 70-year-old man with no medical history was admitted to the Emergency Room. He suffered from a motor and sensory deficit in his left lower limb and a bilateral upper arm neuralgia. DIAGNOSES A contrast-enhanced magnetic resonance imaging (MRI) was performed. It showed a C7-T1 bleeding intramedullary tumor. Laminectomy was decided and performed. The results of the pathologic examination showed a melanocytic tumor harboring GNAQ mutation. Meningeal melanocytoma was the final diagnosis. INTERVENTIONS The patient was treated with 10 radiotherapy sessions and 6 cycles of nivolumab. A year later, the patient experienced neuralgia again with severe pain and an increasing sensory motor deficit. He underwent a second surgery that was incomplete. As the tumor kept growing, he received temozolomide. But the 6th cycle had to be interrupted due to bedsore infection in the hip area. OUTCOMES Disease progression finally led to the patient's death 3 years after diagnosis. LESSONS This case report is the first about a patient with meningeal melanocytoma treated with immunotherapy. Treatment based on biomolecular mutations will probably change spinal melanocytoma therapeutic approach in the next few years.
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Affiliation(s)
- Virginie Hean
- Service de Neurologie, CHU de Saint-Etienne, Hôpital Nord, Avenue Albert Raimond, Saint Etienne CEDEX 2
| | - Wafa Bouleftour
- Département d’Oncologie Médicale, Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez
| | - Carole Ramirez
- Service de Neurologie, CHU de Saint-Etienne, Hôpital Nord, Avenue Albert Raimond, Saint Etienne CEDEX 2
- Département d’Oncologie Médicale, Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez
| | - Fabien Forest
- Laboratoire d’Anatomie et Cytologie Pathologiques, CHU de Saint-Etienne, Hôpital Nord, Avenue Albert Raimond, Saint Etienne CEDEX 2
| | - Claire Boutet
- Service de Radiologie, CHU de Saint-Etienne, Hôpital Nord, Avenue Albert Raimond, Saint Etienne CEDEX, France
| | - Romain Rivoirard
- Département d’Oncologie Médicale, Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez
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San-Miguel T, Navarro L, Sánchez-Sendra B, Megías J, Muñoz-Hidalgo L, Santonja N, López-Ginés C, Cerdá-Nicolas M. Identification of a Novel BRCA1 Alteration in Recurrent Melanocytoma Resulting in Increased Proliferation. J Neuropathol Exp Neurol 2021; 79:1233-1238. [PMID: 32974655 DOI: 10.1093/jnen/nlaa089] [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: 11/12/2022] Open
Abstract
Primary meningeal melanocytomas are rare tumors of the central nervous system. Although they are considered benign neoplasms, some reports describe recurrent rates up to 45%. Little is known about their genetic and epigenetic landscape because of their infrequency. Even less has been described about markers with prognostic value. Here we describe a patient who developed a primary meningeal melanocytoma, suffered 3 recurrences in a period of 6 years and died of the tumor. The genetic and epigenetic changes explored confirmed GNAQ mutation as an initiating event. We found an epigenetic alteration of GSTP1, a feature that has recently been described in meningiomas, from the beginning of the disease. In addition, there was loss of heterozygosity in BRCA1 beginning in the second recurrence that was linked to an increase in the proliferation index; this suggested a progression pathway similar to the one described in uveal melanomas. These findings underscore the necessity of further research focused on these tumors.
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Affiliation(s)
- Teresa San-Miguel
- Department of Pathology, Faculty of Medicine and Odontology, Universitat de València
| | - Lara Navarro
- Department of Pathology, Faculty of Medicine and Odontology, Universitat de València.,INCLIVA Research Institute
| | | | - Javier Megías
- Department of Pathology, Faculty of Medicine and Odontology, Universitat de València
| | | | | | - Concha López-Ginés
- Department of Pathology, Faculty of Medicine and Odontology, Universitat de València
| | - Miguel Cerdá-Nicolas
- Department of Pathology, Faculty of Medicine and Odontology, Universitat de València.,INCLIVA Research Institute
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10
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Piulats JM, Espinosa E, de la Cruz Merino L, Varela M, Alonso Carrión L, Martín-Algarra S, López Castro R, Curiel T, Rodríguez-Abreu D, Redrado M, Gomà M, Rullán AJ, Calvo González A, Berrocal-Jaime A. Nivolumab Plus Ipilimumab for Treatment-Naïve Metastatic Uveal Melanoma: An Open-Label, Multicenter, Phase II Trial by the Spanish Multidisciplinary Melanoma Group (GEM-1402). J Clin Oncol 2021; 39:586-598. [PMID: 33417511 DOI: 10.1200/jco.20.00550] [Citation(s) in RCA: 124] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE This study aimed to assess the efficacy of the combination of nivolumab (nivo) plus ipilimumab (ipi) as a first-line therapy with respect to the 12-month overall survival (OS) in patients with metastatic uveal melanoma (MUM) who are not eligible for liver resection. METHODS This was a single-arm, phase II trial led by the Spanish Multidisciplinary Melanoma Group (GEM) on nivo plus ipi for systemic treatment-naïve patients of age > 18 years, with histologically confirmed MUM, Eastern Cooperative Oncology Group-PS 0/1, and confirmed progressive metastatic disease (M1). Nivo (1 mg/kg once every 3 weeks) and ipi (3 mg/kg once every 3 weeks) were administered during four inductions, followed by nivo (3 mg/kg once every 2 weeks) until progressive disease, toxicity, or withdrawal. The primary end point was 12-month OS. OS, progression-free survival (PFS), and overall response rate were evaluated every 6 weeks using RECIST (v1.1). Safety was also evaluated. Logistic regression and Cox proportional hazard models comprising relevant clinical factors were used to evaluate the potential association with response to treatment and survival. Cytokines were quantified in serum samples for their putative role in immune modulation/angiogenesis and/or earlier evidence of involvement in immunotherapy. RESULTS A total of 52 patients with a median age of 59 years (range, 26-84 years) were enrolled. Overall, 78.8%, 56%, and 32% of patients had liver M1, extra-liver M1, and elevated lactate dehydrogenase. Stable disease was the most common outcome (51.9%). The primary end point was 12-month OS, which was 51.9% (95% CI, 38.3 to 65.5). The median OS and PFS were 12.7 months and 3.0 months, respectively. PFS was influenced by higher LDH values. CONCLUSIONS Nivo plus ipi in the first-line setting for MUM showed a modest improvement in OS over historical benchmarks of chemotherapy, with a manageable toxicity profile.
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Affiliation(s)
- José María Piulats
- Medical Oncology Department, Catalan Institute of Cancer (ICO), IDIBELL-OncoBell, L'Hospitalet de Llobregat, Barcelona, Spain.,Clinical Research in Solid Tumors Group (CREST), Bellvitge Biomedical Research Institute IDIBELL-OncoBell, L'Hospitalet de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Enrique Espinosa
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.,Medical Oncology, Hospital Universitario La Paz, Madrid, Spain
| | - Luis de la Cruz Merino
- Medical Oncology, Hospital Universitario Virgen Macarena, Department of Medicine, Universidad de Sevilla, Sevilla, Spain
| | - Mar Varela
- Pathology Department, Hospital Universitari de Bellvitge (HUB), L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - Rafael López Castro
- Medical Oncology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Teresa Curiel
- Medical Oncology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Delvys Rodríguez-Abreu
- Medical Oncology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Miriam Redrado
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Montserrat Gomà
- Pathology Department, Hospital Universitari de Bellvitge (HUB), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Antonio José Rullán
- Medical Oncology Department, Catalan Institute of Cancer (ICO), IDIBELL-OncoBell, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Alfonso Berrocal-Jaime
- Medical Oncology, Complejo Hospitalario General Universitario de Valencia, Valencia, Spain
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11
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Li C, Chen H, Zhao Y, Chen S, Xiao H. Comparative transcriptomics reveals the molecular genetic basis of pigmentation loss in Sinocyclocheilus cavefishes. Ecol Evol 2020; 10:14256-14271. [PMID: 33391713 PMCID: PMC7771137 DOI: 10.1002/ece3.7024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 07/28/2020] [Accepted: 10/28/2020] [Indexed: 11/13/2022] Open
Abstract
Cave-dwelling animals evolve distinct troglomorphic traits, such as loss of eyes, skin pigmentation, and augmentation of senses following long-term adaptation to perpetual darkness. However, the molecular genetic mechanisms underlying these phenotypic variations remain unclear. In this study, we conducted comparative histology and comparative transcriptomics study of the skin of eight Sinocyclocheilus species (Cypriniformes: Cyprinidae) that included surface- and cave-dwelling species. We analyzed four surface and four cavefish species by using next-generation sequencing, and a total of 802,798,907 clean reads were generated and assembled into 505,495,009 transcripts, which contributed to 1,037,334 unigenes. Bioinformatic comparisons revealed 10,629 and 6,442 significantly differentially expressed unigenes between four different surface-cave fish groups. Further, tens of differentially expressed genes (DEGs) potentially related to skin pigmentation were identified. Most of these DEGs (including GNAQ, PKA, NRAS, and p38) are downregulated in cavefish species. They are involved in key signaling pathways of pigment synthesis, such as the melanogenesis, Wnt, and MAPK pathways. This trend of downregulation was confirmed through qPCR experiments. This study will deepen our understanding of the formation of troglomorphic traits in cavefishes.
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Affiliation(s)
- Chunqing Li
- Yunnan Key Laboratory for Plateau Mountain Ecology and Restoration of Degraded EnvironmentsSchool of Ecology and Environmental SciencesYunnan UniversityKunmingChina
| | - Hongyu Chen
- Yunnan Key Laboratory for Plateau Mountain Ecology and Restoration of Degraded EnvironmentsSchool of Ecology and Environmental SciencesYunnan UniversityKunmingChina
- School of Life SciencesYunnan UniversityKunmingChina
| | - Yinchen Zhao
- School of Life SciencesYunnan UniversityKunmingChina
| | - Shanyuan Chen
- Yunnan Key Laboratory for Plateau Mountain Ecology and Restoration of Degraded EnvironmentsSchool of Ecology and Environmental SciencesYunnan UniversityKunmingChina
| | - Heng Xiao
- Yunnan Key Laboratory for Plateau Mountain Ecology and Restoration of Degraded EnvironmentsSchool of Ecology and Environmental SciencesYunnan UniversityKunmingChina
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12
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Identification of New Genetic Clusters in Glioblastoma Multiforme: EGFR Status and ADD3 Losses Influence Prognosis. Cells 2020; 9:cells9112429. [PMID: 33172155 PMCID: PMC7694764 DOI: 10.3390/cells9112429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 12/12/2022] Open
Abstract
Glioblastoma multiforme (GB) is one of the most aggressive tumors. Despite continuous efforts to improve its clinical management, there is still no strategy to avoid a rapid and fatal outcome. EGFR amplification is the most characteristic alteration of these tumors. Although effective therapy against it has not yet been found in GB, it may be central to classifying patients. We investigated somatic-copy number alterations (SCNA) by multiplex ligation-dependent probe amplification in a series of 137 GB, together with the detection of EGFRvIII and FISH analysis for EGFR amplification. Publicly available data from 604 patients were used as a validation cohort. We found statistical associations between EGFR amplification and/or EGFRvIII, and SCNA in CDKN2A, MSH6, MTAP and ADD3. Interestingly, we found that both EGFRvIII and losses on ADD3 were independent markers of bad prognosis (p = 0.028 and 0.014, respectively). Finally, we got an unsupervised hierarchical classification that differentiated three clusters of patients based on their genetic alterations. It offered a landscape of EGFR co-alterations that may improve the comprehension of the mechanisms underlying GB aggressiveness. Our findings can help in defining different genetic profiles, which is necessary to develop new and different approaches in the management of our patients.
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13
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Amalgamated cross-species transcriptomes reveal organ-specific propensity in gene expression evolution. Nat Commun 2020; 11:4459. [PMID: 32900997 PMCID: PMC7479108 DOI: 10.1038/s41467-020-18090-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 07/29/2020] [Indexed: 12/24/2022] Open
Abstract
The origins of multicellular physiology are tied to evolution of gene expression. Genes can shift expression as organisms evolve, but how ancestral expression influences altered descendant expression is not well understood. To examine this, we amalgamate 1,903 RNA-seq datasets from 182 research projects, including 6 organs in 21 vertebrate species. Quality control eliminates project-specific biases, and expression shifts are reconstructed using gene-family-wise phylogenetic Ornstein-Uhlenbeck models. Expression shifts following gene duplication result in more drastic changes in expression properties than shifts without gene duplication. The expression properties are tightly coupled with protein evolutionary rate, depending on whether and how gene duplication occurred. Fluxes in expression patterns among organs are nonrandom, forming modular connections that are reshaped by gene duplication. Thus, if expression shifts, ancestral expression in some organs induces a strong propensity for expression in particular organs in descendants. Regardless of whether the shifts are adaptive or not, this supports a major role for what might be termed preadaptive pathways of gene expression evolution.
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14
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Pituitary metastasis of malignant melanoma misdiagnosed as pituitary adenoma: A case report and systematic review of the literature. Neurochirurgie 2020; 66:383-390. [PMID: 32777231 DOI: 10.1016/j.neuchi.2020.06.129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/17/2020] [Accepted: 06/13/2020] [Indexed: 11/21/2022]
Abstract
We report a case of malignant melanoma revealed by a metastasis to the pituitary gland. The tumor was misdiagnosed as a pituitary adenoma and aggressive transsphenoidal surgery was complicated by a cerebrospinal fluid fistula. Nine weeks later, the patient presented multiple leptomeningeal and brain metastases spreading from the sellar region. Regarding these observations, we conducted a systematic review of the literature in order to investigate clinicoradiological features that should lead clinicians to suspect pituitary metastasis and how it should impact the surgical management.
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15
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Albano L, Losa M, Barzaghi LR, Spatola G, Panni P, Terreni MR, Mortini P. Primary sellar melanocytoma: pathological, clinical and treatment review. J Endocrinol Invest 2020; 43:575-585. [PMID: 31797309 DOI: 10.1007/s40618-019-01158-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 11/28/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sellar melanocytomas represent a small subgroup of primary melanocytic tumors. They arise from melanocytes located in the meningeal lining of the sellar floor or in the diaphragma sellae and this location is very uncommon. Usually, sellar melanocytomas are benign and slow-growing tumors with a high likelihood of recurrence. PURPOSE To our knowledge, due to the rarity of this condition, there are no guidelines regarding their diagnosis and treatment in the medical literature to date. We have developed a narrative review, analyzing the available studies regarding primary sellar melanocytomas reported in the medical literature. We have found ten papers on this topic and all of them are case reports. In all patients, tumor diagnosis was performed after the occurrence of neurological symptoms, in particular progressive visual loss or endocrinological disorders. The diagnosis is difficult, and it requires several preoperative and postoperative investigations, but histological examination is crucial. CONCLUSIONS Transsphenoidal surgery is the first-choice treatment. In case of tumor's recurrence or regrowth, the role of radiation therapy and chemotherapy is not entirely clear.
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Affiliation(s)
- L Albano
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy.
| | - M Losa
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - L R Barzaghi
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - G Spatola
- Department of Neurosurgery, Assistance Publique Hopitaux de Marseille, Marseille, France
| | - P Panni
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - M R Terreni
- Department of Pathology, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - P Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
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16
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Wang X, Li D, Song S, Zhang Y, Li Y, Wang X, Liu D, Zhang C, Cao Y, Fu Y, Han R, Li W, Liu X, Sun G, Li G, Tian Y, Li Z, Kang X. Combined transcriptomics and proteomics forecast analysis for potential genes regulating the Columbian plumage color in chickens. PLoS One 2019; 14:e0210850. [PMID: 31693656 PMCID: PMC6834273 DOI: 10.1371/journal.pone.0210850] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 10/18/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Coloration is one of the most recognizable characteristics in chickens, and clarifying the coloration mechanisms will help us understand feather color formation. "Yufen I" is a commercial egg-laying chicken breed in China that was developed by a three-line cross using lines H, N and D. Columbian plumage is a typical feather character of the "Yufen I" H line. To elucidate the molecular mechanism underlying the pigmentation of Columbian plumage, this study utilizes high-throughput sequencing technology to compare the transcriptome and proteome differences in the follicular tissue of different feathers, including the dorsal neck with black and white striped feather follicles (Group A) and the ventral neck with white feather follicles (Group B) in the "Yufen I" H line. RESULTS In this study, we identified a total of 21,306 genes and 5,203 proteins in chicken feather follicles. Among these, 209 genes and 382 proteins were differentially expressed in two locations, Group A and Group B, respectively. A total of 8 differentially expressed genes (DEGs) and 9 differentially expressed proteins (DEPs) were found to be involved in the melanogenesis pathway. Additionally, a specifically expressed MED23 gene and a differentially expressed GNAQ protein were involved in melanin synthesis. Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis mapped 190 DEGs and 322 DEPs to 175 and 242 pathways, respectively, and there were 166 pathways correlated with both DEGs and DEPs. 49 DEPs/DEGs overlapped and were enriched for 12 pathways. Transcriptomic and proteomic analyses revealed that the following pathways were activated: melanogenesis, cardiomyocyte adrenergic, calcium and cGMP-PKG. The expression of DEGs was validated by real-time quantitative polymerase chain reaction (qRT-PCR) that produced results similar to those from RNA-seq. In addition, we found that the expression of the MED23, FZD10, WNT7B and WNT11 genes peaked at approximately 8 weeks in the "Yufen I" H line, which is consistent with the molting cycle. As both groups showed significant differences in terms of the expression of the studied genes, this work opens up avenues for research in the future to assess their exact function in determining plumage color. CONCLUSION Common DEGs and DEPs were enriched in the melanogenesis pathway. MED23 and GNAQ were also reported to play a crucial role in melanin synthesis. In addition, this study is the first to reveal gene and protein variations in in the "Yufen I" H line during Columbian feather color development and to discover principal genes and proteins that will aid in functional genomics studies in the future. The results of the present study provide a significant conceptual basis for the future breeding schemes with the "Yufen I" H line and provide a basis for research on the mechanisms of feather pigmentation.
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Affiliation(s)
- Xinlei Wang
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou, Henan, China
- College of Animal Science and Technology, Henan University of Animal Husbandry and Economy, Zhengzhou, Henan, China
| | - Donghua Li
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou, Henan, China
| | - Sufang Song
- College of Animal Science and Technology, Henan University of Animal Husbandry and Economy, Zhengzhou, Henan, China
| | - Yanhua Zhang
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou, Henan, China
| | - Yuanfang Li
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou, Henan, China
| | - Xiangnan Wang
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou, Henan, China
| | - Danli Liu
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou, Henan, China
| | - Chenxi Zhang
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou, Henan, China
| | - Yanfang Cao
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou, Henan, China
| | - Yawei Fu
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou, Henan, China
| | - Ruili Han
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou, Henan, China
| | - Wenting Li
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou, Henan, China
| | - Xiaojun Liu
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou, Henan, China
| | - Guirong Sun
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou, Henan, China
| | - Guoxi Li
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou, Henan, China
| | - Yadong Tian
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou, Henan, China
| | - Zhuanjian Li
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou, Henan, China
| | - Xiangtao Kang
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou, Henan, China
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17
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Fortin Ensign S, Bollin K, Millis SZ, Hinds BR, Kosty M, Uchiyama C. Genomic analysis reveals low tumor mutation burden which may be associated with GNAQ/11 alteration in a series of primary leptomeningeal melanomas. Pigment Cell Melanoma Res 2019; 33:458-465. [PMID: 31663661 DOI: 10.1111/pcmr.12839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 10/16/2019] [Accepted: 10/27/2019] [Indexed: 12/30/2022]
Abstract
Primary central nervous system melanoma is rare and characterized by a variable prognosis, and no current treatment guidelines exist. We describe the clinical course of a 70-year-old female patient diagnosed with primary leptomeningeal melanoma (LMN) whose case represents the diagnostic and management challenges of this tumor. Targeted genomic sequencing of 315 genes from this tumor revealed GNAQ Q209L mutation and low (4 mutations/Megabase) tumor mutation burden (TMB). Wild-type NRAS, KIT, and BRAF were also observed. A cohort of 4,787 melanomas was subsequently analyzed to identify additional primary central nervous system melanomas, of which 10 additional tumors met pathologic criteria (0.21% of total melanoma cohort). These tumors were genomically assessed according to the same targeted sequencing panel, and 6 of the tumors were also found to harbor a GNAQ mutation. All 10 tumors had low (less than or equal to 2 mutations/Megabase) TMB indicating a potential trend between G-protein-coupled receptor (GPCR) alterations and low TMB in LMNs. GPCR alterations were found to significantly correlate with TMB across the cohort of 4,787 melanomas, supporting this potential finding in the limited LMN subset.
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Affiliation(s)
- Shannon Fortin Ensign
- Scripps Translational Science Institute, The Scripps Research Institute, La Jolla, California.,Department of Internal Medicine, Scripps Clinic/Scripps Green Hospital, La Jolla, California
| | - Kathryn Bollin
- Department of Medical Oncology, Scripps Clinic/Scripps Green Hospital, La Jolla, California
| | | | - Brian R Hinds
- Department of Dermatology, University of California San Diego, La Jolla, California
| | - Michael Kosty
- Department of Medical Oncology, Scripps Clinic/Scripps Green Hospital, La Jolla, California
| | - Christopher Uchiyama
- Department of Neurosurgery, Scripps Clinic/Scripps Green Hospital, La Jolla, California
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18
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NRAS Q61K mutated diffuse leptomeningeal melanomatosis in an adult patient with a brief review of the so-called "forme fruste" of neurocutaneous melanosis. Brain Tumor Pathol 2018; 35:217-223. [PMID: 30145692 DOI: 10.1007/s10014-018-0328-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 08/21/2018] [Indexed: 12/17/2022]
Abstract
Primary melanocytic tumors of central nervous system represent rare tumors arising from melanocytes of the leptomeninges. These neoplasms include focal forms like melanocytoma and primary malignant melanoma and diffuse forms like leptomeningeal melanocytosis and primary leptomeningeal melanomatosis. The clinical diagnosis remains challenging, with clinical and radiologic features overlapping with other more common diseases. Here we present a case of a 38 years old male with primary diffuse leptomeningeal melanomatosis with presence of a NRASQ61K mutation without features of neurocutaneous melanosis.
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19
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Tatsi C, Bacopoulou F, Lyssikatos C, Belyavskaya E, Faucz F, Stratakis CA. Sporadic melanotic schwannoma with overlapping features of melanocytoma bearing a GNA11 mutation in an adolescent girl. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26400. [PMID: 28012237 PMCID: PMC6309823 DOI: 10.1002/pbc.26400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 10/08/2016] [Accepted: 10/13/2016] [Indexed: 12/23/2022]
Abstract
Melanotic schwannoma (MS) is a soft tissue neoplasm that shares histologic features with melanocytic tumors and schwannomas. A type of MS, called psammomatous MS (PMS), is associated with Carney complex (CNC), which is caused by PRKAR1A mutations. Other pigmented neoplasms, such as uveal melanomas and melanocytomas (MCs), are associated with genetic defects in other genes including GNA11. We report an adolescent female with a large sporadic mesenteric MS with complex histologic findings reminiscent of both PMS and MC. The lesion carried a mutation of the GNA11 gene. We conclude that sporadic MSs may occur rarely in adolescents without CNC; MSs may also be associated with somatic GNA11 mutations.
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Affiliation(s)
- Christina Tatsi
- Section on Endocrinology & Genetics, and Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD 20892, USA.,Pediatric Endocrinology Inter-institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD 20892, USA.,To whom correspondence should be addressed: Dr. Christina Tatsi, SEGEN, NICHD, NIH, 10 Center Drive, Building 10, NIH-Clinical Research Center, Room 1-3330, MSC1103, Bethesda, MD, 20892-1862,USA, Tel: 001-301-496-4686; 001-301-402-0574,
| | - Flora Bacopoulou
- Pediatric Endocrinology Inter-institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD 20892, USA.,First Department of Pediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, Athens, Greece
| | - Charalampos Lyssikatos
- Pediatric Endocrinology Inter-institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD 20892, USA
| | - Elena Belyavskaya
- Pediatric Endocrinology Inter-institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD 20892, USA
| | - Fabio Faucz
- Pediatric Endocrinology Inter-institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD 20892, USA
| | - Constantine A. Stratakis
- Section on Endocrinology & Genetics, and Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD 20892, USA.,Pediatric Endocrinology Inter-institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD 20892, USA
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20
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Chen Y, Lu X, Montoya-Durango DE, Liu YH, Dean KC, Darling DS, Kaplan HJ, Dean DC, Gao L, Liu Y. ZEB1 Regulates Multiple Oncogenic Components Involved in Uveal Melanoma Progression. Sci Rep 2017; 7:45. [PMID: 28246385 PMCID: PMC5428321 DOI: 10.1038/s41598-017-00079-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 01/31/2017] [Indexed: 12/11/2022] Open
Abstract
Human uveal melanoma (UM) is a major ocular malignant tumor with high risk of metastasis and requires multiple oncogenic factors for progression. ZEB1 is a zinc finger E-box binding transcription factor known for participating epithelial-mesenchymal transition (EMT), a critical cellular event for metastasis of malignant tumors of epithelium origin. ZEB1 is also expressed in UM and high expression of ZEB1 correlates with UM advancement, but has little effect on cell morphology. We show that spindle UM cells can become epithelioid but not vice versa; and ZEB1 exerts its tumorigenic effects by promoting cell dedifferentiation, proliferation, invasiveness, and dissemination. We provide evidence that ZEB1 binds not only to repress critical genes involving in pigment synthesis, mitosis, adherent junctions, but also to transactivate genes involving in matrix degradation and cellular locomotion to propel UM progression towards metastasis. We conclude that ZEB1 is a major oncogenic factor required for UM progression and could be a potential therapeutic target for treating UM in the clinic.
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Affiliation(s)
- Yao Chen
- The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, 410011, China.,Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Xiaoqin Lu
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Diego E Montoya-Durango
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Yu-Hua Liu
- The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, 410011, China
| | - Kevin C Dean
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Douglas S Darling
- Periodontics, Endodontics, and Dental Hygiene, University of Louisville, Louisville, Kentucky, USA
| | - Henry J Kaplan
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Douglas C Dean
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, Kentucky, USA.,James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky, USA
| | - Ling Gao
- The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, 410011, China.
| | - Yongqing Liu
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, Kentucky, USA. .,James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky, USA.
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21
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Marwaha N, Batanian JR, Coppens JR, Pierson MJ, Richards-Yutz J, Ebrahimzadeh J, Ganguly A, Guzman MA. Subcutaneous melanocytoma mimicking a lipoma: a rare presentation of a rare neoplasm with histological, immunohistochemical, cytogenetic and molecular characterization. J Cutan Pathol 2016; 43:1186-1196. [PMID: 27573466 DOI: 10.1111/cup.12808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 08/09/2016] [Accepted: 08/19/2016] [Indexed: 01/06/2023]
Abstract
Melanocytoma are the melanocytic tumors originating from leptomeningeal melanocytes. Melanocytomas are commonly seen in the central nervous system (CNS) and are often associated with neurocutaneous melanosis (NCM). However, simultaneous presentation of intra-axial and extracranial melanocytoma is a very rare event. Here, we report a unique case of 21-year-old male with intermediate-grade subcutaneous (SC) melanocytoma, mimicking lipoma, occurred synchronously with an intracranial melanocytoma, not associated with NCM. A 21-year-old Caucasian male presented to the emergency department (ED) with severe vertigo and vomiting. A magnetic resonance imaging (MRI) of the brain was performed at the ED, which revealed an SC mass in the right occipital scalp and a right cerebellopontine angle (CPA) mass. Excision of the SC mass revealed a well-circumscribed highly pigmented melanocytic tumor. The SC mass tumor cells were positive for melanocytic lineage markers. The histopathological features were between benign melanocytomas and malignant melanomas. The Ki67 and PHH3 IHCs confirm the intermediate grade of the tumors. An array-CGH (comparative genome hybridization) and next-generation sequencing analysis of the tumor DNA extracted from the formalin-fixed paraffin-embedded tissue reveals chromosome 6p gain and p.Q209P mutation in the GNAQ gene, respectively, consistent with the diagnosis of intermediate-grade melanocytoma.
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Affiliation(s)
- Nitin Marwaha
- Department of Pathology, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Jacqueline R Batanian
- Department of Pathology, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Jeroen R Coppens
- Department of Neurosurgery, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Matthew J Pierson
- Department of Neurosurgery, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Jennifer Richards-Yutz
- Department of Genetics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Jessica Ebrahimzadeh
- Department of Genetics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Arupa Ganguly
- Department of Genetics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Miguel A Guzman
- Department of Pathology, Saint Louis University School of Medicine, St. Louis, MO, USA
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22
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Orbital meningeal melanocytoma: Histological, immunohistochemical and molecular characterization of a case and review of the literature. Pathol Res Pract 2016; 212:946-953. [PMID: 27499153 DOI: 10.1016/j.prp.2016.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 07/18/2016] [Indexed: 12/21/2022]
Abstract
AIMS We provide morphological, immunohistochemical and molecular characterization of the 3rd "intermediate-grade" orbital meningeal melanocytoma, testing for the first time Vysis Melanoma FISH Probe Kit. We reviewed the literature in order to discuss the main differential diagnoses and to provide a better molecular description of these unusual tumors of difficult diagnosis and controversial management. METHODS Histochemical stains (Haematoxylin and Eosin, Perls, reticulin), immunohistochemistry (HMB45, p16, Melan-A, S100, EMA, Ki67, CD68), polymerase chain reaction amplification and sequence analysis (BRAF, exon 15; NRAS exons 2 and 3; c-KIT, exons 11, 13, 17, 18; GNAQ, exons 4 and 5; GNA11, exons 4 and 5) and fluorescent in situ hybridization (RREB1, 6p25; MYB, 6q23; CCND1, 11q13; CEP 6, 6p11.1-q11.1) were performed on paraffin-embedded, formalin-fixed material. RESULTS Histological diagnosis of "intermediate-grade" melanocytoma was supported by zonal necrosis and increased Ki67-index (12%). Immunophenotype: HMB45+(strong, >75%), Melan-A+(strong, >75%), p16+(∼20%), S100 -/+ (<5%), EMA -/+ (<5%), CD68 - (positive histiocytes). No gene mutations nor copy-number alterations were identified. The patient was asymptomatic and disease-free 3 years after total surgical excision. CONCLUSIONS Adequate sampling and accurate immunohistochemical characterization are important for a correct diagnosis. Molecular analysis could provide important additional information (especially for "intermediate-grade" tumors), but further data are needed.
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Agarwalla PK, Koch MJ, Mordes DA, Codd PJ, Coumans JV. Pigmented Lesions of the Nervous System and the Neural Crest: Lessons From Embryology. Neurosurgery 2016; 78:142-55. [PMID: 26355366 DOI: 10.1227/neu.0000000000001010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Neurosurgeons encounter a number of pigmented tumors of the central nervous system in a variety of locations, including primary central nervous system melanoma, blue nevus of the spinal cord, and melanotic schwannoma. When examined through the lens of embryology, pigmented lesions share a unifying connection: They occur in structures that are neural crest cell derivatives. Here, we review the important progress made in the embryology of neural crest cells, present 3 cases of pigmented tumors of the nervous system, and discuss these clinical entities in the context of the development of melanoblasts. Pigmented lesions of the nervous system arise along neural crest cell migration routes and from neural crest-derived precursors. Awareness of the evolutionary clues of vertebrate pigmentation by the neurosurgical and neuro-oncological community at large is valuable for identifying pathogenic or therapeutic targets and for designing future research on nervous system pigmented lesions. When encountering such a lesion, clinicians should be aware of the embryological basis to direct additional evaluation, including genetic testing, and to work with the scientific community in better understanding these lesions and their relationship to neural crest developmental biology.
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Affiliation(s)
- Pankaj K Agarwalla
- Departments of *Neurosurgery and‡Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Urtatiz O, Van Raamsdonk CD. Gnaq and Gna11 in the Endothelin Signaling Pathway and Melanoma. Front Genet 2016; 7:59. [PMID: 27148356 PMCID: PMC4837292 DOI: 10.3389/fgene.2016.00059] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/01/2016] [Indexed: 12/21/2022] Open
Abstract
In this article, we first briefly outline the function of G protein coupled receptors in cancer, and then specifically examine the roles of the seven transmembrane G protein coupled Endothelin B receptor (Ednrb) and the G proteins, GNAQ and GNA11, in both melanocyte development and melanoma. Ednrb plays an essential role in melanocyte development. GNAQ and GNA11 are oncogenes when mutated in certain types of melanocytic lesions, being extremely frequent in uveal melanoma, which forms from melanocytes located in the eye. Previously, we reported that in mice, Schwann cell precursor derived melanocytes colonize the dermis and hair follicles, while the inter-follicular epidermis is populated by other melanocytes. A pattern has emerged whereby melanocytes whose activities are affected by gain-of-function mutations of the Endothelin 3 ligand and Gαq/11 are the same subset that arise from Schwann cell precursors. Furthermore, the forced expression of the constitutively active human GNAQQ209L oncogene in mouse melanocytes only causes hyper-proliferation in the subset that arise from Schwann cell precursors. This has led us to hypothesize that in Schwann cell precursor derived melanocytes, Ednrb signals through Gαq/11. Ednrb is promiscuous and may signal through other G protein alpha subunits in melanomas located in the inter-follicular epidermis.
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Affiliation(s)
- Oscar Urtatiz
- Department of Medical Genetics, University of British Columbia Vancouver, BC, Canada
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25
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van de Nes J, Gessi M, Sucker A, Möller I, Stiller M, Horn S, Scholz SL, Pischler C, Stadtler N, Schilling B, Zimmer L, Hillen U, Scolyer RA, Buckland ME, Lauriola L, Pietsch T, Waha A, Schadendorf D, Murali R, Griewank KG. Targeted next generation sequencing reveals unique mutation profile of primary melanocytic tumors of the central nervous system. J Neurooncol 2016; 127:435-44. [PMID: 26744134 DOI: 10.1007/s11060-015-2052-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 12/30/2015] [Indexed: 11/28/2022]
Abstract
Melanocytic tumors originating in the central nervous system (MT-CNS) are rare tumors that generally have a favorable prognosis, however malignant tumors do occur. Pathogenetically MT-CNS are not well characterized. Similar to uveal melanoma and blue nevi, they frequently harbor activating GNAQ or GNA11 mutations. Rare NRAS mutations have also been reported. Other mutations have not yet been described. We analyzed 19 MT-CNS, 7 uveal melanomas and 19 cutaneous melanomas using a targeted next generation sequencing approach analyzing 29 genes known to be frequently mutated in other melanocytic tumors (in particular uveal and cutaneous melanomas). In concordance with previous studies, cutaneous melanoma samples showed frequent NRAS or BRAF mutations, as well as mutations in other genes (e.g. NF1, RAC1, PIK3CA, ARID1A). Metastasized uveal melanomas exhibited mutations in GNAQ, GNA11 and BAP1. In contrast, MT-CNS almost exclusively demonstrated mutations in GNAQ (71 %) or GNA11 (12 %). Interestingly both GNA11 mutations identified were detected in MT-CNS diagnosed as intermediate grade melanocytomas which also recurred. One of these recurrent cases also harbored an inactivating BAP1 mutation and was found to have lost one copy of chromosome 3. Our findings show that while MT-CNS do have GNAQ or GNA11 mutations, they rarely harbor other recurrent mutations found in uveal or cutaneous melanomas. Considering chromosome 3 and BAP1 loss are robust markers of poor prognosis in uveal melanoma, it will prove interesting to determine whether these genomic alterations are also of prognostic significance in MT-CNS.
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Affiliation(s)
- Johannes van de Nes
- Institute of Neuropathology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Duisburg-Essen, Germany
| | - Marco Gessi
- Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany
| | - Antje Sucker
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK) University of Duisburg-Essen, Duisburg-Essen, Germany
| | - Inga Möller
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK) University of Duisburg-Essen, Duisburg-Essen, Germany
| | - Mathias Stiller
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK) University of Duisburg-Essen, Duisburg-Essen, Germany
| | - Susanne Horn
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK) University of Duisburg-Essen, Duisburg-Essen, Germany
| | - Simone L Scholz
- Department of Ophthalmology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Duisburg-Essen, Germany
| | - Carina Pischler
- Institute of Human Genetics, Medical University of Graz, Graz, Austria
| | - Nadine Stadtler
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK) University of Duisburg-Essen, Duisburg-Essen, Germany
| | - Bastian Schilling
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK) University of Duisburg-Essen, Duisburg-Essen, Germany
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK) University of Duisburg-Essen, Duisburg-Essen, Germany
| | - Uwe Hillen
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK) University of Duisburg-Essen, Duisburg-Essen, Germany
| | - Richard A Scolyer
- Tissue Pathology and Diagnostic Oncology, Camperdown, NSW, Australia.,The University of Sydney, Camperdown, NSW, Australia.,Melanoma Institute Australia, North Sydney, NSW, Australia
| | - Michael E Buckland
- Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,The University of Sydney, Camperdown, NSW, Australia
| | | | - Torsten Pietsch
- Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany
| | - Andreas Waha
- Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK) University of Duisburg-Essen, Duisburg-Essen, Germany
| | - Rajmohan Murali
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Klaus G Griewank
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK) University of Duisburg-Essen, Duisburg-Essen, Germany.
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26
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Berwick M, Buller DB, Cust A, Gallagher R, Lee TK, Meyskens F, Pandey S, Thomas NE, Veierød MB, Ward S. Melanoma Epidemiology and Prevention. Cancer Treat Res 2016; 167:17-49. [PMID: 26601858 DOI: 10.1007/978-3-319-22539-5_2] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The epidemiology of melanoma is complex, and individual risk depends on sun exposure, host factors, and genetic factors, and in their interactions as well. Sun exposure can be classified as intermittent, chronic, or cumulative (overall) exposure, and each appears to have a different effect on type of melanoma. Other environmental factors, such as chemical exposures-either through occupation, atmosphere, or food-may increase risk for melanoma, and this area warrants further study. Host factors that are well known to be important are the numbers and types of nevi and the skin phenotype. Genetic factors are classified as high-penetrant genes, moderate-risk genes, or low-risk genetic polymorphisms. Subtypes of tumors, such as BRAF-mutated tumors, have different risk factors as well as different therapies. Prevention of melanoma has been attempted using various strategies in specific subpopulations, but to date optimal interventions to reduce incidence have not emerged.
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Affiliation(s)
- Marianne Berwick
- Department of Internal Medicine, University of New Mexico, MSC10-5550, Albuquerque, NM, 87131-0001, USA.
| | - David B Buller
- Klein Buendel, Inc., 1667 Cole Boulevard, Suite 225, Golden, CO, 80401, USA.
| | - Anne Cust
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Level 6, 119-143 Missenden Road, Camperdown, NSW, 2050, Australia.
| | - Richard Gallagher
- Cancer Control Research Program, BC Cancer Agency, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.
| | - Tim K Lee
- Cancer Control Research Program, BC Cancer Agency, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.
| | - Frank Meyskens
- Public Health and Epidemiology, University of California, Irvine, USA.
| | - Shaily Pandey
- Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Nancy E Thomas
- University of North Carolina, 413 Mary Ellen Jones Bldg. CB#7287, Chapel Hill, NC, 275992, USA.
| | - Marit B Veierød
- Department of Biostatistics, Institute of Basic Medical Sciences, P.O. Box 1122 Blindern, 0317, Oslo, Norway.
| | - Sarah Ward
- Centre for Genetic Origins of Health and Disease (GOHaD), The University of Western Australia, M409, 35 Stirling Hwy, Crawley, WA, 6009, Australia.
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Küsters-Vandevelde HVN, Küsters B, van Engen-van Grunsven ACH, Groenen PJTA, Wesseling P, Blokx WAM. Primary melanocytic tumors of the central nervous system: a review with focus on molecular aspects. Brain Pathol 2015; 25:209-26. [PMID: 25534128 DOI: 10.1111/bpa.12241] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 12/16/2014] [Indexed: 02/06/2023] Open
Abstract
Primary melanocytic tumors of the central nervous system (CNS) represent a spectrum of rare tumors. They can be benign or malignant and occur in adults as well as in children, the latter often in the context of neurocutaneous melanosis. Until recently, the genetic alterations in these tumors were largely unknown. This is in contrast with cutaneous and uveal melanomas, which are known to harbor distinct oncogenic mutations that can be used as targets for treatment with small-molecule inhibitors in the advanced setting. Recently, novel insights in the molecular alterations underlying primary melanocytic tumors of the CNS were obtained, including different oncogenic mutations in tumors in adult patients (especially GNAQ, GNA11) vs. children (especially NRAS). In this review, the focus is on molecular characteristics of primary melanocytic tumors of the CNS. We summarize what is known about their genetic alterations and discuss implications for pathogenesis and differential diagnosis with other pigmented tumors in or around the CNS. Finally, new therapeutic options with targeted therapy are discussed.
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28
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Uguen A, Laurent C, Samaison L, Boisselier B, Talagas M, Costa S, Aziza J, Mokhtari K, Le Maréchal C, Marcorelles P. Severe hydrocephalus caused by diffuse leptomeningeal and neurocutaneous melanocytosis of antenatal onset: a clinical, pathologic, and molecular study of 2 cases. Hum Pathol 2015; 46:1189-96. [DOI: 10.1016/j.humpath.2015.04.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 03/24/2015] [Accepted: 04/20/2015] [Indexed: 11/26/2022]
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29
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Gessi M, Engels AC, Lambert S, Rothämel T, von Hornstein S, Collins VP, Denkhaus D, Gnekow A, Pietsch T. Molecular characterization of disseminated pilocytic astrocytomas. Neuropathol Appl Neurobiol 2015; 42:273-8. [DOI: 10.1111/nan.12256] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/14/2015] [Indexed: 11/28/2022]
Affiliation(s)
- M. Gessi
- Institute of Neuropathology; University of Bonn; Bonn Germany
| | - A. C. Engels
- Institute of Neuropathology; University of Bonn; Bonn Germany
| | - S. Lambert
- Department of Pathology; University of Cambridge; Cambridge UK
| | - T. Rothämel
- Department of Forensic Medicine; University of Hannover Medical School; Hannover Germany
| | - S. von Hornstein
- Department of Pediatric Oncology; Klinikum Augsburg; Augsburg Germany
| | - V. P. Collins
- Department of Pathology; University of Cambridge; Cambridge UK
| | - D. Denkhaus
- Institute of Neuropathology; University of Bonn; Bonn Germany
| | - A. Gnekow
- Department of Pediatric Oncology; Klinikum Augsburg; Augsburg Germany
| | - T. Pietsch
- Institute of Neuropathology; University of Bonn; Bonn Germany
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30
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Huang JLY, Urtatiz O, Van Raamsdonk CD. Oncogenic G Protein GNAQ Induces Uveal Melanoma and Intravasation in Mice. Cancer Res 2015; 75:3384-97. [PMID: 26113083 DOI: 10.1158/0008-5472.can-14-3229] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 06/05/2015] [Indexed: 11/16/2022]
Abstract
GNAQ and GNA11 are heterotrimeric G protein alpha subunits, which are mutated in a mutually exclusive pattern in most cases of uveal melanoma, one of the most aggressive cancers. Here we introduce the first transgenic mouse model of uveal melanoma, which develops cancers induced by expression of oncogenic GNAQ(Q209L) under control of the Rosa26 promoter. Disease penetrance is 100% by 3 months of age, with 94% of mice also developing lung tumors. In this model, the Yap protein of the Hippo pathway is activated in the eyes, and blood vessels near the lesions in the head and lungs exhibit melanocytic invasion. While full transcription levels are not necessary for GNAQ(Q209L) to transform mouse melanocytes, we obtained suggestive evidence of a selective advantage for increased GNAQ(Q209L) expression in human tumors. Intriguingly, enforced expression of GNAQ(Q209L) progressively eliminated melanocytes from the interfollicular epidermis in adults, possibly explaining the near absence of GNAQ(Q209) mutations in human epithelial melanomas. The mouse model also exhibited dermal nevi and melanocytic neoplasms of the central nervous system, accompanied by impaired hearing and balance, identifying a novel role for GNAQ in melanocyte-like cells of the inner ear. Overall, this model offers a new tool to dissect signaling by oncogenic GNAQ and to test potential therapeutics in an in vivo setting where GNAQ(Q209L) mutations contribute to both the initiation and metastatic progression of uveal melanoma.
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Affiliation(s)
- Jenny Li-Ying Huang
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Oscar Urtatiz
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Catherine D Van Raamsdonk
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada.
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31
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Mackenzie R, Kommoss S, Winterhoff BJ, Kipp BR, Garcia JJ, Voss J, Halling K, Karnezis A, Senz J, Yang W, Prigge ES, Reuschenbach M, Doeberitz MVK, Gilks BC, Huntsman DG, Bakkum-Gamez J, McAlpine JN, Anglesio MS. Targeted deep sequencing of mucinous ovarian tumors reveals multiple overlapping RAS-pathway activating mutations in borderline and cancerous neoplasms. BMC Cancer 2015; 15:415. [PMID: 25986173 PMCID: PMC4494777 DOI: 10.1186/s12885-015-1421-8] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 05/06/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Mucinous ovarian tumors represent a distinct histotype of epithelial ovarian cancer. The rarest (2-4 % of ovarian carcinomas) of the five major histotypes, their genomic landscape remains poorly described. We undertook hotspot sequencing of 50 genes commonly mutated in human cancer across 69 mucinous ovarian tumors. Our goals were to establish the overall frequency of cancer-hotspot mutations across a large cohort, especially those tumors previously thought to be "RAS-pathway alteration negative", using highly-sensitive next-generation sequencing as well as further explore a small number of cases with apparent heterogeneity in RAS-pathway activating alterations. METHODS Using the Ion Torrent PGM platform, we performed next generation sequencing analysis using the v2 Cancer Hotspot Panel. Regions of disparate ERBB2-amplification status were sequenced independently for two mucinous carcinoma (MC) cases, previously established as showing ERBB2 amplification/overexpression heterogeneity, to assess the hypothesis of subclonal populations containing either KRAS mutation or ERBB2 amplification independently or simultaneously. RESULTS We detected mutations in KRAS, TP53, CDKN2A, PIK3CA, PTEN, BRAF, FGFR2, STK11, CTNNB1, SRC, SMAD4, GNA11 and ERBB2. KRAS mutations remain the most frequently observed alteration among MC (64.9 %) and mucinous borderline tumors (MBOT) (92.3 %). TP53 mutation occurred more frequently in carcinomas than borderline tumors (56.8 % and 11.5 %, respectively), and combined IHC and mutation data suggest alterations occur in approximately 68 % of MC and as many as 20 % of MBOT. Proven and potential RAS-pathway activating changes were observed in all but one MC. Concurrent ERBB2 amplification and KRAS mutation were observed in a substantial number of cases (7/63 total), as was co-occurrence of KRAS and BRAF mutations (one case). Microdissection of ERBB2-amplified regions of tumors harboring KRAS mutation suggests these alterations are occurring in the same cell populations, while consistency of KRAS allelic frequency in both ERBB2 amplified and non-amplified regions suggests this mutation occurred in advance of the amplification event. CONCLUSIONS Overall, the prevalence of RAS-alteration and striking co-occurrence of pathway "double-hits" supports a critical role for tumor progression in this ovarian malignancy. Given the spectrum of RAS-activating mutations, it is clear that targeting this pathway may be a viable therapeutic option for patients with recurrent or advanced stage mucinous ovarian carcinoma, however caution should be exercised in selecting one or more personalized therapeutics given the frequency of non-redundant RAS-activating alterations.
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Affiliation(s)
| | - Stefan Kommoss
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada. .,Gynecology and Obstetrics, Tuebingen University Hospital, Tuebingen, Germany.
| | | | - Benjamin R Kipp
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA.
| | | | - Jesse Voss
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA.
| | - Kevin Halling
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA.
| | - Anthony Karnezis
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada.
| | - Janine Senz
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada.
| | - Winnie Yang
- Molecular Oncology, BC Cancer Agency Research Centre, Vancouver, Canada.
| | - Elena-Sophie Prigge
- Applied Tumor Biology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany.
| | - Miriam Reuschenbach
- Applied Tumor Biology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany.
| | | | - Blake C Gilks
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada.
| | - David G Huntsman
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada. .,Gynecology and Obstetrics, Division of Gynecologic Oncology, University of British Columbia, Vancouver, Canada.
| | | | - Jessica N McAlpine
- Gynecology and Obstetrics, Division of Gynecologic Oncology, University of British Columbia, Vancouver, Canada.
| | - Michael S Anglesio
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada. .,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada.
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Koelsche C, Hovestadt V, Jones DTW, Capper D, Sturm D, Sahm F, Schrimpf D, Adeberg S, Böhmer K, Hagenlocher C, Mechtersheimer G, Kohlhof P, Mühleisen H, Beschorner R, Hartmann C, Braczynski AK, Mittelbronn M, Buslei R, Becker A, Grote A, Urbach H, Staszewski O, Prinz M, Hewer E, Pfister SM, von Deimling A, Reuss DE. Melanotic tumors of the nervous system are characterized by distinct mutational, chromosomal and epigenomic profiles. Brain Pathol 2014; 25:202-8. [PMID: 25399693 DOI: 10.1111/bpa.12228] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 11/10/2014] [Indexed: 01/23/2023] Open
Abstract
Melanotic tumors of the nervous system show overlapping histological characteristics but differ substantially in their biological behavior. In order to achieve a better delineation of such tumors, we performed an in-depth molecular characterization. Eighteen melanocytomas, 12 melanomas, and 14 melanotic and 14 conventional schwannomas (control group) were investigated for methylome patterns (450k array), gene mutations associated with melanotic tumors and copy number variants (CNVs). The methylome fingerprints assigned tumors to entity-specific groups. Methylation groups also showed a substantial overlap with histology-based diagnosis suggesting that they represent true biological entities. On the molecular level, melanotic schwannomas were characterized by a complex karyotype with recurrent monosomy of chromosome 22q and variable whole chromosomal gains and recurrent losses commonly involving chromosomes 1, 17p and 21. Melanocytomas carried GNAQ/11 mutations and presented with CNV involving chromosomes 3 and 6. Melanomas were frequently mutated in the TERT promoter, harbored additional oncogene mutations and showed recurrent chromosomal losses involving chromosomes 9, 10 and 6q, as well as gains of 22q. Together, melanotic nervous system tumors have several distinct mutational and chromosomal alterations and can reliably be distinguished by methylome profiling.
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Affiliation(s)
- Christian Koelsche
- Department of Neuropathology, Institute of Pathology, University Medical Center, Heidelberg, Germany; German Cancer Consortium (DKTK), Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Berghoff AS, Bartsch R, Wöhrer A, Streubel B, Birner P, Kros JM, Brastianos PK, von Deimling A, Preusser M. Predictive molecular markers in metastases to the central nervous system: recent advances and future avenues. Acta Neuropathol 2014; 128:879-91. [PMID: 25287912 DOI: 10.1007/s00401-014-1350-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 09/26/2014] [Accepted: 09/28/2014] [Indexed: 12/14/2022]
Abstract
Metastases to the central nervous system (CNS) are common in several cancer types. For most primary tumors that commonly metastasize to the CNS, molecular biomarker analyses are recommended in the clinical setting for selection of appropriate targeted therapies. Therapeutic efficacy of some of these agents has been documented in patients with brain metastases, and molecular testing of CNS metastases should be considered in the clinical setting. Here, we summarize the clinically relevant biomarker tests that should be considered in neurosurgical specimens based on the current recommendations of the European Society of Medical Oncology (ESMO) or the National Comprehensive Cancer Network (NCCN) for the most relevant primary tumor types: lung cancer (EGFR mutations, ALK rearrangement, BRAF mutations), breast cancer (HER2 amplification, steroid receptor overexpression), melanoma (BRAF mutations), and colorectal cancer (RAS mutations). Furthermore, we discuss emerging therapeutic targets including novel oncogenic alterations (ROS1 rearrangements, FGFR1 amplifications, CMET amplifications, and others) and molecular features of the tumor microenvironment (including immune-checkpoint molecules such as CTLA4 and PD-1/PD-L1). We also discuss the potential role of advanced biomarker tests such as next-generation sequencing and "liquid biopsies" for patients with CNS metastases.
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Küsters-Vandevelde HVN, van Engen- van Grunsven IACH, Coupland SE, Lake SL, Rijntjes J, Pfundt R, Küsters B, Wesseling P, Blokx WAM, Groenen PJTA. Mutations in G Protein Encoding Genes and Chromosomal Alterations in Primary Leptomeningeal Melanocytic Neoplasms. Pathol Oncol Res 2014; 21:439-47. [DOI: 10.1007/s12253-014-9841-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 09/11/2014] [Indexed: 10/24/2022]
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Gessi M, van de Nes J, Griewank K, Barresi V, Buckland ME, Kirfel J, Caltabiano R, Hammes J, Lauriola L, Pietsch T, Waha A. Absence ofTERTpromoter mutations in primary melanocytic tumours of the central nervous system. Neuropathol Appl Neurobiol 2014; 40:794-7. [DOI: 10.1111/nan.12138] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 03/10/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Marco Gessi
- Institute of Neuropathology; University of Bonn Medical Center; Bonn Germany
| | - Johannes van de Nes
- Institute of Neuropathology; University Duisburg-Essen; University Hospital Essen; Essen Germany
| | - Klaus Griewank
- Department of Dermatology; University Duisburg-Essen; University Hospital Essen; Essen Germany
| | - Valeria Barresi
- Institute of Pathology; University of Messina; Messina Italy
| | - Michael E. Buckland
- Department of Neuropathology; Royal Prince Alfred Hospital; Sydney NSW Australia
| | - Jutta Kirfel
- Institute of Pathology; University of Bonn Medical Center; Bonn Germany
| | - Rosario Caltabiano
- Department ‘G.F. Ingrassia’; Section of Anatomic Pathology; University of Catania; Catania Italy
| | - Jennifer Hammes
- Institute of Neuropathology; University of Bonn Medical Center; Bonn Germany
| | | | - Torsten Pietsch
- Institute of Neuropathology; University of Bonn Medical Center; Bonn Germany
| | - Andreas Waha
- Institute of Neuropathology; University of Bonn Medical Center; Bonn Germany
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Cornejo KM, Hutchinson L, Cosar EF, Smith T, Tomaszewicz K, Dresser K, Deng A. Is it a primary or metastatic melanocytic neoplasm of the central nervous system?: A molecular based approach. Pathol Int 2014; 63:559-64. [PMID: 24274719 DOI: 10.1111/pin.12107] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 10/03/2013] [Indexed: 12/11/2022]
Abstract
Primary melanocytic neoplasms of the central nervous system (CNS) are uncommon and must be distinguished from metastatic lesions as patients with metastatic disease carry a worse prognosis. Therefore, tools to aid in the diagnosis of a primary CNS melanocytic neoplasm would be of clinical utility. Primary CNS melanocytic neoplasms, including uveal melanomas have frequent mutations in GNAQ and GNA11, but are rare in cutaneous and mucosal melanomas. Additionally, primary uveal melanomas often exhibit monosomy 3 conferring an elevated risk of metastasis. We present a 63 year-old male with a melanocytic neoplasm in the thoracic spinal cord. Molecular studies revealed the tumor contained a GNAQ mutation and four-color fluorescent in situ hybridization (FISH) composed of chromosome enumeration probes for 3, 7, 17 and a locus specific probe for 9p21/CDKN2A yielded a normal result (i.e. two copies per cell), favoring a primary versus metastatic melanocytic neoplasm of the CNS. We report a case in which the combination of mutational analysis and FISH aided in identifying the origin of the neoplasm.
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Affiliation(s)
- Kristine M Cornejo
- Department of Pathology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA
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Mandalà M, Merelli B, Massi D. Nras in melanoma: targeting the undruggable target. Crit Rev Oncol Hematol 2014; 92:107-22. [PMID: 24985059 DOI: 10.1016/j.critrevonc.2014.05.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 05/01/2014] [Accepted: 05/09/2014] [Indexed: 12/30/2022] Open
Abstract
RAS belongs to the guanosine 5'-triphosphate (GTP)-binding proteins' family, and oncogenic mutations in codons 12, 13, or 61 of RAS family occur in approximately one third of all human cancers with N-RAS mutations found in about 15-20% of melanomas. The importance of RAS signaling as a potential target in cancer is emphasized not only by the prevalence of RAS mutations, but also by the high number of RAS activators and effectors identified in mammalian cells that places the RAS proteins at the crossroads of several, important signaling networks. Ras proteins are crucial crossroads of signaling pathways that link the activation of cell surface receptors with a wide variety of cellular processes leading to the control of proliferation, apoptosis and differentiation. Furthermore, oncogenic ras proteins interfere with metabolism of tumor cells, microenvironment's remodeling, evasion of the immune response, and finally contributes to the metastatic process. After 40 years of basic, translational and clinical research, much is now known about the molecular mechanisms by which these monomeric guanosine triphosphatase-binding proteins promote cellular malignancy, and it is clear that they regulate signaling pathways involved in the control of cell proliferation, survival, and invasiveness. In this review we summarize the biological role of RAS in cancer by focusing our attention on the biological rational and strategies to target RAS in melanoma.
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Affiliation(s)
- Mario Mandalà
- Unit of Medical Oncology, Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Barbara Merelli
- Unit of Medical Oncology, Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Daniela Massi
- Division of Pathological Anatomy, Department of Surgery and Translational Medicine, University of Florence, Italy
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Küsters-Vandevelde HVN, Willemsen AECAB, Groenen PJTA, Küsters B, Lammens M, Wesseling P, Djafarihamedani M, Rijntjes J, Delye H, Willemsen MA, van Herpen CML, Blokx WAM. Experimental treatment of NRAS-mutated neurocutaneous melanocytosis with MEK162, a MEK-inhibitor. Acta Neuropathol Commun 2014; 2:41. [PMID: 24713450 PMCID: PMC4023633 DOI: 10.1186/2051-5960-2-41] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 04/01/2014] [Indexed: 12/17/2022] Open
Abstract
Neurocutaneous melanosis (NCM) is a rare congenital disorder characterized by the association of large and/or multiple congenital melanocytic nevi (CMN) of the skin with melanocytic lesions of the leptomeninges, including melanocytosis. Leptomeningeal melanocytosis carries a poor prognosis once neurological symptoms develop. Despite surgery, which is often not radical, few other treatment options exist. Recently, it was demonstrated that early embryonic, post-zygotic somatic mutations in the NRAS gene are implicated in the pathogenesis of NCM. In this report, we present a 13-year-old boy with NCM and progressive symptomatic leptomeningeal melanocytosis. A somatic NRASQ61K mutation was present in both CMN as well as the melanocytosis. Despite repeated surgery, the patient showed clinical progression. Therefore, treatment with MEK162, a MEK inhibitor, was started on compassionate use base. The patient died only five days later, i.e. too early to expect a clinical effect of MEK162 therapy. We therefore studied the effect of MEK162 at the protein level in the leptomeningeal tumor by immunohistochemical and Western Blot analyses using Ki67 and pERK antibodies. We observed lower MIB-1 expression and lower pERK expression in the post-treatment samples compared to pre-treatment, suggesting a potential effect of MEK inhibiting therapy. Further studies are needed to determine whether MEK inhibitors can effectively target NRAS-mutated symptomatic NCM, a rare but potentially fatal disease.
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Gessi M, Pietsch T. The diagnostic role and clinical relevance of determination of BRAF status in brain tumors. Per Med 2013; 10:405-412. [PMID: 29783415 DOI: 10.2217/pme.13.27] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BRAF protein is a serine/threonine kinase that serves as an immediate downstream effector of the MAPK signaling cascade, a signal transduction pathway that modulates cell proliferation and survival. BRAF alterations leading to MAPK pathway activation have been identified in gliomas and glioneuronal tumors of the CNS. Whereas BRAF mutations have been found in a wide spectrum of CNS tumors, BRAF fusions have been almost exclusively found in pilocytic astrocytomas. BRAF fusion identification provides an additional help in the differential diagnosis of supratentorial gliomas. Although the prognostic significance of BRAF alterations in different CNS tumors is still under investigation, the evidence of BRAF-dependent MAPK-pathway activation in gliomas has moreover drawn attention to the potential use of MEK1/2 and RAF inhibitors in clinical neuro-oncology. Given the promising results of the therapeutic management of several cancer types, clinical studies investigating the suitability of such inhibitors for the therapy of gliomas are ongoing.
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Affiliation(s)
- Marco Gessi
- Institute of Neuropathology, University of Bonn Medical Center, Sigmund-Freud-Strasse 25, D-53105, Bonn, Germany.
| | - Torsten Pietsch
- Institute of Neuropathology, University of Bonn Medical Center, Sigmund-Freud-Strasse 25, D-53105, Bonn, Germany
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Pedersen M, Küsters-Vandevelde HV, Viros A, Groenen PJ, Sanchez-Laorden B, Gilhuis JH, van Engen- van Grunsven IA, Renier W, Schieving J, Niculescu-Duvaz I, Springer CJ, Küsters B, Wesseling P, Blokx WA, Marais R. Primary melanoma of the CNS in children is driven by congenital expression of oncogenic NRAS in melanocytes. Cancer Discov 2013; 3:458-469. [PMID: 23303902 PMCID: PMC3999382 DOI: 10.1158/2159-8290.cd-12-0464] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED NRAS mutations are common in human melanoma. To produce a mouse model of NRAS-driven melanoma, we expressed oncogenic NRAS (NRAS(G12D)) in mouse melanocytes. When NRAS(G12D) was expressed in the melanocytes of developing embryos, it induced melanocyte proliferation and congenital melanocytic lesions reminiscent of human blue nevi but did not induce cutaneous melanoma. Unexpectedly, however, it did induce early-onset primary melanoma of the central nervous system (CNS). The tumors were rapidly proliferating and caused neurologic symptoms, rapid health deterioration, and death. NRAS is not a common driver oncogene of primary melanoma of the CNS in adults, but we report two cases of primary melanoma of the CNS in children, both of which carried oncogenic mutations in NRAS. We conclude that acquisition of somatic mutations in NRAS in CNS melanocytes is a predisposing risk factor for primary melanoma of the CNS in children, and we present a mouse model of this disease. SIGNIFICANCE We show that the acquisition of NRAS mutations in melanocytes during embryogenesis is a risk factor for early-onset melanoma of the CNS. We have developed a powerful mouse model to study this rare but devastating childhood disease, and to develop therapeutic approaches for its treatment.
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Affiliation(s)
- Malin Pedersen
- Signal Transduction Team, The Institute of Cancer Research, London, SW3 6JB, UK
| | | | - Amaya Viros
- Signal Transduction Team, The Institute of Cancer Research, London, SW3 6JB, UK
| | - Patricia J.T.A. Groenen
- Department of Pathology, Radboud University Nijmegen Medical Centre, PO Box 9100, 6500 HB Nijmegen, The Netherlands
| | | | - Jacobus H. Gilhuis
- Department of Neurology, Reinier De Graaf Hospital, PO Box 5011, 2600 GA Delft, The Netherlands
| | | | - Willy Renier
- Department of Neurology, Canisius Wilhelmina Hospital, PO Box 9015, 6500 GS Nijmegen, The Netherlands
| | - Jolanda Schieving
- Department of Neurology, Radboud University Nijmegen Medical Centre, PO Box 9100, 6500 HB Nijmegen, The Netherlands
| | - Ion Niculescu-Duvaz
- Gene and Oncogene Targeting Team, Cancer Research UK Centre for Cancer Therapeutics, The Institute of Cancer Research, Surrey SM2 5NG, UK
| | - Caroline J. Springer
- Gene and Oncogene Targeting Team, Cancer Research UK Centre for Cancer Therapeutics, The Institute of Cancer Research, Surrey SM2 5NG, UK
| | - Benno Küsters
- Department of Pathology, Canisius Wilhelmina Hospital, PO Box 9015, 6500 GS Nijmegen, The Netherlands
| | - Pieter Wesseling
- Department of Pathology, Canisius Wilhelmina Hospital, PO Box 9015, 6500 GS Nijmegen, The Netherlands
- Department of Pathology, Radboud University Nijmegen Medical Centre, PO Box 9100, 6500 HB Nijmegen, The Netherlands
- Department of Pathology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Willeke A.M. Blokx
- Department of Pathology, Radboud University Nijmegen Medical Centre, PO Box 9100, 6500 HB Nijmegen, The Netherlands
| | - Richard Marais
- Signal Transduction Team, The Institute of Cancer Research, London, SW3 6JB, UK
- Molecular Oncology Group, CRUK Manchester Institute, University of Manchester, Manchester M20 4BX, UK
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