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Bianconi A, Panico F, Lo Zito B, Do Trinh A, Cassoni P, Ricardi U, Garbossa D, Cofano F, Mantovani C, Bertero L. Understanding and Managing Pineal Parenchymal Tumors of Intermediate Differentiation: An In-Depth Exploration from Pathology to Adjuvant Therapies. J Clin Med 2024; 13:1266. [PMID: 38592098 PMCID: PMC10931940 DOI: 10.3390/jcm13051266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Pineal parenchymal cell tumors constitute a rare group of primary central nervous system neoplasms (less than 1%). Their classification, especially the intermediate subtype (PPTIDs), remains challenging. METHODS A literature review was conducted, navigating through anatomo-pathological, radiotherapy, and neurosurgical dimensions, aiming for a holistic understanding of these tumors. RESULTS PPTIDs, occupying an intermediate spectrum of malignancy, reveal diverse histological patterns, mitotic activity, and distinct methylation profiles. Surgical treatment is the gold standard, but when limited to partial removal, radiotherapy becomes crucial. While surgical approaches are standardized, due to the low prevalence of the pathology and absence of randomized prospective studies, there are no shared guidelines about radiation treatment modalities. CONCLUSION Surgical removal remains pivotal, demanding a personalized approach based on the tumor extension. This review underscores the considerable variability in treatment approaches and reported survival rates within the existing literature, emphasizing the need for ongoing research to better define optimal therapeutic strategies and prognostic factors for PPTIDs, aiming for further and more detailed stratification among them.
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Affiliation(s)
- Andrea Bianconi
- Neurosurgery Unit, Department of Neuroscience, University of Turin, 10126 Turin, Italy
| | - Flavio Panico
- Neurosurgery Unit, Department of Neuroscience, University of Turin, 10126 Turin, Italy
| | - Bruna Lo Zito
- Radiation Oncology Unit, Department of Oncology, University of Turin, 10126 Turin, Italy
| | - Andrea Do Trinh
- Pathology Unit, Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Paola Cassoni
- Pathology Unit, Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Umberto Ricardi
- Radiation Oncology Unit, Department of Oncology, University of Turin, 10126 Turin, Italy
| | - Diego Garbossa
- Neurosurgery Unit, Department of Neuroscience, University of Turin, 10126 Turin, Italy
| | - Fabio Cofano
- Neurosurgery Unit, Department of Neuroscience, University of Turin, 10126 Turin, Italy
| | - Cristina Mantovani
- Radiation Oncology Unit, Department of Oncology, University of Turin, 10126 Turin, Italy
| | - Luca Bertero
- Pathology Unit, Department of Medical Sciences, University of Turin, 10126 Turin, Italy
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Mohebbi M, Shokripour M, Mokhtari M. Evaluation of INI1 Protein Expression Through IHC Study in Pediatric High-Grade Brain Tumors in South of Iran in 2008-2021. IRANIAN JOURNAL OF PATHOLOGY 2023; 18:279-288. [PMID: 37942202 PMCID: PMC10628376 DOI: 10.30699/ijp.2023.561858.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 06/06/2023] [Indexed: 11/10/2023]
Abstract
Background & Objective Brain tumors are the most frequent solid tumors in children. High-grade tumors are more challenging in diagnosis. Atypical teratoid rhabdoid tumor (ATRT) may be mistaken for other high-grade brain tumors. Molecular genetic analysis of ATRT has shown deletion and mutation in the hSNF5/INI1 gene in most of the cases. The INI1 protein expression can be helpful for the accurate diagnosis. Methods In this study, immunohistochemical staining (IHC) using INI1 antibody was performed to determine the possibility of ATRT misdiagnosis. Totally, 147 tumors including 6 ATRTs, 81 medulloblastomas, and 60 other CNS tumors were examined in children between 0 and 17 years old. Results No nuclear staining was found in the six ATRT cases, while most of other CNS tumors demonstrated nuclear staining. Five cases were previously diagnosed with medulloblastoma, primitive neuroectodermal tumor (PNET), and anaplastic oligodendroglioma, while the diagnoses were changed to ATRT based on the re-evaluation of the H&E slides and INI1 study. Additionally, two cases were recurrent tumors whose features were consistent with those of ATRT. The INI1 immunostaining was negative in these cases. Conclusion INI1 was very helpful in distinguishing ATRT from its mimickers in challenging cases. All known ATRT cases in this study were immunonegative for INI1. Thus, INI1 is recommended to be used in the initial IHC panel for the high-grade brain tumors, especially in children under the age of three years, so that they can benefit from intensified therapeutic regimens.
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Affiliation(s)
| | - Mansoureh Shokripour
- Department of Pathology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
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3
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Atypical teratoid/rhabdoid tumour in the pineal and suprasellar regions: report of 2 cases and review of the literature. Childs Nerv Syst 2022; 38:1429-1432. [PMID: 35711065 DOI: 10.1007/s00381-022-05586-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/10/2022] [Indexed: 11/03/2022]
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Kristensen BW, Priesterbach-Ackley LP, Petersen JK, Wesseling P. Molecular pathology of tumors of the central nervous system. Ann Oncol 2019; 30:1265-1278. [PMID: 31124566 PMCID: PMC6683853 DOI: 10.1093/annonc/mdz164] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Since the update of the 4th edition of the WHO Classification of Central Nervous System (CNS) Tumors published in 2016, particular molecular characteristics are part of the definition of a subset of these neoplasms. This combined 'histo-molecular' approach allows for a much more precise diagnosis of especially diffuse gliomas and embryonal CNS tumors. This review provides an update of the most important diagnostic and prognostic markers for state-of-the-art diagnosis of primary CNS tumors. Defining molecular markers for diffuse gliomas are IDH1/IDH2 mutations, 1p/19q codeletion and mutations in histone H3 genes. Medulloblastomas, the most frequent embryonal CNS tumors, are divided into four molecularly defined groups according to the WHO 2016 Classification: wingless/integrated (WNT) signaling pathway activated, sonic hedgehog (SHH) signaling pathway activated and tumor protein p53 gene (TP53)-mutant, SHH-activated and TP53-wildtype, and non-WNT/non-SHH-activated. Molecular characteristics are also important for the diagnosis of several other CNS tumors, such as RELA fusion-positive subtype of ependymoma, atypical teratoid rhabdoid tumor (AT/RT), embryonal tumor with multilayered rosettes, and solitary fibrous tumor/hemangiopericytoma. Immunohistochemistry is a helpful alternative for further molecular characterization of several of these tumors. Additionally, genome-wide methylation profiling is a very promising new tool in CNS tumor diagnostics. Much progress has thus been made by translating the most relevant molecular knowledge into a more precise clinical diagnosis of CNS tumors. Hopefully, this will enable more specific and more effective therapeutic approaches for the patients suffering from these tumors.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/pharmacology
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/antagonists & inhibitors
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Brain/pathology
- Brain Neoplasms/diagnosis
- Brain Neoplasms/drug therapy
- Brain Neoplasms/genetics
- Brain Neoplasms/mortality
- DNA Methylation
- Drug Resistance, Neoplasm/genetics
- Gene Expression Regulation, Neoplastic/drug effects
- Glioma/diagnosis
- Glioma/drug therapy
- Glioma/genetics
- Glioma/mortality
- Humans
- Immunohistochemistry
- Molecular Targeted Therapy/methods
- Mutation
- Neoplasms, Germ Cell and Embryonal/diagnosis
- Neoplasms, Germ Cell and Embryonal/drug therapy
- Neoplasms, Germ Cell and Embryonal/genetics
- Neoplasms, Germ Cell and Embryonal/mortality
- Prognosis
- Survival Rate
- Treatment Outcome
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Affiliation(s)
- B W Kristensen
- Department of Pathology, Odense University Hospital, Odense; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | | | - J K Petersen
- Department of Pathology, Odense University Hospital, Odense; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - P Wesseling
- Department of Pathology, University Medical Center Utrecht, Utrecht; Princess Máxima Center for Pediatric Oncology, Utrecht; Department of Pathology, Amsterdam University Medical Centers/VU Medical Center, Amsterdam, The Netherlands.
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Stiller CA, Bayne AM, Chakrabarty A, Kenny T, Chumas P. Incidence of childhood CNS tumours in Britain and variation in rates by definition of malignant behaviour: population-based study. BMC Cancer 2019; 19:139. [PMID: 30744596 PMCID: PMC6371471 DOI: 10.1186/s12885-019-5344-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 02/01/2019] [Indexed: 11/26/2022] Open
Abstract
Background Intracranial and intraspinal tumours are the most numerous solid tumours in children. Some recently defined subtypes are relatively frequent in childhood. Many cancer registries routinely ascertain CNS tumours of all behaviours, while others only cover malignant neoplasms. Some behaviour codes have changed between revisions of the International Classification of Diseases for Oncology, including pilocytic astrocytoma, downgraded to uncertain behaviour in ICD-O-3. Methods We used data from the population-based National Registry of Childhood Tumours, which routinely included non-malignant CNS tumours, to document the occurrence of CNS tumours among children aged < 15 years in Great Britain during 2001–2010 and to document the descriptive epidemiology of childhood CNS tumours over the 40-year period 1971–2010, during which several new entities were accommodated in successive editions of the WHO Classification and revisions of ICD-O. Eligible cases were all those with a diagnosis included in Groups III (CNS tumours) and Xa (CNS germ-cell tumours) of the International Classification of Childhood Cancer, Third Edition. The population at risk was derived from annual mid-year estimates by sex and single year of age compiled by the Office for National Statistics and its predecessors. Incidence rates were calculated for age groups 0, 1–4, 5–9 and 10–14 years, and age-standardised rates were calculated using the weights of the world standard population. Results Age-standardised incidence in 2001–10 was 40.1 per million. Astrocytomas accounted for 41%, embryonal tumours for 17%, other gliomas for 10%, ependymomas for 7%, rarer subtypes for 20% and unspecified tumours for 5%. Incidence of tumours classified as malignant and non-malignant by ICD-O-3 increased by 30 and 137% respectively between 1971-75 and 2006–10. Conclusions Total incidence was similar to that in other large western countries. Deficits of some, predominantly low-grade, tumours or differences in their age distribution compared with the United States and Nordic countries are compatible with delayed diagnosis. Complete registration regardless of tumour behaviour is essential for assessing burden of disease and changes over time. This is particularly important for pilocytic astrocytoma, because of its recent downgrading to non-malignant and time trends in the proportion of astrocytomas with specified subtype.
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Affiliation(s)
- Charles A Stiller
- National Cancer Registration and Analysis Service, Public Health England, 4150 Chancellor Court, Oxford Business Park South, Oxford, OX4 2GX, UK.
| | - Anita M Bayne
- National Cancer Registration and Analysis Service, Public Health England, 4150 Chancellor Court, Oxford Business Park South, Oxford, OX4 2GX, UK
| | | | - Tom Kenny
- Faculty of Health & Social Sciences, University of Bournemouth, Bournemouth, UK
| | - Paul Chumas
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
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7
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Wang GY, Li L, Liu B, Han X, Wang CH, Wang JW. Integrated bioinformatic analysis unveils significant genes and pathways in the pathogenesis of supratentorial primitive neuroectodermal tumor. Onco Targets Ther 2018; 11:1849-1859. [PMID: 29670360 PMCID: PMC5894672 DOI: 10.2147/ott.s148776] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose This study aimed to explore significant genes and pathways involved in the pathogenesis of supratentorial primitive neuroectodermal tumor (sPNET). Materials and methods Gene expression profile of GSE14295 was downloaded from publicly available Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) were screened out in primary sPNET samples compared with normal fetal and adult brain reference samples (sPNET vs fetal brain and sPNET vs adult brain). Pathway enrichment analysis of these DEGs was conducted, followed by protein–protein interaction (PPI) network construction and significant module selection. Additionally, transcription factors (TFs) regulating the common DEGs in the two comparison groups were identified, and the regulatory network was constructed. Results In total, 526 DEGs (99 up- and 427 downregulated) in sPNET vs fetal brain and 815 DEGs (200 up- and 615 downregulated) in sPNET vs adult brain were identified. DEGs in sPNET vs fetal brain and sPNET vs adult brain were associated with calcium signaling pathway, cell cycle, and p53 signaling pathway. CDK1, CDC20, BUB1B, and BUB1 were hub nodes in the PPI networks of DEGs in sPNET vs fetal brain and sPNET vs adult brain. Significant modules were extracted from the PPI networks. In addition, 64 upregulated and 200 downregulated overlapping DEGs were identified in both sPNET vs fetal brain and sPNET vs adult brain. The genes involved in the regulatory network upon overlapping DEGs and the TFs were correlated with calcium signaling pathway. Conclusion Calcium signaling pathway and several genes (CDK1, CDC20, BUB1B, and BUB1) may play important roles in the pathogenesis of sPNET.
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Affiliation(s)
| | - Ling Li
- Department of Pediatrics, Qilu Children's Hospital of Shandong University, Jinan, Shandong
| | - Bo Liu
- Department of Neurosurgery
| | | | | | - Ji-Wen Wang
- Department of Neurology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Pudong New District, Shanghai, People's Republic of China
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Nasser MM, Mehdipour P. Exploration of Involved Key Genes and Signaling Diversity in Brain Tumors. Cell Mol Neurobiol 2018; 38:393-419. [PMID: 28493234 DOI: 10.1007/s10571-017-0498-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 05/02/2017] [Indexed: 02/05/2023]
Abstract
Brain tumors are becoming a major cause of death. The classification of brain tumors has gone through restructuring with regard to some criteria such as the presence or absence of a specific genetic alteration in the 2016 central nervous system World Health Organization update. Two categories of genes with a leading role in tumorigenesis and cancer induction include tumor suppressor genes and oncogenes; tumor suppressor genes are inactivated through a variety of mechanisms that result in their loss of function. As for the oncogenes, overexpression and amplification are the most common mechanisms of alteration. Important cell cycle genes such as p53, ATM, cyclin D2, and Rb have shown altered expression patterns in different brain tumors such as meningioma and astrocytoma. Some genes in signaling pathways have a role in brain tumorigenesis. These pathways include hedgehog, EGFR, Notch, hippo, MAPK, PI3K/Akt, and WNT signaling. It has been shown that telomere length in some brain tumor samples is shortened compared to that in normal cells. As the shortening of telomere length triggers chromosome instability early in brain tumors, it could lead to initiation of cancer. On the other hand, telomerase activity was positive in some brain tumors. It is suggestive that telomere length and telomerase activity are important diagnostic markers in brain tumors. This review focuses on brain tumors with regard to the status of oncogenes, tumor suppressors, cell cycle genes, and genes in signaling pathways as well as the role of telomere length and telomerase in brain tumors.
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Affiliation(s)
- Mojdeh Mahdian Nasser
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Parvin Mehdipour
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Pickles JC, Hawkins C, Pietsch T, Jacques TS. CNS embryonal tumours: WHO 2016 and beyond. Neuropathol Appl Neurobiol 2018; 44:151-162. [DOI: 10.1111/nan.12443] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 09/21/2017] [Indexed: 12/21/2022]
Affiliation(s)
- J. C. Pickles
- Developmental Biology and Cancer Programme; UCL GOS Institute of Child Health; London UK
- Department of Histopathology; Great Ormond Street Hospital for Children; NHS Foundation Trust; London UK
| | - C. Hawkins
- Division of Pathology; Hospital for Sick Children; University of Toronto; Toronto Ontario Canada
| | - T. Pietsch
- Department of Neuropathology; Brain Tumor Reference Center of the DGNN; University of Bonn, Medical Center Sigmund-Freud; Bonn Germany
| | - T. S. Jacques
- Developmental Biology and Cancer Programme; UCL GOS Institute of Child Health; London UK
- Department of Histopathology; Great Ormond Street Hospital for Children; NHS Foundation Trust; London UK
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11
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Barresi V, Branca G, Raso A, Mascelli S, Caffo M, Tuccari G. Atypical teratoid rhabdoid tumor involving the nasal cavities and anterior skull base. Neuropathology 2015; 36:283-289. [PMID: 26567940 DOI: 10.1111/neup.12271] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 10/12/2015] [Accepted: 10/13/2015] [Indexed: 12/19/2022]
Abstract
Rhabdoid tumors are a spectrum of neoplasias composed of cells which show rhabdoid morphology but are devoid of skeletal muscle differentiation. These tumors are characterized by inactivation of the INI1/SMARCB1 gene and they have been described in virtually every anatomical site, including the central nervous system (CNS) and sinonasal tract. Rhabdoid tumor of the CNS was named atypical teratoid rhabdoid tumor (ATRT) and it mainly affects children under the age of 3 years with supra- or infra-tentorial location.Herein we report the first case of ATRT infiltrating the nasal cavities and skull base in an adolescent. Due to its unusual location, differential diagnosis was challenging and included several other entities such as sinonasal carcinoma or meningioma. Awareness that ATRT may infiltrate the nasal tract and knowledge of its clinico-pathological, immunohistochemical and biomolecular features are essential for its distinction from other rhabdoid tumors which more frequently involve this anatomical site and for appropriate therapeutic management.
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Affiliation(s)
- Valeria Barresi
- Department of Human Pathology, University of Messina, Messina, Italy
| | - Giovanni Branca
- Department of Human Pathology, University of Messina, Messina, Italy
| | - Alessandro Raso
- Departement of Neurosciences, University of Messina, Messina, Italy
| | | | | | - Giovanni Tuccari
- Department of Human Pathology, University of Messina, Messina, Italy
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12
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Kim NR, Park SH. The Continuing Value of Ultrastructural Observation in Central Nervous System Neoplasms in Children. J Pathol Transl Med 2015; 49:427-37. [PMID: 26459406 PMCID: PMC4696531 DOI: 10.4132/jptm.2015.09.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 09/19/2015] [Indexed: 12/03/2022] Open
Abstract
Central nervous system (CNS) neoplasms are the second most common childhood malignancy after leukemia and the most common solid organ neoplasm in children. Diagnostic dilemmas with small specimens from CNS neoplasms are often the result of multifactorial etiologies such as frozen or fixation artifact, biopsy size, or lack of knowledge about rare or unfamiliar entities. Since the late 1950s, ultrastructural examination has been used in the diagnosis of CNS neoplasms, though it has largely been replaced by immunohistochemical and molecular cytogenetic studies. Nowadays, pathologic diagnosis of CNS neoplasms is achieved through intraoperative cytology, light microscopy, immunohistochemistry, and molecular cytogenetic results. However, the utility of electron microscopy (EM) in the final diagnosis of CNS neoplasms and investigation of its pathogenetic origin remains critical. Here, we reviewed the distinguishing ultrastructural features of pediatric CNS neoplasms and emphasize the continuing value of EM in the diagnosis of CNS neoplasms.
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Affiliation(s)
- Na Rae Kim
- Department of Pathology, Gachon University Gil Medical Center, Incheon, Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
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Atypical teratoid rhabdoid tumors of the posterior fossa in children. Childs Nerv Syst 2015; 31:1717-28. [PMID: 26351225 DOI: 10.1007/s00381-015-2844-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 07/16/2015] [Indexed: 12/23/2022]
Abstract
PURPOSE Atypical teratoid rhabdoid tumors (AT/RT) are rare, aggressive, central nervous system neoplasms that typically affect children under 3 years of age and have a very poor prognosis. Early case series consistently demonstrated rapid recurrence with progression to death, but more recent experience has shown significant improvements in progression free and overall survival. METHODS A retrospective analysis of the clinical data of children diagnosed with AT/RT at the Ann & Robert H. Lurie Children's Hospital of Chicago (formerly Children's Memorial Hospital) between 2000 and 2014 was performed. Overall survival (OS) was used to describe outcome. Our small sample size and the utilization of different adjuvant regimens over the study period precluded a detailed statistical analysis. RESULTS Eight children with AT/RT of the posterior fossa were included in our report. Gross total resection (GTR) was achieved in five children (63 %), two children underwent subtotal resection (25 %), and there was one who underwent biopsy. Patients were treated with various combinations of chemotherapy with or without conformal radiation therapy (RT). Median overall survival was 5 months (range 1 to 107 months) with two patients achieving sustained responses to 45 and 107 months. CONCLUSIONS Our experience is in line with prior reports that show that children diagnosed with AT/RT of the posterior fossa have a poor prognosis, but that long-term survival is possible. These tumors provide many challenges, but contemporary series are beginning to show improvements in survival.
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Ryzhova MV, Shishkina LV. [Molecular methods in diagnosis of poorly differentiated malignant brain tumors in children]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2015; 79:10-20. [PMID: 26146040 DOI: 10.17116/neiro201579210-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The histological diagnosis of malignant brain tumors in children is a complex process. In some cases, glioblastoma, primitive neuroectodermal tumor of the central nervous system, and atypical teratoid/rhabdoid tumor have a histological type similar to that of small blue round cell malignant tumor. Despite the similar histology, biological properties and approaches to treatment, these neoplasms are completely different and require their own treatment protocols. We retrospectively reviewed the most malignant types of childhood tumors and analyzed our own experience to propose a diagnostic algorithm for intracerebral small blue round cell malignant tumors in children based on the use of immunohistochemistry and fluorescence in situ hybridization.
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Affiliation(s)
- M V Ryzhova
- Burdenko Neurosurgical Institute, Moscow, Russia
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Wetmore C, Boyett J, Li S, Lin T, Bendel A, Gajjar A, Orr BA. Alisertib is active as single agent in recurrent atypical teratoid rhabdoid tumors in 4 children. Neuro Oncol 2015; 17:882-8. [PMID: 25688119 DOI: 10.1093/neuonc/nov017] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/18/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Aurora Kinase A (AURKA) encodes a protein that regulates the formation and stability of the mitotic spindle and is highly active in atypical teratoid rhabdoid tumors (ATRT) through loss of the INI1 tumor suppressor gene. Alisertib (MLN8237) inhibits AURKA in vitro and in vivo. Given the strong preclinical data supporting the use of alisertib for ATRT patients, we sought and obtained permission to use alisertib in single patient treatment plans for 4 recurrent pediatric ATRT patients. METHODS Patients with recurrent or progressive ATRT received alisertib 80 mg/m(2) by mouth once daily for 7 days of a 21-day treatment cycle. Disease evaluation (MRI of brain and spine and lumbar puncture) was done after 2 cycles of alisertib and every 2-3 cycles thereafter for as long as the patients remained free from tumor progression. RESULTS Four patients with median age of 2.5 years (range, 1.39-4.87 y) at diagnosis received alisertib 80 mg/m(2) by mouth once daily for 7 days of a 21-day treatment cycle, and all 4 patients had disease stabilization and/or regression after 3 cycles of alisertib therapy. Two patients continued to have stable disease regression for 1 and 2 years, respectively, on therapy. CONCLUSIONS Single-agent alisertib produced marked and durable regression in disease burden, as detected by brain and spine MRI and by evaluation of spinal fluid cytology. Alisertib has moderate but manageable toxicities, and its chronic administration appears feasible in this pediatric population. These novel data support the incorporation of alisertib in future therapeutic trials for children with ATRT.
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Affiliation(s)
- Cynthia Wetmore
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (C.W., A.G.); Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee (J.B., S.L., T.L.); Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota (A.B.); Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee (B.A.O.)
| | - James Boyett
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (C.W., A.G.); Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee (J.B., S.L., T.L.); Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota (A.B.); Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee (B.A.O.)
| | - Shaoyu Li
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (C.W., A.G.); Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee (J.B., S.L., T.L.); Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota (A.B.); Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee (B.A.O.)
| | - Tong Lin
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (C.W., A.G.); Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee (J.B., S.L., T.L.); Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota (A.B.); Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee (B.A.O.)
| | - Anne Bendel
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (C.W., A.G.); Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee (J.B., S.L., T.L.); Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota (A.B.); Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee (B.A.O.)
| | - Amar Gajjar
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (C.W., A.G.); Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee (J.B., S.L., T.L.); Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota (A.B.); Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee (B.A.O.)
| | - Brent A Orr
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (C.W., A.G.); Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee (J.B., S.L., T.L.); Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota (A.B.); Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee (B.A.O.)
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VandenHeuvel KA, Al-Rohil RN, Stevenson ME, Qian J, Gross NL, McNall-Knapp R, Li S, Wartchow EP, Mierau GW, Fung KM. Primary intracranial Ewing's sarcoma with unusual features. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:260-274. [PMID: 25755713 PMCID: PMC4348914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 12/22/2014] [Indexed: 06/04/2023]
Abstract
Pediatric primary "small round blue cell" tumors in the CNS represent several entities, some more common than others. Ewing sarcoma/peripheral primitive neuroectodermal tumor (ES/pPNET) is rare and must be distinguished from other tumors such as medulloblastoma [1, 2], atypical rhabdoid/teratoid tumor, ependymomal tumors, metastatic sarcomas, hematologic malignancies, and other mimics. Although therapy for ES/pPNET is effective, it brings severe side effects, including cardiac toxicity, making correct recognition important [3]. As small blue cell tumors look similar, diagnosis often depends on special stains, immunohistochemistry, and molecular techniques. While the combination of membranous immunohistochemical reactivity for CD99 with cytoplasmic glycogen provides effective screening, demonstration of characteristic translocations of EWSR1 (chromosome 22) or FUS (chromosome 16) by fluorescent in situ hybridization (FISH) can confirm the diagnosis. We are reporting three primary ES/pPNET of the CNS, two of which occurred in children. While the adult case demonstrates the classic histopathology, the two pediatric cases have histopathology that significantly deviates from the usual. One is suggestive of a primary sarcoma, and the other mimics an ependymoma, but all three cases are confirmed with FISH. These observations suggest that primary ES in the CNS may have histology different from the classic morphology and a high index of suspicion should be maintained in order to make the correct diagnosis. A search of the literature suggests that these tumors are most frequently seen in children and young adults. Imaging often shows a supratentorial enhancing mass that touches the leptomeninges. Survival over three years is good but long term prognosis is unknown [3, 4].
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Affiliation(s)
- Katherine A VandenHeuvel
- Department of Pathology, University of Oklahoma Health Sciences CenterOklahoma City, OK 73104, USA
| | - Rami N Al-Rohil
- Department of Pathology and Laboratory Medicine, Albany Medical CollegeAlbany, NY 12208, USA
| | - Michael E Stevenson
- Department of Pathology, University of Oklahoma Health Sciences CenterOklahoma City, OK 73104, USA
| | - Jiang Qian
- Department of Pathology and Laboratory Medicine, Albany Medical CollegeAlbany, NY 12208, USA
| | - Naina L Gross
- Department of Neurosurgery, University of Oklahoma Health Sciences CenterOklahoma City, OK 73104, USA
| | - Rene McNall-Knapp
- Department of Pediatrics, University of Oklahoma Health Sciences CenterOklahoma City, OK 73104, USA
| | - Shibo Li
- Department of Pediatrics, University of Oklahoma Health Sciences CenterOklahoma City, OK 73104, USA
| | - Eric P Wartchow
- Department of Pathology, Children’s Hospital of ColoradoCO, USA
| | - Gary W Mierau
- Department of Pathology, Children’s Hospital of ColoradoCO, USA
| | - Kar-Ming Fung
- Department of Pathology, University of Oklahoma Health Sciences CenterOklahoma City, OK 73104, USA
- Department of Pathology, Oklahoma City Veterans Administration Medical CenterOklahoma City, OK 73104, USA
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Abstract
Rhabdoid tumors (RT), or malignant rhabdoid tumors, are among the most aggressive and lethal forms of human cancer. They can arise in any location in the body but are most commonly observed in the brain, where they are called atypical teratoid/rhabdoid tumors (AT/RT), and in the kidneys, where they are called rhabdoid tumors of the kidney. The vast majority of rhabdoid tumors present with a loss of function in the SMARCB1 gene, also known as INI1, BAF47, and hSNF5, a core member of the SWI/SNF chromatin-remodeling complex. Recently, mutations in a 2nd locus of the SWI/SNF complex, the SMARCA4 gene, also known as BRG1, were found in rhabdoid tumors with retention of SMARCB1 expression. Familial cases may occur in a condition known as rhabdoid tumor predisposition syndrome (RTPS). In RTPS, germline inactivation of 1 allele of a gene occurs. When the mutation occurs in the SMARCB1 gene, the syndrome is called RTPS1, and when the mutation occurs in the SMARCA4 gene it is called RTPS2. Children presenting with RTPS tend to develop tumors at a younger age, but the impact that germline mutation has on survival remains unclear. Adults who carry the mutation tend to develop multiple schwannomas. The diagnosis of RTPS should be considered in patients with RT, especially if they have multiple primary tumors, and/or in individuals with a family history of RT. Because germline mutations result in an increased risk of carriers developing RT, genetic counseling for families with this condition is recommended.
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Affiliation(s)
- Simone T Sredni
- 1 Ann and Robert H. Lurie Children's Hospital of Chicago-Division of Pediatric Neurosurgery, 225 E. Chicago Avenue Box #28, Chicago, IL 60611, USA
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Yang M, Chen X, Wang N, Zhu K, Hu YZ, Zhao Y, Shu Y, Zhao ML, Gu WZ, Tang HF. Primary atypical teratoid/rhabdoid tumor of central nervous system in children: a clinicopathological analysis and review of literature in China. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2014; 7:2411-2420. [PMID: 24966951 PMCID: PMC4069879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 04/26/2014] [Indexed: 06/03/2023]
Abstract
Atypical teratoid/rhabdoid tumor (AT/RT) is a very rare and highly malignant embryonal tumor in the central nervous system (CNS). Five patients (4 girls and 1 boy) with AT/RT were treated in our hospital. The clinical histories, symptoms, neuroimaging aspects, therapies, histological and immunohistochemical findings and follow-up information were reviewed. The patients ranged from 8 to 40 months with a mean age of 20.6 months. One tumor was located in the spinal cord, two in cerebellum and two in the pineal region. The imagings of the tumors resemble medulloblastomas. Pathological examinations showed that one patient had medulloblastoma differentiation, one had choroid plexus carcinoma differentiation, and one had mesenchymal components. Immunohistochemical staining showed that all of the tumors lost the nuclear expression of integrase interactor 1 (INI1), and were positive for Vimentin, S-100 protein and epithelial membrane antigen. One case with no recurrence after 24 months may have benefited from radical excision and postoperative radiotherapy. The other 4 patients died 8, 4, 1 and 1-month respectively after operation without radiotherapy. The diagnosis of AT/RT depends on full sampling, careful observation the morphological characteristics and INI1 examination, even when the tumor are presented in uncommon sites, such as the spinal cord and the pineal region.
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Affiliation(s)
- Min Yang
- Department of Pathology, Children’s Hospital, Zhejiang University School of MedicineHangzhou 310003, China
| | - Xi Chen
- Department of Experimental Testing, Children’s Hospital, Zhejiang University School of MedicineHangzhou 310003, China
| | - Ning Wang
- Department of Neurosurgery, Children’s Hospital, Zhejiang University School of MedicineHangzhou 310003, China
| | - Kun Zhu
- Department of Pathology, Children’s Hospital, Zhejiang University School of MedicineHangzhou 310003, China
| | - Ying-Zi Hu
- Department of Radiology, Children’s Hospital, Zhejiang University School of MedicineHangzhou 310003, China
| | - Yun Zhao
- Department of Pathology, Children’s Hospital, Zhejiang University School of MedicineHangzhou 310003, China
| | - Yan Shu
- Department of Pathology, Children’s Hospital, Zhejiang University School of MedicineHangzhou 310003, China
| | - Man-Li Zhao
- Department of Pathology, Children’s Hospital, Zhejiang University School of MedicineHangzhou 310003, China
| | - Wei-Zhong Gu
- Department of Pathology, Children’s Hospital, Zhejiang University School of MedicineHangzhou 310003, China
| | - Hong-Feng Tang
- Department of Pathology, Children’s Hospital, Zhejiang University School of MedicineHangzhou 310003, China
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19
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Warmuth-Metz M, Bison B, Gerber NU, Pietsch T, Hasselblatt M, Frühwald MC. Bone involvement in atypical teratoid/rhabdoid tumors of the CNS. AJNR Am J Neuroradiol 2013; 34:2039-42. [PMID: 23681355 DOI: 10.3174/ajnr.a3554] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
SUMMARY Destruction of the bony structures of the skull is rare in primary tumors of the CNS. In low-grade gliomas, modeling of the skull is caused by slow growth and chronic pressure. Bony destruction is exceptional even in highly malignant gliomas. Atypical teratoid/rhabdoid tumors of the CNS are highly malignant neoplasms diagnosed with an increasing frequency, mainly in young children. On imaging, these tumors exhibit distinct though not specific morphologic features including peripheral cysts, bleeding residues, and a distinct bandlike, wavy pattern of enhancement. A combination of these single characteristics together with a predilection for young age is suggestive of an atypical teratoid/rhabdoid tumor. We present 5 children with an atypical teratoid/rhabdoid tumor affecting the adjacent bone. These 5 patients were collected in our imaging data base for childhood atypical teratoid/rhabdoid tumor consisting of 91 children at the time of this evaluation and thus representing 6.6%. The mean age of children with bone involvement (4.8 years) was above the average age (2 years) of all children in the data base. We add this rare feature to the list of typical features in MR imaging and CT morphology of atypical teratoid/rhabdoid tumor.
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Affiliation(s)
- M Warmuth-Metz
- National Reference Center for Neuroradiology, Department of Neuroradiology, University Hospital of Wurzburg, Wurzburg, Germany
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