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Gupta P, Siraj F, Shankar KB, Rawat M, Mankotia DS, Yadav V, Dagar A. Clinical and histopathological spectrum of cranial small round cell tumors: An experience from a tertiary care center. J Cancer Res Ther 2024; 20:238-242. [PMID: 38554327 DOI: 10.4103/jcrt.jcrt_383_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 09/21/2022] [Indexed: 04/01/2024]
Abstract
BACKGROUND Small round cell tumors (SRCTs) are a group of malignant neoplasms with minimal or no differentiation, characterized by the presence of round cells with high nuclear-cytoplasmic ratio. Although SRCTs can occur in any part of the body, involvement of central nervous system (CNS) is uncommon. AIM We aimed to study the clinicopathological spectrum of cranial SRCT diagnosed in our institute over a period of four years (2016-2019). MATERIAL AND METHODS A retrospective review of medical records (2016-2019) with a morphological diagnosis of cranial SRCT was made. Both intra-axial and extra-axial tumors were included. A total of 60 cases were retrieved, and the clinical and histopathological features were studied. Special cytochemical staining and immunohistochemistry were performed, where needed. RESULTS The mean age at presentation was 18.4 years (range, 1-60 years), with a male-to-female ratio of 2.5:1. The most common site was posterior fossa of brain (n = 28, 47%), followed by dorso-lumbar spine (n = 9, 15%). The most common type of tumor was medulloblastoma (n = 29, 48.3%), followed by Ewing sarcoma (ES)/peripheral primitive neuroectodermal tumor (pPNET) (n = 11, 18.3%), non-Hodgkin lymphoma (NHL) (n = 9, 15%), neuroblastoma (n = 3, 5%), and CNS embryonal tumor, NOS (n = 2, 3.3%). One case each of atypical teratoid rhabdoid tumor (ATRT), rhabdomyosarcoma, pineoblastoma, melanoma, rhabdomyosarcoma, and undifferentiated pleomorphic sarcoma was also documented. CONCLUSIONS SRCTs have a variable age of presentation. Their incidence in CNS is low as compared to other organ systems. On light microscopy, the histopathology of these lesions is overlapping, posing a great diagnostic dilemma for the pathologist. The use of ancillary techniques like immunohistochemistry helps in arriving at the correct diagnosis. Treatment strategy and tumor prognosis also vary along the entire spectrum of SRCT, thus making exact characterization essential for proper management.
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Affiliation(s)
- Pooja Gupta
- Department of Pathology, ICMR-National Institute of Pathology, New Delhi, India
| | - Fouzia Siraj
- Department of Pathology, ICMR-National Institute of Pathology, New Delhi, India
| | - K B Shankar
- Department of Neurosurgery, Vardhman Mahavir Medical College and Safdarjung Hospital New Delhi, India
| | - Manish Rawat
- Department of Neurosurgery, Vardhman Mahavir Medical College and Safdarjung Hospital New Delhi, India
| | - Dipanker S Mankotia
- Department of Neurosurgery, Vardhman Mahavir Medical College and Safdarjung Hospital New Delhi, India
| | - Vivek Yadav
- Department of Neurosurgery, Vardhman Mahavir Medical College and Safdarjung Hospital New Delhi, India
| | - Amit Dagar
- Department of Neurosurgery, Vardhman Mahavir Medical College and Safdarjung Hospital New Delhi, India
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2
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Kartal İ, Dağdemir A, Dinçer OS, Şimşek HK, Uygun A, Gürsel ŞB. Treatment Outcomes of Childhood Medulloblastoma with the SIOP/UKCCSG PNET-3 Protocol. Indian J Pediatr 2023; 90:1116-1122. [PMID: 37335442 PMCID: PMC10581932 DOI: 10.1007/s12098-023-04675-w] [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: 09/22/2022] [Accepted: 03/17/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES To retrospectively compare the overall and event-free survival rates of patients with standard and high risk medulloblastoma who received postoperative radiotherapy (RT) followed by maintenance chemotherapy. METHODS The study included 48 patients with medulloblastoma who were treated and followed-up between 2005 and 2021. Patients were classified according to the Chang classification because no molecular analysis was done. Immediately after surgery all patients received postoperative RT followed by eight cycles of chemotherapy (SIOP/UKCCSG PNET-3 protocol); if thrombocytopenia developed, carboplatin was replaced by cisplatin to avoid treatment delay. The clinical characteristics, risk categories and treatment outcomes of all patients were analyzed. RESULTS The mean age of the 48 patients (26 males, 22 females) at diagnosis was 7.27±4.21 y. The median start time of RT after surgery was 37 (range 19-80) d. The median follow-up was 56 (3-216) mo. The 5-year event-free survival was 61.2±10% in the high-risk group and 82.5±11.5% in the standard-risk group. The 5-year overall survival was 73.2±7.1%; it was 61.2±10% and 92.9±6.9% for high- and standard-risk patients, respectively (p = 0.026). CONCLUSIONS The outcomes of patients who were started on the modified SIOP/UKCCSG PNET-3 chemotherapy protocol, in which RT was begun as soon as possible after surgery, were comparable to those of current treatment protocols. Although a definitive conclusion is difficult, given the limited number of patients in the present study, authors suggest that their treatment protocol is a viable option for centers with limited facilities (such as an inability to perform molecular analysis).
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Affiliation(s)
- İbrahim Kartal
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey.
| | - Ayhan Dağdemir
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Oğuz Salih Dinçer
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Hülya Kangal Şimşek
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Alper Uygun
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Şükriye Bilge Gürsel
- Department of Radiation Oncology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
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3
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Xiao X, Liu X, Liang W, Han LY, Li XD, Guo LJ, He WL, Liu XM, Zhou J, Cai Q, Xu YK, Tan XL, Wu YK. Conventional MRI Features of Central Nervous System Embryonal Tumor, Not Otherwise Specified in Adults: Comparison with Glioblastoma. Acad Radiol 2022; 29 Suppl 3:S44-S51. [PMID: 33504445 DOI: 10.1016/j.acra.2021.01.010] [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: 08/08/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 11/01/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to explore conventional MRI features that can accurately differentiate central nervous system embryonal tumor, not otherwise specified (CNS ETNOS) from glioblastoma (GBM) in adults. MATERIALS AND METHODS Preoperative conventional MRI images of 30 CNS ETNOS and 98 GBMs were analyzed by neuroradiologists retrospectively to identify valuable MRI features. Five blinded neuroradiologists independently reviewed all these MRI images, and scored MRI features on a five-point scale. Kendall's coefficient of concordance was used to measure inter-rater agreement. Diagnostic value was assessed by the area under the curve (AUC) of receiver operating curve, and sensitivity and specificity were also calculated. RESULTS Seven MRI features, including isointensity on T1WI, T2WI, and FLAIR, ill-defined margin, severe peritumoral edema, ring enhancement, and broad-based attachment sign, were helpful for the differential diagnosis of these two entities. Among these features, ring enhancement showed the highest inter-rater concordance (0.80). Ring enhancement showed the highest AUC value (0.79), followed by severe peritumoral edema (0.67). The combination of seven features showed the highest AUC value (0.86), followed by that of three features (ill-defined margin, severe peritumoral edema, and ring enhancement) (0.83). CONCLUSION Enhancement pattern, peritumoral edema, and margin are valuable for the discrimination between CNS ETNOS and GBM in adults.
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4
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Nicoll JAR, Bloom T, Clarke A, Boche D, Hilton D. BRAIN UK: Accessing NHS tissue archives for neuroscience research. Neuropathol Appl Neurobiol 2021; 48:e12766. [PMID: 34528715 DOI: 10.1111/nan.12766] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 11/29/2022]
Abstract
The purpose of BRAIN UK (the UK BRain Archive Information Network) is to make the very extensive and comprehensive National Health Service (NHS) Neuropathology archives available to the national and international neuroscience research community. The archives comprise samples of tumours and a wide range of other neurological disorders, not only from the brain but also spinal cord, peripheral nerve, muscle, eye and other organs when relevant. BRAIN UK was founded after the recognition of the importance of this large tissue resource, which was not previously readily accessible for research use. BRAIN UK has successfully engaged the majority of the regional clinical neuroscience centres in the United Kingdom to produce a centralised database of the extensive autopsy and biopsy archive. Together with a simple application process and its broad ethical approval, BRAIN UK offers researchers easy access to most of the national archives of neurological tissues and tumours (http://www.brain-uk.org). The range of tissues available reflects the spectrum of disease in society, including many conditions not covered by disease-specific brain banks, and also allows relatively large numbers of cases of uncommon conditions to be studied. BRAIN UK has supported 141 studies (2010-2020) that have generated 70 publications employing methodology as diverse as morphometrics, genetics, proteomics and methylomics. Tissue samples that would otherwise have been unused have supported valuable neuroscience research. The importance of this unique resource will only increase as molecular techniques applicable to human tissues continue to develop and technical advances permit large-scale high-throughput studies.
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Affiliation(s)
- James A R Nicoll
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Department of Cellular Pathology, University Hospital Southampton, Southampton, UK
| | - Tabitha Bloom
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Amelia Clarke
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Delphine Boche
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - David Hilton
- Neuropathology, Derriford Hospital, Plymouth, UK
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Gershanov S, Madiwale S, Feinberg-Gorenshtein G, Vainer I, Nehushtan T, Michowiz S, Goldenberg-Cohen N, Birger Y, Toledano H, Salmon-Divon M. Classifying Medulloblastoma Subgroups Based on Small, Clinically Achievable Gene Sets. Front Oncol 2021; 11:637482. [PMID: 34178626 PMCID: PMC8223061 DOI: 10.3389/fonc.2021.637482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 05/10/2021] [Indexed: 12/21/2022] Open
Abstract
As treatment protocols for medulloblastoma (MB) are becoming subgroup-specific, means for reliably distinguishing between its subgroups are a timely need. Currently available methods include immunohistochemical stains, which are subjective and often inconclusive, and molecular techniques—e.g., NanoString, microarrays, or DNA methylation assays—which are time-consuming, expensive and not widely available. Quantitative PCR (qPCR) provides a good alternative for these methods, but the current NanoString panel which includes 22 genes is impractical for qPCR. Here, we applied machine-learning–based classifiers to extract reliable, concise gene sets for distinguishing between the four MB subgroups, and we compared the accuracy of these gene sets to that of the known NanoString 22-gene set. We validated our results using an independent microarray-based dataset of 92 samples of all four subgroups. In addition, we performed a qPCR validation on a cohort of 18 patients diagnosed with SHH, Group 3 and Group 4 MB. We found that the 22-gene set can be reduced to only six genes (IMPG2, NPR3, KHDRBS2, RBM24, WIF1, and EMX2) without compromising accuracy. The identified gene set is sufficiently small to make a qPCR-based MB subgroup classification easily accessible to clinicians, even in developing, poorly equipped countries.
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Affiliation(s)
- Sivan Gershanov
- Department of Molecular Biology, Ariel University, Ariel, Israel
| | - Shreyas Madiwale
- Hemato-Oncology Laboratory, Division of Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Galina Feinberg-Gorenshtein
- Hemato-Oncology Laboratory, Division of Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Igor Vainer
- Department of Molecular Biology, Ariel University, Ariel, Israel
| | - Tamar Nehushtan
- Department of Molecular Biology, Ariel University, Ariel, Israel
| | - Shalom Michowiz
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Pediatric Neurosurgery, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel
| | - Nitza Goldenberg-Cohen
- Department of Ophthalmology, Bnai Zion Medical Center, Haifa, Israel.,The Krieger Eye Research Laboratory, Felsenstein Medical Research Center, Rabin Medical Center, Petach-Tikva, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Yehudit Birger
- Hemato-Oncology Laboratory, Division of Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Helen Toledano
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Pediatric Oncology, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel
| | - Mali Salmon-Divon
- Department of Molecular Biology, Ariel University, Ariel, Israel.,Adelson School of Medicine, Ariel University, Ariel, Israel
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Attallah O. CoMB-Deep: Composite Deep Learning-Based Pipeline for Classifying Childhood Medulloblastoma and Its Classes. Front Neuroinform 2021; 15:663592. [PMID: 34122031 PMCID: PMC8193683 DOI: 10.3389/fninf.2021.663592] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/26/2021] [Indexed: 12/28/2022] Open
Abstract
Childhood medulloblastoma (MB) is a threatening malignant tumor affecting children all over the globe. It is believed to be the foremost common pediatric brain tumor causing death. Early and accurate classification of childhood MB and its classes are of great importance to help doctors choose the suitable treatment and observation plan, avoid tumor progression, and lower death rates. The current gold standard for diagnosing MB is the histopathology of biopsy samples. However, manual analysis of such images is complicated, costly, time-consuming, and highly dependent on the expertise and skills of pathologists, which might cause inaccurate results. This study aims to introduce a reliable computer-assisted pipeline called CoMB-Deep to automatically classify MB and its classes with high accuracy from histopathological images. This key challenge of the study is the lack of childhood MB datasets, especially its four categories (defined by the WHO) and the inadequate related studies. All relevant works were based on either deep learning (DL) or textural analysis feature extractions. Also, such studies employed distinct features to accomplish the classification procedure. Besides, most of them only extracted spatial features. Nevertheless, CoMB-Deep blends the advantages of textural analysis feature extraction techniques and DL approaches. The CoMB-Deep consists of a composite of DL techniques. Initially, it extracts deep spatial features from 10 convolutional neural networks (CNNs). It then performs a feature fusion step using discrete wavelet transform (DWT), a texture analysis method capable of reducing the dimension of fused features. Next, the CoMB-Deep explores the best combination of fused features, enhancing the performance of the classification process using two search strategies. Afterward, it employs two feature selection techniques on the fused feature sets selected in the previous step. A bi-directional long-short term memory (Bi-LSTM) network; a DL-based approach that is utilized for the classification phase. CoMB-Deep maintains two classification categories: binary category for distinguishing between the abnormal and normal cases and multi-class category to identify the subclasses of MB. The results of the CoMB-Deep for both classification categories prove that it is reliable. The results also indicate that the feature sets selected using both search strategies have enhanced the performance of Bi-LSTM compared to individual spatial deep features. CoMB-Deep is compared to related studies to verify its competitiveness, and this comparison confirmed its robustness and outperformance. Hence, CoMB-Deep can help pathologists perform accurate diagnoses, reduce misdiagnosis risks that could occur with manual diagnosis, accelerate the classification procedure, and decrease diagnosis costs.
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Affiliation(s)
- Omneya Attallah
- Department of Electronics and Communications Engineering, College of Engineering and Technology, Arab Academy for Science, Technology and Maritime Transport, Alexandria, Egypt
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An efficient and novel treatment regimen including temozolomide for medulloblastoma: a case study. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396921000340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background:
The central nervous system (CNS) embryonal tumour is a rare malignancy reported in adults and more commonly in children. The most available treatments may cause neurological dysfunctions requiring clinical attention.
Case presented:
A 29-year-old male was referred with ataxia and diplopia, and brain imaging revealed a posterior fossa lesion suggesting medulloblastoma. The tumour and related symptoms were notably alleviated following treatment with dexamethasone. Following the recurrence of tumour, a biopsy and pathology report, the diagnosis of desmoplastic/nodular medulloblastoma was confirmed. The patient underwent 18 fractions of 180 cGy spine and whole-brain radiation therapy (RT). In addition, 5400 cGy irradiation in 12 fractions was given to the posterior fossa together with 2 mg/m2 intravenous vincristine (VCR) weekly over 6 weeks. Following a 3-week break, the patient was scheduled to receive 150 mg/m2/day temozolomide for 5 days, 2 mg VCR and 65 mg/m2/day cisplatin every 3 weeks for 8 cycles.
Conclusion:
The patient gained survival benefit to date (60 months since diagnosis) with favourable life quality. The promising response in this one exemplary case study proposes that a combined chemotherapy regimen including temozolomide, vincristine and cisplatin is an effective treatment choice for CNS embryonal tumours following RT; however, the further evaluation and a randomised clinical trial are needed.
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Autopsy report and review of the 2016 WHO classification of congenital supratentorial embryonal tumors, not otherwise specified. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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9
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Attallah O. MB-AI-His: Histopathological Diagnosis of Pediatric Medulloblastoma and its Subtypes via AI. Diagnostics (Basel) 2021; 11:359. [PMID: 33672752 PMCID: PMC7924641 DOI: 10.3390/diagnostics11020359] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/11/2021] [Accepted: 02/11/2021] [Indexed: 12/17/2022] Open
Abstract
Medulloblastoma (MB) is a dangerous malignant pediatric brain tumor that could lead to death. It is considered the most common pediatric cancerous brain tumor. Precise and timely diagnosis of pediatric MB and its four subtypes (defined by the World Health Organization (WHO)) is essential to decide the appropriate follow-up plan and suitable treatments to prevent its progression and reduce mortality rates. Histopathology is the gold standard modality for the diagnosis of MB and its subtypes, but manual diagnosis via a pathologist is very complicated, needs excessive time, and is subjective to the pathologists' expertise and skills, which may lead to variability in the diagnosis or misdiagnosis. The main purpose of the paper is to propose a time-efficient and reliable computer-aided diagnosis (CADx), namely MB-AI-His, for the automatic diagnosis of pediatric MB and its subtypes from histopathological images. The main challenge in this work is the lack of datasets available for the diagnosis of pediatric MB and its four subtypes and the limited related work. Related studies are based on either textural analysis or deep learning (DL) feature extraction methods. These studies used individual features to perform the classification task. However, MB-AI-His combines the benefits of DL techniques and textural analysis feature extraction methods through a cascaded manner. First, it uses three DL convolutional neural networks (CNNs), including DenseNet-201, MobileNet, and ResNet-50 CNNs to extract spatial DL features. Next, it extracts time-frequency features from the spatial DL features based on the discrete wavelet transform (DWT), which is a textural analysis method. Finally, MB-AI-His fuses the three spatial-time-frequency features generated from the three CNNs and DWT using the discrete cosine transform (DCT) and principal component analysis (PCA) to produce a time-efficient CADx system. MB-AI-His merges the privileges of different CNN architectures. MB-AI-His has a binary classification level for classifying among normal and abnormal MB images, and a multi-classification level to classify among the four subtypes of MB. The results of MB-AI-His show that it is accurate and reliable for both the binary and multi-class classification levels. It is also a time-efficient system as both the PCA and DCT methods have efficiently reduced the training execution time. The performance of MB-AI-His is compared with related CADx systems, and the comparison verified the powerfulness of MB-AI-His and its outperforming results. Therefore, it can support pathologists in the accurate and reliable diagnosis of MB and its subtypes from histopathological images. It can also reduce the time and cost of the diagnosis procedure which will correspondingly lead to lower death rates.
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Affiliation(s)
- Omneya Attallah
- Department of Electronics and Communications Engineering, College of Engineering and Technology, Arab Academy for Science, Technology and Maritime Transport, Alexandria 1029, Egypt
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10
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Reis J, Stahl R, Zimmermann H, Ruf V, Thon N, Kunz M, Liebig T, Forbrig R. Advanced MRI Findings in Medulloblastomas: Relationship to Genetic Subtypes, Histopathology, and Immunohistochemistry. J Neuroimaging 2021; 31:306-316. [PMID: 33465267 DOI: 10.1111/jon.12831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/06/2020] [Accepted: 12/24/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE For diagnosis of medulloblastoma, the updated World Health Organization classification now demands for genetic typing, defining more precisely the tumor biology, therapy, and prognosis. We investigated potential associations between magnetic resonance imaging (MRI) parameters including apparent diffusion coefficient (ADC) and neuropathologic features of medulloblastoma, focusing on genetic subtypes. METHODS This study was a retrospective single-center analysis of 32 patients (eight females, median age = 9 years [range, 1-57], mean 12.6 ± 11.3) from 2012 to 2019. Genetic subtypes (wingless [WNT]; sonic hedgehog [SHH]; non-WNT/non-SHH), histopathology, immunohistochemistry (p53, Ki67), and the following MRI parameters were correlated: tumor volume, location (midline, pontocerebellar, and cerebellar hemisphere), edema, hydrocephalus, metastatic disease (presence/absence and each), contrast-enhancement (minor, moderate, and distinct), cysts (none, small, and large), hemorrhage (none, minor, and major), and ADCmean . The ADCmean was calculated using manually set regions of interest within the solid tumor. Statistics comprised univariate and multivariate testing. RESULTS Out of 32 tumors, three tumors were WNT activated (9.4%), 13 (40.6%) SHH activated, and 16 (50.0%) non-WNT/non-SHH. Hemispherical location (n = 7/8, P = .003) and presence of edema (8/8; P < .001, specificity 100%, positive predictive value 100%) were significantly associated with SHH activation. The combined parameter "no edema + no metastatic disease + cysts" significantly discriminated WNT-activated from SHH-activated medulloblastoma (P = .036). ADCmean (10-6 mm2 /s) was 484 for WNT-activated, 566 for SHH-activated, and 624 for non-WNT/non-SHH subtypes (P = .080). A significant negative correlation was found between ADCmean and Ki67 (r = -.364, P = .040). CONCLUSION MRI analysis enabled noninvasive differentiation of SHH-activated medulloblastoma. ADC alone was not reliable for genetic characterization, but associated with tumor proliferation rate.
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Affiliation(s)
- Jonas Reis
- Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Robert Stahl
- Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Hanna Zimmermann
- Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Viktoria Ruf
- Department of Neuropathology, University Hospital, LMU Munich, Munich, Germany
| | - Niklas Thon
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| | - Mathias Kunz
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| | - Thomas Liebig
- Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Robert Forbrig
- Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
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11
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Hesham D, El-Naggar S. Transcriptomic Analysis Revealed an Emerging Role of Alternative Splicing in Embryonal Tumor with Multilayered Rosettes. Genes (Basel) 2020; 11:genes11091108. [PMID: 32971786 PMCID: PMC7563716 DOI: 10.3390/genes11091108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/02/2020] [Accepted: 09/11/2020] [Indexed: 11/30/2022] Open
Abstract
Embryonal tumor with multilayered rosettes (ETMR) is an aggressive and rare pediatric embryonal brain tumor. Amplification of C19MC microRNA cluster and expression of LIN28 are distinctive features of ETMR. Despite the increasing efforts to decipher ETMR, the biology remains poorly understood. To date, the role of aberrant alternative splicing in ETMR has not been thoroughly investigated. In the current study, a comprehensive analysis was performed on published unprocessed RNA-seq reads of tissue-matched ETMR and fetal controls datasets. Gene expression was quantified in samples using Kallisto/sleuth pipeline. For the alternative splicing analysis, STAR, SplAdder and rMATS were used. Functional enrichment analysis was subsequently performed using Metascape. The expression analysis identified a total of 3622 differentially expressed genes (DEGs) between ETMR and fetal controls while 1627 genes showed differential alternative splicing patterns. Interestingly, genes with significant alternative splicing events in ETMR were identified to be involved in signaling pathways such as ErbB, mTOR and MAPK pathways as well as ubiquitin-mediated proteolysis, cell cycle and autophagy. Moreover, up-regulated DEGs with alternative splicing events were involved in important biological processes including nuclear transport, regulation of cell cycle and regulation of Wnt signaling pathway. These findings highlight the role of aberrant alternative splicing in shaping the ETMR tumor landscape, and the identified pathways constitute potential therapeutic targets.
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12
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Furuta T, Moritsubo M, Muta H, Koga M, Komaki S, Nakamura H, Morioka M, Ohshima K, Sugita Y. Central nervous system neuroblastic tumor with FOXR2 activation presenting both neuronal and glial differentiation: a case report. Brain Tumor Pathol 2020; 37:100-104. [PMID: 32535663 DOI: 10.1007/s10014-020-00370-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/09/2020] [Indexed: 12/14/2022]
Abstract
A subset of central nervous system neuroblastomas (CNS NB), rare primary embryonal CNS tumors, has been encompassed in CNS NB with FOXR2 activation (CNS NB-FOXR2) and usually shows the primitive neuronal architecture and occasional neurocytic differentiation. Here, we report a rare case of 3-year-old female with uncommon morphology of CNS embryonal tumor with FOXR2 activation presenting bidirectional differentiation to neurocytic small primitive cells and astrocytic spindle cells both of which are positive for synaptophysin and GFAP. Ultrastructural study also showed that there were presynaptic structure and intermediate filament in the tumor cells, suggesting glioneuronal differentiation. This case indicates the possibility of CNS neuroblastic tumor to differentiate neuronal and glial lineages.
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Affiliation(s)
- Takuya Furuta
- Department of Pathology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
| | - Mayuko Moritsubo
- Department of Pathology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Hiroko Muta
- Department of Pathology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Motohisa Koga
- Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan
| | - Satoru Komaki
- Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan
| | - Hideo Nakamura
- Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan
| | - Motohiro Morioka
- Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan
| | - Koichi Ohshima
- Department of Pathology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Yasuo Sugita
- Department of Neuropathology, St. Mary's Hospital, Kurume, Japan
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13
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Bhimani AD, Ryoo JS, Reddy AK, Denyer S, McGuire LS, Alonso M, Mehta AI. Differentiation of Outcomes by Treatment Regimen and Histology in Central Nervous System Primary Embryonal Tumors. World Neurosurg 2020; 141:e289-e306. [PMID: 32434022 DOI: 10.1016/j.wneu.2020.05.103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Central nervous system (CNS) embryonal tumors are malignant neoplasms of undifferentiated embryonic cells that typically occur in the pediatric population. They are further divided into many subgroups by distinct histologic and genetic profiles. We present the largest study to date to identify differential survival outcomes within each subgroup by treatment regimen. METHODS The SEER (Surveillance Epidemiology and End Results) database was queried from 1973 to 2015 for embryonal tumors of primary CNS origin (n = 3900). The effects of patient demographics, tumor characteristics, and treatment regimen were analyzed using a multivariate Cox proportional hazard model in CNS embryonal tumor subtypes divided into medulloblastoma, atypical teratoid/rhabdoid tumor, and primitive neuroectodermal tumor. RESULTS No significant patient demographic factors were found to be associated with increased mortality. In all 3 CNS embryonal tumor subtypes, most monotherapy and combinatorial treatment paradigms showed a higher hazard ratio compared with gross total resection with adjuvant chemoradiotherapy (hazard ratio, 1.72-22.94; P < 0.05 for all). In a subgroup analysis of patients with medulloblastoma ≤3 years of age, patients who did not receive radiation showed lower survival probabilities at 1, 5, and 10 years (odds ratio [OR], 0.37, P < 0.0001; OR, 0.39, P < 0.0001; OR, 0.34, P < 0.0001, respectively). Kaplan-Meier analysis of medulloblastoma histologic subtypes showed that use of radiation imparted a higher survival probability in the desmoplastic/nodular medulloblastoma and medulloblastoma not otherwise specified groups (P < 0.001 for both). CONCLUSIONS CNS embryonal tumors are highly malignant in all populations and the best survival is seen with aggressive combination therapies. Radiation therapy may have a role in prolonging survival in patients with medulloblastoma ≤3 years of age.
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Affiliation(s)
- Abhiraj D Bhimani
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - James S Ryoo
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Abhinav K Reddy
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Steven Denyer
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Laura S McGuire
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Matthew Alonso
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
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14
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Stachowicz-Stencel T, Synakiewicz A. Biomarkers for pediatric cancer detection: latest advances and future perspectives. Biomark Med 2020; 14:391-400. [PMID: 32270691 DOI: 10.2217/bmm-2019-0613] [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: 11/21/2022] Open
Abstract
Cancer is one of the major health problems of the modern world. With the development of novel biochemistry and analytical instrumentation, precancer diagnosis has become a major focus of clinical and preclinical research. Finding appropriate biomarkers is crucial to make an early diagnosis, before the disease fully develops. With the improvement of precancer studies, cancer biomarkers prove their usefulness in providing important data on the cancer type and the status of patients' progression at a very early stage of the disease. Due to the constant evolution of pediatric cancer diagnosis, which includes highly advanced molecular techniques, the authors have decided to focus on selected groups of neoplastic disease and these include brain tumors, neuroblastoma, osteosarcoma and Hodgkin lymphoma.
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Affiliation(s)
- Teresa Stachowicz-Stencel
- Department of Pediatrics, Hematology & Oncology, Medical University of Gdansk, Poland 7 Debinki Street, 80-952 Gdansk, Poland
| | - Anna Synakiewicz
- Department of Pediatrics, Hematology & Oncology, Medical University of Gdansk, Poland 7 Debinki Street, 80-952 Gdansk, Poland
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15
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Pickles JC, Stone TJ, Jacques TS. Methylation-based algorithms for diagnosis: experience from neuro-oncology. J Pathol 2020; 250:510-517. [PMID: 32057098 DOI: 10.1002/path.5397] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 01/31/2020] [Accepted: 02/10/2020] [Indexed: 12/17/2022]
Abstract
Brain tumours are the most common tumour-related cause of death in young people. Survivors are at risk of significant disability, at least in part related to the effects of treatment. Therefore, there is a need for a precise diagnosis that stratifies patients for the most suitable treatment, matched to the underlying biology of their tumour. Although traditional histopathology has been accurate in predicting treatment responses in many cases, molecular profiling has revealed a remarkable, previously unappreciated, level of biological complexity in the classification of these tumours. Among different molecular technologies, DNA methylation profiling has had the most pronounced impact on brain tumour classification. Furthermore, using machine learning-based algorithms, DNA methylation profiling is changing diagnostic practice. This can be regarded as an exemplar for how molecular pathology can influence diagnostic practice and illustrates some of the unanticipated benefits and risks. © 2020 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Jessica C Pickles
- Developmental Biology and Cancer Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK.,Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Thomas J Stone
- Developmental Biology and Cancer Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK.,Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Thomas S Jacques
- Developmental Biology and Cancer Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK.,Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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16
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Abstract
Even though the treatment of childhood cancer has evolved significantly in recent decades, aggressive central nervous system (CNS) tumors are still a leading cause of morbidity and mortality in this population. Consequently, the identification of molecular targets that can be incorporated into diagnostic practice, effectively predict prognosis, follow treatment response, and materialize into potential targeted therapeutic approaches are still warranted. Since the first evidence of the participation of miRNAs in cancer development and progression 20 years ago, notable progress has been made in the basic understanding of the contribution of their dysregulation as epigenetic driver of tumorigenesis. Nevertheless, among the plethora of articles in the literature, microRNA profiling of pediatric tumors are scarce. This article gives an overview of the recent advances in the diagnostic/prognostic potential of miRNAs in a selection of pediatric CNS tumors: medulloblastoma, ependymoma, pilocytic astrocytoma, glioblastoma, diffuse intrinsic pontine glioma, atypical teratoid/rhabdoid tumors, and choroid plexus tumors.
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17
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Pickles JC, Fairchild AR, Stone TJ, Brownlee L, Merve A, Yasin SA, Avery A, Ahmed SW, Ogunbiyi O, Gonzalez Zapata J, Peary AF, Edwards M, Wilkhu L, Dryden C, Ladon D, Kristiansen M, Rowe C, Kurian KM, Nicoll JAR, Mitchell C, Bloom T, Hilton DA, Al-Sarraj S, Doey L, Johns PN, Bridges LR, Chakrabarty A, Ismail A, Rathi N, Syed K, Lammie GA, Limback-Stanic C, Smith C, Torgersen A, Rae F, Hill RM, Clifford SC, Grabovska Y, Williamson D, Clarke M, Jones C, Capper D, Sill M, von Deimling A, Pfister SM, Jones DTW, Hargrave D, Chalker J, Jacques TS. DNA methylation-based profiling for paediatric CNS tumour diagnosis and treatment: a population-based study. THE LANCET. CHILD & ADOLESCENT HEALTH 2020; 4:121-130. [PMID: 31786093 DOI: 10.1016/s2352-4642(19)30342-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/11/2019] [Accepted: 10/11/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Marked variation exists in the use of genomic data in tumour diagnosis, and optimal integration with conventional diagnostic technology remains uncertain despite several studies reporting improved diagnostic accuracy, selection for targeted treatments, and stratification for trials. Our aim was to assess the added value of molecular profiling in routine clinical practice and the impact on conventional and experimental treatments. METHODS This population-based study assessed the diagnostic and clinical use of DNA methylation-based profiling in childhood CNS tumours using two large national cohorts in the UK. In the diagnostic cohort-which included routinely diagnosed CNS tumours between Sept 1, 2016, and Sept 1, 2018-we assessed how the methylation profile altered or refined diagnosis in routine clinical practice and estimated how this would affect standard patient management. For the archival cohort of diagnostically difficult cases, we established how many cases could be solved using modern standard pathology, how many could only be solved using the methylation profile, and how many remained unsolvable. FINDINGS Of 484 patients younger than 20 years with CNS tumours, 306 had DNA methylation arrays requested by the neuropathologist and were included in the diagnostic cohort. Molecular profiling added a unique contribution to clinical diagnosis in 107 (35%; 95% CI 30-40) of 306 cases in routine diagnostic practice-providing additional molecular subtyping data in 99 cases, amended the final diagnosis in five cases, and making potentially significant predictions in three cases. We estimated that it could change conventional management in 11 (4%; 95% CI 2-6) of 306 patients. Among 195 historically difficult-to-diagnose tumours in the archival cohort, 99 (51%) could be diagnosed using standard methods, with the addition of methylation profiling solving a further 34 (17%) cases. The remaining 62 (32%) cases were unresolved despite specialist pathology and methylation profiling. INTERPRETATION Together, these data provide estimates of the impact that could be expected from routine implementation of genomic profiling into clinical practice, and indicate limitations where additional techniques will be required. We conclude that DNA methylation arrays are a useful diagnostic adjunct for childhood CNS tumours. FUNDING The Brain Tumour Charity, Children with Cancer UK, Great Ormond Street Hospital Children's Charity, Olivia Hodson Cancer Fund, Cancer Research UK, and the National Institute of Health Research.
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Affiliation(s)
- Jessica C Pickles
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK; Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Amy R Fairchild
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK; Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Thomas J Stone
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK; Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lorelle Brownlee
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Ashirwad Merve
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Shireena A Yasin
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Aimee Avery
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Saira W Ahmed
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Olumide Ogunbiyi
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jamie Gonzalez Zapata
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Abigail F Peary
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Marie Edwards
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lisa Wilkhu
- Specialist Integrated Haematology and Malignancy Diagnostic Service-Acquired Genomics, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Carryl Dryden
- Specialist Integrated Haematology and Malignancy Diagnostic Service-Acquired Genomics, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Dariusz Ladon
- Specialist Integrated Haematology and Malignancy Diagnostic Service-Acquired Genomics, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Mark Kristiansen
- UCL Genomics, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Catherine Rowe
- Department of Neuropathology, North Bristol NHS Trust, Bristol, UK
| | | | - James A R Nicoll
- Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK; BRAIN UK, Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Clare Mitchell
- BRAIN UK, Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Tabitha Bloom
- BRAIN UK, Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - David A Hilton
- Cellular and Anatomical Pathology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Safa Al-Sarraj
- Department of Clinical Neuropathology, Kings College Hospital NHS Trust, London, UK
| | - Lawrence Doey
- Department of Clinical Neuropathology, Kings College Hospital NHS Trust, London, UK
| | - Paul N Johns
- Department of Cellular Pathology, St George's University Hospital NHS Foundation Trust, London, UK
| | - Leslie R Bridges
- Department of Cellular Pathology, St George's University Hospital NHS Foundation Trust, London, UK
| | - Aruna Chakrabarty
- St James's University Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Azzam Ismail
- St James's University Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nitika Rathi
- Department of Neuropathology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Khaja Syed
- Department of Neuropathology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | - Clara Limback-Stanic
- Department of Cellular Pathology, Imperial College Healthcare NHS Trust, London, UK
| | - Colin Smith
- Western General Hospital, NHS Lothian, Edinburgh, UK
| | | | - Frances Rae
- Western General Hospital, NHS Lothian, Edinburgh, UK
| | - Rebecca M Hill
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Steven C Clifford
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Yura Grabovska
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Daniel Williamson
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Matthew Clarke
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - Chris Jones
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - David Capper
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neuropathology, Berlin, Germany; German Cancer Consortium Partner Site Berlin, German Cancer Research Center, Heidelberg, Germany
| | - Martin Sill
- Hopp Children's Cancer Center Heidelberg, Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | - Stefan M Pfister
- Hopp Children's Cancer Center Heidelberg, Heidelberg, Germany; Department of Pediatric Oncology, Hematology, Immunology, and Pulmonology, University Hospital Heidelberg, Heidelberg, Germany; Division of Pediatric Neurooncology, German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | - David T W Jones
- Hopp Children's Cancer Center Heidelberg, Heidelberg, Germany; Pediatric Glioma Research Group, German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | - Darren Hargrave
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jane Chalker
- Specialist Integrated Haematology and Malignancy Diagnostic Service-Acquired Genomics, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Thomas S Jacques
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK; Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
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18
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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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19
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Human Sialic acid O-acetyl esterase (SIAE) - mediated changes in sensitivity to etoposide in a medulloblastoma cell line. Sci Rep 2019; 9:8609. [PMID: 31197190 PMCID: PMC6565703 DOI: 10.1038/s41598-019-44950-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 05/15/2019] [Indexed: 12/31/2022] Open
Abstract
Medulloblastoma (MB), the most common malignant paediatric brain tumour occurs in the cerebellum. Advances in molecular genomics have led to the identification of defined subgroups which are associated with distinct clinical prognoses. Despite this classification, standard therapies for all subgroups often leave children with life-long neurological deficits. New therapeutic approaches are therefore urgently needed to reduce current treatment toxicity and increase survival for patients. GD3 is a well-studied ganglioside which is known to have roles in the development of the cerebellum. Post-partum GD3 is not highly expressed in the brain. In some cancers however GD3 is highly expressed. In MB cells GD3 is largely acetylated to GD3A. GD3 is pro-apoptotic but GD3A can protect cells from apoptosis. Presence of these gangliosides has previously been shown to correlate with resistance to chemotherapy. Here we show that the GD3 acetylation pathway is dysregulated in MB and as a proof-of-principle we show that increased GD3 expression sensitises an MB cell line to etoposide.
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20
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Schwake M, Schipmann S, Müther M, Köchling M, Brentrup A, Stummer W. 5-ALA fluorescence-guided surgery in pediatric brain tumors-a systematic review. Acta Neurochir (Wien) 2019; 161:1099-1108. [PMID: 30989383 DOI: 10.1007/s00701-019-03898-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/28/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND 5-Aminolevulinic acid (5-ALA)-guided resection of gliomas in adults enables better differentiation between tumor and normal brain tissue, allowing a higher degree of resection, and improves patient outcomes. In recent years, several reports have emerged regarding the use of 5-ALA in other brain tumor entities, including pediatric brains tumors. Since gross total resection (GTR) of many brain tumors in children is crucial and the role of 5-ALA-guided resection of these tumors is not clear, we sought to perform a comprehensive literature review on this topic. METHODS A systematic literature review of EMBASE and MEDLINE/PubMed databases revealed 19 eligible publications encompassing 175 5-ALA-guided operations on pediatric brain tumors. To prevent bias, publications were revised independently by two authors. RESULTS We found that 5-ALA-guided resection enabled the surgeons to identify the tumor more easily and was considered helpful mainly in cases of glioblastoma (GBM, 21/27, 78%), anaplastic ependymoma WHO grade III (10/14, 71%), and anaplastic astrocytoma (4/6, 67%). In contrast, cases of pilocytic astrocytomas (PAs) and medulloblastomas 5-ALA-guided surgery did not show consistent fluorescent signals and 5-ALA was considered helpful only in 12% and 22% of cases, respectively. Accumulation of fluorescent porphyrins seems to depend on WHO tumor grading. One important finding is that when 5-ALA-guided resections were considered helpful, the degree of resection was higher than is cases where it was not helpful. The rate of adverse events related to 5-ALA was negligible, especially new postoperative sequelae. CONCLUSION 5-ALA could play a role in resection of pediatric brain tumors. However, further prospective clinical trials are needed.
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21
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Hartman LLR, Oaxaca DM, Carcamo B, Wilson HL, Ross JA, Robles-Escajeda E, Kirken RA. Integration of a Personalized Molecular Targeted Therapy into the Multimodal Treatment of Refractory Childhood Embryonal Tumor with Multilayered Rosettes (ETMR). Case Rep Oncol 2019; 12:211-217. [PMID: 31011318 PMCID: PMC6465683 DOI: 10.1159/000497380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 01/31/2019] [Indexed: 01/28/2023] Open
Abstract
Embryonal tumor with multilayered rosettes (ETMR) are rare pediatric brain tumors with increased malignant potential. Despite the advances in multimodal treatment schemes the overall 5-year event free survival rates for ETMR are not favorable. Further, therapeutic regimes are limited to a case by case basis due to the limited amount of literature and guidelines available for treating childhood ETMR. We report one patient with refractory ETMR who was successfully treated by implementing a molecular profiling approach which identified the tyrosine kinase inhibitor dasatinib as a viable therapy. Our results suggest that utilizing this precision medicine approach might prove useful in treating patients with refractory ETMR.
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Affiliation(s)
- Lisa L R Hartman
- Texas Tech University Health Sciences Center at El Paso, El Paso, Texas, USA.,El Paso Children's Hospital, El Paso, Texas, USA
| | - Derrick M Oaxaca
- Texas Tech University Health Sciences Center at El Paso, El Paso, Texas, USA.,Department of Biological Sciences, The University of Texas at El Paso, El Paso, Texas, USA
| | - Benjamin Carcamo
- Texas Tech University Health Sciences Center at El Paso, El Paso, Texas, USA.,El Paso Children's Hospital, El Paso, Texas, USA
| | - Harry L Wilson
- Texas Tech University Health Sciences Center at El Paso, El Paso, Texas, USA.,El Paso Children's Hospital, El Paso, Texas, USA
| | - Jeremy A Ross
- Department of Biological Sciences, The University of Texas at El Paso, El Paso, Texas, USA
| | - Elisa Robles-Escajeda
- Department of Biological Sciences, The University of Texas at El Paso, El Paso, Texas, USA
| | - Robert A Kirken
- Department of Biological Sciences, The University of Texas at El Paso, El Paso, Texas, USA
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22
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Scheie D, Kufaishi HHA, Broholm H, Lund EL, de Stricker K, Melchior LC, Grauslund M. Biomarkers in tumors of the central nervous system - a review. APMIS 2019; 127:265-287. [PMID: 30740783 DOI: 10.1111/apm.12916] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 12/07/2018] [Indexed: 12/21/2022]
Abstract
Until recently, diagnostics of brain tumors were almost solely based on morphology and immunohistochemical stainings for relatively unspecific lineage markers. Although certain molecular markers have been known for longer than a decade (combined loss of chromosome 1p and 19q in oligodendrogliomas), molecular biomarkers were not included in the WHO scheme until 2016. Now, the classification of diffuse gliomas rests on an integration of morphology and molecular results. Also, for many other central nervous system tumor entities, specific diagnostic, prognostic and predictive biomarkers have been detected and continue to emerge. Previously, we considered brain tumors with similar histology to represent a single disease entity. We now realize that histologically identical tumors might show alterations in different molecular pathways, and often represent separate diseases with different natural history and response to treatment. Hence, knowledge about specific biomarkers is of great importance for individualized treatment and follow-up. In this paper we review the biomarkers that we currently use in the diagnostic work-up of brain tumors.
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Affiliation(s)
- David Scheie
- Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | | | - Helle Broholm
- Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | - Eva Løbner Lund
- Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Morten Grauslund
- Department of Genetics and Pathology, Laboratory Medicine, Lund, Sweden
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23
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Wesseling P, Jacques TS. Taxonomy of CNS tumours; a series of three short reviews on the WHO 2016 classification and beyond. Neuropathol Appl Neurobiol 2019; 44:137-138. [PMID: 28944505 DOI: 10.1111/nan.12442] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- P Wesseling
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands.,Department of Pathology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,University Medical Center Utrecht, Utrecht, The Netherlands
| | - T S Jacques
- Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health and Department of Histopathology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
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Priesterbach-Ackley LP, Wesseling P, Snijders TJ, de Vos FYFL, de Leng WWJ. Molecular tools for the pathologic diagnosis of central nervous system tumors. Neurooncol Pract 2019; 6:4-16. [PMID: 31386041 PMCID: PMC6656323 DOI: 10.1093/nop/npy041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Molecular diagnostics currently has a crucial role in neuro-oncological patient care. (Epi)genetic assays testing for point mutations, copy number variations, gene fusions, translocations, and methylation status are of main diagnostic interest in neuro-oncology. Multiple assays have been developed for this purpose, ranging from single gene tests to high-throughput, integrated techniques enabling detection of multiple genetic aberrations in a single workflow. This review describes the nature of the simpler and more complex assays for molecular diagnostics of tumors of the central nervous system and briefly discusses their strengths and weaknesses.
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Affiliation(s)
| | - Pieter Wesseling
- Department of Pathology, Princess Máxima Center for Pediatric Oncology and University Medical Center Utrecht, The Netherlands
- Department of Pathology, VU University Medical Center/Brain Tumor Center Amsterdam, The Netherlands
| | - Tom J Snijders
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands
| | - Filip Y F L de Vos
- Department of Medical Oncology, University Medical Center Utrecht, The Netherlands
| | - Wendy W J de Leng
- Department of Pathology, University Medical Center Utrecht, The Netherlands
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Di Pietro C, La Sala G, Matteoni R, Marazziti D, Tocchini-Valentini GP. Genetic ablation of Gpr37l1 delays tumor occurrence in Ptch1 +/- mouse models of medulloblastoma. Exp Neurol 2018; 312:33-42. [PMID: 30452905 DOI: 10.1016/j.expneurol.2018.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/06/2018] [Accepted: 11/15/2018] [Indexed: 02/07/2023]
Abstract
The G-protein coupled receptor 37-like 1 (Gpr37l1) is specifically expressed in most astrocytic glial cells, including cerebellar Bergmann astrocytes and interacts with patched 1 (Ptch1), a co-receptor of the sonic hedgehog (Shh)-smoothened (Smo) signaling complex. Gpr37l1 null mutant mice exhibit precocious post-natal cerebellar development, with altered Shh-Smo mitogenic cascade and premature down-regulation of granule cell precursor (GCP) proliferation. Gpr37l1 expression is downregulated in medulloblastoma (MB) and upregulated in glioma and glioblastoma tumors. Shh-associated MBs originate postnatally, from dysregulated hyperproliferation of GCPs in developing cerebellum's external granular layer (EGL), as shown in heterozygous Ptch1+/- knock-out mouse strains that model human MB occurrence and progression. This study investigates cerebellar MB phenotypes in newly produced Gpr37l1, Ptch1 double mutant mice. Natural history analysis shows that Gpr37l1 genetic ablation, in Ptch1+/- model animals, results in marked deferment of post-natal tumor occurrence and decreased incidence of more aggressive tumor types. It is also associated with the delayed and diminished presence of more severe types of hyperplastic lesions in Ptch1+/- mice. Consistently, during early post-natal development Gpr37l1-/-;Ptch1+/- pups exhibit reduction in cerebellar GCP proliferation and EGL thickness and a precocious, sustained expression of wingless-type MMTV integration site member 3 (Wnt3), a specific inhibitor of Shh-induced neuronal mitogenesis, in comparison with Ptch1+/- heterozygous single mutants. These findings highlight the specific involvement of Gpr37l1 in modulating postnatal cerebellar Shh-Ptch1-Smo mitogenic signaling in both normal and pathological conditions. The novel Gpr37l1-/-;Ptch1+/- mouse models may thus be instrumental in the detailed characterization of the initial phases of Shh-associated MB insurgence and development.
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Affiliation(s)
- Chiara Di Pietro
- Institute of Cell Biology and Neurobiology, Italian National Research Council (CNR), I-00015, Monterotondo Scalo, Rome, Italy
| | - Gina La Sala
- Institute of Cell Biology and Neurobiology, Italian National Research Council (CNR), I-00015, Monterotondo Scalo, Rome, Italy
| | - Rafaele Matteoni
- Institute of Cell Biology and Neurobiology, Italian National Research Council (CNR), I-00015, Monterotondo Scalo, Rome, Italy
| | - Daniela Marazziti
- Institute of Cell Biology and Neurobiology, Italian National Research Council (CNR), I-00015, Monterotondo Scalo, Rome, Italy.
| | - Glauco P Tocchini-Valentini
- Institute of Cell Biology and Neurobiology, Italian National Research Council (CNR), I-00015, Monterotondo Scalo, Rome, Italy
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Clinical Applications of Quantitative 3-Dimensional MRI Analysis for Pediatric Embryonal Brain Tumors. Int J Radiat Oncol Biol Phys 2018; 102:744-756. [DOI: 10.1016/j.ijrobp.2018.05.077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 05/22/2018] [Accepted: 05/28/2018] [Indexed: 12/23/2022]
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Kim J, Kim J, Lee Y. DNA polymerase β deficiency in the p53 null cerebellum leads to medulloblastoma formation. Biochem Biophys Res Commun 2018; 505:548-553. [PMID: 30274781 DOI: 10.1016/j.bbrc.2018.09.166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 09/26/2018] [Indexed: 10/28/2022]
Abstract
Defects in DNA damage response or repair mechanisms during neurogenesis result in genomic instability, which is causative for several neural defects. These include brain tumors, particularly medulloblastoma, which occurs in the cerebellum with a high incidence in children. We generated an animal model with defective base excision repair during brain development through selective inactivation of DNA polymerase β (Polb) in neuroprogenitor cells. All of Polb conditional knockout mice developed medulloblastoma in a p53 null background, similar to the Xrcc1 and p53 double deficient animal model. XRCC1 is a scaffolding protein which is involved in DNA damage repair and binds to POLB. In both animal models, the histopathological characteristics of the medulloblastoma were similar to those of human classic medulloblastoma. Brain tumor development was slower in the Polb and p53 double null animals than in the Xrcc1 and p53 double knockout animals. Molecular marker analysis suggested that Polb- and Xrcc1-deficient medulloblastomas belonged to the SHHα subtype, underscoring the important role of genomic stability in preventing this devastating pediatric cerebellar tumor.
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Affiliation(s)
- Jusik Kim
- Genomic Instability Research Center, Ajou University School of Medicine, Suwon, Republic of Korea; Department of Biomedical Sciences, The Graduate School, Ajou University, Suwon, Republic of Korea
| | - Jaemi Kim
- Genomic Instability Research Center, Ajou University School of Medicine, Suwon, Republic of Korea; Genome Stability Institute, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Youngsoo Lee
- Genomic Instability Research Center, Ajou University School of Medicine, Suwon, Republic of Korea; Genome Stability Institute, Ajou University School of Medicine, Suwon, Republic of Korea; Department of Biomedical Sciences, The Graduate School, Ajou University, Suwon, Republic of Korea.
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Oxamate, but Not Selective Targeting of LDH-A, Inhibits Medulloblastoma Cell Glycolysis, Growth and Motility. Brain Sci 2018; 8:brainsci8040056. [PMID: 29601482 PMCID: PMC5924392 DOI: 10.3390/brainsci8040056] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 03/16/2018] [Accepted: 03/28/2018] [Indexed: 12/11/2022] Open
Abstract
Medulloblastoma is the most common malignant paediatric brain tumour and current therapies often leave patients with severe neurological disabilities. Four major molecular groups of medulloblastoma have been identified (Wnt, Shh, Group 3 and Group 4), which include additional, recently defined subgroups with different prognosis and genetic characteristics. Lactate dehydrogenase A (LDHA) is a key enzyme in the aerobic glycolysis pathway, an abnormal metabolic pathway commonly observed in cancers, associated with tumour progression and metastasis. Studies indicate MBs have a glycolytic phenotype; however, LDHA has not yet been explored as a therapeutic target for medulloblastoma. LDHA expression was examined in medulloblastoma subgroups and cell lines. The effects of LDHA inhibition by oxamate or LDHA siRNA on medulloblastoma cell line metabolism, migration and proliferation were examined. LDHA was significantly overexpressed in Group 3 and Wnt MBs compared to non-neoplastic cerebellum. Furthermore, we found that oxamate significantly attenuated glycolysis, proliferation and motility in medulloblastoma cell lines, but LDHA siRNA did not. We established that aerobic glycolysis is a potential therapeutic target for medulloblastoma, but broader LDH inhibition (LDHA, B, and C) may be more appropriate than LDHA inhibition alone.
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