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Perez-Vega C, Akinduro OO, Cheek BJ, Beier AD. Spinal Cord Diffuse Leptomeningeal Glioneuronal Tumor Presenting without Leptomeningeal Dissemination. Pediatr Neurosurg 2021; 56:563-568. [PMID: 34518487 DOI: 10.1159/000518802] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/29/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND IMPORTANCE Diffuse leptomeningeal glioneuronal tumor (DLGNT) represents a provisional entity in the 2016 World Health Organization classification of tumors; it is characterized by a widespread leptomeningeal growth and oligodendroglial-like cytology. To this day, 4 pediatric patients have been reported to present with an isolated spinal cord tumor in the absence of leptomeningeal dissemination. Gross total resection (GTR) was achieved in only 1 patient. We present the clinical and technical nuances of this unique type of tumor, as well as the second reported case of GTR in a patient with DLGNT. CLINICAL PRESENTATION A 4-year-old boy presented to the emergency department after an episode of flaccid paralysis of bilateral lower extremities. MRI showed an intramedullary spinal cord tumor centered at T8. The patient was taken to the operative room, where a laminectomy and tumor resection were performed; cystic and solid tumor components were identified. Pathology report was consistent with DLGNT. After achieving GTR, patient is free of recurrence after a 15-month follow-up. CONCLUSION No standard treatment for DLGNT has been identified. Current literature report surgery and chemotherapy with variable success rates. DLGNT presenting as an isolated intramedullary tumor is an uncommon condition which progression appears to be halted when treated promptly. Identifying solid and cystic components of this tumor is crucial for achieving GTR.
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Affiliation(s)
- Carlos Perez-Vega
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA,
| | | | - Bradley J Cheek
- Section of Pediatric Pathology, Wolfson Children's Hospital, Jacksonville, Florida, USA
| | - Alexandra D Beier
- Division of Pediatric Neurosurgery, University of Florida Health, Jacksonville, Florida, USA
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Giunti L, Buccoliero AM, Pantaleo M, Lucchesi M, Provenzano A, Palazzo V, Guarducci S, Guidi M, Genitori L, Zuffardi O, Sardi I, Giglio S. Molecular characterization of paediatric glioneuronal tumours with neuropil-like islands: a genome-wide copy number analysis. Am J Cancer Res 2016; 6:2910-2918. [PMID: 28042510 PMCID: PMC5199764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 07/23/2016] [Indexed: 06/06/2023] Open
Abstract
Paediatric glioneuronal tumour with neuropil-like islands (GTNI) is a rare neoplasm of neuronal differentiation and diffusely infiltrating astroglial and oligodendrocyte-like components. The 2007 World Health Organization classification of central nervous system tumours considered it as a pattern variation of anaplastic astrocytoma. There are few data on paediatric GTNI probably both for their rarity and variable clinical aggressiveness. We studied by SNP/CGH array four tumour samples of GTNI from two males and two females (one new-born and three children aged from 4 to 8 years), in order to identify any possible common genomic alteration. All patients received chemo- and radiotherapy after their surgical treatment. No genomic instability nor recurrent alterations have been demonstrated in two of our GTNI cases. In the remaining two, we detected a mosaic trisomy 8 (15-20%) in one case, and an amplification at 5q14.1 involving DMGDH (partially), BHMT2 and BHMT genes, with the distal breakpoint falling at 23 Kbp from the 5'UTR of JMY, a p53 cofactor. Although the smallness of the sample impairs any clinical-histological correlation, GTNI appear different at the molecular level, with genomic imbalances playing a possible role in at least part of them. Our work gives an important contribution in knowledge and classification of this family of tumours.
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Affiliation(s)
- Laura Giunti
- Medical Genetics Unit, Meyer Children’s University HospitalViale Pieraccini 2450139, Florence, Italy
| | - Anna Maria Buccoliero
- Anatomic Pathology Unit, Meyer Children’s University HospitalViale Pieraccini 2450139, Florence, Italy
| | - Marilena Pantaleo
- Medical Genetics Unit, Meyer Children’s University HospitalViale Pieraccini 2450139, Florence, Italy
| | - Maurizio Lucchesi
- Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children’s University HospitalViale Pieraccini 2450139, Florence, Italy
| | - Aldesia Provenzano
- Medical Genetics Unit, Department of Clinical and Experimental Biomedical Sciences “Mario Serio”, University of FlorenceViale Morgagni 5050134, Florence, Italy (S.G.)
| | - Viviana Palazzo
- Medical Genetics Unit, Department of Clinical and Experimental Biomedical Sciences “Mario Serio”, University of FlorenceViale Morgagni 5050134, Florence, Italy (S.G.)
| | - Silvia Guarducci
- Medical Genetics Unit, Meyer Children’s University HospitalViale Pieraccini 2450139, Florence, Italy
| | - Milena Guidi
- Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children’s University HospitalViale Pieraccini 2450139, Florence, Italy
| | - Lorenzo Genitori
- Neurosurgery Unit, Department of Neuroscience, Meyer Children’s University HospitalViale Pieraccini 2450139, Florence, Italy
| | - Orsetta Zuffardi
- Department of Molecular Medicine, University of PaviaViale Forlanini 1427100, Pavia, Italy
| | - Iacopo Sardi
- Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children’s University HospitalViale Pieraccini 2450139, Florence, Italy
| | - Sabrina Giglio
- Medical Genetics Unit, Meyer Children’s University HospitalViale Pieraccini 2450139, Florence, Italy
- Medical Genetics Unit, Department of Clinical and Experimental Biomedical Sciences “Mario Serio”, University of FlorenceViale Morgagni 5050134, Florence, Italy (S.G.)
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Kakkar A, Nambirajan A, Kaur K, Kumar A, Mallick S, Suri V, Sarkar C, Kale SS, Garg A, Sharma MC. ATRX loss in glioneuronal tumors with neuropil-like islands indicates similarity to diffuse astrocytic tumors. J Neurooncol 2016; 130:63-68. [PMID: 27469217 DOI: 10.1007/s11060-016-2224-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 07/22/2016] [Indexed: 11/27/2022]
Abstract
Glioneuronal tumor with neuropil-like islands (GTNI) is a rare, recently described neoplasm, whose pathogenesis has not been studied extensively. The role of ATRX mutations, a class-defining alteration in diffuse astrocytic neoplasms, has not been assessed in GTNIs previously. We therefore aimed to assess the status of ATRX, along with IDH1, 1p/19q and p53, in cases of GTNI in order to evaluate the molecular profile of these tumors. All cases of GTNI diagnosed at our Institute were retrieved and clinicopathological features were reviewed. Immunohistochemistry for ATRX, IDH1 and p53 was performed. We identified four cases of GTNI, majority of which occurred in young adults. Loss of ATRX immunoexpression, a surrogate marker for ATRX mutation, was seen in all four cases. All cases were immunopositive for p53, while IDH1 positivity was seen in all three cases assessed. 1p/19q codeletion was absent in the three cases analyzed. These results indicate that the molecular pathogenesis of GTNIs similar to that of diffuse astrocytic tumors. Further, the loss of ATRX expression is seen in both the glial as well as neuronal components, indicating that both arise from the same tumor stem/progenitor cell and that the latter may be a metaplastic change. Thus, loss of ATRX immunoexpression, shown for the first time in these tumors, along with immunopositivity for p53 and IDH1, indicates that these tumors are molecular astrocytomas, and their clinical behaviour is likely to recapitulate that of ATRX-mutant and IDH-mutant diffuse astrocytomas of the same grade.
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Affiliation(s)
- Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Aruna Nambirajan
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Kavneet Kaur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Anupam Kumar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Supriya Mallick
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Vaishali Suri
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Chitra Sarkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Shashank Sharad Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Mehar Chand Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India.
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