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Raveneau M, Guerrini-Rousseau L, Levy R, Roux CJ, Bolle S, Doz F, Bourdeaut F, Colas C, Blauwblomme T, Beccaria K, Tauziède-Espariat A, Varlet P, Dufour C, Grill J, Boddaert N, Dangouloff-Ros V. Specific brain MRI features of constitutional mismatch repair deficiency syndrome in children with high-grade gliomas. Eur Radiol 2024:10.1007/s00330-024-10885-3. [PMID: 38981890 DOI: 10.1007/s00330-024-10885-3] [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: 02/10/2024] [Revised: 03/27/2024] [Accepted: 05/04/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Children with constitutional mismatch repair deficiency (CMMRD) syndrome have an increased risk of high-grade gliomas (HGG), and brain imaging abnormalities. This study analyzes brain imaging features in CMMRD syndrome children versus those with HGG without CMMRD. METHODS Retrospective comparative analysis of brain imaging in 30 CMMRD children (20 boys, median age eight years, 22 with HGG), seven with Lynch syndrome (7 HGG), 39 with type 1 neurofibromatosis (NF1) (four with HGG) and 50 with HGG without MMR or NF1 pathogenic variant ("no-predisposition" patients). RESULTS HGG in CMMRD and Lynch patients were predominantly hemispheric (versus midline) compared to NF1 and no-predisposition patients (91% and 86%, vs 25% and 54%, p = 0.004). CMMRD-associated tumors often had ill-defined boundaries (p = 0.008). All CMMRD patients exhibited at least one developmental venous anomaly (DVA), versus 14%, 10%, and 6% of Lynch, NF1, and no-predisposition patients (p < 0.0001). Multiple DVAs were observed in 83% of CMMRD patients, one NF1 patient (3%), and never in other groups (p < 0.0001). Cavernomas were discovered in 21% of CMMRD patients, never in other groups (p = 0.01). NF1-like focal areas of high T2-FLAIR signal intensity (FASI) were more prevalent in CMMRD patients than in Lynch or no-predisposition patients (50%, vs 20% and 0%, respectively, p < 0.0001). Subcortical and ill-limited FASI, possibly involving the cortex, were specific to CMMRD (p < 0.0001) and did not evolve in 93% of patients (13/14). CONCLUSION Diffuse hemispherically located HGG associated with multiple DVAs, cavernomas, and NF1-like or subcortical FASI strongly suggests CMMRD syndrome compared to children with HGG in other contexts. CLINICAL RELEVANCE STATEMENT The radiologic suggestion of CMMRD syndrome when confronted with HGGs in children may prompt genetic testing. This can influence therapeutic plans. Therefore, imaging features could potentially be incorporated into CMMRD testing recommendations. KEY POINTS Using imaging to detect CMMRD syndrome early may improve patient care. CMMRD features include: hemispheric HGG with multiple developmental venous anomalies and NF1-like or subcortical areas with high T2-FLAIR intensity. We propose novel imaging features to improve the identification of potential CMMRD patients.
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Affiliation(s)
- Magali Raveneau
- Pediatric Radiology Department, AP-HP, Hôpital Universitaire Necker-Enfants Malades, F-75015, Paris, France
| | - Léa Guerrini-Rousseau
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Institute, 114 rue Edouard Vaillant, 94805, Villejuif, France
- Génomique et Oncogénèse des Tumeurs Cérébrales Pédiatriques, Gustave Roussy Cancer Center and Paris-Saclay University, INSERM U981, Villejuif, France
| | - Raphael Levy
- Pediatric Radiology Department, AP-HP, Hôpital Universitaire Necker-Enfants Malades, F-75015, Paris, France
- INSERM U1299, F-75015, Paris, France
- UMR 1163, Institut Imagine, F-75015, Paris, France
| | - Charles-Joris Roux
- Pediatric Radiology Department, AP-HP, Hôpital Universitaire Necker-Enfants Malades, F-75015, Paris, France
- INSERM U1299, F-75015, Paris, France
- UMR 1163, Institut Imagine, F-75015, Paris, France
| | - Stéphanie Bolle
- Radiation Therapy Department, Gustave Roussy Institute, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - François Doz
- 12 rue de l'École de Médecine, Université Paris Cité, Paris, France
- Oncology Center SIREDO (Care Innovation and Research for Children, Adolescents and Young Adults with Cancer), Institute Curie, 26 rue d'Ulm, 75005, Paris, France
| | - Franck Bourdeaut
- 12 rue de l'École de Médecine, Université Paris Cité, Paris, France
- Oncology Center SIREDO (Care Innovation and Research for Children, Adolescents and Young Adults with Cancer), Institute Curie, 26 rue d'Ulm, 75005, Paris, France
| | - Chrystelle Colas
- Clinical Genetics Unit, Institute Curie, 26 rue d'Ulm, 75005, Paris, France
| | - Thomas Blauwblomme
- 12 rue de l'École de Médecine, Université Paris Cité, Paris, France
- Pediatric Neurosurgery Department, AP-HP, Hôpital Universitaire Necker-Enfants Malades, F-75015, Paris, France
| | - Kevin Beccaria
- 12 rue de l'École de Médecine, Université Paris Cité, Paris, France
- Pediatric Neurosurgery Department, AP-HP, Hôpital Universitaire Necker-Enfants Malades, F-75015, Paris, France
| | - Arnault Tauziède-Espariat
- Department of Neuropathology, GHU Paris-Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 75014, Paris, France
- Ima-Brain team, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université Paris Cité, 75014, Paris, France
| | - Pascale Varlet
- 12 rue de l'École de Médecine, Université Paris Cité, Paris, France
- Department of Neuropathology, GHU Paris-Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 75014, Paris, France
- Ima-Brain team, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université Paris Cité, 75014, Paris, France
| | - Christelle Dufour
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Institute, 114 rue Edouard Vaillant, 94805, Villejuif, France
- Génomique et Oncogénèse des Tumeurs Cérébrales Pédiatriques, Gustave Roussy Cancer Center and Paris-Saclay University, INSERM U981, Villejuif, France
| | - Jacques Grill
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Institute, 114 rue Edouard Vaillant, 94805, Villejuif, France
- Génomique et Oncogénèse des Tumeurs Cérébrales Pédiatriques, Gustave Roussy Cancer Center and Paris-Saclay University, INSERM U981, Villejuif, France
| | - Nathalie Boddaert
- Pediatric Radiology Department, AP-HP, Hôpital Universitaire Necker-Enfants Malades, F-75015, Paris, France
- INSERM U1299, F-75015, Paris, France
- UMR 1163, Institut Imagine, F-75015, Paris, France
- 12 rue de l'École de Médecine, Université Paris Cité, Paris, France
| | - Volodia Dangouloff-Ros
- Pediatric Radiology Department, AP-HP, Hôpital Universitaire Necker-Enfants Malades, F-75015, Paris, France.
- INSERM U1299, F-75015, Paris, France.
- UMR 1163, Institut Imagine, F-75015, Paris, France.
- 12 rue de l'École de Médecine, Université Paris Cité, Paris, France.
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Hadad S, Gupta R, Oberheim Bush NA, Taylor JW, Villanueva-Meyer JE, Young JS, Wu J, Ravindranathan A, Zhang Y, Warrier G, McCoy L, Shai A, Pekmezci M, Perry A, Bollen AW, Phillips JJ, Braunstein SE, Raleigh DR, Theodosopoulos P, Aghi MK, Chang EF, Hervey-Jumper SL, Costello JF, de Groot J, Butowski NA, Clarke JL, Chang SM, Berger MS, Molinaro AM, Solomon DA. "De novo replication repair deficient glioblastoma, IDH-wildtype" is a distinct glioblastoma subtype in adults that may benefit from immune checkpoint blockade. Acta Neuropathol 2023; 147:3. [PMID: 38079020 PMCID: PMC10713691 DOI: 10.1007/s00401-023-02654-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/24/2023] [Accepted: 10/24/2023] [Indexed: 12/18/2023]
Abstract
Glioblastoma is a clinically and molecularly heterogeneous disease, and new predictive biomarkers are needed to identify those patients most likely to respond to specific treatments. Through prospective genomic profiling of 459 consecutive primary treatment-naïve IDH-wildtype glioblastomas in adults, we identified a unique subgroup (2%, 9/459) defined by somatic hypermutation and DNA replication repair deficiency due to biallelic inactivation of a canonical mismatch repair gene. The deleterious mutations in mismatch repair genes were often present in the germline in the heterozygous state with somatic inactivation of the remaining allele, consistent with glioblastomas arising due to underlying Lynch syndrome. A subset of tumors had accompanying proofreading domain mutations in the DNA polymerase POLE and resultant "ultrahypermutation". The median age at diagnosis was 50 years (range 27-78), compared with 63 years for the other 450 patients with conventional glioblastoma (p < 0.01). All tumors had histologic features of the giant cell variant of glioblastoma. They lacked EGFR amplification, lacked combined trisomy of chromosome 7 plus monosomy of chromosome 10, and only rarely had TERT promoter mutation or CDKN2A homozygous deletion, which are hallmarks of conventional IDH-wildtype glioblastoma. Instead, they harbored frequent inactivating mutations in TP53, NF1, PTEN, ATRX, and SETD2 and recurrent activating mutations in PDGFRA. DNA methylation profiling revealed they did not align with known reference adult glioblastoma methylation classes, but instead had unique globally hypomethylated epigenomes and mostly classified as "Diffuse pediatric-type high grade glioma, RTK1 subtype, subclass A". Five patients were treated with immune checkpoint blockade, four of whom survived greater than 3 years. The median overall survival was 36.8 months, compared to 15.5 months for the other 450 patients (p < 0.001). We conclude that "De novo replication repair deficient glioblastoma, IDH-wildtype" represents a biologically distinct subtype in the adult population that may benefit from prospective identification and treatment with immune checkpoint blockade.
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Affiliation(s)
- Sara Hadad
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Rohit Gupta
- Department of Pathology, University of California, San Francisco, San Francisco, CA, USA
| | - Nancy Ann Oberheim Bush
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Jennie W Taylor
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Javier E Villanueva-Meyer
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Jacob S Young
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Jasper Wu
- Department of Pathology, University of California, San Francisco, San Francisco, CA, USA
| | - Ajay Ravindranathan
- Department of Pathology, University of California, San Francisco, San Francisco, CA, USA
| | - Yalan Zhang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Gayathri Warrier
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Lucie McCoy
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Anny Shai
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Melike Pekmezci
- Department of Pathology, University of California, San Francisco, San Francisco, CA, USA
| | - Arie Perry
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Department of Pathology, University of California, San Francisco, San Francisco, CA, USA
| | - Andrew W Bollen
- Department of Pathology, University of California, San Francisco, San Francisco, CA, USA
| | - Joanna J Phillips
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Department of Pathology, University of California, San Francisco, San Francisco, CA, USA
| | - Steve E Braunstein
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - David R Raleigh
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Philip Theodosopoulos
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Manish K Aghi
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Edward F Chang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Shawn L Hervey-Jumper
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Joseph F Costello
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - John de Groot
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Nicholas A Butowski
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Jennifer L Clarke
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Susan M Chang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Mitchel S Berger
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Annette M Molinaro
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.
| | - David A Solomon
- Department of Pathology, University of California, San Francisco, San Francisco, CA, USA.
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