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Franca RA, Ugga L, Della Monica R, Corvino S. A "masked" pleomorphic xanthoastrocytoma. Pathol Res Pract 2023; 248:154698. [PMID: 37499517 DOI: 10.1016/j.prp.2023.154698] [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: 06/22/2023] [Revised: 07/14/2023] [Accepted: 07/15/2023] [Indexed: 07/29/2023]
Abstract
The latest WHO Classification of tumours of the Central Nervous System (CNS) emphasizes the necessity of an integrated diagnostic approach during the workup of a CNS neoplasm. In addition to the mutational status, assessment of methylation profile of a tumour emerged as a helpful (often necessary) tool to make a correct and unequivocal diagnosis. Here we present a case of a Pleomorphic Xanthoastrocytoma with clinical, radiological and histopathological findings remarkably overlapping with a recently described paediatric-type glioma namly Polymorphic Low-grade Neuroepithelial Tumour of the Young (PLNTY). The differential diagnosis here discussed represents a methodological paradigm in the modern neuropathology. In fact, the presentation of this case is a demonstration that in day-to-day practice, clinical, radiological, and histopathological data can all be misleading, and the correct diagnosis can only be reached by integration with molecular analysis. In the modern neuro-oncology, it is by far mandatory for all the specialists dealing with cerebral tumours to "contaminate" their own cultural heritage with other ones, to optimally manage a patient with CNS tumour.
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Affiliation(s)
- Raduan Ahmed Franca
- Department of Advanced Biomedical Sciences, Pathology Section, University of Naples "Federico II", Naples, Italy.
| | - Lorenzo Ugga
- Department of Advavanced Biomedical Sciences, University of Naples "Federico II" Naples, Italy
| | - Rosa Della Monica
- CEINGE Biotecnologie Avanzate scarl, via Gaetano Salvatore, 486, Naples, Italy.
| | - Sergio Corvino
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università di Napoli Federico II, Naples 80131, Italy
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Tang K, Kurland D, Vasudevaraja V, Serrano J, Delorenzo M, Radmanesh A, Thomas C, Spino M, Gardner S, Allen JC, Nicolaides T, Osorio DS, Finlay JL, Boué DR, Snuderl M. Exploring DNA Methylation for Prognosis and Analyzing the Tumor Microenvironment in Pleomorphic Xanthoastrocytoma. J Neuropathol Exp Neurol 2021; 79:880-890. [PMID: 32594172 DOI: 10.1093/jnen/nlaa051] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/13/2020] [Accepted: 05/11/2020] [Indexed: 12/20/2022] Open
Abstract
Pleomorphic xanthoastrocytoma (PXA) is a rare type of brain tumor that affects children and young adults. Molecular prognostic markers of PXAs remain poorly established. Similar to gangliogliomas, PXAs show prominent immune cell infiltrate, but its composition also remains unknown. In this study, we correlated DNA methylation and BRAF status with clinical outcome and explored the tumor microenvironment. We performed DNA methylation in 21 tumor samples from 18 subjects with a histological diagnosis of PXA. MethylCIBERSORT was used to deconvolute the PXA microenvironment by analyzing the associated immune cell-types. Median age at diagnosis was 16 years (range 7-32). At median follow-up of 30 months, 3-year and 5-year overall survival was 73% and 71%, respectively. Overall survival ranged from 1 to 139 months. Eleven out of 18 subjects (61%) showed disease progression. Progression-free survival ranged from 1 to 89 months. Trisomy 7 and CDKN2A/B (p16) homozygous deletion did not show any association with overall survival (p = 0.67 and p = 0.74, respectively). Decreased overall survival was observed for subjects with tumors lacking the BRAF V600E mutation (p = 0.02). PXAs had significantly increased CD8 T-cell epigenetic signatures compared with previously profiled gangliogliomas (p = 0.0019). The characterization of immune cell-types in PXAs may have implications for future development of immunotherapy.
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Affiliation(s)
- Karen Tang
- From the Department of Pediatrics, Division of Hematology/Oncology, New York University Langone Health, New York, New York.,Clinical and Translational Science Institute, New York University Langone Health, New York, New York
| | - David Kurland
- Department of Neurosurgery, New York University Langone Health, New York, New York
| | - Varshini Vasudevaraja
- Department of Biomedical Informatics, New York University Langone Health, New York, New York
| | - Jonathan Serrano
- Department of Biomedical Informatics, New York University Langone Health, New York, New York
| | - Michael Delorenzo
- Department of Neuropathology, New York University Langone Health, New York, New York
| | - Alireza Radmanesh
- Department of Neuroradiology, New York University Langone Health, New York, New York
| | - Cheddhi Thomas
- Department of Neuropathology, New York University Langone Health, New York, New York.,Department of Neuropathology, Incyte Diagnostics, Spokane Valley, Washington
| | - Marissa Spino
- Department of Neuropathology, New York University Langone Health, New York, New York
| | - Sharon Gardner
- From the Department of Pediatrics, Division of Hematology/Oncology, New York University Langone Health, New York, New York
| | - Jeffrey C Allen
- From the Department of Pediatrics, Division of Hematology/Oncology, New York University Langone Health, New York, New York
| | - Theodore Nicolaides
- From the Department of Pediatrics, Division of Hematology/Oncology, New York University Langone Health, New York, New York
| | - Diana S Osorio
- Department of Pediatrics, Division of Hematology, Oncology and Bone Marrow Transplant
| | - Jonathan L Finlay
- Department of Pediatrics, Division of Hematology, Oncology and Bone Marrow Transplant
| | - Daniel R Boué
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, and the Ohio State University, Columbus, Ohio
| | - Matija Snuderl
- Department of Neuropathology, New York University Langone Health, New York, New York
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Klinger DR, Dillon RL, Clement NF, Cloran FJ, Horkayne-Szakaly I. Intradural extramedullary pleomorphic xanthoastrocytoma: A case report. Surg Neurol Int 2020; 11:368. [PMID: 33194301 PMCID: PMC7656036 DOI: 10.25259/sni_682_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/07/2020] [Indexed: 11/05/2022] Open
Abstract
Background: Pleomorphic xanthoastrocytomas (PXAs) are uncommon intradural and typically intramedullary astrocytic central nervous system tumors. Although they commonly occur supratentorially, they are rarely seen in the spine. Case Description: A 43-year-old male presented with cervical neck pain and right-sided radicular symptoms. He was found to have an intradural extramedullary mass at the C5–C6 level. The lesion was fully excised and proved to be a PXA. Of interest, the lesion did not recur on postoperative MR imaging studies obtained 7 months later. Conclusion: While rare, primary intradural extramedullary spinal PXA has been reported. Here, we review such a lesion occurring in a 43-year-old male who did well following gross total excision of the tumor.
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Affiliation(s)
- Daniel R Klinger
- Department of Neurosurgery, Brooke Army Medical Center, Roger Brooke Drive, Fort Sam Houston, San Antonio, Texas, United States
| | - Rebecca L Dillon
- Department of Radiology Brooke Army Medical Center, Roger Brooke Drive, Fort Sam Houston, San Antonio, Texas, United States
| | - Nathan F Clement
- Department of Pathology, Brooke Army Medical Center, Roger Brooke Drive, Fort Sam Houston, San Antonio, Texas, United States
| | - Francis J Cloran
- Department of Radiology Brooke Army Medical Center, Roger Brooke Drive, Fort Sam Houston, San Antonio, Texas, United States
| | - Iren Horkayne-Szakaly
- Department of Neuropathology and Ophthalmic Pathology, The Joint Pathology Center, Silver Spring, Maryland, United States
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