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Chen Y, Buchanan P, Brossier NM, Navalkele P. Incidence and survival characteristics of pediatric ganglioglioma from 2004 to 2018, with focus on infratentorial sites. Neurooncol Pract 2024; 11:328-335. [PMID: 38737603 PMCID: PMC11085854 DOI: 10.1093/nop/npae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Background Ganglioglioma (GG) is a slow-growing glioneuronal neoplasm, most frequently seen in the supratentorial location in older children and associated with epilepsy syndromes. GG is rare in the infratentorial location, hence we embarked upon analyzing the National Cancer Institute's (NCI) Survival, Epidemiology, and End Results (SEER) database to better evaluate GG outcomes by location in comparison to the broader pediatric low-grade glioma (pLGG) population. Methods Pediatric patients diagnosed with GG and pLGG from 2004 to 2018 were included in the study. Their demographic, clinical, and survival characteristics were analyzed using SEER*Stat. Results This study describes the largest cohort of pediatric GG, including 852 cases from year 2004 to 2018, with focus on infratentorial sites. Patients with brainstem GG or those with subtotally resected disease were identified as having higher risk of death. Conclusions Our analysis highlights brainstem GG as a high-risk, poor-prognostic subgroup and elaborates on the incidence and survival characteristic of this lesser-known subgroup.
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Affiliation(s)
- Yongzhen Chen
- Saint Louis University School of Medicine, 1402 S Grand Blvd, Saint Louis, Missouri, USA
| | - Paula Buchanan
- Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Nicole M Brossier
- Department of Pediatrics, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Pournima Navalkele
- Division of Oncology, Children’s Hospital Orange County, Orange, California, USA
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2
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Komboz F, Zechel S, Malinova V, Mielke D, Rohde V, Abboud T. Infratentorial ganglioglioma mimicking a cerebellar metastasis. Int J Neurosci 2024; 134:11-15. [PMID: 35633078 DOI: 10.1080/00207454.2022.2082965] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/17/2022] [Indexed: 10/18/2022]
Abstract
We report a case of an infratentorial ganglioglioma in a 56-year-old male, who underwent magnetic resonance imaging (MRI) during the diagnostic workup for a suspected lung cancer. The MRI scan revealed a space-occupying lesion of the left lobulus semilunaris superior cerebelli, which was assumed being a metastasis. The asymptomatic lesion was resected to establish the diagnosis. Histologic and immunohistochemical studies showed a ganglioglioma with World Health Organization grade I characteristics. Although ganglioglioma typically exhibits a supratentorial predilection, it should be included in the differential diagnosis of lesions occurring in the cerebellum.
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Affiliation(s)
- Fares Komboz
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - Sabrina Zechel
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Vesna Malinova
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - Dorothee Mielke
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - Veit Rohde
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - Tammam Abboud
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
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Crainic N, Furtner J, Pallud J, Bielle F, Lombardi G, Rudà R, Idbaih A. Rare Neuronal, Glial and Glioneuronal Tumours in Adults. Cancers (Basel) 2023; 15:cancers15041120. [PMID: 36831464 PMCID: PMC9954092 DOI: 10.3390/cancers15041120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023] Open
Abstract
Rare glial, neuronal and glioneuronal tumours in adults form a heterogeneous group of rare, primary central nervous system tumours. These tumours, with a glial and/or neuronal component, are challenging in terms of diagnosis and therapeutic management. The novel classification of primary brain tumours published by the WHO in 2021 has significantly improved the diagnostic criteria of these entities. Indeed, diagnostic criteria are nowadays multimodal, including histological, immunohistochemical and molecular (i.e., genetic and methylomic). These integrated parameters have allowed the specification of already known tumours but also the identification of novel tumours for a better diagnosis.
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Affiliation(s)
- Nicolas Crainic
- Sorbonne Université, Institut du Cerveau—Paris Brain Institute—ICM, Inserm, CNRS, AP-HP, Hôpital Universitaire La Pitié Salpêtrière, DMU Neurosciences, Service de Neurologie 2, 75013 Paris, France
- Department of Neurology, University Hospital of Brest, 29200 Brest, France
- Correspondence: (N.C.); (A.I.)
| | - Julia Furtner
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
- Research Center of Medical Image Analysis and Artificial Intelligence (MIAAI), Danube Private University, 3500 Krems, Austria
| | - Johan Pallud
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 75014 Paris, France
- Institute of Psychiatry and Neuroscience of Paris, IMABRAIN, INSERM U1266, Université de Paris, 75014 Paris, France
| | - Franck Bielle
- Sorbonne Université, Institut du Cerveau—Paris Brain Institute—ICM, Inserm, CNRS, AP-HP, Hôpital Universitaire La Pitié Salpêtrière, DMU Neurosciences, Service de Neuropathologie, 75013 Paris, France
| | - Giuseppe Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology-IRCCS, 35128 Padua, Italy
| | - Roberta Rudà
- Division of Neurology, Castelfranco Veneto and Treviso Hospitals, 31033 Treviso, Italy
- Department of Neuro-Oncology, University of Turin, 10126 Turin, Italy
| | - Ahmed Idbaih
- Sorbonne Université, Institut du Cerveau—Paris Brain Institute—ICM, Inserm, CNRS, AP-HP, Hôpital Universitaire La Pitié Salpêtrière, DMU Neurosciences, Service de Neurologie 2, 75013 Paris, France
- Correspondence: (N.C.); (A.I.)
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Lin X, Huang R, Zhang P, Sun J, Dong G, Huang Y, Tian X. Low-grade gangliogliomas in adults: A population-based study. Cancer Med 2020; 10:416-423. [PMID: 33107220 PMCID: PMC7826489 DOI: 10.1002/cam4.3577] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/01/2020] [Accepted: 10/12/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Low-grade gangliogliomas (GGs) are rare tumors of the central nervous system in adults. This study aims to define their characteristics, prognostic factors, and the impact of different treatment patterns on survival. METHODS The Surveillance, Epidemiology, and End Results (SEER) database was used to investigate the potential clinicopathological factors of low-grade GGs in adult patients (age ≥18 years). Kaplan-Meier method and Cox regression model were utilized to evaluate the associations between variables and overall survival (OS). RESULTS A total of 703 adult patients diagnosed with low-grade GGs were identified between 2004 and 2016, with a median follow-up period of 60.0 months. The median age at diagnosis was 32.0 years, with 50.1% of patients being male, 84.2% white people, and 40.2% of married status. The predominant tumor site was located in temporal lobe (38.8%). The median OS time for the whole cohort was not reached. The 5- and 10-year OS rates for patients underwent gross total resection (GTR) were 92.5% and 87.2%, respectively. Univariate and multivariate analysis showed age, gender, tumor site, and treatment pattern were significant factors for OS. The employment of adjuvant radiotherapy (RT) and/or chemotherapy would significantly shorten OS time. CONCLUSIONS This is the largest retrospective study of adult low-grade GGs up to date. Younger age, female gender, temporal lobe location, and GTR indicated better survival. Adjuvant RT and/or chemotherapy should not be considered after whatever surgery in adult patients with low-grade GGs, unless the malignant transformation has been confirmed.
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Affiliation(s)
- Xiaoning Lin
- Department of Neurosurgery, Zhongshan Hospital Xiamen University, Xiamen, China
| | - Rong Huang
- Department of Child Health, Women and Children's Hospital, Xiamen University, Xiamen, China
| | - Pengfei Zhang
- Institute of Molecular Immunology, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, China
| | - Jin Sun
- Department of Neurosurgery, Zhongshan Hospital Xiamen University, Xiamen, China
| | - Guijiang Dong
- Department of Neurosurgery, Zhongshan Hospital Xiamen University, Xiamen, China
| | - Yanlin Huang
- Department of Neurosurgery, Zhongshan Hospital Xiamen University, Xiamen, China
| | - Xinhua Tian
- Department of Neurosurgery, Zhongshan Hospital Xiamen University, Xiamen, China
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Oushy S, Perry A, Graffeo CS, Raghunathan A, Carlstrom LP, Daniels DJ. Pediatric ganglioglioma of the brainstem and cervicomedullary junction: a retrospective cohort study. J Neurosurg Pediatr 2019; 25:30-36. [PMID: 31585412 DOI: 10.3171/2019.7.peds1961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 07/29/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Ganglioglioma is a low-grade central nervous system neoplasm with a pediatric predominance, accounting for 10% of all brain tumors in children. Gangliogliomas of the cervicomedullary junction (GGCMJs) and brainstem (GGBSs) present a host of management challenges, including a significant risk of surgical morbidity. At present, understanding of the prognostic factors-including BRAF V600E status-is incomplete. Here, the authors report a single-institution GGCMJ and GGBS experience and review the pertinent literature. METHODS A prospectively maintained neurosurgical database at a large tertiary care academic referral center was retrospectively queried for cases of GGCMJ pathologically confirmed in the period from 1995 to 2015; appropriate cases were defined by diagnosis codes and keywords. Secondary supplemental chart review was conducted to confirm or capture relevant data. The primary study outcome was treatment failure as defined by evidence of radiographic recurrence or progression and/or clinical or functional decline. A review of the literature was conducted as well. RESULTS Five neurosurgically managed GGBS patients were identified, and the neoplasms in 4 were classified as GGCMJ. All 5 patients were younger than 18 years old (median 15 years, range 4-16 years) and 3 (60%) were female. One patient underwent gross-total resection, 2 underwent aggressive subtotal resection (STR), and 2 underwent stereotactic biopsy only. All patients who had undergone STR or biopsy required repeat resection for tumor control or progression. Progressive disease was treated with radiotherapy in 2 patients, chemotherapy in 2, and chemoradiotherapy alone in 1. Immunostaining for BRAF V600E was positive in 3 patients (60%). All 5 patients experienced at least one major complication, including wound infection, foot drop, hemiparesis, quadriparesis, cranial neuropathy, C2-3 subluxation, syringomyelia, hydrocephalus, aspiration, and coma. Overall mortality was 20%, with 1 death observed over 11 years of follow-up. CONCLUSIONS GGBS and GGCMJ are rare, benign posterior fossa tumors that carry significant perioperative morbidity. Contemporary management strategies are heterogeneous and include combinations of resection, radiotherapy, and chemotherapy. The BRAF V600E mutation is frequently observed in GGBS and GGCMJ and appears to have both prognostic and therapeutic significance with targeted biological agents.
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Bahrami E, Taheri M, Ebrahimniya F. Cervicomedullary Ganglioglioma in a Child - A Case Report. Prague Med Rep 2018; 119:122-127. [PMID: 30414363 DOI: 10.14712/23362936.2018.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Ganglioglioma is a benign slow-growing neoplasm that most frequently occurs at the supratentorial region. Nevertheless, there are occasional reports of ganglioglioma occurring in the brainstem and spinal cord. Here we report a rare case of the craniocervical ganglioglioma. A 3.5-year-old male, presented with severe progressive quadriparesis, gait disturbance, and sphincter deficit. Physical examination demonstrated the quadriparesis, associated with positive Hoffman, Babinski, and clonus signs, and increased respond of deep tendon reflexes. Magnetic resonance imaging (MRI) demonstrated an ill-defined mass within medulla and upper cervical spinal cord, which was hypo to iso signal on T1, heterogeneous iso to hypersignal on T2 and demonstrated marked bright enhancement on T1 with gadolinium (Gad) injection. On surgery, the mass had a soft texture, ill-defined border, and grey to brown appearance. According to the frozen section report, and due to the absence of the tumour-neural parenchymal interference, only decompression of the tumour and expansile duraplasty were performed. The histopathology revealed ganglioglioma. On last follow-up 14 months after surgery, the patient was asymptomatic and neurological status was improved. The craniocervical MRI demonstrated the tumour that did not grow. Although it is rare, the ganglioglioma should be in the differentiated diagnoses of tumours with compatible clinical and radiologic features even in the unusual locations, especially in the pediatric and young patients. Safety surgical resection should be considered in these patients, whenever possible. In the case of partial resection, that is common in the tumours located within functionally critical structures, long close follow-up rather than radiation therapy is required.
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Affiliation(s)
- Eshagh Bahrami
- Department of Neurosurgery, Iran University of Medical Sciences, Rasool Akram Hospital, Tehran, Iran
| | - Morteza Taheri
- Department of Neurosurgery, Iran University of Medical Sciences, Rasool Akram Hospital, Tehran, Iran.
| | - Feyzollah Ebrahimniya
- Department of Neurosurgery, Iran University of Medical Sciences, Rasool Akram Hospital, Tehran, Iran
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Trapp B, Hsu CCT, Panwar J, Krings T. High Resolution MRI of Vestibulocochlear Nerve Involvement by a Posterior Fossa Ganglioglioma: Case Report and Review of Literature. Clin Neuroradiol 2018; 29:171-174. [PMID: 29858609 DOI: 10.1007/s00062-018-0698-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/18/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Bárbara Trapp
- Division of Neuroradiology, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Charlie Chia-Tsong Hsu
- Division of Neuroradiology, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, Canada.
| | - Jyoti Panwar
- Division of Neuroradiology, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Timo Krings
- Division of Neuroradiology, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, Canada
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Lundar T, Due-Tønnessen BJ, Fric R, Egge A, Krossnes B, Due-Tønnessen P, Stensvold E, Brandal P. Neurosurgical treatment of gangliogliomas in children and adolescents: long-term follow-up of a single-institution series of 32 patients. Acta Neurochir (Wien) 2018; 160:1207-1214. [PMID: 29680921 PMCID: PMC5948304 DOI: 10.1007/s00701-018-3550-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/11/2018] [Indexed: 11/28/2022]
Abstract
Object The object of this study was to delineate long-term results of the surgical treatment of pediatric tumors classified as ganglioglioma or gangliocytoma. Methods A cohort of consecutive patients 19 years or younger who had undergone primary resection of CNS tumors during the years 1980–2016 at a single institution were reviewed in this retrospective study of surgical morbidity, mortality, and academic achievement and/or work participation. Gross motor function and activities of daily living were scored using the Barthel Index (BI). Results Patient records for 32 consecutive children and adolescents who had undergone resection for a ganglioglioma were included in this study. Of the 32 patients, 13 were in the first decade at the first surgery, whereas 19 were in the second decade. The male/female ratio was 1.0 (16/16). No patient was lost to follow-up. The tumor was localized to the supratentorial compartment in 26 patients, to the posterior fossa in 5 patients, and to the spinal cord in 1 patient. Only two of the tumors were classified as anaplastic. Of the 30 low-grade tumors, 2 were classified as gangliocytomas, 6 were desmoplastic infantile gangliogliomas, and 22 were ordinary gangliogliomas. The aim of primary surgery was gross-total resection (GTR) and was achieved in 23 patients (71.9%). Altogether, 43 tumor resections were performed. Eight patients underwent a second resection from 1 to 10 years after primary surgery and three of these also had a third resection from 2 to 24 years after initial surgery. The reason for further resection was clinical (seizure control failure/recurrence of epilepsy or progressive neurological deficit) and/or residual tumor progression/recurrence. There was no operative mortality in this series and all 32 patients are alive with follow-up periods from 0.5 to 36 years (median 14 years). Observed 14-year survival is thus 100%. One out of two children with primary anaplastic tumor received local radiotherapy (proton) postoperatively. The other 31 patients did not have any kind of non-surgical adjuvant therapy. Twenty-one out of 26 children with supratentorial tumor had epilepsy as one of their presenting symptoms. Nineteen of these became seizure-free after initial surgery (18 of them after GTR), but 3 patients experienced recurrence of seizures within some years. Functional outcome in terms of ADL, schooling, and work participation was gratifying in most patients. Five patients have persistent hydrocephalus (HC), treated with ventriculoperitoneal (VP) shunts. Conclusion Low-grade gangliogliomas (GGs) can be surgically treated with good long-term results including seizure and tumor control as well as school and working participation.
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Affiliation(s)
- Tryggve Lundar
- Department of Neurosurgery, Oslo University Hospital, Postboks 4054, Nydalen, 0407, Oslo, Norway.
- Faculty of Medicine, University of Oslo, Oslo, Norway.
| | | | - Radek Fric
- Department of Neurosurgery, Oslo University Hospital, Postboks 4054, Nydalen, 0407, Oslo, Norway
| | - Arild Egge
- Department of Neurosurgery, Oslo University Hospital, Postboks 4054, Nydalen, 0407, Oslo, Norway
| | - Bård Krossnes
- Department of Pathology, Oslo University Hospital, Oslo, Norway
| | | | - Einar Stensvold
- Department of Pediatrics, Oslo University Hospital, Oslo, Norway
| | - Petter Brandal
- Department of Oncology, Oslo University Hospital, Oslo, Norway
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BRAF V600E mutation is a significant prognosticator of the tumour regrowth rate in brainstem gangliogliomas. J Clin Neurosci 2017; 46:50-57. [PMID: 28986151 DOI: 10.1016/j.jocn.2017.09.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 08/22/2017] [Accepted: 09/18/2017] [Indexed: 02/01/2023]
Abstract
BRAF V600E mutations are progression factors in paediatric low-grade gliomas. Furthermore, a high percentage of paediatric brainstem gangliogliomas have BRAF V600E mutations. However, their clinical significance, including possible connections between the biomarkers and ganglioglioma's clinical features, especially a brainstem counterpart, is unclear. To identify potential molecular features predictive of brainstem ganglioglioma's clinical outcomes, a retrospective cohort of 28 World Health Organization (WHO) grade I brainstem gangliogliomas was analysed for BRAF V600E, IDH1 R132H, and IDH2 R172K mutations, TERT C228T/C250T promoter mutation, H3F3A K27M mutation and MGMT methylation. The volume of tumours was calculated accurately by using 3D Slicer software. The clinical data of these patients were retrospectively analysed. In tumours with BRAF V600E mutations, the tumour regrowth rate was significantly faster than that of the wild type group (p=0.001). Moreover, the BRAF V600E mutant group had shorter progression-free survival (PFS) compared with wild type (p=0.012). On multivariate analysis, no factor was found to be an independent prognostic factor; however, tumours with faster regrowth rates had a strong trend towards an increased risk for shorter PFS (HR=1.027, p=0.056). No statistical analysis could be performed to evaluate factors affecting overall survival (OS). These data suggest that BRAF V600E can predict the regrowth rate of brainstem gangliogliomas after microsurgery, and a BRAF V600E-targeted therapeutic may be a promising early intervention measure for patients who harbour BRAF V600E mutation after microsurgery.
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Ganglioglioma of brain stem and cervicomedullary junction: A 50 years review of literature. J Clin Neurosci 2017; 44:34-46. [DOI: 10.1016/j.jocn.2017.06.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/13/2017] [Indexed: 11/18/2022]
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Zhang YS, Pan CC, Zhang P, Dai B, Tang J, Wu Z, Zhang JT, Zhang LW. Prognostic indicators of adult medullary gliomas after microsurgical treatment - A retrospective analysis of 54 patients. J Clin Neurosci 2017; 44:122-127. [PMID: 28711295 DOI: 10.1016/j.jocn.2017.05.041] [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: 09/29/2016] [Revised: 04/13/2017] [Accepted: 05/21/2017] [Indexed: 10/19/2022]
Abstract
Due to the low incidence of medullary gliomas, the special location, and the function of the gliomas in the medulla oblongata, microsurgical treatment is still challenging for neurosurgeons. The aim of this study was to observe the effect of microsurgical treatment of adult medullary gliomas and to explore the prognostic factors after treatment. The clinical data from 54 patients with adult medullary gliomas who received microsurgical treatment at Beijing Tiantan Hospital (China) from April 2008 to April 2014 was retrospectively analyzed. The factors affecting their prognosis were analyzed with log-rank univariate analysis. The factors that affected prognosis included age, gender, duration of preoperative symptoms, Karnofsky Performance Scale (KPS) score, World Health Organization (WHO) grade, extent of tumor resection, and postoperative complications. Those with statistical significance in the univariate analysis were entered into a multivariate Cox regression analysis. WHO grading showed 7 cases of grade I, 30 cases of grade II, 14 cases of grade III, and 3 cases of grade IV tumors. Univariable analysis showed that postoperative nasogastric feeding (P=0.031), WHO pathological grade (P=0.018), extent of resection (P=0.016), and preoperative involvement of ≥3 cranial nerves (CNs) (P=0.014) affected overall survival. The WHO pathological grade of the tumor was an independent risk factor for prognosis. In conclusion, the WHO pathological grade of the tumor was an important prognostic indicator.
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Affiliation(s)
- Yi-Song Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing 100050, China; China National Clinical Research Center for Neurological Disease, Tiantanxili 6, Dongcheng District, Beijing 100050, China
| | - Chang-Cun Pan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing 100050, China; China National Clinical Research Center for Neurological Disease, Tiantanxili 6, Dongcheng District, Beijing 100050, China
| | - Peng Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing 100050, China; China National Clinical Research Center for Neurological Disease, Tiantanxili 6, Dongcheng District, Beijing 100050, China
| | - Bin Dai
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing 100050, China; China National Clinical Research Center for Neurological Disease, Tiantanxili 6, Dongcheng District, Beijing 100050, China
| | - Jie Tang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing 100050, China; China National Clinical Research Center for Neurological Disease, Tiantanxili 6, Dongcheng District, Beijing 100050, China
| | - Zhen Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing 100050, China; China National Clinical Research Center for Neurological Disease, Tiantanxili 6, Dongcheng District, Beijing 100050, China
| | - Jun-Ting Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing 100050, China; China National Clinical Research Center for Neurological Disease, Tiantanxili 6, Dongcheng District, Beijing 100050, China
| | - Li-Wei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing 100050, China; China National Clinical Research Center for Neurological Disease, Tiantanxili 6, Dongcheng District, Beijing 100050, China.
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14
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Multimodal Neuronavigation in Microsurgery Resection of BrainStem Tumors. J Craniofac Surg 2016; 27:e769-e772. [DOI: 10.1097/scs.0000000000003123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Clinicopathological, Radiological, and Genetic Analyses of Cerebellar Gangliogliomas with Long-Term Survival. World Neurosurg 2016; 94:521-528. [DOI: 10.1016/j.wneu.2016.07.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/12/2016] [Accepted: 07/13/2016] [Indexed: 12/11/2022]
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Brainstem gangliogliomas: prognostic factors, surgical indications and functional outcomes. J Neurooncol 2016; 128:445-53. [PMID: 27112924 DOI: 10.1007/s11060-016-2131-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
Abstract
To explore the prognostic factors and discuss the surgical indications of brainstem gangliogliomas. Twenty-one patients with brainstem ganglioglioma were surgically treated at our hospital between 2006 and 2014. The clinical, radiological, operative, and pathological findings of these patients were retrospectively reviewed. The 3-years overall survival and event-free survival (EFS) rates were 90.5 % and 68.4 %, respectively. Four patients (4/18, 22 %) experienced a recurrence with a mean recurrence-free survival of 5.5 months and a mean follow-up of 37 months. Three patients died of surgery-related complications. Three growth patterns were identified: exophytic (6/21), intrinsic (2/21), and endo-exophytic (13/21). Eight patients (8/15, 53 %) harbored a BRAF V600E mutation. All recurrent tumors were endo-exophytic, and except the one without molecular information, were BRAF V600E mutants. A Cox hazard proportion ratio model was used to identify factors influencing EFS, including sex, age, location, growth patterns, extent of resection (EOR), and BRAF V600E mutation status. On univariate analysis, none of these factors reached statistical significance. Among them, EOR and growth patterns were strongly associated with each other (Fisher's exact test, P < 0.01). A multivariate analysis demonstrated that growth patterns were the only factor associated with EFS (P = 0.02; HR 49.05; 95 % CI 1.76-1365.13). Growth patterns may be useful to select surgery candidates and predict prognosis for patients with brainstem gangliogliomas. BRAF V600E was frequently present and appeared to be associated with shorter recurrence-free survival. Studies on BRAF V600E-targeted therapy for patients with high surgical risks are needed.
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Radiological Evaluation of Infratentorial Gangliogliomas in Various Anatomic Locations of the Cerebellum and Brainstem. Clin Neuroradiol 2016; 27:319-327. [DOI: 10.1007/s00062-015-0495-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 12/15/2015] [Indexed: 12/19/2022]
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Patibandla MR, Ridder T, Dorris K, Torok MR, Liu AK, Handler MH, Stence NV, Fenton LZ, Hankinson TC. Atypical pediatric ganglioglioma is common and associated with a less favorable clinical course. J Neurosurg Pediatr 2016; 17:41-8. [PMID: 26431248 DOI: 10.3171/2015.6.peds15215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECT Ganglioglioma (GG) is commonly recognized as a low-grade tumor located in the temporal lobe, often presenting with seizures. Most are amenable to complete resection and are associated with excellent oncological outcome. The authors encountered several GGs in various locations, which seem to have a less favorable clinical course than GGs in the temporal lobe. METHODS The authors performed a single-center retrospective review of all children with a histological diagnosis of GG who were treated at Children's Hospital Colorado between 1997 and 2013. Each tumor was categorized by 2 pediatric neuroradiologists as typical or atypical based on preoperative MRI appearance. Typical lesions were cortically based, within a single cerebral lobe, well-circumscribed, and solid or mixed solid/cystic. The treatment and clinical course of each patient was analyzed. RESULTS Thirty-seven children were identified, with a median age at presentation of 8.2 years and median follow-up of 38.0 months. Eighteen tumors (48.6%) were typical and 19 (51.4%) were atypical. All typical lesions presented with seizures, whereas no atypical lesions did so. Sixteen (88.9%) typical lesions were located in the temporal lobe. In the atypical group, tumor location was variable, including 11 (57.9%) in the brainstem. Death during follow-up was statistically more common in the atypical group (31.6% vs 0%, p = 0.02). Gross-total resection (GTR) was achieved for 15 of 16 typical tumors (93.8%), compared with 3 atypical tumors (15.8%, p < 0.0001). Presentation with seizure or non-brainstem location were each associated with survival (p = 0.02 and 0.004, respectively). The presence of mutation in BRAF exon 15 did not differ between the 2 groups. CONCLUSIONS Pediatric GG with typical imaging features is associated with excellent rates of GTR and overall survival. Atypical GG is commonly encountered, less amenable to GTR, and associated with a worse outcome. This may relate to anatomical or biological characteristics and merits further investigation.
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Affiliation(s)
| | | | | | - Michelle R Torok
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | | | - Nicholas V Stence
- Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus; and
| | - Laura Z Fenton
- Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus; and
| | - Todd C Hankinson
- Pediatric Neurosurgery;,Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Abstract
PURPOSE Pediatric infratentorial gangliogliomas are exceedingly rare tumors; thus, the factors affecting their outcome are poorly understood and their optimal management has still to be defined. METHODS We reviewed the literature on pediatric gangliogliomas with a focus on those located in the posterior fossa to study treatment and outcome data. We added to this review some of our clinical cases. RESULTS We found 100 and 80 cases of brainstem and cerebellar pediatric ganglioglioma, respectively, in our literature review. The surgical management varied from biopsy to gross total resection, and adjuvant treatment was given after incomplete resection or at time of progression. A gross total resection should be attempted to remove the contrast enhancing part of the tumor, which may be possible in most of the cerebellar gangliogliomas and some of the brainstem lesions. The cervicomedullary ganglioglioma seems to be the most infiltrative and least amenable to complete resection. Chemotherapy has a limited role and BRAF mutation was reported in 38 to 54 % of cases. The use of radiotherapy exposes the patient to a risk of malignant transformation and should be reserved for unresectable tumors which progress. CONCLUSION Pediatric posterior fossa gangliogliomas are rare and challenging tumors due to their frequent infiltrative component involving the brainstem. To date, adjuvant therapy has a limited role that may evolve with time thanks to the use of targeted therapies against BRAF mutation. The surgical resection of well-defined contrast enhancing parts should be attempted even in staged surgeries and balanced with the risks of neurological deterioration.
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Zhang L, Pan CC, Li D. The historical change of brainstem glioma diagnosis and treatment: from imaging to molecular pathology and then molecular imaging. Chin Neurosurg J 2015. [DOI: 10.1186/s41016-015-0006-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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21
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Dudley RW, Torok MR, Gallegos DR, Mulcahy-Levy JM, Hoffman LM, Liu AK, Handler MH, Hankinson TC. Pediatric low-grade ganglioglioma: epidemiology, treatments, and outcome analysis on 348 children from the surveillance, epidemiology, and end results database. Neurosurgery 2015; 76:313-9; discussion 319; quiz 319-20. [PMID: 25603107 PMCID: PMC4333003 DOI: 10.1227/neu.0000000000000619] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Low-grade gangliogliomas/gangliocytomas (GGs) are rare tumors of the central nervous system that occur mostly in young people. Because of their rarity, large-scale, population-based studies focusing on epidemiology and outcomes are lacking. OBJECTIVE To use the Surveillance, Epidemiology, and End Results (SEER) data sets of the National Cancer Institute to study demographics, tumor location, initial treatment, and outcome data on low-grade GGs in children. METHODS SEER-STAT v8.1.2 identified all patients aged 0 to 19 years in the SEER data sets with low-grade GGs. Using the Kaplan-Meier method and Cox proportional hazard regression, we examined associations between these characteristics and survival. RESULTS There were 348 children with low-grade GGs diagnosed from 2004 to 2010, with a median follow-up of 37 months. Tumors were more prevalent in males (n = 208, 59.8%) than females (n = 140, 40.2%) (P < .001). Almost 63% occurred in children >10 years, whereas only 3.5% were found in those <1 year old. Approximately 50% were located in the temporal lobes, and only 3.7% and 3.5% were located in the brainstem and spinal cord, respectively. Surgery was performed on 91.6% of cases, with gross total resection achieved in 68.3%. Radiation was used in 3.2%. Young age (<1 year) and brainstem location were associated with worse overall survival. CONCLUSION This study shows that low-grade GGs occur in older children with a male preference. Gross total resection is achieved in the majority of cases, and radiation is rarely used. Although the majority of patients have an excellent prognosis, infants and patients with brainstem tumors have worse survival rates.
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Affiliation(s)
- Roy W.R. Dudley
- Pediatric Neurosurgery, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Michelle R. Torok
- Children's Outcomes Research Program, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Danielle R. Gallegos
- Children's Outcomes Research Program, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jean M. Mulcahy-Levy
- Division of Neuro-oncology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Lindsey M. Hoffman
- Division of Neuro-oncology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Arthur K. Liu
- Department of Radiation Oncology, University of Colorado Anschutz Medical Campus, Anschutz Cancer Pavilion, Aurora, CO
| | - Michael H. Handler
- Pediatric Neurosurgery, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Todd C. Hankinson
- Pediatric Neurosurgery, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO
- Children's Outcomes Research Program, University of Colorado Anschutz Medical Campus, Aurora, CO
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22
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Anqi X, Zhenlin L, Xin H, Chao Y. Suggestive value of predilection site and imaging features of pediatric brainstem ganglioglioma including a case report. Neurochirurgie 2015; 61:50-3. [PMID: 25665772 DOI: 10.1016/j.neuchi.2014.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 10/16/2014] [Accepted: 11/02/2014] [Indexed: 02/05/2023]
Abstract
Brainstem ganglioglioma is rarely reported. Due to its low incidence and atypical site, a brainstem ganglioglioma could easily be misdiagnosed as occurs with other pathological neoplasms radiologically. Here, we report an 8-year-old girl with a brainstem tumor confirmed as a ganglioglioma based on postoperative pathology results. We suggest that when a tumor located in the lower brainstem with benign radiological characteristics occurs in a child with a long-term history, the possibility of brainstem ganglioglioma should be considered in the preoperative diagnosis in addition to other low-grade neoplasms. Early stage diagnosis of brainstem ganglioglioma based on the clinical and imaging features is valuable for clinicians in order to perform effective treatment and achieve a good prognosis.
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Affiliation(s)
- X Anqi
- Department of Neurosurgery, West China Hospital, Sichuan University, 37, Guo Xue Xiang Street, Chengdu, Sichuan, 610041, PR China
| | - L Zhenlin
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - H Xin
- Department of Pathology, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Y Chao
- Department of Neurosurgery, West China Hospital, Sichuan University, 37, Guo Xue Xiang Street, Chengdu, Sichuan, 610041, PR China.
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Comparisons of MR Findings Between Supratentorial and Infratentorial Gangliogliomas. Clin Neuroradiol 2014; 26:65-71. [DOI: 10.1007/s00062-014-0333-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 08/05/2014] [Indexed: 10/24/2022]
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Kim SD, Kim JH, Lee CY, Kim HW. Ganglioglioma in brainstem : case report and a review of literatures. J Korean Neurosurg Soc 2014; 55:164-6. [PMID: 24851154 PMCID: PMC4024818 DOI: 10.3340/jkns.2014.55.3.164] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 10/25/2013] [Accepted: 02/28/2014] [Indexed: 11/27/2022] Open
Abstract
Ganglioglioma is an infrequent tumor of the central nervous system (CNS); mostly supratentorial region. But, they can occur anywhere in the central nervous system such as brainstem, cerebellopontine angle (CPA), thalamus, optic nerve and spinal cord. Although it occurs rarely, ganglioglioma should be included in the differential diagnosis of a posterior fossa mass because early recognition is important for treatment and patient counseling.
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Affiliation(s)
- Sung-Duk Kim
- Department of Neurosurgery, Konyang University Hospital, Daejeon, Korea
| | - Jong Hyun Kim
- Department of Neurosurgery, Konyang University Hospital, Daejeon, Korea
| | - Cheol-Young Lee
- Department of Neurosurgery, Konyang University Hospital, Daejeon, Korea. ; Graduate School of Medicine, Kyung Hee University, Seoul, Korea
| | - Hyun-Woo Kim
- Department of Neurosurgery, Konyang University Hospital, Daejeon, Korea
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Gupta K, Orisme W, Harreld JH, Qaddoumi I, Dalton JD, Punchihewa C, Collins-Underwood R, Robertson T, Tatevossian RG, Ellison DW. Posterior fossa and spinal gangliogliomas form two distinct clinicopathologic and molecular subgroups. Acta Neuropathol Commun 2014; 2:18. [PMID: 24529209 PMCID: PMC3931494 DOI: 10.1186/2051-5960-2-18] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 01/17/2014] [Indexed: 11/20/2022] Open
Abstract
Background Gangliogliomas are low-grade glioneuronal tumors of the central nervous system and the commonest cause of chronic intractable epilepsy. Most gangliogliomas (>70%) arise in the temporal lobe, and infratentorial tumors account for less than 10%. Posterior fossa gangliogliomas can have the features of a classic supratentorial tumor or a pilocytic astrocytoma with focal gangliocytic differentiation, and this observation led to the hypothesis tested in this study - gangliogliomas of the posterior fossa and spinal cord consist of two morphologic types that can be distinguished by specific genetic alterations. Results Histological review of 27 pediatric gangliogliomas from the posterior fossa and spinal cord indicated that they could be readily placed into two groups: classic gangliogliomas (group I; n = 16) and tumors that appeared largely as a pilocytic astrocytoma, but with foci of gangliocytic differentiation (group II; n = 11). Detailed radiological review, which was blind to morphologic assignment, identified a triad of features, hemorrhage, midline location, and the presence of cysts or necrosis, that distinguished the two morphological groups with a sensitivity of 91% and specificity of 100%. Molecular genetic analysis revealed BRAF duplication and a KIAA1549-BRAF fusion gene in 82% of group II tumors, but in none of the group I tumors, and a BRAF:p.V600E mutation in 43% of group I tumors, but in none of the group II tumors. Conclusions Our study provides support for a classification that would divide infratentorial gangliogliomas into two categories, (classic) gangliogliomas and pilocytic astrocytomas with gangliocytic differentiation, which have distinct morphological, radiological, and molecular characteristics.
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Donson AM, Kleinschmidt-DeMasters BK, Aisner DL, Bemis LT, Birks DK, Levy JMM, Smith AA, Handler MH, Foreman NK, Rush SZ. Pediatric brainstem gangliogliomas show BRAF(V600E) mutation in a high percentage of cases. Brain Pathol 2013; 24:173-83. [PMID: 24238153 DOI: 10.1111/bpa.12103] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 11/06/2013] [Indexed: 12/01/2022] Open
Abstract
Brainstem gangliogliomas (GGs), often cannot be resected, have a much poorer prognosis than those located in more common supratentorial sites and may benefit from novel therapeutic approaches. Therapeutically targetable BRAF c.1799T>A (p.V600E) (BRAF(V600E) ) mutations are harbored in roughly 50% of collective GGs taken from all anatomical sites. Large numbers of pediatric brainstem GGs, however, have not been specifically assessed and anatomic-and age-restricted assessment of genetic and biological factors are becoming increasingly important. Pediatric brainstem GGs (n = 13), non-brainstem GGs (n = 11) and brainstem pilocytic astrocytomas (PAs) (n = 8) were screened by standard Sanger DNA sequencing of BRAF exon 15. Five of 13 (38%) pediatric GG harbored a definitive BRAF(V600E) mutation, with two others exhibiting an equivocal result by this method. BRAF(V600E) was also seen in five of 11 (45%) non-brainstem GGs and one of eight (13%) brainstem PAs. VE1 immunostaining for BRAF(V600E) showed concordance with sequencing in nine of nine brainstem GGs including the two cases equivocal by Sanger. The equivocal brainstem GGs were subsequently shown to harbor BRAF(V600E) using a novel, more sensitive, RNA-sequencing approach, yielding a final BRAF(V600E) mutation frequency of 54% (seven of 13) in brainstem GGs. BRAF(V600E) -targeted therapeutics should be a consideration for the high percentage of pediatric brainstem GGs refractory to conventional therapies.
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Affiliation(s)
- Andrew M Donson
- Department of Pediatrics, Children's Hospital Colorado, Aurora, CO
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