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Kamenova M, Kaneva R, Genova K, Gabrovsky N. Embryonal Tumors of the Central Nervous System with Multilayered Rosettes and Atypical Teratoid/Rhabdoid Tumors. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:225-252. [PMID: 37452940 DOI: 10.1007/978-3-031-23705-8_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
The 2016 WHO classification of tumors of the central nervous system affected importantly the group of CNS embryonal tumors. Molecular analysis on methylome, genome, and transcriptome levels allowed better classification, identification of specific molecular hallmarks of the different subtypes of CNS embryonal tumors, and their more precise diagnosis. Routine application of appropriate molecular testing and standardized reporting are of pivotal importance for adequate prognosis and treatment, but also for epidemiology studies and search for efficient targeted therapies. As a result of this approach, the term primitive neuroectodermal tumor-PNET was removed and a new clinic-pathological entity was introduced-Embryonal tumor with multilayered rosettes (ETMR). The group of CNS embryonal tumors include also medulloblastoma, medulloepithelioma, CNS neuroblastoma, CNS ganglioneuroblastoma, atypical teratoid/rhabdoid tumor (ATRT) and their subtypes. This chapter will focus mainly on ETMR and ATRT. Embryonal tumors with multilayered rosettes and the atypical teratoid/rhabdoid tumors are undifferentiated or poorly differentiated tumors of the nervous system that originate from primitive brain cells, develop exclusively in childhood or adolescence, and are characterized by a high degree of malignancy, aggressive evolution and a tendency to metastasize to the cerebrospinal fluid. Their clinical presentation is similar to other malignant, intracranial, neoplastic lesions and depends mainly on the localization of the tumor, the rise of the intracranial pressure, and eventually the obstruction of the cerebrospinal fluid pathways. The MRI image characteristics of these tumors are largely overlappingintra-axial, hypercellular, heterogeneous tumors, frequently with intratumoral necrosis and/or hemorrhages. Treatment options for ETMR and ATRT are very restricted. Surgery can seldom achieve radical excision. The rarity of the disease hampers the establishment of a chemotherapy protocol and the usual age of the patients limits severely the application of radiotherapy as a therapeutic option. Consequently, the prognosis of these undifferentiated, malignant, aggressive tumors remains dismal with a 5-year survival between 0 and 30%.
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Affiliation(s)
| | - Radka Kaneva
- Molecular Medicine Center, Department of Medical Chemistry and Biochemistry, Medical University, Sofia, Bulgaria
| | - Kamelia Genova
- Department of Image Diagnostic, University Hospital "Pirogov", Sofia, Bulgaria
| | - Nikolay Gabrovsky
- Department of Neurosurgery, University Hospital "Pirogov", Sofia, Bulgaria.
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Foiani G, Mandara MT, Carminato A, Melchiotti E, Corrò M, Vascellari M. Case report: Infratentorial Embryonal Tumor with Abundant Neuropil and True Rosettes (ETANTR) in an 8-month-old Maine Coon. Front Vet Sci 2022; 9:961056. [PMID: 36090160 PMCID: PMC9453206 DOI: 10.3389/fvets.2022.961056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/11/2022] [Indexed: 11/24/2022] Open
Abstract
An 8-month-old female Main Coon with a history of recurrent behavioral changes and anorexia was presented with sternal recumbency and depression. Within 5 days, the cat progressively worsened with symptoms of stupor and coma and was euthanized. At post-mortem examination, a solid, grayish infratentorial mass located in the midline rostrally to the cerebellum, was observed. Histologically, highly cellular clusters of small-to-medium undifferentiated cells were intermingled with paucicellular areas with fibrillary eosinophilic (neuropil-like) appearance. Numerous multilayered (ependymoblastic) true rosettes were present. The mitotic activity was frequent (up to 15 mitoses/HPF), involving both undifferentiated cells and rosettes. By immunohistochemistry (IHC), tumor cells were diffusely positive for vimentin, variably for synaptophysin, S-100, and NSE, and focally for NeuN; they were negative for GFAP and CK AE1/AE3. The histological and IHC aspects were consistent with an Embryonal Tumor with Abundant Neuropil and True Rosettes (ETANTR). Embryonal neoplasms of the central nervous system (CNS) are characterized by primitive undifferentiated cells, able to develop toward neuronal, glial, ependymal, and mesenchymal lines. Although extremely rare, juvenile embryonal tumors should be considered in the differentials of CNS disorders in young cats.
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Affiliation(s)
- Greta Foiani
- Laboratory of Histopathology, Istituto Zooprofilattico Sperimentale delle Venezie, SCS3, Legnaro, Italy
- *Correspondence: Greta Foiani
| | | | - Antonio Carminato
- Laboratory of Histopathology, Istituto Zooprofilattico Sperimentale delle Venezie, SCS3, Legnaro, Italy
| | - Erica Melchiotti
- Laboratory of Histopathology, Istituto Zooprofilattico Sperimentale delle Venezie, SCS3, Legnaro, Italy
| | - Michela Corrò
- Clinical Diagnostic Laboratory, Istituto Zooprofilattico Sperimentale delle Venezie, SCT3, Legnaro, Italy
| | - Marta Vascellari
- Laboratory of Histopathology, Istituto Zooprofilattico Sperimentale delle Venezie, SCS3, Legnaro, Italy
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Meliti A, Gasim W, Al-Maghrabi H, Mokhtar G. Embryonal tumor with multilayered rosettes; rare pediatric CNS tumor. A case report and review of literature. Int J Pediatr Adolesc Med 2021; 9:174-178. [PMID: 36090134 PMCID: PMC9441255 DOI: 10.1016/j.ijpam.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/17/2021] [Indexed: 11/26/2022]
Abstract
Embryonal tumor with multilayered rosettes (ETMR), C19MC-altered is a newly designated entity of the embryonal tumors of the central nervous system (CNS) according to the 2016 WHO classification system of CNS. Characteristically, these tumors are newly defined based on their specific molecular genetic amplification in chromosome 19q13.42 found at locus C19MC. To the best of our knowledge, we present the first reported case of ETMR in Saudi Arabian pediatric population. A 2-year-old boy presented to the hospital with generalized tonic-colonic seizure, vomiting, irritability, and inability to walk. Computed tomography (CT) scan showed a large left thalamic supratentorial brain tumor. The tumor measured 6.1 × 5.6 × 5.6 cm and was characterized by cystic changes, prominent vasculature, and calcifications. Histopathology, immunohistochemistry examination, and fluorescence in situ hybridization (FISH) analysis confirmed the diagnosis of ETMR. In addition to reporting this rare case, we provide a brief literature review, treatment options, patient outcome, and disease prognosis. Embryonal tumor with multilayered rosettes (ETMR), C19MC-altered is a new entity of the embryonal brain tumors. Genomic alterations include a gain of chromosome 2, gain of chromosome 11, and gain/low-level amplification of 19q13.42 (ultimately resulting in TTYH1-C19MC fusion). The clinical behavior is usually aggressive, with dismal with poor outcome. Histopathologic evaluation, immunohistochemistry, and fluorescence in situ hybridization (FISH) analysis are required to confirm the diagnosis of ETMR.
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Hamilton P, Lawrence P, Jaggon J, Greaves V, Reece-Mills M, Hazrati LN, Eisenring CV. Embryonal tumour with multi-layered rosettes a case based review of the literature. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Embryonal tumor with multilayered rosettes: illustrative case and review of the literature. Childs Nerv Syst 2018; 34:2361-2369. [PMID: 30215121 DOI: 10.1007/s00381-018-3972-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Embryonal tumor with multilayered rosettes (ETMR) is a very rare entity and has seldom been reported. It has been newly defined tumor entity included in the latest update (revised fourth edition) of WHO 2016 Classification of Tumors of the Central Nervous System which portends a uniform dismal prognosis and survival even with the best of multimodality approaches. ILLUSTRATIVE CASE This report documents the presentation of a 2-year-old girl with voluminous intracranial ETMR in the right parieto-occipital region. We describe clinical diagnosis, histological aspects, radiological features, and current management of this very aggressive tumor. CONCLUSION Pediatric intracranial ETMR is a highly aggressive neoplasm, and it should be considered in the differential diagnosis of pediatric brain tumors.
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Jaramillo S, Grosshans DR, Philip N, Varan A, Akyüz C, McAleer MF, Mahajan A, McGovern SL. Radiation for ETMR: Literature review and case series of patients treated with proton therapy. Clin Transl Radiat Oncol 2018; 15:31-37. [PMID: 30582019 PMCID: PMC6297264 DOI: 10.1016/j.ctro.2018.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/05/2018] [Accepted: 11/05/2018] [Indexed: 12/21/2022] Open
Abstract
Background and purpose Embryonal tumors with multilayered rosettes (ETMRs) are aggressive tumors that typically occur in young children. Radiation is often deferred or delayed for these patients due to late effects; proton therapy may mitigate some of these concerns. This study reviews the role of radiation in ETMR and describes initial results with proton therapy. Materials and methods Records of patients with embryonal tumor with abundant neuropil and true rosettes (ETANTR), medulloepithelioma (MEP), and ependymoblastoma (EPL) treated with proton therapy at our institution were retrospectively reviewed. A literature review of cases of CNS ETANTR, MEP, and EPL published since 1990 was also conducted. Results Seven patients were treated with proton therapy. Their median age at diagnosis was 33 months (range 10-57 months) and their median age at radiation start was 42 months (range 17-58 months). Their median overall survival (OS) was 16 months (range 8-64 months), with three patients surviving 36 months or longer. Five patients had disease progression prior to starting radiation; all 5 of these patients failed in the tumor bed. A search of the literature identified 204 cases of ETMR with a median OS of 10 months (range 0.03-161 months). Median OS of 18 long-term survivors (≥36 months) in the literature was 77 months (range 37-184 months). Of these 18 long-term survivors, 17 (94%) received radiotherapy as part of their initial treatment; 14 of them were treated with craniospinal irradiation. Conclusions Outcomes of patients with ETMR treated with proton therapy are encouraging compared to historical results. Further study of this rare tumor is warranted to better define the role of radiotherapy.
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Affiliation(s)
- Sergio Jaramillo
- Department of Radiation Oncology, Baylor College of Medicine, Houston, TX, United States
| | - David R Grosshans
- Department of Radiation Oncology, UT MD Anderson Cancer Center, Houston, TX, United States
| | - Nancy Philip
- Department of Radiation Oncology, UT MD Anderson Cancer Center, Houston, TX, United States
| | - Ali Varan
- Department of Pediatric Oncology, Hacettepe University, Institute of Oncology, Ankara, Turkey
| | - Canan Akyüz
- Department of Pediatric Oncology, Hacettepe University, Institute of Oncology, Ankara, Turkey
| | - Mary Frances McAleer
- Department of Radiation Oncology, UT MD Anderson Cancer Center, Houston, TX, United States
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Susan L McGovern
- Department of Radiation Oncology, UT MD Anderson Cancer Center, Houston, TX, United States
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Wang B, Gogia B, Fuller GN, Ketonen LM. Embryonal Tumor with Multilayered Rosettes, C19MC-Altered: Clinical, Pathological, and Neuroimaging Findings. J Neuroimaging 2018; 28:483-489. [DOI: 10.1111/jon.12524] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/01/2018] [Accepted: 05/02/2018] [Indexed: 11/27/2022] Open
Affiliation(s)
- Bing Wang
- Department of Diagnostic Radiology, Section of Neuroradiology; University of Texas MD Anderson Cancer Center; Houston TX
| | - Bhanu Gogia
- Department of Diagnostic Radiology, Section of Neuroradiology; University of Texas MD Anderson Cancer Center; Houston TX
| | - Gregory N. Fuller
- Department of Pathology, Section of Neuropathology; University of Texas MD Anderson Cancer Center; Houston TX
| | - Leena M. Ketonen
- Department of Diagnostic Radiology, Section of Neuroradiology; University of Texas MD Anderson Cancer Center; Houston TX
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Tariq MU, Ahmad Z, Minhas MK, Memon A, Mushtaq N, Hawkins C. Embryonal tumor with multilayered rosettes, C19MC-altered: Report of an extremely rare malignant pediatric central nervous system neoplasm. SAGE Open Med Case Rep 2017; 5:2050313X17745208. [PMID: 29230288 PMCID: PMC5718304 DOI: 10.1177/2050313x17745208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 11/03/2017] [Indexed: 11/17/2022] Open
Abstract
The 2016 update of the WHO Classification of Tumours of the Central Nervous System has redefined a number of tumors. Embryonal tumor with multilayered rosettes, C19MC-altered is one such tumor entity which has been newly defined on the basis of a characteristic molecular alteration. We report, to our knowledge, the first case of this rare pediatric brain neoplasm in the Pakistani population. An 8-month-old girl was presented with vomiting and left-sided ptosis, and magnetic resonance imaging scan showed a cerebellar tumor. Histologically, a highly cellular population of primitive cells was seen alternating with hypocellular neuropil-rich regions containing multilayered true rosettes and cells with glial and neuronal differentiation. Amplification of 19q13. 42 chromosome region on fluorescence in situ hybridization analysis confirmed the diagnosis. Post-operative radiological examination revealed widespread central nervous system involvement. Adjuvant treatment was not offered due to complications. Patient expired a week after diagnosis.
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Affiliation(s)
- Muhammad Usman Tariq
- Section of Histopathology, Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Pakistan
| | - Zubair Ahmad
- Section of Histopathology, Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Pakistan
| | - Muhammad Khurram Minhas
- Section of Histopathology, Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Pakistan
| | - Aisha Memon
- Section of Histopathology, Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Pakistan
| | - Noreen Mushtaq
- Section of Paediatric Oncology, Department of Oncology, The Aga Khan University, Karachi, Pakistan
| | - Cynthia Hawkins
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children (Sickkids), Toronto, ON, Canada
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