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Offenbacher R, Kobets A, Dalvi N, Hsu K, Chin S, Snuderl M, Levy A, Martin A. A nine-month-old boy with regression of milestones and severe constipation: an unusual case of a large spinal NTRK1 fusion pilocytic astrocytoma. Childs Nerv Syst 2023; 39:801-805. [PMID: 36107222 DOI: 10.1007/s00381-022-05662-w] [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: 06/10/2022] [Accepted: 09/03/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Pilocytic astrocytoma, a World Health Organization grade 1 tumor, is the most common brain tumor in children between 5 and 14 years of age and the second most common in children younger than 5 and older than 14. Although classical to the cerebellum and hypothalamic regions, it can also arise in the spinal cord. Larotrectinib, a selective inhibitor of tropomyosin receptor kinase, has been effective in pediatric tumors with NTRK fusion mutations in children as young as 1-month-old. CASE We share the case of a 9-month-old boy who presented with a 4-month history of regression of his milestones and severe constipation who was found to have a large spinal pilocytic astrocytoma with multiple intracranial periventricular lesions.
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Affiliation(s)
- Rachel Offenbacher
- Department of Pediatrics, Albert Einstein College of Medicine and Division of Pediatric Hematology, Oncology and Cellular Therapy, Children's Hospital at Montefiore, 3411 Wayne Ave., 9th Floor, Bronx, NY, 10467, USA.
| | - Andrew Kobets
- Department of Neurosurgery, Albert Einstein College of Medicine, Montefiore, Bronx, NY, USA
| | - Nagma Dalvi
- Department of Pediatrics, Albert Einstein College of Medicine and Division of Pediatric Hematology, Oncology and Cellular Therapy, Children's Hospital at Montefiore, 3411 Wayne Ave., 9th Floor, Bronx, NY, 10467, USA
- Department of Neurology, Albert Einstein College of Medicine and Division of Pediatric Neurology, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Kevin Hsu
- Department of Radiology, Albert Einstein College of Medicine, Montefiore, Bronx, NY, USA
| | - Steven Chin
- Department of Pathology, Albert Einstein College of Medicine, Montefiore, Bronx, NY, USA
| | - Matija Snuderl
- Department of Pathology, NYU Langone Health, 550 First Avenue, New York, NY, 10016, USA
| | - Adam Levy
- Department of Pediatrics, Albert Einstein College of Medicine and Division of Pediatric Hematology, Oncology and Cellular Therapy, Children's Hospital at Montefiore, 3411 Wayne Ave., 9th Floor, Bronx, NY, 10467, USA
| | - Allison Martin
- Department of Pediatrics, Albert Einstein College of Medicine and Division of Pediatric Hematology, Oncology and Cellular Therapy, Children's Hospital at Montefiore, 3411 Wayne Ave., 9th Floor, Bronx, NY, 10467, USA
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Estevez-Ordonez D, Gary SE, Atchley TJ, Maleknia PD, George JA, Laskay NMB, Gross EG, Devulapalli RK, Johnston JM. Immunotherapy for Pediatric Brain and Spine Tumors: Current State and Future Directions. Pediatr Neurosurg 2022; 58:313-336. [PMID: 36549282 PMCID: PMC10233708 DOI: 10.1159/000528792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Brain tumors are the most common solid tumors and the leading cause of cancer-related deaths in children. Incidence in the USA has been on the rise for the last 2 decades. While therapeutic advances in diagnosis and treatment have improved survival and quality of life in many children, prognosis remains poor and current treatments have significant long-term sequelae. SUMMARY There is a substantial need for the development of new therapeutic approaches, and since the introduction of immunotherapy by immune checkpoint inhibitors, there has been an exponential increase in clinical trials to adopt these and other immunotherapy approaches in children with brain tumors. In this review, we summarize the current immunotherapy landscape for various pediatric brain tumor types including choroid plexus tumors, embryonal tumors (medulloblastoma, AT/RT, PNETs), ependymoma, germ cell tumors, gliomas, glioneuronal and neuronal tumors, and mesenchymal tumors. We discuss the latest clinical trials and noteworthy preclinical studies to treat these pediatric brain tumors using checkpoint inhibitors, cellular therapies (CAR-T, NK, T cell), oncolytic virotherapy, radioimmunotherapy, tumor vaccines, immunomodulators, and other targeted therapies. KEY MESSAGES The current landscape for immunotherapy in pediatric brain tumors is still emerging, but results in certain tumors have been promising. In the age of targeted therapy, genetic tumor profiling, and many ongoing clinical trials, immunotherapy will likely become an increasingly effective tool in the neuro-oncologist armamentarium.
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Affiliation(s)
- Dagoberto Estevez-Ordonez
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA,
- Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, Alabama, USA,
| | - Sam E Gary
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Travis J Atchley
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, Alabama, USA
| | - Pedram D Maleknia
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jordan A George
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Nicholas M B Laskay
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, Alabama, USA
| | - Evan G Gross
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rishi K Devulapalli
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James M Johnston
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, Alabama, USA
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Abstract
Pilocytic and pilomyxoid astrocytomas are some of the most common gliomas in children and young adults. These gliomas are indolent neoplasms with long overall survival probability. The genetic characteristics of these neoplasms are well known, and our deepened understanding of their associated molecular alterations has led to the development of novel treatment strategies and approaches. Currently, we can account for some of the unusual behavior, such as oncogene-induced senescence, associated spontaneous regression, anaplastic transformation, and cerebrospinal dissemination, of these gliomas. Nevertheless, enigmatic issues continue to surround these chronic tumors. Here, we review the classical and uncommon clinical pathological and genetic features of these indolent gliomas.
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Affiliation(s)
- Cristine Ding
- Division of Neuropathology, Department of Pathology, UCSF School of Medicine, California, USA,Department of Pathology, Tan Tock Seng Hospital, Novena, Singapore
| | - Tarik Tihan
- Division of Neuropathology, Department of Pathology, UCSF School of Medicine, California, USA
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Forte D, Nabais A, Pontinha C, Mafra M, Mateus L. Simultaneous Supratentorial and Infratentorial Pilocytic Astrocytomas in an Adult Patient with Concurrent Neurofibromatosis Type 1 and HIV Infection. World Neurosurg 2018; 117:172-177. [PMID: 29908379 DOI: 10.1016/j.wneu.2018.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/02/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Neurofibromatosis type 1 (NF1) has been identified as a predisposing factor in the development of pilocytic astrocytoma (PA), a common benign central nervous system tumor. Although this is a common association, simultaneous development of multiple lesions is an infrequent finding, especially in nonoptic and hypothalamic locations. CASE DESCRIPTION A 41-year-old female patient with NF1 and uncontrolled human immunodeficiency virus (HIV) type 1 infection presented with a first generalized seizure and associated headache and ataxia. Imaging studies revealed 2 large intra-axial PAs, nodular-cystic in the supratentorial compartment and solid in the infratentorial compartment. Both lesions were treated by gross total resection in 2 surgeries performed 1 week apart. Despite their different imaging patterns, the tumors were histologically and genetically identical. CONCLUSIONS We present a unique case involving 2 histologically and genetically identical PAs occurring simultaneously in supratentorial and infratentorial locations. We suggest that an intrinsic predisposition to tumor development in patients with NF1 might have been enhanced by the HIV-related immunosuppression in this case. Strict oncologic surveillance is essential in patients with a tumor predisposition syndrome combined with immunosuppression.
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Affiliation(s)
- Dalila Forte
- Neurosurgery Department, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
| | - Anabela Nabais
- Neurosurgery Department, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Carlos Pontinha
- Pathology Department, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Manuela Mafra
- Pathology Department, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Luís Mateus
- Neurosurgery Department, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
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Abstract
RATIONALE Pilocytic astrocytoma (PA) typically shows biphasic pattern with a mixture of loose microcystic and compact regions, in which it is not uncommon to see heterogeneous morphology. However, there has not been reported in the literatures of the PA type that shows similarity to dysembryoplastic neuroepithelial tumor (DNT) in both histological morphology and immunophenotype. PATIENT CONCERNS The present study described a case of PA affecting the right temporal-occipital lobe in a 22-year-old male patient. Morphologically, it composed of totally distinctive microcystic pattern. The classical biphasic pattern of PA was not observed. Immunohistochemically, neuronal marker NeuN was expressed in tumor cells scattered in the background which simulated its expression morphology in DNT. However, KIAA1549-BRAF fusion gene was identified by fluorescence in situ hybridization (FISH), supporting for the diagnosis of PA. DIAGNOSES DNT-like PA (WHO grade I). INTERVENTIONS The tumor was totally removed via a right temporal-occipital craniotomy. OUTCOMES The patient is free of local recurrence and dissemination eleven months after surgical resection of the lesion. LESSONS We herein report a rare case of DNT-like PA. For diagnosis, KIAA1549-BRAF fusion gene should be detected under similar situation.
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Affiliation(s)
- Jia-Ming Liao
- Department of Clinical Laboratory, Southern District of Anhui Provincial Hospital
| | - Wei Wang
- High Magnetic Field Laboratory, Chinese Academy of Sciences
| | - Jing Xie
- Department of Pathology, Southern District of Anhui Provincial Hospital, Hefei, Anhui, China
| | - Hai-Bo Wu
- Department of Pathology, Southern District of Anhui Provincial Hospital, Hefei, Anhui, China
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