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Leclerc T, Levy R, Tauziède-Espariat A, Roux CJ, Beccaria K, Blauwblomme T, Puget S, Grill J, Dufour C, Guerrini-Rousseau L, Abbou S, Bolle S, Roux A, Pallud J, Provost C, Oppenheim C, Varlet P, Boddaert N, Dangouloff-Ros V. Imaging features to distinguish posterior fossa ependymoma subgroups. Eur Radiol 2024; 34:1534-1544. [PMID: 37658900 DOI: 10.1007/s00330-023-10182-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/03/2023] [Accepted: 07/12/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVES Posterior fossa ependymoma group A (EPN_PFA) and group B (EPN_PFB) can be distinguished by their DNA methylation and give rise to different prognoses. We compared the MRI characteristics of EPN_PFA and EPN_PFB at presentation. METHODS Preoperative imaging of 68 patients with posterior fossa ependymoma from two centers was reviewed by three independent readers, blinded for histomolecular grouping. Location, tumor extension, tumor volume, hydrocephalus, calcifications, tissue component, enhancement or diffusion signal, and histopathological data (cellular density, calcifications, necrosis, mitoses, vascularization, and microvascular proliferation) were compared between the groups. Categorical data were compared between groups using Fisher's exact tests, and quantitative data using Mann-Whitney tests. We performed a Benjamini-Hochberg correction of the p values to account for multiple tests. RESULTS Fifty-six patients were categorized as EPN_PFA and 12 as EPN_PFB, with median ages of 2 and 20 years, respectively (p = 0.0008). The median EPN_PFA tumoral volume was larger (57 vs 29 cm3, p = 0.003), with more pronounced hydrocephalus (p = 0.002). EPN_PFA showed an exclusive central position within the 4th ventricle in 61% of patients vs 92% for EPN_PFB (p = 0.01). Intratumor calcifications were found in 93% of EPN_PFA vs 40% of EPN_PFB (p = 0.001). Invasion of the posterior fossa foramina was mostly found for EPN_PFA, particularly the foramina of Luschka (p = 0.0008). EPN_PFA showed whole and homogeneous tumor enhancement in 5% vs 75% of EPN_PFB (p = 0.0008). All mainly cystic tumors were EPN_PFB (p = 0.002). The minimal and maximal relative ADC was slightly lower in EPN_PFA (p = 0.02 and p = 0.01, respectively). CONCLUSION Morphological characteristics from imaging differ between posterior fossa ependymoma subtypes and may help to distinguish them preoperatively. CLINICAL RELEVANCE STATEMENT This study provides a tool to differentiate between group A and group B ependymomas, which will ultimately allow the therapeutic strategy to be adapted in the early stages of patient management. KEY POINTS • Posterior fossa ependymoma subtypes often have different imaging characteristics. • Posterior fossa ependymomas group A are commonly median or lateral tissular calcified masses, with incomplete enhancement, affecting young children and responsible for pronounced hydrocephalus and invasion of the posterior fossa foramina. • Posterior fossa ependymomas group B are commonly median non-calcified masses of adolescents and adults, predominantly cystic, and minimally invasive, with total and homogeneous enhancement.
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Affiliation(s)
- Thomas Leclerc
- Pediatric Radiology Department, Assistance-Publique Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France
- Université Paris Cité, INSERM U1299, Paris, France
- UMR 1163, Institut Imagine, Université Paris Cité, Paris, France
| | - Raphael Levy
- Pediatric Radiology Department, Assistance-Publique Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France
- Université Paris Cité, INSERM U1299, Paris, France
- UMR 1163, Institut Imagine, Université Paris Cité, Paris, France
| | | | - Charles-Joris Roux
- Pediatric Radiology Department, Assistance-Publique Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France
- Université Paris Cité, INSERM U1299, Paris, France
- UMR 1163, Institut Imagine, Université Paris Cité, Paris, France
| | - Kevin Beccaria
- Pediatric Neurosurgery Department, AP-HP, Hôpital Universitaire Necker-Enfants Malades, Paris, France
- Université Paris Cité, Paris, France
| | - Thomas Blauwblomme
- Pediatric Neurosurgery Department, AP-HP, Hôpital Universitaire Necker-Enfants Malades, Paris, France
- Université Paris Cité, Paris, France
| | - Stéphanie Puget
- Pediatric Neurosurgery Department, AP-HP, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Jacques Grill
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Institute, Villejuif, France
| | - Christelle Dufour
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Institute, Villejuif, France
| | - Léa Guerrini-Rousseau
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Institute, Villejuif, France
| | - Samuel Abbou
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Institute, Villejuif, France
| | - Stéphanie Bolle
- Department of Radiotherapy Oncology, Gustave Roussy, Villejuif, France
| | - Alexandre Roux
- Neurosurgery Department, GHU Paris, Université Paris Cité, Paris, France
| | - Johan Pallud
- Neurosurgery Department, GHU Paris, Université Paris Cité, Paris, France
| | - Corentin Provost
- Neuroradiology Department, GHU Paris, Université Paris Cité, Paris, France
- INSERM U1266, Institut de Psychiatrie Et Neurosciences de Paris, Université Paris Cité, Paris, France
| | - Catherine Oppenheim
- Neuroradiology Department, GHU Paris, Université Paris Cité, Paris, France
- INSERM U1266, Institut de Psychiatrie Et Neurosciences de Paris, Université Paris Cité, Paris, France
| | - Pascale Varlet
- Neuropathology Department, GHU Paris, Université Paris Cité, Paris, France
- INSERM U1266, Institut de Psychiatrie Et Neurosciences de Paris, Université Paris Cité, Paris, France
| | - Nathalie Boddaert
- Pediatric Radiology Department, Assistance-Publique Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France
- Université Paris Cité, INSERM U1299, Paris, France
- UMR 1163, Institut Imagine, Université Paris Cité, Paris, France
| | - Volodia Dangouloff-Ros
- Pediatric Radiology Department, Assistance-Publique Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France.
- Université Paris Cité, INSERM U1299, Paris, France.
- UMR 1163, Institut Imagine, Université Paris Cité, Paris, France.
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Miranda-Lloret P, Plaza-Ramírez E, Simal-Julián JA, Pancucci G, Cañete A, Montoya-Filardi A, Llavador G. Lateral-type posterior fossa ependymomas in pediatric population. NEUROCIRUGIA (ENGLISH EDITION) 2024; 35:87-94. [PMID: 38244924 DOI: 10.1016/j.neucie.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/03/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Lateral-type posterior fossa ependymomas are a well-defined subtype of tumours both clinically and pathologically, with a poor prognosis. Their incidence is low and surgical management is challenging. The objective of the present work is to review our series of lateral-tye posterior fossa ependymomas and compare our results with those of previous series. METHODS Among 30 cases of ependymoma operated in our paediatric department in the last ten years, we identified seven cases of lateral-type posterior fossa ependymomas. We then performed a retrospective, descriptive study. RESULTS Mean age of our patients was 3.75 years. 6 cases presented with hydrocephalus. Mean tumour volume at diagnosis was 61 cc. A complete resection was achieved in six cases and a near-total resection in one patient. 5 patients transiently required a gastrostomy and a tracheostomy. Mean follow-up was 58 months. One case progressed along this period and eventually died. 4 cases of hydrocephalus required a ventriculoperitoneal CSF shunt and two were managed with a third ventriculostomy. At last follow-up 4 patients carried a normal life and two displayed a mild restriction according to Lansky´s scale. CONCLUSIONS The aim of surgical treatment in lateral-type posterior fossa ependymomas is complete resection. Neurological deficits associated to lower cranial nerve dysfunction are common but transient. Deeper genetic characterization of these tumours may identify risk factors that guide stratification of adjuvant therapies.
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Affiliation(s)
- Pablo Miranda-Lloret
- Servicios de Neurocirugía, Oncología Pediátrica, Radiología Pediátrica y Anatomía Patológica, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | - Estela Plaza-Ramírez
- Servicios de Neurocirugía, Oncología Pediátrica, Radiología Pediátrica y Anatomía Patológica, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Juan Antonio Simal-Julián
- Servicios de Neurocirugía, Oncología Pediátrica, Radiología Pediátrica y Anatomía Patológica, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Giovanni Pancucci
- Servicios de Neurocirugía, Oncología Pediátrica, Radiología Pediátrica y Anatomía Patológica, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Adela Cañete
- Servicios de Neurocirugía, Oncología Pediátrica, Radiología Pediátrica y Anatomía Patológica, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Alejandro Montoya-Filardi
- Servicios de Neurocirugía, Oncología Pediátrica, Radiología Pediátrica y Anatomía Patológica, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Gemma Llavador
- Servicios de Neurocirugía, Oncología Pediátrica, Radiología Pediátrica y Anatomía Patológica, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Miranda-Lloret P, Plaza-Ramírez E, López-Guerrero A, López-Bermeo D, García-Campos T, Vázquez-Sufuentes S, Munárriz PM, López-García E, Londoño-Quiroz A, Ferreras-García C, García-Conde M, Saceda-Gutiérrez J, Giménez-Pando J, Pancucci G, Iglesias-Moroño S. Lateral-type posterior fossa ependymomas in pediatric patients: a national collaborative study. Childs Nerv Syst 2024; 40:407-416. [PMID: 37889277 DOI: 10.1007/s00381-023-06194-7] [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: 08/28/2023] [Accepted: 10/14/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE To review a multicentric series of lateral-type posterior fossa ependymomas operated in the last ten years and to analyze the factors related to clinical evolution and tumor survival. METHODS Descriptive, retrospective study. Active members of the Spanish Society of Pediatric Neurosurgery were invited to participate in this multicentric study. Clinical and radiological data were incorporated to an open database. The role of histologic grade, grade of resection, postoperative morbidities, and clinical follow-up was evaluated through bivariate associations (chi-square), Kaplan-Meier's curves (log-rank test), and multivariate analysis (binary logistic regression). RESULTS Fourteen centers entered the study, and 25 cases with a minimum follow-up of 6 months were included. There were 13 boys and 12 girls with a mean age close to 3 years. Mean tumor volume at diagnosis was over 60 cc. A complete resection was achieved in 8 patients and a near-total resection in 5 cases. Fifteen tumors were diagnosed as ependymoma grade 2 and ten as ependymoma grade 3. Major morbidity occurred postoperatively in 14 patients but was resolved in twelve within 6 months. There were six cases of death and 11 cases of tumor progression along the observation period. Mean follow-up was 44.8 months. Major morbidity was significantly associated with histologic grade but not with the degree of resection. Overall and progression-free survival were significantly associated with complete surgical resection. At the last follow-up, 16 patients carried a normal life, and three displayed a mild restriction according to Lansky's scale. CONCLUSIONS Lateral-type posterior fossa ependymomas constitute a specific pathologic and clinical tumor subtype with bad prognosis. Gross total resection is the goal of surgical treatment, for it significantly improves prognosis with no additional morbidity. Neurological deficits associated to lower cranial nerve dysfunction are common, but most are transient. Deeper genetic characterization of these tumors may identify risk factors that guide new treatments and stratification of adjuvant therapies.
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Affiliation(s)
- Pablo Miranda-Lloret
- Unidad de Neurocirugía Pediátrica, Hospital Universitario y Politécnico La Fe, Avda Fernando Abril Martorell, 106, 46026, Valencia, Spain.
| | - Estela Plaza-Ramírez
- Unidad de Neurocirugía Pediátrica, Hospital Universitario y Politécnico La Fe, Avda Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Antonio López-Guerrero
- Unidad de Neurocirugía Pediátrica, Hospital Universitario y Politécnico La Fe, Avda Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Diego López-Bermeo
- Unidad de Neurocirugía Pediátrica, Hospital Universitario y Politécnico La Fe, Avda Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Teresa García-Campos
- Unidad de Neurocirugía Pediátrica, Hospital Universitario y Politécnico La Fe, Avda Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Silvia Vázquez-Sufuentes
- Unidad de Neurocirugía Pediátrica, Hospital Universitario y Politécnico La Fe, Avda Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Pablo M Munárriz
- Unidad de Neurocirugía Pediátrica, Hospital Universitario y Politécnico La Fe, Avda Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Elena López-García
- Unidad de Neurocirugía Pediátrica, Hospital Universitario y Politécnico La Fe, Avda Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Alejandra Londoño-Quiroz
- Unidad de Neurocirugía Pediátrica, Hospital Universitario y Politécnico La Fe, Avda Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Cristina Ferreras-García
- Unidad de Neurocirugía Pediátrica, Hospital Universitario y Politécnico La Fe, Avda Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Mario García-Conde
- Unidad de Neurocirugía Pediátrica, Hospital Universitario y Politécnico La Fe, Avda Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Javier Saceda-Gutiérrez
- Unidad de Neurocirugía Pediátrica, Hospital Universitario y Politécnico La Fe, Avda Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Jorge Giménez-Pando
- Unidad de Neurocirugía Pediátrica, Hospital Universitario y Politécnico La Fe, Avda Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Giovanni Pancucci
- Unidad de Neurocirugía Pediátrica, Hospital Universitario y Politécnico La Fe, Avda Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Sara Iglesias-Moroño
- Unidad de Neurocirugía Pediátrica, Hospital Universitario y Politécnico La Fe, Avda Fernando Abril Martorell, 106, 46026, Valencia, Spain
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Rigsby RK, Brahmbhatt P, Desai AB, Bathla G, Ebner BA, Gupta V, Vibhute P, Agarwal AK. Newly Recognized CNS Tumors in the 2021 World Health Organization Classification: Imaging Overview with Histopathologic and Genetic Correlation. AJNR Am J Neuroradiol 2023; 44:367-380. [PMID: 36997287 PMCID: PMC10084895 DOI: 10.3174/ajnr.a7827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/14/2022] [Indexed: 04/01/2023]
Abstract
In 2021, the World Health Organization released an updated classification of CNS tumors. This update reflects the growing understanding of the importance of genetic alterations related to tumor pathogenesis, prognosis, and potential targeted treatments and introduces 22 newly recognized tumor types. Herein, we review these 22 newly recognized entities and emphasize their imaging appearance with correlation to histologic and genetic features.
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Affiliation(s)
- R K Rigsby
- From the Department of Radiology (R.K.R., P.B., A.B.D., V.G., P.V., A.K.A.), Mayo Clinic, Jacksonville, Florida
| | - P Brahmbhatt
- From the Department of Radiology (R.K.R., P.B., A.B.D., V.G., P.V., A.K.A.), Mayo Clinic, Jacksonville, Florida
| | - A B Desai
- From the Department of Radiology (R.K.R., P.B., A.B.D., V.G., P.V., A.K.A.), Mayo Clinic, Jacksonville, Florida
| | - G Bathla
- Department of Radiology (G.B.), Mayo Clinic, Rochester, Minnesota
| | - B A Ebner
- Department of Laboratory Medicine and Pathology (B.A.E.), Mayo Clinic, Rochester, Minnesota
| | - V Gupta
- From the Department of Radiology (R.K.R., P.B., A.B.D., V.G., P.V., A.K.A.), Mayo Clinic, Jacksonville, Florida
| | - P Vibhute
- From the Department of Radiology (R.K.R., P.B., A.B.D., V.G., P.V., A.K.A.), Mayo Clinic, Jacksonville, Florida
| | - A K Agarwal
- From the Department of Radiology (R.K.R., P.B., A.B.D., V.G., P.V., A.K.A.), Mayo Clinic, Jacksonville, Florida
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