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Ahn WK, Hahn SM, Yoon HI, Lee J, Park EK, Shim KW, Kim DS, Suh CO, Kim SH, Lyu CJ, Han JW. Long-term Outcomes of Protocol-Based Treatment for Newly Diagnosed Medulloblastoma. Cancer Res Treat 2024; 56:652-664. [PMID: 38037318 PMCID: PMC11016662 DOI: 10.4143/crt.2023.865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 11/29/2023] [Indexed: 12/02/2023] Open
Abstract
PURPOSE The Korean Society of Pediatric Neuro-Oncology (KSPNO) conducted treatment strategies for children with medulloblastoma (MB) by using alkylating agents for maintenance chemotherapy or tandem high-dose chemotherapy (HDC) with autologous stem cell rescue (ASCR) according to the risk stratification. The purpose of the study was to assess treatment outcomes and complications based on risk-adapted treatment and HDC. MATERIALS AND METHODS Fifty-nine patients diagnosed with MB were enrolled in this study. Patients in the standard-risk (SR) group received radiotherapy (RT) after surgery and chemotherapy using the KSPNO M051 regimen. Patients in the high-risk (HR) group received two and four chemotherapy cycles according to the KSPNO S081 protocol before and after reduced RT for age following surgery and two cycles of tandem HDC with ASCR consolidation treatment. RESULTS In the SR group, 24 patients showed 5-year event-free survival (EFS) and overall survival (OS) estimates of 86.7% (95% confidence interval [CI], 73.6 to 100) and 95.8% (95% CI, 88.2 to 100), respectively. In the HR group, more infectious complications and mortality occurred during the second HDC than during the first. In the HR group, the 5-year EFS and OS estimates were 65.5% (95% CI, 51.4 to 83.4) and 72.3% (95% CI, 58.4 to 89.6), respectively. CONCLUSION High intensity of alkylating agents for SR resulted in similar outcomes but with a high incidence of hematologic toxicity. Tandem HDC with ASCR for HR induced favorable EFS and OS estimates compared to those reported previously. However, infectious complications and treatment-related mortalities suggest that a reduced chemotherapy dose is necessary, especially for the second HDC.
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Affiliation(s)
- Won Kee Ahn
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University Health System, Yonsei University College of Medicine, Seoul
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Seung Min Hahn
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University Health System, Yonsei University College of Medicine, Seoul
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Hong In Yoon
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Jeongshim Lee
- Department of Radiation Oncology, Inha University Hospital, Incheon, Korea
| | - Eun Kyung Park
- Department of Neurosurgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul
| | - Kyu Won Shim
- Department of Neurosurgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul
| | - Dong Seok Kim
- Department of Neurosurgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul
| | - Chang-Ok Suh
- Department of Radiation Oncology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Se Hoon Kim
- Department of Pathology, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea
| | - Chuhl Joo Lyu
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University Health System, Yonsei University College of Medicine, Seoul
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Jung Woo Han
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University Health System, Yonsei University College of Medicine, Seoul
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
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Svaldi C, Paquier P, Keulen S, van Elp H, Catsman-Berrevoets C, Kingma A, Jonkers R, Kohnen S, de Aguiar V. Characterising the Long-Term Language Impairments of Children Following Cerebellar Tumour Surgery by Extracting Psycholinguistic Properties from Spontaneous Language. Cerebellum 2024; 23:523-544. [PMID: 37184608 PMCID: PMC10951034 DOI: 10.1007/s12311-023-01563-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/16/2023]
Abstract
Following cerebellar tumour surgery, children may suffer impairments of spontaneous language. Yet, the language processing deficits underlying these impairments are poorly understood. This study is the first to try to identify these deficits for four levels of language processing in cerebellar tumour survivors. The spontaneous language of twelve patients who underwent cerebellar tumour surgery (age range 3-24 years) was compared against his or her controls using individual case statistics. A distinction was made between patients who experienced postoperative cerebellar mutism syndrome (pCMS) and those who did not. Time since surgery ranged between 11 months and 12;3 years. In order to identify the impaired language processing levels at each processing level (i.e., lexical, semantic, phonological and/or morphosyntactic) nouns and verbs produced in the spontaneous language samples were rated for psycholinguistic variables (e.g., concreteness). Standard spontaneous language measures (e.g., type-token ratio) were calculated as well. First, inter-individual heterogeneity was observed in the spontaneous language outcomes in both groups. Nine out of twelve patients showed language processing deficits three of whom were diagnosed with pCMS. Results implied impairments across all levels of language processing. In the pCMS-group, the impairments observed were predominantly morphosyntactic and semantic, but the variability in nature of the spontaneous language impairments was larger in the non-pCMS-group. Patients treated with cerebellar tumour surgery may show long-term spontaneous language impairments irrespective of a previous pCMS diagnosis. Individualised and comprehensive postoperative language assessments seem necessary, given the inter-individual heterogeneity in the language outcomes.
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Affiliation(s)
- Cheyenne Svaldi
- Center for Language and Cognition, University of Groningen, PO box 716, 9700 AS, Groningen, the Netherlands.
- Clinical and Experimental Neurolinguistics (CLIEN), Brussels Centre for Language Studies (BCLS), Language, Brain and Cognition, Vrije Universiteit Brussel (VUB), Pleinlaan 2, 1050, Brussels, Belgium.
- School of Psychological Sciences, Macquarie University, University Avenue, Macquarie Park, NSW, 2109, Australia.
- International Doctorate for Experimental Approaches to Language and Brain (IDEALAB), Newcastle University, Newcastle Upon Tyne, UK; Macquarie University, Sydney, Australia; University of Potsdam, Potsdam, Germany; University of Groningen, , Groningen, the Netherlands.
| | - Philippe Paquier
- Clinical and Experimental Neurolinguistics (CLIEN), Brussels Centre for Language Studies (BCLS), Language, Brain and Cognition, Vrije Universiteit Brussel (VUB), Pleinlaan 2, 1050, Brussels, Belgium
- Centre for Research in Cognition and Neurosciences (CRCN), Université Libre de Bruxelles (ULB), Avenue Franklin D. Roosevelt 50, 1050, Brussels, Belgium
- Department of Translational Neurosciences (TNW), Universiteit Antwerpen (UA), Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Stefanie Keulen
- Clinical and Experimental Neurolinguistics (CLIEN), Brussels Centre for Language Studies (BCLS), Language, Brain and Cognition, Vrije Universiteit Brussel (VUB), Pleinlaan 2, 1050, Brussels, Belgium
| | - Henrieke van Elp
- Center for Language and Cognition, University of Groningen, PO box 716, 9700 AS, Groningen, the Netherlands
| | - Coriene Catsman-Berrevoets
- Department of Paediatric Neurology Erasmus Medical Centre, Sophia Children's Hospital Rotterdam, Dr Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Annet Kingma
- Department of Paediatrics, University Medical Centre Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands
| | - Roel Jonkers
- Center for Language and Cognition, University of Groningen, PO box 716, 9700 AS, Groningen, the Netherlands
| | - Saskia Kohnen
- School of Psychological Sciences, Macquarie University, University Avenue, Macquarie Park, NSW, 2109, Australia
| | - Vânia de Aguiar
- Center for Language and Cognition, University of Groningen, PO box 716, 9700 AS, Groningen, the Netherlands
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Fang CH, Wen C, Yang B, Song YH, Liu HQ, Tian L, Chen H, Bao N. Development and validation of a nomogram and risk stratification system to predict overall survival after surgical repair for pediatric patients with medulloblastoma based on easily accessible variables. Eur Rev Med Pharmacol Sci 2024; 28:969-980. [PMID: 38375704 DOI: 10.26355/eurrev_202402_35363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
OBJECTIVE This study aimed to develop and validate a nomogram and risk stratification system for the overall survival of pediatric patients with medulloblastoma after surgical repair. PATIENTS AND METHODS In this multicenter, retrospective study, consecutive patients who underwent surgery for medulloblastoma at Shanghai Children's Medical Center and the First Affiliated Hospital of Fujian Medical University from 2010 to 2022 formed the training and external validation datasets, respectively. Univariable and multivariable Cox regression analyses were performed to identify variables associated with mortality in the training dataset. A nomogram prediction model was developed based on independent variables in the multivariable Cox regression analysis to predict the 1-, 3-, and 5-year overall survival. The area under receiver operating characteristic curve (AUC) and calibration curve were used to evaluate the discrimination and calibration of the nomogram. A risk stratification system based on the median risk score was also established to divide patients into two risk groups. RESULTS In the training dataset, Cox regression analyses identified tumor size, brainstem involvement and chemotherapy as independent predictors for overall survival. The AUC of the nomogram was 0.75 at 1 year, 0. 75 at 3 years, 0.77 at 5 years in the training dataset, 0.74 at 1 year, 0.70 at 3 years, and 0.70 at 5 years in the validation dataset. The calibration curve for the probability of 1-, 3-, and 5-year survival showed good agreement between the nomogram prediction and actual observation in the training and validation datasets. The risk stratification system could perfectly classify patients into two risk groups, and the overall survival in the two groups had a good division. CONCLUSIONS This low-cost, convenient, and noninvasive nomogram can be translated into clinical practice as a tool for risk stratification and individualized prognosis prediction for children with medulloblastoma.
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Affiliation(s)
- C-H Fang
- Department of Neurosurgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Kohe S, Bennett C, Burté F, Adiamah M, Rose H, Worthington L, Scerif F, MacPherson L, Gill S, Hicks D, Schwalbe EC, Crosier S, Storer L, Lourdusamy A, Mitra D, Morgan PS, Dineen RA, Avula S, Pizer B, Wilson M, Davies N, Tennant D, Bailey S, Williamson D, Arvanitis TN, Grundy RG, Clifford SC, Peet AC. Metabolite profiles of medulloblastoma for rapid and non-invasive detection of molecular disease groups. EBioMedicine 2024; 100:104958. [PMID: 38184938 PMCID: PMC10808898 DOI: 10.1016/j.ebiom.2023.104958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/13/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND The malignant childhood brain tumour, medulloblastoma, is classified clinically into molecular groups which guide therapy. DNA-methylation profiling is the current classification 'gold-standard', typically delivered 3-4 weeks post-surgery. Pre-surgery non-invasive diagnostics thus offer significant potential to improve early diagnosis and clinical management. Here, we determine tumour metabolite profiles of the four medulloblastoma groups, assess their diagnostic utility using tumour tissue and potential for non-invasive diagnosis using in vivo magnetic resonance spectroscopy (MRS). METHODS Metabolite profiles were acquired by high-resolution magic-angle spinning NMR spectroscopy (MAS) from 86 medulloblastomas (from 59 male and 27 female patients), previously classified by DNA-methylation array (WNT (n = 9), SHH (n = 22), Group3 (n = 21), Group4 (n = 34)); RNA-seq data was available for sixty. Unsupervised class-discovery was performed and a support vector machine (SVM) constructed to assess diagnostic performance. The SVM classifier was adapted to use only metabolites (n = 10) routinely quantified from in vivo MRS data, and re-tested. Glutamate was assessed as a predictor of overall survival. FINDINGS Group-specific metabolite profiles were identified; tumours clustered with good concordance to their reference molecular group (93%). GABA was only detected in WNT, taurine was low in SHH and lipids were high in Group3. The tissue-based metabolite SVM classifier had a cross-validated accuracy of 89% (100% for WNT) and, adapted to use metabolites routinely quantified in vivo, gave a combined classification accuracy of 90% for SHH, Group3 and Group4. Glutamate predicted survival after incorporating known risk-factors (HR = 3.39, 95% CI 1.4-8.1, p = 0.025). INTERPRETATION Tissue metabolite profiles characterise medulloblastoma molecular groups. Their combination with machine learning can aid rapid diagnosis from tissue and potentially in vivo. Specific metabolites provide important information; GABA identifying WNT and glutamate conferring poor prognosis. FUNDING Children with Cancer UK, Cancer Research UK, Children's Cancer North and a Newcastle University PhD studentship.
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Affiliation(s)
- Sarah Kohe
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Birmingham Children's Hospital, Birmingham, UK
| | - Christopher Bennett
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Birmingham Children's Hospital, Birmingham, UK
| | - Florence Burté
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Magretta Adiamah
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Heather Rose
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Birmingham Children's Hospital, Birmingham, UK
| | - Lara Worthington
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Birmingham Children's Hospital, Birmingham, UK; RRPPS, University Hospital Birmingham, Birmingham, UK
| | - Fatma Scerif
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Simrandip Gill
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Birmingham Children's Hospital, Birmingham, UK
| | - Debbie Hicks
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Edward C Schwalbe
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK; Department of Applied Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Stephen Crosier
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Lisa Storer
- Children's Brain Tumour Research Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Ambarasu Lourdusamy
- Children's Brain Tumour Research Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Dipyan Mitra
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Paul S Morgan
- Children's Brain Tumour Research Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Robert A Dineen
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK; Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | | | | | - Martin Wilson
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Birmingham Children's Hospital, Birmingham, UK
| | - Nigel Davies
- RRPPS, University Hospital Birmingham, Birmingham, UK
| | - Daniel Tennant
- Institute of Metabolism and Systems Research, University of Birmingham, UK
| | - Simon Bailey
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Daniel Williamson
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Theodoros N Arvanitis
- Department of Electronic, Electrical and Systems Engineering, University of Birmingham, UK
| | - Richard G Grundy
- Children's Brain Tumour Research Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Steven C Clifford
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - Andrew C Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Birmingham Children's Hospital, Birmingham, UK.
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Aboubakr O, Métais A, Doz F, Saffroy R, Masliah-Planchon J, Hasty L, Beccaria K, Ayrault O, Dufour C, Varlet P, Tauziède-Espariat A. LEF-1 immunohistochemistry, a better diagnostic biomarker than β-catenin for medulloblastoma, WNT-activated subtyping. J Neuropathol Exp Neurol 2024; 83:136-138. [PMID: 38237134 DOI: 10.1093/jnen/nlad104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2024] Open
Affiliation(s)
- Oumaima Aboubakr
- Department of Neuropathology, GHU Paris-Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Department of Pediatric Neurosurgery, Necker Hospital, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Université de Paris, Paris, France
| | - Alice Métais
- Department of Neuropathology, GHU Paris-Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Université de Paris, Paris, France
- Institute of Psychiatry and Neurosciences de Paris (IPNP), UMR S1266, INSERM, IMA-BRAIN, Paris, France
| | - François Doz
- Université de Paris, Paris, France
- Institut Curie, Paris Sciences Lettres University, SIREDO, INSERM U830, Laboratory of translational research in pediatric oncology, Paris, France
- INSERM U830, Laboratoire de Génétique et Biologie des Cancers, Institut Curie, Paris, France
| | - Raphaël Saffroy
- Department of Biochemistry and Oncogenetics, Paul Brousse Hospital, Villejuif, France
| | - Julien Masliah-Planchon
- Institut Curie, Laboratory of Somatic Genetics, PMDT, Paris Sciences Lettres Research University Paris, France
| | - Lauren Hasty
- Department of Neuropathology, GHU Paris-Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Kevin Beccaria
- Department of Pediatric Neurosurgery, Necker Hospital, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Université de Paris, Paris, France
| | - Olivier Ayrault
- Institut Curie, PSL Research University, CNRS UMR, INSERM, Orsay, France
- Université Paris Sud, Université Paris-Saclay, CNRS UMR 3347, INSERM U1021, Orsay, France
| | - Christelle Dufour
- Department of Children and Adolescents Oncology, Gustave Roussy, Paris Saclay University, Villejuif, France
| | - Pascale Varlet
- Department of Neuropathology, GHU Paris-Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Université de Paris, Paris, France
- Institute of Psychiatry and Neurosciences de Paris (IPNP), UMR S1266, INSERM, IMA-BRAIN, Paris, France
| | - Arnault Tauziède-Espariat
- Department of Neuropathology, GHU Paris-Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Université de Paris, Paris, France
- Institute of Psychiatry and Neurosciences de Paris (IPNP), UMR S1266, INSERM, IMA-BRAIN, Paris, France
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Svaldi C, Ntemou E, Jonkers R, Kohnen S, de Aguiar V. Language outcomes in children who underwent surgery for the removal of a posterior fossa tumor: A systematic review. Eur J Paediatr Neurol 2024; 48:129-141. [PMID: 38377646 DOI: 10.1016/j.ejpn.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/22/2023] [Accepted: 12/19/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND Children who underwent posterior fossa tumor removal may have spoken or written language impairments. The present systematic review synthesized the literature regarding the language outcomes in this population. Benefits of this work were the identification of shortcomings in the literature and a starting point toward formulating guidelines for postoperative language assessment. METHODS A systematic literature search was conducted, identifying studies with patients who had posterior fossa surgery before 18 years of age. Included studies were narratively synthesized to understand language outcomes by language function (e.g., phonology, morphosyntax) at a group and individual level. Furthermore, the influence of several mediators (e.g., postoperative cerebellar mutism syndrome (pCMS), tumor type) was investigated. A critical evaluation of the language assessment tools was conducted. RESULTS The narrative synthesis of 66 studies showed that a broad spectrum of language impairments has been described, characterized by a large interindividual heterogeneity. Patients younger at diagnosis, receiving treatment for a high-grade tumor and/or radiotherapy and diagnosed with pCMS seemed more prone to impairment. Several gaps in language assessment remain, such as a baseline preoperative assessment and the assessment of pragmatics and morphosyntax. Further, there were important methodological differences in existing studies which complicated our ability to accurately guide clinical practice. CONCLUSION Children who had posterior fossa surgery seem to be at risk for postoperative language impairment. These results stress the need for language follow-up in posterior fossa tumor survivors.
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Affiliation(s)
- Cheyenne Svaldi
- Center for Language and Cognition, University of Groningen, PO box 716, 9700 AS, Groningen, the Netherlands; School of Psychological Sciences, Macquarie University, University Avenue, NSW, 2109, Australia; International Doctorate for Experimental Approaches to Language and Brain (IDEALAB); Newcastle University, Newcastle upon Tyne, United Kingdom; Macquarie University, Sydney, Australia; University of Potsdam, Potsdam, Germany; University of Groningen, Groningen, the Netherlands.
| | - Effy Ntemou
- Center for Language and Cognition, University of Groningen, PO box 716, 9700 AS, Groningen, the Netherlands; International Doctorate for Experimental Approaches to Language and Brain (IDEALAB); Newcastle University, Newcastle upon Tyne, United Kingdom; Macquarie University, Sydney, Australia; University of Potsdam, Potsdam, Germany; University of Groningen, Groningen, the Netherlands; Linguistics Department, University of Potsdam, Haus 14, Karl-Liebknecht-Strasse 24-25, 14476, Potsdam, Germany.
| | - Roel Jonkers
- Center for Language and Cognition, University of Groningen, PO box 716, 9700 AS, Groningen, the Netherlands.
| | - Saskia Kohnen
- School of Psychological Sciences, Macquarie University, University Avenue, NSW, 2109, Australia.
| | - Vânia de Aguiar
- Center for Language and Cognition, University of Groningen, PO box 716, 9700 AS, Groningen, the Netherlands.
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Tam LT, Cole B, Stasi SM, Paulson VA, Wright JN, Hoeppner C, Holtzclaw S, Crotty EE, Ellenbogen RG, Lee A, Ermoian RP, Lockwood CM, Leary SES, Ronsley R. Somatic Versus Germline: A Case Series of Three Children With ATM-Mutated Medulloblastoma. JCO Precis Oncol 2024; 8:e2300333. [PMID: 38207225 DOI: 10.1200/po.23.00333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/03/2023] [Accepted: 11/07/2023] [Indexed: 01/13/2024] Open
Abstract
Somatic versus Germline-A Case Series of Three Children with ATM- mutated Medulloblastoma.
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Affiliation(s)
- Lydia T Tam
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Bonnie Cole
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
- Department of Laboratories, Seattle Children's Hospital, Seattle, WA
| | - Shannon M Stasi
- Department of Laboratories, Seattle Children's Hospital, Seattle, WA
- Division of Hematology, Oncology, Bone Marrow Transplant & Cellular Therapy, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Vera A Paulson
- Genetics Division, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Jason N Wright
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Corrine Hoeppner
- Division of Hematology, Oncology, Bone Marrow Transplant & Cellular Therapy, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Susan Holtzclaw
- Division of Hematology, Oncology, Bone Marrow Transplant & Cellular Therapy, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Erin E Crotty
- Division of Hematology, Oncology, Bone Marrow Transplant & Cellular Therapy, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
- Department of Neurological Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - Richard G Ellenbogen
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA
| | - Amy Lee
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA
| | | | - Christina M Lockwood
- Genetics Division, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Sarah E S Leary
- Division of Hematology, Oncology, Bone Marrow Transplant & Cellular Therapy, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
- Department of Neurological Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - Rebecca Ronsley
- Division of Hematology, Oncology, Bone Marrow Transplant & Cellular Therapy, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
- Department of Neurological Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA
- Department of Radiation Oncology, University of Washington, Seattle, WA
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8
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Liu H, Sun P. A Nomogram Model for Predicting Prognosis of Patients with Medulloblastoma. Turk Neurosurg 2024; 34:38-45. [PMID: 37309623 DOI: 10.5137/1019-5149.jtn.40397-22.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
AIM To identify the prognostic factors associated with cancer-specific survival in medulloblastoma (MB), and to use them for establishing a nomogram model to predict cancer-specific survival. MATERIAL AND METHODS In total, 268 patients with MB were included; they were rigorously respectively screened from the Surveillance, Epidemiology, and End Results database from 1988 to 2015 and statistically analyzed in R language. This study focused on cancer-specific death and used the cox regression analysis for variable filtering. The model was calibrated using C-index, area under the curve (AUC), and calibration curve. RESULTS As per our findings, it was determined that extension (localized: hazard ratio [HR]=0.5899, p=0.00963; further extension: indicator) and treatment modality (radiation after surgery chemotherapy sequence unknown: HR=0.3646, p=0.00192; no surgery: indicator) were statistically significant in the prognosis of MB and were finally utilized to construct a nomogram model for predicting the condition. The AUC values were 0.649, 0.629, and 0.64 at 2, 3, and 5 years, respectively. CONCLUSION Tumor extension and treatment modality were independent prognostic factors for MB.
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Affiliation(s)
- Hui Liu
- Affiliated Hospital of Qingdao University, Department of Neurosurgery, Qingdao, China
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Li Q, Jia Y, Tang B, Yang H, Yang Q, Luo X, Pan Y. Mitochondrial subtype MB-G3 contains potential novel biomarkers and therapeutic targets associated with prognosis of medulloblastoma. Biomarkers 2023; 28:643-651. [PMID: 37886818 DOI: 10.1080/1354750x.2023.2276670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/22/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Medulloblastoma is the most common malignant brain tumor in children. There are four groups, each with different causal mutations, affected pathways and prognosis. Here, we investigated the role of mitochondria in medulloblastoma and whether there are differences between the different groups. METHODS We compared the gene expression levels in the four different medulloblastoma groups (MB-WNT, MB-SHH, MB-G3 and MB-G4), with the focus on genes associated with mitochondria. We used several tools including Salmon, Tximeta, DESeq2, BiomaRt, STRING, Ggplot2, EnhancedVolcano, Venny 2.1 and Metscape. RESULTS A total of 668 genes were differentially expressed and the most abundant genes were associated with cell division pathway followed by modulation of chemical synaptic transmission. We also identified several genes (ABAT, SOX9, ALDH5A, FOXM1, ABL1, NHLH1, NEUROD1 and NEUROD2) known to play vital role in medulloblastoma. Comparative expression analysis revealed OXPHOS complex-associated proteins of mitochondria. The most significantly expressed genes in the MB-SHH and MB-G4 groups were AHCYL1 and SFXN5 while PAICS was significantly upregulated in MB-WNT group. Notably, MB-G3 contained the most downregulated genes from the OXPHOS complexes, except COX6B2 which was strongly upregulated. CONCLUSIONS We show the importance of mitochondria and compare their role in the four different medulloblastoma groups.
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Affiliation(s)
- Qiang Li
- Department of Neurosurgery, China Lanzhou University Second Hospital, Lanzhou, Gansu Province, China
| | - Yanfei Jia
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bo Tang
- Department of Neurosurgery, China Lanzhou University Second Hospital, Lanzhou, Gansu Province, China
| | - Hu Yang
- Department of Neurosurgery, China Lanzhou University Second Hospital, Lanzhou, Gansu Province, China
| | - Qiang Yang
- Department of Neurosurgery, China Lanzhou University Second Hospital, Lanzhou, Gansu Province, China
| | - Xiaodong Luo
- Department of Neurosurgery, China Lanzhou University Second Hospital, Lanzhou, Gansu Province, China
| | - Yawen Pan
- Department of Neurosurgery, China Lanzhou University Second Hospital, Lanzhou, Gansu Province, China
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Mironova D, Benjamin P, Zacharoulis S, Stapleton S, Bridges LR, Jacques TS, Mandeville H, Carceller F. Cortical laminar necrosis mimicking leptomeningeal recurrence in a child with medulloblastoma and epilepsy. Pediatr Blood Cancer 2023; 70:e30641. [PMID: 37644658 DOI: 10.1002/pbc.30641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Denitza Mironova
- Children & Young People's Unit, Royal Marsden Hospital NHS Foundation Trust, Sutton, UK
| | - Philip Benjamin
- Department of Diagnostic Radiology, The Royal Marsden NHS Foundation Trust, London, UK
- Department of Radiology, St George's Hospital, London, UK
| | - Stergios Zacharoulis
- Children & Young People's Unit, Royal Marsden Hospital NHS Foundation Trust, Sutton, UK
- Department of Pediatrics, Irving Medical Center, Columbia University, New York, USA
- Department of Pediatric Oncology, Bristol Myers Squibb, New York, USA
| | - Simon Stapleton
- Department of Neurosurgery, St George's Hospital, London, UK
| | - Leslie R Bridges
- Department of Cellular Pathology, St George's Hospital, London, UK
| | - Thomas S Jacques
- Developmental Biology and Cancer Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Henry Mandeville
- Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Fernando Carceller
- Children & Young People's Unit, Royal Marsden Hospital NHS Foundation Trust, Sutton, UK
- Division of Clinical Studies, The Institute of Cancer Research, London, UK
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11
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Yang W, Ma W, Huang J, Cai Y, Peng X, Zhao F, Zhang D, Zou Z, Sun H, Qi X, Ge M. Beijing Children's Hospital guidelines on the design and conduction of the first standardized database for medulloblastoma. Metab Brain Dis 2023; 38:2393-2400. [PMID: 37261631 DOI: 10.1007/s11011-023-01233-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/09/2023] [Indexed: 06/02/2023]
Abstract
Medulloblastoma (MB) is one of the most common malignant childhood brain tumors (WHO grade IV). Its high degree of malignancy leads to an unsatisfactory prognosis, requiring more precise and personalized treatment in the near future. Multi-omics and artificial intelligence have been playing a significant role in precise medical research, but their implementation needs a large amount of clinical information and biomaterials. For these reasons, it is urgent for current MB researchers to establish a large sample-size database of MB that contains complete clinical data and sufficient biomaterials such as blood, cerebrospinal fluid (CSF), cancer tissue, and urine. Unfortunately, there are few biobanks of pediatric central nervous system (CNS) tumors throughout the world for limited specimens, scarce funds, different standards collecting methods and et cl. Even though, China falls behind western countries in this area. The present research set up a standard workflow to construct the Beijing Children's Hospital Medulloblastoma (BCH-MB) biobank. Clinical data from children with MB and for collecting and storing biomaterials, along with regular follow-up has been collected and recorded in this database. In the future, the BCH-MB biobank could make it possible to validate the promising biomarkers already identified, discover unrevealed MB biomarkers, develop novel therapies, and establish personalized prognostic models for children with MB upon the support of its sufficient data and biomaterials, laying the foundation for individualized therapies of children with MB.
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Affiliation(s)
- Wei Yang
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Wenping Ma
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Jiansong Huang
- Department of Neurosurgery, Peking University International Hospital, Peking University Health Science Center, Peking University, Beijing, 102200, China
| | - Yingjie Cai
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Xiaojiao Peng
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Fengmao Zhao
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Di Zhang
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Zhewei Zou
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Hailang Sun
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
| | - Xiang Qi
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
| | - Ming Ge
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
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12
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Neth BJ, Raghunathan A, Kizilbash SH, Uhm JH, Breen WG, Johnson DR, Daniels DJ, Sener U, Carabenciov ID, Campian JL, Khatua S, Mahajan A, Ruff MW. Management and Long-term Outcomes of Adults With Medulloblastoma: A Single-Center Experience. Neurology 2023; 101:e1256-e1271. [PMID: 37524533 PMCID: PMC10516280 DOI: 10.1212/wnl.0000000000207631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 05/30/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Medulloblastomas are embryonal tumors predominantly affecting children. Recognition of molecularly defined subgroups has advanced management. Factors influencing the management and prognosis of adult patients with medulloblastoma remains poorly understood. METHODS We examined the management, prognostic factors, and, when possible, molecular subgroup differences (subset) in adult patients (aged 18 years or older) with medulloblastoma from our center (specialty Neuro-Oncology clinic within a large academic practice) diagnosed between 1992 and 2020. Molecular subtyping corresponding to the 2021 WHO Classification was performed. Kaplan-Meier estimates (with log-rank test) were performed for univariate survival analysis with Cox regression used for multivariate analyses. RESULTS We included 76 adult patients with medulloblastoma (62% male), with a median age of 32 years at diagnosis (range: 18-66) and median follow-up of 7.7 years (range: 0.6-27). A subset of 58 patients had molecular subgroup characterization-37 SHH-activated, 12 non-WNT/non-SHH, and 9 WNT-activated. Approximately 67% underwent gross total resection, 75% received chemotherapy at diagnosis, and 97% received craniospinal irradiation with boost. The median overall survival (OS) for the whole cohort was 14.8 years. The 2-, 5-, and 10-year OS rates were 93% (95% CI 88-99), 86% (78-94), and 64% (53-78), respectively. Survival was longer for younger patients (aged 30 years or older: 9.9 years; younger than 30 years: estimated >15.4 years; log-rank p < 0.001). There was no survival difference by molecular subgroup or extent of resection. Only age at diagnosis remained significant in multivariate survival analyses. DISCUSSION We report one of the largest retrospective cohorts in adult patients with medulloblastoma with molecular subtyping. Survival and molecular subgroup frequencies were similar to prior reports. Survival was better for adult patients younger than 30 years at diagnosis and was not significantly different by molecular subgroup or management characteristics (extent of resection, RT characteristics, or chemotherapy timing or regimen).
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Affiliation(s)
- Bryan J Neth
- From the Departments of Neurology (B.J.N., J.H.U., D.R.J., U.S., I.D.C., M.W.R.), Pathology (A.R.), Medical Oncology (S.H.K., J.H.U., U.S., I.D.C., J.L.C., M.W.R.), Radiation Oncology (W.G.B., A.M.), Radiology (D.R.J.), Neurosurgery (D.J.D.), and Pediatrics (S.K.), Mayo Clinic, Rochester, MN
| | - Aditya Raghunathan
- From the Departments of Neurology (B.J.N., J.H.U., D.R.J., U.S., I.D.C., M.W.R.), Pathology (A.R.), Medical Oncology (S.H.K., J.H.U., U.S., I.D.C., J.L.C., M.W.R.), Radiation Oncology (W.G.B., A.M.), Radiology (D.R.J.), Neurosurgery (D.J.D.), and Pediatrics (S.K.), Mayo Clinic, Rochester, MN
| | - Sani H Kizilbash
- From the Departments of Neurology (B.J.N., J.H.U., D.R.J., U.S., I.D.C., M.W.R.), Pathology (A.R.), Medical Oncology (S.H.K., J.H.U., U.S., I.D.C., J.L.C., M.W.R.), Radiation Oncology (W.G.B., A.M.), Radiology (D.R.J.), Neurosurgery (D.J.D.), and Pediatrics (S.K.), Mayo Clinic, Rochester, MN
| | - Joon H Uhm
- From the Departments of Neurology (B.J.N., J.H.U., D.R.J., U.S., I.D.C., M.W.R.), Pathology (A.R.), Medical Oncology (S.H.K., J.H.U., U.S., I.D.C., J.L.C., M.W.R.), Radiation Oncology (W.G.B., A.M.), Radiology (D.R.J.), Neurosurgery (D.J.D.), and Pediatrics (S.K.), Mayo Clinic, Rochester, MN
| | - William G Breen
- From the Departments of Neurology (B.J.N., J.H.U., D.R.J., U.S., I.D.C., M.W.R.), Pathology (A.R.), Medical Oncology (S.H.K., J.H.U., U.S., I.D.C., J.L.C., M.W.R.), Radiation Oncology (W.G.B., A.M.), Radiology (D.R.J.), Neurosurgery (D.J.D.), and Pediatrics (S.K.), Mayo Clinic, Rochester, MN
| | - Derek R Johnson
- From the Departments of Neurology (B.J.N., J.H.U., D.R.J., U.S., I.D.C., M.W.R.), Pathology (A.R.), Medical Oncology (S.H.K., J.H.U., U.S., I.D.C., J.L.C., M.W.R.), Radiation Oncology (W.G.B., A.M.), Radiology (D.R.J.), Neurosurgery (D.J.D.), and Pediatrics (S.K.), Mayo Clinic, Rochester, MN
| | - David J Daniels
- From the Departments of Neurology (B.J.N., J.H.U., D.R.J., U.S., I.D.C., M.W.R.), Pathology (A.R.), Medical Oncology (S.H.K., J.H.U., U.S., I.D.C., J.L.C., M.W.R.), Radiation Oncology (W.G.B., A.M.), Radiology (D.R.J.), Neurosurgery (D.J.D.), and Pediatrics (S.K.), Mayo Clinic, Rochester, MN
| | - Ugur Sener
- From the Departments of Neurology (B.J.N., J.H.U., D.R.J., U.S., I.D.C., M.W.R.), Pathology (A.R.), Medical Oncology (S.H.K., J.H.U., U.S., I.D.C., J.L.C., M.W.R.), Radiation Oncology (W.G.B., A.M.), Radiology (D.R.J.), Neurosurgery (D.J.D.), and Pediatrics (S.K.), Mayo Clinic, Rochester, MN
| | - Ivan D Carabenciov
- From the Departments of Neurology (B.J.N., J.H.U., D.R.J., U.S., I.D.C., M.W.R.), Pathology (A.R.), Medical Oncology (S.H.K., J.H.U., U.S., I.D.C., J.L.C., M.W.R.), Radiation Oncology (W.G.B., A.M.), Radiology (D.R.J.), Neurosurgery (D.J.D.), and Pediatrics (S.K.), Mayo Clinic, Rochester, MN
| | - Jian L Campian
- From the Departments of Neurology (B.J.N., J.H.U., D.R.J., U.S., I.D.C., M.W.R.), Pathology (A.R.), Medical Oncology (S.H.K., J.H.U., U.S., I.D.C., J.L.C., M.W.R.), Radiation Oncology (W.G.B., A.M.), Radiology (D.R.J.), Neurosurgery (D.J.D.), and Pediatrics (S.K.), Mayo Clinic, Rochester, MN
| | - Soumen Khatua
- From the Departments of Neurology (B.J.N., J.H.U., D.R.J., U.S., I.D.C., M.W.R.), Pathology (A.R.), Medical Oncology (S.H.K., J.H.U., U.S., I.D.C., J.L.C., M.W.R.), Radiation Oncology (W.G.B., A.M.), Radiology (D.R.J.), Neurosurgery (D.J.D.), and Pediatrics (S.K.), Mayo Clinic, Rochester, MN
| | - Anita Mahajan
- From the Departments of Neurology (B.J.N., J.H.U., D.R.J., U.S., I.D.C., M.W.R.), Pathology (A.R.), Medical Oncology (S.H.K., J.H.U., U.S., I.D.C., J.L.C., M.W.R.), Radiation Oncology (W.G.B., A.M.), Radiology (D.R.J.), Neurosurgery (D.J.D.), and Pediatrics (S.K.), Mayo Clinic, Rochester, MN
| | - Michael W Ruff
- From the Departments of Neurology (B.J.N., J.H.U., D.R.J., U.S., I.D.C., M.W.R.), Pathology (A.R.), Medical Oncology (S.H.K., J.H.U., U.S., I.D.C., J.L.C., M.W.R.), Radiation Oncology (W.G.B., A.M.), Radiology (D.R.J.), Neurosurgery (D.J.D.), and Pediatrics (S.K.), Mayo Clinic, Rochester, MN.
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13
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Hacking JPR, Thompson D, Schwalbe EC, Clifford SC, Williamson D. Deriving a continuum score for group 3 and 4 medulloblastoma tumor samples analyzed via RNA-sequencing or DNA methylation microarray. STAR Protoc 2023; 4:102509. [PMID: 37573504 PMCID: PMC10448413 DOI: 10.1016/j.xpro.2023.102509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/12/2023] [Accepted: 07/25/2023] [Indexed: 08/15/2023] Open
Abstract
Here, we present a protocol for deriving a continuum score for group 3 and 4 medulloblastoma tumor samples analyzed via RNA-sequencing or DNA methylation microarray. We describe steps for utilizing NMF-defined group 3/group 4 metagenes to calculate a continuum score between 0 and 1 that can be projected onto new sample data analyzed via RNA-sequencing. We then detail procedures for reverse engineering a continuum score for samples analyzed via DNA methylation microarray using a random forest classifier.
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Affiliation(s)
- James P R Hacking
- Wolfson Childhood Cancer Research Centre, Translational and Clinical Research Institute, Newcastle University for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Dean Thompson
- Wolfson Childhood Cancer Research Centre, Translational and Clinical Research Institute, Newcastle University for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Edward C Schwalbe
- Wolfson Childhood Cancer Research Centre, Translational and Clinical Research Institute, Newcastle University for Cancer, Newcastle University, Newcastle upon Tyne, UK; Department of Applied Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Steven C Clifford
- Wolfson Childhood Cancer Research Centre, Translational and Clinical Research Institute, Newcastle University for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Daniel Williamson
- Wolfson Childhood Cancer Research Centre, Translational and Clinical Research Institute, Newcastle University for Cancer, Newcastle University, Newcastle upon Tyne, UK.
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14
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Yamaguchi S, Fujimura M. [Medulloblastoma]. No Shinkei Geka 2023; 51:858-866. [PMID: 37743337 DOI: 10.11477/mf.1436204827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
In the 5th edition of the WHO classification, medulloblastomas, which are representative pediatric brain tumors, are categorized into four groups: WNT, SHH-TP53 wild, SHH-TP53 mutant, and non-WNT/non-SHH, based on their molecular background. While the histopathological findings still hold importance in predicting prognosis, the histopathological classification is no longer utilized in this edition. SHH medulloblastomas are further subdivided into two groups based on the presence or absence of TP53 mutation, as their clinical characteristics and prognosis differ. Group 3 and Group 4 medulloblastomas, recognized as distinct molecular groups in clinical practice, are combined into a single group called "non-WNT/non-SHH", because they lack specific molecular pathway activation. Furthermore, based on methylation profiling, dividing SHH medulloblastoma into four subgroups and non-WNT/non-SHH medulloblastoma into eight subgroups was proposed. Understanding the unique clinical characteristics and prognosis associated with each group is crucial. However, it is important to acknowledge that our current understanding of prognosis is based on treatment approaches guided by clinical risk factors such as postoperative residual tumor volume and the presence of metastatic disease. This molecular-based classification holds promise in guiding the development of optimal treatment strategies for patients with medulloblastoma.
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Affiliation(s)
- Shigeru Yamaguchi
- Department of Neurosurgery, Faculty of Medicine, Hokkaido University
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15
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Chinnam D, Saraswati A, Jogunoori S, Verma A, Kiran T, Salunke P, Gupta N, Kumar N, Madan R, Radotra BD, Gupta K. Immunohistochemical Surrogates for Molecular Stratification in Medulloblastoma. Appl Immunohistochem Mol Morphol 2023; 31:561-568. [PMID: 37471625 DOI: 10.1097/pai.0000000000001143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 06/07/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND The WHO classification of central nervous system neoplasms (2016) recognized 4 histologic variants and genetically defined molecular subgroups within medulloblastoma (MB). Further, in the 2021 classification, new subtypes have been provisionally added within the existing subgroups reflecting the biological diversity. YAP1, GAB1, and β-catenin were conventionally accepted as surrogate markers to identify these genetic subgroups. OBJECTIVES We aimed to stratify MB into molecular subgroups using 3 immunohistochemical markers. TP53 mutation was also assessed in Wingless (WNT), and Sonic Hedgehog (SHH) subgroups. Demographic profiles, imaging details, and survival outcomes were compared within these molecular subgroups. PATIENTS AND METHODS Our cohort included 164 MB cases diagnosed over the last 10 years. The histologic variants were identified on histology, and tumors were molecularly stratified using YAP1, GAB1, and β-catenin. Further, TP53 mutation was assessed using immunohistochemical in WNT and SHH subgroups. The clinical details and survival outcomes were retrieved from the records, and the mentioned correlates were evaluated statistically. RESULTS The age ranged from 1 to 52 years with M:F ratio of 2:1. Group 3/group 4 constituted the majority (48.4%), followed by SHH (45.9%) and WNT subgroups (5.7%). Desmoplastic/nodular and MB with extensive nodularity had the best survival, whereas large cell/anaplastic had the worst. The follow-up period ranged from 1 to 129 months. The best outcome was observed for the WNT subgroup, followed by the SHH subgroup; group 3/group 4 had the worst. Among the SHH subgroup, TP53 mutant tumors had a significantly poorer outcome compared with SHH-TP53 wildtype. CONCLUSIONS Molecular stratification significantly contributes to prognostication, and a panel of 3 antibodies is helpful in stratifying MB into its subgroups in centers where access to advanced molecular testing is limited. Our study reinforces the efficacy of incorporating this cost-effective, minimal panel into routine practice for stratification. Further, we propose a 3-risk stratification grouping, incorporating morphology and molecular markers.
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Affiliation(s)
| | | | | | | | - Tanvi Kiran
- Department of Community Medicine and School of Public Health
| | | | | | - Narendra Kumar
- Departments of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Renu Madan
- Departments of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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16
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Huang Z, Li X, Wei B, Yu Y. Global metabolomics study on the pathogenesis of pediatric medulloblastoma via UPLC- Q/E-MS/MS. PLoS One 2023; 18:e0287121. [PMID: 37319142 PMCID: PMC10270352 DOI: 10.1371/journal.pone.0287121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 05/30/2023] [Indexed: 06/17/2023] Open
Abstract
Medulloblastoma is one of the most frequent malignant brain tumors in infancy and childhood. Early diagnosis and treatment are quite crucial for the prognosis. However, the pathogenesis of medulloblastoma is still not completely clarified. High-resolution mass spectrometry has enabled a comprehensive investigation on the mechanism of disease from the perspective of metabolism. Herein, we compared the difference of metabolic profiles of serum between medulloblastoma (n = 33) and healthy control (HC, n = 16) by using UPLC-Q/E-MS/MS. Principal component analysis and orthogonal projections to latent structures discriminant analysis (OPLS-DA) intuitively revealed the significantly distinct metabolic profiles between medulloblastoma and HC (p < 0.01 for permutation test on OPLS-DA model). Total of 25 significantly changed metabolites were identified. ROC analysis reported that six of them (Phosphatidic acid (8:0/15:0), 3'-Sialyllactose, Isocoproporphyrin, Acetylspermidine, Fructoseglycine and 3-Hydroxydodecanedioate) showed high specificity and precision to be potential diagnosis biomarkers (AUC > 0.98). Functional analysis discovered that there are four pathways notably perturbed for medulloblastoma. These pathways are related with the dysfunction of arachidonic acid metabolism, steroid hormone biosynthesis, and folate-related metabolism. The target intervention on these pathways may reduce the mortality of medulloblastoma.
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Affiliation(s)
- Zhehao Huang
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Xianglan Li
- Department of Dermatology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Bo Wei
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Yin Yu
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
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17
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Cooney T, Lindsay H, Leary S, Wechsler-Reya R. Current studies and future directions for medulloblastoma: A review from the pacific pediatric neuro-oncology consortium (PNOC) disease working group. Neoplasia 2022; 35:100861. [PMID: 36516489 PMCID: PMC9755363 DOI: 10.1016/j.neo.2022.100861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
Medulloblastoma (MB) is the most common malignant central nervous system tumor of childhood, comprising a heterogenous group of tumors each with distinct biology, clinical behavior, and prognosis. Long-term survival remains unacceptable, and those who do survive face high late mortality risk, new chronic treatment-related medical conditions, neurocognitive impairments, and poor health-related quality of life. Up-front treatment strategies now integrate molecular subgrouping with standard clinico-radiological factors to more actually risk stratify newly-diagnosed patients. To what extent this new stratification will lead to improvements in treatment outcome will be determined in the coming years. In parallel, discovery and appreciation for medulloblastoma's inter- and intra-tumoral heterogeneity continues growing. Clinical trials treating relapsed disease now encompass precision medicine, epigenetic modification, and immune therapy approaches. The Pacific Pediatric Neuro-Oncology (PNOC) Medulloblastoma Working Group is committed to developing clinical trials based on these evolving therapeutic strategies and supports translational efforts by PNOC researchers and the multi-stakeholder medulloblastoma community at large.
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Affiliation(s)
- Tab Cooney
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Holly Lindsay
- Texas Children's Cancer and Hematology Center, Baylor College of Medicine, Houston, TX, USA
| | - Sarah Leary
- Seattle Children's Hospital, Seattle, WA, USA
| | - Robert Wechsler-Reya
- Department of Neurology and Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
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18
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Bageac DV, Bulsara KR. A cerebellar hemangioblastoma and visual and sensory disturbances presenting post partum. Lancet 2022; 399:2065. [PMID: 35644156 DOI: 10.1016/s0140-6736(22)00822-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/24/2022] [Accepted: 04/29/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Devin V Bageac
- Division of Neurosurgery, University of Connecticut Health Center, UConn Health, Farmington, CT, USA
| | - Ketan R Bulsara
- Division of Neurosurgery, University of Connecticut Health Center, UConn Health, Farmington, CT, USA.
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Cho HW, Lee H, Ju HY, Yoo KH, Koo HH, Lim DH, Sung KW, Shin HJ, Suh YL, Lee JW. Risk Stratification of Childhood Medulloblastoma Using Integrated Diagnosis: Discrepancies with Clinical Risk Stratification. J Korean Med Sci 2022; 37:e59. [PMID: 35191235 PMCID: PMC8860767 DOI: 10.3346/jkms.2022.37.e59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/09/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Recent genomic studies identified four discrete molecular subgroups of medulloblastoma (MB), and the risk stratification of childhood MB in the context of subgroups was refined in 2015. In this study, we investigated the effect of molecular subgroups on the risk stratification of childhood MB. METHODS The nCounter® system and a customized cancer panel were used for molecular subgrouping and risk stratification in archived tissues. RESULTS A total of 44 patients were included in this study. In clinical risk stratification, based on the presence of residual tumor/metastasis and histological findings, 24 and 20 patients were classified into the average-risk and high-risk groups, respectively. Molecular subgroups were successfully defined in 37 patients using limited gene expression analysis, and DNA panel sequencing additionally classified the molecular subgroups in three patients. Collectively, 40 patients were classified into molecular subgroups as follows: WNT (n = 7), SHH (n = 4), Group 3 (n = 8), and Group 4 (n = 21). Excluding the four patients whose molecular subgroups could not be determined, among the 17 average-risk group patients in clinical risk stratification, one patient in the SHH group with the TP53 variant was reclassified as very-high-risk using the new risk classification system. In addition, 5 out of 23 patients who were initially classified as high-risk group in clinical risk stratification were reclassified into the low- or standard-risk groups in the new risk classification system. CONCLUSION The new risk stratification incorporating integrated diagnosis showed some discrepancies with clinical risk stratification. Risk stratification based on precise molecular subgrouping is needed for the tailored treatment of MB patients.
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Affiliation(s)
- Hee Won Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyunwoo Lee
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Young Ju
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keon Hee Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Hoe Koo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon-Lim Suh
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Ji Won Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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20
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Davies NP, Rose HEL, Manias KA, Natarajan K, Abernethy LJ, Oates A, Janjua U, Davies P, MacPherson L, Arvanitis TN, Peet AC. Added value of magnetic resonance spectroscopy for diagnosing childhood cerebellar tumours. NMR Biomed 2022; 35:e4630. [PMID: 34647377 DOI: 10.1002/nbm.4630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 08/20/2021] [Accepted: 09/15/2021] [Indexed: 06/13/2023]
Abstract
1 H-magnetic resonance spectroscopy (MRS) provides noninvasive metabolite profiles with the potential to aid the diagnosis of brain tumours. Prospective studies of diagnostic accuracy and comparisons with conventional MRI are lacking. The aim of the current study was to evaluate, prospectively, the diagnostic accuracy of a previously established classifier for diagnosing the three major childhood cerebellar tumours, and to determine added value compared with standard reporting of conventional imaging. Single-voxel MRS (1.5 T, PRESS, TE 30 ms, TR 1500 ms, spectral resolution 1 Hz/point) was acquired prospectively on 39 consecutive cerebellar tumours with histopathological diagnoses of pilocytic astrocytoma, ependymoma or medulloblastoma. Spectra were analysed with LCModel and predefined quality control criteria were applied, leaving 33 cases in the analysis. The MRS diagnostic classifier was applied to this dataset. A retrospective analysis was subsequently undertaken by three radiologists, blind to histopathological diagnosis, to determine the change in diagnostic certainty when sequentially viewing conventional imaging, MRS and a decision support tool, based on the classifier. The overall classifier accuracy, evaluated prospectively, was 91%. Incorrectly classified cases, two anaplastic ependymomas, and a rare histological variant of medulloblastoma, were not well represented in the original training set. On retrospective review of conventional MRI, MRS and the classifier result, all radiologists showed a significant increase (Wilcoxon signed rank test, p < 0.001) in their certainty of the correct diagnosis, between viewing the conventional imaging and MRS with the decision support system. It was concluded that MRS can aid the noninvasive diagnosis of posterior fossa tumours in children, and that a decision support classifier helps in MRS interpretation.
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Affiliation(s)
- Nigel P Davies
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Department of Medical Physics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Heather E L Rose
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Karen A Manias
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Kal Natarajan
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Department of Medical Physics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Adam Oates
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Umair Janjua
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Paul Davies
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Lesley MacPherson
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Theodoros N Arvanitis
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
| | - Andrew C Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
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21
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Li L, Xie HM, Richard SA, Lan Z. Hemangioblastoma masquerading as a ring enhancing lesion in the cerebellum: A case report. Medicine (Baltimore) 2022; 101:e28665. [PMID: 35060562 PMCID: PMC8772639 DOI: 10.1097/md.0000000000028665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/05/2022] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Hemangioblastomas (HGBMs) are very rare, and the cerebellum is usually the most common site of occurrence. HGBMs with ring-enhanced walls are often misdiagnosed as metastases, abscesses, glioblastomas, tuberculomas, and demyelinating diseases. Thus, we present a rare case of HGBM masquerading as a ring-enhancing lesion in the cerebellum. PATIENT CONCERNS We present a 33-year-old female who was admitted to our department because of headaches, unstable walking, and visual loss in both eyes. Cranial nerve examination revealed deficits in cranial nerve II. DIAGNOSIS Magnetic resonance imaging revealed 2 cystic lesions in the cerebellum, with irregular ring-enhanced cyst walls composed of smaller nodular parts. Immunohistochemical staining of resected specimens established HGBM. INTERVENTIONS The lesions were completely resected using a right retrosigmoid approach. OUTCOMES Two years of follow-up revealed no recurrence of her symptoms or tumor. She is currently well and performs her daily duties. LESSONS HGBMs with enhanced cysts are often misdiagnosed by radiology because of their ring-enhanced nature. Computed tomography angiography may be the best modality for differentiating cerebellar HGBM from other ring-enhancing lesions. Surgery is the gold standard of treatment for these lesions.
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Affiliation(s)
- Li Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Hui-Min Xie
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Seidu A. Richard
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Department of Medicine, Princefield University, Ghana, West Africa
| | - Zhigang Lan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
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22
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Paslaru FG, Panaitescu AM, Nestian E, Iancu G, Veduta A, Paslaru AC, Pop LG, Gorgan RM. Medulloblastoma Presenting as Severe Headache during Pregnancy: A Case Report and Review of the Literature. Medicina (Kaunas) 2022; 58:127. [PMID: 35056435 PMCID: PMC8778892 DOI: 10.3390/medicina58010127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/31/2021] [Accepted: 01/13/2022] [Indexed: 06/14/2023]
Abstract
Headache is a common complaint during pregnancy and the puerperium. The differentiation between a benign headache and a headache that has an underlying more endangering cause, such as an intracranial tumor, can be difficult and often requires diagnostic procedures and brain imaging techniques. We report the case of an 18-year-old female patient who developed clinical symptoms-persistent headache followed by neurological deficit-in the last part of her pregnancy. A medulloblastoma (MB) was diagnosed and treated after delivery. We review 11 other cases of MB in pregnancy reported in the literature. The most common clinical manifestation at diagnosis was headache followed by neurological deficits. We discuss the association of brain tumor growth with physiological changes during pregnancy. We conclude that clinical features of intracranial tumors can be misinterpreted as pregnancy-related symptoms and should not be dismissed.
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Affiliation(s)
- Francesca Gabriela Paslaru
- Neurosurgical Department, Bagdasar-Arseni Clinical Emergency Hospital, 041915 Bucharest, Romania; (F.G.P.); (E.N.); (R.M.G.)
- Department of Neurosurgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Anca Maria Panaitescu
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania; (G.I.); (A.V.)
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Elena Nestian
- Neurosurgical Department, Bagdasar-Arseni Clinical Emergency Hospital, 041915 Bucharest, Romania; (F.G.P.); (E.N.); (R.M.G.)
| | - George Iancu
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania; (G.I.); (A.V.)
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Alina Veduta
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania; (G.I.); (A.V.)
| | - Alexandru Catalin Paslaru
- Department of Physiology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Dr. Victor Gomoiu Children’s Clinical Hospital, 020021 Bucharest, Romania
| | - Lucian Gheorghe Pop
- Department of Obstetrics and Gynecology, National Institute of Mother and Child Care Alessandrescu-Rusescu, 020395 Bucharest, Romania;
| | - Radu Mircea Gorgan
- Neurosurgical Department, Bagdasar-Arseni Clinical Emergency Hospital, 041915 Bucharest, Romania; (F.G.P.); (E.N.); (R.M.G.)
- Department of Neurosurgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
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23
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Suk Y, Gwynne WD, Burns I, Venugopal C, Singh SK. Childhood Medulloblastoma: An Overview. Methods Mol Biol 2022; 2423:1-12. [PMID: 34978683 DOI: 10.1007/978-1-0716-1952-0_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Medulloblastoma (MB) is the most common malignant pediatric brain tumor, representing 60% of childhood intracranial embryonal tumors. Despite multimodal advances in therapies over the last 20 years that have yielded a 5-year survival rate of 75%, high-risk patients (younger than 3 years, subtotal resection, metastatic lesions at diagnosis) still experience a 5-year overall survival of less than 70%. In this introductory chapter on pediatric MB, we describe the initial discrimination of MB based on histopathological examination and the more recent progress made in global gene expression profiling methods that have allowed scientists to more accurately subclassify and prognosticate on MB based on molecular characteristics. The identification of subtype-specific molecular drivers and pathways presents novel therapeutic targets that could lead to MB subtype-specific treatment modalities. Additionally, we detail how the cancer stem cell (CSC) hypothesis provides an explanation for tumor recurrence, and the potential for CSC-targeted therapies to address treatment-refractory MB. These personalized therapies can potentially increase MB survivorship and negate some of the long-term neurotoxicity associated with the current standard of care for MB patients.
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Affiliation(s)
- Yujin Suk
- Department of Biochemistry and Biomedical Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - William D Gwynne
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Ian Burns
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Chitra Venugopal
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Sheila K Singh
- Department of Biochemistry and Biomedical Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
- Department of Surgery, McMaster University, Hamilton, ON, Canada.
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24
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Kunder R, Shirsat NV. Real-Time PCR Assays on Formalin-Fixed, Paraffin-Embedded Medulloblastomas. Methods Mol Biol 2022; 2423:15-25. [PMID: 34978684 DOI: 10.1007/978-1-0716-1952-0_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Real-time PCR technology has been instrumental in contributing toward biomarker discovery, classification of tumors as well as risk stratification of patients. However, much of its success depends on the quality and quantity of the starting material used for RNA extraction. Clinical samples are most often provided as formalin-fixed and paraffin-embedded, wherein the RNA is extensively degraded, affecting sensitivity. Here, we describe a real-time PCR based assay developed for molecular subgrouping of medulloblastomas that is particularly useful for formalin-fixed, paraffin-embedded (FFPE) samples.
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Affiliation(s)
- Ratika Kunder
- Advanced Centre for Treatment, Research & Education in Cancer, Tata Memorial Centre, Navi Mumbai, Maharashtra, India.
| | - Neelam Vishwanath Shirsat
- Advanced Centre for Treatment, Research & Education in Cancer, Tata Memorial Centre, Navi Mumbai, Maharashtra, India
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25
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Liu APY, Smith KS, Kumar R, Paul L, Bihannic L, Lin T, Maass KK, Pajtler KW, Chintagumpala M, Su JM, Bouffet E, Fisher MJ, Gururangan S, Cohn R, Hassall T, Hansford JR, Klimo P, Boop FA, Stewart CF, Harreld JH, Merchant TE, Tatevossian RG, Neale G, Lear M, Klco JM, Orr BA, Ellison DW, Gilbertson RJ, Onar-Thomas A, Gajjar A, Robinson GW, Northcott PA. Serial assessment of measurable residual disease in medulloblastoma liquid biopsies. Cancer Cell 2021; 39:1519-1530.e4. [PMID: 34678152 PMCID: PMC9620970 DOI: 10.1016/j.ccell.2021.09.012] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/18/2021] [Accepted: 09/22/2021] [Indexed: 12/20/2022]
Abstract
Nearly one-third of children with medulloblastoma, a malignant embryonal tumor of the cerebellum, succumb to their disease. Conventional response monitoring by imaging and cerebrospinal fluid (CSF) cytology remains challenging, and a marker for measurable residual disease (MRD) is lacking. Here, we show the clinical utility of CSF-derived cell-free DNA (cfDNA) as a biomarker of MRD in serial samples collected from children with medulloblastoma (123 patients, 476 samples) enrolled on a prospective trial. Using low-coverage whole-genome sequencing, tumor-associated copy-number variations in CSF-derived cfDNA are investigated as an MRD surrogate. MRD is detected at baseline in 85% and 54% of patients with metastatic and localized disease, respectively. The number of MRD-positive patients declines with therapy, yet those with persistent MRD have significantly higher risk of progression. Importantly, MRD detection precedes radiographic progression in half who relapse. Our findings advocate for the prospective assessment of CSF-derived liquid biopsies in future trials for medulloblastoma.
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Affiliation(s)
- Anthony P Y Liu
- Division of Neuro-Oncology, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA; Division of Brain Tumor Research, Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Kyle S Smith
- Division of Brain Tumor Research, Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Rahul Kumar
- Division of Brain Tumor Research, Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA; St. Jude Graduate School of Biomedical Sciences, Memphis, TN 38105, USA
| | - Leena Paul
- Division of Brain Tumor Research, Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Laure Bihannic
- Division of Brain Tumor Research, Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Tong Lin
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Kendra K Maass
- Division of Pediatric Neuro-oncology, German Cancer Research Center, 69120 Heidelberg, Germany
| | - Kristian W Pajtler
- Division of Pediatric Neuro-oncology, German Cancer Research Center, 69120 Heidelberg, Germany; Department of Pediatric Oncology, Hematology and Immunology, University Hospital of Heidelberg, 69120 Heidelberg, Germany
| | - Murali Chintagumpala
- Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jack M Su
- Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Eric Bouffet
- Division of Hematology-Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Michael J Fisher
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Sridharan Gururangan
- Preston A. Wells Jr. Center for Brain Tumor Therapy, UF Health Shands Hospital, Gainesville, FL 32608, USA
| | - Richard Cohn
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, and UNSW, Sydney, NSW 2031, Australia
| | - Tim Hassall
- Queensland Children's Hospital, Brisbane, QLD 4101, Australia
| | - Jordan R Hansford
- Children's Cancer Centre, The Royal Children's Hospital, Murdoch Children's Research Institute, Department of Pediatrics, University of Melbourne, Melbourne, VIC 3052, Australia
| | - Paul Klimo
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN 38105, USA; Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN 38105, USA; Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN 38105, USA
| | - Frederick A Boop
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN 38105, USA; Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN 38105, USA; Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN 38105, USA
| | - Clinton F Stewart
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Julie H Harreld
- Department of Radiology, Dartmouth Geisel School of Medicine, Hanover, NH 03755, USA
| | - Thomas E Merchant
- Department of Radiation Oncology, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Ruth G Tatevossian
- Diagnostic Biomarkers Shared Resource, Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Geoffrey Neale
- Hartwell Center, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Matthew Lear
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Jeffery M Klco
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Brent A Orr
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - David W Ellison
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Richard J Gilbertson
- Cancer Research UK Cambridge Centre, CRUK Cambridge Institute, Li Ka Shing Centre, Cambridge CB2 0RE, UK
| | - Arzu Onar-Thomas
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Amar Gajjar
- Division of Neuro-Oncology, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Giles W Robinson
- Division of Neuro-Oncology, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Paul A Northcott
- Division of Brain Tumor Research, Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
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Delaidelli A, Dunham C, Santi M, Negri GL, Triscott J, Zheludkova O, Golanov A, Ryzhova M, Okonechnikov K, Schrimpf D, Stichel D, Ellison DW, von Deimling A, Kool M, Pfister SM, Ramaswamy V, Korshunov A, Taylor MD, Sorensen PH. Clinically Tractable Outcome Prediction of non-WNT/non-SHH Medulloblastoma Based on TPD52 Immunohistochemistry in a Multicohort Study. Clin Cancer Res 2021; 28:116-128. [PMID: 34702771 DOI: 10.1158/1078-0432.ccr-21-2057] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/12/2021] [Accepted: 10/22/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE International consensus and the 2021 WHO classification recognize eight molecular subgroups among non-WNT/non-SHH (Group 3/4) medulloblastoma, representing ~60% of tumors. However, very few clinical centers worldwide possess the technical capabilities to determine DNA-methylation profiles or other molecular parameters of high-risk for Group 3/4 tumors. As a result, biomarker-driven risk stratification and therapy assignment constitutes a major challenge in medulloblastoma research. Here, we identify an immunohistochemistry (IHC) marker as a clinically tractable method for improved medulloblastoma risk stratification. EXPERIMENTAL DESIGN We bioinformatically analyzed published medulloblastoma transcriptomes and proteomes identifying as a potential biomarker TPD52, whose IHC prognostic value was validated across three Group 3/4 medulloblastoma clinical cohorts (n = 387) treated with conventional therapies. RESULTS TPD52 IHC positivity represented a significant independent predictor of early relapse and death for Group 3/4 medulloblastoma (HRs between 3.67-26.7 [95% CIs between 1.00-706.23], p = 0.05, 0.017 and 0.0058). Cross-validated survival models incorporating TPD52 IHC with clinical features outperformed existing state-of-the-art risk stratification schemes, and reclassified ~50% of patients into more appropriate risk categories. Finally, TPD52 immunopositivity was a predictive indicator of poor response to chemotherapy (HR 12.66 [95% CI 3.53-45.40], p < 0.0001), suggesting important implication for therapeutic choices. CONCLUSIONS The current study redefines the approach to risk stratification in Group 3/4 medulloblastoma in global practice. Since integration of TPD52 IHC in classification algorithms significantly improved outcome prediction, this test could be rapidly adopted for risk stratification on a global scale, independently of advanced but technically challenging molecular profiling techniques.
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Affiliation(s)
- Alberto Delaidelli
- Department of Molecular Oncology, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher Dunham
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, Children's and Women's Health Centre of British Columbia, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Mariarita Santi
- Department of Genomic Diagnostics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Gian Luca Negri
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, Canada
| | - Joanna Triscott
- Department of BioMedical Research, University of Bern, Bern, Switzerland
| | - Olga Zheludkova
- St Luka's Clinical Research Center for Children, Moscow, Russian Federation
| | - Andrey Golanov
- Neurosurgical NN Burdenko Institute, Moscow, Russian Federation
| | - Marina Ryzhova
- Neurosurgical NN Burdenko Institute, Moscow, Russian Federation
| | - Konstantin Okonechnikov
- Hopp Children's Cancer Center Heidelberg (KiTZ), Division of Pediatric Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ)
| | - Daniel Schrimpf
- Department of Neuropathology of Heidelberg University and CCU Neuropathology, German Cancer Research Center, Heidelberg, Germany
| | - Damian Stichel
- Department of Neuropathology of Heidelberg University and CCU Neuropathology, German Cancer Research Center, Heidelberg, Germany
| | - David W Ellison
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Andreas von Deimling
- Department of Neuropathology of Heidelberg University and CCU Neuropathology, German Cancer Research Center, Heidelberg, Germany
| | - Marcel Kool
- Hopp Children's Cancer Center Heidelberg (KiTZ), Division of Pediatric Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ)
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Stefan M Pfister
- Hopp Children's Cancer Center Heidelberg (KiTZ), Division of Pediatric Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ)
- Department of Pediatric Hematology and Oncology, University Hospital, Heidelberg, Germany
| | - Vijay Ramaswamy
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrey Korshunov
- Department of Neuropathology of Heidelberg University and CCU Neuropathology, German Cancer Research Center, Heidelberg, Germany
| | - Michael D Taylor
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Poul H Sorensen
- Department of Molecular Oncology, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada.
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Kajtazi NI, Nahrir S, Al Shakweer W, Al Ghamdi J, Al Fakeeh A, Al Hameed M. Malignant idiopathic intracranial hypertension revealed a hidden primary spinal leptomeningeal medulloblastoma. BMJ Case Rep 2021; 14:e243506. [PMID: 34321265 PMCID: PMC8319973 DOI: 10.1136/bcr-2021-243506] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 11/04/2022] Open
Abstract
Frequently the cause of raised intracranial pressure remains unresolved and rarely is related to spinal tumours, moreover less to spinal medulloblastoma without primary brain focus. An 18-year-old woman had a 3-month history of headache and impaired vision. Neurological examination revealed bilateral sixth cranial nerve palsies with bilateral papilloedema of grade III. No focal brain or spine lesion was found on imaging. Consecutive lumbar punctures showed high opening pressure and subsequent increasing protein level. Meningeal biopsy was negative. At one point, she developed an increasing headache, vomiting and back pain. Spine MRI showed diffuse nodular leptomeningeal enhancement with the largest nodule at T6-T7. Malignant cells were detected in cerebrospinal fluid. She underwent laminectomy with excisional biopsy, and pathology showed medulloblastoma WHO grade IV. She was treated with chemotherapy and craniospinal irradiation and made a good recovery.
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Affiliation(s)
- Naim Izet Kajtazi
- Department of Neurology, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Shahpar Nahrir
- Department of Neurology, King Saud Medical Complex, Riyadh, Saudi Arabia
| | - Wafa Al Shakweer
- Pathology and Clinical Laboratory Administration Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Juman Al Ghamdi
- Medical Imaging Administration, Intervention Neuroradiology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ali Al Fakeeh
- Department of Oncology, Comprehensive Cancer Centre, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Majed Al Hameed
- Department of Neurology, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia
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Luque R, Benavides M, del Barco S, Egaña L, García-Gómez J, Martínez-García M, Pérez-Segura P, Pineda E, Sepúlveda JM, Vieito M. SEOM clinical guideline for management of adult medulloblastoma (2020). Clin Transl Oncol 2021; 23:940-947. [PMID: 33792841 PMCID: PMC8057961 DOI: 10.1007/s12094-021-02581-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 11/25/2022]
Abstract
Recent advances in molecular profiling, have reclassified medulloblastoma, an undifferentiated tumor of the posterior fossa, in at least four diseases, each one with differences in prognosis, epidemiology and sensibility to different treatments. The recommended management of a lesion with radiological characteristics suggestive of MB includes maximum safe resection followed by a post-surgical MR < 48 h, LCR cytology and MR of the neuroaxis. Prognostic factors, such as presence of a residual tumor volume > 1.5 cm2, presence of micro- or macroscopic dissemination, and age > 3 years as well as pathological (presence of anaplastic or large cell features) and molecular findings (group, 4, 3 or p53 SHH mutated subgroup) determine the risk of relapse and should guide adjuvant management. Although there is evidence that both high-risk patients and to a lesser degree, standard-risk patients benefit from adjuvant craneoespinal radiation followed by consolidation chemotherapy, tolerability is a concern in adult patients, leading invariably to dose reductions. Treatment after relapse is to be considered palliative and inclusion on clinical trials, focusing on the molecular alterations that define each subgroup, should be encouraged. Selected patients can benefit from surgical rescue or targeted radiation or high-dose chemotherapy followed by autologous self-transplant. Even in patients that are cured by chemorradiation presence of significant sequelae is common and patients must undergo lifelong follow-up.
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Affiliation(s)
- R. Luque
- Department of Medical Oncology, Hospital Universitario Virgen de Las Nieves, Granada, Spain
| | - M. Benavides
- Department of Medical Oncology, Hospital Regional Universitario Carlos Haya, Malaga, Spain
| | - S. del Barco
- Department of Medical Oncology, Hospital Universitari Dr. Josep Trueta. ICO Girona, Girona, Spain
| | - L. Egaña
- Department of Medical Oncology, Hospital Donostia-Donostia Ospitalea, San Sebastián, Spain
| | - J. García-Gómez
- Department of Medical Oncology, Complexo Hospitalario de Ourense (CHUO), Orense, Spain
| | - M. Martínez-García
- Department of Medical Oncology, Hospital del Mar - Parc de Salut Mar, Barcelona, Spain
| | - P. Pérez-Segura
- Department of Medical Oncology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - E. Pineda
- Department of Medical Oncology, Hospital Clinic I Provincial de Barcelona, Barcelona, Spain
| | - J. M. Sepúlveda
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M. Vieito
- Department of Medical Oncology, Hospital Universitario Vall D’Hebron, Barcelona, Spain
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Picart T, Meyronet D, Pallud J, Dumot C, Metellus P, Zouaoui S, Berhouma M, Ducray F, Bauchet L, Guyotat J. Management, functional outcomes and survival in a French multicentric series of 118 adult patients with cerebellar glioblastoma. J Cancer Res Clin Oncol 2021; 147:1843-1856. [PMID: 33399987 DOI: 10.1007/s00432-020-03474-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/18/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE To analyze the outcomes and predictors in a large series of cerebellar glioblastomas in order to guide patient management. METHODS The French brain tumor database and the Club de Neuro-Oncologie of the Société Française de Neurochirurgie retrospectively identified adult patients with cerebellar glioblastoma diagnosed between 2003 and 2017. Diagnosis was confirmed by a centralized neuropathological review. RESULTS Data from 118 cerebellar glioblastoma patients were analyzed (mean age 55.9 years, 55.1% males). The clinical presentation associated raised intracranial pressure (50.8%), static cerebellar syndrome (68.6%), kinetic cerebellar syndrome (49.2%) and/or cranial nerve disorders (17.8%). Glioblastomas were hemispheric (55.9%), vermian (14.4%) or both (29.7%). Hydrocephalus was present in 49 patients (41.5%). Histologically, tumors corresponded either to IDH-wild-type or to K27-mutant glioblastomas. Surgery consisted of total (12.7%), subtotal (35.6%), partial resection (33.9%) or biopsy (17.8%). The postoperative Karnofsky performance status was improved, stable and worsened in 22.4%, 43.9% and 33.7% of patients, respectively. Progression-free and overall survivals reached 5.1 months and 9.1 months, respectively. Compared to other surgical strategies, total or subtotal resection improved the Karnofsky performance status (33.3% vs 12.5%, p < 0.001), prolonged progression-free and overall survivals (6.5 vs 4.3 months, p = 0.015 and 16.7 vs 6.2 months, p < 0.001, respectively) and had a comparable complication rate (40.4% vs 31.1%, p = 0.29). After total or subtotal resection, the functional outcomes were correlated with age (p = 0.004) and cerebellar hemispheric tumor location (p < 0.001) but not brainstem infiltration (p = 0.16). CONCLUSION In selected patients, maximal resection of cerebellar glioblastoma is associated with improved onco-functional outcomes, compared with less invasive procedures.
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Affiliation(s)
- Thiébaud Picart
- Department of Neurosurgery, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69667, Bron, France.
- Claude Bernard University Lyon 1, Lyon, France.
- Department of Cancer Cell Plasticity, INSERM U1052, Cancer Research Center of Lyon, Lyon, France.
| | - David Meyronet
- Claude Bernard University Lyon 1, Lyon, France
- Department of Cancer Cell Plasticity, INSERM U1052, Cancer Research Center of Lyon, Lyon, France
- Groupe Hospitalier Est, Department of Neuropathology, Hospices Civils de Lyon, Bron, France
| | - Johan Pallud
- Department of Neurosurgery, Hôpital Sainte-Anne, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- IMA-Brain, INSERM U894, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Chloé Dumot
- Department of Neurosurgery, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69667, Bron, France
- Claude Bernard University Lyon 1, Lyon, France
- CarMeN Laboratory, Inserm U1060, INRA U1397, INSA Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Philippe Metellus
- Hôpital Privé Clairval, Ramsay Général de Santé, Marseille, France
- Institut de Neurophysiopathologie, UMR 7051, Université D'Aix-Marseille, Marseille, France
| | - Sonia Zouaoui
- Department of Neurosurgery, Montpellier University Hospital, Montpellier, France
- FBTDB (French Brain Tumor DataBase), Montpellier University Hospital, Montpellier, France
| | - Moncef Berhouma
- Department of Neurosurgery, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69667, Bron, France
- Claude Bernard University Lyon 1, Lyon, France
- CREATIS Laboratory, Inserm U1206, UMR 5220, Université de Lyon, Villeurbanne, France
| | - François Ducray
- Claude Bernard University Lyon 1, Lyon, France
- Department of Cancer Cell Plasticity, INSERM U1052, Cancer Research Center of Lyon, Lyon, France
- Department of Neurooncology, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Bron, France
| | - Luc Bauchet
- Department of Neurosurgery, Montpellier University Hospital, Montpellier, France
- FBTDB (French Brain Tumor DataBase), Montpellier University Hospital, Montpellier, France
- Institut Des Neurosciences de Montpellier, INSERM U1051, Hôpital Saint Eloi, Montpellier, France
| | - Jacques Guyotat
- Department of Neurosurgery, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69667, Bron, France
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Schmidt K, Hametner S. Medulloblastoma in Adulthood. Dtsch Arztebl Int 2020; 117:792. [PMID: 33533716 PMCID: PMC7930460 DOI: 10.3238/arztebl.2020.0792b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Kathie Schmidt
- *Institut für Diagnostische und Interventionelle Neuroradiologie, Georg-August-Universität Gottingen,
| | - Simon Hametner
- **Klinisches Institut für Neurologie, Medizinische Universität Wien
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Li J, Zhao S, Lee M, Yin Y, Li J, Zhou Y, Ballester LY, Esquenazi Y, Dashwood RH, Davies PJA, Parsons DW, Li XN, Huang Y, Sun D. Reliable tumor detection by whole-genome methylation sequencing of cell-free DNA in cerebrospinal fluid of pediatric medulloblastoma. Sci Adv 2020; 6:6/42/eabb5427. [PMID: 33067228 PMCID: PMC7567591 DOI: 10.1126/sciadv.abb5427] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 09/01/2020] [Indexed: 05/11/2023]
Abstract
Medulloblastoma (MB), the most common form of pediatric brain malignancy, has a low frequency of oncogenic mutations but pronouncedly abnormal DNA methylation changes. Epigenetic analysis of circulating cell-free tumor DNA (ctDNA) by liquid biopsy offers an approach for real-time monitoring of tumor status without tumor dissection. In this study, we identified 6598 differentially methylated CpGs in both MB tumors and the ctDNA isolated from matched cerebrospinal fluid (CSF) compared with normal cerebellum, which could be used to detect MB tumor occurrence and determine its subtype. Furthermore, DNA methylation changes in serial CSF samples could be used to monitor the treatment response and tumor recurrence. Integrating our data with large public datasets, we identified reliable MB DNA methylation signatures in ctDNA that have potential diagnostic and prognostic values. Our study sets the stage for exploiting epigenetic markers in CSF to improve the clinical management of patients with MB.
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Affiliation(s)
- Jia Li
- Center for Epigenetics and Disease Prevention, Institute of Biosciences and Technology, Texas A&M University, Houston, TX 77030, USA
| | - Sibo Zhao
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Hematology and Oncology, Cook Children's Medical Center, Fort Worth, TX 76104, USA
| | - Minjung Lee
- Center for Epigenetics and Disease Prevention, Institute of Biosciences and Technology, Texas A&M University, Houston, TX 77030, USA
| | - Yue Yin
- Center for Epigenetics and Disease Prevention, Institute of Biosciences and Technology, Texas A&M University, Houston, TX 77030, USA
| | - Jin Li
- Center for Epigenetics and Disease Prevention, Institute of Biosciences and Technology, Texas A&M University, Houston, TX 77030, USA
| | - Yubin Zhou
- Center for Translational Cancer Research, Institute of Biosciences and Technology, Texas A&M University, Houston, TX 77030, USA
| | - Leomar Y Ballester
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Yoshua Esquenazi
- Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Roderick H Dashwood
- Center for Epigenetics and Disease Prevention, Institute of Biosciences and Technology, Texas A&M University, Houston, TX 77030, USA
| | - Peter J A Davies
- Center for Translational Cancer Research, Institute of Biosciences and Technology, Texas A&M University, Houston, TX 77030, USA
| | - D Williams Parsons
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030, USA
| | - Xiao-Nan Li
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030, USA.
- Program of Precision Medicine PDOX Modeling of Pediatric Cancers, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Yun Huang
- Center for Epigenetics and Disease Prevention, Institute of Biosciences and Technology, Texas A&M University, Houston, TX 77030, USA.
| | - Deqiang Sun
- Center for Epigenetics and Disease Prevention, Institute of Biosciences and Technology, Texas A&M University, Houston, TX 77030, USA.
- Gomics Technology Corporation, 7707 Fannin Street, Suite 200, Houston, TX 77054, USA
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
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32
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Cao J, Shi X, Gurav DD, Huang L, Su H, Li K, Niu J, Zhang M, Wang Q, Jiang M, Qian K. Metabolic Fingerprinting on Synthetic Alloys for Medulloblastoma Diagnosis and Radiotherapy Evaluation. Adv Mater 2020; 32:e2000906. [PMID: 32342553 DOI: 10.1002/adma.202000906] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 03/17/2020] [Indexed: 05/25/2023]
Abstract
Diagnostics is the key in screening and treatment of cancer. As an emerging tool in precision medicine, metabolic analysis detects end products of pathways, and thus is more distal than proteomic/genetic analysis. However, metabolic analysis is far from ideal in clinical diagnosis due to the sample complexity and metabolite abundance in patient specimens. A further challenge is real-time and accurate tracking of treatment effect, e.g., radiotherapy. Here, Pd-Au synthetic alloys are reported for mass-spectrometry-based metabolic fingerprinting and analysis, toward medulloblastoma diagnosis and radiotherapy evaluation. A core-shell structure is designed using magnetic core particles to support Pd-Au alloys on the surface. Optimized synthetic alloys enhance the laser desorption/ionization efficacy and achieve direct detection of 100 nL of biofluids in seconds. Medulloblastoma patients are differentiated from healthy controls with average diagnostic sensitivity of 94.0%, specificity of 85.7%, and accuracy of 89.9%, by machine learning of metabolic fingerprinting. Furthermore, the radiotherapy process of patients is monitored and a preliminary panel of serum metabolite biomarkers is identified with gradual changes. This work will lead to the application-driven development of novel materials with tailored structural design and establishment of new protocols for precision medicine in near future.
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Affiliation(s)
- Jing Cao
- State Key Laboratory for Oncogenes and Related Genes, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, P. R. China
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, 160 Pujian Road, Shanghai, 200127, P. R. China
| | - Xuejiao Shi
- Department of Oncology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, P. R. China
| | - Deepanjali D Gurav
- State Key Laboratory for Oncogenes and Related Genes, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, P. R. China
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, 160 Pujian Road, Shanghai, 200127, P. R. China
| | - Lin Huang
- State Key Laboratory for Oncogenes and Related Genes, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, P. R. China
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, 160 Pujian Road, Shanghai, 200127, P. R. China
| | - Haiyang Su
- State Key Laboratory for Oncogenes and Related Genes, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, P. R. China
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, 160 Pujian Road, Shanghai, 200127, P. R. China
| | - Keke Li
- Department of Oncology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, P. R. China
| | - Jingyang Niu
- State Key Laboratory for Oncogenes and Related Genes, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, P. R. China
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, 160 Pujian Road, Shanghai, 200127, P. R. China
| | - Mengji Zhang
- State Key Laboratory for Oncogenes and Related Genes, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, P. R. China
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, 160 Pujian Road, Shanghai, 200127, P. R. China
| | - Qian Wang
- State Key Laboratory for Oncogenes and Related Genes, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, P. R. China
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, 160 Pujian Road, Shanghai, 200127, P. R. China
| | - Mawei Jiang
- Department of Oncology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, P. R. China
| | - Kun Qian
- State Key Laboratory for Oncogenes and Related Genes, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, P. R. China
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, 160 Pujian Road, Shanghai, 200127, P. R. China
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Joo G, Doumanian J. Radiographic Findings of Dysplastic Cerebellar Gangliocytoma (Lhermitte-Duclos Disease) in a Woman with Cowden Syndrome: A Case Study and Literature Review. J Radiol Case Rep 2020; 14:1-6. [PMID: 33082915 DOI: 10.3941/jrcr.v14i3.3814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The following case report features a middle-aged female patient, previously diagnosed with Cowden syndrome, who presented to the hospital with symptoms of headaches and changes in vision that began with no apparent cause and persisted for almost a month. MRI of the head confirmed a diagnosis of dysplastic cerebellar gangliocytoma, also known as Lhermitte-Duclos disease. This cerebellar tumor, while extremely rare in incidence, is classified as the most common type of brain lesion in adult patients with Cowden syndrome. This report will also include a comprehensive literature review of Cowden syndrome and Lhermitte-Duclos disease, with greater emphasis on the radiologic characteristics of Lhermitte-Duclos disease.
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Affiliation(s)
- Gloria Joo
- Dept of Radiology, Rush Copley Medical Center, 2000 Ogden Ave, Aurora IL 60504, USA
| | - John Doumanian
- Dept of Radiology, Rush Copley Medical Center, 2000 Ogden Ave, Aurora IL 60504, USA
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Yue X, Huang J, Zhu Y, Du Y. Solitary fibrous tumor/hemangiopericytoma in the cerebellopontine angle mimicking vestibular schwannoma: A case report and literature review. Medicine (Baltimore) 2020; 99:e19651. [PMID: 32221091 PMCID: PMC7220372 DOI: 10.1097/md.0000000000019651] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
RATIONALE Intracranial solitary fibrous tumors (SFTs) and hemangiopericytomas (HPCs) are rare spindle cell tumors of mesenchymal origin that include benign and malignant neoplasms. PATIENT CONCERNS We present a 66-year-old male with a 5-year history of headache and dizziness, with left progressive sensorineural hearing loss over 1 month. DIAGNOSES WHO grade II SFT/HPC originating from the internal auditory canal in the left cerebellopontine angle. INTERVENTIONS surgical resection. OUTCOMES No local recurrence or metastases were observed in the follow-up 3 months after the surgery. LESSONS Intracranial SFTs/HPCs are rare mesenchymal neoplasms that are challenging to manage. If the imaging characteristics of tumor are not typical, clinicians should depend on tissue biopsy and immunohistochemistry to make a definitive diagnosis.
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Yeo KK, Margol AS, Kennedy RJ, Hung L, Robison NJ, Dhall G, Asgharzadeh S. Prognostic significance of molecular subgroups of medulloblastoma in young children receiving irradiation-sparing regimens. J Neurooncol 2019; 145:375-383. [PMID: 31621042 PMCID: PMC7543681 DOI: 10.1007/s11060-019-03307-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 10/09/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Irradiation-avoiding strategies have been used with relative success in the treatment of infants and young children with medulloblastoma. While advances in cancer genomics have significantly improved our understanding of the tumor biology of medulloblastoma allowing for improved prognostication and risk-stratification, the molecular subgroup-specific outcomes of infants and young children with medulloblastoma treated with irradiation-avoiding strategies remains unknown. METHODS Molecular and clinical features of children with medulloblastoma treated with irradiation-avoiding strategies at Children's Hospital Los Angeles were analyzed. Molecular subgrouping of these patients was determined using a 31-gene TaqMan Low Density Array signature. Survival analyses were conducted based on 3 molecular subgroups (SHH, Group 3, and Group 4). RESULTS Twenty-eight patients with medulloblastoma received irradiation-sparing regimens and were included in this analysis. Patients were divided into SHH (n = 16), Group 3 (n = 3) and Group 4 subgroups (n = 9). Subgroup specific 5-year progression-free and overall survival was 81.2% (95% CI 52.5-93.5) and 93.7% (95% CI 63.2-99.1) for SHH, 0% and 0% for Group 3 and 0% and 44.4% (95% CI 13.6-71.9) for Group 4. CONCLUSION The majority of young children with SHH-subgroup medulloblastoma can be treated effectively with irradiation-sparing regimens. Our results support the use of chemotherapy-only strategies for upfront treatment of young children with SHH medulloblastoma, while demonstrating the urgent need for intensification/augmentation of treatment for patients with group 3/4 medulloblastoma.
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Affiliation(s)
- Kee Kiat Yeo
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #54, Los Angeles, CA, 90027-6016, USA
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, USA
| | - Ashley S Margol
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #54, Los Angeles, CA, 90027-6016, USA.
| | - Rebekah J Kennedy
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #54, Los Angeles, CA, 90027-6016, USA
| | - Long Hung
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #54, Los Angeles, CA, 90027-6016, USA
| | - Nathan J Robison
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #54, Los Angeles, CA, 90027-6016, USA
| | - Girish Dhall
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #54, Los Angeles, CA, 90027-6016, USA
- The Alabama Center for Childhood Cancer and Blood Disorders at Children's of Alabama, University of Alabama at Birmingham (UAB), Birmingham, USA
| | - Shahab Asgharzadeh
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #54, Los Angeles, CA, 90027-6016, USA
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Eterovic AK, Maher OM, Chandra J, Chen K, Huse J, Zaky W. Metachronous Medulloblastoma in a Child With Successfully Treated Neuroblastoma: Case Report and Novel Findings of DNA Sequencing. J Natl Compr Canc Netw 2019; 16:683-691. [PMID: 29891519 DOI: 10.6004/jnccn.2018.7009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 01/24/2018] [Indexed: 11/17/2022]
Abstract
Metachronous neoplasms have rarely been reported in patients with neuroblastoma. This report presents the clinical case of a 23-month-old child who was diagnosed with an anaplastic medulloblastoma 5 months after completing treatment for stage IV neuroblastoma. The patient was treated with complete surgical resection and adjuvant chemoradiation followed by maintenance chemotherapy at an outside institution and came to our institution for further management. A pathologic diagnosis and review of both the suprarenal and posterior fossa masses were performed, as well as a genetic analysis of both cerebellar tumor tissue and blood using next-generation gene sequencing. At our institution, the patient was submitted to induction chemotherapy followed by high-dose chemotherapy and autologous stem cell transplantation and remains free of disease 2 years after completion of treatment. Genetic analysis revealed multiple somatic copy number variations with most deleted genes located in 2q37, a region which harbors genes involved in epigenetic regulation and tumor suppression. A homozygous deletion was found in the TSC2 gene, which is a clinically actionable gene, and patients with activating deletions in TSC2 can potentially be eligible for basket clinical trials with mTOR inhibitors. Germline single nucleotide variants were also identified in multiple genes involved in cancer (ALK, FGFR3, FLT3/4, HNF1A, NCOR1, and NOTCH2/3), cancer predisposition (TP53, TSC1, and BRCA1/2), and genes involved in DNA repair (MSH6, PMS2, POLE, and ATM). Metachronous neoplasms are rare and challenging to treat, hence genetic analysis and referral are needed to exclude hereditary cause. DNA sequencing of the tumor and germline can help identify alterations that increase predisposition or can be used to guide treatment decisions on recurrence and when standard options fail.
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Abstract
INTRODUCTION Medulloblastoma (MB) is the most common malignant brain tumour in children. Despite significant progress in its management, a proportion of children relapse; tumour recurrence still carries a poor prognosis. While surgery is a mainstay of the management of primary MB, its role in recurrent MB is unclear. The objective of this literature review is to explore current practice and potential benefits of surgery in recurrent MB. MATERIAL AND METHODS We reviewed all articles published in PubMed and Scholar from 1990 to 2018 with the following terms: "medulloblastoma" AND "recurrence" AND "neurosurgical procedures". Among 69 articles, 12 were directly relevant. RESULTS A total of 581 cases of recurrent MB were identified from published series. Median time from diagnosis to relapse was 20.4months. The majority of relapses involved disseminated craniospinal disease and only one-fifth relapses was located in the posterior fossa. The outcome was consistently poor, with a median survival of 12.4% and a median survival time after relapse of 18.5months. In the HIP-SIOP-PNET4 study, surgery at relapse was performed in 25% of cases and was associated with improved prognosis in solitary posterior fossa recurrence. CONCLUSION Recurrent medulloblastoma is often fatal in children who have previously received radiotherapy. The role of surgery in improving survival is unclear, but there is some evidence that resection of a focal single posterior fossa recurrence can bring survival benefit. The value of biopsy lies in the optimisation and selection of appropriate targeted therapy and in excluding a second malignancy.
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Affiliation(s)
- A Rolland
- University College London Great Ormond Street Institute of Child Health, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
| | - K Aquilina
- University College London Great Ormond Street Institute of Child Health, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Luryi AL, Michaelides EM, Babu S, Bojrab DI, Kveton JF, Hong RS, Zappia J, Sargent EW, Schutt CA. Reliability of clinical diagnosis of masses of the cerebellopontine angle: A retrospective multi-institutional study. Am J Otolaryngol 2019; 40:133-136. [PMID: 30717992 DOI: 10.1016/j.amjoto.2019.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 01/18/2019] [Accepted: 01/28/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the accuracy of pre-operative diagnosis of masses of the cerebellopontine angle (CPA) when compared to surgical pathology. DESIGN Retrospective chart review. PARTICIPANTS Patients who underwent surgery for CPA masses at two tertiary care institutions from 2007 to 2017. MAIN OUTCOME MEASURES Percent concordance between pre-operative and surgical pathologic diagnosis; sensitivity, specificity, positive predictive value, and negative predictive value for predicted diagnoses. RESULTS Concordance between pre-operative diagnosis and surgical pathology was 93.2% in 411 sampled patients. Concordance was 57.9% for masses other than vestibular schwannoma. Prediction of vestibular schwannoma and meningioma had high positive (0.95 and 0.97, respectively) and negative (0.76 and 0.99, respectively) predictive values. Prediction of facial neuroma had sensitivity of 0.13 and positive predictive value of 0.25. Headache (p = 0.001) and facial weakness (p = 0.003) were significantly associated with different pathologic profiles. Hearing loss was associated with differences in diagnostic prediction (p = 0.02) but not with differences in surgical pathology (p > 0.05). CONCLUSIONS Comparison between pre-operative predicted diagnosis and surgical pathology for cerebellopontine angle masses is presented. Vestibular schwannoma and meningioma were effectively identified while rarer CPA masses including facial neuroma were rarely identified correctly. Clinicians caring for patients with CPA masses should be mindful of diagnostic uncertainty which may lead to changes in treatment plan or prognosis.
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Affiliation(s)
- Alexander L Luryi
- Department of Surgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06511, United States
| | - Elias M Michaelides
- Department of Surgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06511, United States
| | - Seilesh Babu
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, 30055 Northwestern Highway, Suite #101, Farmington Hills, MI 48334, United States
| | - Dennis I Bojrab
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, 30055 Northwestern Highway, Suite #101, Farmington Hills, MI 48334, United States
| | - John F Kveton
- Department of Surgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06511, United States
| | - Robert S Hong
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, 30055 Northwestern Highway, Suite #101, Farmington Hills, MI 48334, United States
| | - John Zappia
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, 30055 Northwestern Highway, Suite #101, Farmington Hills, MI 48334, United States
| | - Eric W Sargent
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, 30055 Northwestern Highway, Suite #101, Farmington Hills, MI 48334, United States
| | - Christopher A Schutt
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, 30055 Northwestern Highway, Suite #101, Farmington Hills, MI 48334, United States.
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Ryzhova MV, Snigireva GP, Golanov AV, Zheludkova OG, Trunin YY, Antipina NA. [Correct use of Kreatech DNA probes to detect MYC gene amplification in medulloblastomas by fluorescence in situ hybridization]. Arkh Patol 2019; 81:66-72. [PMID: 31407721 DOI: 10.17116/patol20198104166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
UNLABELLED In most cases, oncogene amplification are prognostic and predictive markers for various tumors, therefore DNA probes are unable to reveal changes in the copy numbers should not be used to diagnose malignant tumors. OBJECTIVE To comparatively analyze DNA probes from different manufacturers to detect MYC gene amplification in routine practice. MATERIAL AND METHODS The study material was formalin-fixed paraffin-embedded medulloblastoma fragments from 4 patients, with discrepancies in the results in the detection of MYC gene amplification. RESULTS MYC gene amplification was determined using DNA probes: Kreatech MYC (8q24)/SE 8, Vysis LSI MYC SO, Vysis CEP 8 (D8Z2) SG, and Zytolight SPEC MYC/CEN 8 Dual Color Probe. The use of the probes Kreatech TERC (3q26)/MYC (8q24)/SE7 Triple-Color probe failed to detect MYC gene amplification; this probe showed a balanced profile of chromosome 8. CONCLUSION In routine practice, fluorescence in situ hybridization with the DNA probes Kreatech MYC (8q24)/SE 8, Vysis LSI MYC SO, Vysis CEP 8 (D8Z2) SG and Zytolight SPEC MYC/CEN 8 Dual Color Probe can be the method of choice for studying the copy number of the MYC gene. However, the authors strongly recommend that the Kreatech TERC (3q26)/MYC (8q24)/SE7 Triple-Color should not be used for this purpose. In addition, probes for fluorescence in situ hybridization must be necessarily tested in large reference laboratories dealing with one or another area of oncopathology.
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Affiliation(s)
- M V Ryzhova
- Acad. N.N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of Russia, Moscow, Russia
| | - G P Snigireva
- Russian Research Center of Roentgenology and Radiology, Ministry of Health of Russia, Moscow, Russia
| | - A V Golanov
- Acad. N.N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of Russia, Moscow, Russia
| | - O G Zheludkova
- Russian Research Center of Roentgenology and Radiology, Ministry of Health of Russia, Moscow, Russia
| | - Yu Yu Trunin
- Acad. N.N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of Russia, Moscow, Russia
| | - N A Antipina
- Acad. N.N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of Russia, Moscow, Russia
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Abstract
RATIONALE Cystic meningioma located at the cerebellopontine angle (CPA) is an extremely rare occurrence. It is frequently misdiagnosed preoperatively. Little is known about the clinical features and outcome of this rare disease. PATIENT CONCERNS A 70-year-old male presenting with progressive headache and gait disturbance. DIAGNOSIS According to the symptoms, signs, and Gd-enhanced magnetic resonance images (MRI), a preoperative diagnosis of hemangioblastoma located in left CPA was made. Finally, the histological examination revealed a meningioma. INTERVENTIONS A complete resection, including the part of the solid mass together with cyst, was performed. OUTCOMES The postoperative course of the patient was uneventful, and no residual or recurrent tumor was found during the 24-month follow-up period. LESSONS Cystic meningioma should be included in the differential diagnosis of a CPA mass with atypical radiologic features, such as a large cyst and enhanced mural nodule. By summarizing the related literature, we found that the most common pathological subtype of CPA cystic meningioma is the clear cell subtype, which belongs to WHO grade II. Gross total resection including the enhanced cyst wall is extremely important. A close follow-up is necessary because of the high recurrence rate in this subset of meningioma.
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Affiliation(s)
- Jiuhong Li
- Department of Neurosurgery, West China Hospital, Sichuan University
| | - Jinli Meng
- Department of Radiology, Hospital of Chengdu office of People's Government of Tibetan Autonomous Region (Hospital C.T), Chengdu, China
| | - Qiguang Wang
- Department of Neurosurgery, West China Hospital, Sichuan University
| | - Yanchao Wang
- Department of Neurosurgery, West China Hospital, Sichuan University
| | - Wenke Liu
- Department of Neurosurgery, West China Hospital, Sichuan University
| | - Xuhui Hui
- Department of Neurosurgery, West China Hospital, Sichuan University
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Xu K, Khine KT, Ooi YC, Quinsey CS. A systematic review of shunt-related extraneural metastases of primary central nervous system tumors. Clin Neurol Neurosurg 2018; 174:239-243. [PMID: 30292900 DOI: 10.1016/j.clineuro.2018.09.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 09/24/2018] [Accepted: 09/26/2018] [Indexed: 11/19/2022]
Abstract
Extraneural metastasis (ENM) of primary central nervous system (CNS) tumors is an uncommon occurrence. Case reports and case series describe ENM after shunting, but this phenomenon has not been well characterized. In this review we aim to better understand the risk factors and clinical implications of ENM associated with shunting. A literature search of cases of ENM related to shunt placement in patients with primary CNS tumors reported through January 2018 was performed using PubMed and Google Scholar. We identified 106 cases of ENM of primary CNS tumors related to shunt placement. The three most common tumor histologies resulting in ENM were germinoma (24%), medulloblastoma (21%), and glioblastoma (11%). Of the patients with ENM, 48% had leptomeningeal spread and 37% had brain or spinal cord metastasis. Mean survival time from shunt placement was 13 months. Ventriculoatrial-shunted cases had higher rates of widespread metastasis and shorter average survival time from shunt placement (2 months) than the average of all types of shunts. Given the known association with ENM, careful consideration should be given to shunt placement in patients with primary CNS tumors, especially germinomas, medulloblastomas, and glioblastomas. Appropriate surveillance should be instituted after shunt placement, and leptomeningeal or neural metastasis should prompt the consideration of potential ENM. When considering distal shunt options, our review suggests that ventriculoatrial shunts should be avoided if possible. For truly obstructive pathologies, the risk of ENM is a further indication to consider other treatment options such as endoscopic third ventriculostomy rather than shunt placement.
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Affiliation(s)
- Kali Xu
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States
| | - Kay T Khine
- Department of Ophthalmology, Kittner Eye Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States; Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Yinn Cher Ooi
- Department of Neurosurgery, David Geffen School of Medicine at the University of California (UCLA), Los Angeles, California, United States
| | - Carolyn S Quinsey
- Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States.
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Sun S, Zhou H, Ding ZZ, Shi H. Cerebellar pilocytic astrocytomas with spontaneous intratumoral hemorrhage in the elderly: A case report and review of the literature. Medicine (Baltimore) 2018; 97:e11329. [PMID: 30075500 PMCID: PMC6081062 DOI: 10.1097/md.0000000000011329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
RATIONALE Pilocytic astrocytoma (PA) is the most common pediatric central nervous system glial tumor. Adult occurrence is rare, especially in elderly adults. How to manage the pilocytic astrocytoma with spontaneous intratumoral hemorrhage in the elderly is still unfamiliar with clinician. PATIENT CONCERNS Reports of tumors with intratumoral hemorrhage in elderly adults are extremely rare. We report a case of a 62-year-old male diagnosed with cerebellar pilocytic astrocytomas with spontaneous intratumoral hemorrhage. Informed consent was obtained from the patient. DIAGNOSES Histological examination of the specimens revealed pilocytic astrocytomas, including a hemorrhagic portion. INTERVENTIONS The patient underwent the radical resections of tumour and was given the regular follow-up. OUTCOMES 12 months later, he recovered without evidence of disease. LESSONS Cerebellar pilocytic astrocytomas associated with hemorrhages occur over the age of 60 is extremely rare. Removing the tumor and hematoma completely is the best treatment options. Long term follow-up is very necessary for this tumor.
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Visser M, Walz H, Shrader S, Koehler J, Bellah J. Central Nervous System B-cell Lymphoma in a Bald Eagle ( Haliaeetus leucocephalus). J Avian Med Surg 2018; 32:40-44. [PMID: 29698076 DOI: 10.1647/2016-188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An adult bald eagle ( Haliaeetus leucocephalus) presented for nystagmus and an inability to fly. On physical examination, the eagle was open-mouth breathing and tachycardic at 200 beats per minute, had a wrinkled cere and sunken eyes, and was an estimated 10% dehydrated. Additionally, the eagle was extremely weak, with neurologic abnormalities including bilateral proprioceptive deficits, nystagmus, and no pupillary light reflex in the left eye. Despite aggressive treatment, the eagle continued to decline rapidly and subsequently died. On histologic examination, diffuse and widespread infiltration of neoplastic lymphocytes was present in the brain, optic nerves, and pecten. Immunohistochemical PAX-5 labeling confirmed B-cell lymphoma confined to the eye and nervous system. Test results for select avian retroviruses, Marek's disease, West Nile virus, avian influenza viruses, and Mycoplasma were negative. To our knowledge, this is the first report of B-cell lymphoma in a bald eagle. Although rare, this condition is a differential diagnosis in cases of neurologic or ocular diseases in birds.
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Zhao F, Zhang J, Li P, Zhou Q, Zhang S, Zhao C, Wang B, Yang Z, Li C, Liu P. Prognostic value of Ki-67 index in adult medulloblastoma after accounting for molecular subgroup: a retrospective clinical and molecular analysis. J Neurooncol 2018; 139:333-340. [PMID: 29687281 DOI: 10.1007/s11060-018-2865-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/08/2018] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Medulloblastoma (MB) is a rare primary brain tumor in adults. We previously evaluated that combining both clinical and molecular classification could improve current risk stratification for adult MB. In this study, we aimed to identify the prognostic value of Ki-67 index in adult MB. METHOD Ki-67 index of 51 primary adult MBs was reassessed using a computer-based image analysis (Image-Pro Plus). All patients were followed up ranging from 12 months up to 15 years. Gene expression profiling and immunochemistry were used to establish the molecular subgroups in adult MB. Combined risk stratification models were designed based on clinical characteristics, molecular classification and Ki-67 index, and identified by multivariable Cox proportional hazards analysis. RESULTS In our cohort, the mean Ki-67 value was 30.0 ± 11.3% (range 6.56-63.55%). The average Ki-67 value was significantly higher in LC/AMB than in CMB and DNMB (P = .001). Among three molecular subgroups, Group 4-tumors had the highest average Ki-67 value compared with WNT- and SHH-tumors (P = .004). Patients with Ki-67 index large than 30% displayed poorer overall survival (OS) and progression free survival (PFS) than those with Ki-67 less than 30% (OS: P = .001; PFS: P = .006). Ki-67 index (i.e. > 30%, < 30%) was identified as an independent significant prognostic factor (OS: P = .017; PFS: P = .024) by using multivariate Cox proportional hazards model. CONCLUSIONS In conclusion, Ki-67 index can be considered as a valuable independent prognostic biomarker for adult patients with MB.
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Affiliation(s)
- Fu Zhao
- Neural Reconstruction Department, Beijing Neurosurgical Institute, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, China.
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.
| | - Jing Zhang
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Peng Li
- Neural Reconstruction Department, Beijing Neurosurgical Institute, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, China
| | - Qiangyi Zhou
- Neural Reconstruction Department, Beijing Neurosurgical Institute, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, China
| | - Shun Zhang
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Chi Zhao
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Bo Wang
- Neural Reconstruction Department, Beijing Neurosurgical Institute, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, China
| | - Zhijun Yang
- Neural Reconstruction Department, Beijing Neurosurgical Institute, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, China
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Chunde Li
- Neural Reconstruction Department, Beijing Neurosurgical Institute, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, China
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Pinan Liu
- Neural Reconstruction Department, Beijing Neurosurgical Institute, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, China.
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.
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Mehrvar A, Tashvighi M, Hedayati Asl AA, Niktoreh-Mofrad N, Mehrvar N, Afsar N, Naderi A, Allebouyeh M, Qaddoumi I, Faranoush M. Management and outcomes of treating pediatric medulloblastoma: an eight years' experience in an Iranian pediatric center. Childs Nerv Syst 2018; 34:639-647. [PMID: 29214340 DOI: 10.1007/s00381-017-3672-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 11/27/2017] [Indexed: 12/30/2022]
Abstract
PURPOSE The clinical management of pediatric medulloblastoma requires a multidisciplinary approach, which can be challenging, especially in low- and middle-income countries. The aim of this study was to identify current challenges and describe the treatment and outcomes of Iranian pediatric patients with medulloblastoma who were referred to our center in Tehran, Iran. METHODS Our retrospective review included 126 patient records from April 2007 to May 2015. The records were analyzed for epidemiologic features, treatment modalities, overall survival, and progression-free survival. Data were analyzed using SPSS 22.0 software. RESULTS Median age at diagnosis was 6 years (male:female ratio, 2.3:1). At the time of diagnosis, 7 patients were 2 years or younger, and 76 (60.3%) were categorized as having high-risk disease. Overall, 100 patients had gross or near-total surgical resection. Cerebral spinal fluid involvement was detected in 22.2% of the patients tested, and spinal involvement was detected in 25% of the patients who underwent spinal MRI. Metastasis stages at the time of diagnosis were as follows: M0: 48.4% patients, M1: 16.7%, M2: 5.5%, and M3: 21.4%. Median times of follow-up and progression-free survival were 16 and 12 months, respectively. Probability of 7-year overall survival and progression-free survival were 59 and 53.8%, respectively. CONCLUSIONS Results of the current retrospective study emphasize the need for implementing measures to improve outcome for our patients with medulloblastoma. Such measures include a multidisciplinary approach, unified national treatment guidelines, better disease and metastasis staging, twinning initiatives, and seeking a second opinion when needed.
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Affiliation(s)
- Azim Mehrvar
- MAHAK Pediatric Cancer Treatment and Research Center, Tehran, Iran
- AJA University of Medical Sciences, Tehran, Iran
| | - Maryam Tashvighi
- MAHAK Pediatric Cancer Treatment and Research Center, Tehran, Iran
- Islamic Azad University of Medical Sciences, Qom, Iran
| | | | - Naghmeh Niktoreh-Mofrad
- MAHAK Pediatric Cancer Treatment and Research Center, Tehran, Iran.
- Department of Pediatric Hematology and Oncology, University Children's Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Narjes Mehrvar
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Negar Afsar
- MAHAK Pediatric Cancer Treatment and Research Center, Tehran, Iran
| | - Ali Naderi
- MAHAK Pediatric Cancer Treatment and Research Center, Tehran, Iran
| | | | - Ibrahim Qaddoumi
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Mohammad Faranoush
- MAHAK Pediatric Cancer Treatment and Research Center, Tehran, Iran
- Pediatric Growth and Development Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
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Donofrio CA, Gagliardi F, Callea M, da Passano CF, Terreni MR, Cavalli A, Spina A, Acerno S, Bailo M, Elbabaa SK, Mortini P. Pediatric cerebellar pilocytic astrocytoma presenting with spontaneous intratumoral hemorrhage. Neurosurg Rev 2018; 43:9-16. [PMID: 29569086 DOI: 10.1007/s10143-018-0969-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/14/2018] [Accepted: 03/13/2018] [Indexed: 11/25/2022]
Abstract
Pilocytic astrocytomas (PAs) are benign glial tumors and one of the most common childhood posterior fossa tumors. Spontaneous intratumoral hemorrhage in PAs occurs occasionally, in about 8-20% of cases. Cerebellar hemorrhages in pediatric population are rare and mainly due to head injuries, rupture of vascular malformations, infections, or hematological diseases. We have investigated the still controversial and unclear pathophysiology underlying intratumoral hemorrhage in PAs. Bleeding in low-grade tumors might be related to structural abnormalities and specific angio-architecture of tumor vessels, such as degenerative mural hyalinization, "glomeruloid" endothelial proliferation, presence of encased micro-aneurysms, and glioma-induced neoangiogenesis. The acute hemorrhagic presentation of cerebellar PA in childhood although extremely uncommon is of critical clinical importance and necessitates promptly treatment. We described a case of hemorrhagic cerebellar PA in a 9-year-old child and reviewed the English-language literature that reported spontaneous hemorrhagic histologically proven cerebellar PA in pediatric patients (0-18 years). According to our analysis, the mortality was not related to symptom onset, tumor location, hemorrhage distribution, presence of acute hydrocephalous, and timing of surgery, while the GCS at hospital admission resulted to be the only statistically significant prognostic factor affecting survival outcome. The abrupt onset of signs and symptoms of acute hydrocephalous and consequent raised intracranial pressure are life-threatening conditions, which need emergent medical and neurosurgical treatments. At a later time, the identification of posterior fossa hemorrhage etiology is crucial to select the appropriate treatment and address the surgical strategy, optimizing the postoperative results.
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Affiliation(s)
- Carmine Antonio Donofrio
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
| | - Filippo Gagliardi
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Marcella Callea
- Service of Pathology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Camillo Ferrari da Passano
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Maria Rosa Terreni
- Service of Pathology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Cavalli
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Alfio Spina
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Stefania Acerno
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Michele Bailo
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Samer K Elbabaa
- Division of Pediatric Neurosurgery, Department of Neurological Surgery, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
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Abstract
RATIONALE Most of the intracranial epidermoid cysts are benign, but malignant lesions are occasionally reported. These lesions appear as squamous cell carcinoma and carry a dismal prognosis. Here, we report a case of a primary intracranial squamous cell carcinoma arising in a cerebellopontine epidermoid cyst. The relevant literatures were also reviewed. PATIENT CONCERNS A 53-year-old woman presented with dizziness and diplopia 9 months in duration. Magnetic resonance imaging revealed an epidermoid cyst in the left cerebellopontine angle and prepontine region with a focal enhancing lesion on T1-weighted gadolinium-enhanced images. DIAGNOSES Histopathologic diagnosis revealed squamous cell carcinoma on a background of epidermoid cyst. Imaging studies excluded metastases. INTERVENTIONS The tumor was removed subtotally through a lateral suboccipital approach. The patient received intensity modulated radiation therapy (6720 cGy total) postoperatively. OUTCOMES The patient was free from recurrence of the tumor until 3 years after surgery, at which point she was lost to follow-up. The patient died 4 years after the surgery. LESSONS The epidermoid cyst may occasionally become malignant. Finding an area of enhancement through preoperative magnetic resonance imaging can help to make a correct diagnosis. Based on the review of previous reports, surgical removal followed by radiotherapy shows the best result to treat malignant epidermoid cysts.
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Affiliation(s)
- Tae Hoon Roh
- Yonsei University Graduate School
- Department of Neurosurgery, Ajou University Hospital, Suwon
| | - Yong Sook Park
- Department of Neurological Surgery, Chung-Ang University Yongsan Hospital
| | | | - Se Hoon Kim
- Department of Pathology, Brain Tumor Center, Brain Research Institute, Yonsei University Health System, Seoul, Republic of Korea
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Zhou JJ, Xu JF, Zheng XN, Peng GP. Asymptomatic syringomyelia accompanied with metastatic cerebellar and spinal intramedullary lymphoma: A case report. Medicine (Baltimore) 2017; 96:e8593. [PMID: 29145275 PMCID: PMC5704820 DOI: 10.1097/md.0000000000008593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Asympotamic syringomyelia accompanied with metastatic cerebellar and thoracic spinal intramedullary lymphoma is rare in clinical practice. If the intramedullary lymphoma is large enough, the patient will rapidly develop neurologic signs of spinal injury. The prognosis of this type of complication is always bad. PATIENT CONCERNS Rapid and correct diagnosis and treatment is important for metastatic extranodal lymphoma with B cell of origin. DIAGNOSES Syringomyelia accompanied with metastatic cerebellar and thoracic spinal intramedullary lymphoma. INTERVENTIONS The patient was treated with a combination of systemic chemotherapy and focal radiotherapy and intrathecal therapy. OUTCOMES Resolution of metastatic lymphoma was not continued after conservative medical management and the patient died finally due to multiple organ failure. LESSONS Syringomyelia can develop due to the metastatic thoracic intramedullary lymphoma in patients with diffuse malignant large B cell lymphoma. Early and accurate diagnosis, anti-lymphoma treatment, and timely neurosurgical intervention may delay the development of the disease.
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Affiliation(s)
| | - Jin-Feng Xu
- Department of Radiology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Park BS, Smith SV, Sadaka A, Lee AG. Cerebellopontine angle astrocytoma producing Bruns nystagmus mimicking vestibular schwannoma. Can J Ophthalmol 2017; 52:e181-e182. [PMID: 28985828 DOI: 10.1016/j.jcjo.2017.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 02/07/2017] [Indexed: 11/17/2022]
Affiliation(s)
| | - Stacy V Smith
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, Tex
| | - Ama Sadaka
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Tex
| | - Andrew G Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Tex; Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, N.Y.; Department of Ophthalmology, The University of Iowa, Iowa City, Ia; Department of Ophthalmology, Baylor College of Medicine, Houston, Tex; Department of Ophthalmology, University of Texas Medical Branch, Galveston, Tex; Section of Ophthalmology, UT MD Anderson Cancer Center, Houston, Tex; Department of Ophthalmology, University at Buffalo (SUNY), Buffalo, N.Y.
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Abetel G, Guyot JP, Momjian S, Plan PA. [Not Available]. Rev Med Suisse 2017; 13:719-721. [PMID: 28722384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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