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Auffret L, Ajlil Y, Tauziède-Espariat A, Kergrohen T, Puiseux C, Riffaud L, Blouin P, Bertozzi AI, Leblond P, Blomgren K, Froelich S, Picca A, Touat M, Sanson M, Beccaria K, Blauwblomme T, Dangouloff-Ros V, Boddaert N, Varlet P, Debily MA, Grill J, Castel D. A new subtype of diffuse midline glioma, H3 K27 and BRAF/FGFR1 co-altered: a clinico-radiological and histomolecular characterisation. Acta Neuropathol 2023; 147:2. [PMID: 38066305 PMCID: PMC10709479 DOI: 10.1007/s00401-023-02651-4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/22/2023] [Accepted: 10/24/2023] [Indexed: 12/18/2023]
Abstract
Diffuse midline gliomas (DMG) H3 K27-altered are incurable grade 4 gliomas and represent a major challenge in neuro-oncology. This tumour type is now classified in four subtypes by the 2021 edition of the WHO Classification of the Central Nervous System (CNS) tumours. However, the H3.3-K27M subgroup still appears clinically and molecularly heterogeneous. Recent publications reported that rare patients presenting a co-occurrence of H3.3K27M with BRAF or FGFR1 alterations tended to have a better prognosis. To better study the role of these co-driver alterations, we assembled a large paediatric and adult cohort of 29 tumours H3K27-altered with co-occurring activating mutation in BRAF or FGFR1 as well as 31 previous cases from the literature. We performed a comprehensive histological, radiological, genomic, transcriptomic and DNA methylation analysis. Interestingly, unsupervised t-distributed Stochastic Neighbour Embedding (tSNE) analysis of DNA methylation profiles regrouped BRAFV600E and all but one FGFR1MUT DMG in a unique methylation cluster, distinct from the other DMG subgroups and also from ganglioglioma (GG) or high-grade astrocytoma with piloid features (HGAP). This new DMG subtype harbours atypical radiological and histopathological profiles with calcification and/or a solid tumour component both for BRAFV600E and FGFR1MUT cases. The analyses of a H3.3-K27M BRAFV600E tumour at diagnosis and corresponding in vitro cellular model showed that mutation in H3-3A was the first event in the oncogenesis. Contrary to other DMG, these tumours occur more frequently in the thalamus (70% for BRAFV600E and 58% for FGFR1MUT) and patients have a longer overall survival with a median above three years. In conclusion, DMG, H3 K27 and BRAF/FGFR1 co-altered represent a new subtype of DMG with distinct genotype/phenotype characteristics, which deserve further attention with respect to trial interpretation and patient management.
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Affiliation(s)
- Lucie Auffret
- Molecular Predictors and New Targets in Oncology, Inserm, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Yassine Ajlil
- Molecular Predictors and New Targets in Oncology, Inserm, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Arnault Tauziède-Espariat
- Department of Neuropathology, GHU Paris-Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
- UMR 1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Inserm, Paris, France
| | - Thomas Kergrohen
- Molecular Predictors and New Targets in Oncology, Inserm, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Département de Cancérologie de L'Enfant et de L'Adolescent, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Chloé Puiseux
- Department of Pediatric Oncology, Rennes University Hospital, Rennes, France
| | - Laurent Riffaud
- Department of Pediatric Neurosurgery, Rennes University Hospital, Rennes, France
| | - Pascale Blouin
- Department of Pediatric Hematology, CHRU de Tours, Tours, France
| | | | - Pierre Leblond
- Institute of Pediatric Hematology and Oncology, Centre Léon Bérard, Lyon, France
| | - Klas Blomgren
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Pediatric Hematology and Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Sébastien Froelich
- Service de Neurochirurgie-Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Alberto Picca
- Inserm U1127, CNRS UMR 7225, Institut du Cerveau, ICM, Charles Foix, Service de Neurologie 2-Mazarin, Sorbonne Université, AP-HP, Hôpitaux Universitaires la Pitié Salpêtrière, Paris, France
| | - Mehdi Touat
- Inserm U1127, CNRS UMR 7225, Institut du Cerveau, ICM, Charles Foix, Service de Neurologie 2-Mazarin, Sorbonne Université, AP-HP, Hôpitaux Universitaires la Pitié Salpêtrière, Paris, France
| | - Marc Sanson
- Inserm U1127, CNRS UMR 7225, Institut du Cerveau, ICM, Charles Foix, Service de Neurologie 2-Mazarin, Sorbonne Université, AP-HP, Hôpitaux Universitaires la Pitié Salpêtrière, Paris, France
| | - Kévin Beccaria
- Molecular Predictors and New Targets in Oncology, Inserm, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Department of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Cité, Paris, France
| | - Thomas Blauwblomme
- Department of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Cité, Paris, France
| | - Volodia Dangouloff-Ros
- Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, AP-HP, Université Paris-Cité, Paris, France
- INSERM U1163, Institut Imagine, Université Paris Cité, Paris, France
| | - Nathalie Boddaert
- Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, AP-HP, Université Paris-Cité, Paris, France
- INSERM U1163, Institut Imagine, Université Paris Cité, Paris, France
| | - Pascale Varlet
- Department of Neuropathology, GHU Paris-Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
- UMR 1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Inserm, Paris, France
| | - Marie-Anne Debily
- Molecular Predictors and New Targets in Oncology, Inserm, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Département de Biologie, Université Évry Paris-Saclay, Évry, France
| | - Jacques Grill
- Molecular Predictors and New Targets in Oncology, Inserm, Gustave Roussy, Université Paris-Saclay, Villejuif, France.
- Département de Cancérologie de L'Enfant et de L'Adolescent, Gustave Roussy, Université Paris-Saclay, Villejuif, France.
| | - David Castel
- Molecular Predictors and New Targets in Oncology, Inserm, Gustave Roussy, Université Paris-Saclay, Villejuif, France.
- Département de Cancérologie de L'Enfant et de L'Adolescent, Gustave Roussy, Université Paris-Saclay, Villejuif, France.
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Métais A, Bouchoucha Y, Kergrohen T, Dangouloff-Ros V, Maynadier X, Ajlil Y, Carton M, Yacoub W, Saffroy R, Figarella-Branger D, Uro-Coste E, Sevely A, Larrieu-Ciron D, Faisant M, Machet MC, Wahler E, Roux A, Benichi S, Beccaria K, Blauwblomme T, Boddaert N, Chrétien F, Doz F, Dufour C, Grill J, Debily MA, Varlet P, Tauziède-Espariat A. Pediatric spinal pilocytic astrocytomas form a distinct epigenetic subclass from pilocytic astrocytomas of other locations and diffuse leptomeningeal glioneuronal tumours. Acta Neuropathol 2023; 145:83-95. [PMID: 36264505 PMCID: PMC9582396 DOI: 10.1007/s00401-022-02512-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 01/05/2023]
Abstract
Pediatric spinal low-grade glioma (LGG) and glioneuronal tumours are rare, accounting for less 2.8-5.2% of pediatric LGG. New tumour types frequently found in spinal location such as diffuse leptomeningeal glioneuronal tumours (DLGNT) have been added to the World Health Organization (WHO) classification of tumours of the central nervous system since 2016, but their distinction from others gliomas and particularly from pilocytic astrocytoma (PA) are poorly defined. Most large studies on this subject were published before the era of the molecular diagnosis and did not address the differential diagnosis between PAs and DLGNTs in this peculiar location. Our study retrospectively examined a cohort of 28 children with LGGs and glioneuronal intramedullary tumours using detailed radiological, clinico-pathological and molecular analysis. 25% of spinal PAs were reclassified as DLGNTs. PA and DLGNT are nearly indistinguishable in histopathology or neuroradiology. 83% of spinal DLGNTs presented first without leptomeningeal contrast enhancement. Unsupervised t-distributed stochastic neighbor embedding (t-SNE) analysis of DNA methylation profiles showed that spinal PAs formed a unique methylation cluster distinct from reference midline and posterior fossa PAs, whereas spinal DLGNTs clustered with reference DLGNT cohort. FGFR1 alterations were found in 36% of spinal tumours and were restricted to PAs. Spinal PAs affected significantly younger patients (median age 2 years old) than DLGNTs (median age 8.2 years old). Progression-free survival was similar among the two groups. In this location, histopathology and radiology are of limited interest, but molecular data (methyloma, 1p and FGFR1 status) represent important tools differentiating these two mitogen-activated protein kinase (MAPK) altered tumour types, PA and DLGNT. Thus, these molecular alterations should systematically be explored in this type of tumour in a spinal location.
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Affiliation(s)
- Alice Métais
- Service de Neuropathologie, GHU Psychiatrie et Neurosciences, Site Sainte-Anne, 1 Rue Cabanis, 75014, Paris, France.
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Université de Paris, Equipe IMA-BRAIN (Imaging Biomarkers for Brain Development and Disorders), 102-108 rue de la Santé, 75014, Paris, France.
| | - Yassine Bouchoucha
- SIREDO Center (Care, Innovation and Research for Children, Adolescents and Young Adults), Institut Curie, Paris, France
- Université Paris-Cité, Paris, France
| | - Thomas Kergrohen
- Team Genomics and Oncogenesis of Pediatric Brain Tumors, Molecular Predictors and New Targets in Oncology, INSERM U981, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Volodia Dangouloff-Ros
- Pediatric Radiology Department, AP-HP, Hôpital Necker Enfants Malades, Université Paris Cité, Institut Imagine INSERM U1163, 75015, Paris, France
| | - Xavier Maynadier
- Department of Biostatistics, Institut Curie, PSL University, Paris, France
| | - Yassine Ajlil
- Team Genomics and Oncogenesis of Pediatric Brain Tumors, Molecular Predictors and New Targets in Oncology, INSERM U981, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Matthieu Carton
- Department of Biostatistics, Institut Curie, PSL University, Paris, France
| | - Wael Yacoub
- Pediatric Radiology Department, AP-HP, Hôpital Necker Enfants Malades, Université Paris Cité, Institut Imagine INSERM U1163, 75015, Paris, France
| | - Raphael Saffroy
- Department of Biochemistry and Oncogenetic, Paul-Brousse Hospital, Villejuif, France
| | - Dominique Figarella-Branger
- Aix-Marseille Univ, APHM, CNRS, INP, Inst Neurophysiopathol, CHU Timone, Service d'Anatomie Pathologique et de Neuropathologie, Marseille, France
| | - Emmanuelle Uro-Coste
- Département d'anatomie et Cytologie Pathologiques, CHU de Toulouse, IUCT-Oncopole, Toulouse, France
| | - Annick Sevely
- Department of Radiology, Toulouse University Hospital, Toulouse, France
| | - Delphine Larrieu-Ciron
- Department of Neurology, Toulouse University Hospital, Toulouse, France
- Department of Medical Oncology, IUCT-Oncopole, Toulouse, France
| | | | | | - Ellen Wahler
- Service de Neuropathologie, GHU Psychiatrie et Neurosciences, Site Sainte-Anne, 1 Rue Cabanis, 75014, Paris, France
| | - Alexandre Roux
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Université de Paris, Equipe IMA-BRAIN (Imaging Biomarkers for Brain Development and Disorders), 102-108 rue de la Santé, 75014, Paris, France
- Department of Neurosurgery, GHU Paris-Psychiatrie et Neurosciences Sainte-Anne Hospital, Paris, France
| | - Sandro Benichi
- Department of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris-Université Paris Cité, Paris, France
| | - Kevin Beccaria
- Department of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris-Université Paris Cité, Paris, France
| | - Thomas Blauwblomme
- Department of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris-Université Paris Cité, Paris, France
| | - Nathalie Boddaert
- Pediatric Radiology Department, AP-HP, Hôpital Necker Enfants Malades, Université Paris Cité, Institut Imagine INSERM U1163, 75015, Paris, France
| | - Fabrice Chrétien
- Service de Neuropathologie, GHU Psychiatrie et Neurosciences, Site Sainte-Anne, 1 Rue Cabanis, 75014, Paris, France
| | - François Doz
- SIREDO Center (Care, Innovation and Research for Children, Adolescents and Young Adults), Institut Curie, Paris, France
- Université Paris-Cité, Paris, France
| | - Christelle Dufour
- Département de Cancérologie de l'Enfant et de l'Adolescent, Institut Gustave Roussy, Université Paris-Sud, Villejuif, France
| | - Jacques Grill
- Département de Cancérologie de l'Enfant et de l'Adolescent, Institut Gustave Roussy, Université Paris-Sud, Villejuif, France
| | - Marie Anne Debily
- Team Genomics and Oncogenesis of Pediatric Brain Tumors, Molecular Predictors and New Targets in Oncology, INSERM U981, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Univ. Evry, Université Paris-Saclay, Evry, France
| | - Pascale Varlet
- Service de Neuropathologie, GHU Psychiatrie et Neurosciences, Site Sainte-Anne, 1 Rue Cabanis, 75014, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Université de Paris, Equipe IMA-BRAIN (Imaging Biomarkers for Brain Development and Disorders), 102-108 rue de la Santé, 75014, Paris, France
| | - Arnault Tauziède-Espariat
- Service de Neuropathologie, GHU Psychiatrie et Neurosciences, Site Sainte-Anne, 1 Rue Cabanis, 75014, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Université de Paris, Equipe IMA-BRAIN (Imaging Biomarkers for Brain Development and Disorders), 102-108 rue de la Santé, 75014, Paris, France
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