Diffuse pediatric-type high-grade gliomas (pedHGG), H3- and IDH-wildtype, encompass three main DNA-methylation-based subtypes: pedHGG-MYCN, pedHGG-RTK1A/B/C, and pedHGG-RTK2A/B. Since their first description in 2017 tumors of pedHGG-RTK2A/B have not been comprehensively characterized and clinical correlates remain elusive. In a recent series of pedHGG with a Gliomatosis cerebri (GC) growth pattern, an increased incidence of pedHGG-RTK2A/B (n = 18) was observed. We added 14 epigenetically defined pedHGG-RTK2A/B tumors to this GC series and provided centrally reviewed radiological, histological, and molecular characterization. The final cohort of 32 pedHGG-RTK2A/B tumors consisted of 25 pedHGG-RTK2A (78%) and seven pedHGG-RTK2B (22%) cases. The median age was 11.6 years (range, 4-17) with a median overall survival of 16.0 months (range 10.9-28.2). Seven of 11 of the newly added cases with imaging available showed a GC phenotype at diagnosis or follow-up. PedHGG-RTK2B tumors exhibited frequent bithalamic involvement (6/7, 86%). Central neuropathology review confirmed a diffuse glial neoplasm in all tumors with prominent angiocentric features in both subclasses. Most tumors (24/27 with available data, 89%) diffusely expressed EGFR with focal angiocentric enhancement. PedHGG-RTK2A tumors lacked OLIG2 expression, whereas 43% (3/7) of pedHGG-RTK2B expressed this glial transcription factor. ATRX loss occurred in 3/6 pedHGG-RTK2B samples with available data (50%). DNA sequencing (pedHGG-RTK2A: n = 18, pedHGG-RTK2B: n = 5) found EGFR alterations (15/23, 65%; predominantly point mutations) in both subclasses. Mutations in BCOR (14/18, 78%), SETD2 (7/18, 39%), and the hTERT promoter (7/19, 37%) occurred exclusively in pedHGG-RTK2A tumors, while pedHGG-RTK2B tumors were enriched for TP53 alterations (4/5, 80%). In conclusion, pedHGG-RTK2A/B tumors are characterized by highly diffuse-infiltrating growth patterns and specific radiological and histo-molecular features. By comprehensively characterizing methylation-based tumors, the chance to develop specific and effective therapy concepts for these detrimental tumors increases.
- MeSH
- dítě MeSH
- fenotyp MeSH
- gliom * genetika patologie diagnostické zobrazování MeSH
- lidé MeSH
- metylace DNA * MeSH
- mladiství MeSH
- nádory mozku * genetika patologie diagnostické zobrazování MeSH
- neuroepitelové nádory * genetika patologie diagnostické zobrazování MeSH
- předškolní dítě MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: The term gliomatosis cerebri (GC), a radiology-defined highly infiltrating diffuse glioma, has been abandoned since molecular GC-associated features could not be established. METHODS: We conducted a multinational retrospective study of 104 children and adolescents with GC providing comprehensive clinical and (epi-)genetic characterization. RESULTS: Median overall survival (OS) was 15.5 months (interquartile range, 10.9-27.7) with a 2-year survival rate of 28%. Histopathological grading correlated significantly with median OS: CNS WHO grade II: 47.8 months (25.2-55.7); grade III: 15.9 months (11.4-26.3); grade IV: 10.4 months (8.8-14.4). By DNA methylation profiling (n = 49), most tumors were classified as pediatric-type diffuse high-grade glioma (pedHGG), H3-/IDH-wild-type (n = 31/49, 63.3%) with enriched subclasses pedHGG_RTK2 (n = 19), pedHGG_A/B (n = 6), and pedHGG_MYCN (n = 5), but only one pedHGG_RTK1 case. Within the pedHGG, H3-/IDH-wild-type subgroup, recurrent alterations in EGFR (n = 10) and BCOR (n = 9) were identified. Additionally, we observed structural aberrations in chromosome 6 in 16/49 tumors (32.7%) across tumor types. In the pedHGG, H3-/IDH-wild-type subgroup TP53 alterations had a significant negative effect on OS. CONCLUSIONS: Contrary to previous studies, our representative pediatric GC study provides evidence that GC has a strong predilection to arise on the background of specific molecular features (especially pedHGG_RTK2, pedHGG_A/B, EGFR and BCOR mutations, chromosome 6 rearrangements).
- MeSH
- dítě MeSH
- fenotyp MeSH
- gliom * genetika patologie MeSH
- kojenec MeSH
- lidé MeSH
- metylace DNA MeSH
- míra přežití MeSH
- mladiství MeSH
- mutace MeSH
- nádorové biomarkery genetika MeSH
- nádory mozku * genetika patologie MeSH
- následné studie MeSH
- neuroepitelové nádory * patologie genetika MeSH
- předškolní dítě MeSH
- prognóza MeSH
- retrospektivní studie MeSH
- stupeň nádoru MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
Large-scale molecular profiling studies in recent years have shown that central nervous system (CNS) tumors display a much greater heterogeneity in terms of molecularly distinct entities, cellular origins and genetic drivers than anticipated from histological assessment. DNA methylation profiling has emerged as a useful tool for robust tumor classification, providing new insights into these heterogeneous molecular classes. This is particularly true for rare CNS tumors with a broad morphological spectrum, which are not possible to assign as separate entities based on histological similarity alone. Here, we describe a molecularly distinct subset of predominantly pediatric CNS neoplasms (n = 60) that harbor PATZ1 fusions. The original histological diagnoses of these tumors covered a wide spectrum of tumor types and malignancy grades. While the single most common diagnosis was glioblastoma (GBM), clinical data of the PATZ1-fused tumors showed a better prognosis than typical GBM, despite frequent relapses. RNA sequencing revealed recurrent MN1:PATZ1 or EWSR1:PATZ1 fusions related to (often extensive) copy number variations on chromosome 22, where PATZ1 and the two fusion partners are located. These fusions have individually been reported in a number of glial/glioneuronal tumors, as well as extracranial sarcomas. We show here that they are more common than previously acknowledged, and together define a biologically distinct CNS tumor type with high expression of neural development markers such as PAX2, GATA2 and IGF2. Drug screening performed on the MN1:PATZ1 fusion-bearing KS-1 brain tumor cell line revealed preliminary candidates for further study. In summary, PATZ1 fusions define a molecular class of histologically polyphenotypic neuroepithelial tumors, which show an intermediate prognosis under current treatment regimens.
- MeSH
- dítě MeSH
- fúzní onkogenní proteiny genetika MeSH
- lidé MeSH
- nádorové biomarkery genetika MeSH
- nádory mozku genetika patologie MeSH
- neuroepitelové nádory genetika patologie MeSH
- onkogenní fúze MeSH
- předškolní dítě MeSH
- represorové proteiny genetika MeSH
- transkripční faktory Krüppel-like genetika MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Central nervous system high-grade neuroepithelial tumor with MN1 alteration (CNS HGNET-MN1) is a rare recently described entity. Fourteen CNS HGNET-MN1 patients were identified using genome-wide methylation arrays/RT-PCR across seven institutions. All patients had surgery (gross total resection: 10; subtotal resection: four) as initial management followed by observation alone in three patients, followed by radiotherapy in eight patients (focal: five; craniospinal: two; CyberKnife: one) and systemic chemotherapy in three patients. Seven patients relapsed; five local and two metastatic, despite adjuvant radiotherapy, of which three died. Treatment of CNS HGNET-MN1 remains a major treatment challenge despite aggressive surgical resections and upfront radiotherapy, warranting new approaches to this rare malignancy.
- MeSH
- dítě MeSH
- dospělí MeSH
- kombinovaná terapie MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mutace * MeSH
- nádorové supresorové proteiny genetika MeSH
- nádory centrálního nervového systému genetika patologie terapie MeSH
- následné studie MeSH
- neuroepitelové nádory genetika patologie terapie MeSH
- předškolní dítě MeSH
- prognóza MeSH
- retrospektivní studie MeSH
- trans-aktivátory genetika MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Klíčová slova
- grafoelementy, resekce nádoru,
- MeSH
- antikonvulziva aplikace a dávkování MeSH
- bolesti hlavy etiologie MeSH
- diferenciální diagnóza MeSH
- dítě MeSH
- elektroencefalografie MeSH
- epilepsie etiologie farmakoterapie prevence a kontrola MeSH
- levetiracetam aplikace a dávkování MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- mozková kůra patologie MeSH
- neuroepitelové nádory * chirurgie diagnostické zobrazování patologie terapie MeSH
- výsledek terapie MeSH
- záchvaty etiologie farmakoterapie prevence a kontrola MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- biopsie MeSH
- dospělí MeSH
- imunohistochemie MeSH
- lidé MeSH
- meningeální nádory genetika chirurgie patologie MeSH
- mutace genetika MeSH
- neuroepitelové nádory * genetika chirurgie patologie MeSH
- oligodendrogliom genetika chirurgie patologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- biopsie MeSH
- dospělí MeSH
- imunohistochemie MeSH
- lidé MeSH
- meningeální nádory genetika chirurgie patologie MeSH
- mutace genetika MeSH
- neuroepitelové nádory * genetika chirurgie patologie MeSH
- oligodendrogliom genetika chirurgie patologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Rhabdoid phenotype and loss of SMARCB1 expression in a brain tumor are characteristic features of atypical teratoid/rhabdoid tumors (ATRT). Rare non-rhabdoid brain tumors showing cribriform growth pattern and SMARCB1 loss have been designated cribriform neuroepithelial tumor (CRINET). Small case series suggest that CRINETs may have a relatively favorable prognosis. However, the long-term outcome is unclear and it remains uncertain whether CRINET represents a distinct entity or a variant of ATRT. Therefore, 10 CRINETs were clinically and molecularly characterized and compared with 10 ATRTs of each of three recently described molecular subgroups (i.e. ATRT-TYR, ATRT-SHH and ATRT-MYC) using Illumina Infinium HumanMethylation450 arrays, FISH, MLPA, and sequencing. Furthermore, outcome was compared to a larger cohort of 27 children with ATRT-TYR. Median age of the 6 boys and 4 girls harboring a CRINET was 20 months. On histopathological examination, all CRINETs demonstrated a cribriform growth pattern and distinct tyrosinase staining. On unsupervised cluster analysis of methylation data, all CRINETs examined exclusively clustered within the ATRT-TYR molecular subgroup. As ATRT-TYR, CRINETs mainly showed large heterozygous 22q deletions (9/10) and SMARCB1 mutations of the other allele. In two patients, SMARCB1 mutations were also present in the germline. Estimated mean overall survival in patients with CRINETs was 125 months (95% confidence interval 100-151 months) as compared to only 53 (33-74) months in patients with ATRTs of the ATRT-TYR subgroup (Log-Rank P < 0.05). In conclusion, CRINET represents a SMARCB1-deficient non-rhabdoid tumor, which shares molecular similarities with the ATRT-TYR subgroup but has distinct histopathological features and favorable long-term outcome.
- MeSH
- dítě MeSH
- gen SMARCB1 nedostatek genetika MeSH
- Kaplanův-Meierův odhad MeSH
- kojenec MeSH
- lidé MeSH
- metylace DNA genetika MeSH
- mutace genetika MeSH
- nádory mozku genetika MeSH
- neparametrická statistika MeSH
- neuroepitelové nádory genetika patologie MeSH
- předškolní dítě MeSH
- rhabdoidní nádor genetika patologie MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
V následujícím krátkém sdělení autoři poukazují na atypickou formu dysembryoplastického neuroepiteliálního tumoru (DNET) u dětí s odlišným klinickým radiologickým, operačním a cytogenetickým profilem. Hlavním klinickým projevem DNET nádorů je epilepsie s dobrou odpovědí na resekční terapii. Tyto tumory rostou intrakortikálně s predominantní lokalizací v temporálním laloku. Autoři předkládají tři kazuistiky dětí s DNET tumorem operovaných během posledních osmi měsíců, přičemž jedna pacientka měla atypický klinický, pooperační a hlavně cytogenetický nález odpovídající v literatuře vzácně popisované atypické formě DNET.
In this short summary, the authors describe an atypical form of dysembryoplastic neuroepithelial tumor (DNET) in children that has a different clinical, radiological and cytological profile that the typical DNET. Epileptic seizures with good response to radical surgical resection are the main clinical feature of a typical DNET. These tumors are typically in frontal or temporal locations. We describe three patients who underwent surgery during the last eight months, including a girl with an atypical form of DNET presenting with atypical clinical and, mainly, cytogenetic findings.
- Klíčová slova
- neuroepiteliální nádory, atypické formy,
- MeSH
- cytogenetické vyšetření * MeSH
- diagnostické techniky molekulární MeSH
- dítě MeSH
- epilepsie parciální etiologie komplikace MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- nádory mozku * genetika chirurgie patologie MeSH
- neurochirurgické výkony MeSH
- neuroepitelové nádory * genetika chirurgie patologie MeSH
- předškolní dítě MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
