中枢神经系统胚胎性肿瘤的分子诊断。

Molecular diagnostics of CNS embryonal tumors.

机构信息

German Cancer Research Center, Heidelberg, Germany.

出版信息

Acta Neuropathol. 2010 Nov;120(5):553-66. doi: 10.1007/s00401-010-0751-5. Epub 2010 Sep 30.

Abstract

Tremendous progress has recently been made in both molecular subgrouping, and the establishment of prognostic biomarkers for embryonal brain tumors, particularly medulloblastoma. Several prognostic biomarkers that were initially identified in retrospective cohorts of medulloblastoma, including MYC and MYCN amplification, nuclear β-catenin accumulation, and chromosome 17 aberrations have now been validated in clinical trials. Moreover, molecular subgroups based on distinct transcriptome profiles have been consistently reported from various groups on different platforms demonstrating that the concept of distinct medulloblastoma subgroups is very robust. Well-described subgroups of medulloblastomas include tumors showing wingless signaling pathway (Wnt) activation, and another characterized by sonic hedgehog pathway activity. Two or more additional subgroups were consistently reported to contain the vast majority of high-risk tumors, including most tumors with metastatic disease at diagnosis and/or large cell/anaplastic histology. Several years ago, atypical teratoid rhabdoid tumor (AT/RT) was recognized as a separate entity based on its distinct biology and particularly aggressive clinical behavior. These tumors may occur supra or infratentorially and are usually found to have genetic alterations of SMARCB1 (INI1/hSNF5), a tumor suppressor gene located on chromosome 22q. Subsequent loss of SMARCB1 protein expression comprises a relatively specific and sensitive diagnostic marker for AT/RT. For CNS primitive neuroectodermal tumors (CNS PNETs), a consistent finding has been that they are molecularly distinct from medulloblastoma. Furthermore, a distinct fraction of CNS PNETs with particularly poor prognosis only occurring in young children was delineated, which was previously labeled ependymoblastoma or embryonal tumor with abundant neuropil and true rosettes (ETANTR) and which is morphologically characterized by the presence of multilayered "ependymoblastic" rosettes. This group of tumors shows a unique cytogenetic abnormality not seen in other brain tumors: focal amplification of a micro-RNA cluster at chromosome 19q13.42, which has never been found to be amplified in other CNS PNETs, medulloblastoma or AT/RT. In summary, these consistent findings have significantly contributed to our ability to sub-classify embryonal brain tumors into clinically and biologically meaningful strata and, for some of the subgroups, have led to the identification of specific targets for future development of molecularly targeted therapies.

摘要

最近在胚胎性脑肿瘤的分子亚群分类和预后生物标志物的建立方面取得了巨大进展,特别是髓母细胞瘤。最初在髓母细胞瘤的回顾性队列中确定的几个预后生物标志物,包括 MYC 和 MYCN 扩增、核 β-连环蛋白积累和 17 号染色体异常,现在已经在临床试验中得到验证。此外,基于不同转录组图谱的分子亚群已在不同平台的不同小组中得到一致报道,证明了不同髓母细胞瘤亚群的概念非常稳健。描述良好的髓母细胞瘤亚组包括显示无翅信号通路 (Wnt) 激活的肿瘤和另一种以 sonic hedgehog 通路活性为特征的肿瘤。两个或更多其他亚组被一致报道包含绝大多数高危肿瘤,包括大多数在诊断时具有转移性疾病和/或大细胞/间变性组织学的肿瘤。几年前,根据其独特的生物学特性和特别侵袭性的临床行为,认识到非典型畸胎样横纹肌样肿瘤 (AT/RT) 是一种独立的实体。这些肿瘤可能发生在幕上或幕下,通常发现存在位于染色体 22q 上的肿瘤抑制基因 SMARCB1 (INI1/hSNF5) 的遗传改变。随后的 SMARCB1 蛋白表达缺失构成了 AT/RT 的相对特异性和敏感性诊断标志物。对于中枢神经系统原始神经外胚层肿瘤 (CNS PNETs),一致的发现是它们在分子上与髓母细胞瘤不同。此外,还划定了一个预后特别差的 CNS PNET 亚组,仅发生在幼儿中,以前称为室管膜母细胞瘤或富含神经纤维的胚胎肿瘤和真正的玫瑰花结 (ETANTR),其形态学特征是存在多层“室管膜样”玫瑰花结。该组肿瘤表现出一种独特的细胞遗传学异常,在其他脑肿瘤中从未发现过:19q13.42 染色体上微小 RNA 簇的局灶性扩增,这在其他 CNS PNETs、髓母细胞瘤或 AT/RT 中从未发现过扩增。总之,这些一致的发现极大地促进了我们将胚胎性脑肿瘤分为具有临床和生物学意义的亚类的能力,对于一些亚组,已经确定了用于未来开发分子靶向治疗的特定靶点。

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索