Furuta Takuya, Miyoshi Hiroaki, Komaki Satoru, Arakawa Fumiko, Morioka Motohiro, Ohshima Koichi, Nakada Mitsutoshi, Sugita Yasuo
Department of Pathology, Kurume University School of Medicine, Kurume, Japan.
Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan.
Neuropathology. 2018 Jun;38(3):218-227. doi: 10.1111/neup.12459. Epub 2018 Mar 13.
Epithelioid glioblastoma (eGBM) is a rare variant of GBM which was adopted in the 2016 WHO classification. eGBM and pleomorphic xanthoastrocytoma (PXA) sometimes show overlapping features histologically and genetically, such as epithelioid pattern and a highly frequent V600E mutation in the gene for vRAF murine sarcoma viral oncogene homolog B1 (BRAF), respectively. Accurate diagnosis of these rare tumors is challenging according to the new criteria in the revised 2016 WHO classification. It is an urgent task to elucidate the biological properties of the tumors and to select appropriate treatment. Twenty consecutive cases diagnosed as PXA or eGBM histologically were investigated. Twelve of the 20 cases were PXAs and eight were eGBMs. Morphologically, mitotic activity, necrosis and degenerative changes such as intracellular lipid accumulation, eosinophilic granular bodies and reticulin fiber deposits were scored. Immunohistochemical and molecular biological assessment for isocitrate dehydrogenases 1 and 2 (IDH1/2), α-thalassemia/mental-retardation-syndrome-X-linked gene (ATRX), p53, BRAF, telomere reverse transcriptase promoter (TERT-p), H3F3A, and integrase interactor 1 (INI1) were performed. eGBM tended to lack the degenerative changes characteristic for PXA. Of the 20 cases tested, Sanger technique showed no mutation in IDH1/2. BRAF mutation at T1799 > A (V600E) was detected in 4/12 (33.3%) PXA and 4/8 (50.0%) eGBM, while TERT-p mutation was detected at C228 > T in 2/12 (16.7%) PXA and at C250 > T in 1/8 (12.5%) eGBM. Retained nuclear ATRX was observed in 12/12 (100%) PXA and 6/7 (85.7%) eGBM while p53 mutation was observed in 2/10 (20%) PXA and 7/7 (100%) eGBM. All tumors retained INI1 expression in their nuclei. None of the tumors harbored H3F3A mutation. One PXA without BRAF mutation acquired TERT-p mutation at recurrence and one eGBM harbored both BRAF and TERT-p mutation. Molecular biological similarity between eGBM and PXA was suggested in our series, while degenerative changes reflected the features of PXA. It was speculated that the common genetic alterations for development and progression of eGBM and PXA might include BRAF and TERT-p mutations.
上皮样胶质母细胞瘤(eGBM)是胶质母细胞瘤的一种罕见变体,已被纳入2016年世界卫生组织(WHO)分类。eGBM和多形性黄色星形细胞瘤(PXA)有时在组织学和遗传学上表现出重叠特征,例如上皮样模式以及vRAF鼠肉瘤病毒癌基因同源物B1(BRAF)基因中高度频发的V600E突变。根据2016年WHO修订分类中的新标准,准确诊断这些罕见肿瘤具有挑战性。阐明肿瘤的生物学特性并选择合适的治疗方法是一项紧迫任务。对连续20例经组织学诊断为PXA或eGBM的病例进行了研究。20例病例中12例为PXA,8例为eGBM。在形态学上,对有丝分裂活性、坏死以及退行性改变(如细胞内脂质蓄积、嗜酸性颗粒体和网状纤维沉积)进行了评分。对异柠檬酸脱氢酶1和2(IDH1/2)、α地中海贫血/智力发育迟缓综合征X连锁基因(ATRX)、p53、BRAF、端粒逆转录酶启动子(TERT-p)、H3F3A和整合酶相互作用因子1(INI1)进行了免疫组织化学和分子生物学评估。eGBM往往缺乏PXA特有的退行性改变。在检测的20例病例中,桑格技术显示IDH1/2无突变。在4/12(33.3%)的PXA和4/8(50.0%)的eGBM中检测到BRAF基因T1799>A(V600E)突变,而在2/12(16.7%)的PXA中检测到TERT-p基因C228>T突变,在1/8(12.5%)的eGBM中检测到TERT-p基因C250>T突变。在12/12(100%)的PXA和