Department of Human Pathology, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, 371-8511, Gunma, Japan.
Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Japan.
Brain Tumor Pathol. 2019 Jul;36(3):103-111. doi: 10.1007/s10014-019-00344-z. Epub 2019 Apr 10.
We report four cases of high-grade astrocytoma with a BRAF V600E mutation, ATRX inactivation, and CDKN2A/B homozygous deletion. Children to young adults aged 3-46 presented with a well demarcated contrast-enhancing mass in the supratentorial area. Pathological examination revealed packed growth of short spindle to round polygonal cells including some pleomorphic cells. The tumors had less ability to infiltrate into the adjacent brain parenchyma and presented a circumscribed growth pattern. Mitosis was readily found, accompanied by focal necrosis and/or microvascular proliferation. Tumors were histologically similar in part to pleomorphic xanthoastrocytoma (PXA) or anaplastic PXA, but did not fit criteria for either neoplasm. A BRAF V600E mutation and homozygous deletion of CDKN2A/B were observed, which is similar to the genetic features of PXA or epithelioid glioblastoma, but the additional loss of ATRX nuclear immunoreactivity and absence of TERT promoter mutation were unusual findings, indicating a novel genetic profile. Despite their malignant histological features, all patients had a favorable clinical course and remained alive for 6 months to 28 years under standard medical treatment for malignant glioma. In summary, high grade astrocytomas with BRAF V600E, ATRX, and CDKN2A/B alternations had unique clinicopathological features and may be a novel subset of high grade glioma.
我们报告了 4 例具有 BRAF V600E 突变、 ATRX 失活和 CDKN2A/B 纯合缺失的高级别星形细胞瘤。3-46 岁的儿童至年轻成年人表现为幕上区边界清楚的对比增强肿块。病理检查显示短梭形至圆形多角形细胞的密集生长,包括一些多形性细胞。肿瘤对相邻脑实质的浸润能力较弱,呈局限性生长模式。有丝分裂很容易找到,伴有局灶性坏死和/或微血管增生。肿瘤在部分组织学上类似于多形性黄色星形细胞瘤(PXA)或间变性 PXA,但不符合这两种肿瘤的任何标准。观察到 BRAF V600E 突变和 CDKN2A/B 的纯合缺失,这与 PXA 或上皮样胶质母细胞瘤的遗传特征相似,但额外的 ATRX 核免疫反应缺失和 TERT 启动子突变缺失是不寻常的发现,表明存在一种新的遗传谱。尽管具有恶性组织学特征,但所有患者均具有良好的临床病程,在标准恶性胶质瘤治疗下,6 个月至 28 年仍存活。总之,具有 BRAF V600E、ATRX 和 CDKN2A/B 改变的高级别星形细胞瘤具有独特的临床病理特征,可能是高级别胶质瘤的一个新亚群。