CNS5:Diffuse leptomeningeal glioneuronal tumour: Difference between revisions
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{{DISPLAYTITLE:Diffuse leptomeningeal glioneuronal tumour}} | |||
[[CNS5:Table_of_Contents|Central Nervous System Tumours (WHO Classification, 5th ed.)]] | |||
{{Under Construction}} | {{Under Construction}} | ||
<br /> | |||
==Primary Author(s)*== | ==Primary Author(s)*== | ||
Laveniya Satgunaseelan, MBBS BMedSc FRCPA, Royal Prince Alfred Hospital | |||
==WHO Classification of Disease== | ==WHO Classification of Disease== | ||
{| class="wikitable" | {| class="wikitable" | ||
!Structure | !Structure | ||
| Line 12: | Line 17: | ||
|- | |- | ||
|Book | |Book | ||
| | |Central Nervous System Tumours (5th ed.) | ||
|- | |- | ||
|Category | |Category | ||
| | |Gliomas, glioneuronal tumours, and neuronal tumours | ||
|- | |- | ||
|Family | |Family | ||
| | |Gliomas, glioneuronal tumours, and neuronal tumours | ||
|- | |- | ||
|Type | |Type | ||
| | |Glioneuronal and neuronal tumours | ||
|- | |- | ||
|Subtype(s) | |Subtype(s) | ||
| | |Diffuse leptomeningeal glioneuronal tumour | ||
|} | |} | ||
==Related Terminology== | ==Related Terminology== | ||
{| class="wikitable" | {| class="wikitable" | ||
|+ | |||
|Acceptable | |Acceptable | ||
| | |N/A | ||
|- | |- | ||
|Not | |Not Recommended | ||
| | |Disseminated oligodendroglioma-like leptomeningeal neoplasm; primary leptomeningeal oligodendrogliomatosis | ||
|} | |} | ||
== | |||
==Gene Rearrangements== | |||
{| class="wikitable sortable" | {| class="wikitable sortable" | ||
|- | |- | ||
!Driver Gene!! | !Driver Gene!!Fusion(s) and Common Partner Genes!!Molecular Pathogenesis!!Typical Chromosomal Alteration(s) | ||
! | !Prevalence -Common >20%, Recurrent 5-20% or Rare <5% (Disease) | ||
! | !Diagnostic, Prognostic, and Therapeutic Significance - D, P, T | ||
! | !Established Clinical Significance Per Guidelines - Yes or No (Source) | ||
!Notes | !Clinical Relevance Details/Other Notes | ||
|- | |- | ||
| | |''BRAF'' | ||
| | |''KIAA1549::BRAF'' | ||
| | |Tandem duplication at chr7q34 - duplication and insertion of ~2Mb fragment resulting in fusion of 5’ of ''KIAA1549'' with 3’ of ''BRAF''||t(7;7)(q34;q34) | ||
| | |Common (72%; WHO) | ||
|< | |D, T | ||
| | |Yes (WHO) | ||
| | |Case report evidence of efficacy of BRAF inhibitors in DLGNT case harboring ''KIAA1549::BRAF'' fusion<ref>{{Cite journal|last=Valiakhmetova|first=Andge|last2=Papusha|first2=Ludmila|last3=Yasko|first3=Ludmila|last4=Druy|first4=Alexander|last5=Karachunsky|first5=Alexander|last6=Novichkova|first6=Galina|last7=Hwang|first7=Eugene I|last8=Packer|first8=Roger J|date=2020-12-04|title=LGG-26. DIFFUSE LEPTOMENINGEAL GLIONEURONAL TUMOR (DLGNT) IN CHILDREN: DIFFERENT CLINICAL PRESENTATIONS AND OUTCOMES|url=https://academic.oup.com/neuro-oncology/article/22/Supplement_3/iii371/6018960|journal=Neuro-Oncology|language=en|volume=22|issue=Supplement_3|pages=iii371–iii371|doi=10.1093/neuonc/noaa222.408|issn=1522-8517|pmc=7715974}}</ref> | ||
|- | |- | ||
| | |''NTRK1/2/3'' | ||
| | |Fusion partner not specified (PMID: 29766299) | ||
| | |Downstream activation of MAPK/ERK signalling pathway in CNS tumors | ||
| | |Not specified | ||
|< | |Rare | ||
| | |D,T | ||
| | |Yes (WHO) | ||
| | |3 cases with ''NTRK1/2/3'' fusions<ref>{{Cite journal|last=Deng|first=Maximilian Y.|last2=Sill|first2=Martin|last3=Chiang|first3=Jason|last4=Schittenhelm|first4=Jens|last5=Ebinger|first5=Martin|last6=Schuhmann|first6=Martin U.|last7=Monoranu|first7=Camelia-Maria|last8=Milde|first8=Till|last9=Wittmann|first9=Andrea|date=2018-08|title=Molecularly defined diffuse leptomeningeal glioneuronal tumor (DLGNT) comprises two subgroups with distinct clinical and genetic features|url=https://pubmed.ncbi.nlm.nih.gov/29766299|journal=Acta Neuropathologica|volume=136|issue=2|pages=239–253|doi=10.1007/s00401-018-1865-4|issn=1432-0533|pmid=29766299}}</ref> | ||
|- | |||
|''RAF1'' | |||
|''TRIM33:RAF1'' | |||
|Downstream activation of MAPK/ERK signalling pathway in CNS tumors | |||
|t(1;3)(p13;p25) | |||
|Rare | |||
|D | |||
|Yes (WHO) | |||
|1 case with ''TRIM33::RAF1'' fusion<ref>{{Cite journal|last=Deng|first=Maximilian Y.|last2=Sill|first2=Martin|last3=Chiang|first3=Jason|last4=Schittenhelm|first4=Jens|last5=Ebinger|first5=Martin|last6=Schuhmann|first6=Martin U.|last7=Monoranu|first7=Camelia-Maria|last8=Milde|first8=Till|last9=Wittmann|first9=Andrea|date=2018-08|title=Molecularly defined diffuse leptomeningeal glioneuronal tumor (DLGNT) comprises two subgroups with distinct clinical and genetic features|url=https://pubmed.ncbi.nlm.nih.gov/29766299|journal=Acta Neuropathologica|volume=136|issue=2|pages=239–253|doi=10.1007/s00401-018-1865-4|issn=1432-0533|pmid=29766299}}</ref> | |||
|- | |- | ||
| | | colspan="8" | | ||
| | |} | ||
==Individual Region Genomic Gain/Loss/LOH== | |||
{| class="wikitable sortable" | |||
| | |||
|- | |- | ||
!Chr #!!Gain, Loss, Amp, LOH!!Minimal Region Cytoband and/or Genomic Coordinates [Genome Build; Size]!!Relevant Gene(s) | |||
!Diagnostic, Prognostic, and Therapeutic Significance - D, P, T | |||
!Established Clinical Significance Per Guidelines - Yes or No (Source) | |||
!Clinical Relevance Details/Other Notes | |||
! | |||
|- | |- | ||
|1p | |||
|Loss | |||
|Complete arm loss (PMIDs: 22941225, 29766299) | |||
|Chr1p | |||
|Unknown | |||
|D | |||
|Yes (WHO) | |||
|Prevalence common, between 59% (by FISH; PMIDs: 22596013, 17184079, 19486008, 22941225, 25720745) and 100% (by CNV calling from DNA methylation array data<ref>{{Cite journal|last=Deng|first=Maximilian Y.|last2=Sill|first2=Martin|last3=Chiang|first3=Jason|last4=Schittenhelm|first4=Jens|last5=Ebinger|first5=Martin|last6=Schuhmann|first6=Martin U.|last7=Monoranu|first7=Camelia-Maria|last8=Milde|first8=Till|last9=Wittmann|first9=Andrea|date=2018-08|title=Molecularly defined diffuse leptomeningeal glioneuronal tumor (DLGNT) comprises two subgroups with distinct clinical and genetic features|url=https://pubmed.ncbi.nlm.nih.gov/29766299|journal=Acta Neuropathologica|volume=136|issue=2|pages=239–253|doi=10.1007/s00401-018-1865-4|issn=1432-0533|pmid=29766299}}</ref>). | |||
|- | |- | ||
|< | |1q | ||
| | |Gain | ||
| | |Complete arm gain (PMIDs: 29766299, 30465258) | ||
| | |Chr1q | ||
|Unknown | |||
| | |D | ||
| | |Yes (WHO) | ||
| | |Prevalence common, between 56% and 63% (by CNV calling from DNA methylation array data<ref>{{Cite journal|last=Deng|first=Maximilian Y.|last2=Sill|first2=Martin|last3=Chiang|first3=Jason|last4=Schittenhelm|first4=Jens|last5=Ebinger|first5=Martin|last6=Schuhmann|first6=Martin U.|last7=Monoranu|first7=Camelia-Maria|last8=Milde|first8=Till|last9=Wittmann|first9=Andrea|date=2018-08|title=Molecularly defined diffuse leptomeningeal glioneuronal tumor (DLGNT) comprises two subgroups with distinct clinical and genetic features|url=https://pubmed.ncbi.nlm.nih.gov/29766299|journal=Acta Neuropathologica|volume=136|issue=2|pages=239–253|doi=10.1007/s00401-018-1865-4|issn=1432-0533|pmid=29766299}}</ref><ref>{{Cite journal|last=Chiang|first=Jason|last2=Dalton|first2=James|last3=Upadhyaya|first3=Santhosh A.|last4=Patay|first4=Zoltán|last5=Qaddoumi|first5=Ibrahim|last6=Li|first6=Xiaoyu|last7=Segura|first7=Annette D.|last8=Sharma|first8=Suash|last9=Ismail|first9=Azzam|date=2019-01|title=Chromosome arm 1q gain is an adverse prognostic factor in localized and diffuse leptomeningeal glioneuronal tumors with BRAF gene fusion and 1p deletion|url=https://pubmed.ncbi.nlm.nih.gov/30465258|journal=Acta Neuropathologica|volume=137|issue=1|pages=179–181|doi=10.1007/s00401-018-1940-x|issn=1432-0533|pmid=30465258}}</ref>) | ||
Found in all cases of DLGNT methylation class (MC)-2<ref>{{Cite journal|last=Deng|first=Maximilian Y.|last2=Sill|first2=Martin|last3=Chiang|first3=Jason|last4=Schittenhelm|first4=Jens|last5=Ebinger|first5=Martin|last6=Schuhmann|first6=Martin U.|last7=Monoranu|first7=Camelia-Maria|last8=Milde|first8=Till|last9=Wittmann|first9=Andrea|date=2018-08|title=Molecularly defined diffuse leptomeningeal glioneuronal tumor (DLGNT) comprises two subgroups with distinct clinical and genetic features|url=https://pubmed.ncbi.nlm.nih.gov/29766299|journal=Acta Neuropathologica|volume=136|issue=2|pages=239–253|doi=10.1007/s00401-018-1865-4|issn=1432-0533|pmid=29766299}}</ref> | |||
|- | |- | ||
| | | colspan="8" | | ||
| | |||
|} | |} | ||
==Characteristic Chromosomal or Other Global Mutational Patterns== | ==Characteristic Chromosomal or Other Global Mutational Patterns== | ||
{| class="wikitable sortable" | {| class="wikitable sortable" | ||
|- | |- | ||
!Chromosomal Pattern | !Chromosomal Pattern | ||
! | !Molecular Pathogenesis | ||
! | !Prevalence - | ||
! | Common >20%, Recurrent 5-20% or Rare <5% (Disease) | ||
! | !Diagnostic, Prognostic, and Therapeutic Significance - D, P, T | ||
!Notes | !Established Clinical Significance Per Guidelines - Yes or No (Source) | ||
!Clinical Relevance Details/Other Notes | |||
|- | |- | ||
| | |Co-deletion of 1p and 19q | ||
|< | |Unknown | ||
| | |Recurrent to common | ||
| | |D | ||
|Yes (WHO) | |||
|Prevalence between 18% and 33%<ref>{{Cite journal|last=Rodriguez|first=Fausto J.|last2=Schniederjan|first2=Matthew J.|last3=Nicolaides|first3=Theo|last4=Tihan|first4=Tarik|last5=Burger|first5=Peter C.|last6=Perry|first6=Arie|date=2015-04|title=High rate of concurrent BRAF-KIAA1549 gene fusion and 1p deletion in disseminated oligodendroglioma-like leptomeningeal neoplasms (DOLN)|url=https://pubmed.ncbi.nlm.nih.gov/25720745|journal=Acta Neuropathologica|volume=129|issue=4|pages=609–610|doi=10.1007/s00401-015-1400-9|issn=1432-0533|pmc=4696044|pmid=25720745}}</ref><ref>{{Cite journal|last=Deng|first=Maximilian Y.|last2=Sill|first2=Martin|last3=Chiang|first3=Jason|last4=Schittenhelm|first4=Jens|last5=Ebinger|first5=Martin|last6=Schuhmann|first6=Martin U.|last7=Monoranu|first7=Camelia-Maria|last8=Milde|first8=Till|last9=Wittmann|first9=Andrea|date=2018-08|title=Molecularly defined diffuse leptomeningeal glioneuronal tumor (DLGNT) comprises two subgroups with distinct clinical and genetic features|url=https://pubmed.ncbi.nlm.nih.gov/29766299|journal=Acta Neuropathologica|volume=136|issue=2|pages=239–253|doi=10.1007/s00401-018-1865-4|issn=1432-0533|pmid=29766299}}</ref> | |||
|- | |- | ||
| | | colspan="6" | | ||
| | |||
|} | |} | ||
==Gene Mutations (SNV / INDEL)== | |||
==Gene Mutations (SNV/INDEL)== | |||
{| class="wikitable sortable" | {| class="wikitable sortable" | ||
|- | |- | ||
!Gene!! | !Gene!!Genetic Alteration!!Tumor Suppressor Gene, Oncogene, Other!!Prevalence - | ||
! | Common >20%, Recurrent 5-20% or Rare <5% (Disease) | ||
!Notes | !Diagnostic, Prognostic, and Therapeutic Significance - D, P, T | ||
!Established Clinical Significance Per Guidelines - Yes or No (Source) | |||
!Clinical Relevance Details/Other Notes | |||
|- | |- | ||
|< | |''BRAF'' | ||
|p.V600E (activating mutation) | |||
|Oncogene | |||
<br /> | |||
|Rare | |||
|D, T | |||
|Yes (WHO, NCCN) | |||
|Rare reports of DLGNTs harboring ''BRAF'' p.V600E mutations\<ref>{{Cite journal|last=Dodgshun|first=Andrew J.|last2=SantaCruz|first2=Nadine|last3=Hwang|first3=Jaeho|last4=Ramkissoon|first4=Shakti H.|last5=Malkin|first5=Hayley|last6=Bergthold|first6=Guillaume|last7=Manley|first7=Peter|last8=Chi|first8=Susan|last9=MacGregor|first9=Duncan|date=2016-06|title=Disseminated glioneuronal tumors occurring in childhood: treatment outcomes and BRAF alterations including V600E mutation|url=https://pubmed.ncbi.nlm.nih.gov/26994902|journal=Journal of Neuro-Oncology|volume=128|issue=2|pages=293–302|doi=10.1007/s11060-016-2109-x|issn=1573-7373|pmid=26994902}}</ref><ref>{{Cite journal|last=Appay|first=Romain|last2=Pages|first2=Mélanie|last3=Colin|first3=Carole|last4=Jones|first4=David T. W.|last5=Varlet|first5=Pascale|last6=Figarella-Branger|first6=Dominique|date=2020-06-30|title=Diffuse leptomeningeal glioneuronal tumor: a double misnomer? A report of two cases|url=https://pubmed.ncbi.nlm.nih.gov/32605662|journal=Acta Neuropathologica Communications|volume=8|issue=1|pages=95|doi=10.1186/s40478-020-00978-7|issn=2051-5960|pmc=7325675|pmid=32605662}}</ref>, including abstracts detailing efficacy of BRAF inhibtors in ''BRAF''-mutant DLGNT<ref>{{Cite journal|last=Valiakhmetova|first=Andge|last2=Papusha|first2=Ludmila|last3=Yasko|first3=Ludmila|last4=Druy|first4=Alexander|last5=Karachunsky|first5=Alexander|last6=Novichkova|first6=Galina|last7=Hwang|first7=Eugene I|last8=Packer|first8=Roger J|date=2020-12-04|title=LGG-26. DIFFUSE LEPTOMENINGEAL GLIONEURONAL TUMOR (DLGNT) IN CHILDREN: DIFFERENT CLINICAL PRESENTATIONS AND OUTCOMES|url=https://academic.oup.com/neuro-oncology/article/22/Supplement_3/iii371/6018960|journal=Neuro-Oncology|language=en|volume=22|issue=Supplement_3|pages=iii371–iii371|doi=10.1093/neuonc/noaa222.408|issn=1522-8517|pmc=7715974}}</ref><ref>{{Cite journal|last=Aung|first=Le Le|date=2020-12-01|title=HGG-06. REMARKABLE RESPONSE TO BRAF INHIBITOR IN AN INFANT WITH DISSEMINATED DIFFUSE LEPTOMENINGEAL GLIONEURONAL TUMOR (DLGNT)|url=https://doi.org/10.1093/neuonc/noaa222.297|journal=Neuro-Oncology|volume=22|issue=Supplement_3|pages=iii345|doi=10.1093/neuonc/noaa222.297|issn=1522-8517|pmc=7715114}}</ref>) | |||
<br /> | <br /> | ||
|- | |- | ||
| | |''PIK3CA'' | ||
|p.E545A | |||
'' | |Oncogene | ||
|< | <br /> | ||
|Rare | |||
|Nil | |||
|< | |No | ||
| | |Case report of co-occurring ''PIK3CA'' variant<ref>{{Cite journal|last=Appay|first=Romain|last2=Pages|first2=Mélanie|last3=Colin|first3=Carole|last4=Jones|first4=David T. W.|last5=Varlet|first5=Pascale|last6=Figarella-Branger|first6=Dominique|date=2020-06-30|title=Diffuse leptomeningeal glioneuronal tumor: a double misnomer? A report of two cases|url=https://pubmed.ncbi.nlm.nih.gov/32605662|journal=Acta Neuropathologica Communications|volume=8|issue=1|pages=95|doi=10.1186/s40478-020-00978-7|issn=2051-5960|pmc=7325675|pmid=32605662}}</ref> | ||
| | |||
| | |||
| | |||
|- | |- | ||
| | |''TERT'' | ||
|Activating mutations in promoter region | |||
'' | |Oncogene | ||
| | |Rare | ||
|Nil | |||
|No | |||
|< | |Point mutations described include C228T and C228A<ref>{{Cite journal|last=Deng|first=Maximilian Y.|last2=Sill|first2=Martin|last3=Chiang|first3=Jason|last4=Schittenhelm|first4=Jens|last5=Ebinger|first5=Martin|last6=Schuhmann|first6=Martin U.|last7=Monoranu|first7=Camelia-Maria|last8=Milde|first8=Till|last9=Wittmann|first9=Andrea|date=2018-08|title=Molecularly defined diffuse leptomeningeal glioneuronal tumor (DLGNT) comprises two subgroups with distinct clinical and genetic features|url=https://pubmed.ncbi.nlm.nih.gov/29766299|journal=Acta Neuropathologica|volume=136|issue=2|pages=239–253|doi=10.1007/s00401-018-1865-4|issn=1432-0533|pmid=29766299}}</ref> | ||
| | |||
| | |||
|- | |- | ||
| | | | ||
| Line 219: | Line 178: | ||
| | | | ||
| | | | ||
|}Note: A more extensive list of mutations can be found in | |}Note: A more extensive list of mutations can be found in [https://www.cbioportal.org/ <u>cBioportal</u>], [https://cancer.sanger.ac.uk/cosmic <u>COSMIC</u>], and/or other databases. When applicable, gene-specific pages within the CCGA site directly link to pertinent external content. | ||
==Epigenomic Alterations== | ==Epigenomic Alterations== | ||
On methylation profiling of a large series of DLGNTs, two methylation classes have been defined - DLGNT methylation class (MC)-1 and DLGNT methylation class (MC)-2. All cases of DLGNT-MC-2 exhibited gain of chr1q, with 1p/19q codeletion more common in DLGNT-MC-1<ref>{{Cite journal|last=Deng|first=Maximilian Y.|last2=Sill|first2=Martin|last3=Chiang|first3=Jason|last4=Schittenhelm|first4=Jens|last5=Ebinger|first5=Martin|last6=Schuhmann|first6=Martin U.|last7=Monoranu|first7=Camelia-Maria|last8=Milde|first8=Till|last9=Wittmann|first9=Andrea|date=2018-08|title=Molecularly defined diffuse leptomeningeal glioneuronal tumor (DLGNT) comprises two subgroups with distinct clinical and genetic features|url=https://pubmed.ncbi.nlm.nih.gov/29766299|journal=Acta Neuropathologica|volume=136|issue=2|pages=239–253|doi=10.1007/s00401-018-1865-4|issn=1432-0533|pmid=29766299}}</ref>. | |||
==Genes and Main Pathways Involved== | ==Genes and Main Pathways Involved== | ||
{| class="wikitable sortable" | {| class="wikitable sortable" | ||
|- | |- | ||
!Gene; Genetic Alteration!!Pathway!!Pathophysiologic Outcome | !Gene; Genetic Alteration!!Pathway!!Pathophysiologic Outcome | ||
|- | |- | ||
| | |''BRAF, FGFR1''; Activating mutations | ||
| | |MAPK signaling | ||
| | |Increased cell growth and proliferation | ||
|- | |- | ||
| | |''FGFR1, PIK3CA''; Activating mutations | ||
| | |PI3K–Akt signaling pathway | ||
| | |Increased cell growth, proliferation, survival and motility | ||
|- | |- | ||
| | | colspan="3" | | ||
| | |||
|} | |} | ||
==Genetic Diagnostic Testing Methods== | ==Genetic Diagnostic Testing Methods== | ||
- Fusion detection via targeted NGS (RNA or DNA panels) or FISH | |||
- Chromosomal alterations can be detected by FISH, SNP array, methylation array or NGS | |||
- Methylation profiling via CNS tumor classifiers for DLGNT-MCs | |||
==Familial Forms== | ==Familial Forms== | ||
One case of DLGNT in which a germline mutation in ''RAF1'' has been documented<ref>{{Cite journal|last=Dodgshun|first=Andrew J.|last2=SantaCruz|first2=Nadine|last3=Hwang|first3=Jaeho|last4=Ramkissoon|first4=Shakti H.|last5=Malkin|first5=Hayley|last6=Bergthold|first6=Guillaume|last7=Manley|first7=Peter|last8=Chi|first8=Susan|last9=MacGregor|first9=Duncan|date=2016-06|title=Disseminated glioneuronal tumors occurring in childhood: treatment outcomes and BRAF alterations including V600E mutation|url=https://pubmed.ncbi.nlm.nih.gov/26994902|journal=Journal of Neuro-Oncology|volume=128|issue=2|pages=293–302|doi=10.1007/s11060-016-2109-x|issn=1573-7373|pmid=26994902}}</ref>. | |||
<br /> | |||
==Additional Information== | ==Additional Information== | ||
Put your text here | Put your text here | ||
==Links== | ==Links== | ||
Put a link here or anywhere appropriate in this page <span style="color:#0070C0">(''Instructions: Highlight the text to which you want to add a link in this section or elsewhere, select the "Link" icon at the top of the wiki page, and search the name of the internal page to which you want to link this text, or enter an external internet address by including the "<nowiki>http://www</nowiki>." portion.'')</span> | |||
==References== | ==References== | ||
<references /> | |||
==Notes== | ==Notes== | ||
<nowiki>*</nowiki>Primary authors will typically be those that initially create and complete the content of a page. If a subsequent user modifies the content and feels the effort put forth is of high enough significance to warrant listing in the authorship section, please contact the CCGA | <nowiki>*</nowiki>Primary authors will typically be those that initially create and complete the content of a page. If a subsequent user modifies the content and feels the effort put forth is of high enough significance to warrant listing in the authorship section, please contact the [[Leadership|''<u>Associate Editor</u>'']] or other CCGA representative. When pages have a major update, the new author will be acknowledged at the beginning of the page, and those who contributed previously will be acknowledged below as a prior author. | ||
[[Category:CNS5]] | |||
[[Category:DISEASE]] | |||
[[Category:Diseases D]] | |||