Glial and glioneuronal tumors: Navigating the complexity of evolving concepts and new classification.

The World Health Organization (WHO) published the 5th edition classification of tumors of central nervous system in 2021, commonly abbreviated as WHO CNS5, which became the new standard for brain tumor diagnosis and therapy. This edition dramatically impacted tumor diagnostics. In short it introduced new tumors, changed the names of previously recognized tumors, and modified the working definition of previously known tumors. The new system appears complex due to the integration of morphological and multiple molecular criteria. The most radical changes occurred in the field of glial and glioneuronal tumors, which constitutes the lengthy first chapter of this new edition. Herein we present an illustrative outline of the evolving concepts of glial and glioneuronal tumors. We also attempt to explain the rationales behind this substantial change in tumor classification and the challenges to update and integrate it into clinical practice. We aim to present a concise and precise roadmap to aid navigation through the intricate conceptual framework of glial and glioneuronal tumors in the context of WHO CNS5.

Postmortem Diagnosis of the Proteus Syndrome by Next Generation Sequencing of Affected Brain Tissue.

We report a case of a somatic overgrowth syndrome diagnosed at forensic autopsy with the aid of next generation sequencing as Proteus syndrome. Somatic overgrowth syndromes result from spontaneous somatic mutations that arise early in development and display a mosaic pattern of expression in patient tissues. Due to the temporal and anatomic heterogeneity of these syndromes, phenotypes vary widely, resulting in clinical overlap. Furthermore, the variable ratio of mutated to nonmutated cells in patient tissue can result in low-level mutations that could be missed using Sanger sequencing. Due to these factors, recent literature points to next generation sequencing (NGS) as an adjunct to diagnosis of these rare entities. A male in his fourth decade of life presented to our forensic autopsy service with physical features suggestive of a somatic overgrowth syndrome. Due to the paucity of clinical information accompanying the individual, a definitive diagnosis based on physical characteristics, alone, was not possible. Next generation sequencing of affected formalin-fixed and paraffin-embedded brain tissue confirmed the presence of the variant in AKT1 (c.49G>A, p.Glu17Lys, in 14.13% of reads) found in Proteus syndrome. To our knowledge, this is the first report of the mosaic variant of AKT1 detected in brain tissue and the first reported case of a postmortem diagnosis of Proteus syndrome with the aid of NGS. We conclude that NGS can be used as an adjunctive method to support a specific diagnosis among the somatic overgrowth syndromes postmortem in the absence of sufficient clinical history.

Epithelioid Sarcoma Arising in a Long-Term Survivor of an Atypical Teratoid/Rhabdoid Tumor in a Patient With Rhabdoid Tumor Predisposition Syndrome.

Rhabdoid tumor predisposition syndrome (RTPS) is defined as the presence of a SMARCB1 or SMARCA4 genetic aberration in a patient with malignant rhabdoid tumor. Patients with RTPS are more likely to present with synchronous or metachronous rhabdoid tumors. Based on the current state of rhabdoid tumor taxonomy, these diagnoses are based largely on patient demographics, anatomic location of disease, and immunohistochemistry, despite their nearly identical histologic and immunohistochemical profiles. Thus, the true distinction between such tumors remains a diagnostic challenge. Central nervous system atypical teratoid/rhabdoid tumor (AT/RT) is a rare, aggressive, primarily pediatric malignancy with variable histologic features and a well documented association with loss of SMARCB1 expression. Epithelioid sarcoma (ES) is a rare soft tissue tumor arising in patients of all ages and characteristically staining for both mesenchymal and epithelial immunohistochemical markers while usually demonstrating loss of SMARCB1 expression. To our knowledge we herein present the first documented case of a patient with RTPS who presented with metachronous AT/RT and ES.

Lovastatin protects against cisplatin-induced hearing loss in mice.

Cisplatin is used to treat a variety of solid tumors in both children and adults. However, cisplatin has serious side-effects, some of which may permanently affect patients' quality of life following treatment, such as ototoxicity. There is currently no FDA-approved therapy for the prevention or treatment of cisplatin-induced hearing loss. Herein we examine the potential for statins to prevent cisplatin-induced ototoxicity. Statins, a class of drugs commonly used to prevent or manage hypercholesterolemia, have been of clinical utility for decades with dependable outcomes and reliable safety profiles in humans. Statins are known to be protective in animal models of noise-induced and age-related hearing loss. Moreover, studies have demonstrated an additive benefit of statins in cancer treatment. In the current study, lovastatin reduces cisplatin-induced hearing loss in adult mice. Lovastatin-mediated protection was significantly greater among female than male mice, and the dose of lovastatin required for protection was different between the sexes. Taken together our data indicate that lovastatin reduces cisplatin-induced hearing loss in mice and suggest that concurrent statin and cisplatin therapy may represent a feasible clinical strategy for reducing cisplatin-induced ototoxicity that should be explored for future clinical use.

Near haploidization is a genomic hallmark which defines a molecular subgroup of giant cell glioblastoma.

BACKGROUND: Giant cell glioblastoma (gcGBM) is a rare histologic subtype of glioblastoma characterized by numerous bizarre multinucleate giant cells and increased reticulin deposition. Compared with conventional isocitrate dehydrogenase (IDH)-wildtype glioblastomas, gcGBMs typically occur in younger patients and are generally associated with an improved prognosis. Although prior studies of gcGBMs have shown enrichment of genetic events, such as TP53 alterations, no defining aberrations have been identified. The aim of this study was to evaluate the genomic profile of gcGBMs to facilitate more accurate diagnosis and prognostication for this entity. METHODS: Through a multi-institutional collaborative effort, we characterized 10 gcGBMs by chromosome studies, single nucleotide polymorphism microarray analysis, and targeted next-generation sequencing. These tumors were subsequently compared to the genomic and epigenomic profile of glioblastomas described in The Cancer Genome Atlas (TCGA) dataset. RESULTS: Our analysis identified a specific pattern of genome-wide massive loss of heterozygosity (LOH) driven by near haploidization in a subset of glioblastomas with giant cell histology. We compared the genomic signature of these tumors against that of all glioblastomas in the TCGA dataset (n = 367) and confirmed that our cohort of gcGBMs demonstrated a significantly different genomic profile. Integrated genomic and histologic review of the TCGA cohort identified 3 additional gcGBMs with a near haploid genomic profile. CONCLUSIONS: Massive LOH driven by haploidization represents a defining molecular hallmark of a subtype of gcGBM. This unusual mechanism of tumorigenesis provides a diagnostic genomic hallmark to evaluate in future cases, may explain reported differences in survival, and suggests new therapeutic vulnerabilities.

Heat shock protein-mediated protection against Cisplatin-induced hair cell death.

Cisplatin is a highly successful and widely used chemotherapy for the treatment of various solid malignancies in both adult and pediatric patients. Side effects of cisplatin treatment include nephrotoxicity and ototoxicity. Cisplatin ototoxicity results from damage to and death of cells in the inner ear, including sensory hair cells. We showed previously that heat shock inhibits cisplatin-induced hair cell death in whole-organ cultures of utricles from adult mice. Since heat shock protein 70 (HSP70) is the most upregulated HSP in response to heat shock, we investigated the role of HSP70 as a potential protectant against cisplatin-induced hair cell death. Our data using utricles from HSP70 (-/-) mice indicate that HSP70 is necessary for the protective effect of heat shock against cisplatin-induced hair cell death. In addition, constitutive expression of inducible HSP70 offered modest protection against cisplatin-induced hair cell death. We also examined a second heat-inducible protein, heme oxygenase-1 (HO-1, also called HSP32). HO-1 is an enzyme responsible for the catabolism of free heme. We previously showed that induction of HO-1 using cobalt protoporphyrin IX (CoPPIX) inhibits aminoglycoside-induced hair cell death. Here, we show that HO-1 also offers significant protection against cisplatin-induced hair cell death. HO-1 induction occurred primarily in resident macrophages, with no detectable expression in hair cells or supporting cells. Depletion of macrophages from utricles abolished the protective effect of HO-1 induction. Together, our data indicate that HSP induction protects against cisplatin-induced hair cell death, and they suggest that resident macrophages mediate the protective effect of HO-1 induction.

Metamicrocotyla macracantha, a polyopisthocotylid gill parasite of the striped mullet, Mugil cephalus: population dynamics in South Carolina estuaries.

In the estuarine system of South Carolina (USA), the striped mullet, Mugil cephalus, was found to be parasitized by the polyopisthocotylid monogenean Metamicrocotyla macracantha among other gill parasites. Mullet of various ages were collected monthly for 1 year from oligohaline, mesohaline, polyhaline, and euryhaline localities. The population dynamics of M. macracantha was analyzed according to time of year, different salinity levels, and host age and sex. Out of the 770 mullet studied, 11.2% were infected (mean, two worms per host). Neither prevalence nor mean intensity was correlated with biotic factors. However, significant seasonal variation in prevalence was observed, and the worm was found more frequently in higher salinities. Mean intensity, however, did not change significantly with time of year or salinity. This is the first published report of M. macracantha in the South Carolina estuarine system and represents the northernmost record for this parasite. Furthermore, the lack of common egg-bearing individuals and juveniles indicated that this area is likely the northern limit of the geographical range of M. macracantha, whose life cycle seems restricted to more constant water temperatures than those found at the South Carolina latitudes.

Stock identification of the sciaenid fish Micropogonias undulatus in the western North Atlantic Ocean using parasites as biological tags.

Proper fisheries management of the Atlantic croaker Micropogonias undulatus is necessary in the United States due to the commercial and recreational importance of this fish species. Croaker stock structure in the western North Atlantic has been investigated in the past by various authors, with inconclusive results. In this study, macroparasites were used as biological tags to identify putative croaker stocks in the area between New Jersey and Florida, which encompasses the Mid Atlantic Bight and the South Atlantic Bight separated at Cape Hatteras, North Carolina. The macroparasite community of the fish was identified, showing the presence of 30 species in four phyla, of which several were new host records, and one species, a monogenean, was new to science. A canonical correspondence analysis was applied to determine the variables responsible for parasite species composition, to resolve the question of croaker stock structure in the western North Atlantic Ocean. This analysis showed that latitude was the deciding variable delineating the parasite community composition of the Atlantic croaker. Among the 30 parasites, 15 were identified as putative tags according to qualitative criteria, and then 10 out of those 15 were selected as being appropriate tags using quantitative criteria. These parasite tags support the presence of two stocks roughly separated at the known biogeographical barrier at Cape Hatteras.

Co-occurrence of Naobranchia lizae (Copepoda) and Metamicrocotyla macracantha (Monogenea), gill parasites of the striped mullet Mugil cephalus.

The copepod Naobranchia lizae (Kroyer, 1863) and the monogenean Metamicrocotyla macracantha (Alexander, 1954; Koratha, 1955) are gill parasites found on the striped mullet (Mugil cephalus) in the Charleston Harbor Estuarine System (South Carolina, USA). Branchial distribution of each species was studied in mono- and bispecific conditions. No preference for the right or left side of the fish host was observed for either species in either condition. Both species exhibited heterogeneous distribution among the gill arches, with a preference for arch I. N. lizae exhibited intraspecific competition and a saturation threshold in both mono- and bispecific conditions. A shift in niche toward the posterior arches was observed for M. macracantha only in bispecific infection. Interspecific competition was detected exclusively on the posterior arches, where M. macracantha seemed out-competed by N. lizae. The data indicated that both neutral and negative interactions played a role in determining the distribution of N. lizae and M. macracantha individuals on the gill arches of M. cephalus.