Intracranial mesenchymal tumors with FET-CREB fusion are composed of at least two epigenetic subgroups distinct from meningioma and extracranial sarcomas

Authors

Emily A. Sloan, University of California, San Francisco, San Francisco, California, USA.
Rohit Gupta, University of California, San Francisco, San Francisco, California, USA.
Christian Koelsche, Heidelberg University Hospital, Heidelberg, Germany
Jason Chiang, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
Javier E. Villanueva-Meyer, University of California, San Francisco, California, USA.
Sanda Alexandrescu, Harvard Medical School, Boston, Massachusetts, USA.
Jennifer E. Eschbacher, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Wesley Wang, The Ohio State University, Columbus, Ohio, USA.
Manuela Mafra, The Portuguese Institute of Oncology, Lisbon, Portugal
Nasir Ud Din, Aga Khan UniversityFollow

Document Type

Article

Department

Pathology and Laboratory Medicine

Abstract

Intracranial mesenchymal tumor, FET-CREB fusion-positive' occurs primarily in children and young adults and has previously been termed intracranial angiomatoid fibrous histiocytoma (AFH) or intracranial myxoid mesenchymal tumor (IMMT). Here we performed genome-wide DNA methylation array profiling of 20 primary intracranial mesenchymal tumors with FET-CREB fusion to further study their ontology. These tumors resolved into two distinct epigenetic subgroups that were both divergent from all other analyzed intracranial neoplasms and soft tissue sarcomas, including meningioma, clear cell sarcoma of soft tissue (CCS), and AFH of extracranial soft tissue. The first subgroup (Group A, 16 tumors) clustered nearest to but independent of solitary fibrous tumor and AFH of extracranial soft tissue, whereas the second epigenetic subgroup (Group B, 4 tumors) clustered nearest to but independent of CCS and also lacked expression of melanocytic markers (HMB45, Melan A, or MITF) characteristic of CCS. Group A tumors most often occurred in adolescence or early adulthood, arose throughout the neuroaxis, and contained mostly EWSR1-ATF1 and EWSR1-CREB1 fusions. Group B tumors arose most often in early childhood, were located along the cerebral convexities or spinal cord, and demonstrated an enrichment for tumors with CREM as the fusion partner (either EWSR1-CREM or FUS-CREM). Group A tumors more often demonstrated stellate/spindle cell morphology and hemangioma-like vasculature, whereas Group B tumors more often demonstrated round cell or epithelioid/rhabdoid morphology without hemangioma-like vasculature, although robust comparison of these clinical and histologic features requires future study. Patients with Group B tumors had inferior progression-free survival relative to Group A tumors (median 4.5 vs. 49 months, p = 0.001). Together, these findings confirm that intracranial AFH-like neoplasms and IMMT represent histologic variants of a single tumor type ('intracranial mesenchymal tumor, FET-CREB fusion-positive') that is distinct from meningioma and extracranial sarcomas. Additionally, epigenomic evaluation may provide important prognostic subtyping for this unique tumor entity.

Comments

Volume, issue, and pagination are not provided by the author/publisher

Publication (Name of Journal)

Brain Pathology

Recommended Citation

Sloan, E. A., Gupta, R., Koelsche, C., Chiang, J., Villanueva-Meyer, J. E., Alexandrescu, S., Eschbacher, J. E., Wang, W., Mafra, M., Din, N. U. (2021). Intracranial mesenchymal tumors with FET-CREB fusion are composed of at least two epigenetic subgroups distinct from meningioma and extracranial sarcomas. Brain Pathology, e13037.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_pathol_microbiol/1368

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