Glioma-like proliferation within tissues excised as tubers in patients with tuberous sclerosis complex.
We describe diffuse glioma-like infiltrates in excised tubers in five out of forty Tuberous sclerosis complex (TSC) patients undergoing excision of a tuber at our institution within the last 10 years. All patients presented with refractory seizures. Resection specimens from four patients had the pathognomonic histologic features of neuroglial hamartomas (tubers) and in one case there was cortical microdysgenesis lacking cells typical of TSC. All lesions were associated with an infiltrate of atypical, mostly elongate, glioma-like small cells, which were immunoreactive for GFAP in three, and pS6 (a marker for activity of the mTOR pathway), in two cases. MAP-2 and CD34, were negative and MIB-1 (Ki67) immunostains ranged from <1-21%. Array-based comparative genomic hybridization revealed that these proliferative phenomena were associated with 21 different copy number aberrations in comparison with a tuber without atypical infiltrates. Postoperatively (follow-up period ranging from 8 to 34 months) none of the patients have any evidence of a glioma. We report that tubers resected for treatment of seizures are sometimes associated with glioma-like lesions, which are indistinguishable from infiltrating gliomas by morphology and immunohistochemistry. Genomic analysis with SNP arrays revealed copy number changes which may be associated with the pathogenesis of such infiltrates.
Fischer
Ingeborg
I
Department of Pathology, New York University School of Medicine, New York, NY, USA. ingeborg_fischer@yahoo.com
Cunliffe
Clare
C
Bollo
Robert J
RJ
Weiner
Howard L
HL
Devinsky
Orrin
O
Ruiz-Tachiquin
Martha-Eugenia
ME
Venuto
Toni
T
Pearlman
Alexander
A
Chiriboga
Luis
L
Schneider
Robert J
RJ
Ostrer
Harry
H
Miller
Douglas C
DC
D000293:Adolescent; D001921:Brain / Q000473:pathology*; D001932:Brain Neoplasms / Q000150:complications* / Q000235:genetics / Q000473:pathology; D005260:Female; D018628:Gene Dosage; D005910:Glioma / Q000150:complications* / Q000235:genetics / Q000473:pathology; D006222:Hamartoma / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D017403:In Situ Hybridization; D007223:Infant; D008297:Male; D016133:Polymerase Chain Reaction; D014402:Tuberous Sclerosis / Q000150:complications* / Q000235:genetics / Q000473:pathology*