title: Low-level copy gain versus amplification of myc oncogenes in medulloblastoma: utility in predicting prognosis and survival. Laboratory investigation.
abstract: OBJECTIVE
  Medulloblastoma (MB) is a malignant embryonal tumor of the cerebellum. Amplification of c-myc or N-myc is infrequently identified and, when present, is often associated with the large cell/anaplastic (LC/A) phenotype. The frequency of low-level copy gain of myc oncogenes and its relationship to prognosis of MB has not been explored.
  
  
  METHODS
  Archival cases of MB were histologically reviewed and classified into 3 major subtypes: classic, nodular, and LC/A. Using quantitative real-time polymerase chain reaction (PCR), the authors analyzed 58 cases with a pure histological subtype for the copy number (CN) of myc (c-myc and N-myc) oncogenes. Cases with > 5-fold CN were further analyzed using the fluorescent in situ hybridization (FISH) assay. Kaplan-Meier survival analysis was performed.
  
  
  RESULTS
  A > 5-fold myc CN was noted in 5 (20.8%) of 24 LC/A, 1 (5.3%) of 19 classic, and 2 (13.3%) of 15 nodular subtypes. In a significant number of tumors (14 [56%] of 24 LC/A, 13 [68%] of 19 classic, and 10 [67%] of 15 nodular MBs) the CN was > 2-fold but < 5-fold. High-level amplification, defined as > 10-fold CN, was only seen in the LC/A subtype (5 cases), although moderate amplification (> 5-fold but < 10-fold) could be detected in other histological subtypes. Fluorescence in situ hybridization readily detected most cases corresponding to tumors with > 5-fold amplicon CN by quantitative real-time PCR, and could detect all 5 cases with > 10-fold CN by quantitative real-time PCR. The group of patients with > 5-fold myc amplicon CN showed significantly shorter survival than those with < 5-fold CN (p = 0.045), independent of histological subtype.
  
  
  CONCLUSIONS
  Since FISH could easily detect most cases in the moderate-to-high myc gene amplification (> 5-fold CN) group, the FISH assay has utility in detecting subsets of MB with poorer prognosis.
authors.affiliation: Department of Pathology, The Methodist Hospital, Texas Children's Cancer Center and Baylor College of Medicine, Houston, Texas 77030, USA. takei327@aol.com
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Takei
authors.forename: Yummy
authors.initials: Y
authors.lastname: Nguyen
authors.forename: Vidya
authors.initials: V
authors.lastname: Mehta
authors.forename: Murali
authors.initials: M
authors.lastname: Chintagumpala
authors.forename: Robert C
authors.initials: RC
authors.lastname: Dauser
authors.forename: Adekunle M
authors.initials: AM
authors.lastname: Adesina
mesh_terms: D002528:Cerebellar Neoplasms / Q000235:genetics* / Q000401:mortality / Q000473:pathology; D002531:Cerebellum / Q000473:pathology; D002648:Child; D005784:Gene Amplification / Q000235:genetics*; D018628:Gene Dosage / Q000235:genetics*; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D053208:Kaplan-Meier Estimate; D008527:Medulloblastoma / Q000235:genetics* / Q000401:mortality / Q000473:pathology; D010641:Phenotype; D011379:Prognosis; D016271:Proto-Oncogene Proteins c-myc / Q000235:genetics*; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction
chemical_list: D016271:Proto-Oncogene Proteins c-myc