Dynamic changes in magnetic resonance imaging appearance of dysembryoplastic neuroepithelial tumor with or without malignant transformation

J Neurosurg Pediatr. 2013 May;11(5):518-25. doi: 10.3171/2013.1.PEDS11449. Epub 2013 Feb 22.

Abstract

Dysembryoplastic neuroepithelial tumors (DNETs) have conventionally been regarded as benign and stable tumors and considered curable with surgery without adjunctive therapy. Recently, recurrent DNETs with or without malignant transformation have been described. The authors report 2 unusual cases of DNET: 1) an enlarging lesion that developed an enhancing component over the natural course of 4 years, and 2) a recurrent DNET that developed an enhancing component 10-11 years after gross-total resection. The patient in the first case was treated with subtotal resection and adjuvant radiochemotherapy; histological examination of the tumor led to the diagnosis of DNET, WHO Grade I, for the nonenhancing component and anaplastic oligodendroglioma, WHO Grade III, for the enhancing component. The patient in the second case was treated with repeat gross-total resection; the original tumor had been histologically diagnosed as DNET, and the nonenhancing and enhancing components of the recurrent tumor were diagnosed as simple and complex forms of DNET, respectively. These and previous reports suggest an aggressive subtype of DNETs. If follow-up MRI reveals progressive behavior, resection should be performed without delay. Additional radiochemotherapy is needed if the histological diagnosis demonstrates malignant transformation.

Publication types

  • Case Reports

MeSH terms

  • Brain Neoplasms / genetics*
  • Brain Neoplasms / pathology
  • Brain Neoplasms / surgery*
  • Cell Transformation, Neoplastic* / genetics
  • Child, Preschool
  • Cyclin-Dependent Kinase Inhibitor p16 / genetics
  • DNA Copy Number Variations
  • DNA Mutational Analysis
  • ErbB Receptors / genetics
  • Female
  • Gene Amplification
  • Humans
  • Immunohistochemistry
  • Isocitrate Dehydrogenase / genetics
  • Magnetic Resonance Imaging
  • Male
  • Neoplasms, Neuroepithelial / genetics*
  • Neoplasms, Neuroepithelial / pathology
  • Neoplasms, Neuroepithelial / surgery*
  • PTEN Phosphohydrolase / genetics
  • Photomicrography
  • Receptor, ErbB-2 / genetics
  • Reoperation
  • Retrospective Studies
  • Tomography, X-Ray Computed
  • Tumor Suppressor Protein p53 / genetics

Substances

  • Cyclin-Dependent Kinase Inhibitor p16
  • TP53 protein, human
  • Tumor Suppressor Protein p53
  • IDH2 protein, human
  • Isocitrate Dehydrogenase
  • IDH1 protein, human
  • ERBB2 protein, human
  • ErbB Receptors
  • Receptor, ErbB-2
  • PTEN Phosphohydrolase
  • PTEN protein, human