Molecular characterization of CNS paragangliomas identifies cauda equina paragangliomas as a distinct tumor entity

Author:

Schweizer LeonilleORCID,Thierfelder Felix,Thomas Christian,Soschinski Patrick,Suwala Abigail,Stichel Damian,Wefers Annika K.,Wessels Lars,Misch Martin,Kim Hee-yeong,Jödicke Ruben,Teichmann Daniel,Kaul David,Kahn Johannes,Bockmayr Michael,Hasselblatt Martin,Younsi Alexander,Unterberg Andreas,Knie Bettina,Walter Jan,Al Safatli Diaa,May Sven-Axel,Jödicke Andreas,Ntoulias Georgios,Moskopp Dag,Vajkoczy Peter,Heppner Frank L.,Capper David,Hartmann Wolfgang,Hartmann Christian,von Deimling Andreas,Reuss David E.,Schöler Anne,Koch Arend

Abstract

AbstractParagangliomas/pheochromocytomas are rare neuroendocrine tumors that arise from the adrenal gland or ganglia at various sites throughout the body. They display a remarkable diversity of driver alterations and are associated with germline mutations in up to 40% of the cases. Comprehensive molecular profiling of abdomino-thoracic paragangliomas revealed four molecularly defined and clinically relevant subtypes. Paragangliomas of the cauda equina region are considered to belong to one of the defined molecular subtypes, but a systematic molecular analysis has not yet been performed. In this study, we analyzed genome-wide DNA methylation profiles of 57 cauda equina paragangliomas and show that these tumors are epigenetically distinct from non-spinal paragangliomas and other tumors. In contrast to paragangliomas of other sites, chromosomal imbalances are widely lacking in cauda equina paragangliomas. Furthermore, RNA and DNA exome sequencing revealed that frequent genetic alterations found in non-spinal paragangliomas—including the prognostically relevant SDH mutations—are absent in cauda equina paragangliomas. Histologically, cauda equina paragangliomas show frequently gangliocytic differentiation and strong immunoreactivity to pan-cytokeratin and cytokeratin 18, which is not common in paragangliomas of other sites. None of our cases had a familial paraganglioma syndrome. Tumors rarely recurred (9%) or presented with multiple lesions within the spinal compartment (7%), but did not metastasize outside the CNS. In summary, we show that cauda equina paragangliomas represent a distinct, sporadic tumor entity defined by a unique clinical and morpho-molecular profile.

Funder

German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany

Charité

Projekt DEAL

Publisher

Springer Science and Business Media LLC

Subject

Cellular and Molecular Neuroscience,Neurology (clinical),Pathology and Forensic Medicine

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