OBJECTIVE: Distinguishing between sporadic and germline/mosaic NF2-related schwannomatosis is important to ensure that patients have appropriate long-term care. With this report, we describe a unique case of a patient with 4 ipsilateral schwannomas and identify a combination of sequencing modalities that can accurately diagnose mosaic NF2-related schwannomatosis.
METHODS: We present a 32-year-old woman with a familial history of vestibular schwannoma in her father and right-sided schwannomas involving the apical and basal turns of cochlea, lateral semicircular canal, and internal auditory canal (IAC). Genetic analysis of blood and frozen tissue from 2 tumors (intralabyrinthine and IAC tumors) was performed using next-generation sequencing (NGS), multiplex ligation-dependent probe amplification (MLPA), and optical genome mapping (OGM).
RESULTS: Germline testing for NF2, LZTR1, and SMARCB1 was negative. Tumor genetic testing revealed a shared NF2 pathogenic variant between the 2 tumors (\"first hit\") but distinct \"second hit\" NF2 variants, including mosaic loss of chromosome 22 in the IAC tumor seen only with OGM, consistent with mosaic NF2-related schwannomatosis.
CONCLUSIONS: Multimodality sequencing, including NGS, MLPA, and OGM, was required to ensure appropriate diagnosis of mosaic NF2-related schwannomatosis in this patient. A similar approach can be used for other patients with multiple ipsilateral tumors and suspected tumor predisposition.

Ovarian ependymomas are rare glial neoplasms that typically occur in women on their third to fourth decades of life. They are histologically similar to ependymomas of the central nervous system but may have a broader immunophenotype. We describe a 27-year-old woman who presented to the emergency department with a 3-week history of cough and shortness of breath. Further workup disclosed a left pelvic mass and extensive intra-abdominal metastases. Pathology revealed sheets of monomorphic cells within a fibrillary stroma, papillary projections, true ependymal rosettes, and pseudorosettes consistent with an ependymoma of ovarian origin. Next-generation sequencing showed ATRX and NF2 copy number losses. Fluorescence in situ hybridization for EWSR1 demonstrated monosomy of 22q in greater than 90% of cells. These molecular alterations have not been previously reported in ovarian or extra-central nervous system ependymomas.

Neurofibromatosis type 2 (NF2) is associated with the development of several types of benign nervous system tumours, while malignancies are rare. We report a 22-year-old man who presented with retroperitoneal and spinal high-grade sarcomas with epithelial features. Samples showed a mixed epithelioid and spindled cell content with little associated matrix and inconclusive immunochemistry. Genetic analysis of a schwannoma and matched blood samples demonstrated a constitutional de novo substitution at the splice donor site of intron 8 of the NF2 gene and aa acquired large deletion of the entire NF2 gene as a second hit, with some loss of SMARCB1. The sarcoma also showed evidence of loss of SMARCB1 and NF2 with loss of INI1 staining. Unfortunately the mass was unresectable and the patient died 6 months after diagnosis. This malignancy was most consistent with SMARCB1-deficient epithelioid malignant peripheral nerve sheath tumour, although a significant differential was proximal-type epithelial sarcoma. Each differential has previously been reported only once with NF2. This demonstrates an extremely rare potential complication of the condition.

BACKGROUND: Neurofibromatosis type 2 (NF2) is a genetic condition with an autosomal dominant pattern of inheritance and incomplete penetrance. It is characterized by multiple benign tumors of the central and peripheral nervous system including astrocytomas, ependymomas, meningeomas, and schwannomas, among which bilateral vestibular schwannomas are the most frequent. Among ocular manifestations of NF2, juvenile subcapsular cataract is the most common followed by epiretinal membranes and combined hamartomas of the retina and retinal pigment epithelium.
METHODS: Multimodal imaging was performed in a female patient and her data were compared to an overview of published cases with retinal hamartoma in NF2.
RESULTS: We report on a case of a 14-year-old girl with genetically confirmed NF2 who presented with bilateral, asymptomatic hyperplasia of glia cells within the ganglion cell and the nerve fibre layer by spectral domain optical coherence tomography (SD-OCT). A metaanalysis of 25 published cases revealed combined hamartomas of the retina and retinal pigment epithelium (CHRRPE) as the most common (16 cases) retinal tumors followed by retinal astrocytic hamartomas (RAH, 7 cases). Retinal hamartomas were most often reported bilaterally and observed prior to the clinical diagnosis of NF2 in 11 of 25 cases. No correlation to sex was observed. Reduced visual acuity, cataracts and epiretinal membranes were the leading ocular manifestations.
CONCLUSIONS: There is a large spectrum of ocular-specific findings in NF2. These are seminal, especially at an early age, enabling an early diagnosis and timely therapy of further tumor manifestations. Retinal astrocytic hamartomas may be very discreet and easily missed on routine examination. Fundus infrared imaging is a useful tool allowing to detect even discreet changes rarely seen by ophthalmoscopy in young children. This allows for a more extensive evaluation by SD-OCT.
UNASSIGNED: Die Neurofibromatose Typ 2 (NF2) ist eine autosomal-dominant vererbliche Erkrankung mit unvollständiger Penetranz, die durch das Vorkommen von gutartigen Tumoren des zentralen und peripheren Nervensystems charakterisiert ist. Zu diesen zählen Astrozytome, Ependymome, Meningeome und Schwannome, bei denen beidseitige Vestibularisschwannome typisch sind. Okulär manifestiert sich die NF2 durch juvenile subkapsuläre Katarakte, epiretinale Membranen sowie kombinierte Hamartome der Retina und des retinalen Pigmentepithels.
METHODS: Bei einer Patientin mit retinalem Hamartom bei NF2 wurde eine multimodale Bilddokumentation durchgeführt und mit einer Metaanalyse publizierter Fälle retinaler Hamartome bei NF2 verglichen.
UNASSIGNED: Berichtet wird über den Fall eines 14-jährigen Mädchens mit molekulargenetisch gesicherter Neurofibromatose Typ 2. In der Spectral-Domain-optischen Kohärenztomografie (SD-OCT) fielen beidseitige, asymptomatische, retinale astrozytäre Hamartome im Bereich der retinalen Ganglienzell- und Nervenfaserschicht auf. Eine Metaanalyse der 25 publizierten Fälle ergab, dass die häufigste Form von Tumoren der Retina das kombinierte Hamartom der Retina und des retinalen Pigmentepithels (CHRRPE, 16 Fälle) war, gefolgt von den retinalen astrozytären Hamartomen (RAH, 7 Fälle). Dabei wurden die retinalen Hamartome meistens beidseitig beschrieben. Es wurden 11 Fälle beschrieben, bei denen retinale Hamartome vor der klinischen Diagnose der NF2 festgestellt wurden. Es konnte keine Geschlechtsprävalenz festgestellt werden. Die 3 häufigsten okulären Befunde bei NF2 waren Sehminderung, Katarakt und epiretinale Membranen.
UNASSIGNED: Das Spektrum der spezifisch okulären Befunde bei NF2 ist sehr groß. Deren Feststellung kann gerade im jungen Alter diagnoseweisend für die Erstdiagnose der NF2 sein und somit eine frühzeitige Erkennung und gegebenenfalls eine rechtzeitige und erfolgreichere Therapie weiterer Tumormanifestationen ermöglichen. Retinale astrozytäre Hamartome können sehr dezent ausgeprägt sein und bei einer Routineuntersuchung nicht auffallen. Eine Fundusinfrarotaufnahme ist bei der ophthalmologischen Untersuchung insbesondere von kleinen Kindern ein nützliches Werkzeug und kann in manchen Fällen funduskopisch kaum erkennbare Befunde aufdecken, die dann gezielt mit SD-OCT untersucht werden können.

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Meningiomas are common intracranial tumors derived from arachnoid cells. Multiple meningiomas are occasionally present even in patients with no history of neurofibromatosis type 2, a condition that can cause the formation of this neoplasm. Previous studies have shown that most multiple meningiomas are monoclonal in origin. In this study, exome sequencing was performed on four meningiomas and the corresponding peripheral blood DNA from a 61-year-old woman with sporadic multiple meningioma. At least three common mutational events (at the NF2, FAM109B, and TPRXL genes) were detected in the tumors\' DNA when they were compared with the lymphocyte DNA from the patient as control. Additionally, an array of unique mutations was detected in each tumor, including in SMARCB1 in two of the samples, a gene whose alteration leads to the development of meningioma. Mutations in other genes, such as IRS4, GULP1, NHSL1, and C10orf53, accounted for one alteration in each meningioma nodule. Our data suggest a monoclonal origin of the meningiomas in this patient, although the numerous alterations contained in each sample indicated multiple secondary variable changes in each tumor nodule. Whether the alterations described in this work are drivers of tumorigenesis or are simply passengers requires further study.

暂无摘要。