Abstract
According to the WHO classification, ependymal tumors are classified as subependymomas, myxopapillary ependymomas, classic ependymomas, anaplastic ependymomas, and RELA-fusion-positive ependymomas (RELA-EPN). Among classic ependymomas, the WHO defines rare histological variants, i.e., the clear cell, papillary, and tanycytic ependymoma. In parallel, global DNA methylation patterns distinguish nine molecular groups, some of which tightly overlap with histopathological subgroups. However, the match of the aforementioned histological variants to DNA methylation classes remains unclear. We analyzed histomorphology, clinical parameters, and global DNA methylation of tumors with the initial histological diagnoses of tanycytic (n = 12), clear cell (n = 14), or papillary ependymoma (n = 19). Forty percent of these tumors did not match to the epigenetic profile of ependymomas, using a previously published DNA methylation-based classifier for brain tumors. Instead, they were classified as low-grade glioma (n = 3), plexus tumor (n = 2), CNS high-grade neuroepithelial tumor with MN1 alteration (n = 2), papillary tumor of the pineal region (n = 2), neurocytoma (n = 1), or did not match to any known brain tumor methylation class (n = 8). Overall, integrated diagnosis had to be changed in 35.6% of cases as compared to the initial diagnosis. Among the tumors molecularly classified as ependymoma (27/45 cases), tanycytic ependymomas were mostly located in the spine (5/7 cases) and matched to spinal or myxopapillary ependymoma. 6/8 clear cell ependymomas were found supratentorially and fell into the methylation class of RELA-EPN. Papillary ependymomas with a positive ependymoma match (12/19 cases) showed either a “papillary” (n = 5), a “trabecular” (n = 1), or a “pseudo-papillary” (n = 6) growth pattern. The papillary growth pattern was strongly associated with the methylation class B of posterior fossa ependymoma (PFB, 5/5 cases) and tumors displayed DNA methylation sites that were significantly different when compared to PFB ependymomas without papillary growth. Tumors with pseudo-papillary histology matched to the methylation class of myxopapillary ependymoma (4/6 cases), whereas the trabecular case was anatomically and molecularly a spinal ependymoma. Our results show that the diagnosis of histological ependymoma variants is challenging and epigenetic profiles may improve diagnostic accuracy of these cases. Whereas clear cell and papillary ependymomas display correlations between localization, histology, and methylation, tanycytic ependymoma does not represent a molecularly distinct subgroup.
Similar content being viewed by others
References
Aryee MJ, Jaffe AE, Corrada-Bravo H, Ladd-Acosta C, Feinberg AP, Hansen KD et al (2014) Minfi: a flexible and comprehensive bioconductor package for the analysis of infinium DNA methylation microarrays. Bioinformatics 30:1363–1369. https://doi.org/10.1093/bioinformatics/btu049
Burger PCSB, Kleinschmidt-DeMasters B, Tihan T, Rodriguez F et al (2016) Diagnostic pathology: neuropathology. Diagnostic pathology series, 2nd edn
Capper D, Jones DTW, Sill M, Hovestadt V, Schrimpf D, Sturm D et al (2018) DNA methylation-based classification of central nervous system tumours. Nature 555:469–474. https://doi.org/10.1038/nature26000
Capper D, Stichel D, Sahm F, Jones DTW, Schrimpf D, Sill M et al (2018) Practical implementation of DNA methylation and copy-number-based CNS tumor diagnostics: the Heidelberg experience. Acta Neuropathol 136:181–210. https://doi.org/10.1007/s00401-018-1879-y
Cavalli FMG, Hubner JM, Sharma T, Luu B, Sill M, Zapotocky M et al (2018) Heterogeneity within the PF-EPN-B ependymoma subgroup. Acta Neuropathol 136:227–237. https://doi.org/10.1007/s00401-018-1888-x
Cepeda S, Hernandez-Lain A, Munarriz PM, Martinez Gonzalez MA, Lagares A (2014) Spinal tanycytic ependymoma associated with neurofibromatosis type 2. Clin Neuropathol 33:311–314. https://doi.org/10.5414/NP300704
Chaudhuri PM, Chakrabarty D, Chaudhuri S, Chatterjee U (2019) Papillary ependymoma of the spinal cord: a case report with summary of prior published cases. Asian J Neurosurg 14:223–226. https://doi.org/10.4103/ajns.AJNS_250_17
Ebert C, von Haken M, Meyer-Puttlitz B, Wiestler OD, Reifenberger G, Pietsch T et al (1999) Molecular genetic analysis of ependymal tumors. NF2 mutations and chromosome 22q loss occur preferentially in intramedullary spinal ependymomas. Am J Pathol 155:627–632. https://doi.org/10.1016/S0002-9440(10)65158-9
Figarella-Branger D, Lechapt-Zalcman E, Tabouret E, Junger S, de Paula AM, Bouvier C et al (2016) Supratentorial clear cell ependymomas with branching capillaries demonstrate characteristic clinicopathological features and pathological activation of nuclear factor-kappaB signaling. Neuro Oncol 18:919–927. https://doi.org/10.1093/neuonc/now025
Fukuoka K, Kanemura Y, Shofuda T, Fukushima S, Yamashita S, Narushima D et al (2018) Significance of molecular classification of ependymomas: C11orf95-RELA fusion-negative supratentorial ependymomas are a heterogeneous group of tumors. Acta Neuropathol Commun 6:134. https://doi.org/10.1186/s40478-018-0630-1
Gatta G, Botta L, Rossi S, Aareleid T, Bielska-Lasota M, Clavel J et al (2014) Childhood cancer survival in Europe 1999-2007: results of EUROCARE-5—a population-based study. Lancet Oncol 15:35–47. https://doi.org/10.1016/S1470-2045(13)70548-5
Grajkowska W, Matyja E, Pronicki M, Daszkiewicz P, Roszkowski M, Perek D et al (2009) Papillary ependymoma with unique superficial cortical location: immunohistochemical and ultrastructural studies. A case report. Folia Neuropathol 47:354–361
Hovestadt VZM (2017) conumee: Enhanced copy-number variation analysis using Illumina DNA methylation arrays. R package version 1.9.0
Hwang EI, Kool M, Burger PC, Capper D, Chavez L, Brabetz S et al (2018) Extensive molecular and clinical heterogeneity in patients with histologically diagnosed CNS-PNET treated as a single entity: a report from the children’s oncology group randomized ACNS0332 trial. J Clin Oncol. https://doi.org/10.1200/jco.2017.76.4720
Kilday JP, Rahman R, Dyer S, Ridley L, Lowe J, Coyle B et al (2009) Pediatric ependymoma: biological perspectives. Mol Cancer Res 7:765–786. https://doi.org/10.1158/1541-7786.MCR-08-0584
Kolde R (2019) pheatmap: Pretty Heatmaps. R package version 1.0.12
Kuga Y, Ohnishi H, Kodama Y, Takakura S, Hayashi M, Yagi R et al (2014) Cerebral and spinal cord tanycytic ependymomas in a young adult with a mutation in the NF2 gene. Neuropathology 34:406–413. https://doi.org/10.1111/neup.12109
Louis DN, Ohgaki H, Wiestler OD, Ellison DW, Figarella-Branger D, Perry A et al (2016) WHO classification of tumours of the central nervous system (revised 4th edn). Lyon, IARC
Min KW, Scheithauer BW (1997) Clear cell ependymoma: a mimic of oligodendroglioma: clinicopathologic and ultrastructural considerations. Am J Surg Pathol 21:820–826
Morris TJ, Butcher LM, Feber A, Teschendorff AE, Chakravarthy AR, Wojdacz TK et al (2013) ChAMP: 450 k chip analysis methylation pipeline. Bioinformatics 30:428–430. https://doi.org/10.1093/bioinformatics/btt684
DNAcopy: DNA copy number data analysis (2019)
Pajtler KW, Wen J, Sill M, Lin T, Orisme W, Tang B et al (2018) Molecular heterogeneity and CXorf67 alterations in posterior fossa group A (PFA) ependymomas. Acta Neuropathol 136:211–226. https://doi.org/10.1007/s00401-018-1877-0
Pajtler KW, Witt H, Sill M, Jones DT, Hovestadt V, Kratochwil F et al (2015) Molecular classification of ependymal tumors across all CNS compartments, histopathological grades, and age groups. Cancer Cell 27:728–743. https://doi.org/10.1016/j.ccell.2015.04.002
Parker M, Mohankumar KM, Punchihewa C, Weinlich R, Dalton JD, Li Y et al (2014) C11orf95-RELA fusions drive oncogenic NF-kappaB signalling in ependymoma. Nature 506:451–455. https://doi.org/10.1038/nature13109
Radhakrishnan N, Nair NS, Hingwala DR, Kapilamoorthy TR, Radhakrishnan VV (2012) Tanycytic ependymoma of filum terminale: a case report. Clin Neurol Neurosurg 114:169–171. https://doi.org/10.1016/j.clineuro.2011.09.017
Rickert CH, Korshunov A, Paulus W (2006) Chromosomal imbalances in clear cell ependymomas. Mod Pathol 19:958–962. https://doi.org/10.1038/modpathol.3800614
Sasaki A, Hirato J, Hirose T, Fukuoka K, Kanemura Y, Hashimoto N et al (2019) Review of ependymomas: assessment of consensus in pathological diagnosis and correlations with genetic profiles and outcome. Brain Tumor Pathol 36:92–101. https://doi.org/10.1007/s10014-019-00338-x
Stark AM, Hugo HH, Nabavi A, Mehdorn HM (2009) Papillary ependymoma WHO Grade II of the aqueduct treated by endoscopic tumor resection. Case Rep Med 2009:434905. https://doi.org/10.1155/2009/434905
Sturm D, Orr BA, Toprak UH, Hovestadt V, Jones DT, Capper D et al (2016) New brain tumor entities emerge from molecular classification of CNS-PNETs. Cell 164:1060–1072. https://doi.org/10.1016/j.cell.2016.01.015
Tao X, Dong J, Hou Z, Hao S, Zhang Q, Wu Z et al (2017) The clinical features and surgical outcomes of intracranial tanycytic ependymomas: a single-institutional experience. J Neurooncol 134:339–347. https://doi.org/10.1007/s11060-017-2531-8
Tao X, Hou Z, Hao S, Zhang Q, Wu Z, Zhang J et al (2017) The clinical features and surgical outcomes of spinal cord tanycytic ependymomas: a report of 40 cases. World Neurosurg 106:60–73. https://doi.org/10.1016/j.wneu.2017.06.111
Upadhyaya SA, Robinson GW, Onar-Thomas A, Orr BA, Billups CA, Bowers DC et al (2019) Molecular grouping and outcomes of young children with newly diagnosed ependymoma treated on the multi-institutional SJYC07 trial. Neuro Oncol. https://doi.org/10.1093/neuonc/noz069
Wickham H (2016) ggplot2: elegant graphics for data analysis. Springer, New York
Acknowledgements
We thank Anne Reichstein for her dedication and excellent technical support concerning the DNA-methylation analyses. We also thank Ulrike Rumpf, Hannelore Junker-Polzin, Carolina Janko, Tasja Lempertz, and Celina Liza Soltwedel for excellent technical support with tissue sections and stainings. J.N. was supported by the Else-Kröner Fresenius Stiftung and the UKE Nachwuchsförderung. This project was generously funded by the Gert and Susanna Mayer Stiftung. U.S. was supported by the Fördergemeinschaft Kinderkrebszentrum Hamburg.
Author information
Authors and Affiliations
Corresponding authors
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
401_2019_2090_MOESM1_ESM.pdf
Supplementary Fig. 1: t-SNE plot including the 45 cases analyzed in this study that were plotted with brain tumor samples of 82 published CNS tumor methylation classes and with cases of nine control tissue methylation classes (n = 2801 [3]). Supplementary Fig. 2: Histomorphology of cases diagnosed as tanycytic ependymoma that did not match to any molecular ependymoma group based on DNA methylation. (a–d) H&E stainings. Scale bar in a is 50 μm for a–d. (a) Case #9 showed astrocytic tumor cells arranged around vessels. No clear pseudorosettes were detected. (b) Case #10 was suggestive of a low-grade glioma with abundant and evenly distributed small round calcifications (see arrows). (c) Case #11 impressed as an ependymoma with tanycytic morphology. (d) Case #12 showed a fibrillary tanycytic pattern with hyalinized vessels (see arrows). Supplementary Fig. 3: Histomorphology of cases diagnosed as clear cell ependymoma that did not match to any molecular ependymoma group based on DNA methylation. (a–f) H&E stainings. Scale bar in a is 50 μm for a–f. (a) Case #21 showed slightly pleomorphic tumor cells with clear cell morphology (left panel) and areas with ependymal pseudorosettes (right panel), being compatible with a clear cell ependymoma. (b) Case 22 showed thin capillaries, small oligodendroglia-like cells and some larger cells suggestive of “floating neurons” (see arrow). (c,d) Cases #23 and #24 impressed as uniformly clear cell tumors without papillary structures. (e) Clear cells with accentuated cell boundaries and nuclei free vascular spaces. (f) Uniform round cells and calcifications (see arrow), well compatible with a neurocytoma. Supplementary Fig. 4: Molecular characteristics of RELA-fusion-positive ependymoma comparing cases with (n = 6) or without clear cell morphology (n = 65). (a) Unsupervised hierarchical clustering of RELA-fusion-positive ependymoma cases with or without clear cell morphology based on 3 significantly differentially methylated CpG sites (FDR < 0.1, delta beta value ≥ 0.2) did not reveal distinct clusters. Details on all 4 significantly differentially methylated CpG sites can be found in supplementary Table 1. (b) t-SNE plot of RELA-fusion-positive ependymomas. Cases with clear cell morphology (n = 6) located scattered among cases without clear cell morphology (n = 65) (c) Stacked integrated copy number plots of cases with or without clear cell morphology showed similar chromosomal alterations. RELA, NCCM = RELA-fusion-positive ependymoma, clear cell morphology. RELA, NCCM = RELA-fusion-positive ependymoma, no clear cell morphology. FDR = false discovery rate. Supplementary Fig. 5: Histomorphology of cases diagnosed as papillary ependymoma that did not match to any molecular ependymoma group based on DNA methylation. (a–g) H&E stainings. Scale bar in a is 50 μm for a–g. (a,d,e) Cases #39, 42 and 43 showed a pseudo-papillary picture with hyalizined vessels being present in cases #42 and 43. (b) Papillary growing tumor, slightly suggestive of plexus tissue, well compatible with a plexus tumor. (c) Case #41 was a highly vascularized tumor with nuclei free areas and circular arrangement of tumor cells around vessels. (f) Case #44 showed abundant trabecular structures resembling ependymal canals. (g) Case #45 showed tumor cell nests within a myxoid matrix. Supplementary Fig. 6: Molecular characteristics of posterior fossa group B ependymoma, comparing papillary morphology (n = 5) with non-papillary morphology (n = 15). (a) t-SNE plot showing cases with papillary morphology or non-papillary morphology including a data set of published posterior fossa group B ependymoma [5]. Histomorphology was not associated with one of the published 5 subtypes of posterior fossa group B ependymoma [5]. (b) Stacked integrated copy number plots of cases with papillary morphology or non-papillary morphology showed common chromosomal alterations but papillary ependymomas lacked gain of chromosome 11. PFB1-5 = posterior fossa group B ependymoma, subtypes 1-5. (PDF 50941 kb)
Rights and permissions
About this article
Cite this article
Neumann, J.E., Spohn, M., Obrecht, D. et al. Molecular characterization of histopathological ependymoma variants. Acta Neuropathol 139, 305–318 (2020). https://doi.org/10.1007/s00401-019-02090-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00401-019-02090-0