Do craniopharyngioma molecular signatures correlate with clinical characteristics?

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OBJECTIVE

Exome sequencing studies have recently demonstrated that papillary craniopharyngiomas (PCPs) and adamantinomatous craniopharyngiomas (ACPs) have distinct genetic origins, each primarily driven by mutually exclusive alterations: either BRAF (V600E), observed in 95% of PCPs, or CTNNB1, observed in 75%–96% of ACPs. How the presence of these molecular signatures, or their absence, correlates with clinical, radiographic, and outcome variables is unknown.

METHODS

The pathology records for patients who underwent surgery for craniopharyngiomas between May 2000 and March 2015 at Weill Cornell Medical College were reviewed. Craniopharyngiomas were identified and classified as PCP or ACP. Patients were placed into 1 of 3 groups based on their genomic mutations: BRAF mutation only, CTNNB1 mutation only, and tumors with neither of these mutations detected (not detected [ND]). Demographic, radiological, and clinical variables were collected, and their correlation with each genomic group was tested.

RESULTS

Histology correlated strongly with mutation group. All BRAF tumors with mutations were PCPs, and all CTNNB1 with mutations and ND tumors were ACPs. Preoperative and postoperative clinical symptoms and radiographic features did not correlate with any mutation group. There was a statistically significant relationship (p = 0.0323) between the age group (pediatric vs adult) and the mutation groups. The ND group tumors were more likely to involve the sella (p = 0.0065).

CONCLUSIONS

The mutation signature in craniopharyngioma is highly predictive of histology. The subgroup of tumors in which these 2 mutations are not detected is more likely to occur in children, be located in the sella, and be of ACP histology.

ABBREVIATIONS ACP = adamantinomatous craniopharyngioma; DI = diabetes insipidus; GTR = gross-total resection; ND = not detected; PCP = papillary craniopharyngioma.

Article Information

Correspondence Theodore H. Schwartz, Department of Neurosurgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, 525 East 68th St., Box #99, New York, NY 10065. email: schwarh@med.cornell.edu.

INCLUDE WHEN CITING Published online July 14, 2017; DOI: 10.3171/2017.1.JNS162232.

Disclosures Dr. Souweidane reports that he is a consultant for Aesculap.

© AANS, except where prohibited by US copyright law.

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    Association of clinical features with mutational subgroups in patients with craniopharyngiomas. Distribution of age (A), sex (B), tumor volume (in cm3) (C), tumor location (D), resection type (E), histological subtype (F), and tumor consistency (G). In the box and whisker plots (A and C), the line within the box indicates the median; the box, the interquartile range; the vertical lines, the entire range; and the dots, the outliers. A = ACP; P = PCP; STR = subtotal resection.

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