case_images: PMC3324141_01
case_images: Molecular characterization of a novel KIAA1549:BRAF fusion alteration in a sporadic pediatric pilocytic astrocytoma. (a) Axial T1-weighted 1.5-Tesla gadolinium-enhanced MRI scan reveals a cystic lesion in the cerebellum with a peripheral enhancing nodule (arrow). Hematoxylin and eosin staining demonstrates a classic pilocytic astrocytoma with compact and loose areas (b), including Rosenthal fibers (arrow) and eosinophilic granular bodies (arrowhead) (c). The tumor is composed of cells with strong GFAP expression (d) and rare Ki-67 immunoreactivity (arrowhead; (e)). Direct amplification of RNA from this tumor demonstrates a 599 bp fragment, which creates a novel fusion KIAA1549:BRAF transcript in which exon 16 of the KIAA1549 gene is joined to BRAF sequences in the middle of exon 10. The bars below the predicted amino acid sequence correspond to BRAF exon 10 (red), BRAF exon 11 (green), and KIAA1549 exon 16 (blue) (f). Immunostaining with phospho-ERK-Thr202/Tyr204 antibodies demonstrates increased ERK activation in the PA tumor (bottom panel). Normal adult human frontal lobe (NB) from an autopsy specimen was included as reference tissue in the top panel (g). Western blot demonstrates 282-fold increase in ERK activation (phospho-ERK-Thr202/Tyr204; p-ERK; Cell Signaling Technologies, catalog no. 4370S) in the tumor (PA) relative to normal human brain (NB). Total ERK is included as internal control for protein loading (h).
case_images: CRIM2012-418672.001.jpg
case_images: PMC3324141_01_CRIM2012-418672.001.jpg
case_images: fig1
case_images: Magnetic resonance imaging (MRI) at that time showed a cystic mass in the cerebellum compressing the fourth ventricle (Figure 1(a)). Neuropathological review revealed a classic pilocytic astrocytoma with alternating areas of compact and loose tissue architecture (Figure 1(b)). The compact areas were composed of piloid neoplastic cells containing numerous Rosenthal fibers and few eosinophilic granular bodies (Figure 1(c)), while the paucicellular areas were largely myxoid with scattered pleomorphic tumor cells, often containing multiple nuclei. Consistent with the glial nature of this tumor, there was diffuse and strong glial fibrillary acidic protein (GFAP) expression in the neoplastic cells (Figure 1(d)). The Ki67 labeling (proliferative) index was <1% (Figure 1(e)), and mitotic figures were not identified. In contrast to previously reported KIAA1549:BRAF alterations, this tumor harbored a novel fusion transcript in which exon 16 of the KIAA1549 gene was fused to sequences within exon 10 of the BRAF gene (Figure 1(f)), generating a protein product in which the BRAF kinase domain is intact. Consistent with this prediction, we found increased ERK activation using activation-specific (phospho-Thr202/Tyr204) antibodies in the tumor by both immunohistochemistry (Figure 1(g)) and Western immunoblotting (Figure 1(h)).