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@ARTICLE{Reisinger:143633,
      author       = {D. Reisinger and J. Gojo and G. Kasprian and C. Haberler
                      and A. Peyrl and A. A. Azizi and L. Mayr and M. Chocholous
                      and M. Kool$^*$ and T. Czech and I. Slavc},
      title        = {{P}redisposition of {W}ingless {S}ubgroup {M}edulloblastoma
                      for {P}rimary {T}umor {H}emorrhage.},
      journal      = {Neurosurgery},
      volume       = {86},
      number       = {4},
      issn         = {0148-396X},
      address      = {Oxford},
      publisher    = {Oxford University Press},
      reportid     = {DKFZ-2019-01210},
      pages        = {478-484},
      year         = {2020},
      note         = {2020 Apr 1;86(4):478-484},
      abstract     = {Primary intratumoral hemorrhage as a presenting sign is
                      rare in children with medulloblastomas but may result in
                      severe complications. Given the distinct properties of
                      molecular medulloblastoma subgroups, the impact on
                      neurosurgical practice has still to be defined.To
                      investigate both clinical and radiological presentation of
                      intratumoral hemorrhage in medulloblastoma patients in the
                      context of molecular subgroups.Data of all consecutive
                      medulloblastoma patients treated at our institution between
                      1993 and 2018 (n = 104) were retrospectively reviewed in
                      respect of clinical and radiological presentation as well as
                      molecular subgroups. For cases with available tumor tissue
                      (n = 86), subgroups were assigned by either 450 K
                      methylation array or immunohistochemistry and CTNNB1
                      sequencing. Available imaging at diagnosis (n = 62) was
                      reviewed by an experienced neuroradiologist.Within the
                      entire cohort, 4 patients $(4\%)$ presented with massive
                      spontaneous hemorrhage. Although no patient died as a direct
                      consequence of hemorrhage, all suffered from serious
                      sequelae. Moreover, 3 additional patients displayed
                      radiological evidence of significant hemorrhage.
                      Interestingly, all 7 cases belonged to the wingless (WNT)
                      subgroup (n = 13), resulting in intratumoral hemorrhage in
                      $54\%$ (7/13) of pediatric WNT medulloblastomas. In
                      contrast, significant hemorrhage was absent in all other
                      molecular subgroups.Our results suggest that a substantial
                      proportion of pediatric WNT medulloblastomas display
                      significant intratumoral hemorrhage at the time of
                      diagnosis. Consequently, the presence of significant
                      hemorrhage in fourth ventricle childhood tumors is
                      suggestive of WNT medulloblastoma and should lead to a less
                      aggressive attempt for total resection in this
                      prognostically favorable tumor type.},
      cin          = {B062 / HD01},
      ddc          = {610},
      cid          = {I:(DE-He78)B062-20160331 / I:(DE-He78)HD01-20160331},
      pnm          = {312 - Functional and structural genomics (POF3-312)},
      pid          = {G:(DE-HGF)POF3-312},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:31065705},
      doi          = {10.1093/neuros/nyz148},
      url          = {https://inrepo02.dkfz.de/record/143633},
}