J A Hainfellner

Medical University of Vienna, Wien, Vienna, Austria

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Publications (103)371.66 Total impact

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    ABSTRACT: Meningeal involvement in multiple myeloma is rare.•We describe a patient with bilateral abducens nerve palsy and meningeal spread of multiple myeloma.•The patient was treated successfully with intrathecal chemotherapy.
    Journal of the Neurological Sciences 10/2014; · 2.26 Impact Factor
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    ABSTRACT: Using conventional MRI methods, the differentiation of primary cerebral lymphomas (PCNSL) and other primary brain tumors, such as glioblastomas, is difficult due to overlapping imaging characteristics. This study was designed to discriminate tumor entities using normalized vascular intratumoral signal intensity values (nVITS) obtained from pulsed arterial spin labeling (PASL), combined with intratumoral susceptibility signals (ITSS) from susceptibility-weighted imaging (SWI). Thirty consecutive patients with glioblastoma (n = 22) and PCNSL (n = 8), histologically classified according to the WHO brain tumor classification, were included. MRIs were acquired on a 3 T scanner, and included PASL and SWI sequences. nVITS was defined by the signal intensity ratio between the tumor and the contralateral normal brain tissue, as obtained by PASL images. ITSS was determined as intratumoral low signal intensity structures detected on SWI sequences and were divided into four different grades. Potential differences in the nVITS and ITSS between glioblastomas and PCNSLs were revealed using statistical testing. To determine sensitivity, specificity, and diagnostic accuracy, as well as an optimum cut-off value for the differentiation of PCNSL and glioblastoma, a receiver operating characteristic analysis was used. We found that nVITS (p = 0.011) and ITSS (p = 0.001) values were significantly higher in glioblastoma than in PCNSL. The optimal cut-off value for nVITS was 1.41 and 1.5 for ITSS, with a sensitivity, specificity, and accuracy of more than 95%. These findings indicate that nVITS values have a comparable diagnostic accuracy to ITSS values in differentiating glioblastoma and PCNSL, offering a completely non-invasive and fast assessment of tumoral vascularity in a clinical setting.
    European Journal of Radiology 05/2014; · 2.16 Impact Factor
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    ABSTRACT: Survival upon diagnosis of brain metastases (BM) in patients with non-small cell lung cancer (NSCLC) is highly variable and established prognostic scores do not include tissue-based parameters. Patients who underwent neurosurgical resection as first-line therapy for newly diagnosed NSCLC BM were included. Microvascular density (MVD), Ki67 tumor cell proliferation index and hypoxia-inducible factor 1 alpha (HIF-1 alpha) index were determined by immunohistochemistry. NSCLC BM specimens from 230 patients (151 male, 79 female; median age 56 years; 199 nonsquamous histology) and 53/230 (23.0 %) matched primary tumor samples were available. Adjuvant whole-brain radiation therapy (WBRT) was given to 153/230 (66.5 %) patients after neurosurgical resection. MVD and HIF-1 alpha indices were significantly higher in BM than in matched primary tumors. In patients treated with adjuvant WBRT, low BM HIF-1 alpha expression was associated with favorable overall survival (OS), while among patients not treated with adjuvant WBRT, BM HIF-1 alpha expression did not correlate with OS. Low diagnosis-specific graded prognostic assessment score (DS-GPA), low Ki67 index, high MVD, low HIF-1 alpha index and administration of adjuvant WBRT were independently associated with favorable OS. Incorporation of tissue-based parameters into the commonly used DS-GPA allowed refined discrimination of prognostic subgroups. Ki67 index, MVD and HIF-1 alpha index have promising prognostic value in BM and should be validated in further studies.
    Strahlentherapie und Onkologie 02/2014; · 2.73 Impact Factor
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    ABSTRACT: Therapeutic options for patients with pretreated advanced high-grade glioma (HGG) are limited. Sorafenib, a small molecule with multiple potential beneficial actions, appears particularly promising. We reviewed the outcomes of 30 patients with recurrent or progressive HGG treated with sorafenib within a named patient program. Overall, 16 patients suffered from recurrent or progressive glioblastoma multiforme and 14 patients had grade 3 gliomas. All but four patients had previously undergone surgical debulking; all but one patient had received previous standard multimodal treatment; and 18 patients (60%) had received more than one line of chemotherapy, in median three. Progression-free survival (PFS), defined as the time from initiation of sorafenib to treatment discontinuation because of tumor progression or death, was selected as the endpoint. The use of sorafenib resulted in a median PFS of 3 months [95% confidence interval (CI) 1.9-4.1 months] in patients with glioblastoma and of 3.1 months (95% CI 1.4-4.8 months) in patients with other HGG. The PFS-6 for the whole cohort was 23%. Sixteen patients reported adverse events, mostly moderate, with hypertension as the most frequently reported toxicity (seven patients). One patient died of cerebral bleeding (grade 5 toxicity). The overall survival after initiation of sorafenib was 6 months (95% CI 3.9-8.0 months) for patients with glioblastoma multiforme and 10 months (95% CI 3.1-16.9 months) for patients with HGG. In this retrospective analysis of heavily pretreated patients with HGG, sorafenib monotherapy was associated with tumor stabilization in a small subset of patients. The risk-benefit ratio was acceptable in the context of an apparent clinical benefit in patients with a fatal disease.
    Anti-cancer drugs 01/2014; · 2.23 Impact Factor
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    ABSTRACT: Background:Unlike malignant primary central nervous system (CNS) tumours outcome data on non-malignant CNS tumours are scarce. For patients diagnosed from 1996 to 2002 5-year relative survival of only 85.0% has been reported. We investigated this rate in a contemporary patient cohort to update information on survival.Methods:We followed a cohort of 3983 cases within the Austrian Brain Tumour Registry. All patients were newly diagnosed from 2005 to 2010 with a histologically confirmed non-malignant CNS tumour. Vital status, cause of death, and population life tables were obtained by 31 December 2011 to calculate relative survival.Results:Overall 5-year relative survival was 96.1% (95% CI 95.1-97.1%), being significantly lower in tumours of borderline (90.2%, 87.2-92.7%) than benign behaviour (97.4%, 96.3-98.3%). Benign tumour survival ranged from 86.8 for neurofibroma to 99.7% for Schwannoma; for borderline tumours survival rates varied from 83.2 for haemangiopericytoma to 98.4% for myxopapillary ependymoma. Cause of death was directly attributed to the CNS tumour in 39.6%, followed by other cancer (20.4%) and cardiovascular disease (15.8%).Conclusion:The overall excess mortality in patients with non-malignant CNS tumours is 5.5%, indicating a significant improvement in survival over the last decade. Still, the remaining adverse impact on survival underpins the importance of systematic registration of these tumours.British Journal of Cancer advance online publication, 19 November 2013; doi:10.1038/bjc.2013.714 www.bjcancer.com.
    British Journal of Cancer 11/2013; · 5.08 Impact Factor
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    ABSTRACT: BACKGROUND AND PURPOSE:Pulsed arterial spin-labeling is a noninvasive MR imaging perfusion method performed with the use of water in the arterial blood as an endogenous contrast agent. The purpose of this study was to determine the inversion time with the largest difference in normalized intratumoral signal intensity between high-grade and low-grade astrocytomas.MATERIALS AND METHODS:Thirty-three patients with gliomas, histologically classified as low-grade (n = 7) or high-grade astrocytomas (n = 26) according to the World Health Organization brain tumor classification, were included. A 3T MR scanner was used to perform pulsed arterial spin-labeling measurements at 8 different inversion times (370 ms, 614 ms, 864 ms, 1114 ms, 1364 ms, 1614 ms, 1864 ms, and 2114 ms). Normalized intratumoral signal intensity was calculated, which was defined by the signal intensity ratio of the tumor and the contralateral normal brain tissue for all fixed inversion times. A 3-way mixed ANOVA was used to reveal potential differences in the normalized vascular intratumoral signal intensity between high-grade and low-grade astrocytomas.RESULTS:The difference in normalized vascular intratumoral signal intensity between high-grade and low-grade astrocytomas obtained the most statistically significant results at 370 ms (P = .003, other P values ranged from .012-.955).CONCLUSIONS:The inversion time by which to differentiate high-grade and low-grade astrocytomas by use of normalized vascular intratumoral signal intensity was 370 ms in our study. The normalized vascular intratumoral signal intensity values at this inversion time mainly reflect the labeled intra-arterial blood bolus and therefore could be referred to as normalized vascular intratumoral signal intensity. Our data indicate that the use of normalized vascular intratumoral signal intensity values allows differentiation between low-grade and high-grade astrocytomas and thus may serve as a new, noninvasive marker for astrocytoma grading.
    American Journal of Neuroradiology 08/2013; · 3.17 Impact Factor
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    ABSTRACT: Background and Purpose Pulsed Arterial Spin Labeling is a non-invasive magnetic resonance imaging perfusion method using water in the arterial blood as an endogenous contrast agent. The purpose of this study was to determine the inversion time with the biggest difference in normalized intratumoral signal intensity between high-grade and low-grade astrocytomas. Materials and Methods Thirty-three patients with gliomas, histologically classified as low-grade (n = 7) or high-grade astrocytomas (n = 26) according to the WHO brain tumor classification, were included. A 3 Tesla MR scanner was used to perform PASL sequences at eight different inversion times (370ms, 614ms, 864ms, 1114ms, 1364ms, 1614ms, 1864ms, 2114ms). Normalized intratumoral signal intensity was calculated, which was defined by the signal intensity ratio of the tumor and the contralateral normal brain tissue for all fixed inversion times. A three-way mixed ANOVA was used to reveal potential differences in the nITS between high-grade and low-grade astrocytomas. Results The difference in nITS between high-grade and low-grade astrocytomas obtained the most statistically significant results at 370ms (p= 0.003, other p-values ranged from 0.012 to 0.955). Conclusion The inversion time with which to differentiate high-grade and low-grade astrocytomas using nITS was 370ms in our study. The nITS values at this inversion time mainly reflect the labeled intraarterial blood bolus and could be therefore referred as normalized vascular intratumoral signal intensity. Our data indicate that the use of nVITS values allow differentiation between low-grade and high-grade astrocytomas, and thus, may serve as a new, non-invasive radiological marker for astrocytoma grading.
    American Journal of Neuroradiology 05/2013; · 3.68 Impact Factor
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    ABSTRACT: In this contribution, indicators for computer-based analysis andpar assessment of tumor cell proliferation in human brain tumors are developed. The methods are applied on (two) samples of digitized human brain tumor tissue sections immunostained with an antibody against the Ki67 epitope.par The Ki67 immunostaining highlights cells undergoing cell division and is thus a surrogate marker for tumor growth.par The challenges are related to the enormous size of the images ("big data") analyzed, some of them are larger than 100 GB. Thus, efficient methods to extract relevant information have to be applied.par Before starting with the statistical analysis, the digitized images are preprocessed to extractthe highlighted cells. Then the distribution of Ki67 immunostaining patterns is analyzed. Starting with a bivariate kernel density estimation, the proposed indicators are used to evaluate and compare the resulting density estimates. Moreover, the spatial distribution of clusters of Ki67-labeled tumor cells is of particular interest.par The results allow to evaluate and compare images or sectors of the images. This evaluation and comparisons of samples or sectors could turn out to be useful in practice since it allows for a pre-selection of interesting sectors and samples. Thus, the time-consuming part of manual inspection of the huge images could be reduced.
    Austrian Journal of Statistics. 01/2013; Volume 42(2):81-100.
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    ABSTRACT: Background Young age is a favorable prognostic factor for patients with glioblastoma multiforme (GBM). We reviewed the outcomes and molecular tumor characteristics of adolescent and young adult patients with GBM treated in 2 Austrian centers.Patients and Methods Data on patients with histologically proven primary GBM diagnosed from 18 through 40 years of age were retrospectively analyzed. All patients were treated with standard first-line therapy. The primary end points were overall survival (OS) and time to progression (TTP). IDH1-R132H mutation status was analyzed using immunohistochemistry, and MGMT promoter methylation was assessed using methylation-specific polymerase chain reaction.ResultsWe included 70 patients (36 men and 34 women) with a median age of 33 years. IDH1-R132H mutations were detected in 22 (39.3%) of 56 cases and MGMT promoter methylation in 33 (61.1%) of 54 cases with available tissue samples. In patients with wild-type IDH, median TTP was 8.2 months and median OS was 24 months, compared with 18 months and 44 months, respectively, observed in patients with mutated IDH. Neither IDH1 nor MGMT status showed a statistically significant association with TTP or OS. Of note, the social and economical situation of the young patients with GBM was alarming, because only 17% succeeded in staying employed after receiving the diagnosis.Conclusions We found a high frequency of IDH1 mutations and MGMT promoter methylation among young adult patients with primary GBM that may contribute to the generally favorable outcome associated with young age. The social and economic coverage of patients with glioma remains an unsolved socio-ethical problem.
    Neuro-Oncology 12/2012; · 5.29 Impact Factor
  • J Haybaeck, G von Campe, J A Hainfellner
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    ABSTRACT: Neuropathological evaluation of frozen sections requires a) special expertise in neuropathological specimen assessment and neurooncology as well as b) a trustful and open communication culture with the neurosurgeons. In addition to frozen sections, cytological examinations of smear and touch preparations as supporting methods are available to reach a correct diagnosis: these additional methods should therefore be performed whenever possible. Besides evaluation of biopsy specimens, appraisal of resection specimens and resection margin controls are of high clinical relevance. In the case of diffusely infiltrating central nervous system (CNS) neoplasms, in particular gliomas, resection margin control is often not feasible in contrast to other types of solid tumor.
    Der Pathologe 08/2012; 33(5):379-88. · 0.64 Impact Factor
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    ABSTRACT: Some unresectable and symptomatic meningiomas recur after conventional radiation therapy or stereotactic radiosurgery and are a therapeutic challenge. Evidence-based data from medical therapy for patients with recurrent meningioma can be deemed insufficient. Because of the prevalent expression of PDGF receptors in meningiomas, the tyrosine kinase imatinib mesylate has attracted interest as a treatment option for this patient group. In this retrospective study we analyzed 18 patients with recurrent meningiomas who were treated at our institution between 1996 and 2008. Nine patients with positive immunohistochemical staining of at least one of the PDGF receptors were given a daily oral dose of 400 mg imatinib mesylate as first, second, or third-line systemic therapy. Immunohistochemical staining was performed on formalin-fixed and paraffin-embedded tumor tissue with antibodies against PDGFR-α and β, c-Kit, Arg, and c-Abl. Imatinib mesylate at a dose of 400-800 mg/day was well tolerated. Of nine patients treated with imatinib, seven had stable disease and two had progressed at the first scan after three months. We observed no complete or partial responses, although prolonged disease stabilization with progression-free survival of 66.7 % at six months was observed. Overall median progression-free survival was 16 months. We conclude that single-agent imatinib mesylate might be a well-tolerated therapeutic option with high achievement of disease stabilization for preselected patients with recurrent meningiomas. Because of the small cohort, non-randomized design, and highly diverse patient population, we propose future prospective studies to validate our results.
    Journal of Neuro-Oncology 05/2012; 109(2):323-30. · 3.12 Impact Factor
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    H Baran, J A Hainfellner, B Kepplinger
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    ABSTRACT: Kynurenic acid, an intermediate metabolite of L-kynurenine, is a competitive antagonist of inotropic excitatory amino acid (EAA) receptors as well as a non competitive antagonist of 7 alpha nicotine cholinergic receptors and its involvement in memory deficit and cognition impairment has been suggested. Alterations of kynurenic acid metabolism in the brain after HIV-1 (human immunodeficiency virus type-1) infection have been demonstrated. The present study evaluates the biosynthetic machinery of kynurenic acid e.g. the content of L-kynurenine and kynurenic acid, as well as the activity of enzymes synthesizing kynurenic acid, kynurenine aminotransferase I (KAT I) and kynurenine aminotransferase II (KAT II) in the frontal cortex and cerebellum of HIV-1 infected patients in relation to different types of pathology classified as follows: HIV in brain (HIV); opportunistic infection (OPP); infarction of brain (INF); malignant lymphoma of brain (LY); and glial dystrophy (GD) and of control (CO) subjects. Of all investigated pathologies the most frequent was OPP (65%), followed by HIV (26%), LY, INF, and GD (each 22%, respectively). Further, 68% of HIV-1 patients had bronchopneumonia, the highest incidence of which, at 60%, was seen in the OPP and LY group. Kynurenic acid was increased significantly in the frontal cortex of LY (392% of CO, P < 0.001), HIV (231% of CO, P < 0.01) and GD (193% of CO, P < 0.05), as well as in the cerebellum of GD (261% of CO, P < 0.01). A significant increase of L-kynurenine was observed in the frontal cortex of LY (385% of CO, P < 0.001) and INF (206% of CO, P < 0.01), and in the cerebellum of GD, LY, OPP and HIV (between 177% and 147% of CO). The KAT I activity increased significantly in the frontal cortex of all pathological subgroups, ie OPP = 420% > INF > LY > HIV > GD = 192% of CO. In the cerebellum, too, all pathological subgroups showed marked increase of KAT I activity (OPP = 320% > LY, HIV > GD > INF = 176% of CO). On contrary, the activity of KAT II was moderately, but significantly, higher in the frontal cortex of INF and OPP; in the cerebellum of HIV, OPP and LY it was comparable to the control, while mildly reduced in INF and GD. Interestingly, normal subjects with the diagnosis of bronchopneumonia were characterized by high kynurenic acid metabolism in the brain, too. Correlation analyses between kynurenine parameters revealed association between high ratio KAT I/KAT II and increased kynurenic acid level and lower L-kynurenine in the frontal cortex and cerebellum of HIV and LY subgroups. The present study revealed a different pattern of alteration of kynurenic acid metabolism in frontal cortex and cerebellum among investigated pathological subgroups of HIV-1 infected patients. Interestingly, a marked enhancement of kynurenic acid metabolism in the brain has been found with occurrence of bronchopneumonia. This finding indicates a notable association between impaired conditions of oxygen availability and enhancement of kynurenic acid formation in the human brain. These observation(s) might have an impact on the understanding of pathological processes in the brain after HIV-1 infection involving the development of neuropsychiatric and neurological symptoms, including memory and cognition impairment.
    International Journal of Tryptophan Research 01/2012; 5:49-64.
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    ABSTRACT: PURPOSE To determine whether there is an accordance between the region of the most malignant part of the tumor related to metabolic changes as demonstrated by multivoxel MR-spectroscopy and the region of the highest tumor perfusion using arterial spin labeling (ASL). METHOD AND MATERIALS 48 patients with primary brain tumours, histologically classified as low-grade (n = 16) or high-grade (n = 32) gliomas according to the WHO brain tumour classification were included. A 3Tesla MR scanner was used to perform multivoxel MR-spectroscopy and pulsed-ASL sequences. The two different sequences were coregistrated and the cerebral lesions were assessed for location of the Cho/Naa ratio peak on MR-spectroscopy and highest signal intensity on the ASL sequence. RESULTS The accordance of the Cho/Naa ratio peak in multivoxel MR-spectroscopy and the region of highest signal intensity in the ASL sequence was 82,5% in high-grade gliomas and 75% in low-grade gliomas. CONCLUSION Our findings may suggest that ASL allows to detect the region of the highest tumor perfusion, which shows a high correlation with the metabolically most malignant region of the brain tumor.The combination of these two non-invasive MR sequences is able to define the tumor hot spot without the use of any contrast media. CLINICAL RELEVANCE/APPLICATION In the clinical setting this would mainly be an advantage for patients with elevated serum creatinine values or known previous allergic reaction associated with contrast media, in which case contrast media application would be a contra indication.
    Radiological Society of North America 2011 Scientific Assembly and Annual Meeting; 12/2011
  • Photodiagnosis and Photodynamic Therapy 06/2011; 8(2):163-164. · 2.52 Impact Factor
  • Photodiagnosis and Photodynamic Therapy 06/2011; 8(2):163-163. · 2.52 Impact Factor
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    ABSTRACT: The codeletion of chromosomal arms 1p 19q is a characteristic and early genetic event in oligodendroglial tumors, that is associated with a better prognosis and enhanced response to therapy. Over the last years, the increasing clinical demand to determine the 1p 19q status has led to the implementation of its testing in many neuropathology laboratories. Several different methods for 1p 19q testing are available: PCR-based loss of heterozygosity analysis, multiplex ligation-dependent probe amplification, array comparative genomic hybridization, and fluorescence in situ hybridization (FISH). Herein, we focus and critically discuss the latter method because a detailed description of procedures and protocols for FISH-based 1p 19q testing in practice is lacking. We present a practical approach to the FISH-based assessment of the 1p 19q status in oligodendroglial tumors, from commonly used locus-specific probes and technical protocols to the neuropathological interpretation of results. Thereby, we aim to facilitate the implementation of FISH-based 1p 19q testing for clinical purposes in standard neuropathology laboratories without special focus on brain tumor research.
    Clinical neuropathology 03/2011; 30(2):47-55. · 1.31 Impact Factor
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    J A Hainfellner, H Heinzl
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    ABSTRACT: Brain tumors comprise a large spectrum of rare malignancies in children and adults that are often associated with severe neurological symptoms and fatal outcome. Neuropathological tumor typing provides both prognostic and predictive tissue information which is the basis for optimal postoperative patient management and therapy. Molecular biomarkers may extend and refine prognostic and predictive information in a brain tumor case, providing more individualized and optimized treatment options. In the recent past a few neuropathological brain tumor biomarkers have translated smoothly into clinical use whereas many candidates show protracted translation. We investigated the causes of protracted translation of candidate brain tumor biomarkers. Considering the research environment from personal, social and systemic perspectives we identified eight determinants of translational success: methodology, funding, statistics, organization, phases of research, cooperation, self-reflection, and scientific progeny. Smoothly translating biomarkers are associated with low degrees of translational complexity whereas biomarkers with protracted translation are associated with high degrees. Key issues for translational efficiency of neuropathological brain tumor biomarker research seem to be related to (i) the strict orientation to the mission of medical research, that is the improval of medical practice as primordial purpose of research, (ii) definition of research priorities according to clinical needs, and (iii) absorption of translational complexities by means of operatively beneficial standards. To this end, concrete actions should comprise adequate scientific education of young investigators, and shaping of integrative diagnostics and therapy research both on the local level and the level of influential international brain tumor research platforms.
    Clinical neuropathology 01/2010; 29(1):41-54. · 1.31 Impact Factor
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    ABSTRACT: We analyzed two unrelated male patients in whom neurofibromatosis type 1 (NF1) was not suspected until they presented with malignant peripheral nerve sheath tumours (MPNSTs) in their thirties and forties, respectively. Patient A presented with progressive peroneus paresis due to a rapidly growing MPNST in the thigh. MRI examination revealed multiple symmetrical spinal neurofibromas in this patient as well as in patient B who presented at the age of 42 with paraparesis and an MPNST at spinal level L4. Dermal features in both patients were strikingly mild, therefore both patients were considered belonging to the NF1-subform of spinal neurofibromatosis (SNF). The novel NF1 mutations identified, i.e. splice mutation, c.7675+1G > A, in patient A and two alterations, p.Cys1016Arg and p.2711delVal, located in trans in patient B support the notion that the phenotype of SNF may be related to mutations with possible residual functionality. The MPNSTs of both patients showed LOH affecting chromosome 17 including the NF1 locus. Furthermore, a truncating TP53 mutation was identified in the tumour of patient A. Both alterations are frequent findings in NF1-associated MPNSTs. To our knowledge these are the first MPNST patients with the clinical phenotype of SNF. The clinical course observed in these two patients suggests that nodular plexiform neurofibromas and spinal-nerve-root neurofibromas which may be asymptomatic for a long time and, hence, unrecognized in SNF patients bear the risk for malignant transformation.
    European journal of medical genetics 11/2009; · 1.57 Impact Factor
  • EJC Supplements 10/2009; 7(4):27-27. · 2.71 Impact Factor
  • J. A. Hainfellner
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    ABSTRACT: A primordial goal of neuropathological brain tumour research is the translation of molecular biomarker candidates into clinical use. Unfortunately, there is currently no general agreement with regard to the sequence and nature of steps that need to be taken to warrant efficient translation of prognostic/predictive biomarker candidates into clinical use. Consequently, the translational path is longwinded for most candidate biomarkers, and only a few candidates have translated swiftly into clinical use. In the molecular era, Neuropathology as medico-academic speciality is challenged to make biomarker translation more efficient. To this end, translational brain tumour biomarker research endeavours need to adopt a systematic stepwise path. A reasonable stepwise path for candidate biomarkers comprises: step 1: profound testing of analytical performance; step 2: verification of clinical performance; step 3: consensus-based definition of best-practice protocols for laboratory testing and interpretation of test results. To shape these changes it seems crucial that Neuropathology is actively involved in the design of research protocols of prospective therapy trials with companion translational research.
    memo - Magazine of European Medical Oncology 07/2009; 2:3-4.

Publication Stats

2k Citations
371.66 Total Impact Points


  • 2003–2014
    • Medical University of Vienna
      • • Department of Neurology
      • • Universitätsklinik für Innere Medizin I
      • • Universitätsklinik für Neurochirurgie
      • • Klinische Abteilung für Onkologie
      Wien, Vienna, Austria
  • 2012
    • Medical University of Graz
      • Institut für Pathologie
      Graz, Styria, Austria
  • 2009
    • Vienna General Hospital
      Wien, Vienna, Austria
  • 2002–2004
    • Institute of Neurology
      Moskva, Moscow, Russia
  • 1993–2004
    • University of Vienna
      • • Institute of Social Medicine
      • • Institute of Neurophysiology
      • • Department of Clinical Pathology
      • • Institute of Clinical Neurobiology
      Vienna, Vienna, Austria
  • 1999
    • University of Zurich
      • Institut für Neuropathologie
      Zürich, ZH, Switzerland
  • 1997
    • University of Veterinary Medicine in Vienna
      • Institute of Pathology and Forensic Veterinary Medicine
      Wien, Vienna, Austria