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However, we report three unusual cases of brainstem tumors with an initial indolent and protracted course, which subsequently developed the classical imaging and clinical features of DIPG. Our findings support this notion that K27M is an early event in development and suggest that the emergence of additional events resulted in rapid progression after a long period of latency. Identification of such markers of aggressive behavior in the context of an indolent course is needed for better characterization and treatment management.<\/jats:p>","DOI":"10.1002\/pbc.28102","type":"journal-article","created":{"date-parts":[[2019,12,3]],"date-time":"2019-12-03T02:02:13Z","timestamp":1575338533000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Indolent course of brainstem tumors with K27M\u2010H3.3 mutation"],"prefix":"10.1002","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1599-7080","authenticated-orcid":false,"given":"Lorena V.","family":"Baroni","sequence":"first","affiliation":[{"name":"Division of Haematology\/Oncology Hospital for Sick Children  Toronto ON Canada"},{"name":"Service of Hematology\/Oncology Hospital JP Garrahan  Buenos Aires Argentina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Palma","family":"Solano\u2010Paez","sequence":"additional","affiliation":[{"name":"Division of Haematology\/Oncology Hospital for Sick Children  Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liana","family":"Nobre","sequence":"additional","affiliation":[{"name":"Division of Haematology\/Oncology Hospital for Sick Children  Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Orli","family":"Michaeli","sequence":"additional","affiliation":[{"name":"Division of Haematology\/Oncology Hospital for Sick Children  Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cynthia","family":"Hawkins","sequence":"additional","affiliation":[{"name":"Department of Pathology Hospital for Sick Children  Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9972-5858","authenticated-orcid":false,"given":"Suzanne","family":"Laughlin","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Imaging Hospital for Sick Children  Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ute","family":"Bartels","sequence":"additional","affiliation":[{"name":"Division of Haematology\/Oncology Hospital for Sick Children  Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6557-895X","authenticated-orcid":false,"given":"Vijay","family":"Ramaswamy","sequence":"additional","affiliation":[{"name":"Division of Haematology\/Oncology Hospital for Sick Children  Toronto ON Canada"},{"name":"Department of Medical Biophysics University of Toronto  Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6832-6539","authenticated-orcid":false,"given":"Eric","family":"Bouffet","sequence":"additional","affiliation":[{"name":"Division of Haematology\/Oncology Hospital for Sick Children  Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,12,2]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00401-016-1568-7"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00401-015-1478-0"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccell.2017.08.017"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccell.2017.03.011"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2017.75.9308"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccell.2017.09.014"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccell.2018.11.015"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccell.2017.10.013"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccell.2018.11.015"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/acn3.184"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00381-016-3161-8"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40478-016-0361-0"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/nan.12329"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10014-019-00347-w"},{"key":"e_1_2_5_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2018.12.147"}],"container-title":["Pediatric Blood &amp; 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