{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T09:19:30Z","timestamp":1770110370116,"version":"3.49.0"},"reference-count":40,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"19","license":[{"start":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T00:00:00Z","timestamp":1747008000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,5,12]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Diffuse midline glioma (DMG) H3 K27\u2013altered is a rare CNS tumor that predominantly affects midline structures in children. A relatively new subtype of glioma, it was first classified in 2016 and was further expanded in 2021 to include 4 molecular subtypes. While reported on in children, this is the first reported case of an H3.3 K27\u2013mutant subtype of DMG affecting the conus medullaris in adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>The authors report the case of a 62-year-old man with gradual onset of bladder and lower-limb dysfunction over a 6-month period. Because of the patient\u2019s synchronous diagnosis of lymphoma, CSF sampling and positron emission tomography (PET) were initially utilized. Ultimately, an open biopsy was required to yield a diagnosis of H3 K27\u2013altered DMG. After multiple disciplinary team discussions and discussions with the patient, radiotherapy was commenced.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>H3 K27\u2013altered DMG affecting the conus medullaris is a very rare tumor that can present with gradual-onset lower-limb dysfunction and can be difficult to diagnose on traditional imaging alone. This case emphasized the continued importance of tissue sampling, with further research required on the utility of PET, CSF sampling, and the significance of molecular subtyping on treatment response and prognosis.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE24879\">https:\/\/thejns.org\/doi\/10.3171\/CASE24879<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case24879","type":"journal-article","created":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T20:15:29Z","timestamp":1747080929000},"source":"Crossref","is-referenced-by-count":0,"title":["Adult H3 K27\u2013altered, H3.3 K27\u2013mutant diffuse midline glioma affecting the conus medullaris: illustrative case"],"prefix":"10.3171","volume":"9","author":[{"given":"Andrei","family":"Sincari","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Royal Brisbane and Women\u2019s Hospital, Brisbane, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saif","family":"Yousif","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Royal Brisbane and Women\u2019s Hospital, Brisbane, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6152-5511","authenticated-orcid":true,"given":"Thomas","family":"Robertson","sequence":"additional","affiliation":[{"name":"Department of Pathology, Royal Brisbane and Women\u2019s Hospital, Brisbane, Queensland, Australia"},{"name":"Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi-Tung Tom","family":"Huang","sequence":"additional","affiliation":[{"name":"Lumus Imaging, St. Vincent\u2019s Private Hospital Northside, Brisbane, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hamish","family":"Alexander","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Royal Brisbane and Women\u2019s Hospital, Brisbane, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"bib1","article-title":"Spinal Cord Tumor\u2014an overview","unstructured":"Spinal Cord Tumor\u2014an overview. 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Front Surg. 2021;8:616334."},{"issue":"1","key":"bib4","series-title":"NMC Case Rep J","first-page":"505","article-title":"Spinal cord diffuse midline glioma, H3K27M-mutant effectively treated with bevacizumab: a report of two cases","volume":"8","author":"Yabuno","year":"2021","unstructured":"Yabuno SKawauchi SUmakoshi MSpinal cord diffuse midline glioma, H3K27M-mutant effectively treated with bevacizumab: a report of two cases. NMC Case Rep J. 2021;8(1):505-511."},{"issue":"16","key":"bib5","series-title":"J Neurosurg Case Lessons","first-page":"CASE22529","article-title":"Diffuse midline glioma, H3K27-altered, of the conus medullaris presenting as acute urinary retention: illustrative case","volume":"5","author":"Saluja","year":"2023","unstructured":"Saluja SRazzaq BServider JASeidman RMushlin H.Diffuse midline glioma, H3K27-altered, of the conus medullaris presenting as acute urinary retention: illustrative case. 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Accessed July 16, 2024. https:\/\/clinicaltrials.gov\/study\/NCT03416530"},{"issue":"1","key":"bib19","series-title":"J Neurooncol","first-page":"87","article-title":"Incidence and clinicopathologic features of H3 K27M mutations in adults with radiographically-determined midline gliomas","volume":"143","author":"Schreck","year":"2019","unstructured":"Schreck KCRanjan SSkorupan NIncidence and clinicopathologic features of H3 K27M mutations in adults with radiographically-determined midline gliomas. J Neurooncol. 2019;143(1):87-93."},{"issue":"6","key":"bib20","series-title":"Acta Neuropathol","first-page":"815","article-title":"Histone H3F3A and HIST1H3B K27M mutations define two subgroups of diffuse intrinsic pontine gliomas with different prognosis and phenotypes","volume":"130","author":"Castel","year":"2015","unstructured":"Castel DPhilippe CCalmon RHistone H3F3A and HIST1H3B K27M mutations define two subgroups of diffuse intrinsic pontine gliomas with different prognosis and phenotypes. Acta Neuropathol. 2015;130(6):815-827."},{"key":"bib1","article-title":"Spinal Cord Tumor\u2014an overview","unstructured":"Spinal Cord Tumor\u2014an overview. ScienceDirect Topics. 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J Neurosurg Case Lessons. 2023;5(16):CASE22529."},{"issue":"6","key":"bib6","series-title":"AJNR Am J Neuroradiol","first-page":"1278","article-title":"PET findings of intramedullary tumors of the spinal cord using [18F] FDG and [11C] methionine","volume":"34","author":"Tomura","year":"2013","unstructured":"Tomura NIto YMatsuoka HPET findings of intramedullary tumors of the spinal cord using [18F] FDG and [11C] methionine. AJNR Am J Neuroradiol. 2013;34(6):1278-1283."},{"issue":"A","key":"bib7","series-title":"J Clin Neurosci","first-page":"1","article-title":"Adult diffuse midline gliomas: clinical, radiological, and genetic characteristics","volume":"82","author":"Dono","year":"2020","unstructured":"Dono ATakayasu TBallester LYEsquenazi Y.Adult diffuse midline gliomas: clinical, radiological, and genetic characteristics. J Clin Neurosci. 2020;82(A):1-8."},{"issue":"8","key":"bib8","series-title":"Neuro Oncol","first-page":"1190","article-title":"High-grade gliomas in adolescents and young adults highlight histomolecular differences from their adult and pediatric counterparts","volume":"22","author":"Roux","year":"2020","unstructured":"Roux APallud JSaffroy RHigh-grade gliomas in adolescents and young adults highlight histomolecular differences from their adult and pediatric counterparts. Neuro Oncol. 2020;22(8):1190-1202."},{"issue":"1","key":"bib9","series-title":"Acta Neuropathol","article-title":"A new subtype of diffuse midline glioma, H3 K27 and BRAF\/FGFR1 co-altered: a clinico-radiological and histomolecular characterisation","volume":"147","author":"Auffret","year":"2023","unstructured":"Auffret LAjlil YTauzi\u00e8de-Espariat AA new subtype of diffuse midline glioma, H3 K27 and BRAF\/FGFR1 co-altered: a clinico-radiological and histomolecular characterisation. Acta Neuropathol. 2023;147(1):2."},{"issue":"8","key":"bib10","series-title":"Neuro Oncol","first-page":"1231","article-title":"The 2021 WHO Classification of Tumors of the Central Nervous System: a summary","volume":"23","author":"Louis","year":"2021","unstructured":"Louis DNPerry AWesseling PThe 2021 WHO Classification of Tumors of the Central Nervous System: a summary. Neuro Oncol. 2021;23(8):1231-1251."},{"issue":"(7)","key":"bib11","first-page":"663","article-title":"Analyses of DNA methylation profiling in the diagnosis of intramedullary astrocytomas","volume":"80","author":"Lebrun","year":"2021","unstructured":"Lebrun L, >Bizet M Melendez B, et al. Analyses of DNA methylation profiling in the diagnosis of intramedullary astrocytomas. J Neuropathol Exp Neurol. 2021; 80(7):663-673."},{"issue":"3","key":"bib12","series-title":"Neuro Oncol","first-page":"309","article-title":"Non-invasive diagnosis of H3 K27M mutant midline glioma","volume":"22","author":"Huang","year":"2020","unstructured":"Huang RYGuenette JP.Non-invasive diagnosis of H3 K27M mutant midline glioma. Neuro Oncol. 2020;22(3):309-310."},{"issue":"6","key":"bib13","series-title":"J Neurosurg","first-page":"1662","article-title":"Imaging characteristics of adult H3 K27M-mutant gliomas","volume":"133","author":"Qiu","year":"2019","unstructured":"Qiu TChanchotisatien AQin ZImaging characteristics of adult H3 K27M-mutant gliomas. J Neurosurg. 2019;133(6):1662-1670."},{"issue":"1","key":"bib14","series-title":"Nucl Med Mol Imaging","first-page":"63","volume":"47","author":"Singhal","year":"2013","unstructured":"Singhal ASharma PKarunanithi S18F-FDG PET-CT for detection of recurrent spinal ependymoma. Nucl Med Mol Imaging. 2013;47(1):63-64."},{"issue":"3","key":"bib15","series-title":"J Magn Reson Imaging","first-page":"690","article-title":"The 2021 WHO classification for gliomas and implications on imaging diagnosis: Part 2\u2014Summary of imaging findings on pediatric-type diffuse high-grade gliomas, pediatric-type diffuse low-grade gliomas, and circumscribed astrocytic gliomas","volume":"58","author":"Park","year":"2023","unstructured":"Park YWVollmuth PFoltyn-Dumitru MThe 2021 WHO classification for gliomas and implications on imaging diagnosis: Part 2\u2014Summary of imaging findings on pediatric-type diffuse high-grade gliomas, pediatric-type diffuse low-grade gliomas, and circumscribed astrocytic gliomas. J Magn Reson Imaging. 2023;58(3):690-708."},{"issue":"5","key":"bib16","series-title":"J Neurosurg","first-page":"392","article-title":"Results of positron emission tomography guidance and reassessment of the utility of and indications for stereotactic biopsy in children with infiltrative brainstem tumors","volume":"107","author":"Pirotte","year":"2007","unstructured":"Pirotte BJMLubansu AMassager NWikler DGoldman SLevivier M.Results of positron emission tomography guidance and reassessment of the utility of and indications for stereotactic biopsy in children with infiltrative brainstem tumors. J Neurosurg. 2007;107(5suppl):392-399."},{"key":"bib17","series-title":"Front Pediatr","first-page":"556802","article-title":"Ventricular cerebrospinal fluid sampling in pediatric diffuse midline glioma patients: institutional experience and review of the literature","volume":"8","author":"Li","year":"2020","unstructured":"Li DStellpflug WRomanski KKilgallon MSpeck SSaratsis AM.Ventricular cerebrospinal fluid sampling in pediatric diffuse midline glioma patients: institutional experience and review of the literature. Front Pediatr. 2020;8:556802."},{"key":"bib18","series-title":"Pediatric H3 K27M Gliomas","article-title":"ONC201 i","unstructured":"ONC201 in Pediatric H3 K27M Gliomas. NCT03416530. ClinicalTrials.gov. 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J Neurooncol. 2019;143(1):87-93."},{"issue":"6","key":"bib20","series-title":"Acta Neuropathol","first-page":"815","article-title":"Histone H3F3A and HIST1H3B K27M mutations define two subgroups of diffuse intrinsic pontine gliomas with different prognosis and phenotypes","volume":"130","author":"Castel","year":"2015","unstructured":"Castel DPhilippe CCalmon RHistone H3F3A and HIST1H3B K27M mutations define two subgroups of diffuse intrinsic pontine gliomas with different prognosis and phenotypes. 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