Abstract

BRAF (alternately referred to as v-raf murine sarcoma viral oncogene homolog B1) is a proto-oncogene involved in the mitogen-activated protein kinase (MAPK) pathway. BRAF alterations are most commonly missense mutations or aberrant fusions. These mutations are observed in numerous primary central nervous system tumors as well as metastases. This review discusses the prevalence of BRAF alteration within select notable CNS tumors, and their prognostic associations. Included are some novel entities such as diffuse leptomeningeal glioneuronal tumor (DLGNT), polymorphous low grade neuroepithelial tumor of the young (PLNTY), and multinodular and vacuolating neuronal tumor (MVNT). Knowledge of this gene’s integrity in CNS and PNS tumors can have profound diagnostic and therapeutic implications. Also reviewed are the current state of targeted therapy against aberrant BRAF as it pertains mostly to the CNS and to a lesser extent in PNS, and certain diagnostic aspects.

Highlights

  • Personalized medicine has revolutionized cancer care in the 21st century, in the areas of diagnosis and treatment

  • We focus on the proto-oncogene BRAF and its relevance in these aspects of CNS and PNS tumors

  • Rare, it should be noted that BRAF fusions and single nucleotide mutation may occur concurrently, as is the case in an estimated 1–3% of low grade gliomas, 3% of Pilocytic astrocytoma (PA) and Pleomorphic xanthoastrocytoma (PXA), and 1.6% of pilocytic astrocytomas [5, 9] (Table 2)

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Summary

Frontiers in Oncology

BRAF alterations are most commonly missense mutations or aberrant fusions. These mutations are observed in numerous primary central nervous system tumors as well as metastases. This review discusses the prevalence of BRAF alteration within select notable CNS tumors, and their prognostic associations. Included are some novel entities such as diffuse leptomeningeal glioneuronal tumor (DLGNT), polymorphous low grade neuroepithelial tumor of the young (PLNTY), and multinodular and vacuolating neuronal tumor (MVNT). Knowledge of this gene’s integrity in CNS and PNS tumors can have profound diagnostic and therapeutic implications.

INTRODUCTION
BRAF Function
BRAF Alteration CNS and PNS Tumors
Mechanisms of Pathologic Activation
PRIMARY CNS TUMORS
Papillary thyroid carcinoma Colorectal carcinoma
Glioneuronal Tumors
MALIGNANT PERIPHERAL NERVE SHEATH TUMORS
METASTATIC TUMORS TO THE CNS
BRAF TESTING IN NEUROPATHOLOGY
Findings
CONCLUSION

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