Intracranial mesenchymal tumor with FET-CREB fusion—A unifying diagnosis for the spectrum of intracranial myxoid mesenchymal tumors and angiomatoid fibrous histiocytoma-like neoplasms

Emily A. Sloan, Jason Chiang, Javier E. Villanueva-Meyer, Sanda Alexandrescu, Jennifer M. Eschbacher, Wesley Wang, Manuela Mafra, Nasir Ud Din, Emily Carr-Boyd, Michael Watson, Michael Punsoni, Angelica Oviedo, Ahmed Gilani, Bette K. Kleinschmidt-DeMasters, Dylan J. Coss, M. Beatriz Lopes, Corey Raffel, Mitchel S. Berger, Susan M. Chang, Alyssa ReddyBiswarathan Ramani, Sean P. Ferris, Julieann C. Lee, Jeffrey W. Hofmann, Soo Jin Cho, Andrew E. Horvai, Melike Pekmezci, Tarik Tihan, Andrew W. Bollen, Fausto J. Rodriguez, David W. Ellison, Arie Perry, David A. Solomon

Research output: Contribution to journalArticlepeer-review

50 Citations (Scopus)


Intracranial mesenchymal tumors with FET-CREB fusions are a recently described group of neoplasms in children and young adults characterized by fusion of a FET family gene (usually EWSR1, but rarely FUS) to a CREB family transcription factor (ATF1, CREB1, or CREM), and have been variously termed intracranial angiomatoid fibrous histiocytoma or intracranial myxoid mesenchymal tumor. The clinical outcomes, histologic features, and genomic landscape are not well defined. Here, we studied 20 patients with intracranial mesenchymal tumors proven to harbor FET-CREB fusion by next-generation sequencing (NGS). The 16 female and four male patients had a median age of 14 years (range 4–70). Tumors were uniformly extra-axial or intraventricular and located at the cerebral convexities (n = 7), falx (2), lateral ventricles (4), tentorium (2), cerebellopontine angle (4), and spinal cord (1). NGS demonstrated that eight tumors harbored EWSR1-ATF1 fusion, seven had EWSR1-CREB1, four had EWSR1-CREM, and one had FUS-CREM. Tumors were uniformly well circumscribed and typically contrast enhancing with solid and cystic growth. Tumors with EWSR1-CREB1 fusions more often featured stellate/spindle cell morphology, mucin-rich stroma, and hemangioma-like vasculature compared to tumors with EWSR1-ATF1 fusions that most often featured sheets of epithelioid cells with mucin-poor collagenous stroma. These tumors demonstrated polyphenotypic immunoprofiles with frequent positivity for desmin, EMA, CD99, MUC4, and synaptophysin, but absence of SSTR2A, myogenin, and HMB45 expression. There was a propensity for local recurrence with a median progression-free survival of 12 months and a median overall survival of greater than 60 months, with three patients succumbing to disease (all with EWSR1-ATF1 fusions). In combination with prior case series, this study provides further insight into intracranial mesenchymal tumors with FET-CREB fusion, which represent a distinct group of CNS tumors encompassing both intracranial myxoid mesenchymal tumor and angiomatoid fibrous histiocytoma-like neoplasms.

Original languageEnglish
Article numbere12918
JournalBrain Pathology
Issue number4
Publication statusPublished - Jul 2021


  • CREB
  • EWSR1
  • angiomatoid fibrous histiocytoma (AFH)
  • brain tumor
  • intracranial myxoid mesenchymal tumor
  • molecular neuropathology
  • sarcoma


Dive into the research topics of 'Intracranial mesenchymal tumor with FET-CREB fusion—A unifying diagnosis for the spectrum of intracranial myxoid mesenchymal tumors and angiomatoid fibrous histiocytoma-like neoplasms'. Together they form a unique fingerprint.

Cite this