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Sato Y, Morita S, Yoshida A, Yoshinaga S, Nishida T. Small gastric synovial sarcoma diagnosed and treatment by laparoscopic-endoscopic cooperative surgery: a case report. Clin J Gastroenterol 2024; 17:18-22. [PMID: 37966703 DOI: 10.1007/s12328-023-01882-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/19/2023] [Indexed: 11/16/2023]
Abstract
We report a case of small gastric synovial sarcoma (SS) finally diagnosed after laparoscopic-endoscopic cooperative surgery (LECS). A 50 year-old male underwent medical examination for a chief complaint of epigastric pain. Endoscopic examination showed a 20 mm submucosal tumor (SMT) located in the anterior wall which extended to the lesser curvature of the middle stomach. The biopsy tissue did not yield a definitive diagnosis. During 6 months of follow-up for this lesion suspected to be an inflammatory tumor, neither the shape nor the size of the tumor changed. We performed LECS for both diagnosis and treatment. Histologically, the tumor was composed of fascicles of spindle cells. Immunohistochemically, the tumor cells were focally positive for epithelial membrane antigen, cytokeratin (AE1/AE3) and S100 protein, while being negative for desmin, α-smooth muscle actin, CD34, c-kit and DOG1. The expression of INI1 was reduced. Fluorescence in situ hybridization (FISH) detected SS18 rearrangement. The SMT was diagnosed as primary SS. A SMT measuring < 20 mm might be malignant potential tumor such as SS even if there are no typical malignant findings by endoscopy. Surgical resection should be considered for SMT measuring < 20 mm with atypical findings even in the absence of definitive high-risk features.
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Affiliation(s)
- Yuya Sato
- Gastric Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Shinji Morita
- Gastric Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
- First Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga-gun, Tochigi, 321-0293, Japan.
| | - Akihiko Yoshida
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Shigetaka Yoshinaga
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Toshiro Nishida
- Gastric Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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2
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Lasota J, Chłopek M, Kaczorowski M, Natálie K, Ryś J, Kopczyński J, Sulaieva O, Michal M, Kruczak A, Harazin-Lechowska A, Szczepaniak M, Koshyk O, Hałoń A, Czapiewski P, Abdullaev Z, Kowalik A, Aldape KD, Michal M, Miettinen M. Utility of Immunohistochemistry With Antibodies to SS18-SSX Chimeric Proteins and C-Terminus of SSX Protein for Synovial Sarcoma Differential Diagnosis. Am J Surg Pathol 2024; 48:97-105. [PMID: 37899499 DOI: 10.1097/pas.0000000000002144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Synovial sarcoma is a relatively common soft tissue tumor characterized by highly specific t(X;18)(p11;q11) translocation resulting in the fusion of SS18 with members of SSX gene family. Typically, detection of SS18 locus rearrangement by fluorescence in situ hybridization or SS18 :: SSX fusion transcripts confirms the diagnosis. More recently, immunohistochemistry (IHC) for SS18-SSX chimeric protein (E9X9V) and C-terminus of SSX (E5A2C) showed high specificity and sensitivity for synovial sarcoma. This study screened a cohort of >1000 soft tissue and melanocytic tumors using IHC and E9X9V and E5A2C antibodies. Three percent (6/212) of synovial sarcomas were either negative for SS18-SSX or had scattered positive tumor cells (n=1). In these cases, targeted RNA next-generation sequencing detected variants of SS18 :: SSX chimeric transcripts. DNA methylation profiles of 2 such tumors matched with synovial sarcoma. A few nonsynovial sarcoma tumors (n=6) revealed either focal SS18-SSX positivity (n=1) or scattered positive tumor cells. However, targeted RNA next-generation sequencing failed to detect SS18 :: SSX transcripts in these cases. The nature of this immunopositivity remains elusive and may require single cell sequencing studies. All synovial sarcomas showed positive SSX IHC. However, a mosaic staining pattern or focal loss of expression was noticed in a few cases. Strong and diffuse SSX immunoreactivity was also seen in epithelioid sclerosing osteosarcoma harboring EWSR1 :: SSX1 fusion, while several sarcomas and melanocytic tumors including cellular blue nevus (5/7, 71%) revealed focal to diffuse, mostly weak to intermediate SSX staining. The SS18-SSX and SSX IHC is a useful tool for synovial sarcoma differential diagnosis, but unusual immunophenotype should trigger molecular genetic testing.
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Affiliation(s)
- Jerzy Lasota
- Laboratory of Pathology, National Cancer Institute, Bethesda, MD
| | - Małgorzata Chłopek
- Laboratory of Pathology, National Cancer Institute, Bethesda, MD
- Department of Molecular Diagnostics, Holycross Cancer Center
| | - Maciej Kaczorowski
- Laboratory of Pathology, National Cancer Institute, Bethesda, MD
- Department of Clinical and Experimental Pathology, Wrocław Medical University, Wrocław
| | - Klubíčková Natálie
- Sikl's Institute of Pathology, Faculty of Medicine and Teaching Hospital in Plzen, Charles University, Plzen, Czech Republic
| | - Janusz Ryś
- Department of Tumor Pathology, Maria Skłodowska-Curie National Research Institute of Oncology, Cracow Branch, Krakow, Poland
| | | | - Oksana Sulaieva
- Department of Clinical Pathology, Medical Laboratory Care and Safe Diagnostics (CSD), Kyiv, Ukraine
| | - Michael Michal
- Sikl's Institute of Pathology, Faculty of Medicine and Teaching Hospital in Plzen, Charles University, Plzen, Czech Republic
| | - Anna Kruczak
- Department of Tumor Pathology, Maria Skłodowska-Curie National Research Institute of Oncology, Cracow Branch, Krakow, Poland
| | - Agnieszka Harazin-Lechowska
- Department of Tumor Pathology, Maria Skłodowska-Curie National Research Institute of Oncology, Cracow Branch, Krakow, Poland
| | | | | | - Agnieszka Hałoń
- Department of Clinical and Experimental Pathology, Wrocław Medical University, Wrocław
| | - Piotr Czapiewski
- Department of Pathology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau
- Institute of Pathology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Zied Abdullaev
- Laboratory of Pathology, National Cancer Institute, Bethesda, MD
| | - Artur Kowalik
- Department of Molecular Diagnostics, Holycross Cancer Center
- Division of Medical Biology, Institute of Biology Jan Kochanowski University, Kielce
| | - Kenneth D Aldape
- Laboratory of Pathology, National Cancer Institute, Bethesda, MD
| | - Michal Michal
- Sikl's Institute of Pathology, Faculty of Medicine and Teaching Hospital in Plzen, Charles University, Plzen, Czech Republic
| | - Markku Miettinen
- Laboratory of Pathology, National Cancer Institute, Bethesda, MD
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3
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Zang Y, Ma C, Xing X, Li H. Primary synovial sarcoma of the pleura in an 18‑year‑old male patient: A case report. Oncol Lett 2023; 26:461. [PMID: 37745981 PMCID: PMC10512107 DOI: 10.3892/ol.2023.14048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Primary synovial sarcoma of the pleura (PSSP) is a rare disease. The present study reported the case of a patient (male; age, 18 years) with two tumors (7.8×2.8 cm and 6.5×5.8 cm) treated with surgery and chemotherapy. To the best of our knowledge, this is the first reported case of two tumors diagnosed as PSSP, which was confirmed by immunohistochemical staining. After six months of follow-up, the symptoms of dry cough and wheezing disappeared and all of the laboratory results were within normal limits. PSSP requires clinical suspicion combined with strategic diagnostic evaluation to confirm the diagnosis and a comprehensive treatment program based on surgery and assisted by chemotherapy.
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Affiliation(s)
- Yibing Zang
- Department of Thoracic Surgery, The Second People's Hospital of Liaocheng, Linqing, Shandong 252600, P.R. China
| | - Chengquan Ma
- Department of Urology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Xiumei Xing
- Department of Thoracic Surgery, The Second People's Hospital of Liaocheng, Linqing, Shandong 252600, P.R. China
| | - Huimin Li
- Department of Geriatrics Nephrology, Linqing People's Hospital, Linqing, Shandong 252600, P.R. China
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4
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Hiemenz MC, Kaur J, Kuang Z, Huang RSP, Harries L, Metzger D, Schiavone K, Millis SZ, Lin DI, Lechpammer M, Decker B, Mata DA, Reddy A, Parke M, Lee EY, Cui X, Iwenofu OH, Buehler D, Henderson L, Baldwin EM, Boikos SA, Ramkissoon SH, Smith SC. POU2AF3-rearranged sarcomas: A novel tumor defined by fusions of EWSR1 or FUS to a gene formerly designated COLCA2. Genes Chromosomes Cancer 2023; 62:460-470. [PMID: 36862145 DOI: 10.1002/gcc.23136] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/30/2023] [Accepted: 02/25/2023] [Indexed: 03/03/2023] Open
Abstract
Gene fusions involving EWSR1 or FUS as the 5' partner have been reported in a diverse array of sarcomas. Here, we characterize the histopathology and genomics of six tumors harboring a gene fusion between EWSR1 or FUS and POU2AF3, an understudied, putative colorectal cancer predisposition gene. Striking morphologic features reminiscent of synovial sarcoma were observed including a biphasic appearance with variable fusiform to epithelioid cytomorphology and staghorn-type vasculature. RNA sequencing demonstrated variable breakpoints in EWSR1/FUS along with similar breakpoints in POU2AF3 that encompassed a 3' portion of this gene. For cases in which additional information was available, the behavior of these neoplasms was aggressive with local spread and/or distant metastases. Although further studies are needed to confirm the functional significance of our findings, POU2AF3 fusions to EWSR1 or FUS may define a novel type of POU2AF3-rearranged sarcomas with aggressive, malignant behavior.
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Affiliation(s)
| | | | - Zheng Kuang
- Foundation Medicine, Cambridge, Massachusetts, USA
| | | | | | - Dana Metzger
- Foundation Medicine, Cambridge, Massachusetts, USA
| | | | | | | | | | | | | | | | - Matthew Parke
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Eun Y Lee
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Xiaoyan Cui
- Department of Pathology and Laboratory Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - O Hans Iwenofu
- Department of Pathology and Laboratory Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Darya Buehler
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Les Henderson
- Wisconsin State Laboratory of Hygiene, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Erin M Baldwin
- Wisconsin State Laboratory of Hygiene, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Sosipatros A Boikos
- Department of Hematology and Oncology, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
| | - Shakti H Ramkissoon
- Foundation Medicine, Cambridge, Massachusetts, USA
- Department of Pathology, Wake Forest School of Medicine and Wake Forest Comprehensive Cancer Center, Winston-Salem, North Carolina, USA
| | - Steven C Smith
- Departments of Pathology and Surgery and Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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5
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Zhong LL, Huang GX, Xian LY, Wei ZC, Tang ZP, Chen QY, Chen H, Tang F. Novel characteristics for immunophenotype, FISH pattern and molecular cytogenetics in synovial sarcoma. Sci Rep 2023; 13:7954. [PMID: 37193761 DOI: 10.1038/s41598-023-34983-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 05/10/2023] [Indexed: 05/18/2023] Open
Abstract
As a rare and highly aggressive soft tissue sarcoma, the new immunophenotype, atypical FISH pattern and relevant molecular cytogenetics of synovial sarcoma (SS) remain less known, although it is characteristically represented by a pathognomonic chromosomal translocation t (X; 18) (p11.2; q11.2). Methodologically, the morphology was retrospectively analysed by using H&E staining, and immunohistochemical features were investigated by using markers that have been recently applied in other soft tissue tumors. Moreover, FISH signals for SS18 and EWSR-1 break-apart probes were examined. Finally, cytogenetic characteristics were analysed via RT-PCR and Sanger sequencing. Consequently, nine out of thirteen cases that were histologically highly suspected as SS were finally identified as SS via molecular analysis. Histologically, nine SS cases were divided into monophasic fibrous SS (4/9), biphasic SS (4/9) and poorly differentiated SS (1/9). Immunohistochemically, SOX-2 immunostaining was positive in eight cases (8/9) and PAX-7 immunostaining was diffusely positive in the epithelial component of biphasic SS (4/4). Nine cases showed negative immunostaining for NKX3.1 and reduced or absent immunostaining for INI-1. Eight cases showed typically positive FISH signalling for the SS18 break-apart probe, whereas one case exhibited an atypical FISH pattern (complete loss of green signalling, case 2). Furthermore, the SS18-SSX1 and SS18-SSX2 fusion genes were identified in seven cases and two cases, respectively. The fusion site in 8 out of 9 cases was common in the literature, whereas the fusion site in case 2 was involved in exon 10 codon 404 in SS18 and exon 7 codon 119 in SSX1 (which has not been previously reported), which notably corresponded to the complete loss of green signalling in the FISH pattern. Additionally, FISH analysis of the EWSR-1 gene in nine SS cases demonstrated aberrant signalling in three cases that were recognized as a monoallelic loss of EWSR-1 (1/9), an amplification of EWSR-1 (1/9) and a translocation of EWSR-1 (1/9). In conclusion, SS18-SSX fusion gene sequencing is obligatory for a precise diagnosis of SS when dealing with a confusing immunophenotype and atypical or aberrant FISH signalling for SS18 and EWSR-1 detection.
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Affiliation(s)
- Ling Ling Zhong
- Department of Pathology, The 924th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Guangxi Key Laboratory of Metabolic Diseases Research, Guilin, 541002, Guangxi, China
- Guangxi Key Laboratory of Glucose and Lipid Metabolic Diseases, The Second Affiliated Hospital of Guilin Medical University, Guilin, 541199, Guangxi, China
| | - Gao Xiang Huang
- Department of Pathology, The 924th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Guangxi Key Laboratory of Metabolic Diseases Research, Guilin, 541002, Guangxi, China
| | - Li Ying Xian
- Department of Pathology and Laboratory Medicine, Dongguan Affiliated Hospital of Southern Medical University, Dongguan, 523059, Guangdong, China
| | - Zong Chen Wei
- Department of Pathology, The 924th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Guangxi Key Laboratory of Metabolic Diseases Research, Guilin, 541002, Guangxi, China
| | - Zhi Ping Tang
- Department of Pathology, The 924th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Guangxi Key Laboratory of Metabolic Diseases Research, Guilin, 541002, Guangxi, China
| | - Qiu Yue Chen
- Department of Pathology, The 924th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Guangxi Key Laboratory of Metabolic Diseases Research, Guilin, 541002, Guangxi, China
| | - Hao Chen
- Department of Pathology, The 924th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Guangxi Key Laboratory of Metabolic Diseases Research, Guilin, 541002, Guangxi, China
| | - Fang Tang
- Department of Pathology, The 924th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Guangxi Key Laboratory of Metabolic Diseases Research, Guilin, 541002, Guangxi, China.
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6
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Choi JH, Ro JY. The Recent Advances in Molecular Diagnosis of Soft Tissue Tumors. Int J Mol Sci 2023; 24:ijms24065934. [PMID: 36983010 PMCID: PMC10051446 DOI: 10.3390/ijms24065934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/17/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023] Open
Abstract
Soft tissue tumors are rare mesenchymal tumors with divergent differentiation. The diagnosis of soft tissue tumors is challenging for pathologists owing to the diversity of tumor types and histological overlap among the tumor entities. Present-day understanding of the molecular pathogenesis of soft tissue tumors has rapidly increased with the development of molecular genetic techniques (e.g., next-generation sequencing). Additionally, immunohistochemical markers that serve as surrogate markers for recurrent translocations in soft tissue tumors have been developed. This review aims to provide an update on recently described molecular findings and relevant novel immunohistochemical markers in selected soft tissue tumors.
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Affiliation(s)
- Joon Hyuk Choi
- Department of Pathology, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Namgu, Daegu 42415, Republic of Korea
| | - Jae Y Ro
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College, Cornell University, Houston, TX 77030, USA
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7
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De Noon S, Piggott R, Trotman J, Tadross JA, Fittall M, Hughes D, Ye H, Munasinghe E, Murray M, Tirabosco R, Amary F, Coleman N, Watkins J, Hubank M, Tarpey P, Behjati S, Flanagan AM. Recurrent FOSL1 rearrangements in desmoplastic fibroblastoma. J Pathol 2023; 259:119-124. [PMID: 36426824 PMCID: PMC10107450 DOI: 10.1002/path.6038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/02/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022]
Abstract
The FOS gene family has been implicated in tumourigenesis across several tumour types, particularly mesenchymal tumours. The rare fibrous tumour desmoplastic fibroblastoma is characterised by overexpression of FOSL1. However, previous studies using cytogenetic and molecular techniques did not identify an underlying somatic change involving the FOSL1 gene to explain this finding. Prompted by an unusual index case, we report the discovery of a novel FOSL1 rearrangement in desmoplastic fibroblastoma using whole-genome and targeted RNA sequencing. We investigated 15 desmoplastic fibroblastomas and 15 fibromas of tendon sheath using immunohistochemistry, in situ hybridisation and targeted RNA sequencing. Rearrangements in FOSL1 and FOS were identified in 10/15 and 2/15 desmoplastic fibroblastomas respectively, which mirrors the pattern of FOS rearrangements observed in benign bone and vascular tumours. Fibroma of tendon sheath, which shares histological features with desmoplastic fibroblastoma, harboured USP6 rearrangements in 9/15 cases and did not demonstrate rearrangements in any of the four FOS genes. The overall concordance between FOSL1 immunohistochemistry and RNA sequencing results was 90%. These findings illustrate that FOSL1 and FOS rearrangements are a recurrent event in desmoplastic fibroblastoma, establishing this finding as a useful diagnostic adjunct and expanding the spectrum of tumours driven by FOS gene family alterations. © 2022 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Solange De Noon
- Research Department of PathologyUniversity College London Cancer InstituteLondonUK
- Department of HistopathologyRoyal National Orthopaedic HospitalStanmoreUK
| | - Robert Piggott
- Cambridge Genomics LaboratoryCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Jamie Trotman
- Cambridge Genomics LaboratoryCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - John A Tadross
- Cambridge Genomics LaboratoryCambridge University Hospitals NHS Foundation TrustCambridgeUK
- Department of HistopathologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
- MRC Metabolic Diseases Unit, Wellcome Trust‐Medical Research Council Institute of Metabolic ScienceUniversity of CambridgeCambridgeUK
| | - Matthew Fittall
- Department of OncologyUniversity College London Hospitals NHS Foundation TrustLondonUK
- Division of OncologyUniversity College London Cancer InstituteLondonUK
| | - Debbie Hughes
- Paediatric Tumour Biology, Division of Clinical StudiesThe Institute of Cancer ResearchLondonUK
| | - Hongtao Ye
- Department of HistopathologyRoyal National Orthopaedic HospitalStanmoreUK
| | - Emani Munasinghe
- Department of HistopathologyRoyal National Orthopaedic HospitalStanmoreUK
| | - Matthew Murray
- Department of Paediatric Haematology and OncologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
- Department of PathologyUniversity of CambridgeCambridgeUK
| | - Roberto Tirabosco
- Department of HistopathologyRoyal National Orthopaedic HospitalStanmoreUK
| | - Fernanda Amary
- Department of HistopathologyRoyal National Orthopaedic HospitalStanmoreUK
| | | | - James Watkins
- Cambridge Genomics LaboratoryCambridge University Hospitals NHS Foundation TrustCambridgeUK
- Department of HistopathologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Michael Hubank
- Clinical GenomicsThe Royal Marsden NHS Foundation TrustLondonUK
- Molecular PathologyThe Institute of Cancer ResearchLondonUK
| | - Patrick Tarpey
- Cambridge Genomics LaboratoryCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Sam Behjati
- Department of Paediatric Haematology and OncologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
- Cellular GeneticsWellcome Sanger InstituteHinxtonUK
- Department of PaediatricsUniversity of CambridgeCambridgeUK
| | - Adrienne M Flanagan
- Research Department of PathologyUniversity College London Cancer InstituteLondonUK
- Department of HistopathologyRoyal National Orthopaedic HospitalStanmoreUK
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8
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Fujii T, Takeda M, Uchiyama T, Nitta Y, Maebou K, Terada C, Okada F, Matsuoka M, Sugimoto S, Sasaki S, Morita K, Itami H, Miyake M, Takeda M, Sawabata N, Fujimoto K, Ohbayashi C. Identification of fusion transcripts in sarcoma from archival formalin-fixed paraffin-embedded tissues: A next-generation sequencing approach. Pathol Int 2022; 72:444-456. [PMID: 35975909 DOI: 10.1111/pin.13265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/21/2022] [Indexed: 11/30/2022]
Abstract
Most sarcomas are highly aggressive, and cause necrosis and hemorrhage. The diagnosis of sarcoma is challenging because of the lack of specificity of immunohistochemical staining; however, molecular biological approaches, such as genetic mutation, chromosomal translocation, and gene amplification, are promising. In this study, we extracted RNA from formalin-fixed paraffin-embedded (FFPE) tissue derived from surgically resected specimens of sarcoma stored for various periods and performed next-generation sequencing (NGS) analysis by MiniSeq using the Archer Fusion-Plex Sarcoma Panel. RNA was extracted from 63 FFPE tissue samples, and the degree of RNA degradation was assessed. The number of reads and fragment lengths were evaluated by NGS analysis. RNA extraction and cDNA synthesis were successful in 56 cases and library preparation was possible. Fusion genes were detected in 16 of 63 archived FFPE tissue samples in this study. However, in 18 cases, fragmentation was strong, and high-quality libraries could not be obtained. Nevertheless, comprehensive analysis of fusion genes with high sequence specificity by NGS can be a powerful alternative to reverse transcription-polymerase chain reaction and fluorescence in situ hybridization methods.
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Affiliation(s)
- Tomomi Fujii
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Maiko Takeda
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Tomoko Uchiyama
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Yuji Nitta
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Katsuya Maebou
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Chiyoko Terada
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Fumi Okada
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Minami Matsuoka
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Sumire Sugimoto
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Shoh Sasaki
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Kohei Morita
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Hiroe Itami
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University School of Medicine, Nara, Japan
| | - Masayuki Takeda
- Department of Cancer Genomics and Medical Oncology, Nara Medical University School of Medicine, Nara, Japan
| | - Noriyoshi Sawabata
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Nara, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University School of Medicine, Nara, Japan
| | - Chiho Ohbayashi
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
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9
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Meister MT, Groot Koerkamp MJA, de Souza T, Breunis WB, Frazer‐Mendelewska E, Brok M, DeMartino J, Manders F, Calandrini C, Kerstens HHD, Janse A, Dolman MEM, Eising S, Langenberg KPS, van Tuil M, Knops RRG, van Scheltinga ST, Hiemcke‐Jiwa LS, Flucke U, Merks JHM, van Noesel MM, Tops BBJ, Hehir‐Kwa JY, Kemmeren P, Molenaar JJ, van de Wetering M, van Boxtel R, Drost J, Holstege FCP. Mesenchymal tumor organoid models recapitulate rhabdomyosarcoma subtypes. EMBO Mol Med 2022; 14:e16001. [PMID: 35916583 PMCID: PMC9549731 DOI: 10.15252/emmm.202216001] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 02/05/2023] Open
Abstract
Rhabdomyosarcomas (RMS) are mesenchyme-derived tumors and the most common childhood soft tissue sarcomas. Treatment is intense, with a nevertheless poor prognosis for high-risk patients. Discovery of new therapies would benefit from additional preclinical models. Here, we describe the generation of a collection of 19 pediatric RMS tumor organoid (tumoroid) models (success rate of 41%) comprising all major subtypes. For aggressive tumors, tumoroid models can often be established within 4-8 weeks, indicating the feasibility of personalized drug screening. Molecular, genetic, and histological characterization show that the models closely resemble the original tumors, with genetic stability over extended culture periods of up to 6 months. Importantly, drug screening reflects established sensitivities and the models can be modified by CRISPR/Cas9 with TP53 knockout in an embryonal RMS model resulting in replicative stress drug sensitivity. Tumors of mesenchymal origin can therefore be used to generate organoid models, relevant for a variety of preclinical and clinical research questions.
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Affiliation(s)
- Michael T Meister
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands,Oncode InstituteUtrechtThe Netherlands
| | - Marian J A Groot Koerkamp
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands,Oncode InstituteUtrechtThe Netherlands
| | - Terezinha de Souza
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands,Oncode InstituteUtrechtThe Netherlands
| | - Willemijn B Breunis
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands,Department of Oncology and Children's Research CenterUniversity Children's Hospital ZürichZürichSwitzerland
| | - Ewa Frazer‐Mendelewska
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands,Oncode InstituteUtrechtThe Netherlands
| | - Mariël Brok
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands,Oncode InstituteUtrechtThe Netherlands
| | - Jeff DeMartino
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands,Oncode InstituteUtrechtThe Netherlands
| | - Freek Manders
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands,Oncode InstituteUtrechtThe Netherlands
| | - Camilla Calandrini
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands,Oncode InstituteUtrechtThe Netherlands
| | | | - Alex Janse
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
| | - M Emmy M Dolman
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands,Children's Cancer Institute, Lowy Cancer CentreUNSW SydneyKensingtonNSWAustralia,School of Women's and Children's Health, Faculty of MedicineUNSW SydneyKensingtonNSWAustralia
| | - Selma Eising
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
| | | | - Marc van Tuil
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
| | - Rutger R G Knops
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
| | | | | | - Uta Flucke
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
| | | | - Max M van Noesel
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
| | | | | | - Patrick Kemmeren
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands,Center for Molecular MedicineUMC Utrecht and Utrecht UniversityUtrechtThe Netherlands
| | - Jan J Molenaar
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
| | - Marc van de Wetering
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands,Oncode InstituteUtrechtThe Netherlands
| | - Ruben van Boxtel
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands,Oncode InstituteUtrechtThe Netherlands
| | - Jarno Drost
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands,Oncode InstituteUtrechtThe Netherlands
| | - Frank C P Holstege
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands,Center for Molecular MedicineUMC Utrecht and Utrecht UniversityUtrechtThe Netherlands
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10
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Zheng YJ, Ren L, Zhu Y, Yang X, Zhang X, Deng S, Wang ZQ, Chen D, Shao Y, Han PC, Zhang Q. DICER1-associated sarcoma of the aortic arch - a case report and literature review. Cardiovasc Pathol 2022; 60:107451. [PMID: 35835430 DOI: 10.1016/j.carpath.2022.107451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 06/22/2022] [Accepted: 07/06/2022] [Indexed: 11/29/2022] Open
Abstract
Primary sarcoma of the aorta is extremely rare. We herein report a case of DICER1-associated sarcoma originating from the aortic arch. A 45-year-old male was admitted to the hospital with a cold left hand and weakened radial artery pulse in the left side. Computed tomography of the chest showed multiple penetrating ulcers with tumor-like ectasia at the aortic arch, diagnosed as a pseudoaneurysm. Histopathological analysis of the mass revealed a biphasic neoplasm composed of epithelial and mesenchymal components and a transition zone between the epithelial and mesenchymal cells, which supports the diagnosis of a biphasic sarcoma rather than carcinosarcoma. The differentiated cells of soft tissue showed strong and diffuse positivity for TLE-1, Bcl-2, and CD99; the nested epithelial cells were focally positive for CK-pan, but negative for EMA, membranous localization of β-catenin. This case showed a unique pattern of SS18-break-apart probe, with loss of the green signal (approximately 33%) by fluorescence in situ hybridization (FISH). Fusion gene profiling using whole transcriptome RNA sequencing (RNA-seq) indicated that this case was negative for common fusion genes including SS18. Next-generation sequencing (NGS) revealed somatic mutations in DICER1 . Taken together, this case was diagnosed as a DICER-associated biphasic sarcoma of the aortic arch. The patient died four months after aorta replacement therapy without radiotherapy and chemotherapy.
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Affiliation(s)
- Yan-Jun Zheng
- TEDA Hospital of Tianjin University, pathology department, Tianjin, China; Stomatology colledge, Tianjin Medical University
| | - Ling Ren
- TEDA Hospital of Tianjin University, pathology department, Tianjin, China; Stomatology colledge, Tianjin Medical University
| | - Yu Zhu
- TEDA Hospital of Tianjin University, pathology department, Tianjin, China; Stomatology colledge, Tianjin Medical University
| | - Xi Yang
- TEDA Hospital of Tianjin University, pathology department, Tianjin, China; Stomatology colledge, Tianjin Medical University
| | - Xiang Zhang
- Third central hospital of Tianjin Medical University, radiology department, Tianjin, China; Stomatology colledge, Tianjin Medical University
| | - Shu Deng
- Second Hospital of Tianjin Medical University, stomatology department, Tianjin, China; Stomatology colledge, Tianjin Medical University
| | - Zheng-Qing Wang
- Second Hospital of Tianjin Medical University, stomatology department, Tianjin, China; TEDA international Cardiovascular Hospital of Tianjin University, cardiovascular surgery department, Tianjin, China; Stomatology colledge, Tianjin Medical University
| | - Dong Chen
- TEDA international Cardiovascular Hospital of Tianjin University, cardiovascular surgery department, Tianjin, China; Affiliated Anzhen Hospital of Capital Medical University, pathology department, Beijing, China; Stomatology colledge, Tianjin Medical University
| | - Yang Shao
- Affiliated Anzhen Hospital of Capital Medical University, pathology department, Beijing, China; Nanjing Geneseeq Technology, Inc, Nanjing, China; School of Public Health, Nanjing Medical University, Nanjing, China; Stomatology colledge, Tianjin Medical University
| | - Peng-Cheng Han
- Department of Pathology, Tianjin Third Central Hospital, Tianjin, China; Stomatology colledge, Tianjin Medical University
| | - Qin Zhang
- TEDA Hospital of Tianjin University, pathology department, Tianjin, China; TEDA international Cardiovascular Hospital of Tianjin University, cardiovascular surgery department, Tianjin, China; Nanjing Geneseeq Technology, Inc, Nanjing, China; School of Public Health, Nanjing Medical University, Nanjing, China; Stomatology colledge, Tianjin Medical University.
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11
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Predominantly epithelial-type synovial sarcoma with overwhelming neuroendocrine differentiation: a potential diagnostic pitfall. Diagn Pathol 2022; 17:59. [PMID: 35820955 PMCID: PMC9277931 DOI: 10.1186/s13000-022-01243-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/23/2022] [Indexed: 12/04/2022] Open
Abstract
Background Synovial sarcoma is an uncommon soft tissue tumor of soft tissue, characterized by a specific SS18 rearrangement. It generally manifests as a lesion composed of monomorphic spindle cells and sometimes shows variable epithelial differentiation. Epithelial-type synovial sarcoma is rare, and synovial sarcoma with overwhelming neuroendocrine differentiation has not been reported previously. Case presentation Here, we present a case of a young man with an epithelial-type synovial sarcoma of the right leg that showed an overwhelming neuroendocrine differentiation. The diagnosis was confirmed by the detection of targeted fusion re-arrangement associated with synovial sarcoma. Conclusions This study emphasizes the importance of molecular approaches in modern soft tissue pathology. Detecting the expression of neuroendocrine antigens in synovial sarcoma is a pre-requisite to avoid misdiagnosis of metastatic neuroendocrine tumor, malignant peripheral nerve sheath tumor with glandular differentiation, and carcinosarcoma.
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12
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Unusual mimicker of odontogenic carcinoma: Primary synovial sarcoma of the temporomandibular joint- a critical role for molecular diagnosis. Pathol Res Pract 2022; 232:153824. [DOI: 10.1016/j.prp.2022.153824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/19/2022] [Accepted: 02/23/2022] [Indexed: 11/20/2022]
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13
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Identification of novel SSX1 fusions in synovial sarcoma. Mod Pathol 2022; 35:228-239. [PMID: 34504309 DOI: 10.1038/s41379-021-00910-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/13/2021] [Accepted: 08/15/2021] [Indexed: 12/28/2022]
Abstract
Synovial sarcoma is characterized by variable epithelial differentiation and specific SS18-SSX gene fusions. The diagnosis is primarily based on phenotype, but fusion gene detection is increasingly being considered indispensable, with SS18 break-apart fluorescence in situ hybridization (FISH) being favored in many laboratories. However, SS18 FISH assay produces negative or atypical results in a minority of cases, leaving uncertainties in diagnosis and management. Here, we analyzed this challenging subset of SS18 FISH-negative/atypical synovial sarcoma using RNA sequencing and monoclonal antibodies that recognize SS18-SSX and the SSX C-terminus. Among 99 synovial sarcoma cases that were previously subjected to SS18 break-apart FISH, eight cases were reported as negative and three cases were indeterminate, owing to atypical signal patterns. Three of these 11 tumors (two monophasic and one biphasic) harbored novel EWSR1-SSX1 fusions, were negative for SS18-SSX staining, and were positive for SSX C-terminus staining. One monophasic tumor harbored a novel MN1-SSX1 fusion, and showed negative SS18-SSX expression and positive SSX C-terminus staining. Another monophasic tumor carried an SS18L1-SSX1 fusion, and was weakly positive for SS18-SSX, while SMARCB1 expression was reduced. The presence of these novel and/or rare fusions was confirmed using RT-PCR and Sanger sequencing. EWSR1-SSX1 was further validated by EWSR1 FISH assay. The remaining six tumors (five monophasic and one biphasic) showed strong SS18-SSX expression, and RNA sequencing successfully performed in three cases identified canonical SS18-SSX2 fusions. Based on a DNA methylation-based unsupervised clustering, the tumors with EWSR1-SSX1 and SS18L1-SSX1 clustered with synovial sarcoma, while the MN1-SSX1-positive tumor was not co-clustered despite classic histology and immunoprofile. In summary, we discovered novel and rare SSX1 fusions to non-SS18 genes in synovial sarcoma. The expanded genetic landscape carries significant diagnostic implications and advances our understanding of the oncogenic mechanism.
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14
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Reimers MA, Sehn JK, Van Tine BA, Smith ZL. Primary Prostatic Synovial Sarcoma With Pulmonary Metastases Identified by Routine Next-Generation Sequencing. JCO Precis Oncol 2022; 5:1133-1140. [PMID: 34994631 DOI: 10.1200/po.21.00051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Melissa A Reimers
- Division of Oncology, Department of Internal Medicine, Section of Medical Oncology, Washington University in St Louis, St Louis, MO.,Siteman Cancer Center, Washington University in St Louis, St Louis, MO
| | - Jennifer K Sehn
- Department of Pathology and Immunology, Washington University in St Louis, St Louis, MO
| | - Brian A Van Tine
- Division of Oncology, Department of Internal Medicine, Section of Medical Oncology, Washington University in St Louis, St Louis, MO.,Siteman Cancer Center, Washington University in St Louis, St Louis, MO.,Department of Pediatric Hematology and Oncology, St Louis Children's Hospital, St Louis, MO
| | - Zachary L Smith
- Siteman Cancer Center, Washington University in St Louis, St Louis, MO.,Division of Urologic Surgery, Department of Surgery, Washington University in St Louis, St Louis, MO
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15
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Teixeira LN, da Cruz EZ, Rosa ACG, Rodrigues AA, Passador-Santos F, de Araújo VC, Soares AB. Primary Intraosseous Synovial Sarcoma in the Mandible. Case Rep Oncol Med 2021; 2021:9945591. [PMID: 34877023 PMCID: PMC8645409 DOI: 10.1155/2021/9945591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 10/20/2021] [Accepted: 10/26/2021] [Indexed: 11/18/2022] Open
Abstract
Synovial sarcoma (SS) is a rare malignant mesenchymal tumor that mainly occurs in body extremities, being uncommon in the head and neck region. In the present study, we described a case of primary intraosseous SS arising in the mandible of a 22-year-old young male. The patient reported a painful swelling on the left side of the mandible for the last 7 months. Imaging exams showed the presence of an expansive and multilocular radiolucent lesion, extending from the left condyle to the mandibular body. The clinic diagnostic hypotheses were ameloblastoma or malignant neoplasm. Histologically, the lesion was characterized by a proliferation of spindle cells exhibiting vesicular nuclei and evident nucleolus. Neoplastic cells were positive for AE1/AE3, cytokeratin 7, vimentin, CD-99, and TLE-1 and negative for CD-34, S-100, SMA, and HHF-35. A combination of clinical, histologic, and immunohistochemical characteristics supported the diagnosis of SS. The patient was referred for treatment, and preoperative exams did not reveal any other tumor foci in the body of the patient. The final diagnosis was of a primary intraosseous SS of the mandible.
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Affiliation(s)
- Lucas Novaes Teixeira
- Faculdade São Leopoldo Mandic, Rua José Rocha Junqueira 13, Swift, 13045-755 Campinas, SP, Brazil
| | - Eduardo Zambaldi da Cruz
- Faculdade São Leopoldo Mandic, Rua José Rocha Junqueira 13, Swift, 13045-755 Campinas, SP, Brazil
| | - Ana Cláudia Garcia Rosa
- Faculdade São Leopoldo Mandic, Rua José Rocha Junqueira 13, Swift, 13045-755 Campinas, SP, Brazil
- School of Medicine, Federal University of Tocantins, Avenida NS-15, Quadra 109, Norte, S/n-Plano Diretor Norte, Palmas TO 77001-090, Brazil
| | - Anderson Abdo Rodrigues
- School of Medicine, Federal University of Tocantins, Avenida NS-15, Quadra 109, Norte, S/n-Plano Diretor Norte, Palmas TO 77001-090, Brazil
| | - Fabrício Passador-Santos
- Faculdade São Leopoldo Mandic, Rua José Rocha Junqueira 13, Swift, 13045-755 Campinas, SP, Brazil
| | | | - Andresa Borges Soares
- Faculdade São Leopoldo Mandic, Rua José Rocha Junqueira 13, Swift, 13045-755 Campinas, SP, Brazil
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16
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Khalili N, Askari E, Khalili N, Daneshvar-Kakhki A, Sadr M, Haseli S, Pourabdollah Toutkaboni M. Primary Pleuropulmonary Synovial Sarcoma: Report of Two Cases and a Comprehensive Review of the Literature. Cancer Invest 2021; 40:268-281. [PMID: 34726558 DOI: 10.1080/07357907.2021.2001484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Primary sarcomas of the lung represent less than 0.5% of all primary lung tumors and comprise a heterogeneous group of malignancies including synovial sarcoma (SS). Primary pleuropulmonary SS has non-specific presentations, such as chest pain, shortness of breath and cough, and its associated imaging features resemble those of other intrathoracic malignancies. The diagnosis of these tumors needs to be confirmed by cytogenetic and molecular studies. Here, we describe two rare cases of primary pleuropulmonary SS who were admitted to our hospital. We also provide a concise review of clinical, radiological, and histopathological characteristics of pleuropulmonary SS after exploring 168 studies (415 corresponding patients) that were identified through a literature search.
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Affiliation(s)
- Neda Khalili
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Askari
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nastaran Khalili
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Aboulghasem Daneshvar-Kakhki
- Lung Transplantation Research Center (LTRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Makan Sadr
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Haseli
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mihan Pourabdollah Toutkaboni
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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17
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Hadjimichael AC, Pergaris A, Kaspiris A, Foukas AF, Theocharis SE. Liquid Biopsy: A New Translational Diagnostic and Monitoring Tool for Musculoskeletal Tumors. Int J Mol Sci 2021; 22:11526. [PMID: 34768955 PMCID: PMC8583711 DOI: 10.3390/ijms222111526] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 10/21/2021] [Accepted: 10/23/2021] [Indexed: 12/17/2022] Open
Abstract
Soft tissue and bone sarcomas represent a group of aggressive neoplasms often accompanied by dismal patient prognosis, especially when distant metastases are present. Moreover, effective treatment can pose a challenge, as recurrences are frequent and almost half of patients present with advanced disease. Researchers have unveiled the molecular abnormalities implicated in sarcomas' carcinogenesis, paving the way for novel treatment strategies based on each individual tumor's characteristics. Therefore, the development of new techniques aiding in early disease detection and tumor molecular profiling is imperative. Liquid biopsy refers to the sampling and analysis of patients' fluids, such as blood, to identify tumor biomarkers, through a variety of methods, including qRT-PCR, qPCR, droplet digital PCR, magnetic microbeads and digital PCR. Assessment of circulating tumor cells (CTCs), circulating free DNA (ctDNA), micro RNAs (miRs), long non-coding RNAs (lncRNAs), exosomes and exosome-associated proteins can yield a plethora of information on tumor molecular signature, histologic type and disease stage. In addition, the minimal invasiveness of the procedure renders possible its wide application in the clinical setting, and, therefore, the early detection of the presence of tumors. In this review of the literature, we gathered information on biomarkers assessed through liquid biopsy in soft tissue and bone sarcoma patients and we present the information they can yield for each individual tumor type.
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Affiliation(s)
- Argyris C. Hadjimichael
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Street, Bld 10, Goudi, 11527 Athens, Greece; (A.C.H.); (A.P.)
- Third Department of Orthopaedic Surgery, “KAT” General Hospital of Athens, Nikis 2, 14561 Kifissia, Greece;
| | - Alexandros Pergaris
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Street, Bld 10, Goudi, 11527 Athens, Greece; (A.C.H.); (A.P.)
| | - Angelos Kaspiris
- Division for Orthopaedic Research, Laboratory of Molecular Pharmacology, School of Health Sciences, University of Patras, 26504 Patras, Greece;
| | - Athanasios F. Foukas
- Third Department of Orthopaedic Surgery, “KAT” General Hospital of Athens, Nikis 2, 14561 Kifissia, Greece;
| | - Stamatios E. Theocharis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Street, Bld 10, Goudi, 11527 Athens, Greece; (A.C.H.); (A.P.)
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18
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Fiore M, Sambri A, Spinnato P, Zucchini R, Giannini C, Caldari E, Pirini MG, De Paolis M. The Biology of Synovial Sarcoma: State-of-the-Art and Future Perspectives. Curr Treat Options Oncol 2021; 22:109. [PMID: 34687366 PMCID: PMC8541977 DOI: 10.1007/s11864-021-00914-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2021] [Indexed: 12/22/2022]
Abstract
New molecular insights are being achieved in synovial sarcoma (SS) that can provide new potential diagnostic and prognostic markers as well as therapeutic targets. In particular, the advancement of research on epigenomics and gene regulation is promising. The concrete hypothesis that the pathogenesis of SS might mainly depend on the disruption of the balance of the complex interaction between epigenomic regulatory complexes and the consequences on gene expression opens interesting new perspectives. The standard of care for primary SS is wide surgical resection combined with radiation in selected cases. The role of chemotherapy is still under refinement and can be considered in patients at high risk of metastasis or in those with advanced disease. Cytotoxic chemotherapy (anthracyclines, ifosfamide, trabectedin, and pazopanib) is the treatment of choice, despite several possible side effects. Many possible drug-able targets have been identified. However, the impact of these strategies in improving SS outcome is still limited, thus making current and future research strongly needed to improve the survival of patients with SS.
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Affiliation(s)
- Michele Fiore
- Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Andrea Sambri
- Alma Mater Studiorum - University of Bologna, Bologna, Italy. .,IRCCS Azienda Ospedaliero Universitaria di Bologna, via Massarenti 9, 40138, Bologna, Italy.
| | | | | | | | - Emilia Caldari
- IRCCS Azienda Ospedaliero Universitaria di Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - Maria Giulia Pirini
- IRCCS Azienda Ospedaliero Universitaria di Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - Massimiliano De Paolis
- IRCCS Azienda Ospedaliero Universitaria di Bologna, via Massarenti 9, 40138, Bologna, Italy
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19
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De Noon S, Ijaz J, Coorens THH, Amary F, Ye H, Strobl A, Lyskjær I, Flanagan AM, Behjati S. MYC amplifications are common events in childhood osteosarcoma. J Pathol Clin Res 2021; 7:425-431. [PMID: 33969640 PMCID: PMC8363928 DOI: 10.1002/cjp2.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/18/2021] [Accepted: 04/06/2021] [Indexed: 12/04/2022]
Abstract
Osteosarcoma, the most common primary malignant tumour of bone, affects both children and adults. No fundamental biological differences between paediatric and adult osteosarcoma are known. Here, we apply multi-region whole-genome sequencing to an index case of a 4-year-old child whose aggressive tumour harboured high-level, focal amplifications of MYC and CCNE1 connected by translocations. We reanalysed copy number readouts of 258 cases of high-grade osteosarcoma from three different cohorts and identified a significant enrichment of focal MYC, but not CCNE1, amplifications in children. Furthermore, we identified four additional cases of MYC and CCNE1 coamplification, highlighting a rare driver event which warrants further investigation. Our findings indicate that amplification of the MYC oncogene is a major driver of childhood osteosarcoma, while CCNE1 appears recurrently amplified independent of age.
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Affiliation(s)
- Solange De Noon
- Research Department of PathologyUniversity College London (UCL) Cancer InstituteLondonUK
| | | | | | - Fernanda Amary
- Department of HistopathologyRoyal National Orthopaedic HospitalStanmoreUK
| | - Hongtao Ye
- Department of HistopathologyRoyal National Orthopaedic HospitalStanmoreUK
| | - Anna Strobl
- Department of HistopathologyRoyal National Orthopaedic HospitalStanmoreUK
| | - Iben Lyskjær
- Research Department of PathologyUniversity College London (UCL) Cancer InstituteLondonUK
- Medical Genomics Research GroupUCL Cancer InstituteLondonUK
| | - Adrienne M Flanagan
- Research Department of PathologyUniversity College London (UCL) Cancer InstituteLondonUK
- Department of HistopathologyRoyal National Orthopaedic HospitalStanmoreUK
| | - Sam Behjati
- Wellcome Sanger InstituteHinxtonUK
- Cambridge University Hospitals NHS Foundation TrustCambridgeUK
- Department of PaediatricsUniversity of CambridgeCambridgeUK
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20
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Han LM, VandenBussche CJ, Abildtrup M, Chandra A, Vohra P. A Review of Effusion Cytomorphology of Small Round Cell Tumors. Acta Cytol 2021; 66:336-346. [PMID: 34218227 DOI: 10.1159/000516497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/07/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Small round cell tumors (SRCTs) are a broad category of diverse malignant tumors composed of monotonous undifferentiated cells. Involvement of serous fluids by SRCT is rare; however, the identification of exfoliated malignant cells is a crucial component of management and has significant implications for treatment and prognosis. The most common effusion tumors with SRCT morphology include Ewing sarcoma, synovial sarcoma, rhabdomyosarcoma (RMS), small-cell neuroendocrine carcinoma (SCNC), and desmoplastic SRCT, and the cytomorphologic distinction between these tumors is challenging. The purpose of this article is to describe the morphologic features of the most common SRCT in fluids and propose helpful ancillary testing. SUMMARY Effusion SRCTs display similar primitive and undifferentiated morphologic features although each has subtle variations. Ewing sarcoma is a mesenchymal neoplasm and harbors characteristic translocations t(11;22) (EWSR1-FLI1) or t(21;22) (EWSR1-ERG). In fluids, Ewing sarcoma shows poorly differentiated cells of variable size with round to oval nuclei, prominent nucleoli, and scant cytoplasm. In contrast, synovial sarcoma typically involves extremities and expresses a fusion transcript in t(X;18) (SS18-SSX). This soft tissue neoplasm demonstrates uniform cells with irregular nuclear contours, characteristic nuclear folding, and scant cytoplasm. RMS is a neoplasm arising from skeletal muscle, and the alveolar subtype demonstrates a translocation in t(2;13) (PAX3-FOXO1). The malignant cells show a spectrum of small round cells and pleomorphic large cells with rhabdoid morphology. RMS cells characteristically express myogenin and MyoD1, markers of skeletal muscle differentiation. Although SCNC is not a classic SRCT, the morphology is similar. SCNC demonstrates tight clusters of malignant cells with nuclear molding and salt-and-pepper chromatin. This tumor classically has neuroendocrine differentiation and is positive for synaptophysin and chromogranin on immunohistochemistry. And last, desmoplastic SRCT typically presents as an intra-abdominal mass in young men and characteristically harbors the translocation t(11;22) (p13;q12) (EWSR1-WT1). Cytomorphologically, the tumor shows small monomorphic cells occasionally arranged as rosette-like structures. KEY MESSAGE The diagnosis of SRCT can be made in effusion samples and is best achieved with a combination of morphologic features, clinical history, and ancillary testing.
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Affiliation(s)
- Lucy M Han
- Department of Pathology, University of California, San Francisco, California, USA
| | | | - Mads Abildtrup
- Department of Histopathology, King's College Hospital NHS Foundation Trust, London, UK
| | - Ashish Chandra
- Department of Cellular Pathology, St. Thomas' Hospital, London, UK
| | - Poonam Vohra
- Department of Pathology, University of California, San Francisco, California, USA,
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21
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Lyskjær I, De Noon S, Tirabosco R, Rocha AM, Lindsay D, Amary F, Ye H, Schrimpf D, Stichel D, Sill M, Koelsche C, Pillay N, Von Deimling A, Beck S, Flanagan AM. DNA methylation-based profiling of bone and soft tissue tumours: a validation study of the 'DKFZ Sarcoma Classifier'. J Pathol Clin Res 2021; 7:350-360. [PMID: 33949149 PMCID: PMC8185366 DOI: 10.1002/cjp2.215] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/26/2021] [Accepted: 03/18/2021] [Indexed: 01/01/2023]
Abstract
Diagnosing bone and soft tissue neoplasms remains challenging because of the large number of subtypes, many of which lack diagnostic biomarkers. DNA methylation profiles have proven to be a reliable basis for the classification of brain tumours and, following this success, a DNA methylation-based sarcoma classification tool from the Deutsches Krebsforschungszentrum (DKFZ) in Heidelberg has been developed. In this study, we assessed the performance of their classifier on DNA methylation profiles of an independent data set of 986 bone and soft tissue tumours and controls. We found that the 'DKFZ Sarcoma Classifier' was able to produce a diagnostic prediction for 55% of the 986 samples, with 83% of these predictions concordant with the histological diagnosis. On limiting the validation to the 820 cases with histological diagnoses for which the DKFZ Classifier was trained, 61% of cases received a prediction, and the histological diagnosis was concordant with the predicted methylation class in 88% of these cases, findings comparable to those reported in the DKFZ Classifier paper. The classifier performed best when diagnosing mesenchymal chondrosarcomas (CHSs, 88% sensitivity), chordomas (85% sensitivity), and fibrous dysplasia (83% sensitivity). Amongst the subtypes least often classified correctly were clear cell CHSs (14% sensitivity), malignant peripheral nerve sheath tumours (27% sensitivity), and pleomorphic liposarcomas (29% sensitivity). The classifier predictions resulted in revision of the histological diagnosis in six of our cases. We observed that, although a higher tumour purity resulted in a greater likelihood of a prediction being made, it did not correlate with classifier accuracy. Our results show that the DKFZ Classifier represents a powerful research tool for exploring the pathogenesis of sarcoma; with refinement, it has the potential to be a valuable diagnostic tool.
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Affiliation(s)
- Iben Lyskjær
- Research Department of PathologyUniversity College London, UCL Cancer InstituteLondonUK
- Medical Genomics Research GroupUniversity College London, UCL Cancer InstituteLondonUK
| | - Solange De Noon
- Research Department of PathologyUniversity College London, UCL Cancer InstituteLondonUK
- Department of HistopathologyRoyal National Orthopaedic HospitalStanmoreUK
| | - Roberto Tirabosco
- Department of HistopathologyRoyal National Orthopaedic HospitalStanmoreUK
| | - Ana Maia Rocha
- Research Department of PathologyUniversity College London, UCL Cancer InstituteLondonUK
- Department of HistopathologyRoyal National Orthopaedic HospitalStanmoreUK
| | - Daniel Lindsay
- Research Department of PathologyUniversity College London, UCL Cancer InstituteLondonUK
- Department of HistopathologyRoyal National Orthopaedic HospitalStanmoreUK
| | - Fernanda Amary
- Research Department of PathologyUniversity College London, UCL Cancer InstituteLondonUK
- Department of HistopathologyRoyal National Orthopaedic HospitalStanmoreUK
| | - Hongtao Ye
- Department of HistopathologyRoyal National Orthopaedic HospitalStanmoreUK
| | - Daniel Schrimpf
- Department of NeuropathologyUniversity of HeidelbergHeidelbergGermany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK)German Cancer Research Center (DKFZ)HeidelbergGermany
| | - Damian Stichel
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK)German Cancer Research Center (DKFZ)HeidelbergGermany
| | - Martin Sill
- Hopp‐Children's Cancer Center (KiTZ)HeidelbergGermany
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK)German Cancer Research Center (DKFZ)HeidelbergGermany
| | - Christian Koelsche
- Department of NeuropathologyUniversity of HeidelbergHeidelbergGermany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK)German Cancer Research Center (DKFZ)HeidelbergGermany
- Department of General PathologyUniversity of HeidelbergHeidelbergGermany
| | - Nischalan Pillay
- Research Department of PathologyUniversity College London, UCL Cancer InstituteLondonUK
| | - Andreas Von Deimling
- Department of NeuropathologyUniversity of HeidelbergHeidelbergGermany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK)German Cancer Research Center (DKFZ)HeidelbergGermany
| | - Stephan Beck
- Medical Genomics Research GroupUniversity College London, UCL Cancer InstituteLondonUK
| | - Adrienne M Flanagan
- Research Department of PathologyUniversity College London, UCL Cancer InstituteLondonUK
- Department of HistopathologyRoyal National Orthopaedic HospitalStanmoreUK
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22
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Tay TKY, Sukma NB, Lim TH, Kuick CH, Goh JY, Chang KTE. Correlating SS18-SSX immunohistochemistry (IHC) with SS18 fluorescent in situ hybridization (FISH) in synovial sarcomas: a study of 36 cases. Virchows Arch 2021; 479:785-793. [PMID: 34091760 DOI: 10.1007/s00428-021-03135-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/30/2021] [Accepted: 06/01/2021] [Indexed: 12/27/2022]
Abstract
The recently introduced, highly sensitive and specific SS18-SSX immunohistochemistry (IHC) is an attractive alternative to SS18 fluorescence in situ hybridization (FISH) testing in synovial sarcoma (SS). However, little is known about how SS18-SSX IHC correlates with SS18 FISH. We correlated the SS18 FISH results of SS from 36 patients with SS18-SSX IHC. Twenty-six tumours had a classic break-apart FISH pattern (1 fused, 1 red and 1 green signal) and all stained positive for the IHC. Ten had an atypical (non-classic) FISH pattern of which 5 stained positive for the IHC. Four of these (including two with novel atypical SS18 FISH patterns) were confirmed to harbour the SS18-SSX fusion on targeted RNA sequencing, while one had classic features of a biphasic SS. The remaining 5 tumours stained negative for the IHC. One had a TPM3-NTRK1 fusion, and one had no fusion, while the remaining three had insufficient tissue/RNA for sequencing. The sensitivity of the IHC was 91% (after excluding the 2 cases with confirmed absence of SS18-SSX fusion). Twenty histologic mimics of SS also stained negative for the IHC (100% specificity). Our study shows that the SS18-SSX IHC is more specific than SS18 FISH in diagnosing SS, especially in cases with atypical FISH patterns. It correlates well with RNA sequencing result and has the potential to replace SS18 FISH testing. A positive IHC result supports the diagnosis of SS, while a tumour with atypical FISH pattern and negative IHC result should undergo further molecular testing.
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Affiliation(s)
- Timothy Kwang Yong Tay
- Department of Anatomical Pathology, Singapore General Hospital, 20 College Road, Academia, Diagnostic Tower Level 10, Singapore, 169856, Singapore. .,Department of Molecular Pathology, Singapore General Hospital, Singapore, Singapore.
| | - Nadiah Binte Sukma
- Department of Anatomical Pathology, Singapore General Hospital, 20 College Road, Academia, Diagnostic Tower Level 10, Singapore, 169856, Singapore
| | - Tse Hui Lim
- Department of Molecular Pathology, Singapore General Hospital, Singapore, Singapore
| | - Chik Hong Kuick
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jian Yuan Goh
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Kenneth Tou En Chang
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
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23
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Synovial Sarcoma: A Clinical Review. ACTA ACUST UNITED AC 2021; 28:1909-1920. [PMID: 34069748 PMCID: PMC8161765 DOI: 10.3390/curroncol28030177] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 01/26/2023]
Abstract
Synovial sarcomas (SS) represent a unique subset of soft tissue sarcomas (STS) and account for 5–10% of all STS. Synovial sarcoma differs from other STS by the relatively young age at diagnosis and clinical presentation. Synovial sarcomas have unique genomic characteristics and are driven by a pathognomonic t(X;18) chromosomal translocation and subsequent formation of the SS18:SSX fusion oncogenes. Similar to other STS, diagnosis can be obtained from a combination of history, physical examination, magnetic resonance imaging, biopsy and subsequent pathology, immunohistochemistry and molecular analysis. Increasing size, age and tumor grade have been demonstrated to be negative predictive factors for both local disease recurrence and metastasis. Wide surgical excision remains the standard of care for definitive treatment with adjuvant radiation utilized for larger and deeper lesions. There remains controversy surrounding the role of chemotherapy in the treatment of SS and there appears to be survival benefit in certain populations. As the understanding of the molecular and immunologic characteristics of SS evolve, several potential systematic therapies have been proposed.
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24
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Synovial sarcoma with overwhelming glandular (adenocarcinoma-like) component: A case report and review of the literature. Pathol Res Pract 2021; 222:153418. [PMID: 33819897 DOI: 10.1016/j.prp.2021.153418] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 11/23/2022]
Abstract
Synovial sarcoma is an uncommon tumor of soft tissue, characterized by a specific SS18-SSX1/2/4 fusion gene. It is generally a lesion composed of monomorphic spindle cells, and can sometimes show variable epithelial differentiation. Here, we present the case of a young woman with a synovial sarcoma of the abdominal wall that showed an overwhelming (>90 %) epithelial glandular component mimicking adenocarcinoma, and only rare spindled areas. The diagnosis was confirmed by detection of targeted fusion transcripts associated with synovial sarcoma. We review the literature pertaining to synovial sarcoma, and we show that this case is only the sixth molecularly proven epithelial predominant synovial sarcoma in the literature. This report emphasizes the importance of molecular approaches in modern soft tissue pathology. Recognition of synovial sarcoma with predominant glandular component is imperative in order to avoid misdiagnosis of the tumor as metastatic adenocarcinoma, another type of sarcoma with epithelial differentiation, or a carcinoma with a sarcomatous component (sarcomatoid carcinoma), all of which have markedly different clinical management.
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25
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EWSR1-SMAD3 fibroblastic tumour of bone: expanding the clinical spectrum. Skeletal Radiol 2021; 50:445-450. [PMID: 32710151 DOI: 10.1007/s00256-020-03563-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/15/2020] [Accepted: 07/20/2020] [Indexed: 02/02/2023]
Abstract
EWSR1-SMAD3 fibroblastic tumour is a recently described soft tissue lesion. To date, eight cases have been reported, all sited in superficial soft tissue, typically occurring in the hands and feet with a tendency for local recurrence if incompletely excised. No metastatic spread has been reported, and hence, these tumours are currently considered benign. Herein, we present the radiological and histological features of the first reported occurrence of this entity in bone: a 44-year-old man with a tumour in the right tibia, treated with en bloc resection and showing no signs of relapse at 7 years. This tumour should be added to the differential diagnosis of bone lesions which harbour EWSR1 gene rearrangement.
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26
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Abstract
Synovial sarcoma is a mesenchymal neoplasm that shows a specific t(X;18) translocation that leads to the formation of SS18-SSX gene fusions and is most commonly seen in soft tissues of the extremity. The gastrointestinal tract is a very rare site of involvement. We report a case of primary gastric synovial sarcoma in a 13-year-old male child. Synovial sarcoma should be included in the differential diagnosis when spindle cell neoplasms are encountered in the stomach. A high degree of suspicion, followed by the necessary immunohistochemistry and molecular studies, is required to make an accurate diagnosis.
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27
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Abstract
Synovial sarcoma (SS), an aggressive soft tissue sarcoma with a predilection for the extremities of young adults, harbors the pathognomonic t(X;18)(p11;q11) translocation, resulting in SS18-SSX rearrangements. SS includes monophasic, biphasic, and poorly differentiated variants, which show considerable histologic overlap with a range of other tumor types, making the diagnosis challenging on limited biopsies. Immunohistochemistry (IHC) is routinely used in the differential diagnosis; however, presently available markers lack specificity. Thus, cytogenetic or molecular genetic techniques are often employed to confirm the diagnosis. Here, we report the development and characterization of 2 novel antibodies: an SS18-SSX fusion-specific antibody (E9X9V, designed to the breakpoint) as well as an SSX-specific antibody (E5A2C, designed to the SSX C-terminus). We validated the selectivity and specificity of the antibodies using immunoblotting, immunoprecipitation, and chromatin immunoprecipitation followed by next-generation sequencing in SS cell lines and demonstrated that both antibodies capture SS18-SSX on chromatin at established target sites (eg, TLE1 and BCL2) genome-wide. Using IHC in whole sections from 400 tumors including 100 genetically confirmed cases of SS and 300 histologic mimics, the SS18-SSX fusion-specific antibody revealed strong diffuse nuclear staining in 95 of 100 (95%) SS cases, whereas none of the 300 control tumors showed any staining. The SSX antibody showed strong diffuse nuclear staining in all 100 (100%) SS cases; 13 (4%) of the 300 other tumors were also positive, 5 of which displayed >50% nuclear staining. In summary, a novel SS18-SSX fusion-specific antibody is highly sensitive (95%) and specific (100%) for SS, and an antibody to the SSX C-terminus is also highly sensitive (100%), but slightly less specific (96%). IHC using the SS18-SSX antibody could replace molecular genetic or cytogenetic testing in most cases, and these reagents together will also provide the research community with valuable tools for further biochemical and genomic interrogation of the SS18-SSX fusion protein.
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28
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Shetty O, Pai T, Gurav M, Rekhi B. Comparison between Fluorescence in-situ Hybridization (FISH), Reverse Transcriptase PCR (RT-PCR) and fragment analysis, for detection of t (X; 18) (p11; q11) translocation in synovial sarcomas. INDIAN J PATHOL MICR 2020; 63:64-72. [PMID: 32031125 DOI: 10.4103/ijpm.ijpm_851_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Synovial sarcoma (SS) is an aggressive, but a relatively chemosensitive soft tissue sarcoma, characterized by a specific, t (X;18)(p11;q11) translocation, leading to formation of SS18-SSX chimeric transcript. This translocation can be detected by various techniques, such as fluorescence in-situ hybridization (FISH), reverse transcriptase PCR (RT-PCR) and fragment analysis. Objectives To compare the results of detection of t (X;18)(p11;q11) translocation, across three different platforms, in order to determine the most optimal and sensitive technique. Methods Formalin-fixed paraffin embedded (FFPE) tissue sections of 45 soft tissue sarcomas were analyzed, including 16 cases of SS confirmed by histopathology, immunohistochemistry and molecular technique (s)(Group 1); 13 cases, wherein SS was one of the differential diagnosis, preceding molecular testing (Group 2) and 16 cases of various other sarcomas (Group 3). Various immunohistochemical (IHC) markers studied, including INI1/SMARCB1. All cases were tested for t (X;18) translocation, by fragment Analysis, FISH and RT-PCR. Results There were 23 cases of SS, including 16 of group 1 and 7 of group 2. By fragment analysis, t (X;18)(p11;q11) translocation was detected in 22/23 cases (95.6%). By FISH, SS18 gene rearrangement was detected in 18/22 cases (78.2%), whereas by RT-PCR, SS18-SSX transcripts were detected in 15/23 cases (65.2%). Immunohistochemically, a unique "weak to absent"/reduced INI1 immunostaining pattern was exclusively observed in 12/13 cases of SS (92.3%). Fragment analysis and FISH were relatively more sensitive techniques. Unique "weak to absent"INI1 immunoexpression significantly correlated with positive t (X;18) translocation results (P = 0.0001). Conclusion The present study constitutes first such study from our subcontinent. Fragment analysis is a promising technique for detection of t (X;18)(p11;q11) translocation. FISH and INI1 immunostaining pattern were also relatively more sensitive, over RT-PCR.
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Affiliation(s)
- Omshree Shetty
- Division of Molecular Pathology and Translational Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Trupti Pai
- Division of Molecular Pathology and Translational Medicine; Department of Surgical Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Mamta Gurav
- Division of Molecular Pathology and Translational Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Bharat Rekhi
- Division of Molecular Pathology and Translational Medicine; Department of Surgical Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
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29
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Shigematsu Y, Yamashita K, Takamatsu M, Tanizawa T, Togashi Y, Nakajima T, Chino A, Kawachi H, Takeuchi K. Primary intramucosal synovial sarcoma of the sigmoid colon in a patient with a germline mutation in the MSH2 gene: A case report. Pathol Int 2020; 70:1015-1019. [PMID: 32940945 DOI: 10.1111/pin.13020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 11/27/2022]
Abstract
Synovial sarcoma is a high-grade soft tissue sarcoma that occurs primarily in the deep soft tissue of extremities, and primary colorectal synovial sarcoma is extremely rare. In this report, we present a synovial sarcoma mostly located within the mucosa of the sigmoid colon. The patient was a man in his forties with a germline deletion in the MSH2 gene. He had experienced undifferentiated pleomorphic sarcoma of the left forearm 7 years before and adenocarcinoma of the transverse colon 6 years before, both of which were successfully treated and exhibited no recurrence to date. A surveillance colonoscopy for Lynch syndrome revealed the tumor which had a submucosal tumor-like appearance with central erosion and endoscopic resection was performed. Histologically, it was composed of monotonous proliferation of spindle cells arranged in cellular fascicles; these findings were compatible with monophasic fibrous synovial sarcoma. In the tumor cells, the presence of the SS18-SSX1 fusion gene was confirmed. Protein expression of mismatch repair genes was intact in the tumor cells, indicating the association between microsatellite instability and synovial sarcoma was weak. The present case highlights a rare primary site of synovial sarcoma in a patient with Lynch syndrome.
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Affiliation(s)
- Yasuyuki Shigematsu
- Department of Pathology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research (JFCR), Tokyo, Japan.,Division of Pathology, Cancer Institute, JFCR, Tokyo, Japan
| | - Kyoko Yamashita
- Department of Pathology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research (JFCR), Tokyo, Japan.,Division of Pathology, Cancer Institute, JFCR, Tokyo, Japan
| | - Manabu Takamatsu
- Department of Pathology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research (JFCR), Tokyo, Japan.,Division of Pathology, Cancer Institute, JFCR, Tokyo, Japan
| | - Taisuke Tanizawa
- Department of Orthopedic Oncology, The Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Yuki Togashi
- Division of Pathology, Cancer Institute, JFCR, Tokyo, Japan.,Pathology Project for Molecular Targets, Cancer Institute, JFCR, Tokyo, Japan
| | - Takeshi Nakajima
- Department of Clinical Genetics, The Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Akiko Chino
- Division of Gastroenterology Center, The Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Hiroshi Kawachi
- Department of Pathology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research (JFCR), Tokyo, Japan.,Division of Pathology, Cancer Institute, JFCR, Tokyo, Japan
| | - Kengo Takeuchi
- Department of Pathology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research (JFCR), Tokyo, Japan.,Division of Pathology, Cancer Institute, JFCR, Tokyo, Japan.,Pathology Project for Molecular Targets, Cancer Institute, JFCR, Tokyo, Japan
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30
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Zaborowski M, Vargas AC, Pulvers J, Clarkson A, de Guzman D, Sioson L, Maclean F, Chou A, Gill AJ. When used together SS18-SSX fusion-specific and SSX C-terminus immunohistochemistry are highly specific and sensitive for the diagnosis of synovial sarcoma and can replace FISH or molecular testing in most cases. Histopathology 2020; 77:588-600. [PMID: 32559341 DOI: 10.1111/his.14190] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/13/2020] [Indexed: 12/14/2022]
Abstract
AIMS Synovial sarcoma is defined by recurrent t(X;18)(p11;q11) translocations creating SS18-SSX1, SS18-SSX2 or SS18-SSX4 fusions. Recently, a novel rabbit monoclonal antibody designed to identify these fusions (SS18-SSX, clone E9X9V) was proposed to be highly specific (100%), but not completely sensitive (95%) for this diagnosis. Another antibody designed to identify the C-terminal end of SSX (SSX_CT, clone E5A2C) was proposed to be highly sensitive (100%), but not completely specific (96%). We sought to validate these antibodies in an independent cohort. METHODS AND RESULTS We performed immunohistochemistry for SS18-SSX and SSX_CT on 39 synovial sarcoma samples from 25 patients with confirmed gene rearrangements. Thirty-four (87%) and 36 (92%) were positive for SS18-SSX and SSX_CT, respectively. False-negative staining was associated with suboptimally handled small biopsies and decalcified specimens, even when staining was diffuse and strong in subsequent optimally processed excisions and non-decalcified areas. None of 580 non-synovial sarcoma tumours (76 whole sections, 504 TMA samples) were positive for SS18-SSX (100% specificity), whereas 39 (93% specificity) were positive for SSX_CT. CONCLUSIONS SS18-SSX fusion-specific IHC is 87-95% sensitive for the diagnosis of synovial sarcoma and highly (perhaps perfectly) specific. Therefore, positive SS18-SSX staining definitively confirms the diagnosis of synovial sarcoma. SSX_CT is less specific (93-96%) but highly sensitive (92%, but approaching 100% when suboptimally processed biopsies and decalcified specimens are excluded). Negative SSX_CT staining may therefore have an ancillary role as a rule-out test for synovial sarcoma. We caution that both antibodies are prone to false-negative staining in decalcified specimens.
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Affiliation(s)
- Matthew Zaborowski
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia.,NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Ana C Vargas
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia.,Department of Anatomical Pathology, Douglass Hanly Moir Pathology, Macquarie Park, NSW, Australia.,University of Sydney, Sydney, NSW, Australia
| | - Jeremy Pulvers
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia.,NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Adele Clarkson
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia.,NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Danica de Guzman
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia.,NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Loretta Sioson
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia.,NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Fiona Maclean
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia.,Department of Anatomical Pathology, Douglass Hanly Moir Pathology, Macquarie Park, NSW, Australia.,Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Angela Chou
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia.,NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia.,University of Sydney, Sydney, NSW, Australia
| | - Anthony J Gill
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia.,NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia.,University of Sydney, Sydney, NSW, Australia
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31
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Retroperitoneal Sarcomas: An Update on the Diagnostic Pathology Approach. Diagnostics (Basel) 2020; 10:diagnostics10090642. [PMID: 32867125 PMCID: PMC7555595 DOI: 10.3390/diagnostics10090642] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 02/07/2023] Open
Abstract
Retroperitoneal sarcomas are a heterogenous group of rare tumors arising in the retroperitoneum. Retroperitoneal sarcomas comprise approximately 10% of all soft tissue sarcomas. Though any soft tissue sarcoma histologic types may arise in the retroperitoneal space, liposarcoma (especially well-differentiated and dedifferentiated types) and leiomyosarcoma do so most commonly. Retroperitoneal sarcomas are diagnostically challenging, owing to their diversity and morphological overlap with other tumors arising in the retroperitoneum. An accurate diagnosis is necessary for correct management and prognostication. Herein, we provide an update on the diagnostic approach to retroperitoneal sarcomas and review their key histologic findings and differential diagnoses.
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32
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Di Mauro I, Mescam-Mancini L, Chetaille B, Lae M, Pierron G, Dadone-Montaudie B, Bazin A, Bouvier C, Michiels JF, Pedeutour F. MDM2 amplification and fusion gene ss18-ssx in a poorly differentiated synovial sarcoma: A rare but puzzling conjunction. Neoplasia 2020; 22:311-321. [PMID: 32559641 PMCID: PMC7303914 DOI: 10.1016/j.neo.2020.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/30/2020] [Accepted: 05/17/2020] [Indexed: 01/30/2023]
Abstract
The detection of specific alterations by genetic analyses has been included in the diagnostic criterions of the World Health Organization's classification of soft tissues tumors since 2013. The presence of a SS18 rearrangement is pathognomonic of synovial sarcoma (SS). MDM2 amplification is strongly correlated to well-differentiated or dedifferentiated liposarcoma (DDLPS) in the context of sarcoma. We identified one case of poorly differentiated sarcoma harboring both SS18-SSX2 fusion and MDM2 amplification. The review of the literature showed high discrepancies, concerning the incidence of MDM2 amplification in SS: from 1.4% up to 40%. Our goal was to precisely determine the specific clinico-pathological features of this case and to estimate the frequency and characteristics of the association of SS18-SSX fusion/MDM2 amplification in sarcomas. We performed a retrospective and prospective study in 96 sarcomas, (56 SS and 40 DDLPS), using FISH and/or array-CGH to detect MDM2 amplification and SS18 rearrangement. None of the 96 cases presented both genetic alterations. Among the SS, only the index case (1/57: 1.7 %) presented the double anomaly. We concluded that MDM2 amplification in SS is a very rare event. The final diagnosis of the index case was a SS with SS18-SSX2 and MDM2 amplification as a secondary alteration. If the detection of MDM2 amplification is performed first in a poorly differentiated sarcoma, that may lead to not search other anomalies such as SS18 rearrangement and therefore to an erroneous diagnosis. This observation emphasizes the strong complementarity between histomorphology, immunohistochemistry and molecular studies in sarcoma diagnosis.
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Affiliation(s)
- Ilaria Di Mauro
- Laboratory of Solid Tumor Genetics, University Hospital of Nice-Côte d'Azur University, Nice, France; Laboratory of Solid Tumor Genetics, Institute for Research on Cancer and Aging of Nice (IRCAN), CNRS UMR 7284/INSERM U1081, Nice, France
| | | | - Bruno Chetaille
- Department of Cancer Biology, Paoli-Calmettes Institute, Marseille, France
| | - Marick Lae
- Department of Pathology, Curie Institute, Paris, France; Department of Pathology, Henri Becquerel Center, INSERM U1245, UniRouen Normandie University, Rouen, France
| | | | - Bérengère Dadone-Montaudie
- Laboratory of Solid Tumor Genetics, University Hospital of Nice-Côte d'Azur University, Nice, France; Laboratory of Solid Tumor Genetics, Institute for Research on Cancer and Aging of Nice (IRCAN), CNRS UMR 7284/INSERM U1081, Nice, France; Central Laboratory of Pathology, University Hospital of Nice-Côte d'Azur University, Nice, France
| | - Audrey Bazin
- Laboratory of Solid Tumor Genetics, University Hospital of Nice-Côte d'Azur University, Nice, France; Laboratory of Solid Tumor Genetics, Institute for Research on Cancer and Aging of Nice (IRCAN), CNRS UMR 7284/INSERM U1081, Nice, France
| | - Corinne Bouvier
- Department of Pathology, Timone Hospital, APHM, Marseille, France
| | - Jean-François Michiels
- Central Laboratory of Pathology, University Hospital of Nice-Côte d'Azur University, Nice, France
| | - Florence Pedeutour
- Laboratory of Solid Tumor Genetics, University Hospital of Nice-Côte d'Azur University, Nice, France; Laboratory of Solid Tumor Genetics, Institute for Research on Cancer and Aging of Nice (IRCAN), CNRS UMR 7284/INSERM U1081, Nice, France.
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Tahara S, Kohara M, Honma K, Morii E. Detection of synovial sarcoma with an atypical fusion transcript by using SS18-SSX and SSX antibodies. Pathol Int 2020; 70:689-691. [PMID: 32564448 DOI: 10.1111/pin.12976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Shinichiro Tahara
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masaharu Kohara
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Keiichiro Honma
- Department of Pathology, Osaka International Cancer Institute, Osaka, Japan
| | - Eiichi Morii
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
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Smith AP, Dueber JC, Allison DB. A diagnostic review of carcinomas and sarcomas of the mediastinum: making the diagnosis on fine-needle aspiration and core needle biopsy specimens. Semin Diagn Pathol 2020; 37:187-198. [PMID: 32532552 DOI: 10.1053/j.semdp.2020.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 11/11/2022]
Abstract
The mediastinum is a complex anatomic region that can pose many diagnostic challenges on fine-needle aspiration (FNA) and core needle biopsy (CNB). With the recent technological advancements in EBUS-TBNA and EUS-guided procedures, FNA/CNB is being increasingly utilized to obtain the initial and, in many cases, the only diagnosis. As a result, it is imperative to have an understanding of the pearls and pitfalls associated with both the more common and rarer malignancies that occur at this site. Although the vast majority of mediastinal malignancies encountered in routine clinical practice are metastatic carcinomas to mediastinal lymph nodes, primary tumors and tumors that directly extend into the mediastinum are also encountered. As always, a multimodal approach with clinical and radiographic correlation, a targeted IHC panel, and molecular testing when indicated are indisposable and necessary tools in the diagnostic workup of mediastinal malignancies. This review focuses on the salient diagnostic features of malignancies of epithelial and mesenchymal origin, excluding tumors of neurogenic, thymic, hematolymphoid, and germ cell origins, which are discussed in separate articles of this issue.
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Affiliation(s)
- Alexander P Smith
- Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, 800 Rose Street, MS 117, Lexington, KY 40536, USA
| | - Julie C Dueber
- Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, 800 Rose Street, MS 117, Lexington, KY 40536, USA
| | - Derek B Allison
- Department of Pathology and Laboratory Medicine, Markey Cancer Center, University of Kentucky, 800 Rose Street, MS 117, Lexington, KY 40536, USA.
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Sekita T, Yamada T, Kobayashi E, Yoshida A, Hirozane T, Kawai A, Uno Y, Moriyama H, Sawa M, Nagakawa Y, Tsuchida A, Matsumoto M, Nakamura M, Nakayama R, Masuda M. Feasibility of Targeting Traf2-and-Nck-Interacting Kinase in Synovial Sarcoma. Cancers (Basel) 2020; 12:cancers12051258. [PMID: 32429395 PMCID: PMC7281028 DOI: 10.3390/cancers12051258] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/09/2020] [Accepted: 05/10/2020] [Indexed: 01/01/2023] Open
Abstract
Background: The treatment of patients with metastatic synovial sarcoma is still challenging, and the development of new molecular therapeutics is desirable. Dysregulation of Wnt signaling has been implicated in synovial sarcoma. Traf2-and-Nck-interacting kinase (TNIK) is an essential transcriptional co-regulator of Wnt target genes. We examined the efficacy of a small interfering RNA (siRNA) to TNIK and a small-molecule TNIK inhibitor, NCB-0846, for synovial sarcoma. Methods: The expression of TNIK was determined in 20 clinical samples of synovial sarcoma. The efficacy of NCB-0846 was evaluated in four synovial sarcoma cell lines and a mouse xenograft model. Results: We found that synovial sarcoma cell lines with Wnt activation were highly dependent upon the expression of TNIK for proliferation and survival. NCB-0846 induced apoptotic cell death in synovial sarcoma cells through blocking of Wnt target genes including MYC, and oral administration of NCB-846 induced regression of xenografts established by inoculation of synovial sarcoma cells. Discussion: It has become evident that activation of Wnt signaling is causatively involved in the pathogenesis of synovial sarcoma, but no molecular therapeutics targeting the pathway have been approved. This study revealed for the first time the therapeutic potential of TNIK inhibition in synovial sarcoma.
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Affiliation(s)
- Tetsuya Sekita
- Laboratory of Collaborative Research, Division of Cellular Signaling, National Cancer Center Research Institute, Tokyo 104-0045, Japan; (T.S.); (M.M.)
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan; (T.H.); (M.M.); (M.N.); (R.N.)
| | - Tesshi Yamada
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo 160-0023, Japan; (Y.N.); (A.T.)
- Correspondence:
| | - Eisuke Kobayashi
- Division of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan; (E.K.); (A.K.)
| | - Akihiko Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo 104-0045, Japan;
| | - Toru Hirozane
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan; (T.H.); (M.M.); (M.N.); (R.N.)
| | - Akira Kawai
- Division of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan; (E.K.); (A.K.)
| | - Yuko Uno
- Carna Biosciences, Inc., Kobe 650-0047, Japan; (Y.U.); (H.M.); (M.S.)
| | - Hideki Moriyama
- Carna Biosciences, Inc., Kobe 650-0047, Japan; (Y.U.); (H.M.); (M.S.)
| | - Masaaki Sawa
- Carna Biosciences, Inc., Kobe 650-0047, Japan; (Y.U.); (H.M.); (M.S.)
| | - Yuichi Nagakawa
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo 160-0023, Japan; (Y.N.); (A.T.)
| | - Akihiko Tsuchida
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo 160-0023, Japan; (Y.N.); (A.T.)
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan; (T.H.); (M.M.); (M.N.); (R.N.)
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan; (T.H.); (M.M.); (M.N.); (R.N.)
| | - Robert Nakayama
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan; (T.H.); (M.M.); (M.N.); (R.N.)
| | - Mari Masuda
- Laboratory of Collaborative Research, Division of Cellular Signaling, National Cancer Center Research Institute, Tokyo 104-0045, Japan; (T.S.); (M.M.)
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Pagliuca F, Ronchi A, Cozzolino I, Montella M, Zito Marino F, Franco R. Mesenchymal neoplasms: Is it time for cytology? New perspectives for the pre-operative diagnosis of soft tissue tumors in the molecular era. Pathol Res Pract 2020; 216:152923. [PMID: 32303388 DOI: 10.1016/j.prp.2020.152923] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/08/2020] [Accepted: 03/14/2020] [Indexed: 12/26/2022]
Abstract
Soft tissue tumors comprise a great variety of common and rare entities with overlapping features. Their diagnosis is based on the evaluation of several histological parameters which are difficult to assess on small incisional biopsies. Useful diagnostic markers in the field of soft tissue tumors include: 1) molecular biomarkers detecting pathogenetically relevant, distinctive alterations; 2) immunohistochemical surrogate biomarkers of pathogenetically relevant, distinctive molecular alterations; 3) highly specific immunohistochemical biomarkers indicating tumor differentiation. Their introduction in clinical practice has revolutionized the pre-operative diagnosis of soft tissue tumors. Cytology has long been considered inadequate as a first-line approach in this setting. However, since the implementation of new immunohistochemical and molecular tests with high diagnostic specificity, fine needle aspiration cytology (FNAC) is starting to gain acceptance for the pre-operative assessment of soft tissue tumors. FNAC represents a versatile, poorly expensive and well-tolerated diagnostic strategy with relevant advantages over histological biopsies. Moreover, evidences suggest that, in expert hands, FNAC can also aim at a definite diagnosis, especially if a cell block is prepared, allowing the application of multiple ancillary techniques.
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Affiliation(s)
- Francesca Pagliuca
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Andrea Ronchi
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Immacolata Cozzolino
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco Montella
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Federica Zito Marino
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.
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Yao X, Ghert M, Dickson BC, Popovic S, Purgina BM, Verma S, Werier J, Kandel RA. An evidence-based guideline on the application of molecular testing in the diagnosis, prediction of prognosis, and selection of therapy in non-GIST soft tissue sarcomas. Cancer Treat Rev 2020; 85:101987. [PMID: 32092619 DOI: 10.1016/j.ctrv.2020.101987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 02/06/2023]
Abstract
AIMS To make recommendations on the indications for molecular testing regarding the diagnosis, prediction of prognosis, and treatment selection in adult patients with s oft tissue sarcomas (STS) excluding gastrointestinal stromal tumour. MATERIALS AND METHODS This guideline was developed by the Cancer Care Ontario's Program in Evidence-Based Care (PEBC) and the Sarcoma Disease Site Group (DSG). The medline, embase, and Cochrane Library databases, main guideline websites, abstracts of relevant annual meetings, and PROSPERO databases were searched (January 2005 to October 2016). Internal and external reviews were conducted, with final approval by the PEBC and the Sarcoma DSG. RESULTS Based on the available evidence, we made three S trong Recommendations, 14 Recommendations, 9 Qualified Statements, and seven No Recommendations. The three Strong Recommendations include: i) MDM2 amplification by fluorescence in situ hybridization (FISH) is recommended as a sensitive and specific test to differentiate patients with atypical lipomatous tumour/well-differentiated liposarcoma, or dedifferentiated liposarcoma from lipoma or other STS in the differential diagnosis; ii) SS18 (SYT) break-apart by FISH or SS18-SSX (SYT-SSX) fusion by reverse transcription-polymerase chain reaction is recommended as a sensitive and specific test to differentiate patients with synovial sarcoma from other sarcomas; iii) CTNNB1 S45F mutation by polymerase chain reaction is recommended as a prognostic factor for poor recurrence-free survival in patients with desmoid tumours. CONCLUSION This guideline may serve as a framework for the thoughtful implementation of molecular studies at cancer centres and other jurisdictions. Some of the recommendations may need to be updated when new evidence appears in the future.
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Affiliation(s)
- Xiaomei Yao
- Program in Evidence-Based Care, Cancer Care Ontario, Department of Oncology, McMaster University, Hamilton, Ontario, Canada.
| | - Michelle Ghert
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.
| | - Brendan C Dickson
- Division of Orthopedic Surgery, Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada.
| | - Snezana Popovic
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario.
| | - Bibianna M Purgina
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada.
| | - Shailendra Verma
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada.
| | - Joel Werier
- Division of Orthopedic Surgery, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada.
| | - Rita A Kandel
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.
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Cottone L, Eden N, Usher I, Lombard P, Ye H, Ligammari L, Lindsay D, Brandner S, Pižem J, Pillay N, Tirabosco R, Amary F, Flanagan AM. Frequent alterations in p16/CDKN2A identified by immunohistochemistry and FISH in chordoma. JOURNAL OF PATHOLOGY CLINICAL RESEARCH 2020; 6:113-123. [PMID: 31916407 PMCID: PMC7164370 DOI: 10.1002/cjp2.156] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/13/2019] [Accepted: 12/18/2019] [Indexed: 12/19/2022]
Abstract
The expression of p16/CDKN2A, the second most commonly inactivated tumour suppressor gene in cancer, is lost in the majority of chordomas. However, the mechanism(s) leading to its inactivation and contribution to disease progression have only been partially addressed using small patient cohorts. We studied 384 chordoma samples from 320 patients by immunohistochemistry and found that p16 protein was lost in 53% of chordomas and was heterogeneously expressed in these tumours. To determine if CDKN2A copy number loss could explain the absence of p16 protein expression we performed fluorescence in situ hybridisation (FISH) for CDKN2A on consecutive tissue sections. CDKN2A copy number status was altered in 168 of 274 (61%) of samples and copy number loss was the most frequent alteration acquired during clinical disease progression. CDKN2A homozygous deletion was always associated with p16 protein loss but only accounted for 33% of the p16‐negative cases. The remaining immunonegative cases were associated with disomy (27%), monosomy (12%), heterozygous loss (20%) and copy number gain (7%) of CDKN2A, supporting the hypothesis that loss of protein expression might be achieved via epigenetic or post‐transcriptional regulatory mechanisms. We identified that mRNA levels were comparable in tumours with and without p16 protein expression, but other events including DNA promoter hypermethylation, copy number neutral loss of heterozygosity and expression of candidate microRNAs previously implicated in the regulation of CDKN2A expression were not identified to explain the protein loss. The data argue that p16 loss in chordoma is commonly caused by a post‐transcriptional regulatory mechanism that is yet to be defined.
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Affiliation(s)
- Lucia Cottone
- UCL Cancer Institute, University College London, London, UK
| | - Nadia Eden
- UCL Cancer Institute, University College London, London, UK
| | - Inga Usher
- UCL Cancer Institute, University College London, London, UK
| | | | - Hongtao Ye
- Department of Histopathology, Royal National Orthopaedic Hospital, Stanmore, UK
| | | | - Daniel Lindsay
- Department of Histopathology, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Sebastian Brandner
- UCL Queen Square Institute of Neurology, University College London, London, UK.,Division of Neuropathology, The National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Foundation Trust, London, UK
| | - Jože Pižem
- Institute of Pathology, University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
| | - Nischalan Pillay
- UCL Cancer Institute, University College London, London, UK.,Department of Histopathology, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Roberto Tirabosco
- Department of Histopathology, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Fernanda Amary
- UCL Cancer Institute, University College London, London, UK.,Department of Histopathology, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Adrienne M Flanagan
- UCL Cancer Institute, University College London, London, UK.,Department of Histopathology, Royal National Orthopaedic Hospital, Stanmore, UK
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Khalil EZI, Osman NAA. The combined use of H3K27 trimethylation and TLE1 can provide additional diagnostic value for malignant peripheral nerve sheath tumor and synovial sarcoma. Ann Diagn Pathol 2019; 45:151450. [PMID: 32007715 DOI: 10.1016/j.anndiagpath.2019.151450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/02/2019] [Accepted: 11/27/2019] [Indexed: 10/25/2022]
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Amary F, Perez-Casanova L, Ye H, Cottone L, Strobl AC, Cool P, Miranda E, Berisha F, Aston W, Rocha M, O'Donnell P, Pillay N, Tirabosco R, Baumhoer D, Hookway ES, Flanagan AM. Synovial chondromatosis and soft tissue chondroma: extraosseous cartilaginous tumor defined by FN1 gene rearrangement. Mod Pathol 2019; 32:1762-1771. [PMID: 31273315 PMCID: PMC6882679 DOI: 10.1038/s41379-019-0315-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/04/2019] [Accepted: 06/04/2019] [Indexed: 12/21/2022]
Abstract
A fusion between fibronectin 1 (FN1) and activin receptor 2A (ACVR2A) has been reported previously in isolated cases of the synovial chondromatosis. To analyze further and validate the findings, we performed FISH and demonstrated recurrent FN1-ACVR2A rearrangements in synovial chondromatosis (57%), and chondrosarcoma secondary to synovial chondromatosis (75%), showing that FN1 and/or AVCR2A gene rearrangements do not distinguish between benign and malignant synovial chondromatosis. RNA sequencing revealed the presence of the FN1-ACVR2A fusion in several cases that were negative by FISH suggesting that the true prevalence of this fusion is potentially higher than 57%. In soft tissue chondromas, FN1 alterations were detected by FISH in 50% of cases but no ACVR2A alterations were identified. RNA sequencing identified a fusion involving FN1 and fibroblast growth factor receptor 2 (FGFR2) in the case of soft tissue chondroma and FISH confirmed recurrent involvement of both FGFR1 and FGFR2. These fusions were present in a subset of soft tissue chondromas characterized by grungy calcification, a feature reminiscent of phosphaturic mesenchymal tumor. However, unlike the latter, fibroblast growth factor 23 (FGF23) mRNA expression was not elevated in soft tissue chondromas harboring the FN1-FGFR1 fusion. The mutual exclusivity of ACVR2A rearrangements observed in synovial chondromatosis and FGFR1/2 in soft tissue chondromas suggests these represent separate entities. There have been no reports of malignant soft tissue chondromas, therefore differentiating these lesions will potentially alter clinical management by allowing soft tissue chondromas to be managed more conservatively.
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Affiliation(s)
- Fernanda Amary
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, HA7 4LP, UK
| | - Luis Perez-Casanova
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, HA7 4LP, UK
| | - Hongtao Ye
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, HA7 4LP, UK
| | - Lucia Cottone
- Cancer Institute, 72 Huntley Street, University College London, London, WC1E 6BT, UK
| | | | - Paul Cool
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, SY10 7AG, UK
| | - Elena Miranda
- Cancer Institute, 72 Huntley Street, University College London, London, WC1E 6BT, UK
| | - Fitim Berisha
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, HA7 4LP, UK
| | - William Aston
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, HA7 4LP, UK
| | - Maia Rocha
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, HA7 4LP, UK
- Cancer Institute, 72 Huntley Street, University College London, London, WC1E 6BT, UK
| | - Paul O'Donnell
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, HA7 4LP, UK
| | - Nischalan Pillay
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, HA7 4LP, UK
- Cancer Institute, 72 Huntley Street, University College London, London, WC1E 6BT, UK
| | - Roberto Tirabosco
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, HA7 4LP, UK
| | - Daniel Baumhoer
- Bone Tumor Reference Center, Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Edward S Hookway
- Cancer Institute, 72 Huntley Street, University College London, London, WC1E 6BT, UK.
| | - Adrienne M Flanagan
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, HA7 4LP, UK.
- Cancer Institute, 72 Huntley Street, University College London, London, WC1E 6BT, UK.
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41
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Amary F, Markert E, Berisha F, Ye H, Gerrand C, Cool P, Tirabosco R, Lindsay D, Pillay N, O'Donnell P, Baumhoer D, Flanagan AM. FOS Expression in Osteoid Osteoma and Osteoblastoma: A Valuable Ancillary Diagnostic Tool. Am J Surg Pathol 2019; 43:1661-1667. [PMID: 31490237 DOI: 10.1097/pas.0000000000001355] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Osteoblastoma and osteoid osteoma together are the most frequent benign bone-forming tumor, arbitrarily separated by size. In some instances, it can be difficult to differentiate osteoblastoma from osteosarcoma. Following our recent description of FOS gene rearrangement in these tumors, the aim of this study is to evaluate the value of immunohistochemistry in osteoid osteoma, osteoblastoma, and osteosarcoma for diagnostic purposes. A total of 337 cases were tested with antibodies against c-FOS: 84 osteoblastomas, 33 osteoid osteomas, 215 osteosarcomas, and 5 samples of reactive new bone formation. In all, 83% of osteoblastomas and 73% of osteoid osteoma showed significant expression of c-FOS in the osteoblastic tumor cell component. Of the osteosarcomas, 14% showed c-FOS expression, usually focal, and in areas with severe morphologic atypia which were unequivocally malignant: 4% showed more conspicuous expression, but these were negative for FOS gene rearrangement. We conclude that c-FOS immunoreactivity is present in the vast majority of osteoblastoma/osteoid osteoma, whereas its expression is usually focal or patchy, in no more than 14% of osteosarcoma biopsies. Therefore, any bone-forming tumor cases with worrying histologic features would benefit from fluorescence in situ hybridization analysis for FOS gene rearrangement. Our findings highlight the importance of undertaking a thorough assessment of expression patterns of antibodies in the light of morphologic, clinical, and radiologic features.
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Affiliation(s)
- Fernanda Amary
- Royal National Orthopaedic Hospital, Stanmore
- Cancer Institute, University College London, London
| | - Eva Markert
- Royal National Orthopaedic Hospital, Stanmore
| | | | - Hongtao Ye
- Royal National Orthopaedic Hospital, Stanmore
| | | | - Paul Cool
- The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry and Keele University, Owestry, UK
| | | | | | - Nischalan Pillay
- Royal National Orthopaedic Hospital, Stanmore
- Cancer Institute, University College London, London
| | | | - Daniel Baumhoer
- Basel Bone Tumour Reference Centre (BBTRC), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Adrienne M Flanagan
- Royal National Orthopaedic Hospital, Stanmore
- Cancer Institute, University College London, London
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Matsuo S, Tomita E, Fukuhara K, Akashi A, Tsukamoto Y. Two cases of poorly differentiated synovial sarcoma arising from the chest wall - One case of Ewing sarcoma-like small cell type with death 4 years after the first presentation and one case of high-grade spindle cell type receiving postoperative adjuvant chemotherapy. HUMAN PATHOLOGY: CASE REPORTS 2019. [DOI: 10.1016/j.ehpc.2019.200329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Pei J, Zhao X, Patchefsky AS, Flieder DB, Talarchek JN, Testa JR, Wei S. Clinical application of RNA sequencing in sarcoma diagnosis: An institutional experience. Medicine (Baltimore) 2019; 98:e16031. [PMID: 31232935 PMCID: PMC6636967 DOI: 10.1097/md.0000000000016031] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Accurate diagnoses of sarcoma are sometimes challenging on conventional histomorphology and immunophenotype. Many specific genetic aberrations including chromosomal translocations have been identified in various sarcomas, which can be detected by fluorescence in situ hybridization and polymerase chain reaction analysis. Next-generation sequencing-based RNA sequencing can screen multiple sarcoma-specific chromosome translocations/fusion genes in 1 test, which is especially useful for sarcoma without obvious differentiation. In this report, we utilized RNA sequencing on formalin-fixed paraffin-embedded (FFPE) specimens to investigate the possibility of diagnosing sarcomas by identifying disease-specific fusion genes. Targeted RNA sequencing was performed on 6 sarcoma cases. The expected genetic alterations (clear cell sarcoma/EWSR1-ATF1, Ewing sarcoma/EWSR1-FLI1, myxoid liposarcoma/DDIT3-FUS) in four cases were detected and confirmed by secondary tests. Interestingly, three SS18 fusion genes (SS18-SSX2B, SS18-SSX2, and SS18-SSX4) were identified in a synovial sarcoma case. A rare fusion gene (EWSR1-PATZ1) was identified in a morphologically challenging case; which enabled us to establish the diagnosis of low grade glioneural tumor. In conclusion, RNA sequencing on FFPE specimen is a reliable method in establishing the diagnosis of sarcoma in daily practice.
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Affiliation(s)
| | - Xiaofeng Zhao
- Department of Pathology and Laboratory Medicine, Temple University Hospital
| | | | | | | | - Joseph R. Testa
- Genomics Facility, Fox Chase Cancer Center
- Cancer Biology Program, Fox Chase Cancer Center, Philadelphia, PA
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Mihály D, Nagy N, Papp G, Pápai Z, Sápi Z. Release of circulating tumor cells and cell-free nucleic acids is an infrequent event in synovial sarcoma: liquid biopsy analysis of 15 patients diagnosed with synovial sarcoma. Diagn Pathol 2018; 13:81. [PMID: 30326929 PMCID: PMC6191904 DOI: 10.1186/s13000-018-0756-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 10/02/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Synovial sarcoma is a rare soft tissue tumor which contains the unique SS18-SSX1, SS18-SSX2 - or, rarely, SS18-SSX4 - fusion transcripts. It is well known that some soft tissue tumors, like Ewing sarcomas and myxoid liposarcomas, can spread via the blood with free circulating tumor cells (CTC); this can be detected by several sensitive molecular biology methods. Here we report a study of fifteen synovial sarcoma patients with varied clinical backgrounds. METHOD After blood withdrawal and nucleic acid isolation, we attempted to detect the SS18-SSX fusion genes from circulating tumor cells or cell-free nucleic acids with nested PCR and droplet digital PCR. RESULTS SS18-SSX2 fusion transcript was identified in a small copy number with droplet digital PCR in one case. Nested PCR could not detect any of the fusion transcripts in the examined 15 synovial sarcoma cases. CONCLUSIONS Heretofore two case reports could detect CTCs in synovial sarcoma - in the first paper, the patient was diagnosed with poorly differentiated type while the other had a rare primary gastric synovial sarcoma. However, until now, no other studies have detected CTCs in the peripheral blood of synovial sarcoma patients. Based on our findings, we can conclude that detection of the chimeric SS18-SSX fusion gene after surgical excision and/or chemotherapy/radiotherapy is a rare circumstance and hence in itself is not sufficient for monitoring the tumor recurrence. Therefore, monitoring of other possible biomarkers - for example synovial sarcoma specific miRNAs - is recommended.
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Affiliation(s)
- Dóra Mihály
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Üllői út 26, Budapest, H-1085, Hungary
| | - Noémi Nagy
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Üllői út 26, Budapest, H-1085, Hungary
| | - Gergő Papp
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Üllői út 26, Budapest, H-1085, Hungary
| | - Zsuzsanna Pápai
- Department of Oncology, Military Hospital Budapest, Podmaniczky utca 111, Budapest, H-1062, Hungary
| | - Zoltán Sápi
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Üllői út 26, Budapest, H-1085, Hungary.
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46
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Pleural malignant mesothelioma versus pleuropulmonary synovial sarcoma: a clinicopathological study of 22 cases with molecular analysis and survival data. Pathology 2018; 50:629-634. [PMID: 30170702 DOI: 10.1016/j.pathol.2018.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/14/2018] [Accepted: 06/25/2018] [Indexed: 01/02/2023]
Abstract
The aim of this study was to carry out a comparative analysis by transducin-like enhancer of split 1 (TLE1) immunohistochemistry and molecular analysis of SYT-SSX, for 16 pleural predominantly sarcomatoid mesotheliomas and six cases of pleuropulmonary synovial sarcoma (five pleural in distribution only, with one case of a predominantly subpleural upper lobe synovial sarcoma), all of which were solely or predominantly monophasic. Our comparison included survival and some clinical data. We consider that the following points emerged from this study.
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47
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Vargas AC, Selinger C, Satgunaseelan L, Cooper WA, Gupta R, Stalley P, Brown W, Soper J, Schatz J, Boyle R, Thomas DM, Tattersall MH, Bhadri V, Maclean F, Bonar SF, Scolyer RA, Karim RZ, McCarthy SW, Mahar A, O'Toole SA. FISH analysis of selected soft tissue tumors: Diagnostic experience in a tertiary center. Asia Pac J Clin Oncol 2018; 15:38-47. [DOI: 10.1111/ajco.12980] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 03/29/2018] [Indexed: 12/20/2022]
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48
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Molecular analyses in the diagnosis and prediction of prognosis in non-GIST soft tissue sarcomas: A systematic review and meta-analysis. Cancer Treat Rev 2018; 66:74-81. [DOI: 10.1016/j.ctrv.2018.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 04/10/2018] [Accepted: 04/20/2018] [Indexed: 12/14/2022]
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49
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Risk Factors Including Age, Stage and Anatomic Location that Impact the Outcomes of Patients with Synovial Sarcoma. Med Sci (Basel) 2018; 6:medsci6010021. [PMID: 29509716 PMCID: PMC5872178 DOI: 10.3390/medsci6010021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/10/2018] [Accepted: 03/01/2018] [Indexed: 01/12/2023] Open
Abstract
Synovial sarcoma is a high-grade soft tissue sarcoma that inflicts mostly children and young adults with high mortality rate; however, the risk factors that impact the outcomes remain incompletely understood. We have identified the synovial sarcoma cases from the Kaiser Permanente Northern California cancer registry between 1981 and 2014. Kaplan–Meier plots were used to display disease-free survival (DFS) and overall survival (OS); log-rank tests and Cox proportional hazard models were used to determine the impact of clinical factors on DFS, OS, and disease-specific survival. Tumor size > 5.0 cm and age > 50 years were associated with higher risk of presenting with stage IV disease. Median OS for patients with stage IV was 1.3 years and 7.8 years for early-stage disease. For patients with early-stage disease, tumor size > 5.0 cm was significantly associated with worse DFS, sarcoma-specific morality, and OS. Compared to extremity primary, patients with head and neck and trunk primary had approximately three-fold higher sarcoma-specific mortality and lower OS. There was no significant difference in DFS or OS among three histologic subtypes. Pre-operative and/or post-operative chemotherapy was not associated with improvement in DFS or OS. Twenty-six patients relapsed with predominantly lung metastasis, thirteen of whom received metastatectomy with a median OS of 7.8 years, compared to 2.3 years for patients who did not receive metastatectomy. In conclusion, age older than 50 years and tumor size > 5.0 cm are risk factors for presenting with stage IV disease. For early-stage patients, trunk and head and neck primary as well as tumor size > 5.0 cm are risk factors for decreased OS.
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50
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McBride MJ, Kadoch C. Disruption of mammalian SWI/SNF and polycomb complexes in human sarcomas: mechanisms and therapeutic opportunities. J Pathol 2018; 244:638-649. [PMID: 29359803 DOI: 10.1002/path.5042] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/11/2018] [Accepted: 01/12/2018] [Indexed: 01/01/2023]
Abstract
Soft-tissue sarcomas are increasingly characterized and subclassified by genetic abnormalities that represent underlying drivers of their pathology. Hallmark tumor suppressor gene mutations and pathognomonic gene fusions collectively account for approximately one-third of all sarcomas. These genetic abnormalities most often result in global transcriptional misregulation via disruption of protein regulatory complexes which govern chromatin architecture. Specifically, alterations to mammalian SWI/SNF (mSWI/SNF or BAF) ATP-dependent chromatin remodeling complexes and polycomb repressive complexes cause disease-specific changes in chromatin architecture and gene expression across a number of sarcoma subtypes. Understanding the functions of chromatin regulatory complexes and the mechanisms underpinning their roles in oncogenesis will be required for the design and development of new therapeutic strategies in sarcomas. Copyright © 2018 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Matthew J McBride
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Chemical Biology Program, Harvard University, Cambridge, MA, USA
| | - Cigall Kadoch
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, USA
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