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Mavrogenis AF, Angelini A, Drago G, Merlino B, Ruggieri P. Survival analysis of patients with chondrosarcomas of the pelvis. J Surg Oncol 2013; 108:19-27. [DOI: 10.1002/jso.23351] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 04/18/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Andreas F. Mavrogenis
- Department of Orthopaedics, The Istituto Ortopedico Rizzoli; University of Bologna; Bologna Italy
| | - Andrea Angelini
- Department of Orthopaedics, The Istituto Ortopedico Rizzoli; University of Bologna; Bologna Italy
| | - Gabriele Drago
- Department of Orthopaedics, The Istituto Ortopedico Rizzoli; University of Bologna; Bologna Italy
| | - Biagio Merlino
- The Department of Radiology; Catholic University; Rome Italy
| | - Pietro Ruggieri
- Department of Orthopaedics, The Istituto Ortopedico Rizzoli; University of Bologna; Bologna Italy
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53
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Oh YJ, Yang I, Yoon DY, Cho SJ, Lee Y, Woo JY, Jung AY, Hong HS, Jeh SK. Extraskeletal myxoid chondrosarcoma of the neck. Dentomaxillofac Radiol 2013; 42:31808012. [PMID: 23230139 DOI: 10.1259/dmfr/31808012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Extraskeletal myxoid chondrosarcoma is a rare malignant soft-tissue tumour that is typically in the deep soft tissues of the lower extremity. The tumour is usually a well-defined, multinodular soft-tissue mass without calcifications. A 62-year-old woman with a history of nasopharyngeal cancer presented with a palpable mass in the anterior neck. Radiologically, the lesion was a well-defined soft-tissue mass with the extensive calcifications on various imaging examinations. Although this lesion was histopathologically diagnosed as extraskeletal myxoid chondrosarcoma, the unusual imaging findings were challenging and very intriguing.
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Affiliation(s)
- Y J Oh
- Department of Radiology, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea
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54
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Chowhan AK, Rukmangadha N, Patnayak R, Bodapati CMP, Bodagala VL, Reddy MK. Myxoid chondrosarcoma of sphenoid bone. J Neurosci Rural Pract 2012. [PMID: 23189013 PMCID: PMC3505352 DOI: 10.4103/0976-3147.102641] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The myxoid variant of chondrosarcoma is usually seen in soft tissues where it is known as chordoid sarcoma or parachordoma. Rarely, it involves bone and when it does, cranial bones are the preferred location. This tumor is frequently amalgamated with the chondroid variant of chordoma, especially when the lesion occurs in the sphenoid bone/spheno-occipital region, because of their similar clinical presentations, anatomical locations, radiological findings, and mistaken histopathological features. It is essential to distinguish myxoid chondrosarcoma from the chondroid variant of chordoma, because of the different treatment protocol and prognostic importance. We present such a location-based diagnostic dilemma, solved successfully with ancillary immunohistochemistry.
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Affiliation(s)
- Amit K Chowhan
- Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
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55
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Stacchiotti S, Dagrada GP, Morosi C, Negri T, Romanini A, Pilotti S, Gronchi A, Casali PG. Extraskeletal myxoid chondrosarcoma: tumor response to sunitinib. Clin Sarcoma Res 2012; 2:22. [PMID: 23058004 PMCID: PMC3534218 DOI: 10.1186/2045-3329-2-22] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 09/30/2012] [Indexed: 01/26/2023] Open
Abstract
Background Extraskeletal myxoid chondrosarcoma (EMCS) is a rare soft tissue sarcoma of uncertain differentiation, characterized in most cases by a translocation that results in the fusion protein EWSR1-CHN (the latter even called NR4A3 or TEC). EMCS is marked by >40% incidence of metastases in spite of its indolent behaviour. It is generally resistant to conventional chemotherapy, and, to the best of our knowledge, no data have been reported to date about the activity of tirosin-kinase inhibitor (TKI) in this tumor. We report on two consecutive patients carrying an advanced EMCS treated with sunitinib. Methods Since July 2011, 2 patients with progressive pretreated metastatic EMCS (Patient1: woman, 58 years, PS1; Patient2: man, 63 years, PS1) have been treated with continuous SM 37.5 mg/day, on an individual use basis. Both patients are evaluable for response. In both cases diagnosis was confirmed by the presence of the typical EWSR1-CHN translocation. Results Both patients are still on treatment (11 and 8 months). Patient 1 got a RECIST response after 4 months from starting sunitinib, together with a complete response by PET. An interval progression was observed after stopping sunitinib for toxicity (abscess around previous femoral fixation), but response was restored after restarting sunitinib. Patient 2 had an initial tumor disease stabilization detected by CT scan at 3 months. Sunitinib was increased to 50 mg/day, with evidence of a dimensional response 3 months later. Conclusions Sunitinib showed antitumor activity in 2 patients with advanced EMCS. Further studies are needed to confirm these preliminary results.
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Affiliation(s)
- Silvia Stacchiotti
- Department of Cancer Medicine, Adult Sarcoma Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori Milan, via Venezian 1, 20133, Milan, Italy.
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Zhou Q, Lu G, Liu A, Kohno T. Extraskeletal myxoid chondrosarcoma in the lung: asymptomatic lung mass with severe anemia. Diagn Pathol 2012; 7:112. [PMID: 22925697 PMCID: PMC3487864 DOI: 10.1186/1746-1596-7-112] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 08/13/2012] [Indexed: 12/14/2022] Open
Abstract
Extraskeletal myxoid chondrosarcoma (EMC) is a rare soft-tissue sarcoma, which primarily occurs deep in the extremities, especially in skeletal muscle, or tendon. EMC of the pleura has been described, however, no case of primary EMC arising from lung has been previously reported. We describe herein, a 51-year-old Asian female initially manifested with signs of severe anemia who presented with a lung mass unrelated to pleura that was morphologically typical EMC, with strong immunoreactivity for vimentin and NSE. Two weeks after resection, the anemia was cured. The patient continued with follow-up, without sign of abnormality 32 months after operation.
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Affiliation(s)
- Qianjun Zhou
- Department of General thoracic surgery, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, PR China.
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57
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Lee KH, Lall RR, Chandler JP, Bigio EH, Mao Q. Pineal chordoid meningioma complicated by repetitive hemorrhage during pregnancy: Case report and literature review. Neuropathology 2012; 33:192-8. [DOI: 10.1111/j.1440-1789.2012.01337.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Many soft tissue tumors of childhood lack obvious differentiation toward a defined mesenchymal tissue type or have a phenotype that does not correspond to any defined normal tissue. These challenging tumors are currently regarded as neoplasms of uncertain differentiation. Nonetheless, there have been great strides in the understanding of their pathologic and genetic features and biologic underpinnings. The application of new genetic information to the pathologic diagnosis among this group of tumors is an emerging area in diagnostic pediatric pathology. This article reviews the clinicopathologic features of tumors of uncertain and/or miscellaneous origin, with an emphasis on the unique aspects of these neoplasms in children and adolescents, use of diagnostic adjuncts, and differential diagnosis.
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Affiliation(s)
- Rita Alaggio
- Department of Pathology, University of Padova, Padova, Italy.
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59
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Cates JMM, Coffin CM. Extraskeletal cartilaginous, osseous, and chordoid tumors in children and adolescents. Pediatr Dev Pathol 2012; 15:255-66. [PMID: 22420731 DOI: 10.2350/10-07-0875-pb.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Extraskeletal cartilaginous, osseous, and chordoid tumors are extraordinarily rare in children and adolescents. These lesions are diagnostically challenging due to their rarity and their overlap with metastatic osteosarcoma, reactive or metabolic calcifying and bone-forming masses, various pseudosarcomatous proliferations such as myositis ossificans, and other rare genetic or metabolic disorders. This article reviews the clinicopathologic features and differential diagnosis of extraskeletal cartilaginous, osseous, and chordoid neoplasms in the first two decades of life and highlights the use of diagnostic adjuncts.
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Affiliation(s)
- Justin M M Cates
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN, USA
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60
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Flucke U, Tops BBJ, Verdijk MAJ, van Cleef PJH, van Zwam PH, Slootweg PJ, Bovée JVMG, Riedl RG, Creytens DH, Suurmeijer AJH, Mentzel T. NR4A3 rearrangement reliably distinguishes between the clinicopathologically overlapping entities myoepithelial carcinoma of soft tissue and cellular extraskeletal myxoid chondrosarcoma. Virchows Arch 2012; 460:621-8. [PMID: 22569967 PMCID: PMC3371325 DOI: 10.1007/s00428-012-1240-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 03/30/2012] [Accepted: 04/16/2012] [Indexed: 11/05/2022]
Abstract
Myoepithelial carcinoma of soft tissue (MEC) and cellular extraskeletal myxoid chondrosarcoma (cEMC) share striking similarities. In this paper, we compare ten MECs with five cEMCs. MEC patients had an equal gender distribution. The age range was 15–76 years (mean, 42 years). Tumours were located on extremities, pelvic girdle, vulva and neck. Follow-up, available for nine patients, ranged from 4 to 85 months (mean, 35 months). Five patients were alive without evidence of disease, two were alive with disease and two died 8 months after the initial diagnosis. cEMCs were from three males and two females with an age range of 37–82 years (mean, 57 years); they presented in extremities, shoulder and paravertebral/cervical. Follow-up, available for four patients, ranged from 6 to 220 months (mean, 61 months). All patients were alive, two with recurrences and/or metastases and two without evidence of disease. Morphologically, the distinction between these two entities was difficult since all cases exhibited features typically seen in myoepithelial tumours. Immunohistochemically, MECs expressed pan-keratin (80 %), epithelial membrane antigen (EMA; 57 %), S100 (50 %), alpha-smooth muscle actin (ASMA; 75 %), calponin (67 %) and p63 (25 %). S100 and EMA were expressed in 40 % of cEMC cases respectively with additional immunoreactivity for p63, ASMA and glial fibrillary acidic protein in one case. Pan-keratin was negative in all neoplasms. NR4A3 rearrangement was present in four of four cEMCs and in none of the MECs. In contrast, three of nine (33 %) MECs and four of five (80 %) cEMCs showed an EWSR1 rearrangement. In summary, MECs and cEMCs share clinical, morphological, immunohistochemical and genetic characteristics. The pathognomic rearrangement of NR4A3 is a useful diagnostic feature in identifying cEMCs.
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Affiliation(s)
- Uta Flucke
- Department of Pathology, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 Nijmegen, The Netherlands.
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61
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Mavrogenis AF, Gambarotti M, Angelini A, Palmerini E, Staals EL, Ruggieri P, Papagelopoulos PJ. Chondrosarcomas revisited. Orthopedics 2012; 35:e379-90. [PMID: 22385450 DOI: 10.3928/01477447-20120222-30] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Chondrosarcomas are malignant bone tumors with pure hyaline cartilage differentiation; myxoid changes, calcification, or ossification may be present. Several subtypes of chondrosarcomas exist. Behavior patterns vary, ranging from slow-growing nonmetastasizing lesions to aggressive metastasizing sarcomas. Symptoms are usually mild, with duration ranging from several months to years, and usually consist of persistent, dull, aching pain or palpable masses. Radiographic findings include bone expansion with cortical thickening, radiolucent areas with variably distributed punctate or ring-like matrix calcifications, cortical erosion or destruction, endosteal scalloping, and scant or absent periosteal reaction; extension into the soft tissue may be present. Histological differential diagnosis from benign cartilaginous lesions can be achieved by increased cellularity, enlarged plump nuclei, binucleated cells, hyperchromatic nuclear pleomorphism, and permeation of cortical or medullary bone. Atypia is usually mild to moderate; necrosis and mitoses can be seen, particularly in high-grade lesions. Adequate surgery is the mainstay of treatment. High-grade and pelvic chondrosarcomas are best managed with wide resection. Because of the low metastatic potential and low local recurrence rate noted with intralesional surgery, low-grade chondrosarcomas can be treated with curettage (with or without treatment of the defect cavity) with a local adjuvant, such as phenol or cryotherapy. Adjuvant chemotherapy may be considered for mesenchymal and dedifferentiated chondrosarcomas. Radiation therapy can be considered after incomplete resection or if resection is not feasible or would cause unacceptable morbidity.
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Affiliation(s)
- Andreas F Mavrogenis
- First Department of Orthopaedics, ATTIKON University Hospital, Athens University Medical School, 41 Ventouri St, 15562 Holargos, Athens, Greece.
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Abstract
This article presents a review of chondrosarcoma variants, with a focus on the extraordinarily rare variants of chondrosarcoma in which hyaline cartilage is not the dominant feature. Discussed are the differential diagnoses for these neoplasms, radiologic studies, gross and microscopic features, and prognosis. Summaries are provided of the key features for the major variants.
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Affiliation(s)
- Scott E Kilpatrick
- Pathologists Diagnostic Services, Forsyth Medical Center, 3333 Silas Creek Parkway, Winston-Salem, NC 27104, USA
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64
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65
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Khan AS, Bakhshi GD, Shaikh A, Khan AA, Khan AA, Chitale A. Extraskeletal chondrosarcoma of labium majus. Case Rep Pathol 2011; 2011:429562. [PMID: 22937384 PMCID: PMC3420494 DOI: 10.1155/2011/429562] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 07/18/2011] [Indexed: 12/18/2022] Open
Abstract
Extraskeletal myxoid chondrosarcoma (ESMC) is a rare tumor seen more often in men. It is seen to arise from soft tissue of lower extremity or buttocks. We report a case of soft tissue swelling of left labium majus in a 66-year-old female. Patient underwent wide excision with uneventful postoperative course. Histopathology of specimen confirmed it to be ESMC. Patient refused adjuvant therapy. Followup of 1 year has shown her to be disease- and symptom- free. Only two cases arising from vulva have been reported in literature . This is the third case and first from Indian subcontinent. A brief review of clinical features, diagnosis, treatment, and outcome of patients with extraskeletal chondrosarcoma is presented.
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Affiliation(s)
- Arshad S. Khan
- Department of Surgery, Grant Medical College & Sir J. J. Group of Hospitals, Mumbai 400008, India
| | - Girish D. Bakhshi
- Department of Surgery, Grant Medical College & Sir J. J. Group of Hospitals, Mumbai 400008, India
- Plot-61, Sector-7, Koper-Khairane, New Mumbai-400709, Maharashtra, India
| | - Aftab Shaikh
- Department of Surgery, Grant Medical College & Sir J. J. Group of Hospitals, Mumbai 400008, India
| | - Ashraf A. Khan
- Department of Surgery, Grant Medical College & Sir J. J. Group of Hospitals, Mumbai 400008, India
| | - Adil A. Khan
- Department of Surgery, Grant Medical College & Sir J. J. Group of Hospitals, Mumbai 400008, India
| | - Arun Chitale
- Department of Surgery, Grant Medical College & Sir J. J. Group of Hospitals, Mumbai 400008, India
- Department of Pathology, Bombay Hospital, Mumbai 400020, India
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66
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Mitchell AP, Poiesz M, Leung A. A case of highly aggressive extraskeletal myxoid chondrosarcoma. Case Rep Oncol 2011; 4:377-84. [PMID: 21941486 PMCID: PMC3177793 DOI: 10.1159/000331237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Extraskeletal myxoid chondrosarcoma (EMC) is a soft tissue malignancy characterized by specific chromosomal abnormalities involving the TEC gene. This disease has historically been considered largely indolent both histologically and clinically. Rarer subsets of EMC exist that demonstrate aggressive histopathologic features and clinical behavior, though it remains unclear whether or not aggressive histopathology is predictive of outcome. Herein we present a case of EMC with aggressive histopathologic features that underwent rapid clinical progression despite initial treatment with curative intent. This case provides the context for a discussion of the existing literature regarding treatment, prognosis, pathology, and genetic/molecular features of EMC in general and aggressive EMC specifically.
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Affiliation(s)
- Aaron P Mitchell
- Duke University Medical Center, Internal Medicine Residency Program, Durham, N.C., USA
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67
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Sawada M, Tochigi N, Sasajima Y, Hasegawa T, Kasamatsu T, Kitawaki J. Primary extraskeletal myxoid chondrosarcoma of the vulva. J Obstet Gynaecol Res 2011; 37:1706-10. [PMID: 21651669 DOI: 10.1111/j.1447-0756.2011.01559.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Morio Sawada
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Japan.
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68
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Bumpass DB, Kyriakos M, Rubin DA, Manske PR, Goldfarb CA. Myxoid chondrosarcoma of the phalanx with an EWS translocation: a case report and review of the literature. J Bone Joint Surg Am 2011; 93:e23. [PMID: 21411698 DOI: 10.2106/jbjs.j.00520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- David B Bumpass
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
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69
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Goda JS, Ferguson PC, O'Sullivan B, Catton CN, Griffin AM, Wunder JS, Bell RS, Kandel RA, Chung PW. High-risk extracranial chondrosarcoma. Cancer 2011; 117:2513-9. [DOI: 10.1002/cncr.25806] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 09/25/2010] [Accepted: 10/12/2010] [Indexed: 01/02/2023]
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70
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Jung G, Cho KJ, Choi SH, Kim MJ. Dedifferentiated Extraskeletal Myxoid Chondrosarcoma of the Masticator Space - A Case Report -. KOREAN JOURNAL OF PATHOLOGY 2011. [DOI: 10.4132/koreanjpathol.2011.45.s1.s101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Geunyoung Jung
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung-Ja Cho
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Ho Choi
- Department of Otorhinolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi-Jung Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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71
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Ganguly R, Mukherjee A. Maxillo-facial Extraskeletal Myxoid Chondrosarcoma: A Case Report and Discussion. KOREAN JOURNAL OF PATHOLOGY 2011. [DOI: 10.4132/koreanjpathol.2011.45.6.639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ratnadeep Ganguly
- Department of Pathology, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | - Abhishek Mukherjee
- Department of Pathology, The Mission Hospital, Durgapur, West Bengal, India
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Kaplan I, Shah SS, Nicolaou-Ioannou Z, Fliss DM. Clinical-pathological conference: case 1. Head Neck Pathol 2010; 4:214-20. [PMID: 20658218 PMCID: PMC2923303 DOI: 10.1007/s12105-010-0193-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Accepted: 07/09/2010] [Indexed: 01/30/2023]
Affiliation(s)
- Ilana Kaplan
- Institute of Pathology, Tel-Aviv Sourasky Medical Center, 6 Weitzman St, Tel Aviv, Israel
| | - Sonal S. Shah
- Department of Oral and Maxillofacial Pathology, Radiology, and Medicine, College of Dentistry, New York University, New York, NY USA
| | | | - Dan M. Fliss
- Department of Otolaryngology, Head and Neck Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
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Abstract
Bone and soft tissue sarcomas are an infrequent and heterogeneous group of mesenchymal tumors including more than a hundred different entities attending to histologic patterns. Research into the molecular aspects of sarcomas has increased greatly in the last few years. This enormous amount of knowledge has allowed, for instance, to refine the classification of sarcomas, improve the diagnosis, and increase the number of therapeutical targets available, most of them under preclinical evaluation. However, other important key issues, such as sarcomagenesis and the cell of origin of sarcomas, remain unresolved. From a molecular point of view, these neoplasias are grouped into 2 main types: (a) sarcomas showing relatively simple karyotypes and translocations, which originate gene fusions (eg, EWS-FLI1 in Ewing sarcoma) or point mutations (eg, c-kit in the gastrointestinal tumors) and (b) sarcomas showing unspecific gene alterations, very complex karyotypes, and no translocations. The discovery of the early mechanisms involved in the genesis of sarcomas, the more relevant signaling pathways, and the development of genetically engineered mouse models could also provide a new individualized therapeutic strategy against these tumors. This review describes the clinical application of some of the molecular alterations found in sarcomas, some advances in the field of sarcomagenesis, and the development of animal models.
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75
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Alexander GE, Henderson ER, Rodriguez AR, Bui MM, Cheong D, Letson GD. Extraskeletal myxoid chondrosarcoma: rare presentation in the knee joint space. Orthopedics 2009; 32:919. [PMID: 19968226 DOI: 10.3928/01477447-20091020-28] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Extraskeletal myxoid chondrosarcoma is a malignant cartilage tumor that rarely presents in the joint space. This article presents a case of a man who presented with a 1-year history of continuous growth of a mass over the medial aspect of his right knee. Radiographs demonstrated osteoarthritis, and arthroscopy was performed for degenerative joint disease. At the time of surgery, an intra-articular mass was encountered and an unplanned biopsy was performed. Pathological analysis revealed the mass to be a primary extraskeletal, intra-articular chondrosarcoma. He had no history of malignancy. He underwent extra-articular resection of the lesion and reconstruction with endoprosthesis. The patient's clinical course required multiple re-operations, and pulmonary metastases developed. A gastrocnemius flap was performed for wound coverage in proximity to the resected arthroscopy portals. This case emphasizes the importance of proper preoperative imaging and planning for lesion biopsies. Proper initial management may have led to lesser overall morbidity. Review of the literature reveals that this is the only reported case of a primary intra-articular extraskeletal myxoid chondrosarcoma.
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Affiliation(s)
- Gerald E Alexander
- Department of Orthopedics and Sports Medicine, University of South Florida, Tampa, FL 33612, USA
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76
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Electron microscopy morphology of the mitochondrial network in human cancer. Int J Biochem Cell Biol 2009; 41:2062-8. [DOI: 10.1016/j.biocel.2009.02.002] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Revised: 01/08/2009] [Accepted: 02/06/2009] [Indexed: 12/17/2022]
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77
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Domanski HA, Carle´n B, Mertens F, Åkerman M. Extraskeletal Myxoid Chondrosarcoma with Neuroendocrine Differentiation: A Case Report with Fine-Needle Aspiration Biopsy, Histopathology, Electron Microscopy, and Cytogenetics. Ultrastruct Pathol 2009. [DOI: 10.1080/01913120390239999] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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78
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Distinguishing chordoid meningiomas from their histologic mimics: an immunohistochemical evaluation. Am J Surg Pathol 2009; 33:669-81. [PMID: 19194275 DOI: 10.1097/pas.0b013e318194c566] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Chordoid meningioma, World Health Organization grade II, is an uncommon variant of meningioma with a propensity for aggressive behavior and increased likelihood of recurrence. As such, recognition of this entity is important in cases that show similar morphologic overlap with other chondroid/myxoid neoplasms that can arise within or near the central nervous system. A formal comparison of the immunohistochemical features of chordoid meningioma versus tumors with significant histologic overlap has not been previously reported. In this study, immunohistochemical staining was performed with antibodies against D2-40, S100, pankeratin, epithelial membrane antigen (EMA), brachyury, and glial fibrillary acidic protein (GFAP) in 4 cases of chordoid glioma, 6 skeletal myxoid chondrosarcomas, 10 chordoid meningiomas, 16 extraskeletal myxoid chondrosarcoma, 18 chordomas, 22 low-grade chondrosarcomas, and 27 enchondromas. Staining extent and intensity were evaluated semiquantitatively and mean values for each parameter were calculated. Immunostaining with D2-40 showed positivity in 100% of skeletal myxoid chondrosarcomas, 96% of enchondromas, 95% of low-grade chondrosarcomas, 80% of chordoid meningiomas, and 75% of chordoid gliomas. Staining with S100 demonstrated diffuse, strong positivity in all (100%) chordoid gliomas, skeletal myxoid chondrosarcomas, low-grade chondrosarcomas, and enchondromas, 94% of chordomas, and 81% of extraskeletal myxoid chondrosarcomas, with focal, moderate staining in 40% of chordoid meningiomas. Pankeratin highlighted 100% of chordoid gliomas and chordomas, 38% of extraskeletal myxoid chondrosarcomas, and 20% of chordoid meningiomas. EMA staining was positive in 100% of chordoid gliomas, 94% of chordomas, 90% of chordoid meningiomas, and 25% of extraskeletal myxoid chondrosarcomas. Brachyury was positive only in the chordomas (100%), whereas GFAP was positive only in the chordoid gliomas (100%). EMA was the most effective antibody for differentiating chordoid meningioma from skeletal myxoid chondrosarcoma, low-grade chondrosarcoma, and enchondroma, whereas D2-40 was the most effective antibody for differentiating chordoid meningioma from extraskeletal myxoid chondrosarcoma and chordoma. Our findings demonstrate that in conjunction with clinical and radiographic findings, immunohistochemical evaluation with a panel of D2-40, EMA, brachyury, and GFAP is most useful in distinguishing chordoid meningioma from chordoid glioma, skeletal myxoid chondrosarcoma, extraskeletal myxoid chondrosarcoma, chordoma, low-grade chondrosarcoma, and enchondroma. A lack of strong, diffuse S100 reactivity may also be useful in excluding chordoid meningioma. Among the neoplasms evaluated, brachyury and GFAP proved to be both sensitive and specific markers for chordoma and chordoid glioma, respectively. Of note, this study is the first to characterize the D2-40 immunoprofile in extraskeletal myxoid chondrosarcoma, results that could be of utility in differential diagnostic assessment.
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79
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Kumar R, Rekhi B, Shirazi N, Pais A, Amare P, Gawde D, Jambhekar N. Spectrum of cytomorphological features, including literature review, of an extraskeletal myxoid chondrosarcoma with t(9;22)(q22;q12) (TEC/EWS) results in one case. Diagn Cytopathol 2008; 36:868-75. [DOI: 10.1002/dc.20931] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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80
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Fluorescence in situ hybridization is a useful ancillary diagnostic tool for extraskeletal myxoid chondrosarcoma. Mod Pathol 2008; 21:1303-10. [PMID: 18587326 DOI: 10.1038/modpathol.2008.114] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Extraskeletal myxoid chondrosarcoma is a rare soft tissue tumor characterized by a nodular growth pattern with eosinophilic cells usually in a reticular pattern and abundant myxoid stroma. In contrast to other myxoid sarcomas, the majority of extraskeletal myxoid chondrosarcomas harbor a balanced translocation, t(9;22)(q22;q12), that fuses EWSR1 with NR4A3 (also known as CHN). Other less common translocations involving NR4A3 have also been described. We examined the diagnostic utility of fluorescence in situ hybridization for extraskeletal myxoid chondrosarcoma using the LSI EWSR1 break-apart probe (Abbott Molecular/Vysis, Des Plaines, IL, USA). Sixteen cases of extraskeletal myxoid chondrosarcoma with formalin-fixed paraffin-embedded tissue available were retrieved (1991-2007). The mean age at time of presentation was 57 years (range, 30-78). The male to female ratio was 7:1. All cases where either consistent with or highly suggestive of the diagnosis, with most of the primary tumors occurring in the thigh, inguinal or gluteal region. Fifteen of 16 cases were analyzable, of which 14 (93%) were positive for the rearrangement of the EWSR1 locus. In this study, the vast majority of extraskeletal myxoid chondrosarcomas are associated with a rearrangement at the EWSR1 locus (22q12). Fluorescence in situ hybridization is useful to support the diagnosis of extraskeletal myxoid chondrosarcomas and may help to differentiate it from mimics such as other myxoid sarcomas, particularly in limited biopsies.
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81
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Ye XF, Mi C, Li Y, Liu Q. Clinicopathological features of extraskeletal myxoid chondrosarcoma: An analysis of 9 cases. Chin J Cancer Res 2008. [DOI: 10.1007/s11670-008-0230-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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82
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Gelderblom H, Hogendoorn PCW, Dijkstra SD, van Rijswijk CS, Krol AD, Taminiau AHM, Bovée JVMG. The clinical approach towards chondrosarcoma. Oncologist 2008; 13:320-9. [PMID: 18378543 DOI: 10.1634/theoncologist.2007-0237] [Citation(s) in RCA: 482] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
This review provides an overview of the histopathology, classification, diagnostic procedures, and therapy of skeletal chondrosarcoma. Chondrosarcomas that arise de novo are primary chondrosarcomas, whereas chondrosarcomas developing superimposed on pre-existing benign cartilage neoplasms such as enchondromas or osteochondromas are referred to as secondary chondrosarcomas. Conventional chondrosarcomas can be categorized according to their location in bone into central, peripheral, and juxtacortical chondrosarcomas. Histological grading is related to prognosis; however, it is also subject to interobserver variability. Rare subtypes of chondrosarcoma, including dedifferentiated, mesenchymal, and clear cell chondrosarcoma, are discussed as well. Magnetic resonance imaging is necessary to delineate the extent of the intraosseous and soft tissue involvement preoperatively. Computed tomography is especially recommended in the pelvis and other flat bones where it may be difficult to discern the pattern of bone destruction and the presence of matrix mineralization. Wide, en-bloc excision is the preferred surgical treatment in intermediate- and high-grade chondrosarcoma. In low-grade chondrosarcoma confined to the bone, extensive intralesional curettage followed by local adjuvant treatment and filling the cavity with bone graft has promising long-term clinical results and satisfactory local control. Chondrosarcomas are relatively radiotherapy resistant; therefore, doses >60 Gy are needed in attempts to achieve local control after incomplete resection. Irradiation with protons or other charged particles seems beneficial in this curative situation. Chemotherapy is only possibly effective in mesenchymal chondrosarcoma, and is of uncertain value in dedifferentiated chondrosarcoma. Potential new systemic treatment targets are being discussed.
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Affiliation(s)
- Hans Gelderblom
- Department of Clinical Oncology (Medical Oncology and Radiotherapy), Leiden University Medical Center, PO Box 9600, Postzone K1-P, 2300RC Leiden, The Netherlands.
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83
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Brachyury Expression in Extra-axial Skeletal and Soft Tissue Chordomas: A Marker that Distinguishes Chordoma From Mixed Tumor/Myoepithelioma/Parachordoma in Soft Tissue. Am J Surg Pathol 2008; 32:572-80. [DOI: 10.1097/pas.0b013e31815b693a] [Citation(s) in RCA: 191] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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84
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Affiliation(s)
- Jay Pahade
- Department of Radiology, Musculoskeletal Section, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, E/CC-4, Boston, MA 02215, USA
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85
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Kim YJ, Im SA, Lim GY, Chun HJ, Park HJ, Kim MS, Choi YJ. Myxoid chondrosarcoma of the sinonasal cavity in a child: a case report. Korean J Radiol 2007; 8:452-5. [PMID: 17923790 PMCID: PMC2626806 DOI: 10.3348/kjr.2007.8.5.452] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Chondrosarcomas are malignant tumors of cartilage that rarely involve the sinonasal region, and myxoid chondrosarcoma is a rare histologic variant of chondrosarcoma that usually occurs in the soft tissue of extremities. Although several case reports and results of small series of chondrosarcomas in the sinonasal region in children are available, myxoid type chondrosarcoma is extremely rare. We recently experienced a case of low grade myxoid chondrosarcoma involving the sinonasal cavity in a 10-year-old boy, and here we report its radiologic-pathologic findings. In this case, chondroid calcification on CT and septal and marginal enhancement on MRI suggested a chondrosarcoma. Whole body PET-CT demonstrated no definite metastatic lesion and a low peak standardized uptake value primary tumor. However, no definite distinguishing imaging features were observed that distinguished low grade myxoid chondrosarcoma from conventional chondrosarcoma.
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Affiliation(s)
- Yeo Ju Kim
- Department of Radiology, Kangnam St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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86
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Abstract
PURPOSE OF REVIEW This paper reviews recent molecular, biologic, developmental therapeutic, and clinical findings in conventional and variant chondrosarcomas. RECENT FINDINGS The prognosis of chondrosarcomas traditionally correlates with histologic grade and adequacy of surgery. Newer markers of cell differentiation, activation, genetics, and cell signaling may offer important prognostic information. Translational research has validated platelet-derived growth factor receptor, estrogen signaling, matrix metalloproteinase-1, histone deacetylase, methylthioadenosine phosphorylase, and vascular endothelial growth factor-A as potential therapeutic targets. Bisphosphonates may also possess important antitumoral effects. Molecular studies have established that extraskeletal myxoid chondrosarcoma is a unique entity defined by the presence of a fusion gene between the orphan nuclear receptor, CHN/NOR1, and a promiscuous partner, most commonly EWSR1. Clinical studies have shown that development of second malignancies is an uncommon but real risk for chondrosarcoma survivors; the benefit of chemotherapy for dedifferentiated chondrosarcomas remains questionable; and late recurrences of clear cell chondrosarcomas emphasize the need for long-term follow up. SUMMARY Chondrosarcomas are a heterogeneous group of bone and soft tissue tumors. Recent advances in molecular diagnostics, pathobiology, and developmental therapeutics will aid both scientists and clinicians in improving the classification and therapy of this diverse family of cartilaginous tumors.
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Affiliation(s)
- Warren A Chow
- City of Hope Medical Center, Division of Medical Oncology & Therapeutics Research, Duarte, CA 91010, USA.
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87
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Nakamura K, Shibuya K, Hirai T, Nunoya T. An undifferentiated sarcoma in a rat resembling extraskeletal myxoid chondrosarcoma in man. Toxicol Pathol 2007; 35:672-5. [PMID: 17676526 DOI: 10.1080/01926230701481881] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A soft tissue tumor occurring in the inguinal subcutaneous tissue was detected in a 109-week-old male F344 rat. Macroscopically, the tumor mass showed no skeletal relationship and a gelatinous multinodular appearance. Histologically, the tumor consisted of irregular lobules separated by scant fibrous septa. In each lobule, tumor cells were arranged in cords and strands in the plentiful myxoid stroma. The tumor cells showed marked pleomorphism, and had large, round to ovoid nuclei and abundant eosinophilic cytoplasm. Mitotic figures were often seen. Myxoid stroma of the tumor contained a large amount of acid mucopolysaccharides and collagen type II, which were demonstrated by histochemistry and immunohistochemistry respectively. The tumor cells showed positive immunoreactivities for vimentin and S100 protein. Ultrastructural examination revealed that the tumor cells had a large amount of mitochondria, Golgi complex and dilated rough endoplasmic reticulum containing amorphous material, and the myxoid stroma contained collagenous fibrils and proteoglycan particles. Based on these results, the present tumor in a rat resembled extraskeletal myxoid chondrosarcoma in man.
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88
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Kwon JW, Choi JA, Kwack KS, Oh JH, Chung JH, Kang HS. Myxoid chondrosarcoma in the calcaneus: a case report with MR imaging findings. Skeletal Radiol 2007; 36 Suppl 1:S82-5. [PMID: 17219232 DOI: 10.1007/s00256-006-0199-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Revised: 06/16/2006] [Accepted: 08/02/2006] [Indexed: 02/02/2023]
Abstract
Skeletal myxoid chondrosarcoma is an extraordinarily rare neoplasm with a distinct histological morphology. Herein, we report a case of a myxoid chondrosarcoma in the calcaneus of a 20-year-old man with a description of its MR imaging (MRI) and histological findings.
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Affiliation(s)
- Jong Won Kwon
- Department of Radiology, Seoul National University Bundang Hospital, 300 Gumidong, Bundang-Gu, Seong Nam, Gyeongi-Do 463-707, South Korea
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89
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DiFrancesco LM, Davanzo Castillo CA, Temple WJ. Extra-Axial Chordoma. Arch Pathol Lab Med 2006; 130:1871-4. [PMID: 17149966 DOI: 10.5858/2006-130-1871-ec] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2006] [Indexed: 11/06/2022]
Abstract
Abstract
Chordomas are low-grade malignant tumors of bone that occur almost exclusively in the axial skeleton. Other neoplasms with a similar histologic picture but an extra-axial location have been described, including parachordoma, myxoid chondrosarcoma, and extra-axial chordoma. We herein present another case of the rare extra-axial chordoma. A 41-year-old woman developed an 8.3 cm mass in the pubic bone. The gross, microscopic, and immunohistochemical findings were identical to those of a classic chordoma. Parachordoma and myxoid chondrosarcoma were excluded from the differential diagnosis. Five previously reported cases of extra-axial chordoma were reviewed and found also to demonstrate clinical and pathologic features specific to chordoma, despite arising in an extra-axial location. Although rare, extra-axial chordoma does exist and should be recognized and managed in a similar fashion to its well-described counterpart. It must be differentiated from other histologic mimics, because the treatment and prognosis can differ significantly.
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Affiliation(s)
- Lisa M DiFrancesco
- Department of Pathology and Laboratory Medicine, University of Calgary, Alberta.
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90
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Abstract
Ossifying fibromyxoid tumor (OFMT) is an uncommon neoplasm occurring predominantly in the deep soft tissues of the trunk and proximal extremities. The lineage of this rare tumor to date is still uncertain. We present a case of a subcutaneous OFMT that recurred 8 years after initial resection. The histological findings of the primary and recurrent lesions are compared along with the histologic features possibly associated with aggressiveness. Dermatopathologists should consider OFMT in the differential diagnosis of subcutaneous neoplasms with a myxoid matrix.
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Affiliation(s)
- Anthony C Soldano
- Department of Surgical Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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91
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Poulin H, Filion C, Ladanyi M, Labelle Y. Serum- and glucocorticoid-regulated kinase 1 (SGK1) induction by the EWS/NOR1(NR4A3) fusion protein. Biochem Biophys Res Commun 2006; 346:306-13. [PMID: 16756948 DOI: 10.1016/j.bbrc.2006.05.134] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Accepted: 05/19/2006] [Indexed: 11/29/2022]
Abstract
The NR4A3 nuclear receptor (also known as NOR1) is involved in tumorigenesis by the t(9;22) chromosome translocation encoding the EWS/NOR1 fusion protein found in approximately 75% of all cases of extraskeletal myxoid chondrosarcomas (EMC). Several observations suggest that one role of EWS/NOR1 in tumorigenesis may be to deregulate the expression of specific target genes. We have shown previously that constitutive expression of EWS/NOR1 in CFK2 fetal rat chondrogenic cells induces their transformation as measured by growth beyond confluency and growth in soft agar. To identify genes regulated by the fusion protein in this model, we have generated a CFK2 cell line in which the expression of EWS/NOR1 is controlled by tetracycline. Using the differential display technique, we have identified the serum- and glucocorticoid-regulated kinase 1 (SGK1) mRNA as being up-regulated in the presence of EWS/NOR1. Co-immunocytochemistry confirmed over-expression of the SGK1 protein in cells expressing EWS/NOR1. Significantly, immunohistochemistry of 10 EMC tumors positive for EWS/NOR1 showed that all of them over-express the SGK1 protein in contrast to non-neoplastic cells in the same biopsies and various other sarcoma types. These results strongly suggest that SGK1 may be a genuine in vivo target of EWS/NOR1 in EMC.
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Affiliation(s)
- Hugo Poulin
- Human and Molecular Genetic Research Unit, Saint-François d'Assise Hospital, CHUQ, Que., Canada G1L 3L5
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92
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Santacruz MR, Proctor L, Thomas DB, Gehrig PA. Extraskeletal myxoid chondrosarcoma: A report of a gynecologic case. Gynecol Oncol 2005; 98:498-501. [PMID: 15992919 DOI: 10.1016/j.ygyno.2005.04.045] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2004] [Revised: 03/24/2005] [Accepted: 04/18/2005] [Indexed: 12/31/2022]
Abstract
BACKGROUND Extraskeletal myxoid chondrosarcoma is a rare tumor that has been reported and discussed in neurosurgical, orthopedic, and otolaryngologic literature. We report a case of vulvar extraskeletal myxoid chondrosarcoma. CASE This is a case of a 46-year-old woman who presented with a soft tissue mass in the left vulva and underwent local excision. Grossly, the tumors appeared to be leiomyomas. Pathology revealed an extraskeletal myxoid chondrosarcoma. CONCLUSION We report the first case of an extraskeletal myxoid chondrosarcoma arising in the vulva.
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Affiliation(s)
- Mildred R Santacruz
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of North Carolina, 4013-B Old Clinic Building, Chapel Hill, NC 27599, USA.
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93
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Rowsell C, Sirbovan J, Rosenblum MK, Perez-Ordoñez B. Primary chordoid meningioma of lung. Virchows Arch 2005; 446:333-7. [PMID: 15714337 DOI: 10.1007/s00428-004-1192-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2004] [Accepted: 12/02/2004] [Indexed: 02/05/2023]
Abstract
Primary meningiomas of the lung are rare. Most pulmonary meningiomas are typical syncytial or transitional meningiomas with smaller numbers of fibrous-type tumors. Herein, we report an unusual pulmonary tumor with the microscopic, immunohistochemical, and ultrastructural characteristics of a chordoid meningioma. The tumor was composed of cords and fascicles of small- to medium-sized spindle and epithelioid cells with eosinophilic cytoplasm and round nuclei with finely dispersed chromatin. The tumor cells were surrounded by an abundant mucoid, vacuolated stroma. The periphery of the tumor was enveloped by a significant lymphoplasmacytic infiltrate. The neoplastic cells were positive for vimentin and epithelial membrane antigen only. The unusual morphology of the tumor caused significant diagnostic difficulties. The differential diagnosis included inflammatory myofibroblastic tumor, spindle cell myoepithelioma, and extraskeletal myxoid chondrosarcoma. To the best of our knowledge, this is possibly the first description of an extracranial or intrapulmonary chordoid meningioma.
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Affiliation(s)
- Corwyn Rowsell
- Department of Pathology, University Health Network, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario M4N 3M5, Canada
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94
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Abstract
PURPOSE OF REVIEW The burgeoning body of information on the genetic changes present in and underlying the development and biology of human cancers has carried implications regarding the possible genetic events that are responsible for not only the genesis of these cancers but also the hope of the cure for these cancers. Chondrosarcomas are a group of tumors that fall into this category. The purpose of this review is to summarize the genetic findings in these tumors. RECENT FINDINGS The histopathologic variability of chondrosarcomas is reflected in the complexity and lack of specificity of their cytogenetic and molecular genetic findings, except for extraskeletal myxoid chondrosarcomas. These are characterized in the preponderant number of cases by a translocation, t(9;22)(q22;q12), and in a small number of cases by variant translocations t(9;17)(q22;q11) and t(9;15)(q22;q21). These translocations lead to the formation of abnormal fusion genes and gene products (proteins). In each of these translocations, the CHN gene is involved, resulting in the chimeric fusion genes EWS/CHN, RBP56/CHN, and TCF12/CHN, respectively. The specific translocations and their associated molecular genetic changes are diagnostic of extraskeletal myxoid chondrosarcomas. The abnormal proteins resulting from these fusion genes aberrantly affect gene transcription and cellular signaling pathways thought to be responsible for initiating sarcoma formation. In skeletal (central) chondrosarcomas of varying histopathologic types, the cytogenetic and molecular genetic findings are variable, complex, and apparently lacking in specificity. These changes may reflect a stepwise process (or processes) of oncogenesis involving an array of genes. SUMMARY Although some cartilaginous tumors are characterized by specific or recurrent chromosome alterations and molecular genetic changes, much is yet to be learned about the nature and sequence of these genetics events and about their unique role in the stepwise process involved in the development and biology of each tumor type, both malignant and nonmalignant. Until such time, some of the genetic changes, particularly the presence of specific translocations, can be of definite diagnostic value.
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Affiliation(s)
- Avery A Sandberg
- Department of DNA Diagnostics, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
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95
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Hisaoka M, Okamoto S, Yokoyama K, Hashimoto H. Coexpression of NOR1 and SIX3 proteins in extraskeletal myxoid chondrosarcomas without detectable NR4A3 fusion genes. CANCER GENETICS AND CYTOGENETICS 2004; 152:101-7. [PMID: 15262426 DOI: 10.1016/j.cancergencyto.2003.11.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2003] [Revised: 11/18/2003] [Accepted: 11/24/2003] [Indexed: 11/21/2022]
Abstract
Extraskeletal myxoid chondrosarcoma (EMC) is a rare mesenchymal tumor cytogenetically characterized by reciprocal translocations, such as t(9;22)(q22;q12) and t(9;17)(q22;q11), which result in EWSR1/NR4A3 and TAF15/NR4A3 fusion genes (alias EWS/NOR1, TAF2N/NOR1), respectively. NOR1 is an orphan nuclear receptor and acts as a transcription factor that can bind to its putative coactivator, SIX3. Although the NOR1 fusion protein has been implicated in oncogenesis of EMC, a small fraction of EMC lacks detectable rearrangements of the NR4A3 gene or 9q22. We report a case of EMC with no detectable NR4A3 gene alterations, as assessed with various molecular techniques including reverse transcription-polymerase chain reaction (RT-PCR), Southern blotting, interphase fluorescence in situ hybridization, and PCR single-strand conformation polymorphism-but with coexpression of native NOR1 and SIX3. In our survey of another 18 EMCs, we identified one more case expressing both NOR1 and SIX3 but lacking NR4A3 fusion. Fourteen tumors with detectable NR4A3 fusion genes (EWSR1-NR4A3; TAF15-NR4A3) expressed neither native NOR1 nor SIX3. SIX3 expression is normally confined specifically to the developing eye and fetal forebrain, although the expression of NR4A3 is largely ubiquitous. Our data suggest that aberrant coexpression of NOR1 and SIX3 is a potential alternative mechanism underlying the development of EMC.
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MESH Headings
- Aged
- Blotting, Southern
- Bone Neoplasms/genetics
- Bone Neoplasms/metabolism
- Bone Neoplasms/pathology
- Chondrosarcoma/genetics
- Chondrosarcoma/metabolism
- Chondrosarcoma/pathology
- Chromosomes, Human, Pair 9/genetics
- DNA-Binding Proteins/genetics
- DNA-Binding Proteins/metabolism
- Eye Proteins
- Homeodomain Proteins/genetics
- Homeodomain Proteins/metabolism
- Humans
- In Situ Hybridization, Fluorescence
- Interphase
- Male
- Membrane Transport Proteins
- Nasopharyngeal Neoplasms/genetics
- Nasopharyngeal Neoplasms/metabolism
- Nerve Tissue Proteins/genetics
- Nerve Tissue Proteins/metabolism
- Oncogene Proteins, Fusion/genetics
- Oncogene Proteins, Fusion/metabolism
- Polymorphism, Single-Stranded Conformational
- Proteins/genetics
- Proteins/metabolism
- Receptors, Steroid
- Receptors, Thyroid Hormone/genetics
- Receptors, Thyroid Hormone/metabolism
- Reverse Transcriptase Polymerase Chain Reaction
- Homeobox Protein SIX3
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Affiliation(s)
- Masanori Hisaoka
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
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96
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Lee HJ, Kim S, Pelletier J, Kim J. Stimulation of hTAFII68 (NTD)-mediated transactivation by v-Src. FEBS Lett 2004; 564:188-98. [PMID: 15094065 DOI: 10.1016/s0014-5793(04)00314-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2004] [Revised: 03/05/2004] [Accepted: 03/11/2004] [Indexed: 12/17/2022]
Abstract
The three genes hTAF(II)68, EWS, and TLS (called the TET family) encode related RNA binding proteins containing an RNA recognition motif and three glycine-, arginine-, and proline-rich regions in the C-terminus and a degenerated repeat containing the consensus sequence Ser-Tyr-Gly-Gln-Ser in the N-terminus. In many human cancers, the N-terminal portion of hTAF(II)68, EWS, or TLS is fused to the DNA binding domain of one of several transcription factors including Fli-1, ERG, ETV1, E1AF, WT1, ATF-1, CHOP, or TEC. We have recognized the presence of several potential tyrosine phosphorylation sites within the amino-terminal domain of hTAF(II)68 and have investigated the potential effects of cytoplasmic signaling on hTAF(II)68 function. Herein, we find that hTAF(II)68 is phosphorylated on tyrosine residue(s) by ectopic expression of v-Src protein tyrosine kinase in vitro and in vivo. The hTAF(II)68 protein can associated with the SH3 domains of several cell signaling proteins, including v-Src protein tyrosine kinase. We also document that full-length v-Src can stimulate hTAF(II)68-mediated transcriptional activation, whereas deletion mutants of v-Src are unable to exert this effect. In addition, cellular Src activity appears important for hTAF(II)68 function since hTAF(II)68-mediated transactivation is reduced in a dose-dependent fashion by ectopic overexpression of a dominant-negative mutant of Src. Taken together, our results suggest that the biological activities of hTAF(II)68 are linked to the cytoplasmic Src signal transduction pathway.
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Affiliation(s)
- Hye Jin Lee
- Laboratory of Molecular and Cellular Biology, Department of Life Science, Sogang University, Seoul 121-743, South Korea
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Aigner T, Oliveira AM, Nascimento AG. Extraskeletal myxoid chondrosarcomas do not show a chondrocytic phenotype. Mod Pathol 2004; 17:214-21. [PMID: 14657948 DOI: 10.1038/modpathol.3800036] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Extraskeletal myxoid chondrosarcoma is a rare mesenchymal soft-tissue malignancy of putative chondrocytic differentiation. Occasional overt cartilage formation, positivity for S-100 protein, and ultrastructural analysis have supported this view. However, most extraskeletal myxoid chondrosarcomas do not show chondroid tissue formation, and S-100 protein is found much less commonly than has been reported. Both these observations cast doubt on the histogenetic classification of extraskeletal myxoid chondrosarcoma as a chondroblastic entity. Mostly using matrix proteins as markers of mesenchymal cell differentiation, we investigated the biochemical matrix composition and cellular phenotype of the tumor cells in representative specimens from 14 extraskeletal myxoid chondrosarcomas. In all but one tumor specimen, which showed histomorphologically overt cartilage formation, only occasional staining for the proteoglycan aggrecan was found. Specimens from two tumors showed presence of collagen type II, and none was positive for collagen type X. Instead, collagen types I, III, and VI were diffusely positive. Also, S-100 protein was largely absent. Our results suggest that the basic cellular phenotype of extraskeletal myxoid chondrosarcoma is not chondrocytic or prechondrocytic and that extraskeletal myxoid chondrosarcoma is not a chondrosarcomatous entity. Extraskeletal myxoid chondrosarcoma consists most likely of primitive mesenchymal cells with focal, multidirectional differentiation. Chondrocytic differentiation is an unusual facet in the spectrum of differentiation patterns exhibited by these lesions.
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Affiliation(s)
- Thomas Aigner
- Department of Pathology, University of Erlangen-Nürnberg, Erlangen, Germany
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Mukhopadhyay S, Khurana KK, Dexter E, Landas SK. Pathologic quiz case: chest wall mass in a 74-year-old man. Extraskeletal myxoid chondrosarcoma. Arch Pathol Lab Med 2003; 127:e413-4. [PMID: 14521439 DOI: 10.5858/2003-127-e413-pqccwm] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Sanjay Mukhopadhyay
- Department of Pathology, State University of New York Upstate Medical University, Syracuse, NY 13210, USA
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Kamiyama K, Kinjo T, Chinen K, Iwamasa T, Hanzawa H, Maehara H, Hashimoto H. Aggressive mixed tumour, salivary gland type of the bone. Histopathology 2003; 43:408-10. [PMID: 14511267 DOI: 10.1046/j.1365-2559.2003.01694.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Immunohistochemistry is particularly important in the field of soft tissue tumours because of their variety and the frequent difficulty of diagnosis. The first part of this paper discusses useful or new antibodies, together with others that are no longer of use. The second part is devoted to the role of immunohistochemistry in the diagnosis of soft tissue tumours: identification of some rare or atypical benign lesions, identification of non-mesenchymal malignant tumours, and classification of sarcomas. The respective roles of immunohistochemistry and molecular biology are underlined.
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Affiliation(s)
- J M Coindre
- Department of Pathology, Institut Bergonié and University Victor Segalen Bordeaux 2, 229 Cours de l'Argonne, 33076 Bordeaux cedex, France.
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