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Alam MS, Subramanian N, Desai AS, Krishnakumar S. Mesenchymal chondrosarcoma of the orbit: A case report with 5 years of follow-up. Orbit 2017; 37:73-75. [PMID: 28812954 DOI: 10.1080/01676830.2017.1353116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Mesenchymal chondrosarcoma is a rare orbital tumor. Several case reports of this rare tumor have been published in the literature but only 6 cases have documented a follow up of 5 years or more. We report a case of 28 year-old female who presented with left orbital mass. Computed Tomography (CT) revealed a lobulated mass in the superior extraconal space with dense intralesional calcification. Patient underwent complete resection of the mass and histopathology was suggestive of mesenchymal chondrosarcoma. He was given adjuvant radiotherapy and there was no recurrence or metastasis at 5 years of follow-up. The case highlights that a complete resection with adjuvant radiotherapy in cases of orbital mesenchymal chondrosarcoma offers excellent prognosis.
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Affiliation(s)
- Md Shahid Alam
- a Orbit, Oculoplasty, Reconstructive & Aesthetic Services , Sankara Nethralaya, Medical Research Foundation , Chennai , India
| | - Nirmala Subramanian
- a Orbit, Oculoplasty, Reconstructive & Aesthetic Services , Sankara Nethralaya, Medical Research Foundation , Chennai , India
| | - Akruti Sunil Desai
- b Department of Orbit and Oculoplasty , Dr. Agarwals Eye Hospital , Chennai, India
| | - S Krishnakumar
- c Department of Ocular Pathology , Sankara Nethralaya, Medical Research Foundation , Chennai , India
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52
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Derenda M, Borof D, Kowalina I, Wesołowski W, Kloc W, Iżycka-Świeszewska E. Primary Spinal Intradural Mesenchymal Chondrosarcoma with Several Local Regrowths Treated with Osteoplastic Laminotomies: A Case Report. Surg J (N Y) 2017; 3:e117-e123. [PMID: 28825035 PMCID: PMC5553510 DOI: 10.1055/s-0037-1604159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 05/30/2017] [Indexed: 12/26/2022] Open
Abstract
Mesenchymal chondrosarcomas (MCSs) are rare malignant tumors of the bone and soft tissues. Only a few cases of such tumors originating from the spinal canal meninges have been described in the literature. The authors report on a case of a 22-year-old woman with MCS of the arachnoid at the T12-L1 level with a 14-year-long observation. The tumor was totally resected using osteoplastic laminotomy with reconstruction of laminar roof. This small spindle cell tumor was initially microscopically suspected of synovial sarcoma, but correctly verified with widened immunophenotyping and molecular studies as MCS. At its first recurrence, the neoplasm showed microscopically a typical bimorphic pattern of small round cell component with foci of hyaline cartilage. The patient experienced three local recurrences: 4, 6, and 10 years after the initial resection, respectively. The techniques of laminotomy and relaminotomy were also used during three following operations. The repeated surgical removal, radiotherapy, and chemotherapy were the methods of complex oncological treatment. The patient remains now in complete remission, fully self-dependent with slight motor disturbance, and mild sensory deficits. Current views on the clinicopathological characteristics and treatment modalities of the chondrosarcomas of the spinal canal are discussed.
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Affiliation(s)
- Marek Derenda
- Department of Neurosurgery, Regional Hospital, Elblag, Poland
| | - Damian Borof
- Department of Neurosurgery, Regional Hospital, Elblag, Poland
| | | | | | - Wojciech Kloc
- Departments of Neurology & Neurosurgery, University of Varmia & Masuria University, Olsztyn, Poland
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Kumar R, Duran C, Amini B, Araujo DM, Wang WL. Periosteal mesenchymal chondrosarcoma of the tibia with multifocal bone metastases: a case report. Skeletal Radiol 2017; 46:995-1000. [PMID: 28352960 DOI: 10.1007/s00256-017-2626-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/01/2017] [Accepted: 03/05/2017] [Indexed: 02/02/2023]
Abstract
Mesenchymal chondrosarcoma of bone is a rare high-grade variant of chondrosarcoma, which typically has central intramedullary location. The tumor is characterized by admixture of highly anaplastic small round malignant cells and islands of mineralized low-grade hyaline cartilage. It is most unusual for this tumor to arise on the surface of a long bone. We describe a patient with periosteal mesenchymal chondrosarcoma that arose at the surface of the right tibia with multifocal bone metastases. Radiographic, CT, MRI, and PET-CT features of this unusual tumor are presented.
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Affiliation(s)
- Rajendra Kumar
- Department of Diagnostic Imaging, The University of Texas M.D. Anderson Cancer Center, Unit 1475, 1515 Holcombe Blvd, Unit 1475, Houston, Texas, 77030, USA.
| | - Cihan Duran
- Department of Diagnostic Imaging, The University of Texas M.D. Anderson Cancer Center, Unit 1475, 1515 Holcombe Blvd, Unit 1475, Houston, Texas, 77030, USA
| | - Behrang Amini
- Department of Diagnostic Imaging, The University of Texas M.D. Anderson Cancer Center, Unit 1475, 1515 Holcombe Blvd, Unit 1475, Houston, Texas, 77030, USA
| | - Dejka M Araujo
- Department of Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Unit 1475, 1515 Holcombe Blvd, Unit 1475, Houston, Texas, 77030, USA
| | - Wei-Lien Wang
- Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Unit 1475, 1515 Holcombe Blvd, Unit 1475, Houston, Texas, 77030, USA
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54
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Jakhetiya A, Shukla NK, Muduly D, Kale SS. Extraskeletal orbital mesenchymal chondrosarcoma: surgical approach and mini review. BMJ Case Rep 2017; 2017:bcr-2016-218744. [PMID: 28258179 DOI: 10.1136/bcr-2016-218744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Extraskeletal orbital mesenchymal chondrosarcoma (MC) is an extremely rare and highly aggressive tumour. It has characteristic radiological features and pathognomic histological biphasic pattern. Radical resection with negative margins is the mainstay of treatment; role of adjuvant chemotherapy and radiotherapy is yet not well defined. We report a rare case of 18-year-old man who was diagnosed to have orbital MC. He presented with locally advanced disease with no vision in the affected eye. He underwent right orbital exenteration; a transcranial intradural approach was used to divide the optic nerve, and the temporalis muscle flap was utilised to fill the exenterated orbit. Though optic nerve involvement is rare in orbital MCs, a transcranial approach may be used effectively to avoid traction on optic chiasma and ensure margin-free resection in case of optic nerve involvement up to orbital apex. Unfortunately, prognosis remains dismal in MCs despite treatment.
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Affiliation(s)
- Ashish Jakhetiya
- Department of Surgical Oncology, All India Institute of Medical Sciences, NewDelhi, India
| | - Nootan Kumar Shukla
- Department of Surgical Oncology, All India Institute of Medical Sciences, NewDelhi, India
| | - Dillip Muduly
- Department of Surgical Oncology, All India Institute of Medical Sciences, NewDelhi, India
| | - Shashank S Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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55
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Schneiderman BA, Kliethermes SA, Nystrom LM. Survival in Mesenchymal Chondrosarcoma Varies Based on Age and Tumor Location: A Survival Analysis of the SEER Database. Clin Orthop Relat Res 2017; 475:799-805. [PMID: 26975384 PMCID: PMC5289165 DOI: 10.1007/s11999-016-4779-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Studies suggest that mesenchymal chondrosarcoma is associated with a poorer prognosis and a higher proportion of extraskeletal tumors than conventional chondrosarcoma. However, these investigations have been small heterogeneous cohorts, limiting analysis of prognostic factors. QUESTIONS/PURPOSES (1) What is the 5- and 10-year survival rate of patients diagnosed with mesenchymal chondrosarcoma? (2) What is the effect of demographic and tumor characteristics on survival in patients with mesenchymal chondrosarcoma? METHODS The Surveillance, Epidemiology, and End Results (SEER) database was used to identify all patients diagnosed with mesenchymal chondrosarcoma from 1973 to 2011. SEER reports survival data on over 8.2 million patients with cancer and has attained 98% completeness in reporting. Using variables within the database, this study designated each patient's tumor as skeletal or extraskeletal and cranial, axial, or appendicular, respectively. Overall survival (OS) was determined for the entire series as well as each group. Median survival was calculated using Kaplan-Meier methods. Cox proportional hazards regression was used to determine whether demographic and tumor variables affected survival. Two hundred five patients with mesenchymal chondrosarcoma were identified, including 82 (40%) skeletal and 123 (60%) extraskeletal. RESULTS OS for the entire series was 51% (95% confidence interval [CI], 43%-58%) and 43% (95% CI, 35%-51%) at 5 and 10 years, respectively. No difference in OS was detected between extraskeletal and skeletal tumors. Kaplan-Meier analyses showed OS was worse for tumors in axial locations compared with appendicular and cranial locations. Appendicular tumors demonstrated an OS of 50% (95% CI, 36%-63%) at 5 years and 39% (95% CI, 26%-52%) at 10 years. OS for axial tumors was 37% (95% CI, 25%-49%) and 31% (95% CI, 20%-43%), whereas it was 74% (95% CI, 59%-84%) and 67% (95% CI, 50%-79%) for cranial tumors at 5 and 10 years, respectively. When controlling for age, sex, tumor origin, and tumor location, the presence of metastasis (hazard ratio [HR], 12.38; 95% CI, 5.75-26.65; p < 0.001) and 1-cm size increase (HR, 1.16; 95% CI, 1.09-1.23; p < 0.001) were both independently associated with an increased risk of death. Tumor location showed different behaviors depending on patient age. In comparison to cranial tumors at age 20 years, the HR was 5.56 (95% CI, 1.47-21.05; p = 0.01) for axial tumors and 6.26 (95% CI, 1.54-25.42; p = 0.01) for appendicular tumors. At age 60 years, those ratios were 0.10 (95% CI, 0.02-0.55; p = 0.01) and 0.14 (95% CI, 0.04-0.58; p = 0.01), respectively. CONCLUSIONS Our data suggest that extraskeletal tumors are more common than previously reported; however, this factor does not have clear prognostic value. Presence of metastatic disease and increased tumor size are the main predictors of poor survival outcome. Cranial tumors appear to have a different clinical behavior with our data suggesting better overall survival in young patients (compared with axial and appendicular locations) and a worse survival outcome in older patients. LEVEL OF EVIDENCE Level IV, prognostic study.
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Affiliation(s)
- Brian A. Schneiderman
- Harbor-UCLA Medical Center, Los Angeles, CA USA ,Stritch School of Medicine, Loyola University Chicago, 2160 South First Avenue, Maywood, IL 60153 USA
| | - Stephanie A. Kliethermes
- Stritch School of Medicine, Loyola University Chicago, 2160 South First Avenue, Maywood, IL 60153 USA
| | - Lukas M. Nystrom
- Stritch School of Medicine, Loyola University Chicago, 2160 South First Avenue, Maywood, IL 60153 USA
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56
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Thompson LD. Small round blue cell tumors of the sinonasal tract: a differential diagnosis approach. Mod Pathol 2017; 30:S1-S26. [PMID: 28060373 DOI: 10.1038/modpathol.2016.119] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 05/08/2016] [Accepted: 05/15/2016] [Indexed: 01/02/2023]
Abstract
One of the most challenging diagnostic categories within tumors of the sinonasal tract is the small round blue cell tumors. Biopsies are usually small and limited, resulting in considerable diagnostic difficulty for practicing surgical pathologists. These tumors share several overlapping histologic and immunophenotypic findings while also showing considerable variation within and between cases. Specific tumor site of origin, imaging findings, and clinical findings must be combined with the histology and pertinent ancillary studies if the correct diagnosis is to be reached. Discrimination between neoplasms is critical as there are significant differences in therapy and overall outcome. It is important to have a well developed differential diagnosis for this category of tumors, where each of the diagnoses is considered, evaluated, and either confirmed or excluded from further consideration. In an undifferentiated tumor, showing a small round blue cell morphology, using the mnemonic 'MR SLEEP' helps to highlight tumors to consider: melanoma, mesenchymal chondrosarcoma, rhabdomyosarcoma, sinonasal undifferentiated carcinoma, squamous cell carcinoma (including NUT carcinoma), small cell osteosarcoma, lymphoma, esthesioneuroblastoma (olfactory neuroblastoma), Ewing sarcoma/primitive neuroectodermal tumor, pituitary adenoma, and plasmacytoma. A panel of pertinent immunohistochemistry studies, histochemistries and/or molecular tests should aid in reaching a diagnosis, especially when taking the pattern and intensity of reactions into consideration.
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Affiliation(s)
- Lester Dr Thompson
- Department of Pathology, Woodland Hills Medical Center, Southern California Permanente Medical Group, Woodland Hills, CA, USA
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57
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Mendenhall WM, Reith JD, Scarborough MT, Stechmiller BK, Mendenhall NP. Mesenchymal Chondrosarcoma. Int J Part Ther 2016; 3:300-304. [PMID: 31772981 DOI: 10.14338/ijpt-16-00019.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 10/12/2016] [Indexed: 11/21/2022] Open
Abstract
Purpose To review the treatment and outcomes of patients with mesenchymal chondrosarcomas (MC). Materials and Methods Review of the pertinent literature. Results MC is a rare aggressive small round blue cell malignancy that may arise in either bone or soft tissue. It usually presents in the 2nd or 3rd decade of life and exhibits an approximately equal gender predilection. Patients usually present with pain and swelling. The majority of MCs arise in either the trunk or extremities. Distant metastases are present at diagnosis in about 15% of patients. The most common sites for distant metastases are lung and bone. The optimal treatment is surgery. Although the role of adjuvant chemotherapy is unclear, an anthracycline-based chemotherapy regimen combined with ifosfamide or cisplatin, may be considered. Adjuvant radiation therapy (RT) is employed for patients with close (<5 mm) or positive margins as well as those with incompletely resectable tumors. The most common mechanism of recurrence is hematogenous dissemination. Although most recurrences are observed within 5 years of treatment, late recurrences are not unusual. The likelihood of successful salvage in the event of a recurrence is modest. The overall survival rates for all patients are approximately 50% at 5 years and 40% at 10 years. The overall survival rates for the subset of patients with localized disease that is resected are approximately 70% to 80% at 5 years and 60% at 10 years. Conclusion Patients with MCs are optimally treated with surgery. The role of adjuvant chemotherapy is uncertain. However, given the relatively high risk of recurrence, adjuvant chemotherapy should be considered in medically fit patients. Radiation therapy should be considered for those with incompletely resectable tumors and those with inadequate margins.
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Affiliation(s)
- William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA.,University of Florida Health Proton Therapy Institute, Jacksonville, FL, USA
| | - John D Reith
- Department of Pathology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Mark T Scarborough
- Department of Orthopaedic Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Bruce K Stechmiller
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Nancy P Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA.,University of Florida Health Proton Therapy Institute, Jacksonville, FL, USA
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58
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De Amorim Bernstein K, Liebsch N, Chen YL, Niemierko A, Schwab JH, Raskin K, Lozano-Calderon SA, Cote G, Harmon DC, Choy E, Haynes A, Mullen J, Hornicek FJ, DeLaney TF. Clinical outcomes for patients after surgery and radiation therapy for mesenchymal chondrosarcomas. J Surg Oncol 2016; 114:982-986. [PMID: 27790706 DOI: 10.1002/jso.24435] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 08/18/2016] [Indexed: 12/18/2022]
Abstract
INTRODUCTION We report the outcome of 23 patients with mesenchymal chondrosarcomas treated with surgery and radiation therapy +/- chemotherapy. The intent of the project was to review the impact of patient and treatment variables on treatment outcome, in particular with regard to extent of surgery and radiation dose. PATIENTS AND METHODS Twenty-three patients with mesenchymal chondrosarcomas were treated with surgery and radiation therapy (min. dose 44 Gy; max. dose 78 Gy; median dose 60 Gy; mean dose 61 Gy). RESULTS The median survival for the entire cohort of patients was 21.65 years (95% confidence interval ± 4.25). The 5- and 10-year OS was 78.6%. Median disease-free survival for the 23 patients was 7.2 years. Disease-free survival (DFS) at 3 and 5 years was 70.7% and 57.8%, respectively. The local control rate at 5 and 10 years was 89.5% (95%CI 64.1-97.3%). Only three patients experienced local failure, three patients had regional failure, and eight developed distant metastases. CONCLUSIONS In this cohort of patients local tumor control was high when using a combination of surgery and radiation. There was not a clear relationship between radiation dose and local tumor control. J. Surg. Oncol. 2016;114:982-986. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Karen De Amorim Bernstein
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Norbert Liebsch
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yen-Lin Chen
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrzej Niemierko
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joseph H Schwab
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kevin Raskin
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Santiago A Lozano-Calderon
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gregory Cote
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - David C Harmon
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Edwin Choy
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alex Haynes
- Department of General Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - John Mullen
- Department of General Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Francis J Hornicek
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Thomas F DeLaney
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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[Protocol for the study of bone tumours and standardization of pathology reports]. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2016; 50:34-44. [PMID: 29179963 DOI: 10.1016/j.patol.2016.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 08/08/2016] [Accepted: 08/12/2016] [Indexed: 01/21/2023]
Abstract
Primary bone neoplasms represent a rare and heterogeneous group of mesenchymal tumours. The prevalence of benign and malignant tumours varies; the latter (sarcomas) account for less than 0.2% of all malignant tumours. Primary bone neoplasms are usually diagnosed and classified according to the criteria established and published by the World Health Organization (WHO 2013). These criteria are a result of advances in molecular pathology, which complements the histopathological diagnosis. Bone tumours should be diagnosed and treated in referral centers by a multidisciplinary team including pathologists, radiologists, orthopedic surgeons and oncologists. We analyzed different national and international protocols in order to provide a guide of recommendations for the improvement of pathological evaluation and management of bone tumours. We include specific recommendations for the pre-analytical, analytical, and post-analytical phases, as well as protocols for gross and microscopic pathology.
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60
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Pancreatic involvement by mesenchymal chondrosarcoma harboring the HEY1-NCOA2 gene fusion. Hum Pathol 2016; 58:35-40. [PMID: 27544802 DOI: 10.1016/j.humpath.2016.07.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/26/2016] [Accepted: 07/29/2016] [Indexed: 10/21/2022]
Abstract
Mesenchymal chondrosarcoma (MC) is an aggressive small, round, blue cell tumor with chondrogenic differentiation that typically arises in bony sites. Approximately, a third of these tumors develop in extraskeletal sites such as the meninges, and somatic soft tissue. The MCs are well-circumscribed, lobulated masses, with focal calcification. Histologically, 2 distinct populations of neoplastic cells characterize MC: sheets of primitive small, round, blue cells surrounding islands of well-developed hyaline cartilage with mature chondrocytes in lacunae. Involvement of the gastrointestinal tract and pancreas by primary or metastatic MC is a relatively rare occurrence. We identified 8 patients with MC in our departmental archives from 1990 to 2015, two of which had pancreatic involvement. The patients were young women who developed masses in the distal pancreas. Molecular testing demonstrated that both tumors harbored the recently described HEY1-NCOA2 gene fusion. These cases illustrate that pancreatic involvement can occur in MC, and the demonstration of HEY1-NCOA2 fusion can be helpful to confirm the diagnosis.
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61
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Chen S, Wang Y, Su G, Chen B, Lin D. Primary intraspinal dumbbell-shaped mesenchymal chondrosarcoma with massive calcifications: a case report and review of the literature. World J Surg Oncol 2016; 14:203. [PMID: 27487949 PMCID: PMC4973031 DOI: 10.1186/s12957-016-0963-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 07/25/2016] [Indexed: 11/10/2022] Open
Abstract
Background Mesenchymal chondrosarcoma is a rare malignant tumor arising from bone or soft tissues. Instraspinal dumbbell-shaped mesenchymal chondrosarcoma is even rarer; however, it should not be neglected by clinicians. Case presentation A 26-year-old female was referred to our hospital with a 1.5-month history of sciatic pain and numbness in the left leg. Computed tomography and magnetic resonance imaging scans revealed an intraspinal dumbbell-shaped mass which had distinguishing features of neurogenic tumors, surprisingly, with massive calcifications, and no tumor metastasis was found. Then the patient underwent a total resection of the tumor, and during the operation, we found that the right nerve root of the fifth lumbar almost disappeared. The tumor was diagnosed as mesenchymal chondrosarcoma by histopathological examination after operation. Adjuvant therapies were not performed. However, recurrence of the tumor occurred 5 months later, and she underwent a total resection again combined with radiotherapy after second surgery. Conclusions To the best of our knowledge, this case study presents the first report in literature about primary instraspinal dumbbell-shaped mesenchymal chondrosarcoma with massive calcifications, which may provide some evidence for clinical practice. As the clinical symptoms and radiographic findings of mesenchymal chondrosarcoma are usually not specific, clinicians should consider it as a possible case and diagnose it through careful histopathological examination. Sometimes, calcification could be seen in tumors, which may influence or reflect the growth of tumor and disease prognosis. Although prognosis in mesenchymal chondrosarcoma varies from person to person, generally, complete resection, adjuvant therapy, and regular examinations are recommended to perform for patients with mesenchymal chondrosarcoma.
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Affiliation(s)
- Shudong Chen
- Guangdong Provincial Hospital of Chinese Medicine, No. 111 Dade Road, Yuexiu District, Guangzhou, 510120, China.,Guangzhou University of Chinese Medicine, Guangzhou, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Yufeng Wang
- Guangdong Provincial Hospital of Chinese Medicine, No. 111 Dade Road, Yuexiu District, Guangzhou, 510120, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Guoyi Su
- Guangdong Provincial Hospital of Chinese Medicine, No. 111 Dade Road, Yuexiu District, Guangzhou, 510120, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Bolai Chen
- Guangdong Provincial Hospital of Chinese Medicine, No. 111 Dade Road, Yuexiu District, Guangzhou, 510120, China.,Guangzhou University of Chinese Medicine, Guangzhou, China.,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Dingkun Lin
- Guangdong Provincial Hospital of Chinese Medicine, No. 111 Dade Road, Yuexiu District, Guangzhou, 510120, China. .,Guangzhou University of Chinese Medicine, Guangzhou, China. .,Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China.
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Abstract
Mesenchymal chondrosarcomas (MC) are rare and aggressive forms of chondrosarcoma. They are distinct tumors arising in unicentric or multicentric locations from both skeletal and extraskeletal tissues. The most affected region is the facial skeleton, especially the jaws. In this report, we present a case of MC primarily involving the mandible in a 60-year-old female patient.
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Affiliation(s)
- Sumit Majumdar
- Department of Oral Pathology, GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Rajyalakshmi Boddepalli
- Department of Oral Pathology, GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Divya Uppala
- Department of Oral Pathology, GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
| | - A Kameswara Rao
- Department of Oral Pathology, GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
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Abstract
Soft tissue lesions can contain bone or cartilage matrix as an incidental, often metaplastic, phenomenon or as a diagnostic feature. The latter category includes a diverse group ranging from self-limited proliferations to benign neoplasms to aggressive malignancies. Correlating imaging findings with pathology is mandatory to confirm that a tumor producing bone or cartilage, in fact, originates from soft tissue rather than from the skeleton. The distinction can have dramatic diagnostic and therapeutic implications. This content focuses on the gross, histologic, radiographic, and clinical features of bone or cartilage-producing soft tissue lesions. Recent discoveries regarding tumor-specific genetics are discussed.
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Affiliation(s)
- Soo-Jin Cho
- Pathology, UCSF Medical Center Mission Bay, 1825 4th Street, Room M2354, San Francisco, CA 94158, USA
| | - Andrew Horvai
- Pathology, UCSF Medical Center Mission Bay, 1825 4th Street, Room M2354, San Francisco, CA 94158, USA.
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Uppaluri SAS, Yin LH, Goh GH. Maxillary mesenchymal chondrosarcoma presenting with epistaxis in a child. J Radiol Case Rep 2015; 9:33-8. [PMID: 26629302 DOI: 10.3941/jrcr.v9i8.2419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Mesenchymal chondrosarcomas are a rare variant of primary chondrosarcomas and can pose a diagnostic dilemma, especially when the features on conventional imaging are equivocal for an aggressive lesion. There is very little PET-CT experience in mesenchymal chondrosarcomas as per the literature and to the best of our knowledge, we are the first to describe a maxillary mesenchymal chondrosarcoma on PET-CT imaging. We report a case where PET-CT not only complemented conventional imaging in suspecting a malignant osseous lesion, but also was indicative of the grade of the tumor.
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Affiliation(s)
| | - Loi Hoi Yin
- Department of Diagnostic Radiology, National University Hospital, Singapore
| | - Giap Hean Goh
- Department of Pathology, National University Hospital, Singapore
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65
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Guo J, Gu Y, Guo L, Tong Z, Wu X, Zhang J, Wang Z. A Case of Mesenchymal Chondrosarcoma Arising from the Femoral Vein with 8 Years of Follow-up. Ann Vasc Surg 2015; 29:1455.e1-5. [PMID: 26133997 DOI: 10.1016/j.avsg.2015.04.086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 03/25/2015] [Accepted: 04/30/2015] [Indexed: 11/26/2022]
Abstract
Mesenchymal chondrosarcoma (MCS) is an infrequent malignancy of bone and soft tissue that is characterized by a peculiar bimorphic histologic pattern with areas of undifferentiated malignant small cells surrounding well-differentiated cartilaginous islands. Involvement of the large vessels is a rare occurrence. Here, we report a case of MCS arising from the femoral vein that was treated by wide-margin resection combined with autogenous vein revascularization and then followed up for 8 years. The long-term postoperative results showed distant metastasis to the pancreas and both lobes of the lung, without recurrence at the primary site. This case indicates that for MCS arising from the femoral vein, although wide-margin resection combined with autogenous vein revascularization may avoid recurrence at the primary site, this treatment strategy has no obvious benefit for controlling long-term distant metastases.
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Affiliation(s)
- Jianming Guo
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Yongquan Gu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Institute of Vascular Surgery, Capital Medical University, Beijing, China.
| | - Lianrui Guo
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Zhu Tong
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Xin Wu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Jian Zhang
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Zhonggao Wang
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Institute of Vascular Surgery, Capital Medical University, Beijing, China
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Mesenchymal Chondrosarcoma in Children and Young Adults: A Single Institution Retrospective Review. Sarcoma 2015; 2015:608279. [PMID: 26146478 PMCID: PMC4469840 DOI: 10.1155/2015/608279] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 05/04/2015] [Accepted: 05/21/2015] [Indexed: 01/09/2023] Open
Abstract
Background. Mesenchymal chondrosarcoma is an aggressive, uncommon histologic entity arising in bone and soft tissues. We reviewed our institutional experience with this rare diagnosis. Methods. We conducted a retrospective chart review on patients with mesenchymal chondrosarcoma over a 24-year period. Clinicopathologic and radiographic features were reviewed. Results. Twelve patients were identified. Nine were females; median age was 14.5 years (1.2–19.7 years). The most common site was the head/neck (7/12). Disease was localized in 11/12 patients (one with lung nodules). Six with available tissue demonstrated NCOA2 rearrangement by FISH. Six underwent upfront surgical resection, and six received neoadjuvant therapy (2 chemotherapy alone and 4 chemotherapy and radiation). All patients received adjuvant chemotherapy (most commonly ifosfamide/doxorubicin) and/or radiation (median dose 59.4 Gy). At a median follow-up of 4.8 years, 5-year disease-free survival and overall survival were 68.2% (95% CI 39.8%, 96.6%) and 88.9% (95% CI 66.9%, 100%). Two patients had distant recurrences at 15 and 42 months, respectively. Conclusion. Aggressive surgical resection of mesenchymal chondrosarcoma with chemoradiotherapy yields excellent local control and may reduce likelihood of late recurrence. Characterization of downstream targets of the HEY1-NCOA2 fusion protein, xenograft models, and drug screening are needed to identify novel therapeutic strategies.
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67
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Rothberg MB, Bhalodi AA, Reda EF, Zelkovic P, Franco I. Primary renal mesenchymal chondrosarcoma: a case report. Urology 2015; 85:676-8. [PMID: 25733289 DOI: 10.1016/j.urology.2014.11.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 11/05/2014] [Accepted: 11/07/2014] [Indexed: 10/23/2022]
Abstract
A 16-year-old female patient presented to our emergency department with a left upper extremity radiculopathy prompting several imaging studies. Magnetic resonance imaging of the neck revealed multiple cervical vertebrae lesions and computed tomography imaging demonstrated a 15-cm calcified mass originating from the left kidney and extending into the surrounding structures. Pathologic assessment of the open left radical nephrectomy specimen revealed a primary renal mesenchymal chondrosarcoma, a tumor that has only been documented in 5 prior case reports in the literature.
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Affiliation(s)
- Michael B Rothberg
- Section of Pediatric Urology, Department of Urology, New York Medical College, Valhalla, NY
| | - Amul A Bhalodi
- Section of Pediatric Urology, Department of Urology, New York Medical College, Valhalla, NY
| | - Edward F Reda
- Section of Pediatric Urology, Department of Urology, New York Medical College, Valhalla, NY
| | - Paul Zelkovic
- Section of Pediatric Urology, Department of Urology, New York Medical College, Valhalla, NY
| | - Israel Franco
- Section of Pediatric Urology, Department of Urology, New York Medical College, Valhalla, NY.
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68
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Xu J, Li D, Xie L, Tang S, Guo W. Mesenchymal chondrosarcoma of bone and soft tissue: a systematic review of 107 patients in the past 20 years. PLoS One 2015; 10:e0122216. [PMID: 25849226 PMCID: PMC4388572 DOI: 10.1371/journal.pone.0122216] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 02/19/2015] [Indexed: 12/27/2022] Open
Abstract
Background Mesenchymal chondrosarcoma(MCS) is a rare high-grade variant of chondrosarcoma. Consensus has not been reached on its optimal management. Resection with wide margins is usually recommended, but the effect of margins has been demonstrated by little positive evidence. Moreover, the effectiveness of adjuvant chemo- and/or radiotherapy remains controversial. Objectives To describe the clinical characteristics and outcomes of MCS of bone and soft tissue, to assess the efficacies of surgery, chemotherapy and radiation, and finally to deliver a more appropriate therapy. Materials and Methods We reviewed EMBASE-, MEDLINE-, Cochrane-, Ovid- and PubMed-based to find out all cases of MCS of bone and soft tissue described between April 1994 and April 2014. Description of treatment and regular follow-up was required for each study. Language was restricted to English and Chinese. Issues of age, gender, location, metastasis, and treatment were all evaluated for each case. Kaplan-Meier Method and Cox Proportional Hazard Regression Model were used in the survival analysis. Results From the 630 identified publications, 18 meeting the inclusion criteria were selected, involving a total of 107 patients. Based on these data, the 5-, 10-and 20-year overall survival are 55.0%, 43.5% and 15.7% respectively. The 5-, 10-, 20- year event-free survival rates are 45.0%, 27.2% and 8.1%, respectively. Treatment without surgery is associated with poorer overall survival and event-free survival. Negative surgical margins could significantly bring down the local-recurrence rate and are associated with a higher event-free survival rate. Chemotherapy regime based on anthracyclines does not benefit the overall survival. The addition of radiation therapy is not significantly associated with the overall or event-free survival. However, we recommend radiation as the salvage therapy for patients with positive margin so as to achieve better local control. Conclusions This review shows that surgery is essential in the management of MCS of bone and soft tissue. Appropriate adjuvant therapy may reduce local recurrence, but cannot benefit the overall survival.
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Affiliation(s)
- Jie Xu
- Musculoskeletal Tumour Centre, People’s Hospital, Peking University, Beijing, China
| | - Dasen Li
- Musculoskeletal Tumour Centre, People’s Hospital, Peking University, Beijing, China
| | - Lu Xie
- Musculoskeletal Tumour Centre, People’s Hospital, Peking University, Beijing, China
| | - Shun Tang
- Musculoskeletal Tumour Centre, People’s Hospital, Peking University, Beijing, China
| | - Wei Guo
- Musculoskeletal Tumour Centre, People’s Hospital, Peking University, Beijing, China
- * E-mail:
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Tinoco G, Wilky BA, Paz-Mejia A, Rosenberg A, Trent JC. The biology and management of cartilaginous tumors: a role for targeting isocitrate dehydrogenase. Am Soc Clin Oncol Educ Book 2015:e648-e655. [PMID: 25993236 DOI: 10.14694/edbook_am.2015.35.e648] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Chondrosarcomas are rare mesenchymal neoplasms defined by the production of abnormal cartilaginous matrix. Conventional chondrosarcoma is the most common histology. The management of primary conventional chondrosarcoma generally is surgical with the possible addition of radiation therapy. Treatment of conventional chondrosarcoma is problematic in unresectable or metastatic disease because the tumors tend to be resistant to standard sarcoma chemotherapy regimens. Previous attempts at targeted therapy, including inhibitors of Hedgehog signaling, the mTOR pathway, and platelet-derived growth factor receptor (PDGFR) have been largely disappointing. However, heterozygous mutations in isocitrate dehydrogenase (IDH) enzymes recently have been identified in chondrogenic neoplasms, with mutations reported in approximately 87% of benign enchondromas, 70% of conventional chondrosarcomas, and 54% of dedifferentiated chondrosarcomas. The normal IDH protein continues to produce alpha-ketoglutarate (alpha-KG) whereas the mutant IDH protein converts KG to the oncometabolite 2-hydroxyglutarate (2-HG). Clinical trials of novel IDH inhibitors are ongoing, with evidence of early activity in IDH-mutant leukemias. IDH inhibitors show antitumor effects against IDH-mutant chondrosarcoma cell lines, supporting the inclusion of patients with chondrosarcoma with IDH mutations on IDH inhibitor clinical trials for solid tumors. Targeting IDH mutations may offer hope of a novel antineoplastic strategy not only for patients with chondrosarcomas, but also for other solid tumors with aberrant IDH activity.
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Affiliation(s)
- Gabriel Tinoco
- From the Sylvester Comprehensive Cancer Center, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, Department of Pathology, University of Miami Miller School of Medicine, Miami, FL
| | - Breelyn A Wilky
- From the Sylvester Comprehensive Cancer Center, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, Department of Pathology, University of Miami Miller School of Medicine, Miami, FL
| | - Ana Paz-Mejia
- From the Sylvester Comprehensive Cancer Center, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, Department of Pathology, University of Miami Miller School of Medicine, Miami, FL
| | - Andrew Rosenberg
- From the Sylvester Comprehensive Cancer Center, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, Department of Pathology, University of Miami Miller School of Medicine, Miami, FL
| | - Jonathan C Trent
- From the Sylvester Comprehensive Cancer Center, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, Department of Pathology, University of Miami Miller School of Medicine, Miami, FL
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Frezza AM, Cesari M, Baumhoer D, Biau D, Bielack S, Campanacci DA, Casanova J, Esler C, Ferrari S, Funovics PT, Gerrand C, Grimer R, Gronchi A, Haffner N, Hecker-Nolting S, Höller S, Jeys L, Jutte P, Leithner A, San-Julian M, Thorkildsen J, Vincenzi B, Windhager R, Whelan J. Mesenchymal chondrosarcoma: prognostic factors and outcome in 113 patients. A European Musculoskeletal Oncology Society study. Eur J Cancer 2014; 51:374-81. [PMID: 25529371 DOI: 10.1016/j.ejca.2014.11.007] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/03/2014] [Accepted: 11/11/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mesenchymal chondrosarcoma (MCS) is a distinct, very rare sarcoma with little evidence supporting treatment recommendations. PATIENTS AND METHODS Specialist centres collaborated to report prognostic factors and outcome for 113 patients. RESULTS Median age was 30 years (range: 11-80), male/female ratio 1.1. Primary sites were extremities (40%), trunk (47%) and head and neck (13%), 41 arising primarily in soft tissue. Seventeen patients had metastases at diagnosis. Mean follow-up was 14.9 years (range: 1-34), median overall survival (OS) 17 years (95% confidence interval (CI): 10.3-28.6). Ninety-five of 96 patients with localised disease underwent surgery, 54 additionally received combination chemotherapy. Sixty-five of 95 patients are alive and 45 progression-free (5 local recurrence, 34 distant metastases, 11 combined). Median progression-free survival (PFS) and OS were 7 (95% CI: 3.03-10.96) and 20 (95% CI: 12.63-27.36) years respectively. Chemotherapy administration in patients with localised disease was associated with reduced risk of recurrence (P=0.046; hazard ratio (HR)=0.482 95% CI: 0.213-0.996) and death (P=0.004; HR=0.445 95% CI: 0.256-0.774). Clear resection margins predicted less frequent local recurrence (2% versus 27%; P=0.002). Primary site and origin did not influence survival. The absence of metastases at diagnosis was associated with a significantly better outcome (P<0.0001). Data on radiotherapy indications, dose and fractionation were insufficiently complete, to allow comment of its impact on outcomes. Median OS for patients with metastases at presentation was 3 years (95% CI: 0-4.25). CONCLUSIONS Prognosis in MCS varies considerably. Metastatic disease at diagnosis has the strongest impact on survival. Complete resection and adjuvant chemotherapy should be considered as standard of care for localised disease.
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Affiliation(s)
- Anna Maria Frezza
- The London Sarcoma Service, University College of London Hospital, London, United Kingdom; University Campus Bio-Medico, Rome, Italy
| | | | - Daniel Baumhoer
- Bone Tumor Reference Centre at the Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | | | - Stephen Bielack
- The Cooperative German-Austrian-Swiss Osteosarcoma Study Group (COSS Group), Germany
| | | | - José Casanova
- Coimbra University Medical Center, Coimbra, Portugal
| | - Claire Esler
- Leicester Royal Infirmary, Leicester, United Kingdom
| | | | - Philipp T Funovics
- Universitätsklinik für Orthopädie der Medizinischen, Universität Wien, Wien, Austria
| | | | - Robert Grimer
- The Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | | | | | | | - Sylvia Höller
- Bone Tumor Reference Centre at the Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Lee Jeys
- The Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - Paul Jutte
- University Medical Center Groningen, Groningen, The Netherlands
| | | | | | | | | | - Reinhard Windhager
- Universitätsklinik für Orthopädie der Medizinischen, Universität Wien, Wien, Austria
| | - Jeremy Whelan
- The London Sarcoma Service, University College of London Hospital, London, United Kingdom.
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Gherman V, Tomuleasa C, Bungardean C, Crisan N, Ona VD, Feciche B, Irimie A, Coman I. Management of renal extraskeletal mesenchymal chondrosarcoma. BMC Surg 2014; 14:107. [PMID: 25511186 PMCID: PMC4289544 DOI: 10.1186/1471-2482-14-107] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 11/27/2014] [Indexed: 11/11/2022] Open
Abstract
Background Primary mesenchymal chondrosarcoma of the kidney is an extremely rare malignant tumor. To our best knowledge, only 9 such cases have been reported so far. Case presentation In the current paper, we present the case of a 67 year-old patient with recurrent left lumbar pain, increased fatigability and intermittent macroscopic hematuria. He underwent a surgical resection of the left kidney and left hemicolon. The pathological diagnosis was primary extraskeletal renal mesenchymal chondrosarcoma. Overall survival was 9 months, with pulmonary metastasis and local recurrence at 6 months. The management of the patient is described, from the initial differential diagnosis, after the first clinical examination to the surgical resection, with a special emphasis on the surgical procedures that were carried out. Conclusion Extraskeletal chondrosarcoma of primary origin in the kidney are extremely rare tumors with a highly malignant potential and very poor prognosis. Because the role of chemotherapy or radiation therapy has not been evaluated properly yet, we underline the importance of surgery in the management of such cases as the main and best approach to achieve clinical remission and long-term survival, provided the patient is referred to a surgical consult in time.
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Affiliation(s)
| | - Ciprian Tomuleasa
- Research Center for Functional Genomics and Translational Medicine at the Iuliu Hatieganu, University of Medicine and Pharmacy, Cluj Napoca, Romania.
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Suzuki Y, Todo Y, Okamoto K, Kato H, Yamashiro K, Hasegawa T. Mesenchymal chondrosarcoma of the uterus. Pathol Int 2014; 64:45-7. [PMID: 24471970 DOI: 10.1111/pin.12130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yoshihiro Suzuki
- Department of Obstetrics and Gynecology, Abashiri Kosei hospital, Abashiri, Japan
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Yu L, Li M, Lin R, Mu Y, Zhao J. Mesenchymal chondrosarcoma of the right buccal region: A case report and review of the literature. Oncol Lett 2014; 8:2557-2560. [PMID: 25364427 PMCID: PMC4214473 DOI: 10.3892/ol.2014.2595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 08/22/2014] [Indexed: 11/23/2022] Open
Abstract
Extraskeletal mesenchymal chondrosarcoma (EMCS) is a rare malignant cartilaginous tumor arising from the soft tissues. The most common areas of extraskeletal origin are the lower extremities, the orbits and the central nervous system, among others. In this study, the case of primary EMCS arising from the right buccal region in a 26-year old female is presented. Histological and immunohistochemical analysis confirmed the diagnosis of EMCS. Subseqently, the patient was treated with radical surgery, but declined chemotherapy or radiotherapy, which was recommended. One year after surgery, no recurrence had been identified in the patient. To the best of our knowledge, only one case of primary EMCS of the buccal region has been reported previously. In the current study, a case of primary EMCS of the buccal region is presented.
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Affiliation(s)
- Lijiang Yu
- Department of Oral and Maxillofacial Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Mingliang Li
- Department of Oral and Maxillofacial Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Runtai Lin
- Department of Oral and Maxillofacial Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Yue Mu
- Department of Oral and Maxillofacial Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Jizhi Zhao
- Department of Oral and Maxillofacial Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
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Andersson C, Osterlundh G, Enlund F, Kindblom LG, Hansson M. Primary spinal intradural mesenchymal chondrosarcoma with detection of fusion gene HEY1-NCOA2: A paediatric case report and review of the literature. Oncol Lett 2014; 8:1608-1612. [PMID: 25202377 PMCID: PMC4156271 DOI: 10.3892/ol.2014.2364] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 05/07/2014] [Indexed: 11/09/2022] Open
Abstract
Mesenchymal chondrosarcoma is an extremely rare malignant tumour that most commonly originates in the bone, but is also present in extraskeletal sites. The tumour is morphologically characterized by a biphasic pattern of small round cells and islands of cartilage. Spinal mesenchymal chondrosarcomas are even rarer and, therefore, few investigations exist regarding the biological behaviour of the tumours. In the present study, we report a case of a 10-year-old female presenting with 9 months of back pain and radiographic findings of an intradural lesion measuring 1.5 cm at the level of Th4. The tumour was completely excised and subjected to pathological analyses. Following detection of the HEY1-NCOA2 fusion gene, the tumour was morphologically and immunohistochemically defined as an intradural mesenchymal chondrosarcoma attached to the dura mater. In this study, we validate the recent identification of the fusion gene HEY1-NCOA2 in paediatric extraskeletal mesenchymal chondrosarcomas. The relevant literature is reviewed and further discussed in relation to our findings.
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Affiliation(s)
- Carola Andersson
- Department of Clinical Pathology and Cytology, Sahlgrenska University Hospital, Gothenburg SE-413 45, Sweden
| | - Gustaf Osterlundh
- Department of Pediatrics, The Queen Silvia Children's Hospital, University of Gothenburg, Gothenburg SE-416 85, Sweden
| | - Fredrik Enlund
- Department of Clinical Pathology and Cytology, Sahlgrenska University Hospital, Gothenburg SE-413 45, Sweden
| | - Lars-Gunnar Kindblom
- Department of Musculoskeletal Pathology, Royal Orthopedic Hospital, NHS Foundation Trust, Birmingham B31 2AP, UK
| | - Magnus Hansson
- Department of Clinical Pathology and Cytology, Sahlgrenska University Hospital, Gothenburg SE-413 45, Sweden ; Department of Medical Biosciences, Section for Pathology, Umeå University, SE-901 85 Umeå, Sweden
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Kumar M, Suresh K, Patil M, Pramod R, Yusuf R, Bilahari N. Mesenchymal chondrosarcoma of posterior maxilla: report of a case with brief literature review. Ann Med Health Sci Res 2014; 4:S49-52. [PMID: 25031908 PMCID: PMC4083719 DOI: 10.4103/2141-9248.131717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Mesenchymal chondrosarcomas (MCs) are infrequent, slow-growing malignant tumors of head and neck region affecting both bone and soft tissues. It represents approximately 1% of all chondrosarcomas. They usually occur in the middle aged individuals, but rarely seen in young patients. It is commonly found in the ribs and jaws. Involvement of the jaws is evident in 22-27% of cases of MC. Most commonly, MCs are painless and occurs in the anterior portion of maxilla. Maxillofacial MCs are aggressive, has a tendency for recurrence and late metastasis to lung, bone, and lymph nodes, and is associated with an overall poor prognosis. Histopathologically, it is characterized by a biphasic pattern consisting of areas of hyaline cartilage mixed with small cell malignancy. Very few case reports involving the posterior maxillary region has been reported. This article reports a rare case of MC along with a review of the pertinent literature.
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Affiliation(s)
- McD Kumar
- Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Krishna Institute of Medical Sciences, Deemed University, Karad, Satara, Maharashtra, India
| | - Kv Suresh
- Department of Oral Medicine and Radiology, School of Dental Sciences, Krishna Institute of Medical Sciences, Deemed University, Karad, Satara, Maharashtra, India
| | - Mr Patil
- Department of Pediatrics, RCSM Government Medical College, Kolhapur, Maharashtra, India
| | - Rc Pramod
- Department of Oral Pathology and Microbiology, School of Dental Sciences, Krishna Institute of Medical Sciences, Deemed University, Karad, Satara, Maharashtra, India
| | - Raa Yusuf
- Department of Orthodontics and Dentifacial Orthopaedics, School of Dental Sciences, Krishna Institute of Medical Sciences, Deemed University, Karad, Satara, Maharashtra, India
| | - N Bilahari
- Department of Oral Medicine and Radiology, PSM College of Dental Science and Research, Thrisshur, Kerala, India
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Chebib I, Hornicek FJ, Bredella MA, Deshpande V, Nielsen GP. Histologic variants of chondrosarcoma. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.mpdhp.2014.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Abstract
Mesenchymal chondrosarcoma of the kidney is a very rare entity with no definite treatment protocol. Herein, we describe one such case with discussion of its diagnosis and management. The patient had a well circumscribed mass in right kidney extending into the inferior vena cava and metastasis to both the lungs. Right nephrectomy was performed and the histopathological examination confirmed the diagnosis to be renal mesenchymal chondrosarcoma. After surgical removal of the tumor, the patient was given chemotherapy with Cisplatin and Epirubicin, following which there was significant regression of lung nodules.
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Affiliation(s)
- Ruchita Tyagi
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nandita Kakkar
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kumar Vasishta
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mayank Mohan Aggarwal
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Hu HJ, Liao MY, Xu LY. Primary retroperitoneal extraskeletal mesenchymal chondrosarcoma involving the vena cava: A case report. Oncol Lett 2014; 7:1970-1974. [PMID: 24932271 PMCID: PMC4049765 DOI: 10.3892/ol.2014.2012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 03/04/2014] [Indexed: 11/23/2022] Open
Abstract
The current study presents a case of extraskeletal mesenchymal chondrosarcoma (ESMC) involving the vena cava that originally occurred in the retroperitoneum of a 61-year-old female. Following excision of the masses, pathological examination confirmed a diagnosis of primary ESMC. Mesenchymal chondrosarcomas are extremely rare in comparison to conventional chondrosarcomas and even more so when arising in an extraskeletal location. In the current report, the major characteristics of ESMC are discussed and a review of the current knowledge regarding this rare disease entity is presented.
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Affiliation(s)
- Hui-Juan Hu
- Department of Computed Tomography, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Mei-Yan Liao
- Department of Computed Tomography, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Li-Ying Xu
- Department of Computed Tomography, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
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Kawaguchi S, Weiss I, Lin PP, Huh WW, Lewis VO. Radiation therapy is associated with fewer recurrences in mesenchymal chondrosarcoma. Clin Orthop Relat Res 2014; 472:856-64. [PMID: 23709273 PMCID: PMC3916617 DOI: 10.1007/s11999-013-3064-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Mesenchymal chondrosarcoma (MSC) is a rare variant of chondrosarcoma. Because of the rarity of the disease, most studies only contain a small number of patients and thus the prognostic variables and role of adjuvant therapies remain controversial. QUESTIONS/PURPOSES We therefore asked (1) what the overall and disease-free survival were for patients with this diagnosis at 5 and 10 years; (2) whether there were significant prognostic factors associated with survival; and (3) whether use of adjuvant chemotherapy or radiotherapy was associated with survival in patients with MSC. METHODS We retrospectively reviewed the cases of MSC diagnosed from 1979 to 2010 at one referral center. Forty-three cases were identified. Thirty-seven cases were analyzed for demographics, treatments, and outcomes. Thirty patients with localized disease were analyzed for prognostic factors. The minimum followup was 1 month (mean, 6 years; range, 1 month to 17 years). There were 17 females and 20 males. The mean age at diagnosis was 33 years (range, 11-65 years). Nineteen cases were skeletal and 18 cases were extraskeletal. Seventy-six percent of the tumors were located in the trunk. RESULTS Five- and 10-year overall survival was 51% and 37%, respectively. Five- and 10-year disease-free survival was 23% and 5%, respectively. Age (< 30 years) and male sex were associated with poorer overall and disease-free survival in patients presenting with a localized tumor, respectively. Patients who did not receive radiotherapy were more likely to have a local recurrence. Adjuvant chemotherapy failed to show a significant association with overall, disease-free, metastasis-free, or local recurrence-free survival. CONCLUSIONS The present study reinforced the role of adjuvant radiotherapy for local tumor control. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Satoshi Kawaguchi
- />Department of Orthopaedic Oncology, The University of Texas MD Anderson Cancer, 1515 Holcombe Boulevard, Houston, TX 77030 USA
| | | | - Patrick P. Lin
- />Department of Orthopaedic Oncology, The University of Texas MD Anderson Cancer, 1515 Holcombe Boulevard, Houston, TX 77030 USA
| | - Winston W. Huh
- />Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Valerae O. Lewis
- />Department of Orthopaedic Oncology, The University of Texas MD Anderson Cancer, 1515 Holcombe Boulevard, Houston, TX 77030 USA
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80
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Chemotherapy improved prognosis of mesenchymal chondrosarcoma with rare metastasis to the pancreas. Case Rep Oncol Med 2014; 2014:249757. [PMID: 24716041 PMCID: PMC3970347 DOI: 10.1155/2014/249757] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 12/17/2013] [Indexed: 11/18/2022] Open
Abstract
Extraskeletal mesenchymal chondrosarcoma is rare and metastasis to the pancreas is extremely rare, with only four cases reported in the literature. The therapeutic effectiveness of chemotherapy remains uncertain. We report a 39-year-old man with extraskeletal mesenchymal chondrosarcoma of the buttock, who had metastases to the pancreas, bones, and lung. He underwent distal pancreatectomy, resection of the buttock tumor, and chemotherapy. He had a good response to chemotherapy and survived for about 3 years after surgery.
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81
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Abstract
Classification of small round cell tumors of bone is often challenging due to overlapping clinicopathologic features. The purpose of this article is to review the clinical, radiological, histologic, and molecular features of Ewing sarcoma and to provide a discussion of the differential diagnosis of small round cell tumors of bone.
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Affiliation(s)
- Eun-Young K Choi
- Department of Pathology, University of Michigan, 3261G Medical Science I, 1301 Catherine St, SPC 5602, Ann Arbor, Michigan 48109
| | - Jerad M Gardner
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - David R Lucas
- Department of Pathology, University of Michigan, 3261G Medical Science I, 1301 Catherine St, SPC 5602, Ann Arbor, Michigan 48109
| | - Jonathan B McHugh
- Department of Pathology, University of Michigan, 3261G Medical Science I, 1301 Catherine St, SPC 5602, Ann Arbor, Michigan 48109
| | - Rajiv M Patel
- Department of Pathology, University of Michigan, 3261G Medical Science I, 1301 Catherine St, SPC 5602, Ann Arbor, Michigan 48109.
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82
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Dumbbell mesenchymal chondrosarcoma: report of a rare case. J Orthop Sci 2014; 19:190-3. [PMID: 22828915 DOI: 10.1007/s00776-012-0268-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 06/29/2012] [Indexed: 11/27/2022]
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83
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Hanakita S, Kawai K, Shibahara J, Kawahara N, Saito N. Mesenchymal chondrosarcoma of the orbit--case report. Neurol Med Chir (Tokyo) 2013; 52:747-50. [PMID: 23095269 DOI: 10.2176/nmc.52.747] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 20-year-old woman presented with a rare case of intraorbital mesenchymal chondrosarcoma manifesting as a 6-month history of progressive ptosis and exophthalmos of her left eye. Computed tomography and magnetic resonance imaging revealed a partially calcified round mass occupying the postbulbar space. Partial removal of the tumor via a left fronto-orbital approach was performed. The histological diagnosis was mesenchymal chondrosarcoma, and additional intraorbital exenteration was performed. Neither chemotherapy nor radiotherapy was performed. She was free from tumor recurrence at the 6-year follow-up examination. Radical resection, including exenteration if possible, is recommended for intraorbital mesenchymal chondrosarcoma.
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Affiliation(s)
- Shunya Hanakita
- Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan.
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84
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Nugent D, Cheong D, Monforte H, Ayala AG, Letson GD, Keen J. Periosteal Mesenchymal Chondrosarcoma in the Distal Part of the Tibia of a Four-Year-Old Boy: A Case Report. JBJS Case Connect 2013; 3:e117. [PMID: 29252517 DOI: 10.2106/jbjs.cc.m.00044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Dylan Nugent
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine-Jacksonville, 655 West 8th Street, Jacksonville, FL 32209.
| | - David Cheong
- Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612-9416
| | - Hector Monforte
- Anatomic Pathology, All Children's Hospital-Johns Hopkins Medicine, 801 6th Avenue South, St. Petersburg, FL 33701
| | - Alberto G Ayala
- Department of Pathology, The Methodist Hospital, 6565 Fannin Street, Houston, TX 77030
| | - G Douglas Letson
- Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612-9416
| | - Jeffrey Keen
- Flagler Orthopaedics and Sports Medicine, 61 Memorial Medical Parkway, Suite 2801, Palm Coast, FL 32164
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85
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Nakayama R, Miura Y, Ogino J, Susa M, Watanabe I, Horiuchi K, Anazawa U, Toyama Y, Morioka H, Mukai M, Hasegawa T. Detection of HEY1-NCOA2 fusion by fluorescence in-situ hybridization in formalin-fixed paraffin-embedded tissues as a possible diagnostic tool for mesenchymal chondrosarcoma. Pathol Int 2013; 62:823-6. [PMID: 23252872 DOI: 10.1111/pin.12022] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 11/23/2012] [Indexed: 11/28/2022]
Abstract
Mesenchymal chondrosarcoma (MC) is an extremely rare subtype of chondrosarcoma. A tumor specific fusion gene, HEY1-NCOA2 fusion, was recently identified in this tumor. The finding raises the possibility that the diagnosis of MC can be improved by examining the fusion gene. In the present study, we aimed to evaluate the efficacy of fluorescence in situ hybridization (FISH) in detecting HEY1-NCOA2 fusion for the diagnosis of MC. Specimens from 10 patients diagnosed with MC were used for the study. Dual-color FISH was performed using two different probes that specifically hybridize to HEY1 and NCOA2, respectively. Fusion signals were identified in all but two specimens, in which no signal was detected, presumably because of inadequate sample preparation. In accordance with results of a previous study, FISH analysis was highly sensitive in detecting HEY1-NCOA2 fusion in adequately prepared MC samples. The current study adds further support for the use of HEY1-NCOA2 fusion as a valid diagnostic marker for MC.
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Affiliation(s)
- Robert Nakayama
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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86
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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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87
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Cho YA, Yoon HJ, Hong SD, Lee JI, Hong SP. A giant radiopaque mass in the masticatory space. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:566-70. [DOI: 10.1016/j.oooo.2012.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 12/14/2011] [Accepted: 01/02/2012] [Indexed: 12/01/2022]
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88
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A rare case of extraskeletal mesenchymal chondrosarcoma with dedifferentiation arising from the buccal space in a young male. J Maxillofac Oral Surg 2013; 14:293-9. [PMID: 25838713 DOI: 10.1007/s12663-013-0500-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 03/13/2013] [Indexed: 12/23/2022] Open
Abstract
Extraskeletal mesenchymal chondrosarcoma (EMCS) is a rare and aggressive pathological variant of chondrosarcoma arising from soft tissues of mainly the extremities, meninges/dura, trunk, and orbits. EMCS comprises only 2 % of all soft tissue sarcomas and only 6 % of them arise from soft tissue in the head and neck region. It usually affects in the second and third decade of life and is common in women. It runs a very rapid clinical course with distant metastases and has poor prognosis and survival rates. Histologically it has a dimorphic presentation of small round mesenchymal cells interspersed with foci of cartilaginous differentiation. Radiographically it appears as a soft tissue lobulated mass with various patterns of calcification. This is the first case of primary and recurrent EMCS originating in the buccal space with unusual features of dedifferentiation. The diagnostic challenges in this case were the inconclusive FNAC results, lack of radiographic evidence of characteristic calcifications and presence of areas of myxoid material and dedifferentiation on histopathology. The clinical, cytological, histological, immunohistochemical, radiographic, PET-CT findings and management with review of literature is presented. The diagnostic and management pitfalls of this extremely rare tumor are also discussed.
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89
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Abstract
Mesenchymal chondrosarcoma (MSC) is a very rare sarcoma that is highly malignant with frequent local recurrences and distant metastases leading to a very poor long-term outcome. It differs from classical chondrosarcomas in that it occurs more often in children and commonly in extraskeletal locations. Hardly any evidence-based recommendations for treatment exist. We present the case of a 9-year old boy (pre- and intraoperative findings and histopathological details) who was initially admitted with the diagnosis of a jugular paraganglioma and discuss this case in the light of the recent literature.
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90
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91
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Mei B, Lai YL, He GJ, Shou YN, Liu J. Giant primary mesenchymal chondrosarcoma of the lung: case report and review of literature. Ann Thorac Cardiovasc Surg 2012. [PMID: 23196662 DOI: 10.5761/atcs.cr.12.02000] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Mesenchymal chondrosarcoma, a rare malignant tumor, was predominantly occurring in the bone and may involve somatic soft tissue but it is extremely rare in the lung.We report the case of a 20-year-old female who presented with a 2-month history of irritant nonproductive cough and chest pain. The histopathologic examination revealed the tumor composed of atypical undifferentiated small cells and islands of matured chondroid matrix typically presented as bimorphic appearances. Immunohistochemical examination revealed that the tumor cells were positive for vimentin and CD99 for all components, and to S-100 limited to the areas of cartilage. In addition, previously reported cases of primary lung mesenchymal chondrosarcoma were reviewed, and the relevant clinical knowledge regarding its clinical manifestations, diagnosis, and treatment were discussed.
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Affiliation(s)
- Bo Mei
- Department of Cardiothoracic Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
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92
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Nyquist KB, Panagopoulos I, Thorsen J, Haugom L, Gorunova L, Bjerkehagen B, Fosså A, Guriby M, Nome T, Lothe RA, Skotheim RI, Heim S, Micci F. Whole-transcriptome sequencing identifies novel IRF2BP2-CDX1 fusion gene brought about by translocation t(1;5)(q42;q32) in mesenchymal chondrosarcoma. PLoS One 2012. [PMID: 23185413 PMCID: PMC3504151 DOI: 10.1371/journal.pone.0049705] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Mesenchymal chondrosarcomas (MCs) account for 3–10% of primary chondrosarcomas. The cytogenetic literature includes only ten such tumours with karyotypic information and no specific aberrations have been identified. Using a purely molecular genetic approach a HEY1-NCOA2 fusion gene was recently detected in 10 of 15 investigated MCs. The fusion probably arises through intrachromosomal rearrangement of chromosome arm 8 q. We report a new case of MC showing a t(1;5)(q42;q32) as the sole karyotypic aberration. Through FISH and whole transcriptome sequencing analysis we found a novel fusion between the IRF2BP2 gene and the transcription factor CDX1 gene arising from the translocation. The IRF2BP2-CDX1 has not formerly been described in human neoplasia. In our hospital’s archives three more cases of MC were found, and we examined them looking for the supposedly more common HEY1-NCOA2 fusion, finding it in all three tumours but not in the case showing t(1;5) and IRF2BP2-CDX1 gene fusion. This demonstrates that genetic heterogeneity exists in mesenchymal chondrosarcoma.
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Affiliation(s)
- Kaja B Nyquist
- Section for Cancer Cytogenetics, Institute for Medical Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.
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93
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Seo CY, Jung ST, Byun JW. Extraskeletal mesenchymal chondrosarcoma in the axillary region: reports of two cases. KOREAN JOURNAL OF PATHOLOGY 2012; 46:483-8. [PMID: 23136576 PMCID: PMC3490122 DOI: 10.4132/koreanjpathol.2012.46.5.483] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Revised: 12/01/2011] [Accepted: 12/02/2011] [Indexed: 11/24/2022]
Abstract
Extraskeletal mesenchymal chondrosarcomas (EMCs) are relatively uncommon, and a location in the upper extremity, especially in the shoulder or axillary region, is rare. Furthermore, the radiographic findings of EMCs do not show any features that distinguish them from other neoplasms, and therefore, definitive diagnoses are made based on histological features. EMC is an aggressive tumor with a poor prognosis, and requires wide surgical excision. However, its treatment may involve peculiarities such as a difficulty in obtaining a proper surgical margin in the axillary region or shoulder. In this report, the authors present two rare cases of EMCs in the axillary region.
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Affiliation(s)
- Chang-Young Seo
- Department of Orthopedic Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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94
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Cutaneous metastases from internal malignancies: a clinicopathologic and immunohistochemical review. Am J Dermatopathol 2012; 34:347-93. [PMID: 22617133 DOI: 10.1097/dad.0b013e31823069cf] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Skin metastases occur in 0.6%-10.4% of all patients with cancer and represent 2% of all skin tumors. Skin metastases from visceral malignancies are important for dermatologists and dermatopathologists because of their variable clinical appearance and presentation, frequent delay and failure in their diagnosis, relative proportion of different internal malignancies metastasizing to the skin, and impact on morbidity, prognosis, and treatment. Another factor to take into account is that cutaneous metastasis may be the first sign of clinically silent visceral cancer. The relative frequencies of metastatic skin disease tend to correlate with the frequency of the different types of primary cancer in each sex. Thus, women with skin metastases have the following distribution in decreasing order of frequency of primary malignancies: breast, ovary, oral cavity, lung, and large intestine. In men, the distribution is as follows: lung, large intestine, oral cavity, kidney, breast, esophagus, pancreas, stomach, and liver. A wide morphologic spectrum of clinical appearances has been described in cutaneous metastases. This variable clinical morphology included nodules, papules, plaques, tumors, and ulcers. From a histopathologic point of view, there are 4 main morphologic patterns of cutaneous metastases involving the dermis, namely, nodular, infiltrative, diffuse, and intravascular. Generally, cutaneous metastases herald a poor prognosis. The average survival time of patients with skin metastases is a few months. In this article, we review the clinicopathologic and immunohistochemical characteristics of cutaneous metastases from internal malignancies, classify the most common cutaneous metastases, and identify studies that may assist in diagnosing the origin of a cutaneous metastasis.
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95
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Obuchowicz AK, Szumera-Ciećkiewicz A, Ptaszyński K, Rutynowska-Pronicka O, Madziara W, Tiszler-Cieślik E, Cieńciała M, Pietrzak J, Głowacki J, Perek D. Intraspinal mesenchymal chondrosarcoma in a 14-year-old patient: diagnostic and therapeutic problems in relation to the review of literature. J Pediatr Hematol Oncol 2012; 34:e188-92. [PMID: 22627573 DOI: 10.1097/mph.0b013e318257a421] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mesenchymal chondrosarcoma (MC) is an infrequent, highly malignant neoplasm of the soft tissues and bone. It is very rare in the pediatric age group, especially in the intraspinal location. Only 24 cases have been reported to date. The authors present a case of a 14-year-old boy with an intraspinal MC who died of the disease 50 months from the initial diagnosis and after the third local recurrence. The patient was treated with a combination of chemotherapy, radiotherapy, and surgery. The authors review the clinical presentation, diagnostics, and the efficacy of treatment of pediatric patients with MC reported in the literature from 1978 to 2010.
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Affiliation(s)
- Anna Karolina Obuchowicz
- Department of Pediatrics, Bytom §John Paul II Upper Silesian Center for Child Health, Medical University of Silesia, Katowice, Poland
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96
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Primary orbital mesenchymal chondrosarcoma: case report and review of the literature. Case Rep Med 2012; 2012:292147. [PMID: 22761622 PMCID: PMC3385622 DOI: 10.1155/2012/292147] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 04/19/2012] [Indexed: 11/24/2022] Open
Abstract
Orbital mesenchymal chondrosarcoma is a very uncommon lesion of the bone and extraskeletal tissue. To our knowledge, approximately 30 cases have been described. We present the case of a 52-year-old male who presented with a history of progressive proptosis and chemosis of the right eye caused by an orbital tumor. He underwent exenteration of the right orbit, and the histological examination revealed a mesenchymal orbital chondrosarcoma. This paper attempts to describe a rare entity that should be considered in the differential diagnosis of calcified orbital lesions, especially in young adults. Complete removal of the tumor is the mainstay of treatment, but adjuvant radiation therapy and chemotherapy should be considered.
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97
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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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98
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Yang B, Wang Y, Wang X, Wang Z. Mesenchymal chondrosarcoma of the orbit: CT and MRI findings. Clin Radiol 2012; 67:346-51. [DOI: 10.1016/j.crad.2011.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 09/29/2011] [Accepted: 10/10/2011] [Indexed: 10/14/2022]
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99
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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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100
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Abstract
Diagnosing small round cell tumors (SCRTs) can be a difficult task for pathologists due to overlapping clinicopathologic features. This review highlights the clinical, radiographic, histologic, immunohistochemical, and genetic features of the most common SRCTs involving bone with an emphasis on differential diagnosis. SRCTs are a heterogeneous group of neoplasms characterized by poorly differentiated cells with small, blue, round nuclei and scant cytoplasm. They can occur as primary tumors in bone or soft tissue.
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Affiliation(s)
- Justin L Seningen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Carrie Y Inwards
- Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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