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Linos K, Kozel JA, Hurley MY, Andea AA. Review of the medical literature and assessment of current utilization patterns regarding the use of two common fluorescence in situ hybridization assays in the diagnosis of dermatofibrosarcoma protuberans and clear cell sarcoma. J Cutan Pathol 2018; 45:905-913. [DOI: 10.1111/cup.13345] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 07/14/2018] [Accepted: 08/06/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Konstantinos Linos
- Department of Pathology and Laboratory Medicine; Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth Lebanon; Lebanon New Hampshire
| | | | - Maria Yadira Hurley
- Departments of Dermatology and Pathology; Saint Louis University School of Medicine; St. Louis Missouri
| | - Aleodor A. Andea
- Departments of Dermatology and Pathology; University of Michigan Medical Center; Ann Arbor Michigan
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Yadav S, Verma N, Khurana N, Neogi S. Recurrent Dermatofibrosarcoma Protuberans with Pigmentation and Myoid Differentiation. Sultan Qaboos Univ Med J 2018; 18:e228-e230. [PMID: 30210857 DOI: 10.18295/squmj.2018.18.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/25/2017] [Accepted: 02/01/2018] [Indexed: 11/16/2022] Open
Abstract
Dermatofibrosarcomas protuberans (DFSP) are rare low-grade tumours with various subtypes and usually occur among middle-aged adults. However, myoid differentiation is very rare. We report a 44-year-old woman who presented to the Lok Nayak Jai Prakash Hospital, New Delhi, India, in 2017 with a recurrent pigmented DFSP presenting as an arm swelling. Upon histological and immunohistochemical analysis, myoid differentiation was confirmed. A literature review of the clinical and histopathological features of this rare entity is presented.
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Affiliation(s)
- Surekha Yadav
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Nidhi Verma
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Nita Khurana
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Sushant Neogi
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
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Dickson BC, Hornick JL, Fletcher CDM, Demicco EG, Howarth DJ, Swanson D, Zhang L, Sung YS, Antonescu CR. Dermatofibrosarcoma protuberans with a novel COL6A3-PDGFD fusion gene and apparent predilection for breast. Genes Chromosomes Cancer 2018; 57:437-445. [PMID: 30014607 DOI: 10.1002/gcc.22663] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/14/2018] [Accepted: 06/15/2018] [Indexed: 12/12/2022] Open
Abstract
Dermatofibrosarcoma protuberans is a locally aggressive superficial mesenchymal neoplasm. It typically occurs in adulthood, and has been reported to have a slight male predilection. Tumors have a characteristic histopathologic appearance, including: storiform architecture, infiltrative "honeycomb" growth within subcutaneous adipose tissue, and immunoreactivity for CD34. Virtually all molecularly characterized cases to date have been found to harbor a COL1A1-PDGFB fusion product. Following identification of an index patient with a novel COL6A3-PDGFD fusion gene, we undertook a molecular investigation, using a combination of RNA sequencing and fluorescence in situ hybridization (FISH), to assess the prevalence of PDGFD rearrangement in dermatofibrosarcoma protuberans (N = 63). Three additional patients were found to have balanced PDGFD rearrangements. Interestingly, all 4 tumors arose on the breast of females. As a result, we subsequently examined 16 additional cases of primary breast dermatofibrosarcoma protuberans, identifying 2 additional tumors with PDGFD rearrangement. The morphology and immunophenotype of all 6 cases was analogous to those with the canonical COL1A1-PDGFB fusion; none of the cases showed fibrosarcomatous transformation. This study illustrates that the COL6A3-PDGFD fusion product is rare in dermatofibrosarcoma protuberans, and associated with an apparent predilection for breast. An awareness of this variant is important for pathologists, as it will not be detected using conventional reverse transcription polymerase chain reaction or FISH-based diagnostic assays for dermatofibrosarcoma protuberans.
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Affiliation(s)
- Brendan C Dickson
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Jason L Hornick
- Department of Pathology, Brigham & Women's Hospital and Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Christopher D M Fletcher
- Department of Pathology, Brigham & Women's Hospital and Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth G Demicco
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - David J Howarth
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - David Swanson
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Lei Zhang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yun-Shao Sung
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cristina R Antonescu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
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Vidal CI, Armbrect EA, Andea AA, Bohlke AK, Comfere NI, Hughes SR, Kim J, Kozel JA, Lee JB, Linos K, Litzner BR, Missall TA, Novoa RA, Sundram U, Swick BL, Hurley MY, Alam M, Argenyi Z, Duncan LM, Elston DM, Emanuel PO, Ferringer T, Fung MA, Hosler GA, Lazar AJ, Lowe L, Plaza JA, Prieto VG, Robinson JK, Schaffer A, Subtil A, Wang WL. Appropriate use criteria in dermatopathology: Initial recommendations from the American Society of Dermatopathology. J Cutan Pathol 2018; 45:563-580. [DOI: 10.1111/cup.13142] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/21/2018] [Accepted: 03/13/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Claudia I. Vidal
- Departments of Dermatology and Pathology; Saint Louis University School of Medicine; St. Louis Missouri
| | - Eric A. Armbrect
- Center for Health Outcomes Research; Saint Louis University; St. Louis Missouri
| | - Aleodor A. Andea
- Departments of Dermatology and Pathology; University of Michigan Medical Center; Ann Arbor Michigan
| | | | - Nneka I. Comfere
- Department of Dermatology and Laboratory Medicine and Pathology; Mayo Clinic; Rochester Minnesota
| | - Sarah R. Hughes
- Department of Pathology; Gundersen Health System; La Crosse Wisconsin
| | - Jinah Kim
- Departments of Dermatology and Pathology; Stanford University School of Medicine; Stanford California
| | | | - Jason B. Lee
- Departments of Dermatology and Cutaneous Biology; Sidney Kimmel Medical College at Thomas Jefferson University; Philadelphia Pennsylvania
| | - Konstantinos Linos
- Department of Pathology and Laboratory Medicine; Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth Lebanon; Hanover New Hampshire
| | - Brandon R. Litzner
- Departments of Dermatology and Pathology, Via Christi Clinic; Ascension Medical Group; Wichita Kansas
- Department of Family Medicine; University of Kansas Medical Center-Wichita; Wichita Kansas
| | - Tricia A. Missall
- Departments of Dermatology and Pathology; Saint Louis University School of Medicine; St. Louis Missouri
| | - Roberto A. Novoa
- Departments of Dermatology and Pathology; Stanford University School of Medicine; Stanford California
| | - Uma Sundram
- Department of Anatomic Pathology; Oakland University William Beaumont School of Medicine and Beaumont Health Systems; Royal Oak Michigan
| | - Brian L. Swick
- Departments of Dermatology and Pathology; University of Iowa; Iowa City Iowa
| | - Maria Yadira Hurley
- Departments of Dermatology and Pathology; Saint Louis University School of Medicine; St. Louis Missouri
| | - Murad Alam
- Departments of Dermatology Otolaryngology, and Surgery; Feinberg School of Medicine, Northwestern University; Chicago Illinois
| | - Zsolt Argenyi
- Department of Pathology; University of Washington; Seattle Washington
| | - Lyn M. Duncan
- Pathology Service and Dermatopathology Unit; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
| | - Dirk M. Elston
- Department of Dermatology; Dermatologic Surgery, Medical University of SC; Charleston South Carolina
| | - Patrick O. Emanuel
- Department of Pathology and Molecular Medicine; University of Auckland; Auckland New Zealand
| | - Tammie Ferringer
- Departments of Dermatology and Laboratory Medicine; Geisinger Medical Center; Danville Pennsylvania
| | - Maxwell A. Fung
- Departments of Dermatology and Pathology and Laboratory Medicine; University of California, Davis School of Medicine; Sacramento California
| | - Gregory A. Hosler
- ProPath; Departments of Dermatology and Pathology; University of Texas Southwestern Medical Center; Dallas Texas
| | - Alexander J. Lazar
- Departments of Pathology, Dermatology, & Genomic Medicine; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Lori Lowe
- Departments of Dermatology and Pathology; University of Michigan Medical Center; Ann Arbor Michigan
| | | | - Victor G. Prieto
- Departments of Pathology, Dermatology, & Genomic Medicine; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - June K. Robinson
- Department of Dermatology; Northwestern University; Chicago Illinois
| | | | - Antonio Subtil
- Department of Dermatology; Yale School of Medicine; New Haven Connecticut
| | - Wei-Lien Wang
- Departments of Pathology and Translational Molecular Pathology, Division of Pathology and Laboratory Medicine; The University of Texas MD Anderson Cancer Center; Houston Texas
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Meng T, Shi XH, Wu SF, Luo YF, Wang XJ, Long X. Hormone receptors analysis in Chinese patients with dermatofibrosarcoma protuberans. J Surg Oncol 2018; 118:157-166. [PMID: 29878374 DOI: 10.1002/jso.25117] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 04/26/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Tian Meng
- Department of Plastic and Aesthetic Surgery; Peking Union Medical College Hospital; Beijing China
| | - Xiao-hua Shi
- Department of Pathology; Peking Union Medical College Hospital; Beijing China
| | - Sha-fei Wu
- Department of Pathology; Peking Union Medical College Hospital; Beijing China
| | - Yu-feng Luo
- Department of Pathology; Peking Union Medical College Hospital; Beijing China
| | - Xiao-jun Wang
- Department of Plastic and Aesthetic Surgery; Peking Union Medical College Hospital; Beijing China
| | - Xiao Long
- Department of Plastic and Aesthetic Surgery; Peking Union Medical College Hospital; Beijing China
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56
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Vidal CI, Armbrect EA, Andea AA, Bohlke AK, Comfere NI, Hughes SR, Kim J, Kozel JA, Lee JB, Linos K, Litzner BR, Missall TA, Novoa RA, Sundram U, Swick BL, Hurley MY, Alam M, Argenyi Z, Duncan LM, Elston DM, Emanuel PO, Ferringer T, Fung MA, Hosler GA, Lazar AJ, Lowe L, Plaza JA, Prieto VG, Robinson JK, Schaffer A, Subtil A, Wang WL. Appropriate use criteria in dermatopathology: Initial recommendations from the American Society of Dermatopathology. J Am Acad Dermatol 2018; 80:189-207.e11. [PMID: 29689323 DOI: 10.1016/j.jaad.2018.04.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 04/05/2018] [Accepted: 04/15/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Appropriate use criteria (AUC) provide physicians guidance in test selection, and can affect health care delivery, reimbursement policy, and physician decision-making. OBJECTIVES The American Society of Dermatopathology, with input from the American Academy of Dermatology and the College of American Pathologists, sought to develop AUC in dermatopathology. METHODS The RAND/UCLA appropriateness methodology, which combines evidence-based medicine, clinical experience, and expert judgment, was used to develop AUC in dermatopathology. RESULTS With the number of ratings predetermined at 3, AUC were developed for 211 clinical scenarios involving 12 ancillary studies. Consensus was reached for 188 (89%) clinical scenarios, with 93 (44%) considered "usually appropriate" and 52 (25%) "rarely appropriate" and 43 (20%) having "uncertain appropriateness." LIMITATIONS The methodology requires a focus on appropriateness without comparison between tests and irrespective of cost. CONCLUSIONS The ultimate decision to order specific tests rests with the physician and is one where the expected benefit exceeds the negative consequences. This publication outlines the recommendations of appropriateness-the AUC for 12 tests used in dermatopathology. Importantly, these recommendations may change considering new evidence. Results deemed "uncertain appropriateness" and where consensus was not reached may benefit from further research.
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Affiliation(s)
| | - Claudia I Vidal
- Departments of Dermatology and Pathology, Saint Louis University School of Medicine, Saint Louis, Missouri.
| | - Eric A Armbrect
- Center for Health Outcomes Research, Saint Louis University, Saint Louis, Missouri
| | - Aleodor A Andea
- Departments of Dermatology and Pathology, University of Michigan Medical Center, Ann Arbor, Michigan
| | | | - Nneka I Comfere
- Department of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Sarah R Hughes
- Department of Pathology, Gundersen Health System, La Crosse, Wisconsin
| | - Jinah Kim
- Departments of Dermatology and Pathology, Stanford University School of Medicine, Stanford, California
| | | | - Jason B Lee
- Departments of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Konstantinos Linos
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
| | - Brandon R Litzner
- Departments of Dermatology and Pathology, Via Christi Clinic, Ascension Medical Group, Wichita, Kansas; Department of Family Medicine, University of Kansas Medical Center, Wichita, Kansas
| | - Tricia A Missall
- Departments of Dermatology and Pathology, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Roberto A Novoa
- Departments of Dermatology and Pathology, Stanford University School of Medicine, Stanford, California
| | - Uma Sundram
- Department of Anatomic Pathology, Oakland University William Beaumont School of Medicine and Beaumont Health Systems, Royal Oak, Michigan
| | - Brian L Swick
- Departments of Dermatology and Pathology, University of Iowa, Iowa City, Iowa
| | - M Yadira Hurley
- Departments of Dermatology and Pathology, Saint Louis University School of Medicine, Saint Louis, Missouri
| | | | - Murad Alam
- Departments of Dermatology Otolaryngology, and Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Zsolt Argenyi
- Department of Pathology, University of Washington, Seattle, Washington
| | - Lyn M Duncan
- Pathology Service and Dermatopathology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Dirk M Elston
- Department of Dermatology, Dermatologic Surgery Medical University of South Carolina, Charleston, South Carolina
| | - Patrick O Emanuel
- Department of Pathology and Molecular Medicine, University of Auckland, Auckland, New Zealand
| | - Tammie Ferringer
- Departments of Dermatology and Laboratory Medicine, Geisinger Medical Center, Danville, Pennsylvania
| | - Maxwell A Fung
- Departments of Dermatology and Pathology and Laboratory Medicine, University of California, Davis School of Medicine, Sacramento, California
| | - Gregory A Hosler
- ProPath and Departments of Dermatology and Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Alexander J Lazar
- Departments of Pathology, Dermatology, and Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lori Lowe
- Departments of Dermatology and Pathology, University of Michigan Medical Center, Ann Arbor, Michigan
| | | | - Victor G Prieto
- Departments of Pathology, Dermatology, and Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - June K Robinson
- Department of Dermatology, Northwestern University, Chicago, Illinois
| | | | - Antonio Subtil
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Wei-Lien Wang
- Departments of Pathology and Translational Molecular Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Osio A, Xu S, El Bouchtaoui M, Leboeuf C, Gapihan G, Lemaignan C, Bousquet G, Lebbé C, Janin A, Battistella M. EGFR is involved in dermatofibrosarcoma protuberans progression to high grade sarcoma. Oncotarget 2018; 9:8478-8488. [PMID: 29492209 PMCID: PMC5823585 DOI: 10.18632/oncotarget.23899] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 11/10/2017] [Indexed: 01/03/2023] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP), amounting to 6% of all soft tissue sarcomas, has a slow growth rate, contrasting with a likelihood for local recurrence and a 10-20% evolution to higher-grade sarcoma, or "transformed DFSP" (DFSP-T). At molecular level, the characteristic COL1A1-PDGFB rearrangement, leading to sustained PDGFR signaling, is not linked to the evolutive potential. Here, we studied EGFR, another tyrosine kinase receptor, using laser-microdissection to select the different histologic components of DFSP (DFSP center, DFSP infiltrative periphery, DFSP-T higher-grade sarcoma), in 22 patients followed over 3 to 156 months. EGFR protein and mRNA were expressed in 13/22 patients with DFSP or DFSP-T, and increased with tumor progression, both in microdissected areas of higher-grade sarcomas and in microdissected areas of local extension. No cancer-associated EGFR gene mutation or copy-number variation, nor any KRAS, BRAF, NRAS hotspot mutations were found in any microdissected area. Among epithelial-mesenchymal transition factors tested, SNAIL 1/2 had the same expression pattern as EGFR while ZEB1/2 or TWIST1/2 did not. Using a proteome profiler phospho-kinase array on 3 DFSP and 3 DFSP-T cryopreserved tissue samples, EGFR phosphorylation was detected in each case. Among EGFR downstream pathways, we found positive correlations between phosphorylation levels of EGFR and STAT5a/b (r = 0.87, p < 0.05) and TOR (r = 0.95, p < 0.01), but not ERK in the MAPK pathway (r = -0.18, p > 0.70). We thus demonstrated that in DFSP evolution to high grade sarcoma, EGFR and SNAIL were involved, with EGFR activation and signaling through TOR and STAT5a/b downstream effectors, which could lead on to new therapies for advanced DFSP.
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Affiliation(s)
- Amélie Osio
- Pathology Department, Hôpital St Louis, APHP, Paris, France.,Université Paris Diderot, Inserm, UMR_S1165, Paris, France
| | - Shuo Xu
- Université Paris Diderot, Inserm, UMR_S1165, Paris, France
| | - Morad El Bouchtaoui
- Pathology Department, Hôpital St Louis, APHP, Paris, France.,Université Paris Diderot, Inserm, UMR_S1165, Paris, France
| | | | | | | | - Guilhem Bousquet
- Université Paris Diderot, Inserm, UMR_S1165, Paris, France.,Oncology Department, Hôpital Avicenne, Bobigny, France.,Université Paris 13, Villetaneuse, France
| | - Céleste Lebbé
- Dermatology Department, Hôpital St Louis, Paris, France.,Université Paris Diderot, Inserm, UMR_S976, Paris, France
| | - Anne Janin
- Pathology Department, Hôpital St Louis, APHP, Paris, France.,Université Paris Diderot, Inserm, UMR_S1165, Paris, France
| | - Maxime Battistella
- Pathology Department, Hôpital St Louis, APHP, Paris, France.,Université Paris Diderot, Inserm, UMR_S1165, Paris, France
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Schram AM, Chang MT, Jonsson P, Drilon A. Fusions in solid tumours: diagnostic strategies, targeted therapy, and acquired resistance. Nat Rev Clin Oncol 2017; 14:735-748. [PMID: 28857077 PMCID: PMC10452928 DOI: 10.1038/nrclinonc.2017.127] [Citation(s) in RCA: 222] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Structural gene rearrangements resulting in gene fusions are frequent events in solid tumours. The identification of certain activating fusions can aid in the diagnosis and effective treatment of patients with tumours harbouring these alterations. Advances in the techniques used to identify fusions have enabled physicians to detect these alterations in the clinic. Targeted therapies directed at constitutively activated oncogenic tyrosine kinases have proven remarkably effective against cancers with fusions involving ALK, ROS1, or PDGFB, and the efficacy of this approach continues to be explored in malignancies with RET, NTRK1/2/3, FGFR1/2/3, and BRAF/CRAF fusions. Nevertheless, prolonged treatment with such tyrosine-kinase inhibitors (TKIs) leads to the development of acquired resistance to therapy. This resistance can be mediated by mutations that alter drug binding, or by the activation of bypass pathways. Second-generation and third-generation TKIs have been developed to overcome resistance, and have variable levels of activity against tumours harbouring individual mutations that confer resistance to first-generation TKIs. The rational sequential administration of different inhibitors is emerging as a new treatment paradigm for patients with tumours that retain continued dependency on the downstream kinase of interest.
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Affiliation(s)
- Alison M Schram
- Department of Medicine 1275 York Avenue, New York, New York 10065, USA
| | - Matthew T Chang
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065, USA
| | - Philip Jonsson
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065, USA
| | - Alexander Drilon
- Department of Medicine 1275 York Avenue, New York, New York 10065, USA
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60
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Koseła-Paterczyk H, Rutkowski P. Dermatofibrosarcoma protuberans and gastrointestinal stromal tumor as models for targeted therapy in soft tissue sarcomas. Expert Rev Anticancer Ther 2017; 17:1107-1116. [DOI: 10.1080/14737140.2017.1390431] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Hanna Koseła-Paterczyk
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute Oncology Center, Warsaw, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute Oncology Center, Warsaw, Poland
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Dermatofibrosarcoma protuberans of the cheek. JOURNAL OF CANCER RESEARCH AND PRACTICE 2017. [DOI: 10.1016/j.jcrpr.2017.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
OPINION STATEMENT Dermatofibrosarcoma protuberans (DFSP) is a slow growing tumor with a very low metastatic potential but with significant subclinical extension and great capacity for local destruction. Thus, the first surgeon approached with such challenging tumor must attempt to cure the patient with a method that spares healthy tissue and ensures an optimal oncological, functional, and esthetic result. The treatment of DFSP often requires a multidisciplinary approach. Depending on location, dermatologic surgeons, surgical oncologists, head and neck surgeons, neurosurgeons, plastic surgeons, and occasionally medical oncologists may be involved with the management. Mohs micrographic surgery (MMS) is the preferred method when available. In our institution, most of the DFSP cases are often advanced cases; thus, dermatologic surgeons obtain clear margins peripherally and other surgical specialties assist with resection of the fascia and any critical deeper structures. When MMS is not available, wide local excision (at least 2- to 3-cm margins of resection) with exhaustive pathologic assessment of margin status is recommended, and it is best to confirm tumor extirpation prior to any reconstruction. Subclinical extension of the tumor could be related to the size; how long it has been growing or histological markers that are unknown right now. No clinical trials comparing MMS vs WLE are available, and further research should be focused on these subjects as well as the use of imatinib and other targeted therapies for recurrent and metastatic tumors and for neoadjuvant treatment.
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Affiliation(s)
- Alvaro E Acosta
- Dermatology Department, Instituto Nacional de Cancerología, Universidad Nacional de Colombia, Carrera 19C No. 90-14, Bogotá, Colombia.
| | - Catalina Santa Vélez
- Dermatology Oncology Universidad Militar Nueva Granada, Instituto Nacional de Cancerología, Calle 1a No. 9-85, Bogotá, Colombia
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64
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Al-Zaid T, Khoja H. Acral dermatofibrosarcoma protuberans with myoid differentiation: A report of 2 cases. J Cutan Pathol 2017. [DOI: 10.1111/cup.12982] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Tariq Al-Zaid
- Department of Pathology and Laboratory Medicine; King Faisal Specialist Hospital and Research Center; Riyadh Saudi Arabia
| | - Hatim Khoja
- Department of Pathology and Laboratory Medicine; King Faisal Specialist Hospital and Research Center; Riyadh Saudi Arabia
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65
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Long-term results of treatment of advanced dermatofibrosarcoma protuberans (DFSP) with imatinib mesylate – The impact of fibrosarcomatous transformation. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2017; 43:1134-1141. [DOI: 10.1016/j.ejso.2017.03.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/06/2017] [Accepted: 03/14/2017] [Indexed: 11/23/2022]
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66
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Li Y, Wang C, Xiang B, Chen S, Li L, Ji Y. Clinical Features, Pathological Findings and Treatment of Recurrent Dermatofibrosarcoma Protuberans. J Cancer 2017; 8:1319-1323. [PMID: 28607608 PMCID: PMC5463448 DOI: 10.7150/jca.17988] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 03/27/2017] [Indexed: 02/05/2023] Open
Abstract
Dermatofibrosarcoma protuberans (DESP) is a relatively rare and low-grade tumor of the skin and soft tissue. We review the clinical features, pathological findings and management of recurrent DESP with the aim to improve our understanding of this rare tumor. Fifty-seven patients were diagnosed with recurrent DFSP. The mean age at the presentation of DFSP was 30.9 years. The mean age at diagnosis of DFSP was 40.2 years. Chest wall was the dominant location. The histopathological diagnosis was ordinary DFSP (O-DFSP) in 46 cases and fibrosarcomatous DFSP (FS-DFSP) in 11 cases. No differences were noted between FS-DFSP and conventional DFSP in age at presentation and diagnosis, tumor size, as well as CD34 and SMA expression (P > 0.05). However, the time course to recurrence in FS-DFSP group was less than that in O-DFSP group (P = 0.038). All of the patients were treated with Mohs micrographic surgery (MMS). On follow-up, none of the patients had tumor recurrence. Our data demonstrated that the clinical features of recurrent DFSP are non-specific and variable. Our current practice suggests that MMS is very useful treatment choice for recurrent DFSP.
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Affiliation(s)
- Yanan Li
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Chuan Wang
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Bo Xiang
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Siyuan Chen
- Pediatric Intensive Care Unit, Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Li Li
- Laboratory of Pathology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yi Ji
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
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Dermatofibrosarcoma Protuberans-Like Tumor With COL1A1 Copy Number Gain in the Absence of t(17;22). Am J Dermatopathol 2017; 39:304-309. [PMID: 27984233 DOI: 10.1097/dad.0000000000000746] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A 57-year-old woman presented with a 3-year history of a progressive firm plaque on the right cheek. Skin biopsies revealed a bland, storiform, spindle-cell proliferation involving the deep dermis and subcutaneous fat. By immunohistochemistry, the tumor cells were diffusely positive for CD34 and caldesmon with multifocal reactivity for epithelial membrane antigen and focal, weak staining for smooth muscle actin. Retinoblastoma protein expression was not detectable in tumor cells by immunohistochemistry. An interphase fluorescence in situ hybridization analysis for platelet-derived growth factor B (PDGFB) gene rearrangement was negative. A single-nucleotide polymorphism array study detected 1) a gain of chromosome segment 17q21.33-q25.3 which overlapped the entire COL1A1 gene with a breakpoint at 17q21.33, approximately 250 Kb centromeric to the 3' end of COL1A1 gene, 2) several segmental gains on chromosome 11, and 3) an RB1 gene locus with normal copy number and allele frequency. Although the current case resembles dermatofibrosarcoma protuberans, it is unique in that it demonstrates a copy number gain of chromosome 17q in the absence of fusion of COL1A1 and PDGFB genes and an unusual immunohistochemical staining profile. The morphologic and molecular findings suggest a novel molecular variant of dermatofibrosarcoma protuberans not detectable with standard fluorescence in situ hybridization for PDGFB rearrangement. This variant appears to respond to imatinib after 9 months of follow-up.
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68
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Al-Ibraheemi A, Martinez A, Weiss SW, Kozakewich HP, Perez-Atayde AR, Tran H, Parham DM, Sukov WR, Fritchie KJ, Folpe AL. Fibrous hamartoma of infancy: a clinicopathologic study of 145 cases, including 2 with sarcomatous features. Mod Pathol 2017; 30:474-485. [PMID: 28059097 DOI: 10.1038/modpathol.2016.215] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/10/2016] [Accepted: 10/18/2016] [Indexed: 12/12/2022]
Abstract
Fibrous hamartoma of infancy is a rare soft tissue lesion of infants and young children with characteristic triphasic morphology, which typically occurs in the axilla and less commonly in other locations. We reviewed 145 cases of fibrous hamartoma of infancy from our consultation archives. Cases occurred in 106 males and 39 females (mean age-15 months; range-birth to 14 years), and involved both typical sites (eg, axilla/back/upper arm) (n=69) and unusual locations (n=76). Six were congenital. The tumors presented as subcutaneous masses and ranged from 0.4 to 17 cm (mean 3 cm). All displayed triphasic morphology, but varied widely in the relative percentages of fat, fibroblastic fascicles, and primitive mesenchyme. Hyalinized zones with cracking artifact, mimicking giant cell fibroblastoma, were present in a 44 (30%) of cases; however FISH for PDGFB gene rearrangement was negative in five tested cases. In addition to classical fibrous hamartoma of infancy, two lesions contained large sarcomatous-appearing foci with high cellularity, high nuclear grade, and brisk mitotic activity. One occurred in a 10-month-old female as a new mass in a congenital fibrous hamartoma of infancy; the other occurred as a leg mass in a 6-year-old male. ETV6 gene rearrangement was negative in the tumor from the 10-month-old female. Genomic microarray (OncoScan) showed normal molecular karyotype in eight tested cases, whereas the two tumors with sarcomatous features showed a hyperdiploid/near tetraploid molecular karyotype with copy neutral loss of heterozygosity of chromosomes 1p and 11p, and loss of 10p, chromosome 14, and a large portion of chromosome 22q (22q11.23q13.33), respectively. Follow-up (52 patients; range: 1-208 months, median: 8 months) showed only two local recurrences and no metastases. Extensive local disease in the 10-month-old female with sarcomatous-appearing fibrous hamartoma of infancy necessitated forequarter amputation. In summary, our study confirms the classic clinicopathologic features, including the triphasic morphologic appearance of most cases. In contrast to earlier studies, our series illustrates a broader histologic spectrum than previously appreciated, including its close resemblance to giant cell fibroblastoma in one quarter of cases and the rare presence of 'sarcomatous' areas, the latter providing evidence that these are complex neoplasms rather than hamartomas.
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Affiliation(s)
- Alyaa Al-Ibraheemi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Anthony Martinez
- Department of Laboratory Medicine and Pathology, Emory University, Atlanta, GA, USA
| | - Sharon W Weiss
- Department of Laboratory Medicine and Pathology, Emory University, Atlanta, GA, USA
| | - Harry P Kozakewich
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Antonio R Perez-Atayde
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Henry Tran
- Department of Laboratory Medicine and Pathology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - David M Parham
- Department of Laboratory Medicine and Pathology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - William R Sukov
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Karen J Fritchie
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Andrew L Folpe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Abstract
Dermatofibrosarcoma protuberans (DFSP) is a rare superficial soft tissue sarcoma. Its rarity precludes large prospective studies. Clinical diagnosis requires an high index of suspicion. Effective management requires an appreciation of tumor biology and the nature of the characteristic infiltrative growth pattern. DFSP tends to recur locally, with a low risk of dissemination. Aggressive surgical resection with widely negative margins is essential to management. Radiotherapy may be indicated in special circumstances. Understanding the molecular pathogenesis has resulted in use of tyrosine kinase inhibitor therapy for patients with locally advanced disease or in metastatic disease. DFSP patients require long-term follow-up.
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Unusual Signal Patterns of Break-apart FISH Probes Used in the Diagnosis of Soft Tissue Sarcomas. Pathol Oncol Res 2017; 23:863-871. [DOI: 10.1007/s12253-017-0200-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 01/17/2017] [Indexed: 10/20/2022]
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Nodular Fasciitis Complicating a Staged Surgical Excision of Dermatofibrosarcoma Protuberans. Case Rep Dermatol Med 2016; 2016:6074182. [PMID: 28018683 PMCID: PMC5149626 DOI: 10.1155/2016/6074182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/10/2016] [Indexed: 11/28/2022] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is an unusual spindle cell tumor with a high rate of local recurrence with traditional excision. Fortunately, Mohs micrographic surgery yields excellent cure rates for this neoplasm due to contiguous tumor spread and meticulous tumor mapping and margin analysis. We present the unique case of a patient treated with a modified Mohs technique with an analysis of the final margin with permanent sections, who developed a spindle cell neoplasm in the margins of her second stage excision consistent with nodular fasciitis. Distinguishing residual DFSP from a benign reactive process was an essential and challenging component of this patient's management.
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72
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Thway K, Noujaim J, Jones RL, Fisher C. Dermatofibrosarcoma protuberans: pathology, genetics, and potential therapeutic strategies. Ann Diagn Pathol 2016; 25:64-71. [DOI: 10.1016/j.anndiagpath.2016.09.013] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 09/15/2016] [Indexed: 01/14/2023]
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Stacchiotti S, Astolfi A, Gronchi A, Fontana A, Pantaleo MA, Negri T, Brenca M, Tazzari M, Urbini M, Indio V, Colombo C, Radaelli S, Brich S, Dei Tos AP, Casali PG, Castelli C, Dagrada GP, Pilotti S, Maestro R. Evolution of Dermatofibrosarcoma Protuberans to DFSP-Derived Fibrosarcoma: An Event Marked by Epithelial-Mesenchymal Transition-like Process and 22q Loss. Mol Cancer Res 2016; 14:820-9. [PMID: 27256159 DOI: 10.1158/1541-7786.mcr-16-0068] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/16/2016] [Indexed: 11/16/2022]
Abstract
UNLABELLED Dermatofibrosarcoma protuberans (DFSP) is a rare and indolent cutaneous sarcoma. At times, a fibrosarcomatous transformation marked by a more aggressive clinical behavior may be present. We investigated the natural history and the molecular bases of progression from classic DFSP to the fibrosarcomatous form (FS-DFSP), looking, retrospectively, at the outcome of all patients affected by primary DFSP treated at our institution from 1993 to 2012 and analyzing the molecular profile of 5 DFSPs and 5 FS-DFSPs by an integrated genomics approach (whole transcriptome sequencing, copy number analysis, FISH, qRT-PCR, IHC). The presence of fibrosarcomatous features was identified in 20 (7.6%) patients out of 263 DFSP. All cases were treated with macroscopic complete surgery. A local relapse occurred in 4 of 23 patients who received a microscopic marginal surgery (2 classic DFSP, 2 FS-DFSP), while metastasis affected 2 patients, both FS-DFSP (10% of FS-DFSP), being the first event. DFSP evolution to FS-DFSP was paralleled by a transcriptional reprogramming. The recurrent loss of chromosome 22q appeared to contribute to this phenomenon by promoting the expression of epigenetic regulators, such as EZH2. Loss of the p16/CDKN2A/INK4A locus at 9p was also observed in two FS-DFSP metastatic cases. IMPLICATIONS FS-DFSP is a rare subgroup among DFSP, with a 10% metastatic risk, that was independent from local recurrence and that was not observed in DFSP, that were all cured by wide surgery. Chromosome 22q deletion might play a role in FS-DFSP, and p16 loss may convey a poor outcome. EZH2 dysregulation was also found and represents a druggable target. Mol Cancer Res; 14(9); 820-9. ©2016 AACR.
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Affiliation(s)
- Silvia Stacchiotti
- Adult Mesenchymal Tumour and Rare Cancer Medical Oncology Unit, Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Annalisa Astolfi
- Centro Interdipartimentale di Ricerche sul Cancro G. Prodi, Università di Bologna, Bologna, Italy
| | - Alessandro Gronchi
- Melanoma and Sarcoma Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Andrea Fontana
- Melanoma and Sarcoma Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Maria A Pantaleo
- Dipartimento di Medicina Sperimentale, Specialistica e Diagnostica, Università di Bologna, Bologna, Italy
| | - Tiziana Negri
- Department of Diagnostic Pathology and Laboratory, Laboratory of Experimental Molecular Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Monica Brenca
- Unit of Experimental Oncology 1, CRO Aviano National Cancer Institute, Aviano, Italy
| | - Marcella Tazzari
- Unit of Immunotherapy of Human Tumors, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Milena Urbini
- Centro Interdipartimentale di Ricerche sul Cancro G. Prodi, Università di Bologna, Bologna, Italy
| | - Valentina Indio
- Centro Interdipartimentale di Ricerche sul Cancro G. Prodi, Università di Bologna, Bologna, Italy
| | - Chiara Colombo
- Melanoma and Sarcoma Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Stefano Radaelli
- Melanoma and Sarcoma Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Silvia Brich
- Department of Diagnostic Pathology and Laboratory, Laboratory of Experimental Molecular Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
| | - Angelo P Dei Tos
- Department of Anatomic Pathology, General Hospital of Treviso, Treviso, Italy
| | - Paolo G Casali
- Adult Mesenchymal Tumour and Rare Cancer Medical Oncology Unit, Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Chiara Castelli
- Unit of Immunotherapy of Human Tumors, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Gian Paolo Dagrada
- Department of Diagnostic Pathology and Laboratory, Laboratory of Experimental Molecular Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Silvana Pilotti
- Department of Diagnostic Pathology and Laboratory, Laboratory of Experimental Molecular Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Roberta Maestro
- Unit of Experimental Oncology 1, CRO Aviano National Cancer Institute, Aviano, Italy
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Posso-De Los Rios CJ, Lara-Corrales I, Ho N. Dermatofibrosarcoma protuberans in pediatric patients: a report of 17 cases. J Cutan Med Surg 2016; 18:180-5. [PMID: 24800706 DOI: 10.2310/7750.2013.13099] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is an uncommon soft tissue tumor. In children, there are acquired and congenital presentations. Due to clinical similarities with other conditions, diagnosis may be delayed. OBJECTIVE To review the clinical characteristics and treatment of DFSP in pediatric patients. METHODS A retrospective chart review was performed from January 2002 to September 2012. Inclusion criteria were patients under 18 years of age with a histopathologic diagnosis of DFSP. Data on demographics, clinical characteristics, treatments, and outcomes were collected. RESULTS Information was gathered from 17 patients; 9 (53%) were female. Congenital lesions were reported in 7 patients. The mean delay of diagnosis was 5.7 years; the most common anatomic location was the trunk in 8 of 17 (47%) cases. Treatment options included wide local surgery, Mohs surgery, and imatinib mesylate. CONCLUSION A detailed medical history and identification of the natural course of common conditions seen in pediatric patients are important to identify less common lesions and to suspect DFSP.
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75
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Imatinib-induced exacerbation of psoriasis in a patient with recurrent dermatofibrosarcoma protuberans: A case report and review of the literature. DERMATOL SIN 2016. [DOI: 10.1016/j.dsi.2015.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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76
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Kreicher KL, Kurlander DE, Gittleman HR, Barnholtz-Sloan JS, Bordeaux JS. Incidence and Survival of Primary Dermatofibrosarcoma Protuberans in the United States. Dermatol Surg 2016; 42 Suppl 1:S24-31. [PMID: 26730971 DOI: 10.1097/dss.0000000000000300] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous sarcoma for which data on risk factors, incidence, and survival are limited. OBJECTIVE The authors sought to establish a comprehensive report on the incidence of and survival from primary DFSP. METHODS The authors used data from the 18 registries of the Surveillance, Epidemiology, and End Results Program from 2000 to 2010. RESULTS Overall incidence was 4.1 per million person-years and steady over the decade. Trunk was the most common anatomic site except in older men. Incidence among women was 1.14 times higher than men (95% confidence interval [CI] of rate ratio: 1.07-1.22). Incidence among blacks was almost 2 times the rate among whites (95% CI of rate ratio: 1.8-2.1). Ten-year relative survival of DFSP was 99.1% (95% CI: 97.6-99.7). Increased age, male sex, black race, and anatomic location of the limbs and head as compared with the trunk were associated with higher all-cause mortality. CONCLUSION This is the largest population-based study of DFSP derived from a cohort of almost 7,000 patients. The epidemiologic profile of DFSP differs from most skin cancers. Incidence is stable and highest among women and blacks. Worse survival is associated with increased age, male sex, black race, and anatomic location of the limbs and head.
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Affiliation(s)
- Kathryn L Kreicher
- Departments of *Dermatology, and †Plastic Surgery, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio; ‡Department of Epidemiology and Biostatistics, Case Comprehensive Cancer Center, Cleveland, Ohio
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Yen H, Pan SC, Huang CH, Wong TW. Complete remission of a periorbital dermatofibrosarcoma protuberans with adjuvant imatinib mesylate in a child. JAAD Case Rep 2015; 1:172-4. [PMID: 27051721 PMCID: PMC4808742 DOI: 10.1016/j.jdcr.2015.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Hsi Yen
- Department of Dermatology, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan
| | - Shin-Chen Pan
- Section of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan
| | - Chien-Hun Huang
- Department of Dermatology, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan
| | - Tak-Wah Wong
- Department of Dermatology, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan; Department of Biochemistry and Molecular Biology, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan
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78
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Rutkowski P, Debiec-Rychter M. Current treatment options for dermatofibrosarcoma protuberans. Expert Rev Anticancer Ther 2015; 15:901-9. [PMID: 26027711 DOI: 10.1586/14737140.2015.1052799] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Dermatofibrosarcoma protuberans (DFSP) is rare, infiltrating dermal neoplasm, characterized by indolent growth and low probability of metastases. The critical event in DFSP development is the rearrangement of chromosome 17 and 22, leading to transcriptional up-regulation of platelet-derived growth factor, providing an autocrine and/or paracrine stimulus. The cornerstone of treatment for localized DFSP is complete surgical resection with microscopically negative margins. Adjuvant radiotherapy is suggested in cases of positive margins when re-excision is not feasible. The first effective systemic therapy in DFSP introduced into clinical practice was imatinib, demonstrating dramatic activity in advanced cases. Current results indicate that some DFSP patient initially evaluated as unresectable/metastatic or necessitating mutilating surgery turned resectable after imatinib therapy and this rational approach leading to complete remission maybe potentially curative. The clinical experience with other tyrosine kinase inhibitors is limited and imatinib remains the gold standard treatment of locally unresectable/metastatic DFSP. This review summarizes state of the art and perspectives on the DFSP management.
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Affiliation(s)
- Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Roentgena 5, 02-781 Warsaw, Poland
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Karanian M, Pérot G, Coindre JM, Chibon F, Pedeutour F, Neuville A. Fluorescence in situ hybridization analysis is a helpful test for the diagnosis of dermatofibrosarcoma protuberans. Mod Pathol 2015; 28:230-7. [PMID: 25081750 DOI: 10.1038/modpathol.2014.97] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 05/17/2014] [Accepted: 05/18/2014] [Indexed: 11/09/2022]
Abstract
Cytogenetically, most dermatofibrosarcoma protuberans are characterized by chromosomal rearrangements resulting in the collagen type-1 alpha 1 (COL1A1)-platelet-derived growth factor β (PDGFB) fusion gene. This abnormality can be detected by fluorescence in situ hybridization (FISH) analysis in routine practice. The aim of this study was to evaluate the role of the FISH analysis in the diagnosis of dermatofibrosarcoma protuberans. A FISH analysis was prospectively and systematically performed on a series of 448 consecutive tumor specimens. All cases were reviewed by two independent pathologists and classified in three categories according to the probability of a DFSP diagnosis before molecular analyses. Cases were classified as certain when dermatofibrosarcoma protuberans was the only possible diagnosis. Those cases for which dermatofibrosarcoma protuberans remained the first diagnosis, but other differential diagnosis existed, were regarded as probable. When dermatofibrosarcoma protuberans was considered a differential diagnosis, they were labeled as possible. The final diagnosis was supported by clinicopathological findings and results of FISH analyses. Immunohistochemical analysis of CD34 was systematically performed, and additional markers when necessary. The cases (n=37) with a non-interpretable FISH were excluded. For the 185 certain tumors specimens: 178 (96%) FISH analyses showed a PDGFB/COL1A1 rearrangement, 7 (4%) were negative. For the 114 probable tumors specimens: 104 (91%) FISH analyses were positive and 10 (9%) were negative leading to a new diagnosis in 8 cases. For the 112 possible cases: 91 (81%) FISH analyses were negative and 21 (19%) were positive. Of the 21 cases, initial diagnoses included unclassified sarcoma, myxofibrosarcoma, dermatofibroma, reactive lesion, solitary fibrous tumor, perineurioma, benign nerve sheath tumor, and undifferentiated spindle cell tumor without malignant evidence. FISH analysis has been helpful for confirming the diagnosis of dermatofibrosarcoma protuberans in 25% (104/411) of cases and necessary for the diagnosis of dermatofibrosarcoma protuberans in 5% (21/411) of cases.
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Affiliation(s)
- Marie Karanian
- 1] Department of Pathology, Institut Bergonié, Bordeaux, France [2] INSERM U916, Bordeaux, France [3] Université de Bordeaux, Bordeaux, France
| | - Gaëlle Pérot
- 1] Department of Pathology, Institut Bergonié, Bordeaux, France [2] INSERM U916, Bordeaux, France
| | - Jean-Michel Coindre
- 1] Department of Pathology, Institut Bergonié, Bordeaux, France [2] INSERM U916, Bordeaux, France [3] Université de Bordeaux, Bordeaux, France
| | - Frédéric Chibon
- 1] Department of Pathology, Institut Bergonié, Bordeaux, France [2] INSERM U916, Bordeaux, France
| | - Florence Pedeutour
- Laboratoire de Génétique des Tumeurs Solides, Institute for Research on Cancer and Aging (IRCAN), University Hospital of Nice, Bordeaux, France
| | - Agnès Neuville
- 1] Department of Pathology, Institut Bergonié, Bordeaux, France [2] INSERM U916, Bordeaux, France [3] Université de Bordeaux, Bordeaux, France
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80
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Panagopoulos I, Bjerkehagen B, Gorunova L, Berner JM, Boye K, Heim S. Several fusion genes identified by whole transcriptome sequencing in a spindle cell sarcoma with rearrangements of chromosome arm 12q and MDM2 amplification. Int J Oncol 2014; 45:1829-36. [PMID: 25176350 PMCID: PMC4203330 DOI: 10.3892/ijo.2014.2605] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 06/11/2014] [Indexed: 12/04/2022] Open
Abstract
Spindle cell tumors are clinically heterogeneous but morphologically similar neoplasms that can occur anywhere, mostly in adult patients. They are treated primarily with surgery to which is often added adjuvant or neoadjuvant radiation. Sub-classification of spindle cell sarcomas requires integration of histology, clinicopathological parameters, immunohistochemistry, cytogenetics (including fluorescence in situ hybridization) and/or molecular genetics. Some of the tumor subtypes are characterized by the presence of distinct chromosomal translocations and fusion genes. When no signs of differentiation are seen, the diagnosis by exclusion becomes undifferentiated spindle cell sarcoma. Cytogenetic, RNA sequencing and RT-PCR analyses were performed on a case of spindle cell sarcoma. The karyotype of the primary tumor was 46,X,del(X)(p?11p?22), der(12)(12pter→12q?22::12q?15→ q?22::16p11→16pter),-16,+r(12). MDM2 was found amplified in both the primary tumor and a metastasis. RNA-Seq of the primary tumor identified four fusion genes, PTGES3-PTPRB, HMGA2-DYRK2, TMBIM4-MSRB3 and USP15-CNTN1, in which all the partner genes map to the q arm of chromosome 12. In material from the metastasis, RT-PCR detected the PTGES3-PTPRB, HMGA2-DYRK2 and TMBIM4-MSRB3 whereas no USP15-CNTN1 fusion transcript was found. Because MDM2 amplification and the fusion transcripts PTGES3-PTPRB, HMGA2-DYRK2 and TMBIM4-MSRB3 were found both in the primary tumor and in the metastasis, they are components of the same clone and may be involved both in initiation and progression of the tumor. Which of them is pathogenetically primary remains unknown.
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Affiliation(s)
- Ioannis Panagopoulos
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Bodil Bjerkehagen
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Ludmila Gorunova
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Jeanne-Marie Berner
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Kjetil Boye
- Department of Oncology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Sverre Heim
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
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81
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Hameed M. Molecular diagnosis of soft tissue neoplasia: clinical applications and recent advances. Expert Rev Mol Diagn 2014; 14:961-77. [PMID: 25109831 DOI: 10.1586/14737159.2014.946909] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Sarcomas are rare and heterogeneous neoplasms of mesenchymal tissues with diverse morphologies and clinical behavior. In the last few years, the discovery of specific genetic aberrations in these tumors has allowed better classification and understanding of mechanisms driving their pathogenesis. While the majority of sarcomas are still treated by traditional modalities, molecular markers driving the pathogenesis have paved the way for more accurate diagnosis and opportunity to explore other therapeutic strategies. This review discusses the available molecular tools in sarcoma diagnostics and highlight some of the biological significance of the recent discoveries and their clinical applications.
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Affiliation(s)
- Meera Hameed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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82
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Loghdey MS, Varma S, Rajpara SM, Al-Rawi H, Perks G, Perkins W. Mohs micrographic surgery for dermatofibrosarcoma protuberans (DFSP): a single-centre series of 76 patients treated by frozen-section Mohs micrographic surgery with a review of the literature. J Plast Reconstr Aesthet Surg 2014; 67:1315-21. [PMID: 25012249 DOI: 10.1016/j.bjps.2014.05.021] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Revised: 04/13/2014] [Accepted: 05/03/2014] [Indexed: 11/19/2022]
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a rare low-grade sarcoma that typically presents with local invasion but rarely metastasises. Surgical excision remains the first-line treatment for DFSP. There are no randomised controlled or prospective studies comparing wide local excision (WLE) with Mohs micrographic surgery (MMS), but available evidence from the retrospective studies and case series available has consistently shown higher recurrence rates for standard surgery and WLE than for MMS. Combined recurrence rates of data within the last 20 years for WLE have been reported at 7.3% compared with 1.1% for MMS. Our aim was to review the clinical details and recurrence rates of DFSP cases treated with frozen-section MMS in our centre between 1996 and February 2013. The relevant data were collected from the case notes. It involved 76 patients with nine of these patients lost to follow-up. In the remaining 67 (67/76) cases, the recurrence rate was 1.5% during the mean follow-up period of 50 months (2-132). This is comparable to recurrence rates for the MMS in the literature [20,21]. Our series is the largest series for frozen-section MMS reported to date. Based on these findings and the current literature evidence, we advocate MMS as the treatment of choice for DFSP in all locations.
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Affiliation(s)
| | - Sandeep Varma
- Department of Dermatology, Queens Medical Centre, Derby Road, Nottingham NG7 2UH, UK
| | - Sanjay M Rajpara
- Department of Dermatology, Queens Medical Centre, Derby Road, Nottingham NG7 2UH, UK
| | - Haytham Al-Rawi
- Department of Dermatology, Queens Medical Centre, Derby Road, Nottingham NG7 2UH, UK
| | - Graeme Perks
- Department of Plastic Surgery, Queens Medical Centre, Derby Road, Nottingham NG7 2UH, UK
| | - William Perkins
- Department of Dermatology, Queens Medical Centre, Derby Road, Nottingham NG7 2UH, UK
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83
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miR-205 down-regulation promotes proliferation of dermatofibrosarcoma protuberans tumor cells by regulating LRP-1 and ERK phosphorylation. Arch Dermatol Res 2014; 306:367-74. [PMID: 24525843 DOI: 10.1007/s00403-014-1452-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 01/10/2014] [Accepted: 01/28/2014] [Indexed: 12/31/2022]
Abstract
Dermatofibrosarcoma protuberans (DFSP) is an intermediate malignancy of the skin. Although COL1A1/PDGFB fusion gene was identified in the tumor cells recently, not all of the cases were positive for the fusion gene, and further researches are still needed to clarify the pathogenesis of DFSP. In this study, we investigated the role of microRNAs in the tumor. microRNA PCR array showed several microRNAs increased or decreased in DFSP in vivo compared with dermatofibroma (DF) and normal skin. Among them, the expression of miR-205 was down-regulated in DFSP compared with DF and normal skin. In situ hybridization showed that miR-205 expression was evident in dermal fibroblasts of normal skin although hardly detected in tumor cells of DF or DFSP. miR-205 inhibitor increased cell proliferation and the luciferase activity of 3'UTR of low-density lipoprotein receptor-related protein-1 (LRP-1) in cultured normal dermal fibroblasts. Immunohistochemistry showed the expression of LRP-1 was increased in DFSP tissue. Knockdown of LRP-1 suppressed cell growth and down-regulated extracellular signal-regulated kinase (ERK) phosphorylation without affecting MEK phosphorylation in cultured DFSP cells. Taken together, LRP-1 overexpression caused by the miR-205 down-regulation may play a role in the abnormal proliferation of DFSP cells via directly regulating ERK phosphorylation.
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84
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Walther C, Tayebwa J, Lilljebjörn H, Magnusson L, Nilsson J, von Steyern FV, Øra I, Domanski HA, Fioretos T, Nord KH, Fletcher CDM, Mertens F. A novel SERPINE1-FOSB fusion gene results in transcriptional up-regulation of FOSB in pseudomyogenic haemangioendothelioma. J Pathol 2014; 232:534-40. [PMID: 24374978 DOI: 10.1002/path.4322] [Citation(s) in RCA: 137] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 12/03/2013] [Accepted: 12/20/2013] [Indexed: 12/19/2022]
Abstract
Pseudomyogenic haemangioendothelioma (PHE) is an intermediate malignant vascular soft tissue tumour primarily affecting children and young adults. The molecular basis of this neoplasm is unknown. We here used chromosome banding analysis, fluorescence in situ hybridization (FISH), mRNA sequencing, RT-PCR and quantitative real-time PCR on a series of morphologically well-characterized PHEs to show that a balanced translocation, t(7;19)(q22;q13), detected as the sole cytogenetic aberration in two cases, results in fusion of the SERPINE1 and FOSB genes. This translocation has not been observed in any other bone or soft tissue tumour. Interphase FISH on sections from eight additional PHEs identified the same SERPINE1-FOSB fusion in all cases. The role of SERPINE1, which is highly expressed in vascular cells, in this gene fusion is probably to provide a strong promoter for FOSB, which was found to be expressed at higher levels in PHEs than in other soft tissue tumours. FOSB encodes a transcription factor belonging to the FOS family of proteins, which, together with members of the JUN family of transcription factors, are major components of the activating protein 1 (AP-1) complex. Further studies are needed to understand the cellular impact of the aberrant expression of the FOSB gene, but as the t(7;19) resulting in the SERPINE1-FOSB fusion seems to be pathognomonic for PHE, FISH or RT-PCR could be useful for differential diagnostic purposes.
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Affiliation(s)
- Charles Walther
- Department of Clinical Genetics, University and Regional Laboratories, Skåne University Hospital, Lund University, Sweden; Department of Pathology, University and Regional Laboratories, Skåne University Hospital, Lund, Sweden
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85
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Ishigami T, Hida Y, Matsudate Y, Murao K, Kubo Y. The involvement of fibroblast growth factor receptor signaling pathways in dermatofibroma and dermatofibrosarcoma protuberans. THE JOURNAL OF MEDICAL INVESTIGATION 2014; 60:106-13. [PMID: 23614918 DOI: 10.2152/jmi.60.106] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Fibroblast growth factors (FGFs) and their receptors (FGFRs) control a wide range of biological functions; however, their involvement in the pathogenesis of dermatofibroma (DF) and dermatofibrosarcoma protuberans (DFSP) is currently unknown. In this study, we first confirmed the histological diagnosis by detecting fusion COL1A1-PDGFB transcripts in DFSP, and examined the expression of all FGFRs (FGFR1-4), some of their ligands (FGF1, 2, 9), and forkhead box N1 (FOXN1) as a downstream target of FGFR3 in DF and DFSP by immunohistochemical analysis. Although we failed to detect the expression of FGF1 and FGF9 as specific ligands for FGFR3 in DF, overexpression of FGFR3 and FOXN1 was observed in the epidermal regions of DF, suggesting that the epidermal regions of DF were similar to seborrhoeic keratosis both in terms of histological features and the activation of FGFR3/FOXN1. In addition, strong expression of FGF2 and FGFR4 was observed in the tumor lesions of DF. Expression patterns of FGFR3/FOXN1 and FGF2/FGFR4 in DF were in contrast with those of DFSP. The activation of FGFR signaling pathways may be not only relevant to the pathogenesis of DF, but also very useful in the differential diagnosis of DF and DFSP.
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Affiliation(s)
- Takeshi Ishigami
- Department of Dermatology, Institute of Health Biosciences, the University of Tokushima Graduate School, Tokushima, Japan
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86
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Abstract
Over the past two decades, advances in the fields of cancer genetics and molecular biology have elucidated molecular pathways that cause numerous cutaneous malignancies. This in turn has spurred the rational design of molecularly targeted therapies. In this review, we discuss the molecular pathways critical to the development of nonmelanoma skin cancers and the novel pharmacologic agents that target them. Included is a review of vismodegib for basal cell carcinoma, cetuximab for squamous cell carcinomas, imatinib for dermatofibrosarcoma protuberans, and sirolimus for Kaposi's sarcoma.
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Affiliation(s)
- Lucinda S Liu
- Department of Dermatology, Yale School of Medicine, New Haven, CT 06520-8059, USA
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87
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Abstract
Soft tissue sarcomas are a diverse and rare group of neoplasms often found in the extremities. Treatment is best carried out in regional cancer centers by a multidisciplinary group with a common interest in these disorders. Treatment is usually surgical, with radiation used in select cases to try to reduce the risk of local recurrence. The role of chemotherapy is controversial, but it may be useful in patients at highest risk of developing metastatic disease. The development of newer forms of targeted systemic therapy and techniques to reduce the morbidity from local treatment to the extremity are areas of intense research interest.
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Affiliation(s)
- Paul Clarkson
- University of Toronto, Mount Sinai Hospital, 600 University Ave, Suite 476G, Toronto, ON, M5G 1X5, Canada.
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88
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Todd R, Lunec J. Molecular pathology and potential therapeutic targets in soft-tissue sarcoma. Expert Rev Anticancer Ther 2014; 8:939-48. [DOI: 10.1586/14737140.8.6.939] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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89
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Berry RS, Berry TM, Haney M, Shetty A, Yu L, Smidt AC. Congenital dermatofibrosarcoma with associated hypertrichosis. J Cutan Pathol 2013; 40:990-2, quiz 989. [DOI: 10.1111/cup.12259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2013] [Indexed: 01/24/2023]
Affiliation(s)
- Ryan S. Berry
- Department of Pathology; University of New Mexico School of Medicine; Albuquerque NM
| | - Tamara M. Berry
- Department of Dermatology; University of New Mexico School of Medicine; Albuquerque NM
| | - Michaela Haney
- Department of Dermatology; University of New Mexico School of Medicine; Albuquerque NM
| | - Anil Shetty
- Department of Surgery, Division of Plastic Surgery; University of New Mexico School of Medicine; Albuquerque NM
| | - Limin Yu
- Department of Pathology; University of New Mexico School of Medicine; Albuquerque NM
| | - Aimee C. Smidt
- Department of Dermatology; University of New Mexico School of Medicine; Albuquerque NM
- Department of Pediatrics; University of New Mexico School of Medicine; Albuquerque NM
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90
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Abstract
Adult fibrosarcoma, defined by the World Health Organization as a 'malignant neoplasm composed of fibroblasts with variable collagen production and, in classical cases, a "herringbone" architecture', is a very rare soft tissue sarcoma. Once considered the most common adult sarcoma, the incidence of adult fibrosarcoma has declined dramatically over the past several decades. This is due to (i) evolution in the classification of soft tissue tumours (ii) recognition of clinically, morphologically and genetically distinctive subtypes of fibrosarcoma and (iii) increased understanding of the many other mesenchymal and non-mesenchymal tumours that may mimic fibrosarcoma. This review article will summarize the current state of our knowledge about strictly defined adult fibrosarcoma and discuss important entities in its differential diagnosis, including various fibrosarcoma variants, monophasic synovial sarcoma and other potential mesenchymal and non-mesenchymal mimics.
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Affiliation(s)
- Andrew L Folpe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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91
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Analysis of activated platelet-derived growth factor β receptor and Ras-MAP kinase pathway in equine sarcoid fibroblasts. BIOMED RESEARCH INTERNATIONAL 2013; 2013:283985. [PMID: 23936786 PMCID: PMC3726019 DOI: 10.1155/2013/283985] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 06/03/2013] [Accepted: 06/18/2013] [Indexed: 11/24/2022]
Abstract
Equine sarcoids are skin tumours of fibroblastic origin affecting equids worldwide. Bovine papillomavirus type-1 (BPV-1) and, less commonly, type-2 are recognized as etiological factors of sarcoids. The transforming activity of BPV is related to the functions of its major oncoprotein E5 which binds to the platelet-derived growth factor β receptor (PDGFβR) causing its phosphorylation and activation. In this study, we demonstrate, by coimmunoprecipitation and immunoblotting, that in equine sarcoid derived cell lines PDGFβR is phosphorylated and binds downstream molecules related to Ras-mitogen-activated protein kinase-ERK pathway thus resulting in Ras activation. Imatinib mesylate is a tyrosine kinase receptors inhibitor which selectively inhibits the activation of PDGFβR in the treatment of several human and animal cancers. Here we show that imatinib inhibits receptor phosphorylation, and cell viability assays demonstrate that this drug decreases sarcoid fibroblasts viability in a dose-dependent manner. This study contributes to a better understanding of the molecular mechanisms involved in the pathology of sarcoids and paves the way to a new therapeutic approach for the treatment of this common equine skin neoplasm.
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92
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Abstract
Classically, dermatofibrosarcoma protuberans (DFSP) is a disease of adults. The world literature revision shows that several pediatric cases have been reported so far; this might suggest that the number of infants with the condition might be larger than that estimated previously. Here, we report the 183rd case of histologically confirmed DFSP in young age. A 14-year-old white male patient came under our care for a slowly growing, pale brownish lesion on the neck skin. A biopsy specimen showed a DFSP. Subsequently, a wide surgery excision with 3 cm of resection margins including the underlying fascia was performed. To date, the patient has been in follow-up for 6 years without evidence of recurrent disease. The clinical features and treatment of DFSP diagnosed in childhood and adolescence reported in the published literature are reviewed to provide new insights about this rare entity. The aim is to emphasize the importance of biopsy for histologic evaluation in the cases that show a persistent or a large cutaneous plaque or nodule without pathognomonic clinical features that permit a clinical diagnosis. An accurate knowledge of the disease is the prerequisite for a wider recognition and appropriate treatment.
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93
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Multifarious functions of PDGFs and PDGFRs in tumor growth and metastasis. Trends Mol Med 2013; 19:460-73. [PMID: 23773831 DOI: 10.1016/j.molmed.2013.05.002] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 05/03/2013] [Accepted: 05/09/2013] [Indexed: 01/06/2023]
Abstract
Platelet-derived growth factors (PDGFs) and their receptors (PDGFRs) are frequently expressed in various tumors and their expression levels correlate with tumor growth, invasiveness, drug resistance, and poor clinical outcomes. Emerging experimental evidence demonstrates that PDGFs exhibit multiple functions in modulation of tumor growth, metastasis, and the tumor microenvironment by targeting malignant cells, vascular cells, and stromal cells. Understanding PDGF-PDGFR-mediated molecular signaling may provide new mechanistic rationales for optimizing current cancer therapies and the development of future novel therapeutic modalities.
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94
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Kamar FG, Kairouz VF, Sabri AN. Dermatofibrosarcoma protuberans (DFSP) successfully treated with sorafenib: case report. Clin Sarcoma Res 2013; 3:5. [PMID: 23557478 PMCID: PMC3637545 DOI: 10.1186/2045-3329-3-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 03/21/2013] [Indexed: 02/07/2023] Open
Abstract
DFSP is a locally invasive, slow-growing tumor of the subcutaneous tissue that rarely metastasizes but recurs frequently after surgical excision. We report herein a case of highly recurrent, locally invasive DFSP that failed both postoperative radiation therapy and complete trial of Imatinib, but was successfully treated with Sorafenib, which showed unprecedented response.
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Affiliation(s)
- Francois G Kamar
- Division of Hematology & Oncology, Clemenceau Medical Center, City Center Building, Suite 3 A, Avenue Nouvelle, P,O, Box 1076, Beirut, Jounieh, Lebanon.
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95
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Li MM, Ewton AA, Smith JL. Using Cytogenetic Rearrangements for Cancer Prognosis and Treatment (Pharmacogenetics). CURRENT GENETIC MEDICINE REPORTS 2013. [DOI: 10.1007/s40142-013-0011-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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96
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Cheah AL, Goldblum JR, Billings SD. Molecular diagnostics complementing morphology in superficial mesenchymal tumors. Semin Diagn Pathol 2013; 30:95-109. [PMID: 23327733 DOI: 10.1053/j.semdp.2012.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Molecular techniques are increasingly important in the practice of surgical pathology. In soft tissue tumors, there are a number of tumors with recurring cytogenetic abnormalities. Knowledge of these abnormalities has furthered our understanding of these tumors and has also allowed development of molecular techniques to aid in the diagnosis. This review will focus on mesenchymal tumors with specific cytogenetic abnormalities that may present as a superficial tumor of the dermis or subcutis.
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Affiliation(s)
- Alison L Cheah
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH 44195, USA
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97
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98
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99
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The Role of Molecular Testing in the Diagnosis of Cutaneous Soft Tissue Tumors. ACTA ACUST UNITED AC 2012; 31:221-33. [DOI: 10.1016/j.sder.2012.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 07/18/2012] [Indexed: 11/21/2022]
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100
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Kornik RI, Muchard LK, Teng JM. Dermatofibrosarcoma protuberans in children: an update on the diagnosis and treatment. Pediatr Dermatol 2012; 29:707-13. [PMID: 22780227 DOI: 10.1111/j.1525-1470.2012.01767.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a fibrohistiocytic tumor of low grade malignant potential. Although rare, pediatric cases pose a particular challenge in diagnosis and management. In children, the clinical appearance may be heterogeneous and a high index of suspicion is necessary to avoid delays in diagnosis which can lead to further morbidity. Histologic examination, often with the use of appropriate immunostains, is necessary for diagnosis. Advances in the understanding of the molecular genetics of DFSP have led to further diagnostic and therapeutic modalities. DFSP is thought to result from a translocation between platelet-derived growth factor beta (PDGFB, 22q13.1) and type 1 collagen (COL1A1, 17q21≈22) leading to a fusion protein (PDGFB) which stimulates the PDGF receptor. Detection of this translocation in tissue via PCR or fluorescence in situ hybridization (FISH) can be helpful in difficult cases. While surgery with wide local excision or Mohs micrographic surgery is the mainstay of treatment, the use of targeted therapy with imatanib mesylate shows promise in large or unresectable tumors. Knowledge of the clinical features, histology, genetics, and treatment options is important for successful management of these tumors.
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Affiliation(s)
- Rachel I Kornik
- Department of Dermatology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin 53715, USA
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