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Sparber-Sauer M, Vokuhl C, Seitz G, Stegmaier S, Hallmen E, von Kalle T, Scheer M, Münter M, Bielack SS, Ladenstein R, Niggli F, Ljungman G, Fuchs J, Klingebiel T, Koscielniak E. The impact of local control in the treatment of children with advanced infantile and adult-type fibrosarcoma: Experience of the cooperative weichteilsarkom studiengruppe (CWS). J Pediatr Surg 2020; 55:1740-1747. [PMID: 31753608 DOI: 10.1016/j.jpedsurg.2019.10.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/01/2019] [Accepted: 10/07/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVES This study aims at examining the potential survival benefits of primary versus secondary surgery of children diagnosed with advanced infantile (iFS) and adult-type fibrosarcoma (aFS). METHODS Treatment and outcome of 89 children with FS treated within prospective Cooperative Studiengruppe (CWS) trials (1981-2016) were analyzed retrospectively. RESULTS Localized disease (LD) was diagnosed in 87 patients: 64/66 patients with iFS (≤2 years) and 23 with aFS (>2 ≤ 18 years). Two patients (iFS) had metastatic disease. Resection was the mainstay of therapy of patients with LD resulting in microscopically complete (R0, IRS group I) (n = 29/87, 33%), microscopically incomplete (R1, IRS group II) (n = 17/87, 20%) and macroscopically incomplete (R2, IRS group III) (n = 41/87, 47%). Advanced LD (IRS group III) was present in 32/64 (50%) patients with iFS and in 9/23 (39%) with aFS. Chemotherapy was added predominantly in patients with advanced disease and an assessable objective response to CHT was seen in 71% iFS and 75% aFS. The 5-year event-free survival (EFS) of patients with iFS and aFS was 81% (±10, 95% CI) and 70% (±19, 95% CI) (p = 0.24); the 5-year overall survival (OS) was 98% (±3, 95% CI) and 82% (±16, 95% CI) (p = 0.02). Primary resection was no prognostic factor. Secondary R0/ R1 resection in patients with advanced disease improved 5-year EFS and OS in aFS (p = 0.002 and p = 0.000) but not in infants. CONCLUSIONS Secondary resection improves outcome in advanced aFS but not in infants. Mutilating surgery in infants should be avoided. TYPE OF STUDY AND LEVEL OF EVIDENCE Treatment study: patients were enrolled in five prospective studies and one registry, prognosis study: retrospective study. LEVEL OF EVIDENCE II/ III. MINI-ABSTRACT Fibrosarcoma is a very rare malignant tumor. Little is known about differences of local treatment of advanced infantile and adult-type. Data of 89 patients registered in five prospective trials and one registry of the Cooperative Weichteilsarkom Studiengruppe (CWS) (1981-2016) were analyzed.
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Affiliation(s)
- Monika Sparber-Sauer
- Klinikum Stuttgart - Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pediatrics 5 (Oncology, Hematology, Immunology), Stuttgart, Germany.
| | - Christian Vokuhl
- Kiel Pediatric Tumor Registry, Section of Pediatric Pathology Department of Pathology, Kiel, Germany
| | - Guido Seitz
- University Children's Hospital Marburg, Department of Pediatric Surgery, Marburg, Germany
| | - Sabine Stegmaier
- Klinikum Stuttgart - Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pediatrics 5 (Oncology, Hematology, Immunology), Stuttgart, Germany
| | - Erika Hallmen
- Klinikum Stuttgart - Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pediatrics 5 (Oncology, Hematology, Immunology), Stuttgart, Germany
| | - Thekla von Kalle
- Klinikum Stuttgart - Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Olgahospital, Institute of Radiology, Stuttgart, Germany
| | - Monika Scheer
- Klinikum Stuttgart - Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pediatrics 5 (Oncology, Hematology, Immunology), Stuttgart, Germany
| | - Marc Münter
- Klinikum Stuttgart, Institute of Radiotherapy, Stuttgart, Germany
| | - Stefan S Bielack
- Klinikum Stuttgart - Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pediatrics 5 (Oncology, Hematology, Immunology), Stuttgart, Germany; University of Muenster, Department of Pediatric Hematology and Oncology, Muenster, Germany
| | | | - Felix Niggli
- Department of Pediatric Oncology, University of Zurich, Zurich, Switzerland
| | - Gustaf Ljungman
- University of Uppsala, Children's University Hospital, Department of Women's and Children's Health, Uppsala, Sweden
| | - Joerg Fuchs
- University Children's Hospital, Department of Pediatric Surgery and Urology, Tuebingen, Germany
| | - Thomas Klingebiel
- University of Frankfurt, Department for Children and Adolescents, Goethe University, Frankfurt/M., Germany
| | - Ewa Koscielniak
- Klinikum Stuttgart - Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pediatrics 5 (Oncology, Hematology, Immunology), Stuttgart, Germany; Children's Hospital, Department of Pediatric Hematology and Oncology, Tuebingen, Germany
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Epithelioid Sarcoma-From Genetics to Clinical Practice. Cancers (Basel) 2020; 12:cancers12082112. [PMID: 32751241 PMCID: PMC7463637 DOI: 10.3390/cancers12082112] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 11/20/2022] Open
Abstract
Epithelioid sarcoma is a mesenchymal soft tissue sarcoma often arising in the extremities, usually in young adults with a pick of incidence at 35 years of age. Epithelioid sarcoma (ES) is characterized by the loss of SMARCB1/INI1 (integrase interactor 1) or other proteins of the SWI/SNF complex. Two distinct types, proximal and distal, with varying biology and treatment outcomes, are distinguished. ES is known for aggressive behavior, including a high recurrence rate and regional lymph node metastases. An optimal long-term management strategy is still to be defined. The best treatment of localized ES is wide surgical resection. Neo-adjuvant or adjuvant radiotherapy may be recommended, as it reduces the local recurrence rate. Sentinel lymph node biopsy should be considered in ES patients. Patients with metastatic ES have a poor prognosis with an expected median overall survival of about a year. Doxorubicin-based regimens are recommended for advanced ES. Tazemetostat, an EZH2 methyltransferase, has shown promising results in ES patients. Novel therapies, including immunotherapy, are still needed.
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53
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Assi T, Rassy E, Nassereddine H, Farhat F, Kattan J. Epithelioid sarcoma as the prototype for personalized therapy in soft tissue sarcoma. Per Med 2020; 17:241-244. [PMID: 32589100 DOI: 10.2217/pme-2020-0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Tarek Assi
- Saint-Joseph University, Faculty of medicine, Beirut, Lebanon.,Oncology Department, Hammoud Hospital, Saida, Lebanon
| | - Elie Rassy
- Saint-Joseph University, Faculty of medicine, Beirut, Lebanon
| | | | - Fadi Farhat
- Oncology Department, Hammoud Hospital, Saida, Lebanon
| | - Joseph Kattan
- Saint-Joseph University, Faculty of medicine, Beirut, Lebanon
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54
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Epithelioid Cutaneous Mesenchymal Neoplasms: A Practical Diagnostic Approach. Diagnostics (Basel) 2020; 10:diagnostics10040233. [PMID: 32316685 PMCID: PMC7236000 DOI: 10.3390/diagnostics10040233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 12/16/2022] Open
Abstract
Epithelioid cells are rounded or polygonal cells with abundant eosinophilic or clear cytoplasm and ovoid to round nuclei, superficially resembling epithelial cells. Cutaneous mesenchymal neoplasms composed predominantly or exclusively of epithelioid cells are relatively uncommon and can cause considerable diagnostic difficulties due to overlapping histologic features among heterogeneous groups of tumors. Familiarity with practical diagnostic approaches and recognition of key histopathologic features are important for correct diagnosis and management. This review summarizes the histologic features of epithelioid cutaneous mesenchymal neoplasms and discusses their differential diagnoses from malignant melanomas and carcinomas.
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55
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Frezza AM, Sbaraglia M, Lo Vullo S, Baldi GG, Simeone N, Frenos F, Campanacci D, Stacchiotti S, Pasquali S, Callegaro D, Gambarotti M, Barisella M, Palomba A, Mariani L, Casali PG, Dei Tos AP, Gronchi A. The natural history of epithelioid sarcoma. A retrospective multicentre case-series within the Italian Sarcoma Group. Eur J Surg Oncol 2020; 46:1320-1326. [PMID: 32307188 DOI: 10.1016/j.ejso.2020.03.215] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/11/2020] [Accepted: 03/23/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION This case-series is aimed to describe the natural history of epithelioid sarcoma (ES) and to provide insights into the differential clinical behaviour of its two variants ("classic-type" and "proximal-type"). The value of a subtype-adapted grading system based on pathological features is explored. METHODS Data from consecutive, primary, localised, INI1-deleted ES operated at three Italian sarcoma reference centres (1995-2015) were included. Centralised pathological review was performed. Classic-type ES was broken down into "high-grade" and "low-grade", according to number of mitoses, evidence of necrosis and nuclear atypia. Five- and 10-year overall survival (OS) and crude cumulative incidence (CCI) of local recurrence (LR) and distant metastasis (DM) were estimated. RESULTS Fifty-two patients were included. 5- and 10-year OS estimates were 70% and 47% in the whole series, 57% and 37% in patients with proximal-type ES, 77% and 54% in patients with classic-type ES (P = 0.02). In classic-type ES, 5- and 10-year OS was higher for low-grade (95% and 72%, respectively) than high-grade tumours (P = 0.002). 5- and 10-year CCI estimates for LR were 21% and 33% in the whole series. 5- and 10-year CCI estimates for DM were 35% and 39% in the whole series, both 28% in classic-type ES, 47% and 59% in proximal-type ES (P = 0.03). CONCLUSIONS Suffering from a proximal- or a classic-type is the stronger predictor of outcome in patients with localised ES, with proximal-type ES patients having lower survival due to a higher tendency toward metastatic spreading. However, the "high-grade" classic-type ES was associated with outcomes close to proximal-type ES.
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Affiliation(s)
- Anna Maria Frezza
- Department of Medical Oncology, IRCCS Fondazione Istituto Nazionale Tumori, Milan, Italy.
| | - Marta Sbaraglia
- Department of Pathology, Padua University Hospital, Padua, Italy
| | - Salvatore Lo Vullo
- Unit of Clinical Epidemiology and Trial Organization, IRCCS Fondazione Istituto Nazionale Tumori, Milan, Italy
| | | | - Noemi Simeone
- Department of Medical Oncology, IRCCS Fondazione Istituto Nazionale Tumori, Milan, Italy
| | - Filippo Frenos
- Department of Orthopaedic Oncology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Domenico Campanacci
- Department of Orthopaedic Oncology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Silvia Stacchiotti
- Department of Medical Oncology, IRCCS Fondazione Istituto Nazionale Tumori, Milan, Italy
| | - Sandro Pasquali
- Sarcoma Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Dario Callegaro
- Sarcoma Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Gambarotti
- Department of Surgical Pathology, IRCCS-Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Marta Barisella
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Annarita Palomba
- Department of Pathology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Luigi Mariani
- Unit of Clinical Epidemiology and Trial Organization, IRCCS Fondazione Istituto Nazionale Tumori, Milan, Italy
| | - Paolo G Casali
- Department of Medical Oncology, IRCCS Fondazione Istituto Nazionale Tumori, Milan, Italy; University of Milan, Department of Oncology and Hemato-oncology, Milan, Italy
| | | | - Alessandro Gronchi
- Sarcoma Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Bostan E, Yalici-Armagan B, Kosemehmetoglu K, Elcin G. Dermoscopy of a rare case of proximal-type epithelioid sarcoma with oral mucosal and cutaneous metastasis. J Cosmet Dermatol 2020; 19:3441-3443. [PMID: 32250542 DOI: 10.1111/jocd.13400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 02/20/2020] [Accepted: 03/13/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Ecem Bostan
- Department of Dermatology and Venereology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Basak Yalici-Armagan
- Department of Dermatology and Venereology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Kemal Kosemehmetoglu
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gonca Elcin
- Department of Dermatology and Venereology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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57
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Aldarragi A, Hallin M, Jones RL, Qassid OL, Fisher C, Chaudhry I, Thway K. Perineal mass in a 50-year-old man. J Clin Pathol 2020; 73:e5. [PMID: 32111648 DOI: 10.1136/jclinpath-2019-206337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/09/2020] [Accepted: 01/19/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Ameer Aldarragi
- School of Medicine, University of Liverpool, Liverpool, England, UK
| | - Magnus Hallin
- Sarcoma Unit, The Royal Marsden Hospital, London, South West England, UK
| | - Robin L Jones
- Sarcoma Unit, The Royal Marsden Hospital, London, South West England, UK.,The Institute of Cancer Research, London, South West England, UK
| | - Omar L Qassid
- University Hospitals of Leicester, Infirmary Square, Leicester, Leicestershire, UK
| | - Cyril Fisher
- The Institute of Cancer Research, London, South West England, UK.,Department of Musculoskeletal Pathology, Royal Orthopaedic Hospital NHS Foundation Trust, Robert Aitken Institute for Clinical Research, University of Birmingham, Birmingham, England, UK
| | - Iskander Chaudhry
- Department of Histopathology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, L7 8XP, UK, Liverpool, England, United Kingdom
| | - Khin Thway
- Sarcoma Unit, The Royal Marsden Hospital, London, South West England, UK .,The Institute of Cancer Research, London, South West England, UK
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Srinivasan A, Liu M, Parham D, Li M, Wang X, Lu X, Li S, Zhang L, Yu Z. Infantile Epithelioid Sarcoma with Genomic Segmental Amplification of BIRC3/YAP1 as Double Minutes Plus Trisomy 2: A Case Report. Fetal Pediatr Pathol 2020; 39:51-61. [PMID: 31215292 DOI: 10.1080/15513815.2019.1627629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Epithelioid sarcoma is a malignant mesenchymal tumor exhibiting epithelioid cytomorphology and epithelial phenotype. Its histogenesis is unknown, but its tumorigenesis may relate to inactivation of hSNF5/SMARCB1/INI1 tumor suppressor gene. This tumor typically affects young adults and older children, but it is uncommon in infants. Case Report: We describe a unique neoplasm in a 15-month-old infant presenting with a heel mass. The tumor was remarkable for retention of SMARCB1/INI1 expression. Conventional cytogenetic analysis revealed trisomy 2 and double minutes, and SNP array analysis confirmed the trisomy 2 and identified segmental amplification of chromosome 11 containing YAP1 and BIRC3; FISH testing proved that the double minutes consisted of BIRC3 and YAP1, potent oncogenes related to tumorigenesis of several types of tumors but not described in epithelioid sarcoma. Conclusion: Our findings expand the spectrum of cytogenetic alterations in this neoplasm, help in better understanding its tumorigenesis, and suggest potential therapeutic targets.
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Affiliation(s)
- Anand Srinivasan
- Jimmy Everest Section of Pediatric Hematology/Oncology, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OKC, USA
| | - Meng Liu
- Genetic Section of Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OKC, USA.,Department of Hematology, China Medical University First Hospital, Shenyang, China
| | - David Parham
- Pathology and Lab Medicine, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Ming Li
- Genetic Section of Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OKC, USA
| | - Xianfu Wang
- Genetic Section of Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OKC, USA
| | - Xianglan Lu
- Genetic Section of Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OKC, USA
| | - Shibo Li
- Genetic Section of Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OKC, USA
| | - Lijun Zhang
- Department of Hematology, China Medical University First Hospital, Shenyang, China
| | - Zhongxin Yu
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OKC, USA
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Xu Y, Gao H, Gao JL. Myoepithelioma-like tumor of the vulvar region: a case report in China and review of the literature. Diagn Pathol 2020; 15:3. [PMID: 31915021 PMCID: PMC6950797 DOI: 10.1186/s13000-019-0923-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 12/27/2019] [Indexed: 01/30/2023] Open
Abstract
Background Myoepithelioma-like tumor of the vulvar region (MELTVR) is a recently described mesenchymal neoplasm which typically arising in vulvar regions of adult women. Case presentation Here we report a case of a 65-year-old woman who presented with a 6-year history of subcutaneous mass in the vulvar region. The mass had recently increased in size continuously. Histologically, the tumor cells had an epithelioid to spindled shape. Epithelioid tumor cells proliferated singly or in a loosely cohesive manner with myxoid areas, while spindled tumor cells grew in diffuse sheets or storiform arrangements mainly in nonmyxoid areas. Immunohistochemically, the tumor cells were positive for vimentin, epithelial membrane antigen, calponin, and were partially mild to moderate positive for estrogen receptor, but completely negative for S100 protein, glial fibrillary acidic protein, CD34, desmin, SMA and cytokeratin. INI1/SMARCB1 expression was deficient. EWSR1 and FUS genes were intact tested by fluorescence in situ hybridization analysis. Based on these findings, we diagnose this case as MELTVR. The patient remained relapse-free after the lesion was widely excised during 8 months follow-up. Conclusions This disease should be included in the differential diagnostic list of vulvar tumors with epithelioid to spindled morphology. Recognition of its histopathological features and immunohistochemical reactivity will help to understand the tumor better.
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Affiliation(s)
- Yan Xu
- Department of Pathology, East Hospital, Tongji University, 1800 Yuntai Road, Pudong New District, Shanghai, 200120, China.,Central Laboratory, East Hospital, Tongji University, Shanghai, China
| | - Hui Gao
- Department of Pathology, East Hospital, Tongji University, 1800 Yuntai Road, Pudong New District, Shanghai, 200120, China.,Central Laboratory, East Hospital, Tongji University, Shanghai, China
| | - Jin-Li Gao
- Department of Pathology, East Hospital, Tongji University, 1800 Yuntai Road, Pudong New District, Shanghai, 200120, China. .,Central Laboratory, East Hospital, Tongji University, Shanghai, China.
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Cutaneous soft tissue tumors: diagnostically disorienting epithelioid tumors that are not epithelial, and other perplexing mesenchymal lesions. Mod Pathol 2020; 33:66-82. [PMID: 31685962 DOI: 10.1038/s41379-019-0387-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/08/2019] [Accepted: 10/08/2019] [Indexed: 12/19/2022]
Abstract
Cutaneous soft tissue tumors with epithelioid features present a diagnostic challenge given that many entities in this category are rare, and they show morphologic overlap with significantly more common cutaneous epithelial and melanocytic neoplasms. The challenge is compounded by overlapping expression of epithelial or melanocytic markers in some of these entities. A broad spectrum of primary cutaneous epithelioid soft tissue tumors exists, including benign and malignant counterparts of tumors with various differentiation including melanocytic, peripheral nerve sheath, angiomatous, fibrohistiocytic, and myoid or myoepithelial, in addition to translocation-associated tumors lacking a derivative tissue type. Given this spectrum, an initial targeted immunohistochemical panel for epithelioid dermal and subcutaneous neoplasms is recommended, covering a broad spectrum of differentiation. In diagnostically challenging cases, select molecular studies can be employed to make critical distinctions between entities sharing morphologic and immunohistochemical properties. Due to sometimes marked differences in prognosis and treatment, knowledge and familiarity with epithelioid soft tissue tumors is key for any surgical pathologist who evaluates skin and subcutaneous biopsies and excision specimens. This concise review provides brief descriptions, key diagnostic features, and important modern ancillary studies for the diagnosis of non-epithelial, non-melanocytic cutaneous tumors that can exhibit a prominent degree of epithelioid morphology.
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Ahmad Z, Stanazai Q, Wright S, Smolkin M, Ma PC. Primary pleural epithelioid sarcoma of the proximal type: a diagnostic and therapeutic challenge. Transl Lung Cancer Res 2019; 8:700-705. [PMID: 31737506 DOI: 10.21037/tlcr.2019.09.16] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Epithelioid sarcoma (ES) is an uncommon soft tissue neoplasm first described in 1970. It is a unique soft tissue neoplasm of adolescents and younger adults which usually presents as a subcutaneous and deep dermal mass in the distal portions of the extremities. The proximal-type variant of this rare soft tissue neoplasm was only recently reported. The proximal form typically arise in proximal extremities and in the deep parts of pelvis, perineum and genital tract. The proximal type variant has distinct histological characteristics and aggressive clinical course as compared to the distal ES. Inactivation of INI1 has been reported in both distal and proximal variants and can help to make the diagnosis. Furthermore, the proximal variant has a possible association with malignant rhabdoid neoplasm. We describe here a case of primary pleural ES of the proximal type and highlight its diagnostic and therapeutic challenges.
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Affiliation(s)
- Zeeshan Ahmad
- Section of Hematology/Oncology, Department of Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Qasim Stanazai
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Staphanie Wright
- Section of Molecular Pathology, Department of Pathology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Matthew Smolkin
- Section of Molecular Pathology, Department of Pathology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Patrick C Ma
- Penn State Cancer Institute, Penn State Health Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, PA, USA
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Agaimy A. What is new in epithelioid soft tissue tumors? Virchows Arch 2019; 476:81-96. [PMID: 31686193 DOI: 10.1007/s00428-019-02677-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/02/2019] [Accepted: 09/22/2019] [Indexed: 01/03/2023]
Abstract
Epithelioid cell features mimicking carcinomas characterize a variety of histogenetically, phenotypically, and molecularly distinct subsets of mesenchymal neoplasms. In a pathogenetic sense, epithelioid soft tissue tumors basically fall into three main genetic categories: (1) switch/sucrose non-fermenting (SWI/SNF) complex-deficient tumors (with epithelioid sarcoma as their prototype); (2) epithelioid neoplasms driven by specific rare gene fusions (such as sclerosing epithelioid fibrosarcoma with EWSR1 fusions and GLI1-related malignant epithelioid soft tissue neoplasms); and (3) a heterogeneous group encompassing epithelioid variants of diverse other entities. Notably, lesions in the first and third groups may display variable, occasionally prominent, rhabdoid cell morphology, thus further complicating their differential diagnosis. This review summarizes the main clinicopathological, phenotypic, and genotypic features of these diseases and discusses their pertinent differential diagnostic considerations.
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Affiliation(s)
- Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital, Krankenhausstrasse 8-10, 91054, Erlangen, Germany.
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Matos GDR, de Camargo VP, Munhoz RR, de Castro G. Non-gastrointestinal stromal tumours soft tissue sarcomas: an update. Ecancermedicalscience 2019; 13:958. [PMID: 31645886 PMCID: PMC6759358 DOI: 10.3332/ecancer.2019.958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Indexed: 11/21/2022] Open
Abstract
Soft tissue sarcomas (STS) encompass a diverse family of neoplasms of mesenchymal origin, marked by significant heterogeneity in terms of physiopathology, molecular characterisation, natural history and response to different therapies. This review aims to summarise the current strategies for the management of patients with STS, including surgery, systemic treatments and radiation therapy, along with considerations applicable to the most frequent subtypes, as well as particularities associated with less common and specific histologies. It also provides insights into upcoming strategies to tackle this challenging group of diseases.
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Affiliation(s)
- Gustavo Duarte Ramos Matos
- Instituto do Câncer do Estado de São Paulo, São Paulo 01246-000, Brazil.,https://orcid.org/0000-0002-0681-4975
| | - Veridiana Pires de Camargo
- Instituto do Câncer do Estado de São Paulo, São Paulo 01246-000, Brazil.,Onco Star São Luiz Rede D'Or, São Paulo 04544-000, Brazil
| | - Rodrigo Ramella Munhoz
- Instituto do Câncer do Estado de São Paulo, São Paulo 01246-000, Brazil.,Hospital Sírio-Libanês, São Paulo 01308-050, Brazil
| | - Gilberto de Castro
- Instituto do Câncer do Estado de São Paulo, São Paulo 01246-000, Brazil.,Hospital Sírio-Libanês, São Paulo 01308-050, Brazil.,https://orcid.org/0000-0001-8765-3044
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Chen L, Wang L, Zhang X, Yao M, Fu P. Ipsilateral breast metastasis after axillary dissection caused by epithelioid sarcoma: a case report and pathological investigation. Diagn Pathol 2019; 14:111. [PMID: 31615564 PMCID: PMC6792219 DOI: 10.1186/s13000-019-0888-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/11/2019] [Indexed: 11/13/2022] Open
Abstract
Background Epithelioid sarcoma (ES) is a rare malignant soft tissue tumor, commonly occurring in distal extremities, such as fingers, hands and wrists. For oncologists and surgeons, a female patient with enlarged axillary lymph node on one side only is easily diagnosed with an occult breast carcinoma rather than ES. Besides, whole breast metastasis of ES has not been reported yet. Case presentation A 47-year-old Chinese woman came to the outpatient clinic of First Affiliated Hospital of Zhejiang University (FAHZU) with a complaint of an asymptomatic right axillary mass for 3 months. Then she received surgical resection of the right axillary lymph nodes and right supraclavicular lymph nodes. According to the clinical tumor site and routine immunohistochemistry (IHC), suspicion of metastatic epithelial sarcoma and metastatic breast cancer could not be ruled out. Subsequently, with more detailed medical history review and physical examination, a mass on the right forearm was found, which was considered as the primary lesion. Further IHC and Molecular Genetics revealed that all the neoplastic cells exhibited loss of INI1 protein and were negative for ERG gene rearrangement yet positive for epithelial membrane antigen (EMA), cytokeratin (CK) 8, CK19, Vimentin, CD34. The final diagnosis was ES. She received postoperative chemotherapy, without radiotherapy. Unexpectedly, an ipsilateral breast metastasis was developed at ten months after surgery. Regrettably, there was no positive result of the metastatic breast sample, based on a genome sequencing by a 381-cancer-gene panel in a lab. Therefore, she went through another round of chemotherapy and took Apatinib for maintenance treatment. During the last follow-up (26 months after diagnosis), the disease was under control. Conclusion This rare but interesting case enables breast surgeons and pathologists to accumulate more experience of differential diagnosis of axillary mass for personalized treatment in clinical practice. Meanwhile, ipsilateral breast metastasis of ES we reported in the case urges that clinicians attach greater importance to the tumor metastasis mechanism.
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Affiliation(s)
- Luyan Chen
- Department of Breast Center, First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310009, China
| | - Li Wang
- Department of Pathology, Shaoxing People's Hospital, School of Medicine, Zhejiang University, Shaoxing, 312000, China
| | - Xiaochen Zhang
- Department of Oncology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Minya Yao
- Department of Breast Center, First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310009, China
| | - Peifen Fu
- Department of Breast Center, First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310009, China.
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Sparber-Sauer M, Koscielniak E, Vokuhl C, Seitz G, Hallmen E, von Kalle T, Scheer M, Münter M, Bielack SS, Ladenstein R, Fuchs J, Klingebiel T. Epithelioid sarcoma in children, adolescents, and young adults: Localized, primary metastatic and relapsed disease. Treatment results of five Cooperative Weichteilsarkom Studiengruppe (CWS) trials and one registry. Pediatr Blood Cancer 2019; 66:e27879. [PMID: 31215116 DOI: 10.1002/pbc.27879] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/29/2019] [Accepted: 05/28/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Epithelioid sarcoma (ES) is a rare malignant soft-tissue tumor. Little is known about the optimal treatment of primary localized (LD), metastatic (MD), and relapsed disease (RD). METHODS Characteristics, treatment, and outcome of 67 patients registered within the Cooperative Weichteilsarkom Studiengruppe CWS-81, -86, -91, -96, -2002P trials and the registry SoTiSaR were analyzed (1981-2016). RESULTS The median age was 14 years (range, 0.7-26.9); 53 patients had localized disease (LD) and 14 metastatic disease (MD). A total of 58 of 67 patients were treated with primary resection. Resection was microscopically complete (R0) in 35, microscopically incomplete (R1) in 12, macroscopically incomplete (R2) in 20 patients. Radiotherapy (RT) was administered to 33 of 67 patients and 49 of 67 patients received chemotherapy (CHT). Complete remission (CR) was achieved in 45 of 53 (85%) patients with LD. Twenty-seven of 53 patients relapsed after a median time of 0.9 years (range, 0.1-2.3). Relapse therapy consisted of resection (n = 19/27), RT (n = 10/27), CHT (n = 12/27), and limb perfusion (n = 3/27). The five-year event-free survival and overall survival of patients with LD, MD, and RD was 35% (± 12, CI 95%) and 58% (± 14, CI 95%), 7% (± 14, CI 95%), and 9% (± 16, CI 95%), 24% (± 17, CI 95%), and 40% (± 20, CI 95%), respectively. Tumor size, IRS group, tumor invasiveness, nodal status, and best resection correlated with a favorable prognosis in patients with LD while best resection was the only significant factor in patients with RD. CONCLUSIONS Complete tumor resection correlates with long-term survival in patients with ES.
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Affiliation(s)
- Monika Sparber-Sauer
- Klinikum Stuttgart - Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pediatrics 5 (Oncology, Hematology, Immunology), Stuttgart, Germany
| | - Ewa Koscielniak
- Klinikum Stuttgart - Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pediatrics 5 (Oncology, Hematology, Immunology), Stuttgart, Germany.,Children's Hospital, Department of Pediatric Hematology and Oncology, Tuebingen, Germany
| | - Christian Vokuhl
- Kiel Pediatric Tumor Registry, Section of Pediatric Pathology, Department of Pathology, Kiel, Germany
| | - Guido Seitz
- University Children's Hospital Marburg, Department of Pediatric Surgery, Marburg, Germany
| | - Erika Hallmen
- Klinikum Stuttgart - Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pediatrics 5 (Oncology, Hematology, Immunology), Stuttgart, Germany
| | - Thekla von Kalle
- Klinikum Stuttgart - Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Olgahospital, Institute of Radiology, Stuttgart, Germany
| | - Monika Scheer
- Klinikum Stuttgart - Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pediatrics 5 (Oncology, Hematology, Immunology), Stuttgart, Germany
| | - Marc Münter
- Klinikum Stuttgart, Institute of Radiotherapy, Stuttgart, Germany
| | - Stefan S Bielack
- Klinikum Stuttgart - Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pediatrics 5 (Oncology, Hematology, Immunology), Stuttgart, Germany.,University of Muenster, Department of Pediatric Hematology and Oncology, Muenster, Germany
| | | | - Joerg Fuchs
- University Children's Hospital, Department of Pediatric Surgery and Urology, Tuebingen, Germany
| | - Thomas Klingebiel
- University of Frankfurt, Hospital for Children and Adolescents, Frankfurt, Germany
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66
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Chien Y, Hsieh T, Chu P, Hsieh S, Liu M, Lee J, Liu Y, Ku J, Kao Y. Primary malignant epithelioid and rhabdoid tumor of bone harboring
ZNF532‐NUTM1
fusion: the expanding NUT cancer family. Genes Chromosomes Cancer 2019; 58:809-814. [DOI: 10.1002/gcc.22785] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/08/2019] [Accepted: 07/10/2019] [Indexed: 12/20/2022] Open
Affiliation(s)
- Yen‐Wei Chien
- Department of Pathology, Wan Fang HospitalTaipei Medical University Taipei Taiwan
| | - Tsung‐Han Hsieh
- Joint Biobank, Office of Human ResearchTaipei Medical University Taipei Taiwan
| | - Ping‐Yuan Chu
- Department of Pathology, Shuang Ho HospitalTaipei Medical University New Taipei City Taiwan
| | - Shu‐Min Hsieh
- Department of Pathology, Shuang Ho HospitalTaipei Medical University New Taipei City Taiwan
| | - Mei‐Ling Liu
- Department of Pathology, Shuang Ho HospitalTaipei Medical University New Taipei City Taiwan
| | - Jen‐Chieh Lee
- Department and Graduate Institute of Pathology, National Taiwan University HospitalNational Taiwan University College of Medicine Taipei Taiwan
| | - Yun‐Ru Liu
- Joint Biobank, Office of Human ResearchTaipei Medical University Taipei Taiwan
| | - Jan‐Wen Ku
- Department of Radiology, Shuang Ho HospitalTaipei Medical University New Taipei City Taiwan
| | - Yu‐Chien Kao
- Department of Pathology, Shuang Ho HospitalTaipei Medical University New Taipei City Taiwan
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67
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Evert M, Schildhaus HU. [Epithelioid, biphasic and mixed tumors of soft tissue]. DER PATHOLOGE 2019; 40:393-411. [PMID: 31243551 DOI: 10.1007/s00292-019-0627-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Epithelioid soft tissue tumors consist exclusively of epithelioid tumor cells. Biphasic tumors are composed of both a spindle-cell and an epithelioid component. The rare mixed tumors of soft tissue show a broader variety of cellular and stromal differentiation but also include at least one, possibly several, epithelioid portions.The close morphological similarity of some of these entities with each other, as well as with the more frequent soft tissue metastases of carcinomas, carcinosarcomas, and melanomas, to malignant mesothelioma and certain lymphomas, can often make the correct diagnosis extremely difficult. Recent advances in the detection of certain molecular alterations (mostly chromosomal translocations) have contributed to changes in tumor classification but also to improved pathological diagnostics (e.g. through the development of potent diagnostic antibodies) and biological understanding.The present overview should help the pathologist in the diagnosis of these rare tumors through the classical approach of morphological pattern recognition. The most important entities are discussed and illustrated in more detail, with the incorporation of the latest immunohistochemical and molecular aspects and the differential diagnosis of similar tumors.
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Affiliation(s)
- M Evert
- Institut für Pathologie, Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | - H-U Schildhaus
- Institut für Pathologie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland
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68
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Huang X, Nayar R, Zhou H. Primary adrenal gland epithelioid sarcoma: A case report and literature review. Diagn Cytopathol 2019; 47:918-921. [DOI: 10.1002/dc.24211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 04/08/2019] [Accepted: 04/22/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Xiao Huang
- Department of PathologyNorthwestern University, Feinberg School of Medicine Chicago Illinois
| | - Ritu Nayar
- Department of PathologyNorthwestern University, Feinberg School of Medicine Chicago Illinois
| | - Haijun Zhou
- Department of Pathology and Genomic MedicineHouston Methodist Hospital Houston Texas
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69
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Tran H, Shillingford N, Thomas S, Hammoudeh J, Zhou S. Primary Epithelioid Sarcoma of the Zygomatic Bone. Pediatr Dev Pathol 2019; 22:252-257. [PMID: 27442626 DOI: 10.2350/16-03-1798-cr.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Primary epithelioid sarcoma (ES) of bone is extremely rare with only 2 reported cases in the English literature. A previously healthy 18-year-old man presented with a 6-month history of right facial numbness and tingling and right eye diplopia. A computerized tomography scan revealed an ill-defined mass with dense osseous matrix centered in the right zygomatic bone. An outside biopsy was read as osteosarcoma. The resection specimen revealed large epithelioid and spindle cells embedded in a prominent hyalinized matrix with focal metaplastic bone formation. The tumor cells were strongly and diffusely positive for AE1/AE3 and epithelial membrane antigen, but a definitive diagnosis of ES was not immediately reached due to the presence of dense hyalinized matrix and weak expression of SAT2B by tumor cells. Deficient INI1 protein expression by immunohistochemistry and homozygous loss of the SMARCB1 gene by chromosomal microarray analysis ultimately justified this tumor's designation as ES.
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Affiliation(s)
- Henry Tran
- 1 Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California
| | - Nick Shillingford
- 1 Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California.,2 Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Stefanie Thomas
- 2 Keck School of Medicine, University of Southern California, Los Angeles, California.,3 Division of Hematology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Jeffrey Hammoudeh
- 2 Keck School of Medicine, University of Southern California, Los Angeles, California.,4 Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Shengmei Zhou
- 1 Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California.,2 Keck School of Medicine, University of Southern California, Los Angeles, California
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70
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Agaimy A. SWI/SNF Complex-Deficient Soft Tissue Neoplasms: A Pattern-Based Approach to Diagnosis and Differential Diagnosis. Surg Pathol Clin 2019; 12:149-163. [PMID: 30709441 DOI: 10.1016/j.path.2018.10.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Loss of different components of the Switch/sucrose nonfermentable (SWI/SNF) chromatin remodeling complex has been increasingly recognized as a central molecular event driving the initiation and/or dedifferentiation of mostly lethal but histogenetically diverse neoplasms in different body organs. This review summarizes and discusses the morphologic and phenotypic diversity of primary soft tissue neoplasms characterized by SWI/SNF complex deficiency with an emphasis on convergent and divergent cytoarchitectural patterns.
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Affiliation(s)
- Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), University Hospital, Krankenhausstrasse 8-10, 91054 Erlangen, Germany.
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71
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Gajdzis P, Laé M, Klijanienko J. FNA of epithelioid sarcoma: Curie Institute experience and critical review of the literature. Cancer Cytopathol 2018; 126:934-941. [PMID: 30291790 DOI: 10.1002/cncy.22052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/25/2018] [Accepted: 07/25/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Epithelioid sarcoma (ES) is a rare mesenchymal tumor that is divided into 2 types: classic and proximal. To the authors' knowledge, ES has been poorly studied in cytology, with fewer than 50 cases reported to date. The objective of the current study was to analyze the cytological and immunohistochemical information regarding 5 cases of ES. METHODS Five cases of ES were analyzed: 4 of proximal type and 1 of classic type. The cases were taken from 4 female patients and 1 male patient. The patients ranged in age from 10 to 75 years. RESULTS All smears obtained from the proximal type of ES were found to be hypercellular with a necrotic and inflammatory background. Smears from classic-type ES were hypocellular with a hemorrhagic background. Large, dispersed epithelioid cells and loosely cohesive groups of cells were most frequently noted in all cases. All cases of proximal-type ES demonstrated rhabdoid cells and marked nuclear atypia, but in only one case were rhabdoid cells found to be dominant. ES diagnoses were confirmed by immunohistochemistry in histological material. In 4 cases, epithelial marker expression was noted, whereas CD34 was found to be positive in only the classic type of ES. In 2 cases, total loss of SMARCB1/INI1 nuclear expression was observed. In the 2 SMARCB1/INI1-positive cases, loss of SMARCA2/BRM expression was observed in one case and partial loss was observed in the other case. CONCLUSIONS The proximal type of ES differs from the classic type by the presence of rhabdoid cells and marked nuclear atypia. A specific immunohistochemical profile demonstrating loss of SMARCB1/INI1 or other proteins from the SWI/SNF complex also may be indicative of this diagnosis.
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Affiliation(s)
- Paweł Gajdzis
- Department of Pathomorphology and Oncological Cytology, Wroclaw Medical University, Wroclaw, Poland.,Department of Pathology, Curie Institute, Paris, France
| | - Marick Laé
- Department of Pathology, Curie Institute, Paris, France
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72
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Rajeev LK, Asati V, Mallekavu SB, Babu KG, Champka G. Epithelioid Sarcoma Presenting as Recurrent Thumb Ulcer: A Lesson to Learn. Indian J Med Paediatr Oncol 2018. [DOI: 10.4103/ijmpo.ijmpo_87_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AbstractEpithelioid sarcoma (ES) first described by Enzinger in 1970,1 is a rare soft-tissue sarcoma typically presenting as a subcutaneous or deep dermal mass in distal portions of the extremities of adolescents and young adults. They are frequently mistaken for ulcers, abscesses, or infected warts that fail medical management. Patients often develop multiple local recurrences of long duration, with subsequent metastases in 30%–50% of cases.2 We here report a case of left thumb ES that presented as an ulcer and subsequently metastasized to the forearm, arm, axillary lymph nodes, and lungs.
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Affiliation(s)
| | - Vikas Asati
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Suresh Babu Mallekavu
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - K Govind Babu
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - G Champka
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
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73
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Yue Y, Lu Y, Ma X, Tang Z, Cheng Y. Ultrasonography findings of proximal-type epithelioid sarcoma of the vulva: A case report. Mol Clin Oncol 2018; 9:507-510. [PMID: 30345044 DOI: 10.3892/mco.2018.1708] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/30/2018] [Indexed: 02/05/2023] Open
Abstract
Proximal-type epithelioid sarcoma (PES) of the vulva is an exceedingly rare malignant soft tissue tumor. We herein present the case of a 41-year-old female patient who presented to our hospital with complaints of a painless mass in the right mons pubis that she had first noticed 3 years prior. Ultrasonographic (US) and color Doppler ultrasonographic (CDUS) examination revealed a solid mass with well-defined, homogeneous hypoechoic structure and quite hypervascular on CDUS. The results of the immunohistochemical examination confirmed the diagnosis of vulvar PES (myxoid variant). The patient was treated with wide local excision and remained recurrence- and metastasis-free at 9 months postoperatively. Although cases of PES in the pelvic region had been previously reported, to the best of our knowledge, the US or CDUS findings of PES of the vulva have not been described to date.
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Affiliation(s)
- Yuanyuan Yue
- Department of Ultrasound, Chengdu First People's Hospital, Chengdu, Sichuan 610041, P.R. China
| | - Ya Lu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan 610065, P.R. China
| | - Xiaojuan Ma
- Department of Ultrasound, Chengdu First People's Hospital, Chengdu, Sichuan 610041, P.R. China
| | - Zhongping Tang
- Department of Pathology, Chengdu First People's Hospital, Chengdu, Sichuan 610041, P.R. China
| | - Yinrong Cheng
- Department of Ultrasound, Chengdu First People's Hospital, Chengdu, Sichuan 610041, P.R. China
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Abstract
INTRODUCTION Epithelioid sarcoma is a malignant soft tissue tumor arising from mesenchymal tissue and usually occurs in the extremities. The tumor involving the head and neck region is extremely rare. We present radiologically well-documented case of an epithelioid sarcoma arising from the temporal space. CASE PRESENTATION A 35-year-old woman presented with a slowly growing, painless palpable mass in the left temporal area. Ultrasound (US) revealed a lobulated hypoechoic mass with internal vascularity. On magnetic resonance (MR) imaging, the mass showed heterogeneous signal intensity with a central necrotic area and peritumoral infiltration. On the basis of the clinical and radiological characteristics, the lesion was considered to be a malignant tumor originating from soft tissue. An incisional biopsy was performed. The diagnosis of epithelioid sarcoma was based on microscopic examination and immunohistochemical analysis. F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) was used to stage the tumor and demonstrated intense FDG uptake in the mass without regional lymph node or distant metastasis. After the pathologic diagnosis of epithelioid sarcoma, the patient underwent total surgical resection of the tumor followed by postoperative irradiation. There was no evidence of recurrent disease during the follow-up period of 18 months. CONCLUSION An epithelioid sarcoma should be considered in the differential diagnosis of a locally aggressive lesion occurring in the temporal space of head and exhibiting a heterogeneous appearance on imaging studies, including a central necrotic area and signal intensity suggestive of infiltration of soft tissue adjacent to the tumor. It is, however, true that head-and-neck involvement is very rare, and the radiological findings are not pathognomonic.
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Affiliation(s)
- Yong Seek Kim
- Department of Radiology, Chonbuk National University Medical School and Hospital
| | - Hyo Sung Kwak
- Department of Radiology, Chonbuk National University Medical School and Hospital
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital
| | - Gyung Ho Chung
- Department of Radiology, Chonbuk National University Medical School and Hospital
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital
| | - Yo Na Kim
- Department of Pathology, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea
| | - Seungbae Hwang
- Department of Radiology, Chonbuk National University Medical School and Hospital
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital
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75
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Flikweert PE, Bollen TL, Speth MJGM, Wolterbeek N, Timmerman L. Primary intra-articular epithelioid sarcoma of the knee: Unusual presentation of a rare entity. J Orthop 2018; 15:826-828. [PMID: 30140127 DOI: 10.1016/j.jor.2018.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/03/2018] [Indexed: 11/15/2022] Open
Abstract
We report a case of a 60-year-old female with severe and progressive pain of her right knee. Physical therapy, pain medication, and arthroscopic debridement were unsuccessful. Finally, pathological examination revealed an intra-articular epithelioid sarcoma, a rare tumor in an atypical location. Patient died within 5 months after initial admission. Despite this unusual clinical course and presentation, we would like to share the valuable clinical lessons we learned from this case. Introduction of a coordinating physician in combination with a multidisciplinary treatment regarding optimal pain management should optimize treatment results in future patients.
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Affiliation(s)
- P E Flikweert
- Department of Orthopaedic Surgery, St. Antonius Hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands.,Department of Orthopaedic Surgery, HagaZiekenhuis, Els Borst-Eilersplein 275, 2545 AA, Den Haag, The Netherlands
| | - T L Bollen
- Department of Radiology, St. Antonius Hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands
| | - M J G M Speth
- Department of Orthopaedic Surgery, St. Antonius Hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands
| | - N Wolterbeek
- Department of Orthopaedic Surgery, St. Antonius Hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands
| | - L Timmerman
- Department of Anesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands
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76
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Liu Y, Sun B, Yang Y, Zhong L, He X, Wang M, Wang K, Chen L. Proximal-type epithelioid sarcoma of the oral cavity: a case report and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:e258-e263. [PMID: 30087080 DOI: 10.1016/j.oooo.2018.05.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/13/2018] [Accepted: 05/29/2018] [Indexed: 12/31/2022]
Abstract
Proximal-type epithelioid sarcoma (PES) is an exceedingly rare malignant tumor of soft tissue; PES within the oral cavity is even rarer. Pathologic examination is the primary diagnostic modality, and surgical treatment is recommended as the preferred method for the treatment of PES. Currently, there is a paucity of literature that systematically reports on PES in the oral cavity. Here, we describe a 42-year-old man with PES in the oral cavity, which showed positivity for vimentin, cytokeratin, CD31, S-100 but did not express BCL-2, HMB-45, or desmin. We performed a wide excision and neck dissection, and then used the free anterolateral thigh flap to reconstruct the defect in the soft tissue. Furthermore, we review the current literature with regard to diagnosis and treatment of PES.
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Affiliation(s)
- Yutong Liu
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, P. R. China
| | - Bincan Sun
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, P. R. China
| | - Yaocheng Yang
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, P. R. China
| | - Liang Zhong
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, P. R. China
| | - Xifan He
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, P. R. China
| | - Mengxue Wang
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, P. R. China
| | - Kai Wang
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, P. R. China.
| | - Lin Chen
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, P. R. China.
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77
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Sakurai T, Kusumoto H, Wakasa T, Ohta Y, Konishi E, Shiono H. Epithelioid sarcoma in the chest wall: a case report and literature review. Surg Case Rep 2018; 4:77. [PMID: 30006912 PMCID: PMC6045564 DOI: 10.1186/s40792-018-0483-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/02/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Epithelioid sarcoma (ES) is a rare variant of soft tissue sarcoma. The proximal type of ES occurs in various locations. We present a resected case with proximal-type ES that occurred in the chest wall and discuss the relevant literature. CASE PRESENTATION A 47-year-old woman was referred for a 6-month history of a right anterior chest mass with tenderness. Chest computed tomography showed an invasive chest wall mass with calcification surrounding the third rib. Aspiration biopsy cytology suggested malignancy. We performed wide resection, including the middle part of the pectoralis major muscle, the pectoralis minor muscle, the third and fourth ribs, and reconstruction of the chest wall, using a 2-mm polytetrafluoroethylene patch. Severe deformation of the chest wall was avoided. Postoperative physical therapy of the shoulder was effective for the continuous pain and weakness of the arm. She has remained alive for 1 year and 10 months without recurrence. Our literature review showed five previously reported cases of ES in the chest wall, and all of these were surgically resected. Two of these patients suffered from frequent local recurrence and died of disease. CONCLUSIONS ES in the chest wall is rare. Previous reports have indicated that surgical resection with tumor-free margins is essential for treatment. We performed complete resection of the tumor in our case, and a polytetrafluoroethylene patch was effective for reconstructing the deficit in the chest wall.
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Affiliation(s)
- Teiko Sakurai
- Department of General Thoracic Surgery, Kindai University Nara Hospital, Otoda-cho 1248-1, Ikoma, Nara, 630-0293, Japan.
| | - Hidenori Kusumoto
- Department of General Thoracic Surgery, Kindai University Nara Hospital, Otoda-cho 1248-1, Ikoma, Nara, 630-0293, Japan
| | - Tomoko Wakasa
- Diagnostic Pathology and Laboratory Medicine, Kindai University Nara Hospital, Otoda-cho 1248-1, Ikoma, Nara, 630-0293, Japan
| | - Yoshio Ohta
- Diagnostic Pathology and Laboratory Medicine, Kindai University Nara Hospital, Otoda-cho 1248-1, Ikoma, Nara, 630-0293, Japan
| | - Eiichi Konishi
- Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hiroyuki Shiono
- Department of General Thoracic Surgery, Kindai University Nara Hospital, Otoda-cho 1248-1, Ikoma, Nara, 630-0293, Japan
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78
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Sundaram A, Elangovan A, Rajwanshi A, Srinivasan R, Kapoor R. Proximal-type epithelioid sarcoma of the vulva: Cytopathological diagnosis of a rare neoplasm. Cytopathology 2018; 29:471-473. [PMID: 29683530 DOI: 10.1111/cyt.12561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2018] [Indexed: 11/28/2022]
Affiliation(s)
- A Sundaram
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A Elangovan
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A Rajwanshi
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Srinivasan
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Kapoor
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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79
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Haque M, Hameed N, Perry CT, Carter E, Mneimneh WS. Malignant Peritoneal Mesothelioma in the setting of a Ventriculo-Peritoneal Shunt: A novel clinical presentation. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2018; 12:1179554918779583. [PMID: 29899672 PMCID: PMC5992800 DOI: 10.1177/1179554918779583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 04/28/2018] [Indexed: 11/15/2022]
Abstract
We report a case of malignant peritoneal mesothelioma (MPM) in a 31-year-old male with history of cerebral palsy, hydrocephalus, and ventriculoperitoneal shunt (VPS) placed since infancy. He presented with fever, abdominal pain and distension. Computed tomography scan revealed a thick-walled rim-enhancing fluid collection, interpreted as pseudocyst. Intraoperatively, diffuse nodular peritoneal thickening with adhesions was demonstrated. The resection specimen consisted of multiple membranous fragments displaying firm nodules. Microscopic examination revealed a tumefactive malignant-appearing epithelioid proliferation involving the peritoneum, focally invading the underlying fat. Immunohistochemically, the tumor cells expressed keratin AE1/AE3, CK7, CK5/6, Calretinin, WT1 and D2-40, and were negative for CEA and MOC31. The findings were consistent with MPM, epithelioid type. The patient's condition continued to decline with increasing abdominal distension during the month following the original diagnosis. While atypical mesothelial hyperplasia has been described in association with long standing VPS, well-documented cases of MPM have not been previously reported in such context.
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Affiliation(s)
- Monira Haque
- Monira Haque, Department of Pathology, University of South Alabama, 2451 USA Medical Center Drive, Mobile, AL 36617, USA. ;
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80
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Hung YP, Hornick JL. Immunohistochemical Biomarkers of Mesenchymal Neoplasms in Endocrine Organs: Diagnostic Pitfalls and Recent Discoveries. Endocr Pathol 2018; 29:189-198. [PMID: 29340997 DOI: 10.1007/s12022-018-9513-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Mesenchymal neoplasms rarely present in or adjacent to endocrine organs. In this context, the recognition of these rare tumor types can be challenging, with significant potential for misdiagnosis as sarcomatoid carcinomas (i.e., anaplastic thyroid carcinoma and sarcomatoid adrenal cortical carcinoma) or neuroendocrine carcinomas, depending upon the dominant histologic patterns. In this review, we address potential pitfalls in diagnosing selected mesenchymal neoplasms arising within or near endocrine organs, including dedifferentiated liposarcoma, synovial sarcoma, angiosarcoma, PEComa, proximal-type epithelioid sarcoma, Ewing sarcoma, and neuroblastoma. For each of these tumor types, we review clinical and pathologic features, histologic clues to distinguish them from endocrine neoplasms, and recently developed immunohistochemical markers that can be particularly useful for establishing the correct diagnosis.
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Affiliation(s)
- Yin P Hung
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
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82
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Sambri A, Bianchi G, Cevolani L, Donati D, Abudu A. Can radical margins improve prognosis in primary and localized epithelioid sarcoma of the extremities? J Surg Oncol 2018; 117:1204-1210. [PMID: 29266231 DOI: 10.1002/jso.24955] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 11/14/2017] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Epithelioid sarcoma (ES) has a tendency to locally recur, spread proximally, and metastasize, in particular to lymphnodes and lungs. The aim of this report is to study the role of surgery and the extent of margins required for optimal management of patients with localized epithelioid sarcoma of the extremities. MATERIAL AND METHODS We retrospectively evaluated 77 patients affected by ES of the extremities treated at two different Institutions. RESULTS Twenty-two patients had metastasis at diagnosis. Estimated survival was 65.5% at 5 years and 50.9% at 10 years, with a better prognosis in patients with localized disease at diagnosis (P < 0.001). Among patients with localized disease, a significantly better survival was found in patients with primary tumors in which radical surgical margins were achieved (P = 0.043). Among 47 patients presenting with primary tumors, local recurrence-free rate was 72.9% at 5 years, and 61.9% at 10 years, with a better local control achieved in patients with radical margins were achieved (P = 0.026). DISCUSSION We believe that the best approach to improve both local control and survival is to aim for radical margins in patients with primary tumors. Therefore, the best chance for cure is if the first treatment is the right treatment, which we believe to be radical margins.
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Affiliation(s)
- Andrea Sambri
- Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Bianchi
- Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Cevolani
- Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide Donati
- Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
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83
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Rajeev LK, Asati V, Babu S, Babu G, Champaka G. Epithelioid Sarcoma Presenting as Recurrent Thumb Ulcer: a Lesson to Learn. Indian J Surg Oncol 2018; 9:251-253. [PMID: 29887710 DOI: 10.1007/s13193-018-0727-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 01/18/2018] [Indexed: 11/30/2022] Open
Abstract
Epithelioid sarcoma first described by Enzinger (Cancer 26:1029-41, 1970) is a rare soft-tissue sarcoma typically presenting as a subcutaneous or deep dermal mass in distal portions of the extremities of adolescents and young adults. They are frequently mistaken for ulcers, abscesses, or infected warts that fail medical management. Patients often develop multiple local recurrences of long duration, with subsequent metastases in 30 to 50% of cases (Chase and Enzinger (Am J Surg Pathol 9:241-63, 1985)). We here report a case of left thumb epithelioid sarcoma that presented as an ulcer and subsequently metastasized to forearm, arm, axillary lymph nodes, and lungs.
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Affiliation(s)
- L K Rajeev
- 1Department of Medical Oncology, Kidwai Memorial Institute of Oncology, 214, Men's Hostel, Bangalore, 560029 India
| | - Vikas Asati
- 1Department of Medical Oncology, Kidwai Memorial Institute of Oncology, 214, Men's Hostel, Bangalore, 560029 India
| | - Suresh Babu
- 1Department of Medical Oncology, Kidwai Memorial Institute of Oncology, 214, Men's Hostel, Bangalore, 560029 India
| | - Govind Babu
- 1Department of Medical Oncology, Kidwai Memorial Institute of Oncology, 214, Men's Hostel, Bangalore, 560029 India
| | - G Champaka
- 2Department of Pathology, Kidwai Memorial Institute of Oncology, Bangalore, India
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84
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Stephen NS, Gochhait D, Dehuri P, Subramanian H, Goldar RS. Cytomorphology of proximal epithelioid sarcoma in the paratesticular location. Cytopathology 2018; 29:386-389. [PMID: 29508464 DOI: 10.1111/cyt.12528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2017] [Indexed: 11/30/2022]
Affiliation(s)
- N S Stephen
- Department of Pathology, JIPMER, Puducherry, India
| | - D Gochhait
- Department of Pathology, JIPMER, Puducherry, India
| | - P Dehuri
- Department of Pathology, JIPMER, Puducherry, India
| | | | - R S Goldar
- Department of Pathology, Indira Gandhi Government General Hospital, Puducherry, India
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85
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Arnaud O, Le Loarer F, Tirode F. BAFfling pathologies: Alterations of BAF complexes in cancer. Cancer Lett 2018; 419:266-279. [PMID: 29374542 DOI: 10.1016/j.canlet.2018.01.046] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 01/08/2023]
Abstract
To activate or repress specific genes, chromatin is constantly modified by chromatin-remodeling complexes. Among these complexes, the SWItch/Sucrose Non-Fermenting (SWI/SNF) complex, also referred to as BRG1-Associated Factor (BAF) complex, moves the nucleosome along chromatin using energy provided by ATP hydrolysis. In mammalian organisms, the SWI/SNF complex is composed of 10-15 subunits, depending on cell type, and a defect in one of these subunits can have dramatic consequences. In this review we will focus on the alterations identified in the SWI/SNF (BAF) complex subunits that lead to cancerous pathologies. While SMARCB1 was the first mutated subunit to be reported in a majority of malignant rhabdoid tumors, the advent of next-generation sequencing allowed the discovery of mutations in various SWI/SNF subunits within a broad spectrum of cancers. In most cases, the mutation leads to a loss of expression or to a truncated subunit unable to perform its function. Even though it is now commonly acknowledged that approximately 20% of all cancers present a mutation in a SWI/SNF subunit, some cancers are associated to a specific alteration of a SWI/SNF subunit, which acts either as tumor suppressor genes or as oncogenes, and therefore constitute diagnostic or prognostic biomarkers. Consistently, therapeutic strategies targeting SWI/SNF subunits or the genes affected downstream have been revealed to treat cancers.
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Affiliation(s)
- Ophelie Arnaud
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Cancer Research Center of Lyon, Centre Léon Bérard, F-69008, Lyon, France
| | | | - Franck Tirode
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Cancer Research Center of Lyon, Centre Léon Bérard, F-69008, Lyon, France; Department of Translational Research and Innovation, Centre Léon Bérard, F-69008, Lyon, France.
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86
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Abstract
The SMARCB1 gene ( INI1, BAF47) is a member of the SWItch/Sucrose Non-Fermentable (SWI/SNF) chromatin remodeling complex, involved in the epigenetic regulation of gene transcription. SMARCB1 acts as a tumor suppressor gene, and loss of function of both alleles gives rise to SMARCB1-deficient tumors. The prototypical SMARCB1-deficient tumor is the malignant rhabdoid tumor (MRT) which was first described in the kidney but also occurs in soft tissue, viscera, and the brain (where it is referred to as atypical teratoid rhabdoid tumor or AT/RT). These are overwhelmingly tumors of the very young, and most follow an aggressive and ultimately lethal course. Morphologically, most but not all contain a population of "rhabdoid" cells, which are large cells with abundant cytoplasm, perinuclear spherical inclusions, and eccentric vesicular nuclei with large inclusion-like nucleoli. MRT immunohistochemistry reveals complete loss of SMARCB1 nuclear expression, and molecular analysis confirms biallelic SMARCB1 inactivation in the vast majority. Rare AT/RTs have loss of SMARCA4, another SWI/SNF member, rather than SMARCB1. With the widespread adoption of SMARCB1 immunohistochemistry, an increasing number of SMARCB1-deficient tumors outside of the MRT-AT/RT spectrum have been described. In addition to MRT and AT/RT, pediatric tumors with complete loss of SMARCB1 expression include cribriform neuroepithelial tumor, renal medullary carcinoma, and epithelioid sarcoma. Tumors with variable loss of SMARCB1 expression include subsets of epithelioid malignant peripheral nerve sheath tumor, schwannomas arising in schwannomatosis, subsets of chordomas, myoepithelial carcinomas, and sinonasal carcinomas. Variable and reduced expression of SMARCB1 is characteristic of synovial sarcoma. In this review, the historical background, clinical characteristics, morphology, immunohistochemical features, and molecular genetics most germane to these tumors are summarized. In addition, familial occurrence of these tumors (the rhabdoid tumor predisposition syndrome) is discussed. It is hoped that this review may provide practical guidance to pathologists encountering tumors that have altered expression of SMARCB1.
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Affiliation(s)
- Bruce R Pawel
- 1 Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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87
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Siontis BL, Chugh R, Schuetze SM. The potential of emerging therapeutics for epithelioid sarcoma. Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2017.1405805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Brittany L. Siontis
- Hematology/Oncology Fellow, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Rashmi Chugh
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Scott M. Schuetze
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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88
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Zhang Y, Liu F, Pan Y, Liang J, Jiang Y, Jin Y. Clinicopathological analysis of myxoid proximal-type epithelioid sarcoma. J Cutan Pathol 2017; 45:151-155. [PMID: 29068073 DOI: 10.1111/cup.13069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/16/2017] [Accepted: 10/19/2017] [Indexed: 12/28/2022]
Abstract
Proximal-type epithelioid sarcoma (ES) with a diffuse myxoid stroma is rare. Here, we report the case of a 33-year-old man with a perineal mass. Imaging showed the presence of a poorly demarcated 6.9 × 5.3-cm mass in the subcutaneous perineal region. Macroscopic examination showed that the resected tissues were partially necrotic. Histological examination showed that the tumor comprised numerous large or pleomorphic epithelioid cells with large vesicular nuclei and prominent nucleoli. A clear background of necrosis and inflammatory exudates was also present. Immunohistochemical examination showed that the tumor cells were positive for vimentin and CD34 - both of which were expressed throughout the cytoplasm - but typically did not express nuclear INI1 (SMARCB1). Hematoxylin-eosin staining (HE staining) showed that the mucin content of the tumor was approximately 80%. The patient was diagnosed with proximal-type ES with myxoid features. The patient died due to disease progression after 2 months of follow-up and without undergoing further treatment in our department. To our knowledge, only 2 cases of proximal-type ES with diffuse myxoid stroma have been reported. Proximal-type ES is rare, and this is the first case report of proximal ES with myxoid features in the perineal area.
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Affiliation(s)
- Yanyang Zhang
- Department of Interventional Radiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Furong Liu
- Department of General Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuhang Pan
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing Liang
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ye Jiang
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yi Jin
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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89
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Proximal-Type Epithelioid Sarcoma in Skull Base: a Pathological Diagnosis Challenge with Other Intracranial Tumors. Pathol Oncol Res 2017; 25:201-208. [DOI: 10.1007/s12253-017-0318-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
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90
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Wei S, Henderson-Jackson E, Qian X, Bui MM. Soft Tissue Tumor Immunohistochemistry Update: Illustrative Examples of Diagnostic Pearls to Avoid Pitfalls. Arch Pathol Lab Med 2017; 141:1072-1091. [PMID: 28745570 DOI: 10.5858/arpa.2016-0417-ra] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CONTEXT - Current 2013 World Health Organization classification of tumors of soft tissue arranges these tumors into 12 groups according to their histogenesis. Tumor behavior is classified as benign, intermediate (locally aggressive), intermediate (rarely metastasizing), and malignant. In our practice, a general approach to reaching a definitive diagnosis of soft tissue tumors is to first evaluate clinicoradiologic, histomorphologic, and cytomorphologic features of the tumor to generate some pertinent differential diagnoses. These include the potential line of histogenesis and whether the tumor is benign or malignant, and low or high grade. Although molecular/genetic testing is increasingly finding its applications in characterizing soft tissue tumors, currently immunohistochemistry still not only plays an indispensable role in defining tumor histogenesis, but also serves as a surrogate for underlining molecular/genetic alterations. Objective- To provide an overview focusing on the current concepts in the classification and diagnosis of soft tissue tumors, incorporating immunohistochemistry. This article uses examples to discuss how to use the traditional and new immunohistochemical markers for the diagnosis of soft tissue tumors. Practical diagnostic pearls, summary tables, and figures are used to show how to avoid diagnostic pitfalls. DATA SOURCES - Data were obtained from pertinent peer-reviewed English-language literature and the authors' first-hand experience as bone and soft tissue pathologists. CONCLUSIONS - -The ultimate goal for a pathologist is to render a specific diagnosis that provides diagnostic, prognostic, and therapeutic information to guide patient care. Immunohistochemistry is integral to the diagnosis and management of soft tissue tumors.
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Affiliation(s)
| | | | | | - Marilyn M Bui
- From the Department of Pathology, The University of Alabama at Birmingham, Birmingham (Dr Wei); the Departments of Anatomic Pathology (Drs Henderson-Jackson and Bui) and Sarcoma (Dr Bui), Moffitt Cancer Center, Tampa, Florida; Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, and Dana Farber Cancer Institute, Boston, Massachusetts (Dr Qian); and the Department of Cytopathology Fellowship, Morsani College of Medicine at the University of South Florida, Tampa (Dr Bui)
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91
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Abstract
The mesenchymal tumors discussed herein represent a heterogeneous group of neoplasms with distinctive morphologic, immunophenotypic, and molecular genetic features. These uncommon tumors often arise in the dermis and subcutis and can pose a major diagnostic challenge to dermatopathologists because they closely mimic melanoma, carcinoma, fibrous histiocytoma, schwannoma, or granulomatous inflammation. This article reviews the clinical presentation, histopathology, differential diagnosis, and diagnostic pitfalls of epithelioid sarcoma, clear cell sarcoma, perivascular epithelioid cell tumor, ossifying fibromyxoid tumor, pleomorphic hyalinizing angiectatic tumor, and hemosiderotic fibrolipomatous tumor. Associated molecular genetic findings are also briefly reviewed with an emphasis on their diagnostic usefulness.
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Affiliation(s)
- Darya Buehler
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, L5/184 CSC, Madison, WI 53792, USA.
| | - Paul Weisman
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, B1779 WIMR, Madison, WI 53792, USA
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92
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Bhattacharyya R, Ghosh R, Saha K, Chatterjee U. INI Expressing Epithelioid Sarcoma with Osteoclastic Giant Cells in a Child: A Case Report with Summary of Prior Published Cases. Fetal Pediatr Pathol 2017; 36:325-331. [PMID: 28541826 DOI: 10.1080/15513815.2017.1323984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Epithelioid sarcoma is a heterogeneous tumor with 2 subtypes, classic and proximal. The proximal variant is more aggressive and occurs in proximal location in young adults. CASE REPORT We present a proximal epithelioid sarcoma in the leg of an 8 year old girl with rhabdoid morphology and scattered osteoclastic giant cells. Nuclear INI-1 was retained. Despite wide local excision, local recurrence occurred at 8 months. Following re-excision, she developed a chest wall metastasis after 9 months. CONCLUSION Epithelioid sarcoma, proximal type with osteoclastic giant cells in the pediatric age group has not been reported previously and should be considered in the differential diagnoses of tumors with epithelioid cell morphology and scattered osteoclastic giant cells. Retained INI expression helped to differentiate this tumor from malignant rhabdoid tumor.
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Affiliation(s)
| | | | - Koushik Saha
- b Department of Pediatric Surgery , NRS Medical College , Kolkata , India
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93
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Mentzel T, Brenn T. Malignant mesenchymal neoplasms of the dermis and subcutis mimicking benign lesions: a case-based review. Virchows Arch 2017; 471:565-574. [PMID: 28699109 DOI: 10.1007/s00428-017-2187-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/20/2017] [Accepted: 06/28/2017] [Indexed: 01/11/2023]
Abstract
In this short review, malignant mesenchymal neoplasms of the dermis and subcutis mimicking benign lesions and their differential diagnoses are discussed. These include plaque-like dermatofibrosarcoma protuberans, superficial low-grade fibromyxoid sarcoma, low-grade superficial malignant peripheral nerve sheath tumour, epithelioid sarcoma, pseudomyogenic haemangioendothelioma, Kaposi sarcoma mimicking cavernous haemangioma and benign lymphangioendothelioma, and rare forms of angiosarcoma mimicking a benign vascular lesion.
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Affiliation(s)
- Thomas Mentzel
- Dermatopathologie Bodensee, Siemensstrasse 6/1, 88048, Friedrichshafen, Germany.
| | - Thomas Brenn
- Department of Pathology, NHS Lothian University Hospitals Trust and University of Edinburgh, Edinburgh, UK
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94
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Alikhan MB, Pease G, Watkin W, Grogan R, Krausz T, Antic T. Primary epithelioid sarcoma of the kidney and adrenal gland: report of 2 cases with immunohistochemical and molecular cytogenetic studies. Hum Pathol 2017; 61:158-163. [DOI: 10.1016/j.humpath.2016.09.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/06/2016] [Accepted: 09/22/2016] [Indexed: 10/20/2022]
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95
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Kim C, Yoo KH, Kim MH, Chon HJ, Lee SI, Lee HJ, Koh S, Lee HY, Lee HR, Kim KS, Choi YD, Rha SY, Lee SJ, Kim HS. Different subtypes of epithelioid sarcoma and their clinical implication: long-term multi-institutional experience with a rare sarcoma. APMIS 2017; 125:223-229. [PMID: 28233450 DOI: 10.1111/apm.12656] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 12/13/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Chan Kim
- Medical Oncology; CHA Bundang Medical Center; CHA University; Seongnam-si Korea
| | - Kwai Han Yoo
- Division of Hematology and Oncology; Department of Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Min Hwan Kim
- Division of Medical Oncology; Department of Internal Medicine; Yonsei Cancer Center; Yonsei University College of Medicine; Seoul Korea
| | - Hong Jae Chon
- Medical Oncology; CHA Bundang Medical Center; CHA University; Seongnam-si Korea
| | - Soon Il Lee
- Division of Hematology-Oncology; Department of Medicine; Dankook University College of Medicine; Cheonan Korea
| | - Hyo Jin Lee
- Department of Internal Medicine; School of Medicine Chungnam National University; Daejeon Korea
| | - Sujin Koh
- Department of Hematology and Oncology; Ulsan University Hospital; University of Ulsan College of Medicine; Ulsan Korea
| | - Ha Yeon Lee
- Division of Hematology-Oncology; Department of Internal Medicine; Kyunghee University Hospital at Gangdong; Seoul Korea
| | - Hye Ran Lee
- Division of Hematology/Oncology; Department of Internal Medicine; Inje University Ilsan Paik Hospital; Goyang Korea
| | - Kyung Sik Kim
- Department of Surgery; Yonsei University College of Medicine; Seoul Korea
| | - Young Deuk Choi
- Department of Urology; Yonsei University College of Medicine; Seoul Korea
| | - Sun Young Rha
- Division of Medical Oncology; Department of Internal Medicine; Yonsei Cancer Center; Yonsei University College of Medicine; Seoul Korea
| | - Su Jin Lee
- Division of Hematology and Oncology; Department of Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Hyo Song Kim
- Division of Medical Oncology; Department of Internal Medicine; Yonsei Cancer Center; Yonsei University College of Medicine; Seoul Korea
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Emori M, Tamakawa M, Kaya M, Takada K, Murase K, Fujita C, Sato S, Takahashi R, Hatanaka KC, Sugita S, Hirano H, Yamashita T, Hasegawa T. A typical presentation of primary pulmonary epithelioid sarcoma misdiagnosed as non-small cell lung cancer. Pathol Int 2017; 67:222-224. [PMID: 28078765 DOI: 10.1111/pin.12503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Makoto Emori
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | | | | | - Kohichi Takada
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Kazuyuki Murase
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Chisa Fujita
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Sayuri Sato
- Department of Dermatology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Ryuji Takahashi
- Respiratory Medicine, Hakodate Municipal Hospital, Hakodate, Hokkaido, Japan
| | - Kanako C Hatanaka
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Shintaro Sugita
- Department of Surgical Pathology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Hiroshi Hirano
- Department of Surgical Pathology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Toshihiko Yamashita
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Tadashi Hasegawa
- Department of Surgical Pathology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
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98
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Nishibaba R, Higashi Y, Goto Y, Hisaoka M, Kanekura T. Epithelioid sarcoma with multiple lesions on the left arm: a case report. J Med Case Rep 2016; 10:295. [PMID: 27776545 PMCID: PMC5078886 DOI: 10.1186/s13256-016-1088-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 10/04/2016] [Indexed: 11/24/2022] Open
Abstract
Background Epithelioid sarcoma is a rare, high-grade malignant tumor of the soft tissue. The incidence of local recurrence, regional lymph node involvement, and distant metastases is high. Epithelioid sarcoma is most often seen in adolescents and young adults. In the early stage before the development of full clinical features, epithelioid sarcoma is often misdiagnosed as a benign disease such as granuloma. Case presentation We report a case of a 74-year-old Japanese woman whose epithelioid sarcoma was initially misdiagnosed as fungal infection. Rebiopsy revealed the proliferation of atypical polygonal or oval epithelioid cells in the dermis and lymphocyte infiltration through the dermis. Immunohistochemically, the tumor cells were positive for vimentin, cell adhesion molecule 5.2, epithelial membrane antigen, and E26-related gene. The nuclear expression of integrase interactor 1 was lost in the tumor cells. Conclusions We encountered a rare case of epithelioid sarcoma and had difficulty in making the correct diagnosis. We suggest that in patients whose lesions are resistant to conventional treatments, repeat biopsy and immunohistochemical studies should be considered to rule out rare epithelioid sarcoma.
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Affiliation(s)
- Rie Nishibaba
- Department of Dermatology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
| | - Yuko Higashi
- Department of Dermatology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Yuko Goto
- Department of Pathology, Field of Oncology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Masanori Hisaoka
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, Kitakyusyu, Japan
| | - Takuro Kanekura
- Department of Dermatology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
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Abstract
This group of biologically diverse entities is united by topographic localization to the hands and feet. Categorizing tumors by body site narrows the differential into a short list of possibilities that can facilitate accurate and rapid diagnosis. The goal of this review is to provide a practical approach to soft tissue tumors of acral locations for clinicians, pathologists, and researchers alike. What ensues in the following text is that tight coupling of the clinical picture and histopathologic findings should produce the correct diagnosis, or at least an abbreviated differential. The salient clinicopathologic, immunohistochemical, and molecular features are presented alongside current treatment recommendations for each entity.
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Affiliation(s)
- Kristen M Paral
- Section of Dermatology, University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Vesna Petronic-Rosic
- Section of Dermatology, University of Chicago Pritzker School of Medicine, Chicago, IL.
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100
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Mahajan A, Sen I, Hazra D, Agarwal S. Management of Epithelioid Sarcoma of the Inguinal Region with Vascular Invasion. Indian J Surg 2016; 78:315-7. [PMID: 27574351 PMCID: PMC4987559 DOI: 10.1007/s12262-015-1401-x] [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: 07/02/2015] [Accepted: 11/03/2015] [Indexed: 10/22/2022] Open
Abstract
Epithelioid sarcoma (ES) is a rare clinically polymorphic tumor that mimics both benign and malignant conditions. It presents with dermal or subcutaneous nodules on the extremities in young adults. We present here a case of epithelioid sarcoma of the inguinal region infiltrating the femoral vessels. Biopsy is diagnostic and good histopathological evaluation is critical in management.
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Affiliation(s)
- Amit Mahajan
- Department of Vascular Surgery, CMC, Vellore, 632004 India
| | - Indrani Sen
- Department of Vascular Surgery, CMC, Vellore, 632004 India
| | | | - Sunil Agarwal
- Department of Vascular Surgery, CMC, Vellore, 632004 India
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