201
|
Song X, Choi J, Rao C, Nallu S, Nicastri AD. Primary Ewing sarcoma of lumbar spine with massive intraspinal extension. Pediatr Neurol 2008; 38:58-60. [PMID: 18054697 DOI: 10.1016/j.pediatrneurol.2007.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Revised: 07/27/2007] [Accepted: 09/05/2007] [Indexed: 10/22/2022]
Abstract
Primary vertebral Ewing sarcoma-primitive neuroectodermal tumor is uncommon. Although epidural extension has been seen in such tumors, cases with massive intraspinal involvement are decidedly rare. Here we present the case of a 4-year-old girl with back pain and difficulty walking. Magnetic resonance imaging showed a mass filling the spinal canal from T(11) to the L(3)/L(4) levels. Vertebral involvement with extension into the paraspinal soft tissue through neural foramina was seen. Histologically, a small-blue-cell tumor with strong membranous CD99 reactivity was noted. Molecular analysis revealed translocation t(11;22)(q24;q12), thus confirming the diagnosis of Ewing sarcoma-primitive neuroectodermal tumor. Our case emphasizes that vertebral Ewing sarcoma-primitive neuroectodermal tumor may present with massive intraspinal extension and should be included in the differential diagnosis of intraspinal lesions.
Collapse
Affiliation(s)
- Xianyuan Song
- Department of Pathology, SUNY Downstate Medical Center, Brooklyn, New York 11203, USA
| | | | | | | | | |
Collapse
|
202
|
Michal M, Kazakov DV, Síma R, Vanecek T. Primitive small cell tumor with epithelial, gangliocytic, neuroendocrine, and mesenchymal differentiation: report of 2 cases. Int J Surg Pathol 2007; 15:429-36. [PMID: 17913955 DOI: 10.1177/1066896907302424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors describe 2 tumors that, to the best of their knowledge, are hitherto undescribed. The predominant cell type was small round to fusiform dark blue cells. The dark blue cells formed distinct epithelial cords with gland-like formations with mucicarmine-positive mucus. Another distinctive component of the tumors was a mesenchymal one. The mesenchymal areas appeared benign and could be likened to a fibroma having a densely collagenous stroma, or they had spindle cells set in the myxoid background, rendering a myxoma-like appearance. Another distinctive feature was ganglion cell differentiation. Mitotic figures, including atypical forms, were found only in the small cell component. All cells were immunohistochemically negative for actin, calponin, desmin, HMB45, neurofilament protein, CD99/MIC2, Melan A, tyrosinase, serotonin, CD56, Melan A, GFAP, and S-100 protein. Cytokeratin, synaptophysin, FLI1 protein, and chromogranin antibodies reacted only in the primitive small round cells, while all the other components were cytokeratin negative. Fluorescence in situ hybridization showed that the tumors are without the EWSR1 gene translocation and gain 12p. Ultrastructurally, the cells were endowed with well-formed intercellular desmosomes membrane-bound secretory in the cytoplasm. Granules were found in the cytoplasm. We suggest the name "primitive small cell tumor with epithelial, gangliocytic, neuroendocrine, and mesenchymal differentiation" for this neoplasm.
Collapse
MESH Headings
- Aneuploidy
- Biomarkers, Tumor/metabolism
- Carcinoma, Small Cell/genetics
- Carcinoma, Small Cell/metabolism
- Carcinoma, Small Cell/pathology
- Carcinoma, Small Cell/therapy
- Cell Transformation, Neoplastic
- Child, Preschool
- Chromosomes, Human, Pair 12
- Combined Modality Therapy
- Desmosomes/ultrastructure
- Epithelial Cells/metabolism
- Epithelial Cells/pathology
- Humans
- Immunohistochemistry
- In Situ Hybridization, Fluorescence
- Male
- Microscopy, Electron, Transmission
- Neuroendocrine Tumors/genetics
- Neuroendocrine Tumors/metabolism
- Neuroendocrine Tumors/pathology
- Neuroendocrine Tumors/therapy
- Sarcoma, Small Cell/genetics
- Sarcoma, Small Cell/metabolism
- Sarcoma, Small Cell/pathology
- Sarcoma, Small Cell/therapy
- Secretory Vesicles/ultrastructure
- Soft Tissue Neoplasms/genetics
- Soft Tissue Neoplasms/metabolism
- Soft Tissue Neoplasms/pathology
- Soft Tissue Neoplasms/therapy
Collapse
Affiliation(s)
- Michal Michal
- Sikl's Department of Pathology, Charles University, Medical Faculty Hospital, Alej Svobody 80, 304 60 Pilsen, Czech Republic.
| | | | | | | |
Collapse
|
203
|
Teo CHY, Chuah KL, Kaw G, Giron DM. CD99 negative primary sciatic nerve Ewing family tumour in a middle-aged woman: a rare clinical presentation. Pathology 2007; 39:528-31. [PMID: 17886109 DOI: 10.1080/00313020701444580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
204
|
Pollheimer VS, Bodo K, Pollheimer MJ, Zigeuner R, Langner C. Merkel cell carcinoma metastasizing to the kidney mimicking primary neuroendocrine renal cancer. APMIS 2007; 115:774-7. [PMID: 17550389 DOI: 10.1111/j.1600-0463.2007.apm_617.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 56-year-old male with a history of cutaneous neuroendocrine (Merkel cell) carcinoma presented with a solid mass of the left kidney, measuring 10 cm in largest diameter. On histology, the tumour was composed of loosely packed uniform cells with round-to-oval nuclei and scant cytoplasm. Immunohistochemically, the tumour cells diffusely expressed pancytokeratin and neuroendocrine markers, such as chromogranin A, synaptophysin and CD56 (NCAM). Distinct paranuclear dot-like expression of cytokeratin 20 showed the lesion to be metastatic Merkel cell carcinoma. This is the first reported case of Merkel cell carcinoma metastatic to the kidney mimicking primary neuroendocrine renal cancer. We discuss the differential diagnosis of the tumour and perform a systematic literature review, including potential indications for renal tumour biopsy in patients with a history of nonrenal malignancy.
Collapse
|
205
|
Hakozaki M, Hojo H, Tajino T, Yamada H, Kikuta A, Ito M, Sano H, Mochizuki K, Akaihata M, Kikuchi S, Abe M. Periosteal Ewing sarcoma family of tumors of the femur confirmed by molecular detection of EWS-FLI1 fusion gene transcripts: a case report and review of the literature. J Pediatr Hematol Oncol 2007; 29:561-5. [PMID: 17762498 DOI: 10.1097/mph.0b013e3180f61ba3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ewing sarcoma family of tumors (ESFT) comprise common sarcomas in children and young adults. Such tumors usually occur in the medullary cavity of long bones and directly invade cortical bone and circumferential soft tissue, including periosteum. Periosteal ESFT is extremely rare and only a small numbers of cases, including cases not confirmed by molecular detection of chimeric fusion gene, have been reported. We describe herein a case of periosteal ESFT of the femur in a 13-year-old boy harboring EWS-FLI1 chimeric fusion gene transcripts detected by reverse transcription-polymerase chain reaction analysis. This report may provide an opportunity for further evaluation of the EWS-FLI1 type 1 fusion gene and detection of prognostic significance in periosteal ESFT.
Collapse
Affiliation(s)
- Michiyuki Hakozaki
- First Department of Pathology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
206
|
Sanati S, Lu DW, Schmidt E, Perry A, Dehner LP, Pfeifer JD. Cytologic diagnosis of Ewing sarcoma/peripheral neuroectodermal tumor with paired prospective molecular genetic analysis. Cancer 2007; 111:192-9. [PMID: 17487851 DOI: 10.1002/cncr.22692] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Ewing sarcoma/peripheral neuroectodermal tumor (EWS/PNET), since its characterization immunophenotypically and cytogenetically, has emerged as one of most common sarcomas of childhood. Currently, it is recognized that EWS/PNET can occur in any number of extraosseous sites and is one of several distinctive tumor types with an EWS translocation. In the past, the pathologic diagnosis of EWS/PNET relied on an open biopsy with the application of various ancillary studies, ranging from periodic acid-Schiff stain to molecular testing, but the tumor increasingly is diagnosed on the basis of cytologic specimens alone. METHODS The authors report 3 cases of EWS/PNET in patients aged 11 years to 53 years. These 3 patients had tumors that involved the parotid gland, cervical soft tissue, and pelvis, and were diagnosed by cytologic evaluation of fine-needle aspiration (FNA) biopsy material alone. The FNA materials also were evaluated prospectively by fluorescence in situ hybridization and/or reverse transcriptase-polymerase chain reaction. RESULTS The results emphasized the diagnostic utility of FNA biopsy material for morphologic and molecular analysis without compromising conventional cytologic and immunocytochemical analysis, and that prospective molecular testing of FNA specimens has utility in routine practice although it is subject to many of the same limitations that impact molecular analysis when applied to conventional tissue biopsy specimens. CONCLUSIONS The current results demonstrated that molecular genetic techniques can provide clinically useful ancillary information for FNA specimens when cytologic features and/or immunophenotype are equivocal on the basis of limited sampling or secondary changes, such as hemorrhage and/or necrosis.
Collapse
MESH Headings
- 12E7 Antigen
- Adult
- Antigens, CD/analysis
- Cell Adhesion Molecules/analysis
- Child
- Cytodiagnosis/methods
- Female
- Humans
- Immunohistochemistry
- In Situ Hybridization, Fluorescence
- Male
- Middle Aged
- Molecular Diagnostic Techniques/methods
- Neuroectodermal Tumors, Primitive, Peripheral/diagnosis
- Neuroectodermal Tumors, Primitive, Peripheral/genetics
- Oncogene Proteins, Fusion/genetics
- Proto-Oncogene Protein c-fli-1/genetics
- RNA-Binding Protein EWS
- Reverse Transcriptase Polymerase Chain Reaction
- Sarcoma, Ewing/diagnosis
- Sarcoma, Ewing/genetics
- Sarcoma, Ewing/metabolism
- Transcription Factors/genetics
Collapse
Affiliation(s)
- Souzan Sanati
- Lauren V Ackerman Laboratory of Surgical Pathology, Barnes-Jewish and Saint Louis Children's Hospitals, Washington University Medical Center, St Louis, MO 63110-1093, USA
| | | | | | | | | | | |
Collapse
|
207
|
Ng TL, O'Sullivan MJ, Pallen CJ, Hayes M, Clarkson PW, Winstanley M, Sorensen PHB, Nielsen TO, Horsman DE. Ewing sarcoma with novel translocation t(2;16) producing an in-frame fusion of FUS and FEV. J Mol Diagn 2007; 9:459-63. [PMID: 17620387 PMCID: PMC1975098 DOI: 10.2353/jmoldx.2007.070009] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Ewing family tumors are molecularly characterized by expression of chimeric transcripts generated by specific chromosomal translocations, most commonly involving fusion of the EWS gene to a member of the ETS family of transcription factors (including FLI1, ERG, ETV1, E1AF, and FEV). Approximately 85% of reported cases of Ewing sarcoma bear an EWS-FLI1 fusion. In rare cases, FUS can substitute for EWS, with translocation t(16;21)(p11;q24) producing a FUS-ERG fusion with no EWS rearrangement. We report a case of Ewing sarcoma, presenting as a pathological fracture of the distal clavicle in a 33-year-old male, in which cytogenetic analysis revealed a single t(2;16)(q35;p11) balanced translocation. Fluorescence in situ hybridization using a commercially available diagnostic probe was negative for an EWS gene rearrangement; instead, break-apart fluorescence in situ hybridization probes for FUS and FEV were positive for a translocation involving these genes. Cloning and sequencing of the breakpoint region demonstrated an in-frame fusion of FUS to FEV. In conclusion, this represents the first reported case of Ewing family tumors demonstrating a variant translocation involving FUS and FEV and highlights the need to consider alternative permutations of fusion partners for molecular diagnosis of sarcomas.
Collapse
MESH Headings
- Adult
- Base Sequence
- Chromosomes, Human, Pair 16/genetics
- Chromosomes, Human, Pair 2/genetics
- Humans
- Immunohistochemistry
- In Situ Hybridization, Fluorescence
- Male
- Metaphase
- Molecular Sequence Data
- Oligonucleotide Array Sequence Analysis
- Oncogene Proteins, Fusion/chemistry
- Oncogene Proteins, Fusion/genetics
- Sarcoma, Ewing/genetics
- Sarcoma, Ewing/pathology
- Sequence Analysis, DNA
- Translocation, Genetic/genetics
Collapse
Affiliation(s)
- Tony L Ng
- Department of Pathology and Laboratory Medicine, British Columbia Cancer Agency, 600 W. 10th Ave., Vancouver, BC, Canada, V5Z 4E6
| | | | | | | | | | | | | | | | | |
Collapse
|
208
|
Kang SH, Perle MA, Nonaka D, Zhu H, Chan W, Yang GCH. Primary Ewing sarcoma/PNET of the kidney: fine-needle aspiration, histology, and dual color break apart FISH Assay. Diagn Cytopathol 2007; 35:353-7. [PMID: 17497665 DOI: 10.1002/dc.20642] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A 34-year-old previously healthy Hispanic man presented with lower back pain. CT scan revealed an 8-cm space-occupying lesion in the superior pole of the left kidney with numerous small lytic lesions in the skull, vertebrae, ribs, and pelvic bones. CT-guided fine-needle aspiration biopsy revealed a high-grade primitive small round cell tumor with the tumor cells being strongly positive for CD99 and vimentin. The patient subsequently underwent a left nephrectomy. Fluorescence in situ hybridization analysis using a DNA probe for the Ewing Sarcoma breakpoint region 1 (EWSR1) on chromosome 22g12 revealed a rearrangement of the EWSR1 locus. The diagnosis of primary Ewing sarcoma/primitive neuroectodermal tumor of the kidney was established.
Collapse
Affiliation(s)
- Steven H Kang
- Department of Pathology, New York University Medical Center, New York, New York, USA
| | | | | | | | | | | |
Collapse
|
209
|
Alaggio R, Rosolen A, Sartori F, Leszl A, d'Amore ESG, Bisogno G, Carli M, Cecchetto G, Coffin CM, Ninfo V. Spindle cell tumor with EWS-WT1 transcript and a favorable clinical course: a variant of DSCT, a variant of leiomyosarcoma, or a new entity? Report of 2 pediatric cases. Am J Surg Pathol 2007; 31:454-9. [PMID: 17325488 DOI: 10.1097/01.pas.0000213375.02171.43] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report 2 intra-abdominal tumors originally diagnosed as leiomyosarcomas, occurring in adolescents, one as a second malignancy after a Hodgkin lymphoma. Both tumors exhibited unusual morphologic features characterized by spindle cells arranged in sheets or in fascicles, devoid of the typical desmoplastic stroma. Cytokeratins and mesenchymal markers, including smooth muscle actin, desmin, and muscle specific actin, were coexpressed in the tumor cells, whereas EMA was negative. Reverse transcription-polymerase chain reaction analysis showed an EWS-WT1 fusion transcript. Both patients are alive and in complete remission at 3 and 13 years after diagnosis, respectively. These tumors raise a variety of diagnostic possibilities. They could represent intra-abdominal desmoplastic small round cell tumor, with histologic features of epithelioid leiomyosarcoma or an unusual subtype of leiomyosarcoma with an EWS-WT1 transcript. Alternatively, they could represent an unrecognized subgroup of tumors with spindle cell morphology, bearing the same translocation as desmoplastic small round cell tumor, but characterized by a more favorable clinical course.
Collapse
MESH Headings
- Abdominal Neoplasms/genetics
- Abdominal Neoplasms/metabolism
- Abdominal Neoplasms/pathology
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Carcinoma, Small Cell/genetics
- Carcinoma, Small Cell/metabolism
- Carcinoma, Small Cell/secondary
- Child
- Chromosomes, Human, Pair 11
- Chromosomes, Human, Pair 22
- Cytogenetic Analysis
- Desmin/metabolism
- Disease-Free Survival
- Humans
- Leiomyosarcoma/genetics
- Leiomyosarcoma/metabolism
- Leiomyosarcoma/pathology
- Male
- Neoplasms, Second Primary
- Oncogene Proteins, Fusion/genetics
- Oncogene Proteins, Fusion/metabolism
- RNA, Neoplasm/analysis
- Reverse Transcriptase Polymerase Chain Reaction
- Translocation, Genetic
Collapse
Affiliation(s)
- Rita Alaggio
- Dipartimento di Scienze Oncologiche e Chirurgiche Università di Padova and IOV (Istituto Oncologico Veneto) , Padova, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
210
|
Abstract
As with biopsies from other sites in the female genital tract, immunohistochemistry is now being increasingly used in cervical pathology as an aid to diagnosis. In this review, I discuss applications of immunohistochemistry in diagnostic cervical pathology with a particular focus on recent developments. It is emphasised that immunohistochemistry is to be used as an adjunct to routine morphological examination and that no marker is totally specific or sensitive for a given lesion. Although much of this review focuses on glandular lesions, the value of markers, such as MIB1 and p16, in the assessment of pre-invasive cervical squamous lesions is discussed. In the broad field of cervical glandular lesions, topics covered include: the value of markers such as MIB1, p16 and bcl-2 in distinguishing adenocarcinoma in situ and glandular dysplasia from benign mimics; markers of mesonephric lesions, including CD10; markers of value in the diagnosis of minimal deviation adenocarcinoma, such as HIK1083; markers of value in distinguishing metastatic cervical adenocarcinoma in the ovary from primary ovarian endometrioid or mucinous adenocarcinoma. Rarely ectopic prostatic tissue occurs in the cervix, which can be confirmed by positive staining with prostatic markers. A panel of markers, comprising oestrogen receptor, vimentin, monoclonal carcinoembryonic antigen and p16, is of value in distinguishing between a cervical adenocarcinoma and an endometrial adenocarcinoma of endometrioid type. Markers of use in the diagnosis of cervical neuroendocrine neoplasms, including small cell and large cell neuroendocrine carcinoma, are discussed. It is stressed that small cell neuroendocrine carcinomas may be negative with most of the commonly used neuroendocrine markers and this does not preclude the diagnosis. p63, a useful marker of squamous neoplasms within the cervix, is of value in distinguishing small cell neuroendocrine carcinoma (p63 negative) from small cell squamous carcinoma (p63 positive) and in confirming that a poorly differentiated carcinoma is squamous in type.
Collapse
Affiliation(s)
- W Glenn McCluggage
- Department of Pathology, Royal Group of Hospital Trust, Belfast, Northern Ireland.
| |
Collapse
|
211
|
Saxena R, Sait S, Mhawech-Fauceglia P. Ewing sarcoma/primitive neuroectodermal tumor of the kidney: a case report. Diagnosed by immunohistochemistry and molecular analysis. Ann Diagn Pathol 2007; 10:363-6. [PMID: 17126256 DOI: 10.1016/j.anndiagpath.2005.11.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ewing sarcoma/primitive neuroectodermal tumor (EWS/PNET) of the kidney is a rare and aggressive tumor. It has a rapid clinical progression with early metastasis and death. Few cases with documented t(11;22) have been reported in the literature. CASE PRESENTATION We report a case of EWS/PNET of the kidney in a 26-year-old woman with widespread metastasis at initial presentation. The tumor cells showed strong expression for CD99 and FLI-1 monoclonal antibodies and polyclonal antibodies and were negative for WT1 and numerous other markers. The diagnosis was subsequently confirmed by demonstrating t(11;22)(q24;q12) using cytogenetic karyotyping and fluorescence in situ hybridization. CONCLUSIONS Due to the different prognosis and management between EWS/PNET and other primary renal neoplasms with similar morphology, a histopathologic diagnosis with extreme accuracy should be made. Cytogenetic analysis is an important supportive tool to immunohistochemistry in making the final diagnosis.
Collapse
MESH Headings
- Adult
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/metabolism
- Chemotherapy, Adjuvant
- Chromosomes, Human, Pair 11
- Chromosomes, Human, Pair 22
- Fatal Outcome
- Female
- Humans
- Immunohistochemistry
- Interphase
- Kidney Neoplasms/genetics
- Kidney Neoplasms/metabolism
- Kidney Neoplasms/pathology
- Kidney Neoplasms/therapy
- Neoplasms, Multiple Primary/genetics
- Neoplasms, Multiple Primary/metabolism
- Neoplasms, Multiple Primary/pathology
- Nephrectomy
- Neuroectodermal Tumors, Primitive/genetics
- Neuroectodermal Tumors, Primitive/metabolism
- Neuroectodermal Tumors, Primitive/secondary
- Neuroectodermal Tumors, Primitive/therapy
- Sarcoma, Ewing/genetics
- Sarcoma, Ewing/metabolism
- Sarcoma, Ewing/secondary
- Sarcoma, Ewing/therapy
- Spectral Karyotyping
- Translocation, Genetic
Collapse
Affiliation(s)
- Rakhee Saxena
- Department of Surgical Pathology and Laboratory Medicine, Buffalo General Hospital, Buffalo, NY 14263, USA
| | | | | |
Collapse
|
212
|
|
213
|
Mhawech-Fauceglia P, Herrmann F, Penetrante R, Beck A, Sait S, Block AM, Odunsi K, Fisher J, Balos L, Cheney RT. Diagnostic utility of FLI-1 monoclonal antibody and dual-colour, break-apart probe fluorescence in situ (FISH) analysis in Ewing's sarcoma/primitive neuroectodermal tumour (EWS/PNET). A comparative study with CD99 and FLI-1 polyclonal antibodies. Histopathology 2006; 49:569-75. [PMID: 17163841 DOI: 10.1111/j.1365-2559.2006.02535.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To compare the sensitivity and specificity of the recently commercially available FLI-1 monoclonal (FLI-1m) antibody with the currently used antibodies [CD99 and FLI-1 polyclonal (FLI-1p)] in the diagnosis of Ewing's sarcoma/primitive neuroectodermal tumour (EWS/PNET) and to determine the diagnostic value of the EWSR1 (22q12) dual-colour, break-apart rearrangement probe fluorescence in situ hybridization (FISH) technique. MATERIALS AND METHODS Forty-three cases of well-documented EWS/PNET and 15 non-EWS/PNET cases were retrieved from the archival files. Immunohistochemistry (IHC) for FLI-1p, FLI-1m and FISH analysis was performed. RESULTS The most sensitive and specific test panel for the diagnosis of EWS/PNET is the combination of CD99 and FLI-1p. FISH had a very high specificity (100%) but only a moderate sensitivity (50%). CONCLUSION The combination of CD99 and FLI-1p is the method of choice for the diagnosis of EWS/PNET. EWRS1 (22q12) dual-colour, break-apart rearrangement probe FISH should be used as a confirmatory test in addition to CD99 and FLI1-p due to its high specificity.
Collapse
MESH Headings
- 12E7 Antigen
- Actins
- Algorithms
- Antibodies, Monoclonal/immunology
- Antibodies, Neoplasm/immunology
- Antigens, CD/immunology
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/genetics
- Bone Neoplasms/diagnosis
- Bone Neoplasms/genetics
- Bone Neoplasms/immunology
- Cell Adhesion Molecules/immunology
- Chromosome Aberrations
- Female
- Humans
- In Situ Hybridization, Fluorescence/methods
- Male
- Microfilament Proteins/genetics
- Microfilament Proteins/immunology
- Neoplasm Proteins/immunology
- Neuroectodermal Tumors, Primitive/diagnosis
- Neuroectodermal Tumors, Primitive/genetics
- Neuroectodermal Tumors, Primitive/immunology
- Predictive Value of Tests
- ROC Curve
- Receptors, Cytoplasmic and Nuclear/genetics
- Receptors, Cytoplasmic and Nuclear/immunology
- Sarcoma, Ewing/diagnosis
- Sarcoma, Ewing/genetics
- Sarcoma, Ewing/immunology
- Trans-Activators
Collapse
Affiliation(s)
- P Mhawech-Fauceglia
- Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
214
|
Ahmed AA, Nava VE, Pham T, Taubenberger JK, Lichy JH, Sorbara L, Raffeld M, Mackall CL, Tsokos M. Ewing sarcoma family of tumors in unusual sites: confirmation by rt-PCR. Pediatr Dev Pathol 2006; 9:488-95. [PMID: 17163788 DOI: 10.2350/06-01-0007.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2006] [Accepted: 04/07/2006] [Indexed: 11/20/2022]
Abstract
Ewing sarcoma family tumors originating in the palate or adrenal gland are extremely rare and may cause difficulty in diagnosis. More common tumors primary to these sites need to be excluded before one arrives at the correct diagnosis. We have recently diagnosed 2 such cases. The 1st case was that of a 24-year-old woman who presented with a swelling in the right side of the hard palate. The 2nd case was diagnosed in a 28-year-old woman who presented with a mass in the right adrenal gland. In both cases, the diagnosis of Ewing sarcoma family of tumors was confirmed by immunohistochemical studies and reverse transcriptase-polymerase chain reaction (RT-PCR). The hard palate case is the 1st and the adrenal gland the 3rd case of Ewing sarcoma family of tumors arising in these sites, in which the diagnosis was confirmed by RT-PCR and/or cytogenetics. Accurate diagnosis of Ewing sarcoma family of tumors is crucial for the management of patients, and when found in such rare locations, diagnosis should be supported by immunohistochemical and/or molecular genetic studies.
Collapse
Affiliation(s)
- Atif A Ahmed
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
215
|
Ranchère D. Comment classer un sarcome des tissus mous de l”enfant. Ann Pathol 2006. [DOI: 10.1016/s0242-6498(06)78392-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
216
|
Fujii H, Honoki K, Enomoto Y, Kasai T, Kido A, Amano I, Kumamoto M, Morishita T, Mii Y, Nonomura A, Takakura Y. Adamantinoma-like Ewing's sarcoma with EWS-FLI1 fusion gene: a case report. Virchows Arch 2006; 449:579-84. [PMID: 17016721 DOI: 10.1007/s00428-006-0279-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2006] [Accepted: 07/18/2006] [Indexed: 11/28/2022]
Abstract
Recent studies have advocated the genotypic and phenotypic delineation of a novel Ewing's sarcoma histologic variant showing epithelial features defined as "adamantinoma-like Ewing's sarcoma". We described an 18-year-old girl with a primary small round-cell sarcoma of the right tibia showing polyphenotypic differentiation with epithelioid features. The neoplastic cells had mainly round or oval nuclei with fine chromatin with a portion of epithelial arrangements. The immunohistochemical analysis showed the epithelial markers of cytokeratin 5/6/18, AE1/AE3, and cytokeratin high molecular weight were stained especially in the foci with epithelioid features, as well as MIC2, S100, and NSE. The diagnosis of the lesion was confirmed as Ewing's sarcoma by the presence of the EWS-FLI1 fusion transcript, and could be defined as the so-called "adamantinoma-like Ewing's sarcoma". After wide excision and high-dose chemotherapy with peripheral blood stem cell transfusion, the patient has been well and continuously event-free for 3 years since the initial diagnosis.
Collapse
Affiliation(s)
- Hiromasa Fujii
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
217
|
Abstract
A case of primitive neuroectodermal tumor arising in the uterine corpus of a 43-year-old woman is presented. The tumor mass was 13.3 cm and extended to the uterine serosa, endocervical stroma, and left adnexa. Histologically, the tumor was composed of small blue cells with scant cytoplasm, indistinct cell borders, hyperchromatic round nuclei, and inconspicuous nucleoli focally forming pseudorosettes, suggestive of neuroectodermal origin. The tumor cells displayed strong immunoreactivity for CD99 and FLI1. Cytogenetic fluorescence in situ hybridization study revealed presence of an EWS-FLI1 fusion gene. To the best of our knowledge, this is the first case of primitive neuroectodermal tumor of the uterus with diagnosis confirmed by FLI1 immunohistochemical labeling and demonstration of t (11; 22) by fluorescence in situ hybridization.
Collapse
Affiliation(s)
- Linda Varghese
- Department of Pathology, Allina Hospitals and Clinics Pathology Associates, Minneapolis, MN 55455, USA.
| | | | | |
Collapse
|
218
|
de Paula AA, Maltez AR, Mota ED. Small round blue cell tumor of seminal vesicle in a young patient. Int Braz J Urol 2006; 32:566-9. [PMID: 17081327 DOI: 10.1590/s1677-55382006000500011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2006] [Indexed: 11/22/2022] Open
Abstract
Seminal vesicle tumor is a rare disease with unclear origin. Generally, it is presented as a pelvic mass that can be detected by sonography and digital rectal exam. The authors report a 25-year-old patient with a pelvic mass which the magnetic resonance and surgical specimen reveal a seminal vesicle tumor. Immunohistochemical findings favored a primitive neuroectodermal tumor of the seminal vesicle. Herein, the treatment, histological and histochemical findings of this entity are discussed.
Collapse
MESH Headings
- Adult
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Chemotherapy, Adjuvant
- Follow-Up Studies
- Genital Neoplasms, Male/drug therapy
- Genital Neoplasms, Male/pathology
- Genital Neoplasms, Male/surgery
- Humans
- Immunohistochemistry
- Magnetic Resonance Imaging
- Male
- Neuroectodermal Tumors, Primitive, Peripheral/drug therapy
- Neuroectodermal Tumors, Primitive, Peripheral/pathology
- Neuroectodermal Tumors, Primitive, Peripheral/surgery
- Seminal Vesicles/pathology
- Seminal Vesicles/surgery
- Treatment Outcome
Collapse
Affiliation(s)
- Adriano A de Paula
- Sections of Oncological Urology and Pathology, Araujo Jorge Hospital, Goiania, Goias, Brazil.
| | | | | |
Collapse
|
219
|
Cotta CV, Konoplev S, Medeiros LJ, Bueso-Ramos CE. Metastatic tumors in bone marrow: histopathology and advances in the biology of the tumor cells and bone marrow environment. Ann Diagn Pathol 2006; 10:169-92. [PMID: 16730315 DOI: 10.1016/j.anndiagpath.2006.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The nonhematopoietic tumors most often diagnosed in the bone marrow are metastatic. Currently, accurate diagnosis of tumor metastasis requires integration of the clinical findings; morphological features; and results of immunohistochemical stains, cytogenetics, and molecular studies. This review focuses on a practical approach to the diagnosis of metastatic tumors in the bone marrow according to current standards of practice and discusses recent advances in understanding of tumor metastasis and the interaction between tumors and the bone marrow environment.
Collapse
Affiliation(s)
- Claudiu V Cotta
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, 77030, USA
| | | | | | | |
Collapse
|
220
|
Fréneaux P. [Soft tissue non lymphoid malignant round cell tumors in childhood and adolescence: morphological, immunophenotypic, and molecular features of diagnosis]. Ann Pathol 2006; 26:97-109. [PMID: 16791121 DOI: 10.1016/s0242-6498(06)70688-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Soft tissue non lymphoid malignant round cell tumors observed in children and adolescents are rare and are very different from adult tumors. They are often undifferentiated and distinctive key morphologic features are often lacking, but, on the other hand, specific recurrent genetic alterations, mostly translocations, are distinctive. Immunohistochemical features are also important for the diagnosis, and there is sometimes a strong correlation between the presence or the absence of an immunoreactivity for a specific protein and the presence of a specific genetic alteration. Finally, careful morphologic histological examination and immunohistochemical features will lead to a diagnosis which will be often confirmed by cytogenetics (translocations) or molecular techniques (fusion transcripts, deletion, mutation).
Collapse
Affiliation(s)
- Paul Fréneaux
- Service de Pathologie, Département de Biologie des Tumeurs, Institut Curie, 26 rue d'Ulm, 75005 Paris.
| |
Collapse
|
221
|
Olsen SH, Thomas DG, Lucas DR. Cluster analysis of immunohistochemical profiles in synovial sarcoma, malignant peripheral nerve sheath tumor, and Ewing sarcoma. Mod Pathol 2006; 19:659-68. [PMID: 16528378 DOI: 10.1038/modpathol.3800569] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
As a result of overlapping morphologic and immunohistochemical features, it can be difficult to distinguish synovial sarcoma, malignant peripheral nerve sheath tumor, and Ewing sarcoma/primitive neuroectodermal tumor in core biopsies. To analyze and compare immunohistochemical profiles, we stained tissue microarrays of 23 synovial sarcomas, 23 malignant peripheral nerve sheath tumors, and 27 Ewing sarcomas with 22 antibodies potentially useful in the differential diagnosis, and analyzed the data with cluster analysis. Stain intensity was scored as none, weak, or strong. For CD99, tumors with membranous accentuation were independently categorized. Cluster analysis sorted five groups, with like tumors clustering together. Synovial sarcoma clustered into two groups: one cytokeratin and EMA positive (n = 11), the other mostly cytokeratin negative, EMA positive, bcl-2 positive and mostly CD56 positive (n = 9). Malignant peripheral nerve sheath tumor clustered into two groups: one S100 positive, with nestin and NGFR positivity in most (n = 10), the other mostly S100 negative, and variably but mostly weakly positive for nestin and NGFR (n = 11). Ewing sarcomas clustered into a single group driven by membranous CD99 staining. Thirteen cases failed to cluster (outliers), while three Ewing sarcomas clustered into groups of other tumor types. Paired antibodies for each tumor type determined by visual assessment of cluster analysis data and statistical calculations of specificity, sensitivity, and predictive values showed that EMA/CK7 for synovial sarcoma, nestin/S100 for malignant peripheral nerve sheath tumor, and membranous CD99/Fli-1 for Ewing sarcoma yielded high specificity and positive predictive values. Cluster analysis also highlighted aberrant staining reactions and diagnostic pitfalls in these tumors. Hierarchical cluster analysis is an effective method for analyzing high-volume immunohistochemical data.
Collapse
Affiliation(s)
- Stephen H Olsen
- Department of Pathology, The University of Michigan Medical School, Ann Arbor, MI 48109-0054, USA
| | | | | |
Collapse
|
222
|
Castillero-Trejo Y, Eliazer S, Xiang L, Richardson JA, Ilaria RL. Expression of the EWS/FLI-1 oncogene in murine primary bone-derived cells Results in EWS/FLI-1-dependent, ewing sarcoma-like tumors. Cancer Res 2005; 65:8698-705. [PMID: 16204038 DOI: 10.1158/0008-5472.can-05-1704] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Ewing sarcoma is the second most common malignant pediatric bone tumor. Over 80% of Ewing sarcoma contain the oncogene EWS/FLI-1, which encodes the EWS/FLI-1 oncoprotein, a hybrid transcription factor comprised of NH2-terminal sequences from the RNA-binding protein EWS and the DNA-binding and COOH-terminal regions of the Ets transcription factor FLI-1. Although numerous genes are dysregulated by EWS/FLI-1, advances in Ewing sarcoma cancer biology have been hindered by the lack of an animal model because of EWS/FLI-1-mediated cytotoxicity. In this study, we have developed conditions for the isolation and propagation of murine primary bone-derived cells (mPBDC) that stably express EWS/FLI-1. Early-passage EWS/FLI-1 mPBDCs were immortalized in culture but inefficient at tumor induction, whereas later-passage cells formed sarcomatous tumors in immunocompetent syngeneic mice. Murine EWS/FLI-1 tumors contained morphologically primitive cells that lacked definitive lineage markers. Molecular characterization of murine EWS/FLI-1 tumors revealed that some but not all had acquired a novel, clonal in-frame p53 mutation associated with a constitutive loss of p21 expression. Despite indications that secondary events facilitated EWS/FLI-1 mPBDC tumorigenesis, cells remained highly dependent on EWS/FLI-1 for efficient transformation in clonogenic assays. This Ewing sarcoma animal model will be a useful tool for dissecting the molecular pathogenesis of Ewing sarcoma and provides rationale for the broader use of organ-specific progenitor cell populations for the study of human sarcoma.
Collapse
MESH Headings
- Amino Acid Sequence
- Animals
- Bone Neoplasms/genetics
- Bone Neoplasms/metabolism
- Bone Neoplasms/pathology
- Cell Cycle/physiology
- Cell Transformation, Neoplastic/genetics
- Cell Transformation, Neoplastic/metabolism
- Cell Transformation, Neoplastic/pathology
- Disease Models, Animal
- Gene Expression
- Mice
- Mice, Inbred BALB C
- Molecular Sequence Data
- Oncogene Proteins, Fusion/biosynthesis
- Oncogene Proteins, Fusion/genetics
- Proto-Oncogene Protein c-fli-1/biosynthesis
- Proto-Oncogene Protein c-fli-1/genetics
- RNA-Binding Protein EWS/biosynthesis
- RNA-Binding Protein EWS/genetics
- Sarcoma, Ewing/genetics
- Sarcoma, Ewing/metabolism
- Sarcoma, Ewing/pathology
Collapse
Affiliation(s)
- Yeny Castillero-Trejo
- Hamon Center for Therapeutic Oncology Research, Department of Pathology, Division of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | | | | |
Collapse
|