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Kalmykova AV, Baranovska-Andrigo V, Michal M. Update on cutaneous mesenchymal tumors in the 5th edition of WHO classification of skin tumors with an emphasis on new fusion-associated neoplasms. Virchows Arch 2024:10.1007/s00428-024-03925-2. [PMID: 39264472 DOI: 10.1007/s00428-024-03925-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 08/27/2024] [Accepted: 08/31/2024] [Indexed: 09/13/2024]
Abstract
The section on mesenchymal tumors in the 5th edition of WHO classification of skin tumors has undergone several changes, the most important of which is the inclusion of newly identified tumor entities, which will be the main focus of this review article. These specifically include three novel cutaneous mesenchymal tumors with melanocytic differentiation, and rearrangements of the CRTC1::TRIM11, ACTIN::MITF, and MITF::CREM genes as well as EWSR1::SMAD3-rearranged fibroblastic tumors, superficial CD34-positive fibroblastic tumors, and NTRK-rearranged spindle cell neoplasms. Some of the other most important changes will be briefly mentioned as well.
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Affiliation(s)
- Antonina V Kalmykova
- Medical Laboratory CSD, Ltd., Kiev, Ukraine
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Medical Faculty and Charles University Hospital Plzen, Alej Svobody 80, 323 00, Plzen, Czech Republic
| | - Vira Baranovska-Andrigo
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Medical Faculty and Charles University Hospital Plzen, Alej Svobody 80, 323 00, Plzen, Czech Republic
| | - Michael Michal
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Medical Faculty and Charles University Hospital Plzen, Alej Svobody 80, 323 00, Plzen, Czech Republic.
- Bioptical Laboratory, Ltd., Pilsen, Czech Republic.
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2
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Gingrich A, Wangsiricharoen S, Torres MB, Ravi V, Ratan R, Keung EZ, Scally CP, Lazar AJ, Wang WL, Roland CL, Hunt KK, Yu W, Torres KE. Clinical Variables Influencing Outcomes in Patients with Atypical Intradermal Smooth Muscle Neoplasms (Formerly Cutaneous Leiomyosarcomas): Single-Institution Study of 95 Surgical Patients. Ann Surg Oncol 2024:10.1245/s10434-024-15528-x. [PMID: 39150618 DOI: 10.1245/s10434-024-15528-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: 02/05/2024] [Accepted: 05/13/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Atypical intradermal smooth muscle neoplasm, also commonly termed cutaneous leiomyosarcoma, is a soft tissue tumor with a low risk of aggressive behavior. These lesions arise in the dermis with possible superficial subcutaneous extension, demonstrate cytologic atypia, and often show mitotic activity. METHODS A retrospective review of patient demographics, tumor characteristics, and treatment methods was conducted in a consecutive series of patients presenting to MD Anderson Cancer Center (MDACC) from 2002 to 2021 (n = 95). All pathology was reviewed by MDACC pathologists and determined to be atypical intradermal smooth muscle neoplasm. RESULTS Median age at diagnosis was 58 years (range 22-86), and 74% were male. Ninety-five percent (n = 90) of patients identified as White, non-Hispanic. Most tumors were slow-growing, solitary, and painless nodules. Tumors were in the lower extremities (44.2%), followed by the upper extremity (28.4%), trunk (22.1%), and head and neck (5.2%). All patients (n = 44, 46.3%) who had a punch/incisional biopsy for diagnostic purposes had a subsequent tumor excision. Unplanned excision or excisional biopsy was performed on the remaining 46 (48%) patients. Of this subset, 41 of the 46 aforementioned patients (89%) had positive margins and underwent re-excision. Final pathology in 25/38 (66%) re-excision specimens was negative for residual tumor despite an initial positive margin. Two patients in the cohort had local recurrence 2 and 3 years after initial surgery. Both patients had positive margins, underwent excision of the recurrent tumor, and remain free of disease. After median follow-up of 6.9 years (range 1 day-18 years), 5-year recurrence-free survival was 96% and overall survival (OS) of the entire cohort was 78%. CONCLUSION In this study of consecutive patients presenting with atypical intradermal smooth muscle neoplasm, we found good OS and local control after definitive surgical excision with negative margins, including excisional biopsy with close margins. Atypical intradermal smooth muscle neoplasm is unlikely to metastasize and has an excellent prognosis. Guidelines to determine optimal surveillance strategies for these patients should be revisited.
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Affiliation(s)
- Alicia Gingrich
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Madeline B Torres
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vinod Ravi
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ravin Ratan
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Emily Z Keung
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christopher P Scally
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alexander J Lazar
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wei-Lien Wang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christina L Roland
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kelly K Hunt
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wendong Yu
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Keila E Torres
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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3
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Bresler SC, Gosnell HL, Ko JS, Angeles CV, Ronen S, Billings SD, Patel RM. Subcutaneous Leiomyosarcoma: An Aggressive Malignancy Portending a Significant Risk of Metastasis and Death. Am J Surg Pathol 2023; 47:1417-1424. [PMID: 37727934 DOI: 10.1097/pas.0000000000002126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Subcutaneous leiomyosarcoma (LMS) is a rare, poorly understood variant. The current literature on the subject is sparse, consisting of isolated case reports and small clinicopathologic studies compromised by the inclusion of both its more common and indolent counterpart, cutaneous LMS (atypical intradermal smooth muscle neoplasm), as well as highly aggressive deep-seated tumors. Thus, precise clinicopathologic characterization is limited. Cases of subcutaneous LMS reviewed at the University of Michigan and Cleveland Clinic from 1994 to 2022 were included in this retrospective study. A total of 39 cases were identified. The mean age was 61 years, and the cohort was predominantly male (23/39; 59%). Tumors averaged 4.2 cm and most commonly arose on the extremities (32/39; 82%). The majority (38/39; 97%) were diagnosed at an early pathologic stage (pT1 or pT2). Histopathologically, most tumors were well-circumscribed and were assigned a Fédération Nationale des Centers de Lutte Contre le Cancer grade of either 1 or 2 (24/39; 62%). The majority (22/39; 56%) appeared to arise in association with a blood vessel. Of the 36 cases with accessible clinical data and follow-up (mean 34 mo, range 0 to 94 mo), 12 (33%) were noted to have metastasized, with the lung representing the most common anatomic location. One case recurred locally. Six of 36 patients (17%) died from the disease at an average of 47 months after diagnosis (range 16 to 94 mo). Metastasis or death from disease was significantly associated with the Fédération Nationale des Centers de Lutte Contre le Cancer grade ( P =0.0015), the presence of necrosis ( P =0.032), tumor size ( P =0.049), and AJCC tumor stage ( P =0.036). These data demonstrate that subcutaneous LMS are more aggressive than dermal-based tumors and have a prognosis akin to that of deep-seated LMS.
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Affiliation(s)
- Scott C Bresler
- Department of Pathology
- Department of Dermatology
- Rogel Cancer Center
| | | | - Jennifer S Ko
- Department of Pathology, Cleveland Clinic, Cleveland, OH
| | - Christina V Angeles
- Department of Dermatology
- Rogel Cancer Center
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Shira Ronen
- Department of Pathology, Cleveland Clinic, Cleveland, OH
| | | | - Rajiv M Patel
- Department of Pathology
- Department of Dermatology
- Cutaneous Pathology, WCP Laboratories, Inc., Maryland Heights, MO
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4
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Seo YD, Lu H, Black G, Smythe K, Yu Y, Hsu C, Ng J, Hermida de Viveiros P, Warren EH, Schroeder BA, O’Malley RB, Cranmer LD, Loggers ET, Wagner MJ, Bonham L, Pillarisetty VG, Kane G, Berglund P, Hsu FJ, Mi X, Alexiev BA, Pierce RH, Riddell SR, Jones RL, ter Meulen J, Kim EY, Pollack SM. Toll-Like Receptor 4 Agonist Injection With Concurrent Radiotherapy in Patients With Metastatic Soft Tissue Sarcoma: A Phase 1 Nonrandomized Controlled Trial. JAMA Oncol 2023; 9:1660-1668. [PMID: 37824131 PMCID: PMC10570919 DOI: 10.1001/jamaoncol.2023.4015] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/07/2023] [Indexed: 10/13/2023]
Abstract
Importance Metastatic soft tissue sarcomas (STSs) have limited systemic therapy options, and immunomodulation has not yet meaningfully improved outcomes. Intratumoral (IT) injection of the toll-like receptor 4 (TLR4) agonist glycopyranosyl lipid A in stable-emulsion formulation (GLA-SE) has been studied as immunotherapy in other contexts. Objective To evaluate the safety, efficacy, and immunomodulatory effects of IT GLA-SE with concurrent radiotherapy in patients with metastatic STS with injectable lesions. Design, Setting, and Participants This phase 1 nonrandomized controlled trial of patients with STS was performed at a single academic sarcoma specialty center from November 17, 2014, to March 16, 2016. Data analysis was performed from August 2016 to September 2022. Interventions Two doses of IT GLA-SE (5 μg and 10 μg for 8 weekly doses) were tested for safety in combination with concurrent radiotherapy of the injected lesion. Main Outcomes and Measures Primary end points were safety and tolerability. Secondary and exploratory end points included local response rates as well as measurement of antitumor immunity with immunohistochemistry and T-cell receptor (TCR) sequencing of tumor-infiltrating and circulating lymphocytes. Results Twelve patients (median [range] age, 65 [34-78] years; 8 [67%] female) were treated across the 2 dose cohorts. Intratumoral GLA-SE was well tolerated, with only 1 patient (8%) experiencing a grade 2 adverse event. All patients achieved local control of the injected lesion after 8 doses, with 1 patient having complete regression (mean regression, -25%; range, -100% to 4%). In patients with durable local response, there were detectable increases in tumor-infiltrating lymphocytes. In 1 patient (target lesion -39% at 259 days of follow-up), TCR sequencing revealed expansion of preexisting and de novo clonotypes, with convergence of numerous rearrangements coding for the same binding sequence (suggestive of clonal convergence to antitumor targets). Single-cell sequencing identified these same expanded TCR clones in peripheral blood after treatment; these T cells had markedly enhanced Tbet expression, suggesting TH1 phenotype. Conclusions and Relevance In this nonrandomized controlled trial, IT GLA-SE with concurrent radiotherapy was well tolerated and provided more durable local control than radiotherapy alone. Patients with durable local response demonstrated enhanced IT T-cell clonal expansion, with matched expansion of these clonotypes in the circulation. Additional studies evaluating synergism of IT GLA-SE and radiotherapy with systemic immune modulation are warranted. Trial Registration ClinicalTrials.gov Identifier: NCT02180698.
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Affiliation(s)
- Yongwoo David Seo
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
- Department of Surgery, University of Washington, Seattle
| | | | - Graeme Black
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Kimberly Smythe
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Yuexin Yu
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Cynthia Hsu
- Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle
| | - Juliana Ng
- Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - E. Houston Warren
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle
| | - Brett A. Schroeder
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Lee D. Cranmer
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle
| | - Elizabeth T. Loggers
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle
| | - Michael J. Wagner
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle
| | - Lynn Bonham
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | | | - Gabrielle Kane
- Department of Radiation Oncology, University of Washington, Seattle
| | | | | | - Xinlei Mi
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Stanley R. Riddell
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Robin L. Jones
- Royal Marsden and Institute for Cancer Research, London, UK
| | | | - Edward Y. Kim
- Department of Radiation Oncology, University of Washington, Seattle
| | - Seth M. Pollack
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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5
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Updates in Pathology for Retroperitoneal Soft Tissue Sarcoma. Curr Oncol 2022; 29:6400-6418. [PMID: 36135073 PMCID: PMC9497884 DOI: 10.3390/curroncol29090504] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/30/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022] Open
Abstract
Retroperitoneal tumors are extremely rare. More than 70% of primary retroperitoneal soft tissue tumors are malignant. The most common sarcomas in the retroperitoneum include liposarcomas and leiomyosarcoma, however other sarcomas, along with benign mesenchymal tumors, can occur. Sarcomas are a heterogenous group of tumors with overlapping microscopic features, posing a diagnostic challenge for the pathologist. Correct tumor classification has become important for prognostication and the evolving targeted therapies for sarcoma subtypes. In this review, the pathology of retroperitoneal soft tissue sarcomas is discussed, which is important to the surgical oncologist. In addition, less common sarcomas and benign mesenchymal tumors of the retroperitoneum, which may mimic sarcoma clinically and pathologically, are also discussed.
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Mallol C, Gutierrez-Quintana R, Hammond G, Schweizer-Gorgas D, De Decker S, Novellas R, Espada Y, Oevermann A, Ortega M, Parry A, Coelho AM, Gonçalves R, Stalin C, Brocal J. MRI features of canine hemangiosarcoma affecting the central nervous system. Vet Radiol Ultrasound 2021; 63:185-196. [PMID: 34873768 DOI: 10.1111/vru.13041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 09/24/2021] [Accepted: 09/24/2021] [Indexed: 12/13/2022] Open
Abstract
Hemangiosarcoma is the most common metastatic tumor involving the brain in dogs but detailed published descriptions of the magnetic resonance imaging (MRI) features are lacking. The objective of this multi-center, retrospective case series study was to describe MRI characteristics of canine hemangiosarcoma affecting the central nervous system (CNS). Medical records of seven referral institutions were retrospectively reviewed. Dogs were included if they had a histopathologically confirmed diagnosis of hemangiosarcoma affecting the CNS and undergone an MRI of the brain and/or vertebral column. Lesions were independently evaluated by two observers. Twenty dogs met the inclusion criteria and one dog had both intracranial and intramedullary hemangiosarcoma. Consistent MRI features included heterogeneous (17/21) lesions in all sequences with mainly mixed signal intensity (12/21), presence of susceptibility artifact on T2*w (15/16), associated moderate to severe perilesional edema (21/21), and moderate to strong (20/21) heterogeneous (14/21) or ring-like (6/21) contrast enhancement. Intracranial hemangiosarcoma was frequently multiple and intra-axial, affecting consistently the telencephalon and no differences in MRI features were found between primary and metastatic hemangiosarcoma. This is the first MRI description of primary intracranial hemangiosarcoma and primary intracranial epithelioid hemangiosarcoma. Vertebral hemangiosarcomas were segmental poorly marginated polyostotic and highly aggressive lesions invading the thoracic vertebral canal and paraspinal tissues. Epidural hemangiosarcomas were single and well-marginated lesions in the thoracolumbar and/or lumbar region. Intramedullary hemangiosarcomas were cervical, metastatic in origin, and frequently (3/4) accompanied by intracranial lesions. These described MRI features will aid early identification of hemangiosarcoma guiding subsequent diagnostics and therapeutics.
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Affiliation(s)
- Claudia Mallol
- Diagnostic Imaging Service of the Fundació Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Cerdanyola del Vallés, Spain
| | | | - Gawain Hammond
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Daniela Schweizer-Gorgas
- Division of Clinical Radiology, Department of Clinical Veterinary Medicine, Vetsuisse-Faculty, University of Bern, Bern, Switzerland
| | - Steven De Decker
- Department of Veterinary Clinical Science and Services, The Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hertfordshire, UK
| | - Rosa Novellas
- Diagnostic Imaging Service of the Fundació Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Cerdanyola del Vallés, Spain.,Department of Animal Medicine and Surgery, Universitat Autònoma de Barcelona, Cerdanyola del Vallés, Spain
| | - Yvonne Espada
- Diagnostic Imaging Service of the Fundació Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Cerdanyola del Vallés, Spain.,Department of Animal Medicine and Surgery, Universitat Autònoma de Barcelona, Cerdanyola del Vallés, Spain
| | - Anna Oevermann
- Division of Neurological Sciences, Department of Clinical Research and Veterinary Public Health, Vetsuisse-Faculty, University of Bern, Bern, Switzerland
| | - Maria Ortega
- Centro Clínico Veterinario Indautxu, San Mames Zumarkalea 38, Bizkaia, Bilbao, Spain
| | - Andrew Parry
- Willows Referral Service, Highlands Road, Shirley, Solihull, West Midlands, UK
| | - Ana Maria Coelho
- WEAR REFERRALS Veterinary Hospital, Bradbury, Stockton-on-Tees, UK
| | - Rita Gonçalves
- Department of Small Animal Clinical Science, Small Animal Teaching Hospital, University of Liverpool, Leahurst, Chester High Road, Neston, UK
| | - Catherine Stalin
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Josep Brocal
- Anderson Moores Veterinary Specialists, Bunstead Barns, Poles Lane, Hursley, Winchester, Hampshire, UK
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Whaley RD, Thompson LDR. Epstein-Barr Virus-Associated Smooth Muscle Tumors of Larynx: A Clinicopathologic Study and Comprehensive Literature Review of 12 Cases. Head Neck Pathol 2021; 15:1162-1171. [PMID: 33891274 PMCID: PMC8633162 DOI: 10.1007/s12105-021-01328-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/08/2021] [Indexed: 01/13/2023]
Abstract
Laryngeal mesenchymal neoplasms are rare, with smooth muscle tumors comprising a small subset. Specifically, Epstein-Barr virus (EBV)-associated smooth muscle tumors are exceptionally rare, lacking a comprehensive evaluation of their clinical and histologic features. Two patients (a 59 year old male and 51 year old female) had received renal transplants 156 and 240 months, respectively prior to onset of laryngeal symptoms. Supraglottic polypoid masses were identified and removed conservatively. Histologically, the tumors were hypercellular, showing alternating light and dark areas, the latter composed of primitive appearing round cells, while a more characteristic spindled tumor cell population was noted in the remaining areas. Cytoplasmic vacuoles were noted adjacent to the nucleus. There was no tumor necrosis or pleomorphism, but increased mitotic figures (11-12/2 mm2) were seen, without atypical forms. The tumor cells were strongly immunoreactive with smooth muscle actin and smooth muscle myosin heavy chain and with Epstein-Barr virus encoded RNA (EBER) by in situ hybridization. These patients were reviewed in the context of a thorough English literature review, which demonstrates a wide age range at presentation without a sex predilection, but with most patients from specific ethnic groups (Chinese, Thai, Pilipino). Three-quarters of patients are part of multifocal disease and the majority are post-renal transplantation patients. Conservative management seems to yield the best overall outcome for these indolent tumors. In conclusion, EBV-associated smooth muscle tumors should be considered in any immunocompromised patient with a head and neck smooth muscle tumor, especially when EBER is documented by in situ hybridization. Conservative management may be employed, even when multifocal tumors are documented.
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Affiliation(s)
| | - Lester D. R. Thompson
- Department of Pathology, Southern California Permanente Medical Group, 5601 De Soto Avenue, Woodland Hills, CA 91365 USA
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Cazzato F, D'Ercole A, De Luca G, Aiello FB, Croce A. Neck subcutaneous nodule as first metastasis from broad ligament leiomyosarcoma: a case report and review of literature. BMC Surg 2020; 20:297. [PMID: 33238975 PMCID: PMC7687730 DOI: 10.1186/s12893-020-00951-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background Leiomyosarcoma usually develops in the myometrium and is characterized by a high recurrence rate, frequent hematogenous dissemination, and poor prognosis. Metastasis is usually to lungs, liver, and bone, and occasionally to the brain, but seldom to the head and neck region. Primary leiomyosarcoma very rarely arises in the broad ligament. Case presentation A 54-year old woman presented to the otolaryngology department with a mass in the right posterior region of the neck 4 years after surgery for a primary leiomyosarcoma of the right broad ligament. The neck mass was removed and found to be a metastatic leiomyosarcoma. Leiomyosarcoma localizations in lungs and liver were absent. Morphological examination showed both the primary and the secondary leiomyosarcomas to have features of low-grade tumors. One year after excision of the neck mass, the patient presented with tachycardia. Echocardiography detected two intracardiac nodules suggestive of metastatic tumors. Chemotherapy was administered; the disease has been stable since then. Conclusions We report the first case of broad ligament leiomyosarcoma with the neck subcutaneous region being the first site of secondary involvement. We speculate that the Batson venous plexus might have been the pathway of dissemination.
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Affiliation(s)
- Fiorella Cazzato
- Department of Medical, Oral and Biotechnological Sciences, University G. D'Annunzio, Chieti-Pescara, Via dei Vestini, 66100, Chieti, Italy
| | - Angela D'Ercole
- Surgical Pathology Unit, Santissima Annunziata Hospital, Chieti, Italy
| | - Graziano De Luca
- Clinical Pathology Unit, Giuseppe Mazzini Hospital, Teramo, Italy
| | - Francesca B Aiello
- Department of Medicine and Aging Sciences, University G. D'Annunzio, Chieti-Pescara, Chieti, Italy
| | - Adelchi Croce
- Department of Medical, Oral and Biotechnological Sciences, University G. D'Annunzio, Chieti-Pescara, Via dei Vestini, 66100, Chieti, Italy.
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9
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Okamoto M, Matsuoka M, Soma T, Arai R, Kato H, Harabayashi T, Adachi H, Shinohara T, Sagawa T, Nishiyama N, Nambu T, Sakai W, Suzuki H, Kato H, Hiraga H. Metastases of soft tissue sarcoma to the liver: A Historical Cohort Study from a Hospital-based Cancer Registry. Cancer Med 2020; 9:6159-6165. [PMID: 32648686 PMCID: PMC7476817 DOI: 10.1002/cam4.3304] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 06/02/2020] [Accepted: 06/26/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hepatic metastasis of soft tissue sarcoma is rare compared to lung metastasis, and the literature is scarce. We examined the risk of hepatic metastasis according to the site of occurrence and histological type. METHODS From a Hospital-based Cancer Registry, 658 patients registered between 2007 and 2017 with soft tissue sarcomas were evaluated. The exclusion criteria were gastrointestinal stromal tumors, tumors of unknown origin, and follow-up periods of less than 1 month. SPSS 25 was used for statistical analysis. RESULTS The risk of hepatic metastasis was significantly higher in the retroperitoneum (HR, 5.981; 95% CI, 2.793-12.808) and leiomyosarcoma (HR, 4.303; 95% CI, 1.782-10.390). Multivariate analysis showed that the risk of hepatic metastasis as first distant metastasis was high in leiomyosarcoma (HR, 4.546; 95% CI, 2.275-9.086) and retroperitoneal onset (HR, 4.588; 95% CI, 2.280-9.231). The 2-year survival rate after hepatic metastasis was 21.7%. CONCLUSIONS The onset of hepatic metastasis indicates a poor prognosis. However, hepatic metastasis from retroperitoneal sarcoma and leiomyosarcoma may be the first distant metastasis in some cases. For retroperitoneal sarcoma and leiomyosarcoma, additional screening for hepatic metastasis such as contrast CT should be considered during staging and follow-up after treatment.
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Affiliation(s)
- Masanori Okamoto
- Sarcoma CenterNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
- Department of Musculoskeletal OncologyNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
- Department of Orthopaedic SurgeryShinshu University School of MedicineNaganoJapan
| | - Masatake Matsuoka
- Sarcoma CenterNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
- Department of Musculoskeletal OncologyNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
| | - Tamotsu Soma
- Sarcoma CenterNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
- Department of Musculoskeletal OncologyNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
| | - Ryuta Arai
- Sarcoma CenterNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
- Department of Musculoskeletal OncologyNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
| | - Hidenori Kato
- Sarcoma CenterNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
- Department of Gynecologic OncologyNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
| | - Toru Harabayashi
- Sarcoma CenterNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
- Department of UrologyNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
| | - Hirohumi Adachi
- Sarcoma CenterNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
- Department of Thoracic SurgeryNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
| | - Toshiki Shinohara
- Sarcoma CenterNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
- Department of Gastrointestinal SurgeryNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
| | - Tamotsu Sagawa
- Sarcoma CenterNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
- Department of Medical OncologyNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
| | - Noriaki Nishiyama
- Sarcoma CenterNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
- Department of Radiation OncologyNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
| | - Toshikazu Nambu
- Sarcoma CenterNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
- Department of Diagnostic RadiologyNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
| | - Wataru Sakai
- Sarcoma CenterNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
- Department of Diagnostic RadiologyNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
| | - Hiroaki Suzuki
- Sarcoma CenterNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
- Department of PathologyNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
| | - Hiroyuki Kato
- Department of Orthopaedic SurgeryShinshu University School of MedicineNaganoJapan
| | - Hiroaki Hiraga
- Sarcoma CenterNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
- Department of Musculoskeletal OncologyNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
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10
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Peter Christudas Valsamma D, Mani V, Jose SK, Thomas M. Exophytic nodule resembling a horn - an unusual presentation of metastatic cutaneous leiomyosarcoma. Australas J Dermatol 2020; 62:77-78. [PMID: 32686093 DOI: 10.1111/ajd.13403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 06/18/2020] [Accepted: 06/20/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Venkataraman Mani
- Department of Dermatology, Venereology and Leprosy, Christian, Vellore, India
| | - Sheethal K Jose
- Department of Dermatology, Venereology and Leprosy, Christian, Vellore, India.,Department of Pathology, Christian Medical College, Vellore, India
| | - Meera Thomas
- Department of Pathology, Christian Medical College, Vellore, India
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11
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Asadbeigi SN, Zhang L, Linos K. Subcutaneous desmoplastic small round-cell tumor: An unusual primary location expanding the differential of superficial round-cell tumors. J Cutan Pathol 2020; 47:768-775. [PMID: 32249945 DOI: 10.1111/cup.13703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/22/2020] [Accepted: 03/29/2020] [Indexed: 12/27/2022]
Abstract
Desmoplastic small round-cell tumor (DSRCT) is a rare, aggressive malignant tumor, which in the great majority of cases arises at abdominal-pelvic sites. Nevertheless, rare cases of primary extra-abdominal tumors have been reported. In challenging cases, its molecular hallmark, the EWSR1-WT1 reciprocal translocation, can be exploited diagnostically by various molecular techniques. Herein, we report an extremely rare case of primary subcutaneous DSRCT in an effort to raise awareness among our dermatopathology colleagues by expanding the differential of superficial round-cell tumors.
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Affiliation(s)
- Sepideh N Asadbeigi
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Lisheng Zhang
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Konstantinos Linos
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, New Hampshire, USA
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12
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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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13
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Hornick JL. Subclassification of pleomorphic sarcomas: How and why should we care? Ann Diagn Pathol 2018; 37:118-124. [PMID: 30340082 DOI: 10.1016/j.anndiagpath.2018.10.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 10/10/2018] [Indexed: 01/15/2023]
Abstract
Pleomorphic sarcomas are a heterogeneous group of mesenchymal neoplasms with widely varied clinical behavior but overlapping histologic appearances. The following guidelines are helpful when approaching the diagnosis of a pleomorphic sarcoma. (1) Be aware of the relative incidence of the various sarcoma types: several pleomorphic sarcomas are relatively common (e.g., dedifferentiated liposarcoma and undifferentiated pleomorphic sarcoma), whereas others are exceptionally rare. (2) Pay attention to anatomic location: some pleomorphic sarcomas have a predilection for somatic soft tissues, especially the thigh (e.g., undifferentiated pleomorphic sarcoma, pleomorphic liposarcoma, pleomorphic rhabdomyosarcoma), whereas other pleomorphic sarcomas most often arise in the retroperitoneum (e.g., dedifferentiated liposarcoma). (3) Carefully sample the resection specimen, paying particular attention to areas with differences in gross appearances (e.g., fleshy, fibrous, mucoid, or gritty). (4) Search for histologic clues (i.e., myxoid stroma, lipoblasts, and osteoid matrix, in order to diagnose myxofibrosarcoma, pleomorphic liposarcoma, and extraskeletal osteosarcoma, respectively); these critical diagnostic features may be limited in extent. (5) Apply immunohistochemistry judiciously, after generating a differential diagnosis; always exclude metastatic sarcomatoid carcinoma and melanoma before diagnosing a pleomorphic sarcoma. This review will present an approach to the diagnosis of pleomorphic sarcomas, emphasizing differential diagnosis and the application of ancillary studies (immunohistochemistry and FISH), when relevant.
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Affiliation(s)
- Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
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14
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Hannah CE, Moye MS, Liu V, Milhem MM, Wanat KA. Cutaneous metastases of malignant peripheral nerve sheath tumor: Ineffectiveness of intralesional methotrexate. JAAD Case Rep 2018; 4:716-718. [PMID: 30128346 PMCID: PMC6098197 DOI: 10.1016/j.jdcr.2018.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Claire E Hannah
- University of Iowa Carver College of Medicine, Iowa City, Iowa
| | | | - Vincent Liu
- Department of Dermatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.,Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Mohammed M Milhem
- Department of Internal Medicine - Hematology, Oncology and Blood and Marrow Transplantation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Karolyn A Wanat
- Department of Dermatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.,Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.,Department of Dermatology, Iowa City VA Medical Center, Iowa City, Iowa
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15
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Abstract
Smooth muscle tumors occur infrequently in the skin. They consist of a diverse group of lesions representing hamartomas as well as benign and malignant neoplasms. They may arise from arrector pili muscle, specialized smooth muscle of the genitalia, or vascular smooth muscle. Although rare, accurate diagnosis and classification of cutaneous smooth muscle proliferations is important as they can exhibit a range of clinical behavior and may be associated with underlying syndromes. This review summarizes the clinicopathologic spectrum of smooth muscle tumors involving the skin.
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16
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Toquica A, Rueda X, Cervera S, Reina A, Pozzobon C, Morales SD, Parra-Medina R. Ewing's sarcoma metastatic to skin: a case report and review of the literature. Int J Dermatol 2018; 57:1365-1368. [PMID: 29732544 DOI: 10.1111/ijd.14031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 02/25/2018] [Accepted: 04/08/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Alejandra Toquica
- Department of Dermatology Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Xavier Rueda
- Department of Dermatology Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Sergio Cervera
- Department of Breast and Soft Tissues Surgery, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Adriana Reina
- Department of Dermatology Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Carolina Pozzobon
- Department of Dermatology Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Samuel D Morales
- Department of Pathology, Instituto Nacional de Cancerología, Bogotá, Colombia.,Department of Pathology, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
| | - Rafael Parra-Medina
- Department of Pathology, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia.,Research Institute, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
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17
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Rodríguez-Lomba E, Molina-López I, Parra-Blanco V, Suárez-Fernández R, Pulido-Pérez A. Clinical and Histopathologic Findings of Cutaneous Leiomyosarcoma: Correlation With Prognosis in 12 Patients. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2017.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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18
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Rodríguez-Lomba E, Molina-López I, Parra-Blanco V, Suárez-Fernández R, Pulido-Pérez A. Clinical and Histopathologic Findings of Cutaneous Leiomyosarcoma: Correlation with Prognosis in 12 Patients. ACTAS DERMO-SIFILIOGRAFICAS 2017; 109:140-147. [PMID: 29100621 DOI: 10.1016/j.ad.2017.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/30/2017] [Accepted: 08/31/2017] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION Cutaneous leiomyosarcoma is a malignant neoplasm derived from smooth muscle cells. Its low incidence hampers the development of specific protocols for diagnosis and treatment. OBJECTIVES To describe the clinical and histopathologic characteristics of a series of primary and secondary cutaneous leiomyosarcomas and to determine how these characteristics correlate with prognosis. MATERIAL AND METHODS We performed an observational, descriptive, retrospective study based on 17 cutaneous leiomyosarcomas in 12 patients diagnosed between January 1, 2000 and December 31, 2015. We recorded demographic data, clinical and histopathologic characteristics, outcome, and response to treatment. RESULTS We included 5 men and 7 women, all aged more than 50 years at diagnosis. There were 4 cutaneous leiomyosarcomas (23%) in 4 patients, 2 subcutaneous leiomyosarcomas (11.5%) in 2 patients, and 11 skin metastases of leiomyosarcoma (65%) in 6 patients. The most frequently affected sites were the scalp (41%), lower limbs (17%), and trunk (17%). During follow-up, 50% of the cutaneous leiomyosarcomas recurred, 50% of the subcutaneous leiomyosarcomas presented distant metastases, and 83% of the patients with skin metastases of leiomyosarcoma died of their disease. LIMITATIONS Ours was a retrospective review of a small case series at a single center. CONCLUSIONS Cutaneous leiomyosarcoma is an uncommon malignant neoplasm. Our approach to diagnosis and therapy must take into account the marked heterogeneity in the prognosis of the various subtypes.
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Affiliation(s)
- E Rodríguez-Lomba
- Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - I Molina-López
- Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - V Parra-Blanco
- Servicio de Anatomía Patológica, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - R Suárez-Fernández
- Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A Pulido-Pérez
- Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, España
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19
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Pearly Facial Nodule as a Presentation of Late Metastasis of Retroperitoneal Leiomyosarcoma. Dermatol Surg 2017; 44:736-738. [PMID: 28858929 DOI: 10.1097/dss.0000000000001290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Fabbi M, Di Palma S, Manfredi S, Gnudi G, Miduri F, Daga E, Melis GC, Bianchi E, Voccia S, Volta A. IMAGING DIAGNOSIS-ULTRASONOGRAPHIC APPEARANCE OF SKELETAL MUSCLE METASTASES IN A DOG WITH HEMANGIOSARCOMA. Vet Radiol Ultrasound 2016; 58:E64-E67. [PMID: 27699974 DOI: 10.1111/vru.12432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 08/23/2016] [Accepted: 08/23/2016] [Indexed: 12/14/2022] Open
Abstract
A 13-year-old spayed female German shepherd dog was presented for acute onset of lethargy, anorexia, and disseminated erythematous skin lesions. Thoracic radiographs and abdominal ultrasonographic findings were consistent with metastatic hemangiosarcoma. Multiple, ill-defined, irregularly shaped hypoechoic nodules were also detected within the thoracic and abdominal wall. Hemangiosarcoma metastases to the skeletal muscle were confirmed based on histopathological examination. Multivisceral involvement was also confirmed by necropsy. Metastatic neoplasia should be considered as a differential diagnosis for dogs with ill-defined, irregular, hypoechoic, intramuscular nodules.
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Affiliation(s)
- Martina Fabbi
- Dipartimento di Scienze Medico Veterinarie, University of Parma, Italy
| | | | - Sabrina Manfredi
- Dipartimento di Scienze Medico Veterinarie, University of Parma, Italy
| | - Giacomo Gnudi
- Dipartimento di Scienze Medico Veterinarie, University of Parma, Italy
| | - Francesca Miduri
- Dipartimento di Scienze Medico Veterinarie, University of Parma, Italy
| | - Eleonora Daga
- Dipartimento di Scienze Medico Veterinarie, University of Parma, Italy
| | | | - Ezio Bianchi
- Dipartimento di Scienze Medico Veterinarie, University of Parma, Italy
| | - Simone Voccia
- Dipartimento di Scienze Medico Veterinarie, University of Parma, Italy
| | - Antonella Volta
- Dipartimento di Scienze Medico Veterinarie, University of Parma, Italy
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21
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Yu J, Sokumbi O. Cutaneous metastasis of pleomorphic liposarcoma to the scalp: an elusive diagnosis. J Cutan Pathol 2016; 43:526-530. [PMID: 26968423 DOI: 10.1111/cup.12692] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/24/2015] [Accepted: 11/02/2015] [Indexed: 12/17/2022]
Abstract
Liposarcomas are one of the most common sarcomas arising in the extremities of the elderly. Various subtypes of liposarcomas include well-differentiated liposarcomas, dedifferentiated liposarcomas, myxoid liposarcomas and pleomorphic liposarcomas. Pleomorphic liposarcomas are the rarest subtype and have the highest malignant potential compared with the other subtypes of liposarcomas. Metastases to internal organs are common but cutaneous metastasis is very rare with only few cases in the literature. We present a patient with a known diagnosis of stage IV metastatic liposarcoma who presented to our clinic with a rapidly growing nodule on the scalp. A biopsy showed a high-grade poorly differentiated spindled cell neoplasm sparing the epidermis with scattered lipoblasts. Immunostaining for S100, SOX10, and MNF-116 were negative. To further characterize the neoplasm, immunostaining with MDM-2 was performed and was also found to be negative. The histologic appearance, immunohistochemical staining, and clinical history support a diagnosis of metastatic pleomorphic liposarcoma to the scalp. The diagnosis of pleomorphic liposarcoma is challenging. It is often difficult to differentiate from myxofibrosarcoma or other high-grade pleomorphic sarcomas based on histology alone. However, the presence of bizarre lipoblasts and negative MDM-2 staining can be helpful clues to differentiate this neoplasm from histologic mimics.
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Affiliation(s)
- JiaDe Yu
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Olayemi Sokumbi
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
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22
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Kaur S, Tyagi R, Selhi P, Singh A, Puri H, Sood N. Subcutaneous Axillary and Scalp Metastases from Non-Gynecological Retroperitoneal Leiomyosarcoma: An Unusual Presentation After Surgical Resection. Rare Tumors 2015; 7:5970. [PMID: 26788272 PMCID: PMC4703918 DOI: 10.4081/rt.2015.5970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 07/20/2015] [Accepted: 07/29/2015] [Indexed: 01/14/2023] Open
Abstract
Retroperitoneal leiomyosarcomas are rare sarcomas, with an incidence of less than 2 per million population. Cutaneous metastases from sarcoma account for only 1-2.6% of metastatic skin lesions. Cutaneous and subcutaneous metastasis from retroperitoneal leiomyosarcoma is a very rare entity. We present a case of 72-year-old male with scalp nodule and subcutaneous swelling in left posterior axillary fold. Fine needle aspiration cytology from both these sites revealed a sarcoma, which was positive for Smooth Muscle Actin and negative for S100 on cell block immuno-histochemistry (IHC). The past history revealed surgical resection of a retroperitoneal mass in 2010 which was diagnosed on histopathology and IHC as leiomyosarcoma. A final diagnosis of metastatic deposits from leiomyosarcoma was made. Retroperitoneal leiomyosarcoma presenting as scalp and subcutaneous metastasis is an unusual presentation. Adequate clinical history and a high index of clinical suspicion is required to detect cutaneous and subcutaneous metastatic deposits occurring five years after surgical resection.
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Affiliation(s)
- Simrandeep Kaur
- Department of Pathology, Dayanand Medical College and Hospital , Ludhiana, India
| | - Ruchita Tyagi
- Department of Pathology, Dayanand Medical College and Hospital , Ludhiana, India
| | - Pavneet Selhi
- Department of Pathology, Dayanand Medical College and Hospital , Ludhiana, India
| | - Aminder Singh
- Department of Pathology, Dayanand Medical College and Hospital , Ludhiana, India
| | - Harpreet Puri
- Department of Pathology, Dayanand Medical College and Hospital , Ludhiana, India
| | - Neena Sood
- Department of Pathology, Dayanand Medical College and Hospital , Ludhiana, India
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23
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Achtman JC, Pavlidakey PG, Zhang PJ, Elenitsas R, Gutman AB. Synovial sarcoma with cutaneous metastasis. J Cutan Pathol 2015; 43:85-7. [DOI: 10.1111/cup.12565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 07/22/2015] [Accepted: 08/08/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Jordan C. Achtman
- Perelman School of Medicine; University of Pennsylvania; Philadelphia PA USA
| | | | - Paul J. Zhang
- University of Pennsylvania Health System; Philadelphia PA USA
| | | | - Ari B. Gutman
- Pennsylvania Centre for Dermatology; Philadelphia PA USA
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24
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Winchester DS, Hocker TL, Roenigk RK. Skin metastases of leiomyosarcoma (LMS): a retrospective review of 21 cases. J Am Acad Dermatol 2015; 72:910-2. [PMID: 25890461 DOI: 10.1016/j.jaad.2015.01.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 01/14/2015] [Accepted: 01/26/2015] [Indexed: 10/23/2022]
Affiliation(s)
| | - Thomas L Hocker
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
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25
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Duffaud F, Ray-Coquard I, Salas S, Pautier P. Recent advances in understanding and managing leiomyosarcomas. F1000PRIME REPORTS 2015; 7:55. [PMID: 26097728 PMCID: PMC4447031 DOI: 10.12703/p7-55] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Leiomyosarcomas are malignant mesenchymal tumours that derive from the smooth muscle lineage. They are studied and frequently treated as if they are the same as other soft tissue sarcomas. Recent developments suggest that a different approach may be more appropriate. Their underlying genetic mechanisms remain unclear, and complex. Unbalanced karyotypic defects are the only shared features observed across different leiomyosarcoma subtypes. Unlike other soft tissue sarcomas, leiomyosarcomas are particularly sensitive to the combination of gemcitabine and docetaxel. Furthermore, treatment with trabectedin has shown a good efficacy in leiomyosarcomas, mainly in the form of chronic disease stabilisation.
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Affiliation(s)
- Florence Duffaud
- Aix Marseille Université (AMU), Service d'Oncologie médicaleCHU la Timone Boulevard J Moulin 13005 MarseilleFrance
| | - Isabelle Ray-Coquard
- Université Claude Bernard Lyon I, Oncologie Médicale, Centre Leon Bérard28 rue Laennec, 69008 LyonFrance
| | - Sébastien Salas
- Aix Marseille Université (AMU), Service d'Oncologie médicaleCHU la Timone Boulevard J Moulin 13005 MarseilleFrance
| | - Patricia Pautier
- Gustave Roussy Cancer Campus114 Rue E Vaillant, 94805 VillejuifFrance
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26
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Staser K, Mount CE, Solus J, Musiek A. Pleomorphic soft tissue sarcoma metastatic to the skin of the scalp and groin. JAAD Case Rep 2015; 1:96-8. [PMID: 27051696 PMCID: PMC4802572 DOI: 10.1016/j.jdcr.2015.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Karl Staser
- Division of Dermatology, Washington University, St Louis, Missouri
| | - Charles E Mount
- Division of Dermatology, Washington University, St Louis, Missouri
| | - Jason Solus
- Division of Dermatology, Washington University, St Louis, Missouri; Department of Pathology and Immunology, Washington University, St Louis, Missouri
| | - Amy Musiek
- Division of Dermatology, Washington University, St Louis, Missouri
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27
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Winchester DS, Hocker TL, Brewer JD, Baum CL, Hochwalt PC, Arpey CJ, Otley CC, Roenigk RK. Leiomyosarcoma of the skin: Clinical, histopathologic, and prognostic factors that influence outcomes. J Am Acad Dermatol 2014; 71:919-25. [DOI: 10.1016/j.jaad.2014.07.020] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 07/01/2014] [Accepted: 07/14/2014] [Indexed: 10/24/2022]
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28
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Soft-tissue masses in the abdominal wall. Clin Radiol 2014; 69:e422-31. [DOI: 10.1016/j.crad.2014.06.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 05/05/2014] [Accepted: 06/06/2014] [Indexed: 02/07/2023]
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29
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Baltz RG, Kaley JR, Hull CA, Gardner JM. Cutaneous scalp metastases from retroperitoneal leiomyosarcoma: a case report. J Cutan Pathol 2014; 41:680-5. [DOI: 10.1111/cup.12329] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 02/17/2014] [Accepted: 03/03/2014] [Indexed: 12/21/2022]
Affiliation(s)
- Rebekah G. Baltz
- College of Medicine; University of Arkansas for Medical Sciences; Little Rock AR USA
| | - Jennifer R. Kaley
- Department of Pathology; University of Arkansas for Medical Sciences; Little Rock AR USA
| | | | - Jerad M. Gardner
- Department of Pathology; University of Arkansas for Medical Sciences; Little Rock AR USA
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