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Radaelli S, Merlini A, Khan M, Gronchi A. Progress in histology specific treatments in soft tissue sarcoma. Expert Rev Anticancer Ther 2024; 24:845-868. [PMID: 39099398 DOI: 10.1080/14737140.2024.2384584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/22/2024] [Indexed: 08/06/2024]
Abstract
INTRODUCTION Soft tissue sarcomas (STS) represent a heterogenous group of rare tumors, primarily treated with surgery. Preoperative radiotherapy is often recommended for extremity high-risk STS. Neoadjuvant chemotherapy, typically based on doxorubicin with ifosfamide, has shown efficacy in limbs and trunk wall STS. Second-line chemotherapy, commonly utilized in the metastatic setting, is mostly histology-driven. Molecular targeted agents are used across various histologies, and although the use of immunotherapy in STS is still in its early stages, there is increasing interest in exploring its potential. AREAS COVERED This article involved an extensive recent search on PubMed. It explored the current treatment landscape for localized and metastatic STS, focusing on the combined use of radiotherapy and chemotherapy for both extremity and retroperitoneal tumors, and with a particular emphasis on the most innovative histopathology driven therapeutic approaches. Additionally, ongoing clinical trials identified via clinicaltrials.gov are included. EXPERT OPINION Recently there have been advancements in the treatment of STS, largely driven by the outcomes of clinical trials. However further research is imperative to comprehend the effect of chemotherapy, targeted therapy and immunotherapy in various STS, as well as to identify biomarkers able to predict which patients are most likely to benefit from these treatments.
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Affiliation(s)
- Stefano Radaelli
- Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandra Merlini
- Department of Oncology, University of Turin, Orbassano, Italy
- Department of Oncology, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Misbah Khan
- Surgery, East Sussex NHS Healthcare, East Sussex, UK
| | - Alessandro Gronchi
- Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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2
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Ji M, Zhang Y, Liu S, Zhang M, Qiao B. Hepatic perivascular epithelioid cell tumor: a retrospective analysis of 36 cases. Front Oncol 2024; 14:1416254. [PMID: 39220650 PMCID: PMC11361986 DOI: 10.3389/fonc.2024.1416254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
Background and aims Hepatic perivascular epithelioid cell tumor (PEComa) is a rare type of mesenchymal neoplasm and lacks systematic reports. The aim was to analyze the features of hepatic PEComa in order to provide our own experience for diagnosis and management from a single center. Methods We retrospectively analyzed clinical data, imaging findings, pathology, treatments and prognosis of 36 patients with hepatic PEComa in the First Affiliated Hospital of Zhengzhou University from January 2016 to September 2023. Results 29 females and 7 males (median age, 47.8 years) were included in this study. The majority (26/36, 72.2%) of patients were diagnosed incidentally with non-specific symptoms. Abnormal enhancement of enlarged blood vessels (27/36,75%) can be observed on CT/MRI and only 7 patients (19.4%) were correctly diagnosed by imaging examinations. The positive immunohistochemical expressions were HMB-45(35/36,97.2%), Melan-A (34/35,97.1%), SMA (23/26,88.5%) and CD34(86.7%,26/30). Treatments include resection (24/36,67.7%), radiofrequency ablation (6/36,16.7%), transcatheter arterial chemoembolization(1/36,2.7%), conservative clinical follow-up(2/36,5.6%), and sirolimus-chemotherapy (3/36,8.3%). During the follow-up period (range, 2-81 months), except for one patient with a single intrahepatic recurrence and 3 malignant patients died in 6 months, the remaining patients had no signs of recurrence and metastasis. Conclusions Hepatic PEComa has no specific clinical features and mainly depends on clinicopathological characteristics for accurate diagnosis. Resection is the best treatment for benign PEComa, but TACE and radiofrequency ablation can also be considered in case of contraindications for surgery.
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Affiliation(s)
- Min Ji
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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3
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Levin G, Capella MP, Meyer R, Brezinov Y, Gotlieb WH. Gynecologic perivascular epithelioid cell tumors (PEComas): a review of recent evidence. Arch Gynecol Obstet 2024; 309:2381-2386. [PMID: 38664269 PMCID: PMC11147862 DOI: 10.1007/s00404-024-07510-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/07/2024] [Indexed: 06/04/2024]
Abstract
Gynecologic perivascular epithelioid cell (PEC) tumors, or 'PEComas,' represent a rare and intriguing subset of tumors within the female reproductive tract. This systematic literature review aims to provide an updated understanding of gynecologic PEComas based on available literature and data. Although PEComa is rare, there are varied tumor-site presentations across gynecologic organs, with uterine PEComas being the most prevalent. There is scarce high-quality literature regarding gynecologic PEComa, and studies on malignant PEComa underscore the challenges in diagnosis. Among the diverse mutations, mTOR alterations are the most prominent. Survival analysis reveals a high rate of local recurrence and metastatic disease, which commonly affects the lungs. Treatment strategies are limited, however mTOR inhibitors have pivotal role when indicated and chemotherapy may also be used. with some cases demonstrating promising responses. The paucity of data underscores the need for multicentric studies, an international registry for PEComas, and standardized reporting in case series to enhance clinical and pathological data.
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Affiliation(s)
- Gabriel Levin
- Department of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, QC, Canada.
| | - Mariana Pilon Capella
- Department of Oncology, Brazilian Institute for Cancer Control, São Paulo, SP, Brazil
| | - Raanan Meyer
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedar Sinai Medical Center, Los Angeles, CA, USA
| | - Yoav Brezinov
- Experimental Surgery, McGill University, Montreal, Canada
| | - Walter H Gotlieb
- Department of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, QC, Canada
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4
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Liang S, Chen X. Solitary Pulmonary Perivascular Epithelial Cell Tumor Mimicking Pulmonary Metastasis on 68 Ga-DOTATATE PET/CT in a Patient With Pancreatic Neuroendocrine Tumor. Clin Nucl Med 2024; 49:567-568. [PMID: 38631001 DOI: 10.1097/rlu.0000000000005235] [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: 04/19/2024]
Abstract
ABSTRACT We report the findings of 68 Ga-DOTATATE PET/CT in a 56-year-old woman with solitary pulmonary perivascular epithelioid cell tumor. 68 Ga-DOTATATE PET/CT showed a lesion with intense uptake in the region of pancreatic head and a solitary nodule with moderate uptake in the left lung. Pancreatic neuroendocrine tumor with pulmonary metastasis was considered. The postoperative pathological results showed a benign perivascular epithelioid cell tumor of the lung. This case emphasizes the need to increase awareness of benign perivascular epithelioid cell tumors in the differential diagnosis of solitary pulmonary nodule with moderate DOTATATE activity.
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Affiliation(s)
- Shuang Liang
- From the Department of Nuclear Medicine, Chongqing University Cancer Hospital, Chongqing, P. R. China
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5
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Hammer PM, Tan SY. Soft Tissue Perivascular Epithelioid Cell Tumors. Surg Pathol Clin 2024; 17:105-118. [PMID: 38278600 DOI: 10.1016/j.path.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
Perivascular epithelioid cell tumors (PEComas) are a heterogenous group of mesenchymal neoplasms with a mixed myomelanocytic immunophenotype. PEComa-family tumors include angiomyolipoma, lymphangioleiomyomatosis, and a large category of rare neoplasms throughout the body that are now classified under the umbrella term "PEComa." This review focuses on recent advances in the clinicopathological and molecular features of PEComas, with an emphasis on PEComas that originate in soft tissue.
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Affiliation(s)
- Phoebe M Hammer
- Department of Pathology, Stanford University School of Medicine, 1291 Welch Road, Lane Building L235, Stanford, CA 94305, USA
| | - Serena Y Tan
- Department of Pathology, Stanford University School of Medicine, 1291 Welch Road, Lane Building L235, Stanford, CA 94305, USA.
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Yang W, Sun Q, Shang M, Li S, Hu X, Hu X. Multimodal imaging study of hepatic perivascular epithelioid cell tumors: a case report. Front Med (Lausanne) 2023; 10:1322048. [PMID: 38173942 PMCID: PMC10762310 DOI: 10.3389/fmed.2023.1322048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
Hepatic perivascular epithelioid cell tumors (PEComas) are rare interstitial tumors that are often misdiagnosed as hepatocellular carcinomas due to their unique vascular enhancement patterns. Herein, we present a case of a 61-year-old man who was incidentally found to have a lesion in the left medial segment of the liver during a chest computed tomography (CT) examination performed 4 days prior to his presentation for chest discomfort. Imaging revealed solid components with density similar to that of normal liver tissue and areas of low-density adipose tissue within the lesion. The solid components exhibited increased uptake of fluorine-18 fluorodeoxyglucose on positron emission tomography/CT. Magnetic resonance imaging demonstrated areas with unevenly high signal intensity in both T1-weighted imaging (T1WI) in-phase and T2-weighted imaging (T2WI) sequences, while T2WI in the opposite phase displayed areas with unevenly low signal intensity, indicating the presence of fatty components. Contrast-enhanced T1WI displayed a "fast in and fast out" enhancement pattern. These distinct imaging features contribute to the diagnosis of hepatic PEComas and distinguish it from hepatocellular carcinoma.
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Affiliation(s)
| | | | | | | | | | - Xianwen Hu
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
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7
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Wakefield CB, Sadow PM, Hornick JL, Fletcher CDM, Barletta JA, Anderson WJ. PEComa of the Adrenal Gland: A Clinicopathologic Series of 7 Cases. Am J Surg Pathol 2023; 47:1316-1324. [PMID: 37545320 DOI: 10.1097/pas.0000000000002097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
PEComas are a family of mesenchymal neoplasms composed of histologically distinctive perivascular epithelioid cells which demonstrate myomelanocytic differentiation. PEComas of the adrenal gland are very rare and can represent a considerable diagnostic challenge given their morphologic overlap with more common adrenal cortical neoplasms. We present the clinicopathologic features of 7 primary adrenal PEComas. The cohort comprised 5 male and 2 female patients with a median age of 63 years (range: 31 to 71 y). One patient had Birt-Hogg-Dubé syndrome and another had Lynch syndrome; however, none had a history of tuberous sclerosis complex. Histologically, tumors showed nested and/or sheet-like growth and epithelioid cytomorphology with pale-to-eosinophilic granular cytoplasm. Two tumors had an admixed spindle cell component. There was a median of 4 mitoses per 10 HPFs (range: 0 to 8). Necrosis was present in 4 tumors and lymphovascular invasion in 1. Four tumors were classified as malignant. By immunohistochemistry, tumors were positive for HMB-45 (3/7), MITF (3/3), Melan-A (3/7), smooth muscle actin (5/7), desmin (5/7), and caldesmon (1/1). Two tumors were positive for TFE3 (2/4). Inhibin and SF1 were negative in all tumors assessed (0/6). Of 3 patients with available clinical follow-up information, 1 patient developed locally recurrent and metastatic disease (at 18 mo) and was alive with persistent disease at the last follow-up. Two patients had no recurrent or metastatic disease at the last follow-up (60 and 25 mo). Although PEComas of the adrenal gland are rare, pathologists need to be alert to this entity in the differential diagnosis of primary adrenocortical neoplasms. In suspected cases, the judicious use of melanocytic and smooth muscle markers, in addition to TFE3 and markers of adrenocortical differentiation (such as SF1 and inhibin) can assist in diagnosis. As in PEComas arising at other visceral sites, an association with tuberous sclerosis complex seems to be uncommon.
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Affiliation(s)
- Craig B Wakefield
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School
| | - Peter M Sadow
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School
| | | | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School
| | - William J Anderson
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School
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Glaviano A, Foo ASC, Lam HY, Yap KCH, Jacot W, Jones RH, Eng H, Nair MG, Makvandi P, Geoerger B, Kulke MH, Baird RD, Prabhu JS, Carbone D, Pecoraro C, Teh DBL, Sethi G, Cavalieri V, Lin KH, Javidi-Sharifi NR, Toska E, Davids MS, Brown JR, Diana P, Stebbing J, Fruman DA, Kumar AP. PI3K/AKT/mTOR signaling transduction pathway and targeted therapies in cancer. Mol Cancer 2023; 22:138. [PMID: 37596643 PMCID: PMC10436543 DOI: 10.1186/s12943-023-01827-6] [Citation(s) in RCA: 221] [Impact Index Per Article: 221.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/18/2023] [Indexed: 08/20/2023] Open
Abstract
The PI3K/AKT/mTOR (PAM) signaling pathway is a highly conserved signal transduction network in eukaryotic cells that promotes cell survival, cell growth, and cell cycle progression. Growth factor signalling to transcription factors in the PAM axis is highly regulated by multiple cross-interactions with several other signaling pathways, and dysregulation of signal transduction can predispose to cancer development. The PAM axis is the most frequently activated signaling pathway in human cancer and is often implicated in resistance to anticancer therapies. Dysfunction of components of this pathway such as hyperactivity of PI3K, loss of function of PTEN, and gain-of-function of AKT, are notorious drivers of treatment resistance and disease progression in cancer. In this review we highlight the major dysregulations in the PAM signaling pathway in cancer, and discuss the results of PI3K, AKT and mTOR inhibitors as monotherapy and in co-administation with other antineoplastic agents in clinical trials as a strategy for overcoming treatment resistance. Finally, the major mechanisms of resistance to PAM signaling targeted therapies, including PAM signaling in immunology and immunotherapies are also discussed.
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Affiliation(s)
- Antonino Glaviano
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies, University of Palermo, 90123, Palermo, Italy
| | - Aaron S C Foo
- Department of Surgery, National University Hospital Singapore, National University of Singapore, Singapore, Singapore
| | - Hiu Y Lam
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117600, Singapore
- NUS Centre for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119077, Singapore
| | - Kenneth C H Yap
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117600, Singapore
- NUS Centre for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119077, Singapore
| | - William Jacot
- Department of Medical Oncology, Institut du Cancer de Montpellier, Inserm U1194, Montpellier University, Montpellier, France
| | - Robert H Jones
- Cardiff University and Velindre Cancer Centre, Museum Avenue, Cardiff, CF10 3AX, UK
| | - Huiyan Eng
- Department of Surgery, National University Hospital Singapore, National University of Singapore, Singapore, Singapore
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117600, Singapore
| | - Madhumathy G Nair
- Division of Molecular Medicine, St. John's Research Institute, St. John's Medical College, Bangalore, 560034, India
| | - Pooyan Makvandi
- The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, Zhejiang, China
| | - Birgit Geoerger
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Center, Inserm U1015, Université Paris-Saclay, Paris, France
| | - Matthew H Kulke
- Section of Hematology and Medical Oncology, Boston University and Boston Medical Center, Boston, MA, USA
| | - Richard D Baird
- Cancer Research UK Cambridge Centre, Hills Road, Cambridge, CB2 0QQ, UK
| | - Jyothi S Prabhu
- Division of Molecular Medicine, St. John's Research Institute, St. John's Medical College, Bangalore, 560034, India
| | - Daniela Carbone
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies, University of Palermo, 90123, Palermo, Italy
| | - Camilla Pecoraro
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies, University of Palermo, 90123, Palermo, Italy
| | - Daniel B L Teh
- Departments of Ophthalmology and Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, and Neurobiology Programme, National University of Singapore, Singapore, Singapore
| | - Gautam Sethi
- Department of Surgery, National University Hospital Singapore, National University of Singapore, Singapore, Singapore
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117600, Singapore
| | - Vincenzo Cavalieri
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies, University of Palermo, 90123, Palermo, Italy
| | - Kevin H Lin
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | - Eneda Toska
- Department of Biochemistry and Molecular Biology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Matthew S Davids
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Jennifer R Brown
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Patrizia Diana
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies, University of Palermo, 90123, Palermo, Italy
| | - Justin Stebbing
- Division of Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
| | - David A Fruman
- Department of Molecular Biology and Biochemistry, University of California, 216 Sprague Hall, Irvine, CA, USA
| | - Alan P Kumar
- Department of Surgery, National University Hospital Singapore, National University of Singapore, Singapore, Singapore.
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117600, Singapore.
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Haseeb M, Sachdev P, Sravani M, Tadigotla C, Sunkara NABS, Gadyalpatil N. Malignant Perivascular Epithelioid Cell Neoplasm of Left Kidney Treated With Targeted Therapy: A Rare Case Report. Cureus 2023; 15:e43097. [PMID: 37692712 PMCID: PMC10483028 DOI: 10.7759/cureus.43097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2023] [Indexed: 09/12/2023] Open
Abstract
Perivascular epithelioid cell neoplasm (PEComa) is one of the rare entities which is challenging to diagnose clinically. These tumors occur due to tuberous sclerosis complex gene mutations leading to upregulation and overexpression of the mammalian target of rapamycin (mTOR). Malignant PEComas are rare, and we report a peculiar case of PEComa treated with mTOR inhibitors. A 43-year-old woman presented with complaints of back pain, intermittent fever, dysuria, and cough with expectoration for one month. Abdominal computed tomography (CT) revealed heterogeneously enhancing exophytic mass of the left kidney. A positron emission tomography CT whole body showed a primary malignancy in the left kidney, sclerotic lesions in the bony skeleton, and lymphangitis carcinomatosis in both lungs. A biopsy of the left renal mass revealed PEComa, focally positive for melanocytic and muscle markers. She was commenced on treatment with intravenous temsirolimus, and there was a complete tumor regression by the end of the completion of six cycles.
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Affiliation(s)
- Muhammad Haseeb
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Priyanka Sachdev
- Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Mary Sravani
- Internal Medicine, SVS Medical College, Hyderabad, IND
| | - Chandana Tadigotla
- Internal Medicine, P.E.S Institute of Medical Science and Research, Kuppam, IND
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10
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Li CC, Chen TWW. New targeted treatments for advanced sarcomas. Curr Opin Oncol 2023; 35:309-314. [PMID: 37222206 DOI: 10.1097/cco.0000000000000955] [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: 05/25/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide the rationale and results behind recent clinical trials regarding molecular-targeted agents for advanced sarcomas. RECENT FINDINGS Tazemetostat, a first-in-class EZH2 inhibitor, was approved to treat advanced epithelioid sarcoma. In synovial sarcoma, the interaction between pathognomonic SS18-SSX fusion protein and the BAF complex has brought insight in using BRD9 inhibitors as a treatment based on synthetic lethality. MDM2 overexpression is an important mechanism to suppress p53 function, and MDM2 gene amplification is pathognomonic in well differentiated and dedifferentiated liposarcoma. Two MDM2 inhibitors, milademetan and BI907828, have both reached the optimal dosing and have shown promising efficacy in MDM2-amplified liposarcoma. Late-stage pivotal studies are ongoing for both of these MDM2 inhibitors. The co-amplification of CDK4 and MDM2 in liposarcoma also provided a rationale for CDK4/6 inhibitors as a potential therapy. Selinexor, an exportin-1 inhibitor, has shown single-agent activity in dedifferentiated liposarcoma and action in gastrointestinal stromal tumour in combination with imatinib. Lastly, a new formulation of mTOR inhibitor, nab-sirolimus, was recently approved for perivascular epithelioid cell tumour (PEComa). SUMMARY Molecular-guided precision medicine holds a bright future in bringing more active treatments for advanced sarcoma patients.
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Affiliation(s)
- Chia-Chen Li
- Department of Medical Oncology, National Taiwan University Cancer Center
- Department of Oncology, National Taiwan University Hospital
| | - Tom Wei-Wu Chen
- Department of Medical Oncology, National Taiwan University Cancer Center
- Department of Oncology, National Taiwan University Hospital
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
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Testa S, Bui NQ, Ganjoo KN. Systemic Treatments and Molecular Biomarkers for Perivascular Epithelioid Cell Tumors: A Single-institution Retrospective Analysis. CANCER RESEARCH COMMUNICATIONS 2023; 3:1212-1223. [PMID: 37448552 PMCID: PMC10335919 DOI: 10.1158/2767-9764.crc-23-0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/01/2023] [Accepted: 06/06/2023] [Indexed: 07/15/2023]
Abstract
Perivascular epithelioid cell tumors (PEComa) are a large family of mesenchymal neoplasms, with variable clinical course. Evidence regarding treatment of advanced PEComas is scarce, with only one FDA-approved treatment available. The goals of this study were to provide data regarding systemic treatments for advanced PEComas and to identify biomarkers of prognostic relevance. This is a single-institution retrospective study of patients with advanced PEComas requiring systemic treatment, including malignant PEComa, angiomyolipoma (including the epithelioid variant), and lymphangioleiomyomatosis. Outcomes measured were overall survival (OS), first-line and combined progression-free survival (PFS), and tumor response. Kaplan-Meier, univariable, and multivariable Cox proportional hazards analysis were performed. A total of 29 patients were included, most with malignant PEComa (n = 17). Median OS was 204.9 months, while median PFS was 92.4 months from first-line, and 15.8 months for all lines combined. TFE3 overexpression correlated with higher risk of death (HR: 11.8, P = 0.04), and shorter median OS (P = 0.001). Chemotherapy and mTOR inhibitors showed similar OS (P = 0.84), and first-line PFS (P = 0.67). Combined PFS was similar between individual mTOR inhibitors, chemotherapy, immune checkpoint inhibitors and other treatments (P = 0.19). Different mTOR inhibitors demonstrated similar efficacy, making cost and availability important considerations when choosing a specific agent. mTOR inhibitors showed similar outcomes as chemotherapy, suggesting that these should be preferred whenever possible for patients with PEComas given the morbidity associated with chemotherapy. TFE3 overexpression highlighted a subgroup of PEComas with worse prognosis and more aggressive behavior. Significance This study examines systemic treatments for advanced PEComas, a rare group of sarcomas, and identifies molecular biomarkers of prognosis. Our results show that mTOR inhibitors have similar efficacy as chemotherapy, and that TFE3 overexpression, on IHC or FISH, correlates with a more aggressive disease course.
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Affiliation(s)
- Stefano Testa
- Department of Medicine, Stanford University, Stanford, California
- Division of Oncology, Department of Medicine, Stanford University, Stanford, California
| | - Nam Q. Bui
- Division of Oncology, Department of Medicine, Stanford University, Stanford, California
| | - Kristen N. Ganjoo
- Division of Oncology, Department of Medicine, Stanford University, Stanford, California
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Apte SS, Mor E, Mitchell C, Gyorki DE. Practical Management of Adult Ultra-Rare Primary Retroperitoneal Soft Tissue Sarcoma: A Focus on Perivascular Epithelioid Tumours and Extraosseous Ewing Sarcoma. Curr Oncol 2023; 30:5953-5972. [PMID: 37504306 PMCID: PMC10377910 DOI: 10.3390/curroncol30070445] [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: 03/22/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/29/2023] Open
Abstract
With the exception of well-differentiated liposarcoma, dedifferentiated liposarcoma, leiomyosarcoma, solitary fibrous tumour, malignant peripheral nerve sheath tumour, and undifferentiated pleomorphic sarcoma, the majority of the ≈70 histologic subtypes of retroperitoneal sarcoma are defined as 'ultra-rare' sarcomas, with an incidence of ≤1-5/1,000,000 persons/year. For most of these ultra-rare RPS subtypes, diagnosis and treatment follows international guidelines for the management of more common RPS histologies, with en bloc surgical resection as the mainstay of curative treatment, and enrolment in clinical trials where possible. Because the treatment of RPS is heavily driven by histology, the surgeon must be familiar with specific issues related to the diagnosis and management of ultra-rare sarcoma subtypes. Expert radiological and surgeon reviews are required to differentiate similarly presenting tumours where surgery can be avoided (e.g., angiomyolipoma), or where upfront systemic therapy is indicated (e.g., extraosseous Ewing's sarcoma). Thus, the management of all retroperitoneal sarcomas should occur at a sarcoma referral centre, with a multidisciplinary team of experts dedicated to the surgical and medical management of these rare tumours. In this focused review, we highlight how diagnosis and management of the ultra-rare primary RPS histologies of malignant perivascular epithelioid cell tumour (PEComa), extraosseous Ewing sarcoma (EES), extraosseous osteosarcoma (EOS), and rhabdomyosarcoma (RMS) critically diverge from the management of more common RPS subtypes.
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Affiliation(s)
- Sameer S Apte
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- Division of General Surgery, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada
| | - Eyal Mor
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
| | - Catherine Mitchell
- Division of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
| | - David E Gyorki
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
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13
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Mejbel HA, Harada S, Stevens TM, Huang X, Netto GJ, Mackinnon AC, Al Diffalha S. Spindle Cell Sarcoma of the Uterus Harboring MEIS1::NCOA1 Fusion Gene and Mimicking Endometrial Stromal Sarcoma. Int J Surg Pathol 2023; 31:227-232. [PMID: 35477326 DOI: 10.1177/10668969221098081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
MEIS1::NCOA1/2 sarcomas are a newly recognized group of exceedingly rare low-grade spindle cell sarcomas that often involve the genitourinary and gynecologic tracts. Due to its deceptively low-grade morphology and the non-specific immunoprofile, these neoplasms may pose a diagnostic challenge by histologically mimicking other entities such as endometrial stromal sarcoma, smooth muscle tumor, or uterine perivascular epithelioid cell tumor (PEComa). Histologically, MEIS1::NCOA1/2 sarcomas typically show spindle cell proliferation with hyperchromatic nuclei and a generalized cytologic uniformity, arranged in short fascicles and exhibiting alternating zones of hypo- and hypercellularity. Among the previously reported cases, molecular analysis revealed the MEIS1::NCOA2 fusion as the most commonly detected fusion gene, whereas the MEIS1::NCOA1 fusion gene has been reported in only a single case that involved kidney. Herein we report the first case of uterine sarcoma harboring the MEIS1::NCOA1 fusion gene that was initially misclassified as low-grade endometrial stromal sarcoma, demonstrating its clinicopathologic features, and highlighting the essential role of molecular pathology to arrive at the accurate diagnosis that may alter disease classification and inform therapy.
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Affiliation(s)
- Haider A Mejbel
- Division of Genomics Diagnostics and Bioinformatics, Molecular Genetics Pathology, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shuko Harada
- Division of Genomics Diagnostics and Bioinformatics, Molecular Genetics Pathology, 9968The University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Pathology, Division of Anatomic Pathology, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Todd M Stevens
- O'Neal Comprehensive Cancer Center, 189178The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Xiao Huang
- O'Neal Comprehensive Cancer Center, 189178The University of Alabama at Birmingham, Birmingham, AL, USA
| | - George J Netto
- Division of Genomics Diagnostics and Bioinformatics, Molecular Genetics Pathology, 9968The University of Alabama at Birmingham, Birmingham, AL, USA.,O'Neal Comprehensive Cancer Center, 189178The University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Pathology, Division of Anatomic Pathology, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alexander C Mackinnon
- Division of Genomics Diagnostics and Bioinformatics, Molecular Genetics Pathology, 9968The University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Pathology, Division of Anatomic Pathology, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sameer Al Diffalha
- O'Neal Comprehensive Cancer Center, 189178The University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Pathology, Division of Anatomic Pathology, 9968The University of Alabama at Birmingham, Birmingham, AL, USA
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14
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Nassif EF, Joseph CP, Lazcano R, Joseph JT, Thirasastr P, Lazar AJ, Somaiah N. Case report: Responses to the combination of gemcitabine with sirolimus in two patients with TSC-mutated sarcomas. Front Oncol 2023; 13:1046442. [PMID: 36845725 PMCID: PMC9947835 DOI: 10.3389/fonc.2023.1046442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/18/2023] [Indexed: 02/11/2023] Open
Abstract
TSC-mutated sarcomas are rare molecular and histologic types of sarcoma. Due to the presence of their specific oncogenic driver mutation, these sarcomas are particularly sensitive to mTOR inhibitors. Recently, nab-sirolimus, an albumin-bound mTOR inhibitor, was approved by the Food and Drug Administration (FDA) for PEComas, which harbor a TSC mutation, and this drug remains the only FDA-approved systemic treatment for these tumors. We report on two cases of patients with TSC-mutated sarcomas who experienced significant responses to the combination of gemcitabine and sirolimus, after progression on prior gemcitabine-based chemotherapy and single agent mTOR inhibition with nab-sirolimus. Preclinical and clinical data support rationale for a synergistic effect of the combination. This combination may represent a valid therapeutic option after failure of nab-sirolimus in these patients, with no standard-of-care treatment options.
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Affiliation(s)
- Elise F. Nassif
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
| | - Cissimol P. Joseph
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Rossana Lazcano
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jocelyn T. Joseph
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Prapassorn Thirasastr
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Alexander J. Lazar
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States,Division of Pathology and Laboratory Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, United States,Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Neeta Somaiah
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States,*Correspondence: Neeta Somaiah,
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15
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Attia KH, Al Boukai AA, Arafah M, Mohammed MH. Renal and mediastinal perivascular epithelioid cell tumors (PEComas) in a young child with Tuberous Sclerosis; a rare case report. BJR Case Rep 2022; 9:20220105. [PMID: 36998339 PMCID: PMC10043601 DOI: 10.1259/bjrcr.20220105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/31/2022] [Accepted: 11/08/2022] [Indexed: 11/23/2022] Open
Abstract
We describe a unique case of perivascular epithelioid cell tumors PEComas occurring as mediastinal and left renal soft tissue masses discovered incidentally in a five-year-old Tuberous Sclerosis patient upon presentation to the emergency department for upper respiratory illness. The radiographic features were non-specific. However, the similar CT characteristics of both lesions and background history raised the suspicion of a synchronous mesenchymal tumor, and histopathology confirmed the diagnosis. The rarity of these tumors in the pediatric population and lack of specific diagnostic criteria impose reporting the case and emphasize the need for further research on imaging features of such tumors.
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Affiliation(s)
- Kamal H. Attia
- Department of Radiology and Medical Imaging, King Saud university medical city, Riyadh, Saudi Arabia
| | - Ahmad A. Al Boukai
- Department of Radiology and Medical Imaging, King Saud university medical city, Riyadh, Saudi Arabia
| | - Maha Arafah
- Department of Pathology, King Saud University, Riyadh, Saudi Arabia
| | - Muammar H. Mohammed
- Department of Radiology and Medical Imaging, King Saud university medical city, Riyadh, Saudi Arabia
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16
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Zhang Z, Yu Y, Zhang L, Cheng C, Zuo C. 18 F-FDG and 68 Ga-FAPI-04 in the Evaluation of Aggressive Perivascular Epithelioid Cell Tumor. Clin Nucl Med 2022; 47:897-899. [PMID: 35485860 DOI: 10.1097/rlu.0000000000004249] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A 10-year-old girl with a right renal mass underwent 18 F-FDG PET/CT and 68 Ga-FAPI-04 PET/MRI for presurgical assessment of tumor invasion and malignant potential. The mass showed low 18 F-FDG uptake and intense 68 Ga-FAPI-04 uptake. Nephrectomy was performed, and the histopathologic diagnosis was aggressive PEComa (perivascular epithelioid cell tumor). This case showed that 68 Ga-FAPI-04 PET outperformed 18 F-FDG PET in detecting aggressive PEComa.
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Affiliation(s)
- Zeyu Zhang
- From the Departments of Nuclear Medicine
| | - Yongwei Yu
- Pathology, Changhai Hospital, Navy Military Medical University, Shanghai, China
| | - Lu Zhang
- From the Departments of Nuclear Medicine
| | - Chao Cheng
- From the Departments of Nuclear Medicine
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17
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Sui C, Wu J, Mei D, Pan E, Yang P, Wu T, Ma Y, Ou Q, Song L. Uterine perivascular epithelioid tumors (PEComas) with lung metastasis showed good responses to mTOR and VEGFR inhibitors: A case report. Front Oncol 2022; 12:797275. [PMID: 35965503 PMCID: PMC9366196 DOI: 10.3389/fonc.2022.797275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 07/01/2022] [Indexed: 11/30/2022] Open
Abstract
Perivascular epithelioid cell tumors (PEComas) are extremely rare mesenchymal neoplasms for which the uterus is the most common site. The prognosis of malignant PEComa is poor as it is characterized by resistance to classical chemotherapies. Both mTOR inhibitors and VEGFR inhibitors exhibited clinical utility in treating malignant PEComas, but the combination of these two regimens has rarely been reported. In the present case, a uterine PEComa patient developed lung and bone metastases after the failure of chemotherapies and derived benefit from the combination regimen of an mTOR inhibitor (everolimus) and a VEGFR inhibitor (apatinib), achieving a 15-month progression-free survival. Targeted NGS revealed TP53 and TSC2 mutations in the patient’s primary uterine tumors and plasma ctDNA at disease progression. Plasma ctDNA clearance was consistent with a radiologic partial response determined by RECIST 1.1 and a reduction of neuron-specific enolase (NSE) and cancer antigen 125 (CA125) levels. Thus, we provided clinical evidence supporting the administration of combined therapy of mTOR and VEGFR inhibitors to metastatic uterine PEComa patients and highlighted the application of serial plasma ctDNA profiling for dynamic disease monitoring.
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Affiliation(s)
- Chengxu Sui
- Department of Intervention Therapy, The Second Hospital of Dalian Medical University, Dalian, China
| | - Jie Wu
- Department of Intervention Therapy, The Second Hospital of Dalian Medical University, Dalian, China
| | - Dan Mei
- Department of Intervention Therapy, The Second Hospital of Dalian Medical University, Dalian, China
| | - Evenki Pan
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Peng Yang
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Tingting Wu
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Yutong Ma
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Qiuxiang Ou
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Lei Song
- Department of Intervention Therapy, The Second Hospital of Dalian Medical University, Dalian, China
- *Correspondence: Lei Song,
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18
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Unique presentation of retroperitoneal malignant perivascular epithelioid cell tumor (PEComa) in a young male. Urol Case Rep 2022; 43:102077. [PMID: 35433268 PMCID: PMC9010641 DOI: 10.1016/j.eucr.2022.102077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/22/2022] Open
Abstract
Perivascular Epithelioid Cell tumors (PEComas) are rare mesenchymal tumors composed of epithelioid and spindle cells that can be found almost anywhere in the body with predominance for abdominopelvic locations. They are usually diagnosed in middle-aged females and are associated with tuberous sclerosis complex. This report describes an unusual presentation of a malignant retroperitoneal PEComa in an otherwise healthy, young male. Treatment included radical nephrectomy and adrenalectomy followed by medical oncology evaluation.
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19
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Primary Cutaneous Malignant Perivascular Epithelioid Cell Tumor Mimicking Undifferentiated Pleomorphic Sarcoma: A Report of a Rare Entity. Am J Dermatopathol 2022; 44:768-773. [DOI: 10.1097/dad.0000000000002241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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20
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Abstract
This review focuses on recent advances in epithelioid and myxoid uterine mesenchymal neoplasms, a category of tumors whereby diagnostic criteria have been rapidly evolving due to advances in molecular testing. Pertinent clinicopathological and molecular features are highlighted for perivascular epithelioid cell tumors, uterine tumors resembling ovarian sex cord tumors, BCOR/BCORL1-altered high-grade endometrial stromal sarcomas, and inflammatory myofibroblastic tumors. Novel developments in epithelioid and myxoid leiomyosarcomas are briefly discussed, and differential diagnoses with key diagnostic criteria are provided for morphologic mimickers.
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Affiliation(s)
- Elizabeth C Kertowidjojo
- Department of Pathology, University of Chicago Medicine, 5837 South Maryland Avenue, MC 6101, Chicago, IL 60637, USA
| | - Jennifer A Bennett
- Department of Pathology, University of Chicago Medicine, 5837 South Maryland Avenue, MC 6101, Chicago, IL 60637, USA.
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21
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Bose S, Schwartz GK, Ingham M. Novel Therapeutics in the Treatment of Uterine Sarcoma. Am Soc Clin Oncol Educ Book 2022; 42:900-909. [PMID: 35714303 DOI: 10.1200/edbk_350541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Uterine sarcomas reflect the diversity of sarcoma as a whole. The most common histologies include leiomyosarcoma, high- and low-grade endometrial stromal sarcoma, and adenosarcoma. These are clinically and biologically heterogeneous diseases that are challenging to treat in the advanced setting. Recent advances in our understanding of the cancer biology of uterine sarcomas has improved diagnostic evaluation and therapeutic management. Promising approaches for patients with advanced uterine leiomyosarcoma include targeting DNA damage repair pathways and depleting immunosuppressive macrophage populations. A subset of endometrial stromal sarcomas harbor potentially actionable alterations in the Wnt, cyclin D-CDK4/6-Rb, and MDM2-p53 pathways. There remains an urgent need to translate molecular findings into prospective clinical trials of novel agents for patients with these diseases; progress will depend on academic collaborations and enrollment of patients with uterine sarcoma in biomarker-driven basket studies.
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Affiliation(s)
- Sminu Bose
- Division of Hematology and Medical Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Gary K Schwartz
- Division of Hematology and Medical Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Matthew Ingham
- Division of Hematology and Medical Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
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22
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Yuan J, Li X, Yu S. Molecular targeted therapy for advanced or metastatic soft tissue sarcoma. Cancer Control 2021; 28:10732748211038424. [PMID: 34844463 PMCID: PMC8727831 DOI: 10.1177/10732748211038424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Soft tissue sarcomas are a form of rare and heterogeneous neoplasms with high recurrence rate and mortality. Over the past decades, less progress has been achieved. Surgical management with or without adjuvant/neoadjuvant radiotherapy is still the first-line treatment for localized soft tissue sarcomas, and chemotherapy is the additional option for those with high-risk. However, not all patients with advanced or metastatic soft tissue sarcomas benefit from conventional chemotherapy, targeted therapy takes the most relevant role in the management of those resistant to or failed to conventional chemotherapy. Heterogeneous soft tissue sarcomas vary from biological behavior, genetic mutations, and clinical presentation with a low incidence, indicating the future direction of histotype-based even molecule-based personalized therapy. Furthermore, increasing preclinical studies were carried out to investigate the pathogenesis and potential therapeutic targets of soft tissue sarcomas and increasing new drugs have been developed in recent years, which had started opening new doors for clinical treatment for patients with advanced/metastatic soft tissue sarcomas. Here we sought to summarize the concise characteristics and advance in the targeted therapy for the most common subtypes of soft tissue sarcomas.
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Affiliation(s)
- Jin Yuan
- Departments of Orthopedics, 71041National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoyang Li
- Departments of Orthopedics, 71041National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shengji Yu
- Departments of Orthopedics, 71041National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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23
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Wagner AJ, Ravi V, Riedel RF, Ganjoo K, Van Tine BA, Chugh R, Cranmer L, Gordon EM, Hornick JL, Du H, Grigorian B, Schmid AN, Hou S, Harris K, Kwiatkowski DJ, Desai NP, Dickson MA. nab-Sirolimus for Patients With Malignant Perivascular Epithelioid Cell Tumors. J Clin Oncol 2021; 39:3660-3670. [PMID: 34637337 PMCID: PMC8601264 DOI: 10.1200/jco.21.01728] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/12/2021] [Accepted: 08/31/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Malignant perivascular epithelioid cell tumor (PEComa) is a rare aggressive sarcoma, with no approved treatment. To our knowledge, this phase II, single-arm, registration trial is the first prospective clinical trial in this disease, investigating the safety and efficacy of the mammalian target of rapamycin inhibitor nab-sirolimus (AMPECT, NCT02494570). PATIENTS AND METHODS Patients with malignant PEComa were treated with nab-sirolimus 100 mg/m2 intravenously once weekly for 2 weeks in 3-week cycles. The primary end point was objective response rate evaluated by independent radiology review. Key secondary end points included duration of response, progression-free survival, and safety. A key exploratory end point was tumor biomarker analysis. RESULTS Thirty-four patients were treated (safety evaluable), and 31 were evaluable for efficacy. The overall response rate was 39% (12 of 31; 95% CI, 22 to 58) with one complete and 11 partial responses, 52% (16 of 31) of patients had stable disease, and 10% (3 of 31) had progressive disease. Responses were of rapid onset (67% by week 6) and durable. Median duration of response was not reached after a median follow-up for response of 2.5 years, with 7 of 12 responders with treatment ongoing (range, 5.6-47.2+ months). Twenty-five of 31 patients had tumor mutation profiling: 8 of 9 (89%) patients with a TSC2 mutation achieved a confirmed response versus 2 of 16 (13%) without TSC2 mutation (P < .001). The median progression-free survival was 10.6 months (95% CI, 5.5 months to not reached), and the median overall survival was 40.8 months (95% CI, 22.2 months to not reached). Most treatment-related adverse events were grade 1 or 2 and were manageable for long-term treatment. No grade ≥ 4 treatment-related events occurred. CONCLUSION nab-Sirolimus is active in patients with malignant PEComa. The response rate, durability of response, disease control rate, and safety profile support that nab-sirolimus represents an important new treatment option for this disease.
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Affiliation(s)
- Andrew J. Wagner
- Dana-Farber Cancer Institute and Harvard Medical School, Boston MA
| | | | | | | | | | | | - Lee Cranmer
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | - Heng Du
- Brigham and Women's Hospital, Boston, MA
| | | | | | - Shihe Hou
- Aadi Bioscience Inc, Pacific Palisades, CA
| | | | | | | | - Mark A. Dickson
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
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24
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Bourgmayer A, Nannini S, Bonjean P, Kurtz JE, Malouf GG, Gantzer J. Natural History and Treatment Strategies of Advanced PEComas: A Systematic Review. Cancers (Basel) 2021; 13:cancers13205227. [PMID: 34680376 PMCID: PMC8533842 DOI: 10.3390/cancers13205227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/15/2021] [Accepted: 10/16/2021] [Indexed: 01/11/2023] Open
Abstract
Simple Summary In this article, we review the clinical features of advanced PEComas and show the diversity of reported data among authors, emphasizing the heterogeneity of molecular characterization and treatment strategy. Based on clinical data collected from 124 case reports, metastatic disease at diagnosis and a grouped version of the Bleeker’s risk category were the only factors significantly associated with death. Due to a significant number of missing data or short follow-ups, results regarding prognostic factors should, however, be interpreted with caution. Abstract PEComas is a family of rare mesenchymal tumors. This systematic review aims to better understand the natural history of advanced PEComas. After a search on the PubMed database and main oncology meeting libraries according to the PRISMA guidelines, 88 articles reported in the English literature were included. Data on clinical and histological features, treatments and outcomes were collected. To identify risk factors, univariate and multivariate analyses were performed. Seven cohorts of patients and 124 individual patients were identified. Focusing on case reports, most patients were metastatic, and the median overall survival (OS) of the entire cohort was 60 months (95%CI 33; NA). Risk factors significantly associated with OS in the multivariate analysis were the presence of metastasis at diagnosis (HR: 2.59, 95%CI 1.06; 6.33, p = 0.036) and the grouped-Bleeker’s risk category (HR: 4.66; 95%CI 1.07; 20.19; p = 0.039). In the metastatic population, only the presence of lymph node metastasis was associated with OS (HR: 3.11; 95%CI 1.13; 8.60, p < 0.05). Due to a lack of events, it was not possible to conclude on other factors. This review of the literature highlights the heterogeneity of literature data and shows the great diversity of clinical management strategies.
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Affiliation(s)
- Agathe Bourgmayer
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute (ICANS), 67033 Strasbourg, France; (A.B.); (S.N.); (J.-E.K.); (G.G.M.)
| | - Simon Nannini
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute (ICANS), 67033 Strasbourg, France; (A.B.); (S.N.); (J.-E.K.); (G.G.M.)
| | - Paul Bonjean
- Department of Clinical Research and Pharmacology Innovation Unit, CHU de Saint-Etienne, Hôpital Nord, 42270 Saint-Priest en Jarez, France;
| | - Jean-Emmanuel Kurtz
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute (ICANS), 67033 Strasbourg, France; (A.B.); (S.N.); (J.-E.K.); (G.G.M.)
| | - Gabriel G. Malouf
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute (ICANS), 67033 Strasbourg, France; (A.B.); (S.N.); (J.-E.K.); (G.G.M.)
- Davidson Team, Department of Cancer and Functional Genomics, INSERM UMR_S1258, Institute of Genetics and Molecular and Cellular Biology, 67400 Illkirch, France
| | - Justine Gantzer
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute (ICANS), 67033 Strasbourg, France; (A.B.); (S.N.); (J.-E.K.); (G.G.M.)
- Davidson Team, Department of Cancer and Functional Genomics, INSERM UMR_S1258, Institute of Genetics and Molecular and Cellular Biology, 67400 Illkirch, France
- Correspondence:
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25
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Wang MX, Segaran N, Bhalla S, Pickhardt PJ, Lubner MG, Katabathina VS, Ganeshan D. Tuberous Sclerosis: Current Update. Radiographics 2021; 41:1992-2010. [PMID: 34534018 DOI: 10.1148/rg.2021210103] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Tuberous sclerosis complex (TSC) is a relatively rare autosomal dominant neurocutaneous disorder secondary to mutations in the TSC1 or TSC2 tumor suppressor genes. Although manifestation of the classic triad of seizures, intellectual disability, and facial angiofibromas may facilitate timely diagnosis of TSC, the multisystem features that may indicate TSC in the absence of these manifestations remain highly variable. In addition, patients with TSC are at risk of developing multiple benign and malignant tumors in various organ systems, resulting in increased morbidity and mortality. Thus, imaging plays a critical role in diagnosis, surveillance, and management of patients with TSC. It is crucial that radiologists be familiar with TSC and the various associated imaging features to avoid a delayed or incorrect diagnosis. Key manifestations include cortical dysplasias, subependymal nodules, subependymal giant cell astrocytomas, cardiac rhabdomyomas, lymphangioleiomyomatosis, and angiomyolipomas. Renal angiomyolipomas in particular can manifest with imaging features that mimic renal malignancy and pose a diagnostic dilemma. Other manifestations include dermatologic and ophthalmic manifestations, renal cysts, renal cell carcinomas, multifocal micronodular pneumocyte hyperplasia, splenic hamartomas, and other rare tumors such as perivascular epithelioid tumors. In addition to using imaging and clinical features to confirm the diagnosis, genetic testing can be performed. In this article, the molecular pathogenesis, clinical manifestations, and imaging features of TSC are reviewed. Current recommendations for management and surveillance of TSC are discussed as well. ©RSNA, 2021.
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Affiliation(s)
- Mindy X Wang
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (M.X.W., D.G.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (N.S.); Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); and Department of Radiology, University of Texas at San Antonio, San Antonio, Tex (V.S.K.)
| | - Nicole Segaran
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (M.X.W., D.G.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (N.S.); Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); and Department of Radiology, University of Texas at San Antonio, San Antonio, Tex (V.S.K.)
| | - Sanjeev Bhalla
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (M.X.W., D.G.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (N.S.); Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); and Department of Radiology, University of Texas at San Antonio, San Antonio, Tex (V.S.K.)
| | - Perry J Pickhardt
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (M.X.W., D.G.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (N.S.); Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); and Department of Radiology, University of Texas at San Antonio, San Antonio, Tex (V.S.K.)
| | - Meghan G Lubner
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (M.X.W., D.G.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (N.S.); Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); and Department of Radiology, University of Texas at San Antonio, San Antonio, Tex (V.S.K.)
| | - Venkata S Katabathina
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (M.X.W., D.G.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (N.S.); Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); and Department of Radiology, University of Texas at San Antonio, San Antonio, Tex (V.S.K.)
| | - Dhakshinamoorthy Ganeshan
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (M.X.W., D.G.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (N.S.); Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); and Department of Radiology, University of Texas at San Antonio, San Antonio, Tex (V.S.K.)
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26
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Cheng HC, Kuo CY, Huang CW, Shih HH, Lin CH, Wang JY. Unusual paediatric sigmoid perivascular epithelioid cell tumour with regional lymph node metastasis treated using gemcitabine and docetaxel: a case report and literature review. J Int Med Res 2021; 49:3000605211041509. [PMID: 34510959 PMCID: PMC8442492 DOI: 10.1177/03000605211041509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Perivascular epithelioid cell tumour (PEComa) is an extremely rare neoplasm with
distinctive morphology and specific expression of immunohistochemical markers.
The lesion is typically diagnosed in middle-aged women, with few reports of
paediatric cases, and there is no standardized treatment for the tumour type.
Here, the case of a 17-year-old female, who presented with painless
haematochezia for 2 days and was diagnosed with gastrointestinal PEComa of the
sigmoid colon with regional lymph node metastasis after serial examination, is
presented. She was treated by surgical resection of the tumour and cytotoxic
chemotherapy comprising 900 mg/m2 gemcitabine and 100
mg/m2 docetaxel every 3 weeks for six cycles. Haematochezia did
not recur, and complete response was achieved, with progression-free survival at
the 24-month follow-up examination. Surgical resection with adjuvant
conventional cytotoxic chemotherapy may be considered as an option for treating
gastrointestinal PEComa.
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Affiliation(s)
- Hsiu-Chung Cheng
- School of Medicine, College of Medicine, Kaohsiung Medical University
| | - Chia-Yu Kuo
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University
| | - Ching-Wen Huang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University
| | - Hsiang-Hung Shih
- Division of General Paediatrics, Department of Paediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University
| | - Chih-Hung Lin
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University
| | - Jaw-Yuan Wang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University.,Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University.,Graduate Institute of Clinical Medicine, Centre for Cancer Research, Kaohsiung Medical University.,Ministry of Health and Welfare Pingtun Hospital
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27
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Re-evaluating tumors of purported specialized prostatic stromal origin reveals molecular heterogeneity, including non-recurring gene fusions characteristic of uterine and soft tissue sarcoma subtypes. Mod Pathol 2021; 34:1763-1779. [PMID: 33986460 DOI: 10.1038/s41379-021-00818-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 12/14/2022]
Abstract
Tumors of purported specialized prostatic stromal origin comprise prostatic stromal sarcomas (PSS) and stromal tumors of uncertain malignant potential (STUMP). Prior studies have described their clinicopathologic characteristics, but the molecular features remain incompletely understood. Moreover, these neoplasms are morphologically heterogeneous and the lack of specific adjunctive markers of prostatic stromal lineage make precise definition more difficult, leading some to question whether they represent a specific tumor type. In this study, we used next-generation DNA and RNA sequencing to profile 25 primary prostatic mesenchymal neoplasms of possible specialized prostatic stromal origin, including cases originally diagnosed as PSS (11) and STUMP (14). Morphologically, the series comprised 20 cases with solid architecture (11 PSS and 9 STUMP) and 5 cases with phyllodes-like growth pattern (all STUMP). Combined DNA and RNA sequencing results demonstrated that 19/22 (86%) cases that underwent successful sequencing (either DNA or RNA) harbored pathogenic somatic variants. Except for TP53 alterations (6 cases), ATRX mutations (2 cases), and a few copy number variants (-13q, -14q, -16q and +8/8p), the findings were largely nonrecurrent. Eight gene rearrangements were found, and 4 (NAB2-STAT6, JAZF1-SUZ12, TPM3-NTRK1 and BCOR-MAML3) were useful for reclassification of the cases as specific entities. The present study shows that mesenchymal neoplasms of the prostate are morphologically and molecularly heterogeneous and include neoplasms that harbor genetic aberrations seen in specific mesenchymal tumors arising in other anatomic sites, including soft tissue and the uterus. These data suggest that tumors of purported specialized prostatic stromal origin may perhaps not represent a single diagnostic entity or specific disease group and that alternative diagnoses should be carefully considered.
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28
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McBride A, Garcia AJ, Sanders LJ, Yiu K, Cranmer LD, Kuo PH, Kay M, Kraft AS. Sustained response to pembrolizumab in recurrent perivascular epithelioid cell tumor with elevated expression of programmed death ligand: a case report. J Med Case Rep 2021; 15:400. [PMID: 34301321 PMCID: PMC8305520 DOI: 10.1186/s13256-021-02997-x] [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: 02/24/2021] [Accepted: 06/02/2021] [Indexed: 12/30/2022] Open
Abstract
Background Perivascular epithelioid cell tumors are defined by the World Health Organization as “a collection of rare mesenchymal tumors composed of histologically and immunohistochemically distinctive perivascular epithelioid cells.” Whereas localized perivascular epithelioid cell tumor is typically benign and treated successfully with surgical resection, prognosis for patients with advanced or metastatic perivascular epithelioid cell tumor is unfavorable, and there is no standard curative treatment. Case presentation We report a Caucasian case of metastatic perivascular epithelioid cell tumor previously treated with chemotherapy and surgery with elevated surface expression of programmed cell death ligand 1. Based on this result, treatment via immune checkpoint inhibition with the monoclonal antibody pembrolizumab was pursued. After 21 cycles, the patient sustained a complete response. Therapy was stopped after the 40th cycle, and she was moved to surveillance. She remained disease free 19 months off treatment. Conclusions This case report of a patient with perivascular epithelioid cell tumor treated successfully with programmed cell death protein-1 targeted therapy suggests that programmed cell death ligand-1 levels should be measured in patients with perivascular epithelioid cell tumor and immunotherapy considered for recurrent or metastatic patients. Future phase II/III studies in this disease should focus on sequencing of surgery and immunotherapy with a design of curative intent.
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Affiliation(s)
- Ali McBride
- University of Arizona Cancer Center, 1515 N. Campbell Ave., Tucson, AZ, 85718, USA
| | - Andrew J Garcia
- College of Pharmacy, University of Arizona, Tucson, AZ, USA.,College of Medicine, George Washington University, Washington, DC, USA
| | - Lauren J Sanders
- University of Arizona Cancer Center, 1515 N. Campbell Ave., Tucson, AZ, 85718, USA
| | - Kelly Yiu
- College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Lee D Cranmer
- University of Arizona Cancer Center, 1515 N. Campbell Ave., Tucson, AZ, 85718, USA.,Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Phillip H Kuo
- Department of Medical Imaging, Medicine and Biomedical Engineering, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Matthew Kay
- Department of Medical Imaging, Medicine and Biomedical Engineering, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Andrew S Kraft
- University of Arizona Cancer Center, 1515 N. Campbell Ave., Tucson, AZ, 85718, USA.
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29
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Mrozek EM, Bajaj V, Guo Y, Malinowska IA, Zhang J, Kwiatkowski DJ. Evaluation of Hsp90 and mTOR inhibitors as potential drugs for the treatment of TSC1/TSC2 deficient cancer. PLoS One 2021; 16:e0248380. [PMID: 33891611 PMCID: PMC8064564 DOI: 10.1371/journal.pone.0248380] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/10/2021] [Indexed: 11/29/2022] Open
Abstract
Inactivating mutations in either TSC1 or TSC2 cause Tuberous Sclerosis Complex, an autosomal dominant disorder, characterized by multi-system tumor and hamartoma development. Mutation and loss of function of TSC1 and/or TSC2 also occur in a variety of sporadic cancers, and rapamycin and related drugs show highly variable treatment benefit in patients with such cancers. The TSC1 and TSC2 proteins function in a complex that inhibits mTORC1, a key regulator of cell growth, which acts to enhance anabolic biosynthetic pathways. In this study, we identified and validated five cancer cell lines with TSC1 or TSC2 mutations and performed a kinase inhibitor drug screen with 197 compounds. The five cell lines were sensitive to several mTOR inhibitors, and cell cycle kinase and HSP90 kinase inhibitors. The IC50 for Torin1 and INK128, both mTOR kinase inhibitors, was significantly increased in three TSC2 null cell lines in which TSC2 expression was restored. Rapamycin was significantly more effective than either INK128 or ganetespib (an HSP90 inhibitor) in reducing the growth of TSC2 null SNU-398 cells in a xenograft model. Combination ganetespib-rapamycin showed no significant enhancement of growth suppression over rapamycin. Hence, although HSP90 inhibitors show strong inhibition of TSC1/TSC2 null cell line growth in vitro, ganetespib showed little benefit at standard dosage in vivo. In contrast, rapamycin which showed very modest growth inhibition in vitro was the best agent for in vivo treatment, but did not cause tumor regression, only growth delay.
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Affiliation(s)
- Evelyn M. Mrozek
- Cancer Genetics Lab, Pulmonary Medicine Division, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail: (DJK); (EMM)
| | - Vineeta Bajaj
- Cancer Genetics Lab, Pulmonary Medicine Division, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Yanan Guo
- Cancer Genetics Lab, Pulmonary Medicine Division, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Izabela A. Malinowska
- Cancer Genetics Lab, Pulmonary Medicine Division, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jianming Zhang
- Department of Cancer Biology, Dana-Farber Cancer Institute, Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, Massachusetts, United States of America
| | - David J. Kwiatkowski
- Cancer Genetics Lab, Pulmonary Medicine Division, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail: (DJK); (EMM)
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30
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Adib E, Klonowska K, Giannikou K, Do KT, Pruitt-Thompson S, Bhushan K, Milstein MI, Hedglin J, Kargus KE, Sholl LM, Tsuji J, Hyman DM, Sisk A, Shapiro GI, Vargas HA, Harding JJ, Voss MH, Iyer G, Kwiatkowski DJ. Phase II Clinical Trial of Everolimus in a Pan-Cancer Cohort of Patients with mTOR Pathway Alterations. Clin Cancer Res 2021; 27:3845-3853. [PMID: 33727259 DOI: 10.1158/1078-0432.ccr-20-4548] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/09/2021] [Accepted: 03/12/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE This was a multicenter, histology-agnostic, single-arm prospective phase II trial of therapeutic activity of everolimus, an oral mTORC1 inhibitor, in patients with advanced solid tumors that harbored TSC1/TSC2 or MTOR mutations. PATIENTS AND METHODS Patients with tumors with inactivating TSC1/TSC2 or activating MTOR mutations identified in any Clinical Laboratory Improvement Amendments (CLIA)-certified laboratory were eligible. Patients were treated with everolimus 10 mg once daily until disease progression or unacceptable toxicity. The primary endpoint was objective response rate (ORR). Whole-exome sequencing was performed to identify co-occurring genomic alterations. RESULTS Between November 2015 and October 2018, 30 patients were enrolled at Dana-Farber Cancer Institute and Memorial Sloan Kettering Cancer Center. Tumors harbored TSC1 (13/30), TSC2 (15/30), concurrent TSC1 and TSC2 (1/30), or MTOR (1/30) mutations. The most common treatment-related adverse event of any grade was mucositis (8/30, 27%); 1 patient had fatal pneumonitis. Partial responses were seen in 2 patients [7%; 95% confidence interval (CI), 1%-22%]. Median progression-free survival was 2.3 months (95% CI, 1.8-3.7 months) and median overall survival (OS) was 7.3 months (95% CI, 4.5-12.7 months). There was no clear association between other genomic alterations and response. Of the 2 patients with objective response, 1 had upper tract urothelial carcinoma with biallelic inactivation of TSC1 and high tumor mutation burden, and the other had uterine carcinoma with biallelic TSC2-inactivating mutations and PEComa-like pathologic features. CONCLUSIONS Everolimus therapy had a disappointing ORR (7%) in this pan-cancer, mutation-selected, basket study.See related commentary by Kato and Cohen, p. 3807.
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Affiliation(s)
- Elio Adib
- Cancer Genetics Laboratory, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Katarzyna Klonowska
- Cancer Genetics Laboratory, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Krinio Giannikou
- Cancer Genetics Laboratory, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Khanh T Do
- Early Drug Development Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Ketki Bhushan
- Early Drug Development Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Matthew I Milstein
- Early Drug Development Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jennifer Hedglin
- Early Drug Development Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Katherine E Kargus
- Early Drug Development Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Junko Tsuji
- Genomics Platform, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | | | - Anne Sisk
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Geoffrey I Shapiro
- Early Drug Development Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Hebert A Vargas
- Weil Cornell Medical College, New York, New York.,Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James J Harding
- Early Drug Development Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Weil Cornell Medical College, New York, New York.,Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Martin H Voss
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weil Cornell Medical College, New York, New York
| | - Gopa Iyer
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weil Cornell Medical College, New York, New York
| | - David J Kwiatkowski
- Cancer Genetics Laboratory, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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31
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Gu J, Wang W, Wang S. A Retrospective Case Study of 13 Uterine Perivascular Epithelioid Cell Neoplasm (PEComa) Patients. Onco Targets Ther 2021; 14:1783-1790. [PMID: 33727828 PMCID: PMC7955772 DOI: 10.2147/ott.s300523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/23/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction and Hypothesis Perivascular epithelioid cell neoplasms (PEComas) are rare mesenchymal tumors that originate from perivascular epithelioid cells. The uterus is the second most common organ to be affected by PEComa. Most PEComas are benign and the prognosis is usually good. Surgery is the main treatment at present, and adjuvant therapy is mainly used for malignant cases. However, because of the lack of described cases, the best diagnosis and treatment of these tumors cannot be determined. Methods From 2009 to 2020, 13 patients from Shengjing Hospital (China Medical University), with uterine PEComa, who met the inclusion criteria and appropriate pathological diagnosis were enrolled in this study. Clinical, pathological, and therapeutic features were retrospectively analyzed to determine the best approach towards diagnosis and treatment. Results All the enrolled patients underwent surgical treatment; four of them had a malignant PEComa. Three of the malignant patients received chemotherapy after surgery; among them, one died, another showed no obvious recurrence after regular re-examination, and the third did not undergo any further treatment despite short-term recurrence. However, upon regular re-examination, no progress was observed. The fourth malignant patient did not receive chemotherapy after surgery and showed no obvious recurrence during regular reviews. Conclusion The preoperative diagnosis of uterine PEComa lacks specificity and therefore is often confused with uterine leiomyoma or leiomyosarcoma. We conclude that uterine PEComa can be diagnosed by combined analysis of immunohistochemistry and post-operative pathology. Though surgical resection is still the main treatment, high-risk patients can be given adjuvant treatment to strengthen disease control.
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Affiliation(s)
- Jiahui Gu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, 110001, People's Republic of China
| | - Wantong Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, 110001, People's Republic of China
| | - Shizhuo Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, 110001, People's Republic of China
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32
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Histopathologic Characterization of Bladder Perivascular Epithelioid Cell Neoplasms (PEComa): A Series of 11 Cases With a Subset Having TFE3 Rearrangements. Am J Surg Pathol 2021; 45:169-177. [PMID: 33002920 DOI: 10.1097/pas.0000000000001592] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Perivascular epithelioid cell neoplasms (PEComas) of the bladder are extremely rare, with ~30 case reports. A subset of PEComas contain TFE3 gene rearrangement, however, the distinct histomorphologic features of these translocation tumors has not been fully explored in bladder PEComas. In our series, 11 cases of bladder PEComas were collected, including 1 internal and 10 consults, with 1 case previously reported. There was a female predominance (9 female, 2 male) with a mean age of 44.2 years (24 to 61 y). In only 1 of the 10 consult cases was PEComa considered in the differential diagnosis. In 10 of 11 cases, prominent epithelioid features were noted, with the final case having focal epithelioid morphology. Mitotic rate was increased in 2 of 11 cases, and 2 of 11 cases had cytological atypia. Two cases were malignant, with invasion into perivesicle tissue in 1 case, and metastases to lungs and brain followed by death in the other case. Immunohistochemically, there was strong, and diffuse staining for cathepsin K in 10/11 cases with the 1 negative case restained on a previously stained slide. HMB-45 was diffusely positive in 8/11 cases, while melan-A was present in only 1/10 cases. Muscle markers were variably expressed with positivity for both smooth muscle actin in 6/10 cases and desmin in 3/10 cases. Keratin AE1/3 was uniformly negative (0/11). In 5/8 cases where TFE3 was rearranged by fluorescence in situ hybridization, the morphology had a predominantly epithelioid, nested architecture. Overall, bladder PEComas are particularly difficult to diagnose given their rarity, are predominantly epithelioid and do not always express melanocytic markers. Diagnosis in the bladder requires a combination of morphologic characterization, exclusion of other diagnostic possibilities, positive Cathepsin K staining, variable melanocytic marker expression, with some cases showing a TFE3 gene rearrangement.
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33
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Galera López MDM, Márquez Rodas I, Agra Pujol C, García Pérez Á, Velasco Sánchez E, Álvarez Álvarez R. Simultaneous diagnosis of liver PEComa in a family with known Li-Fraumeni syndrome: a case report. Clin Sarcoma Res 2020; 10:24. [PMID: 33292569 PMCID: PMC7684891 DOI: 10.1186/s13569-020-00143-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 11/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background Li–Fraumeni syndrome (LFS) is an autosomal dominant hereditary disease. It is associated with the loss of function of the p53 protein and an increased risk of malignant tumor development at early age. The most frequently detected tumors include breast cancer, sarcomas, leukemia, brain tumors, and adrenocortical carcinomas. While sarcomas account for only 1% of solid tumors, they are more frequently detected in these families. Case presentation We report a simultaneous diagnosis of hepatic perivascular epithelioid cell tumor (PEComa), a very rare subtype of sarcoma, in two siblings with a LFS. Conclusions The simultaneous diagnosis of PEComa in two siblings presented in this case allowed us to review the frequency of PEComa in this genetic syndrome previously reported, which was very little. Despite its rarity, PEComa must be considered in the differential diagnosis of new-onset liver lesions in patients who were previously diagnosed with LFS.
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Affiliation(s)
- María Del Mar Galera López
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Calle Dr. Esquerdo, 46, 28007, Madrid, Spain.
| | - Iván Márquez Rodas
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Calle Dr. Esquerdo, 46, 28007, Madrid, Spain.,CIBERONC, Madrid, Spain
| | - Carolina Agra Pujol
- Department of Pathology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ángela García Pérez
- Department of Radiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Enrique Velasco Sánchez
- Department of General Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Rosa Álvarez Álvarez
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Calle Dr. Esquerdo, 46, 28007, Madrid, Spain
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34
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Xu J, Gong XL, Wu H, Zhao L. Case Report: Gastrointestinal PEComa With TFE3 Rearrangement Treated With Anti-VEGFR TKI Apatinib. Front Oncol 2020; 10:582087. [PMID: 33330059 PMCID: PMC7719820 DOI: 10.3389/fonc.2020.582087] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/26/2020] [Indexed: 12/13/2022] Open
Abstract
Perivascular epithelioid cell tumors (PEComas) are rare mesenchymal tumors. Unresectable malignant PEComas with TFE3 rearrangement have no recommended therapy to date. Here, we report the first case of malignant gastrointestinal PEComa with TFE3 rearrangement which has a response to the targeted therapy of an anti-VEGFR tyrosine kinase inhibitor (TKI), apatinib. A 31-year-old female was diagnosed with malignant gastrointestinal PEComa with TFE3 rearrangement and hepatic metastases. A resection of the giant retroperitoneal mass was performed. The patient received the anti-VEGFR TKI apatinib to treat the hepatic metastasis. The tumor remained stable during apatinib treatment and the progression-free survival (PFS) lasted about 7 months. This case suggests that targeting the VEGF/VEGFR signaling pathway may be an essential new therapeutic choice for TFE3-associated malignant PEComas.
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Affiliation(s)
- Jiaming Xu
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Lei Gong
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huanwen Wu
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Zhao
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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35
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Schmiester M, Dolnik A, Kornak U, Pfitzner B, Hummel M, Treue D, Hartmann A, Agaimy A, Weyerer V, Lekaj A, Brakemeier S, Peters R, Öllinger R, Märdian S, Bullinger L, Striefler JK, Flörcken A. TFE3 activation in a TSC1-altered malignant PEComa: challenging the dichotomy of the underlying pathogenic mechanisms. JOURNAL OF PATHOLOGY CLINICAL RESEARCH 2020; 7:3-9. [PMID: 33180365 PMCID: PMC7737753 DOI: 10.1002/cjp2.187] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/25/2020] [Accepted: 09/30/2020] [Indexed: 02/06/2023]
Abstract
Perivascular epithelioid cell tumors (PEComas) form a family of rare mesenchymal neoplasms that typically display myomelanocytic differentiation. Upregulation of mTOR signaling due the inactivation of TSC1/2 (Tuberous Sclerosis 1 and 2) is believed to be a key oncogenic driver in this disease. Recently, a subgroup of PEComas harboring TFE3 (Transcription Factor E3) rearrangements and presenting with a distinctive morphology has been identified. TSC1/2 and TFE3 aberrations are deemed to be mutually exclusive in PEComa, with two different pathogenic mechanisms assumed to lead to tumorigenesis. Here, we challenge this dichotomy by presenting a case of a clinically aggressive TCS1‐mutated PEComa displaying a TFE3‐altered phenotype. FISH analysis was suggestive of a TFE3 inversion; however, RNA and whole genome sequencing was ultimately unable to identify a fusion involving the gene. However, a copy number increase of the chromosomal region encompassing TFE3 was detected and transcriptome analysis confirmed upregulation of TFE3, which was also seen at the protein level. Therefore, we believe that the TSC1/2‐mTOR pathway and TFE3 overexpression can simultaneously contribute to tumorigenesis in PEComa. Our comprehensive genetic analyses add to the understanding of the complex pathogenic mechanisms underlying PEComa and harbor insights for clinical treatment options.
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Affiliation(s)
- Maren Schmiester
- Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Anna Dolnik
- Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Uwe Kornak
- Institute of Medical Genetics and Human Genetics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Institute of Human Genetics, University Medical Center Göttingen, Göttingen, Germany
| | - Berit Pfitzner
- Institute of Pathology, DRK Kliniken Berlin Westend, Berlin, Germany
| | - Michael Hummel
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Denise Treue
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Arndt Hartmann
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Veronika Weyerer
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Anja Lekaj
- Institute of Medical Genetics and Human Genetics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Susanne Brakemeier
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Robert Peters
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Robert Öllinger
- Department of Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sven Märdian
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Lars Bullinger
- Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,German Cancer Consortium (DKTK), Partner Site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jana Käthe Striefler
- Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anne Flörcken
- Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Bennett JA, Oliva E. Perivascular epithelioid cell tumors (PEComa) of the gynecologic tract. Genes Chromosomes Cancer 2020; 60:168-179. [PMID: 33099813 DOI: 10.1002/gcc.22908] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/21/2020] [Indexed: 12/13/2022] Open
Abstract
PEComas of the female genital tract are rare mesenchymal neoplasms that are most common in the uterus, but also may occur in other gynecologic locations. As they morphologically and immunohistochemically resemble smooth muscle tumors, distinction between the two entities is often challenging, and may be aided by molecular analysis. Thus far, two distinct molecular groups-classic PEComas with TSC mutations and TFE3-translocation associated PEComas with TFE3 fusions have been described. Recognition of the first group is imperative as these patients may benefit from targeted therapy with mTOR inhibitors, if malignant. This review will focus on recognition of the morphologic and immunophenotypic features of PEComas, as well as the role of molecular testing in their diagnosis and treatment, analysis of the different algorithms to predict behavior, and differential diagnosis.
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Affiliation(s)
- Jennifer A Bennett
- Department of Pathology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Esther Oliva
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Zhong J, Hu Y, Si L, Xing Y, Geng J, Jiao Q, Zhang H, Yao W. Primary perivascular epithelioid cell tumor (PEComa) in bone: A review of the literature and a case arising in the humerus with multiple metastases. J Bone Oncol 2020; 26:100336. [PMID: 33240785 PMCID: PMC7674509 DOI: 10.1016/j.jbo.2020.100336] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/24/2020] [Accepted: 10/25/2020] [Indexed: 12/24/2022] Open
Abstract
First case PEComa primary arising in humerus was described. Histology is the basic to determine malignancy of PEComa. TFE3 gene investigation is the key of therapy selection. mTOR inhibitor is believed to be effective for patients without TFE3 rearrangement. More study is needed to understand the role of molecular test and imaging in PEComa.
Introduction Perivascular epithelioid cell tumors (PEComas) are a family of mesenchymal tumors that rarely arise as a primary bone tumor. Material and methods We report a case of primary malignant bone PEComa. A literature review via PubMed, Embase and Web of Science databases with the keyword “PEComa” and “bone” was performed. Results We reported a 33-year-old female with primary malignant bone PEComa in right distal humerus. The patient received an inhibitor of the mammalian target of rapamycin (mTOR) protein based on negative molecular investigation result of transcription factor E3 (TFE3) rearrangement, and additional therapies including palliative radiotherapy, anti-angiogenics and immunotherapy when the disease progression was detected. The patient was alive with the disease twenty-three months postoperatively. A total of nineteen related literature cases were retrieved and reviewed. Taking current case into account, ten males and ten females with median age of 24 years (range, 3–93 years) were identified, who were most frequently affected in tibia. The median follow-up duration of 24 months (range, 3–96 months). One patient died due to this disease, and six patients showed metastases. Three patients experienced recurrence, and two of them experienced twice and three times, respectively. Conclusion To our knowledge, this is the first case of primary malignant bone PEComa arising in humerus. Clinicopathological and radiological correlation is mandatory to the correct diagnosis and to determine its malignancy. More studies are required to understand the role of molecular test and imaging in selecting suitable treatment and mechanisms of treatment resistance.
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Key Words
- 18F-FDG, fluorine-18-fluorodeoxyglucose positron
- ASPS, alveolar soft part sarcoma
- Bone neoplasm
- CT, computed tomography
- ECT, emission computed tomography
- EMA, membrane antigen
- HMB 45, human melanoma black 45
- HPF, high-power fields
- Humerus
- MITF, microphthalmia-associated transcription factor
- MRI, magnetic resonance imaging
- Malignant
- Metastasis
- PEComa, perivascular epithelioid cell tumor
- PET/CT, positron emission tomography/computed tomography
- Perivascular epithelioid cell tumor (PEComa)
- SMA, smooth muscle actin
- SUVmax, maximum standard uptake value
- TFE3, transcription factor E3
- mTOR, mammalian target of rapamycin
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Affiliation(s)
- Jingyu Zhong
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai 200336, China
| | - Yangfan Hu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 YiShan Road, Shanghai 200233, China
| | - Liping Si
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai 200336, China
| | - Yue Xing
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai 200336, China
| | - Jia Geng
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 QingChun Road, Hangzhou 310003, China
| | - Qiong Jiao
- Department of Pathology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 YiShan Road, Shanghai 200233, China
| | - Huizhen Zhang
- Department of Pathology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 YiShan Road, Shanghai 200233, China
| | - Weiwu Yao
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai 200336, China
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Bennett J, Laury R, Dai H, Walde C, Kasi A. A Curious Case of Colonic Perivascular Epithelioid Cell Tumor: A Unique Diagnosis With Variable Presentations. Cureus 2020; 12:e11164. [PMID: 33251071 PMCID: PMC7688055 DOI: 10.7759/cureus.11164] [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] [Indexed: 11/20/2022] Open
Abstract
A 67-year-old female with a history of colon cancer underwent colonoscopy. An 8 mm semi-pedunculated, friable, and ulcerated lesion of the ascending colon was removed completely using a hot snare. Immunohistochemical staining showed strong positivity for transcription factor binding to IGHM enhancer 3 (TFE-3) and was partially positive for Human Melanoma Black (HMB-45), consistent with a diagnosis of perivascular epithelioid cell tumor (PEComa). The patient underwent endoscopic submucosal dissection of the residual lesion in the ascending colon without complications. Here, we discuss the clinical and histopathologic characterizations that helped guide the diagnosis and management of this exceedingly rare entity.
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Affiliation(s)
- Joseph Bennett
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, USA
| | - Raquele Laury
- Department of Pathology, University of Kansas Medical Center, Kansas City, USA
| | - Hongyan Dai
- Department of Pathology, University of Kansas Medical Center, Kansas City, USA
| | - Charles Walde
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, USA
| | - Anup Kasi
- Department of Oncology, University of Kansas Medical Center, Kansas City, USA
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Akumalla S, Madison R, Lin DI, Schrock AB, Yakirevich E, Rosenzweig M, Balar AV, Frampton GM, Edgerly C, Erlich RL, Miller VA, Ganesan S, Ross JS, Ali SM. Characterization of Clinical Cases of Malignant PEComa via Comprehensive Genomic Profiling of DNA and RNA. Oncology 2020; 98:905-912. [PMID: 32966992 DOI: 10.1159/000510241] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/13/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE Perivascular epithelioid cell tumor (PEComa) is a rare mesenchymal soft tissue neoplasm often linked to mTOR pathway activation via TSC2 mutation. We analyzed a series of 31 consecutive metastatic PEComa (mPEComa) cases using a combined DNA/RNA hybrid capture-based comprehensive genomic profiling (CGP) assay to assess the genomic landscape of mPEComa. PATIENTS AND METHODS Formalin-fixed, paraffin-embedded (FFPE) blocks or slides were obtained from tumors from 31 unique patients with mPEC-oma. DNA and RNA were extracted and CGP was performed on 405 genes using a targeted next-generation sequencing (NGS) assay in a CLIA-certified lab. RESULTS All cases had locally advanced or metastatic disease, and 58% of patients were female with a median age of 50 years (range 8-76), and 17 and 14 specimens were from primary and metastatic sites, respectively. One hundred genomic alterations were identified in the cohort, with an average of 3.2 genomic alterations/case including alterations in TSC2 32.3% of cases (10), TSC1 9.6% (3), TFE3 16.1% (5, all fusions), and folliculin (FLCN) 6.4% (2), with all occurring in mutually exclusive fashion. Of TSC2 mutant cases, 70% had biallelic inactivation of this locus, as were 100% of TSC1 mutant cases. Two TSC1/2 wildtype cases harbored truncating mutations in FLCN, both of which were under LOH. Five TFE3 fusion cases were identified including the novel 5' fusion partner ZC3H4. CONCLUSIONS We describe for the first time mPEComa cases with FLCN mutations under LOH, further characterizing dysregulation of the mTOR pathway as a unifying theme in mPEC-oma. Cumulatively, we demonstrate the feasibility and potential utility of segregating mPEComa by TSC, TFE3, and FLCN status via CGP in clinical care.
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Affiliation(s)
| | | | | | | | - Evgeny Yakirevich
- Department of Pathology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | - Arjun V Balar
- Perlmutter Cancer Center, NYU Langone Health, New York, New York, USA
| | | | | | | | | | - Shridar Ganesan
- Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
| | - Jeffrey S Ross
- Foundation Medicine, Cambridge, Massachusetts, USA.,Department of Urology Pathology and Laboratory Medicine, Upstate Medical Center, Syracuse, New York, USA
| | - Siraj M Ali
- Foundation Medicine, Cambridge, Massachusetts, USA,
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Abstract
Perivascular epithelioid cell neoplasms (PEComas) are a family of mesenchymal neoplasms with features of both melanotic and smooth muscle differentiation. PEComa morphology is highly variable and encompasses epithelioid to spindle cells often with clear cytoplasm and prominent nucleoli. Molecularly, most PEComas are defined by a loss of function of the TSC1/TSC2 complex. Additionally, a distinct small subset of PEComas harboring rearrangements of the TFE3 (Xp11) gene locus has been identified. By presenting a series of three case reports with distinct features, we demonstrate diagnostic pitfalls as well as the importance of molecular work-up of PEComas because of important therapeutic consequences.
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Hamza A, Guo CC. Perivascular Epithelioid Cell Tumor of the Urinary Bladder: A Systematic Review. Int J Surg Pathol 2019; 28:393-400. [PMID: 31865807 DOI: 10.1177/1066896919895810] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Perivascular epithelioid cell tumor (PEComa) of the urinary bladder is a rare neoplasm showing distinct melanocytic and smooth muscle differentiation. We aimed to review the clinicopathologic features of bladder PEComa using all the available cases in the literature, along with 2 new cases from our database. The patients included 15 females and 15 males with a mean age of 39.2 ± 15.3 years. Painless hematuria was the most common clinical presentation. The tumors were usually well circumscribed with a mean tumor size of 4.4 ± 2.7 cm. Bladder PEComas demonstrated nests, trabeculae, or sheets of epithelioid cells with intermixed spindled cells and numerous thin-walled vessels. Immunohistochemical studies showed that the tumors were positive for HMB45 (27/27), cathepsin (4/4), SMA (20/22), and caldesmon (3/3) and were negative for pan cytokeratin (0/18) and EMA (0/4). Molecular studies revealed that PEComa was associated with the TFE3 (n = 3) and EWSR1 (n = 1) gene rearrangements. Treatment included partial cystectomy (n = 18), transurethral resection (n = 8), and radical cystectomy (n = 4). Twenty patients had no evidence of disease during a mean follow-up time of 19.4 ± 17.2 months. Two patients had recurrence, and 1 patient died of metastatic disease. In conclusion, bladder PEComas demonstrate distinct morphologic and immunohistochemical features. Although most tumors follow a benign course, a small subset may develop metastasis and cause death.
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Affiliation(s)
- Ameer Hamza
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Charles C Guo
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Touloumis Z, Giannakou N, Sioros C, Trigka A, Cheilakea M, Dimitriou N, Griniatsos J. Retroperitoneal perivascular epithelioid cell tumours: A case report and review of literature. World J Clin Cases 2019; 7:3524-3534. [PMID: 31750334 PMCID: PMC6854398 DOI: 10.12998/wjcc.v7.i21.3524] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/26/2019] [Accepted: 09/09/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The perivascular epithelioid cell tumour (PEComa) family of tumours mainly includes renal and hepatic angiomyolipomas, pulmonary lymphangioleiomyomatosis and clear cell “sugar” tumour of the lung. Several uncommon tumours with similar morphological and immunophenotypical characteristics arising at a variety of sites (abdominal cavity, digestive tract, retroperitoneum, skin, soft tissue and bones) are also included in the PEComa family and are referred to as PEComas not otherwise specified.
CASE SUMMARY We present a 37-year-old female patient who underwent resection of an 8.5 cm × 8 cm × 4 cm retroperitoneal tumour, which eventually was diagnosed as PEComa of uncertain biological behaviour. Three years after the operation, the patient remains without any evidence of recurrence. A search was performed in the Medline and EMBASE databases for articles published between 1996 and 2018, and we identified 31 articles related to retroperitoneal and perinephric PEComas. We focused on sex, age, maximum dimension, histological and immunohistochemical characteristics of the tumour, follow-up and long-term outcome. Thirty-four retroperitoneal (including the present one) and ten perinephric PEComas were identified, carrying a malignant potential rate of 44% and 60%, respectively. Nearly half of the potentially malignant PEComas presented with or developed metastases during the course of the disease.
CONCLUSION Retroperitoneal PEComas are not as indolent as they are supposed to be. Radical surgical resection constitutes the treatment of choice for localized disease, while mammalian target of the rapamycin (mTOR) inhibitors constitute the most promising therapy for disseminated disease. The role of mTOR inhibitors as adjuvant or neoadjuvant therapies needs to be evaluated in the future.
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Affiliation(s)
- Zisis Touloumis
- Department of Surgery, Athens Medical Group, Athens 11525, Greece
| | - Niki Giannakou
- Department of Pathology, Athens Medical Group, Athens 11525, Greece
| | - Christos Sioros
- Department of Surgery, Athens Medical Group, Athens 11525, Greece
| | - Argiro Trigka
- Department of Surgery, Athens Medical Group, Athens 11525, Greece
| | - Maria Cheilakea
- Emergency Department, Konstantopouleio General Hospital, N. Ionia 14233, Greece
| | - Nikoletta Dimitriou
- 1st Department of Surgery, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - John Griniatsos
- 1st Department of Surgery, National and Kapodistrian University of Athens, Athens 11527, Greece
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Touloumis Z, Giannakou N, Sioros C, Trigka A, Cheilakea M, Dimitriou N, Griniatsos J. Retroperitoneal perivascular epithelioid cell tumours: A case report and review of literature. World J Clin Cases 2019. [DOI: 10.12998/wjcc.v7.i21.3507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Zarei M, Du H, Nassar AH, Yan RE, Giannikou K, Johnson SH, Lam HC, Henske EP, Wang Y, Zhang T, Asara J, Kwiatkowski DJ. Tumors with TSC mutations are sensitive to CDK7 inhibition through NRF2 and glutathione depletion. J Exp Med 2019; 216:2635-2652. [PMID: 31506280 PMCID: PMC6829598 DOI: 10.1084/jem.20190251] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 06/26/2019] [Accepted: 08/09/2019] [Indexed: 12/11/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is characterized by tumor development in the brain, heart, kidney, and lungs. In TSC tumors, loss of the TSC1/TSC2 protein complex leads to activation of mTORC1 with downstream effects on anabolism and cell growth. Because mTORC1 activation enhances mRNA transcription, we hypothesized that aberrant mTORC1 activation might confer TSC-null cell dependence on transcriptional regulation. We demonstrate that TSC1- or TSC2-null cells, in contrast to their wild-type counterparts, are sensitive to pharmacological inhibition of CDK7. Mechanistic studies revealed that CDK7 inhibition markedly reduces glutathione levels and increases reactive oxygen species due to reduced expression of NRF2 and glutathione biosynthesis genes. Treatment of both Tsc2+/ - mice and a TSC1-null bladder cancer xenograft model with a CDK7 inhibitor showed marked reduction in tumor volume and absence of regrowth in the xenograft model. These results suggest that CDK7 inhibition is a promising therapeutic approach for treatment of TSC-associated tumors and cancers with mutations in either TSC1 or TSC2.
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Affiliation(s)
- Mahsa Zarei
- Cancer Genetics Laboratory, Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX
| | - Heng Du
- Cancer Genetics Laboratory, Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Amin H Nassar
- Cancer Genetics Laboratory, Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Rachel E Yan
- Cancer Genetics Laboratory, Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Krinio Giannikou
- Cancer Genetics Laboratory, Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Sneha H Johnson
- Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX
| | - Hilaire C Lam
- Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Elizabeth P Henske
- Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Yubao Wang
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA
| | - Tinghu Zhang
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA.,Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA
| | - John Asara
- Division of Signal Transduction, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - David J Kwiatkowski
- Cancer Genetics Laboratory, Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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Xu J, Yan Y, Xiang X, Jiang P, Hu X, Yang W. Gastric Perivascular Epithelioid Cell Tumor (PEComa). Am J Clin Pathol 2019; 152:221-229. [PMID: 31141597 DOI: 10.1093/ajcp/aqz040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To review the clinicopathologic, immunophenotypic, and molecular features of gastric perivascular epithelioid cell tumor (PEComa). METHODS We identified two new cases of gastric PEComa and summarized the clinical and pathologic characteristics of this rare neoplasm. RESULTS The first case was a 48-year-old woman who was treated with an endoscopic submucosal dissection (ESD), and the second case was a 64-year-old man who received a distal gastrectomy. Microscopic examination showed one tumor was composed of purely epithelioid cells, while the other was composed of epithelioid and spindle cells. Both tumors were immunoreactive for melanocytic markers (HMB45 and Melan-A), smooth muscle actin, and vimentin. No TFE3 gene rearrangement was identified by fluorescence in situ hybridization in either case. CONCLUSIONS Gastric PEComa is an exceedingly rare neoplasm, with only seven other reported cases to date. We are the first to report the results of molecular assays for the TFE3 gene rearrangement associated with gastric PEComa.
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Affiliation(s)
- Jinghong Xu
- Department of Pathology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yu Yan
- Department of Pathology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xueping Xiang
- Department of Pathology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Peter Jiang
- University of Florida College of Medicine, Gainesville
| | - Xiangrong Hu
- Department of Pathology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Wenjun Yang
- Department of Pathology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
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Rothenberger R, Jackson A, Kendler A, Herzog T, Billingsley C. An unusual case of uterine PEComa presenting with disseminated intravascular coagulation. Gynecol Oncol Rep 2019; 29:76-78. [PMID: 31384655 PMCID: PMC6664096 DOI: 10.1016/j.gore.2019.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/16/2019] [Indexed: 12/23/2022] Open
Abstract
Perivascular epithelioid cell neoplasms (PEComas) are mesenchymal neoplasms originating from the perivascular epithelioid cell (PEC) line. The World Health Organization (WHO) further defines PEComa as “a mesenchymal tumor composed of histologically and immunohistochemically distinctive perivascular epithelioid cells”. Gynecologic PEComas account for approximately ¼ of the PEComa cases reported in the literature and are histologically characterized by stromal hyalinization with complete or partial circumscription with hyaline background and diffuse, small vessel vascularity (Musella et al., 2015). Uterine PEComas typically present with vaginal bleeding and/or a uterine mass, are managed surgically with resection, and can be followed by adjuvant treatment if indicated based on pathologic risk factors for aggression. Adjuvant therapy is not standardized given the rarity of these tumors, and can include chemotherapy, radiation, targeted therapy (mTOR inhibitors due to common gene mutations and a hypothesized pathophysiology of this neoplasm) and/or hormones. In this case report, we describe an unusual presentation for a uterine PEComa in a woman initially complaining of worsening cutaneous bruising and petechiae, found to be in florid disseminated intravascular coagulation (DIC) without a clear etiology. Ultimately her extensive hematology evaluation only found a large uterine mass that appeared to be a 9 cm fibroid. She underwent hysterectomy following recovery from her DIC, and was diagnosed with a large uterine PEComa. PEComas are mesenchymal perivascular epithelioid cell (PEC) neoplasms. Disseminated intravascular coagulation (DIC) has been reported in solid tumors. DIC is mediated in solid tumors by the generation of tissue factor. Primary treatment for PEComa is excision. Postoperatively, treatment for PEComa can be with targeted medical therapy.
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Affiliation(s)
- Rodger Rothenberger
- Department of Obstetrics and Gynecology, Division of Gynecology Oncology, University of Cincinnati, 231 Albert Sabin Way, Academic Health Center, PO Box 670526, Cincinnati, OH 45267-0526, United States of America
| | - Amanda Jackson
- Department of Obstetrics and Gynecology, Division of Gynecology Oncology, University of Cincinnati, 231 Albert Sabin Way, Academic Health Center, PO Box 670526, Cincinnati, OH 45267-0526, United States of America
| | - Ady Kendler
- Department of Pathology, University of Cincinnati, 234 Goodman Street, Cincinnati, OH 45219, United States of America
| | - Thomas Herzog
- Department of Obstetrics and Gynecology, Division of Gynecology Oncology, University of Cincinnati, 231 Albert Sabin Way, Academic Health Center, PO Box 670526, Cincinnati, OH 45267-0526, United States of America
| | - Caroline Billingsley
- Department of Obstetrics and Gynecology, Division of Gynecology Oncology, University of Cincinnati, 231 Albert Sabin Way, Academic Health Center, PO Box 670526, Cincinnati, OH 45267-0526, United States of America
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Sanfilippo R, Jones RL, Blay JY, Le Cesne A, Provenzano S, Antoniou G, Mir O, Fucà G, Fumagalli E, Bertulli R, Stacchiotti S, Brahmi M, Grosso F, Dufresne A, Hindi N, Sbaraglia M, Gronchi A, Collini P, Dei Tos AP, Casali PG. Role of Chemotherapy, VEGFR Inhibitors, and mTOR Inhibitors in Advanced Perivascular Epithelioid Cell Tumors (PEComas). Clin Cancer Res 2019; 25:5295-5300. [PMID: 31217199 DOI: 10.1158/1078-0432.ccr-19-0288] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 02/27/2019] [Accepted: 06/07/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Perivascular epitheliod cell tumors (PEComas) are rare mesenchymal neoplasms for which the role of systemic treatments is not established as there are no published prospective clinical trials or sufficiently large retrospective case series. The aim of this study is to clarify the activity of conventional chemotherapy and biological agents in advanced/metastatic PEComas. EXPERIMENTAL DESIGN This was an observational, retrospective, international study that included patients with advanced/metastatic PEComa treated with systemic therapy at 5 European sarcoma reference centers and within the Italian Rare Cancer Network. Survival analyses were performed using the Kaplan-Meier method and the Cox hazards regression models. RESULTS A total of 53 patients were included. Cytotoxic chemotherapy regimens were active only in a small proportion of PEComas. Gemcitabine-based regimens [objective response rate (ORR): 20%, median progression-free survival (PFS): 3.4 months] seemed to have the same activity of anthracycline-based regimens (ORR: 13%, median PFS: 3.2 months). Antiangiogenic agents resulted in disease stabilization in some patients, with a number having density changes/tissue response on imaging, with an ORR of 8.3% and a median PFS of 5.4 months. mTOR inhibitors were the most active agents, with an ORR of 41% and a median PFS of 9 months. CONCLUSIONS Our study provides data for the selection of systemic therapy in patients with advanced/metastatic PEComa: mTOR inhibitors are the most active agents. Antiangiogenics and chemotherapy with gemcitabine-based regimens or anthracycline-based regimens are options in further line, but with a lower response rate and PFS.
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Affiliation(s)
- Roberta Sanfilippo
- Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.
| | - Robin L Jones
- Sarcoma Unit, Royal Marsden Hospital, London, United Kingdom
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Axel Le Cesne
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, Villejuif, France
| | - Salvatore Provenzano
- Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | - Olivier Mir
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, Villejuif, France
| | - Giovanni Fucà
- Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Elena Fumagalli
- Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Rossella Bertulli
- Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Silvia Stacchiotti
- Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Mehdi Brahmi
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Federica Grosso
- Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Armelle Dufresne
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Nadia Hindi
- Medical Oncology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain.,Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Marta Sbaraglia
- Department of Pathology and Molecular Genetics, Treviso General Hospital, Treviso, Italy
| | - Alessandro Gronchi
- Melanoma and Sarcoma Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Paola Collini
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Angelo P Dei Tos
- Department of Pathology and Molecular Genetics, Treviso General Hospital, Treviso, Italy.,Department of Medicine, University of Padova School of Medicine, Padova, Italy
| | - Paolo G Casali
- Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.,Oncology and Haemato-Oncology Department, University of Milan, Milan, Italy
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Friend BD, Wolfe Schneider K, Garrington T, Truscott L, Martinez-Agosto JA, Venick RS, Tsai Chambers E, Weng P, Farmer DG, Chang VY, Federman N. Is polycystic kidney disease associated with malignancy in children? Mol Genet Genomic Med 2019; 7:e00725. [PMID: 31197971 PMCID: PMC6625336 DOI: 10.1002/mgg3.725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/18/2019] [Accepted: 04/08/2019] [Indexed: 01/16/2023] Open
Abstract
Background Polycystic kidney disease (PKD) is an inherited condition characterized by progressive development of end‐stage renal disease, hypertension, hepatic fibrosis, and cysts in the kidney, liver, pancreas, spleen, thyroid, and epididymis. While malignancies have been reported in association with PKD in adults, the incidence of malignancies in children with PKD is not currently known. Methods We report on five patients with a known history of PKD who developed a malignancy as children at the University of California, Los Angeles and the University of Colorado Anschutz Medical Campus. Patients were included from 2012 to 2017. Results We present five patients with a history of PKD diagnosed with a malignancy during childhood without any additional known mutations to suggest a genetic predisposition to develop cancer. This includes the first reported case of hepatocellular carcinoma in a patient with autosomal recessive polycystic kidney disease. Conclusion Our report illustrates the potential that PKD may be associated with an increased risk for developing cancer, even in children. Further research is necessary to better understand this relationship.
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Affiliation(s)
- Brian D Friend
- Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, California.,Department of Pediatrics, UCSF Benioff Children's Hospital, San Francisco, California
| | - Kami Wolfe Schneider
- Section of Hematology, Oncology, and Bone Marrow Transplantation, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, Colorado
| | - Timothy Garrington
- Section of Hematology, Oncology, and Bone Marrow Transplantation, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, Colorado
| | - Laurel Truscott
- Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, California
| | - Julian A Martinez-Agosto
- Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, California.,Department of Human Genetics, UCLA David Geffen School of Medicine, Los Angeles, California.,UCLA Clinical Genomics Center, Los Angeles, California
| | - Robert S Venick
- Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, California
| | - Eileen Tsai Chambers
- Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, California.,Division of Pediatric Nephrology, Department of Pediatrics, Duke University, Durham, North Carolina
| | - Patricia Weng
- Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, California
| | - Douglas G Farmer
- Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Vivian Y Chang
- Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, California.,UCLA's Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - Noah Federman
- Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, California.,UCLA's Jonsson Comprehensive Cancer Center, Los Angeles, California.,Department of Orthopaedics, UCLA David Geffen School of Medicine, Los Angeles, California
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49
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[Complexity of PEComas : Diagnostic approach, molecular background, clinical management (German version)]. DER PATHOLOGE 2019; 40:443-453. [PMID: 31165234 DOI: 10.1007/s00292-019-0614-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Perivascular epithelioid cell neoplasms (PEComas) are a family of mesenchymal neoplasms with features of both melanotic and smooth muscle differentiation. PEComa morphology is highly variable and encompasses epithelioid to spindle cells often with clear cytoplasm and prominent nucleoli. Molecularly, most PEComas are defined by a loss of function of the TSC1/TSC2 complex. Additionally, a distinct small subset of PEComas harboring rearrangements of the TFE3 (Xp11) gene locus has been identified. By presenting a series of three case reports with distinct features, we demonstrate diagnostic pitfalls as well as the importance of molecular work-up of PEComas because of important therapeutic consequences.
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Abstract
OPINION STATEMENT Soft tissue sarcomas are rare cancers with an expected incidence of about 14,000 new cases in 2018, and account for less than 1% of all cancers. It includes in excess of 75 heterogeneous subtypes with varying biology, molecular aberrations, and variable response to treatment. Because of the rarity of these tumors and the many different subtypes, there is no large-scale data to guide treatment, and hence the need for a multidisciplinary individualized approach to treatment, preferably at a high-volume tertiary referral center. For localized disease, surgery with or without radiation is the preferred treatment. In metastatic disease, the longest track record is with use of anthracyclines, either alone or in combination with ifosfamide, but the median overall survival even with combination was just over a year. There have been recent advances in understanding the heterogeneity of these tumors and the need for an individualized approach. With that new knowledge, recent approvals of trabectedin, eribulin, and pazopanib have been limited to some select histologic subtypes with improved outcomes. More recently, immunotherapy has been tested in select histotypes of sarcoma with encouraging activity and has led to further evaluation in combination with immunotherapeutic agents, as well as with chemotherapy and radiation treatments. Here, in this article, we summarize the data of the currently approved therapies in metastatic soft tissue sarcoma, with the principal focus on first-line therapies. We also review the recent encouraging data with PDGFR-targeted antibody (olaratumab) with doxorubicin which showed an impressive improvement in overall survival in phase II study. Molecular characterization of sarcoma subtypes will likely improve understanding of these very diverse tumors and improve target characterization. The ongoing efforts in better understanding these rare tumors hold the key to make a difference in the outcome of these patients.
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Affiliation(s)
- Megan Meyer
- Internal Medicine, Mayo Clinic, 5777 E Mayo Blvd., Phoenix, AZ, 85054, USA
| | - Mahesh Seetharam
- Hematology and Oncology, Mayo Clinic, 5881 E Mayo Blvd., Phoenix, AZ, 85054, USA.
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