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Genevois AL, Carton M, Jean-Denis M, Cyrta J, Corradini N, Metayer L, Chemin-Airiau C, Karanian M, Dufresne A, Pannier S, El Zein S, Defachelles AS, Bompas E, Gantzer J, Honoré C, Noal S, Héritier S, Guillemet C, Serre J, Le Loarer F, Pierron G, Merlin MS, Anract P, Gomez-Mascard A, Llacer C, Ducimetière F, Toulmonde M, Blay JY, Orbach D. Alveolar soft part sarcomas in young patients: The French national NETSARC+ network experience. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108483. [PMID: 38897095 DOI: 10.1016/j.ejso.2024.108483] [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: 04/01/2024] [Revised: 05/27/2024] [Accepted: 06/11/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND AND AIMS Alveolar soft part sarcoma (ASPS) is an ultra-rare chemo-resistant sarcoma in children, occurring preferentially in young adults. We aimed to describe and compare its clinical presentation and behaviour in children and young adults to determine whether the same therapeutic strategy should be addressed for both populations. METHODS National retrospective multicentre study of children (0-18 years) vs. young adults (19-30 years) included in the "ConticaBase" sarcoma database, treated for ASPS between 2010 and 2019 with pathology reviewed via the NETSARC + network. RESULTS Overall, 45 patients were identified, 19 children (42%) and 26 young adults (58%). All ASPS diagnoses were confirmed with TFE3 rearrangement by immunohistochemistry or FISH. All clinical characteristics were balanced between both populations with frequent metastases at diagnosis (8/19 vs. 10/26). The therapeutic strategy was based on surgery (17/19 vs. 21/26), radiotherapy (8/19 vs. 12/26) ± systemic treatment (8/19 vs. 9/26). In patients with initially localized disease, metastatic relapse occurred only in adults (8/16), whereas metastatic progression was present in both metastatic groups (5/8 vs. 8/10). After a median follow-up of 5.2 years (range, 0.2-12.2), 5-year EFS was 74% [95%CI, 56-96] vs. 47% [30-74] (p = 0.071) respectively, and 5-year OS was 95% [85-100] vs. 85% [70-100] (p = 0.84). For localized tumours, 5-year MFS was 100% [100-100] vs. 60% [39-91] (p = 0.005). The 5-year OS of all patients with metastasis at diagnosis was 80.2% (62.2%-100%). CONCLUSIONS ASPS appears to have the overall same clinical characteristics, but a more aggressive behaviour in young adults than in children. However, despite frequent metastases at diagnosis, long-term survival is high in both groups. Overall, the same therapeutic strategies may be considered for both populations.
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Affiliation(s)
- Anne-Laure Genevois
- SIREDO Oncology Centre (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, Paris-Saclay University (PSL), Paris, France.
| | - Matthieu Carton
- Unit of Biometry, Institut Curie, DRCI, PSL Research University, Paris, France
| | | | - Joanna Cyrta
- Department of Pathology, Institut Curie, Paris, France
| | - Nadège Corradini
- Department of Paediatric Oncology, Paediatric Haematology and Oncology Institute, Léon Bérard Centre, Lyon, France
| | - Lucy Metayer
- Department of Paediatric and Adolescent Oncology, Gustave Roussy Cancer Centre, Paris-Saclay University, Villejuif, France
| | | | - Marie Karanian
- Department of Biopathology, Léon Bérard Centre, Lyon, France
| | - Armelle Dufresne
- Department of Medical Oncology, Léon Bérard Centre, Lyon, France
| | | | | | | | | | - Justine Gantzer
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute (ICANS), Strasbourg, France
| | - Charles Honoré
- Department of Surgery, Gustave Roussy Cancer Centre, Villejuif, France
| | - Sabine Noal
- Department of Medical Oncology, François Baclesse Centre, Caen, France
| | - Sébastien Héritier
- Department of Paediatric Haematology and Oncology, Trousseau Hospital, Paris, France
| | - Cécile Guillemet
- Department of Medical Oncology, Henry Becquerel Centre, Rouen, France
| | - Jill Serre
- Department of Paediatric Haematology and Oncology, Trousseau Hospital, Tours, France
| | | | | | - Marie-Sophie Merlin
- Department of Paediatric Haematology and Oncology, Brabois Hospital, Nancy, France
| | - Philippe Anract
- Department of Orthopedic and Traumatology, Cochin Hospital, Paris, France
| | | | - Carmen Llacer
- Department of Radiotherapy, Montpellier Cancer Institute, Montpellier, France
| | | | - Maud Toulmonde
- Department of Medical Oncology, Bergonié Institute, Bordeaux, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Léon Bérard Centre, Lyon, France
| | - Daniel Orbach
- SIREDO Oncology Centre (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, Paris-Saclay University (PSL), Paris, France
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Spinnato P, Papalexis N, Colangeli M, Miceli M, Crombé A, Parmeggiani A, Palmerini E, Righi A, Bianchi G. Imaging Features of Alveolar Soft Part Sarcoma: Single Institution Experience and Literature Review. Clin Pract 2023; 13:1369-1382. [PMID: 37987424 PMCID: PMC10660714 DOI: 10.3390/clinpract13060123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023] Open
Abstract
Alveolar soft part sarcoma (ASPS) is an extremely rare and aggressive soft-tissue sarcoma (STS) subtype with poor prognosis and limited response to radiation therapy and chemotherapy. Prompt recognition and referral to sarcoma centers for appropriate management are crucial for patients' survival. The purpose of this study was to report ASPS pre-treatment imaging features and to examine the existing literature on this topic. Twelve patients (7 women, 5 men-mean age 27.1 ± 10.7 years) were included from our single-center experience. Ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) available were reviewed according to an analysis grid incorporating features from the latest research on STS. Clinical, histological, and outcome data were collected. MRI was available in 10 patients (83.3%), US in 7 patients (58.3%), and CT in 3 patients (25%). Mean longest tumor diameter was 7.6 ± 2.9 cm, and all tumors were deeply seated. Large peritumoral feeding vessels were systematically found and identified on ultrasonography (7/7), MRI (10/10), and CT (3/3). US revealed a well-defined heterogeneous hypoechoic pattern, with abundant flow signals in all patients (7/7). In all patients, MRI showed mildly high signal intensity (SI) on T1-WI and high SI on T2-WI and peritumoral edema. Moreover, flow-voids (due to arteriosus high-flow) into the peritumoral/intratumoral feeding vessels were detected in the MRI fluid-sensitive sequences of all patients. At baseline, whole-body contrast-enhanced CT revealed metastases in 8/12 (66.7%) patients. A pre-treatment longest diameter > 5 cm was significantly associated with distant metastases at diagnosis (p = 0.01). A maximum diameter > 5 cm represents a risk of metastatic disease at diagnosis (odds ratio = 45.0000 (95% CI: 1.4908-1358.3585), p = 0.0285). In the comprehensive literature review, we found 14 articles (case series or original research) focusing on ASPS imaging, with a total of 151 patients included. Merging our experience with the data from the existing literature, we conclude that the hallmark of ASPS imaging at presentation are the following characteristics: deep location, a slight hyperintense MRI SI on T1-WI and a hyperintense SI on T2-WI, numerous MRI flow voids, high internal vascularization, and large peritumoral feeding vessels.
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Affiliation(s)
- Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Nicolas Papalexis
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Colangeli
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Amandine Crombé
- Department of Musculoskeletal Imaging, Pellegrin University Hospital, University of Bordeaux, 33000 Bordeaux, France
| | - Anna Parmeggiani
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Emanuela Palmerini
- Osteoncology, Bone and Soft Tissue Sarcomas and Innovative Therapies Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Alberto Righi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Giuseppe Bianchi
- Orthopaedic Oncology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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Al Nakshabandi A, Daher AM. Alveolar Soft Part Sarcoma of Hypopharynx; A Case Report. EAR, NOSE & THROAT JOURNAL 2023; 102:20-23. [PMID: 33320015 DOI: 10.1177/0145561320982164] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Alveolar soft part sarcoma (ASPS) is an aggressive soft-tissue malignancy, notorious for its metastasis to other tissues. A considerable number of cases in the head and neck have been reported but not in the hypopharynx. We describe a 31-year-old man with an incidental finding of a hypopharyngeal mass. Flexible laryngoscopy revealed a fleshy mass 2 × 2 cm2 originating from the left hypopharynx and overlying the epiglottis. Computed tomography scan demonstrated a soft tissue mass in the left wall of the oropharynx measuring about 2.2 × 1.8 cm2, projecting into the hypopharyngeal air space. Magnetic resonance imaging showed a significant thickening of the left hypopharyngeal wall forming a mass lesion occupying the left pyriform sinus and abutting the left aryepiglottic fold. Histopathology indicated that tumor cells were polygonal and epithelioid, with abundant eosinophilic to clear flocculent cytoplasm, eccentric nuclei, and prominent nucleoli. The tumor was positive for smooth muscle actin with rare cells staining for Human Melanoma Black (HMB45). Fluorescence in situ hybridization for transcription factor E3 was also performed and supported the above diagnosis. Our study reports the first case of ASPS in the hypopharynx.
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Affiliation(s)
| | - Aqil M Daher
- Department of Community Medicine, School of Medicine, 50103International Medical University, Kuala Lumpur, Malaysia
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Rafizadeh SM, Cheraqpour K, Amoli FA, Haydar AA. Alveolar soft part sarcoma of the superior rectus muscle: Case report and review of literature. Am J Ophthalmol Case Rep 2022; 27:101645. [PMID: 35813583 PMCID: PMC9260434 DOI: 10.1016/j.ajoc.2022.101645] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/04/2022] [Accepted: 06/28/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose Alveolar soft part sarcoma (ASPS) is a very rare type of soft tissue sarcomas which usually occurs in the limbs and trunk. Observations A 25-year-old woman presented with proptosis and redness of the right eye for 8-month. She suffered from severe right upper lid edema, conjunctival chemosis, downward displacement of the globe, and proptosis. Radiological imaging was nonconclusive. Histopathological evaluations confirmed ASPS. The patient underwent exenteration as a lifesaving procedure. At 16-month follow-up, the patient is stable without any signs of recurrence or metastasis. Conclusions and importance We report an extremely rare case of ASPS occurring in the superior rectus muscle. Few orbital ASPS cases have been reported in the literature. A literature review of orbital ASPS was done to shed lights on the diagnosis and management of this rare tumor.
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Affiliation(s)
- Seyed Mohsen Rafizadeh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kasra Cheraqpour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Asadi Amoli
- Ophthalmic Pathology Department, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali A. Haydar
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author. Farabi Eye Hospital, South Kargar Street, Qazvin Square, Tehran, 1336616351, Iran.
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Souza F, Cardoso FN, Cortes C, Rosenberg A, Subhawong TK. Soft Tissue Tumors. Radiol Clin North Am 2022; 60:283-299. [DOI: 10.1016/j.rcl.2021.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Gulati M, Mittal A, Barwad A, Pandey R, Rastogi S, Dhamija E. Imaging and Pathological Features of Alveolar Soft Part Sarcoma: Analysis of 16 Patients. Indian J Radiol Imaging 2021; 31:573-581. [PMID: 34790300 PMCID: PMC8590546 DOI: 10.1055/s-0041-1735501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Context Alveolar soft part sarcoma (ASPS) is a rare soft tissue tumor most commonly occurring in deep intramuscular plane of lower extremities of adolescents and young adults. It is a highly vascular, slow growing tumor with malignant potential having lung as the most common site of metastases at the time of presentation. Aims The aim is to review the imaging findings of ASPS and determine characteristic imaging features of this rare tumor. Materials and Methods Sixteen patients having histopathological diagnosis and preoperative imaging of ASPS attending the dedicated sarcoma clinic at our institute were included in the study. The demographic, clinical, and imaging data were retrieved from the case records and then evaluated for characteristic imaging features which may raise suspicion of ASPS. Results The patients ranged from 3 to 72 years of age and with a slight male preponderance. Of the eight CECTs evaluated, 62.5% tumors showed well-defined lobulated margins, 87.5% cases showed intense enhancement with presence of feeder vessels. On CEMRI of 10 patients, 70% had well circumscribed lobulated margins with intense enhancement and tortuous flow voids in most of them. All cases showed T2 hyperintense signal. Fourteen of 16 (87.5%) patients had metastatic disease with lung as the most common site (92.8%). Conclusion ASPS is a rare soft tissue sarcoma seen in children and young adults. Imaging may mimic a vascular malformation due to the presence of tortuous feeders. Misdiagnosis at an early stage may lead to later metastatic presentation of the disease, thus emphasizing the need to suspect it on imaging.
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Affiliation(s)
- Malvika Gulati
- Department of Radiodiganosis, Dr. B. R. A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Abhenil Mittal
- Department of Medical Oncology, Dr. B. R. A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Adarsh Barwad
- Department of Pathology, Dr. B. R. A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Rambha Pandey
- Department of Radiation Oncology, Dr. B. R. A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Rastogi
- Department of Medical Oncology, Dr. B. R. A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Ekta Dhamija
- Department of Radiodiganosis, Dr. B. R. A. IRCH, All India Institute of Medical Sciences, New Delhi, India
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Tsukamoto S, Mavrogenis AF, Tanaka Y, Errani C. Imaging of Soft Tissue Tumors. Curr Med Imaging 2021; 17:197-216. [PMID: 32660406 DOI: 10.2174/1573405616666200713183400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/08/2020] [Accepted: 06/20/2020] [Indexed: 02/07/2023]
Abstract
Differentiation of malignant from benign soft tissue tumors is challenging with imaging alone, including that by magnetic resonance imaging and computed tomography. However, the accuracy of this differentiation has increased owing to the development of novel imaging technology. Detailed patient history and physical examination remain essential for differentiation between benign and malignant soft tissue tumors. Moreover, measurement only of tumor size based on Response Evaluation Criteria In Solid Tumors criteria is insufficient for the evaluation of response to chemotherapy or radiotherapy. Change in metabolic activity measured by 18F-fluorodeoxyglucose positron emission tomography or dynamic contrast enhanced-derived quantitative endpoints can more accurately evaluate treatment response compared to change in tumor size. Magnetic resonance imaging can accurately evaluate essential factors in surgical planning such as vascular or bone invasion and "tail sign". Thus, imaging plays a critical role in the diagnosis and treatment of soft tissue tumors.
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Affiliation(s)
- Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Costantino Errani
- Department Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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8
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Bompas E, Martin V, Meniai F, Toulmonde M, Marec-Berard P, Claude L, Ducimetiere F, Chargari C, Minard-Colin V, Corradini N, Laurence V, Piperno-Neumann S, Defachelles AS, Bernier V, Italiano A, Orbach D, Blay JY, Gaspar N, Berlanga P. Management of sarcomas in children, adolescents and adults: Interactions in two different age groups under the umbrellas of GSF-GETO and SFCE, with the support of the NETSARC+ network. Bull Cancer 2021; 108:163-176. [PMID: 33455736 DOI: 10.1016/j.bulcan.2020.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/17/2020] [Accepted: 10/27/2020] [Indexed: 11/17/2022]
Abstract
Sarcomas are a rare heterogeneous group of malignant neoplasms that can arise in almost any anatomic site and any age. Close collaboration among adult and pediatric cancer specialists in the management of these tumors is of foremost importance. In this review, we present the current multidisciplinary organization in care of patients with sarcoma in France and we review the main advances made in the last decades in systemic and radiotherapy treatment in the main sarcoma types diagnosed in children, adolescents and young adults (AYA), thanks to the international collaboration.
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Affiliation(s)
- Emmanuelle Bompas
- Centre René Gauducheau, Medical Oncology Department, Saint-Herblain, France
| | - Valentine Martin
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Fatima Meniai
- University Lille, Inserm, U1189 - ONCO-THAI - Assisted Laser Therapy and Immunotherapy for Oncology, 59000 Lille, France
| | - Maud Toulmonde
- Institut Bergonié, Medical Oncology Department, Bordeaux, France
| | | | - Line Claude
- Centre Léon Bérard, Department of radiotherapy, Lyon, France
| | | | - Cyrus Chargari
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | | | - Nadège Corradini
- Centre Léon Bérard, Department of Pediatric Oncology, Lyon, France
| | | | | | | | - Valérie Bernier
- Oncology Radiotherapy Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
| | | | - Daniel Orbach
- Department of Pediatric Oncology, Institut Curie, Paris, France
| | - Jean-Yves Blay
- Medical Oncology Department, Centre Léon-Bérard, Lyon, France
| | - Nathalie Gaspar
- Department of Pediatric and Adolescent Oncology, Gustave Roussy, Villejuif, France
| | - Pablo Berlanga
- Department of Pediatric and Adolescent Oncology, Gustave Roussy, Villejuif, France.
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9
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Mcaddy NC, Saffar H, Litière S, Jespers P, Schöffski P, Messiou C. iCREATE: imaging features of primary and metastatic alveolar soft part sarcoma from the EORTC CREATE study. Cancer Imaging 2020; 20:79. [PMID: 33121537 PMCID: PMC7597361 DOI: 10.1186/s40644-020-00352-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 09/27/2020] [Indexed: 11/10/2022] Open
Abstract
Background Alveolar Soft Part Sarcoma (ASPS) is a rare, slow-growing, but highly vascular soft tissue sarcoma, characterised by a high rate of metastases at presentation. Although imaging features of the primary are well described, less detail is available on the imaging pattern of metastatic ASPS. The EORTC 90101 (CREATE) study assessed the efficacy of Crizotinib in patients with metastatic ASPS and presents a unique opportunity to describe the imaging phenotype of primary and metastatic ASPS, based on prospectively collected imaging. Methods A retrospective review of the staging CT scans of 32 patients with ASPS from the CREATE study was undertaken and the imaging features of primary and metastatic disease were assessed. Results Imaging of the primary tumour was available in 7/32 cases (28%). All primary tumours demonstrated marked vascularity with prominent feeding vessels (7/7, 100%). The most frequent sites of metastases included lung (30/32, 94%), nodal (7/32, 22%), bone (5/32, 16%) and muscle/subcutaneous (5/32, 16%). Features of hypervascularity were identified at all sites, more appreciable in the lungs, with feeding vessels frequently demonstrated in pulmonary metastases (21/32, 66%). Conclusion Analysis of imaging from the CREATE cohort of patients with metastatic ASPS demonstrates that metastases from ASPS are predominantly hypervascular and demonstrate feeding vessels comparable to primary ASPS, suggesting potential sensitivity of this rare sarcoma for antivascular/antiangiogenic treatment approaches.
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Affiliation(s)
| | - Hind Saffar
- Department of Radiology, The Royal Marsden Hospital, London, UK
| | - Saskia Litière
- Soft Tissue and Bone Sarcoma Group, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Pieter Jespers
- Soft Tissue and Bone Sarcoma Group, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Patrick Schöffski
- Department of General Medical Oncology and Department of Oncology, KU Leuven, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium.,The Institute of Cancer Research, London, UK
| | - Christina Messiou
- Department of Radiology, The Royal Marsden Hospital, London, UK.,Soft Tissue and Bone Sarcoma Group, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium.,The Institute of Cancer Research, London, UK
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Al Ghulaiga FM, Kwon M, Sa HS. Alveolar soft part sarcoma of the lateral rectus muscle: Suture technique to prevent postoperative strabismus. Am J Ophthalmol Case Rep 2020; 18:100668. [PMID: 32322745 PMCID: PMC7163059 DOI: 10.1016/j.ajoc.2020.100668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 03/08/2020] [Accepted: 03/12/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose We present a rare case of intramuscular alveolar soft part sarcoma (ASPS) of the lateral rectus (LR) muscle and the surgical technique used to maintain orthotropia after complete resection of the mass. Observations A 5-year-old boy presented with progressive proptosis of the left eye due to an orbital tumor. The patient was previously diagnosed with ASPS of the left LR muscle from an incisional biopsy, and the tumor size increased despite 5 cycles of chemotherapy prior to presenting to our center. Magnetic resonance imaging showed a 28x19x15mm-sized contrast-enhancing intramuscular mass of the left LR muscle, and there was no evidence of nodal or distant metastasis. The mass was excised en bloc, along with the insertion and the posterior normal part of LR muscle. To maintain proper eye alignment after resecting LR muscle, a 4-0 Prolene® hang-back suture was placed between the scleral insertion and the periorbita of the posterior orbit and the left medial rectus muscle was injected with botulinum toxin. During the follow-up of 51 months after surgery, the patient had no evidence of recurrence or metastasis and remained orthotropic in primary gaze, with a good cosmetic result. Conclusions and Importance ASPS of extraocular muscles is a rare tumor occurring mainly in children and young adults, and treatment may cause significant sequelae such as orbital exenteration, radiation-induced complications, and large-angle strabismus. Complete resection of tumor including the extraocular muscle is essential for treatment, and a subsequent reconstruction using a hang-back suture technique is useful to achieve proper eye alignment as well as a good cosmetic outcome.
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Affiliation(s)
| | - Miyoung Kwon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ho-Seok Sa
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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11
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Tran NA, Guenette JP, Jagannathan J. Soft Tissue Special Issue: Imaging of Bone and Soft Tissue Sarcomas in the Head and Neck. Head Neck Pathol 2020; 14:132-143. [PMID: 31950470 PMCID: PMC7021877 DOI: 10.1007/s12105-019-01102-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 11/16/2019] [Indexed: 12/14/2022]
Abstract
Bone and soft tissue sarcomas of the head and neck are a heterogenous group of tumors with overlapping features. Distinguishing between the various subtypes is challenging but necessary for appropriate diagnosis and management. The purpose of this article is to discuss the role of imaging in evaluating head and neck tumors, provide a general radiographic approach in differentiating between benign versus malignant lesions and give examples of selected subtypes of bone and soft tissue sarcomas in the head and neck with classic or pathognomonic imaging findings.
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Affiliation(s)
- Ngoc-Anh Tran
- Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Jeffrey P Guenette
- Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Jyothi Jagannathan
- Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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12
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Crombé A, Brisse HJ, Ledoux P, Haddag-Miliani L, Bouhamama A, Taieb S, Le Loarer F, Kind M. Alveolar soft-part sarcoma: can MRI help discriminating from other soft-tissue tumors? A study of the French sarcoma group. Eur Radiol 2018; 29:3170-3182. [DOI: 10.1007/s00330-018-5903-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/25/2018] [Accepted: 11/22/2018] [Indexed: 02/07/2023]
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13
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Flores RJ, Harrison DJ, Federman NC, Furman WL, Huh WW, Broaddus EG, Okcu MF, Venkatramani R. Alveolar soft part sarcoma in children and young adults: A report of 69 cases. Pediatr Blood Cancer 2018; 65:e26953. [PMID: 29350467 DOI: 10.1002/pbc.26953] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/16/2017] [Accepted: 12/03/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Alveolar soft part sarcoma (ASPS) is a rare mesenchymal tumor characterized by ASPL-TFE3 translocation. Apart from complete surgical resection, there is no standard management strategy. PROCEDURE The clinical data of 69 children and young adults less than 30 years old with ASPS diagnosed from 1980-2014 were retrospectively collected from four major institutions. RESULTS Median age at diagnosis was 17 years (range: 1.5-30). Forty-four (64%) were female. Median follow-up was 46 months (range: 1-409). Most common primary sites were limbs (58%) and trunk (24%). ASPL-TFE3 translocation was present in all 26 patients tested. IRS postsurgical staging was I in 19 (28%), II in 7 (10%), III in 5 (7%), and IV in 38 (55%) patients. The 5-year event-free survival (EFS) and overall survival (OS) were 38% and 72%, respectively. The 5-year EFS and OS were 80% and 87%, respectively, for the 31 patients with localized tumors (IRS-I-II-III), and 7% and 61%, respectively, for the 38 patients with metastatic tumors (IRS-IV). Of 11 IRS-IV patients who received targeted therapy upfront, two had partial response, six had stable disease, and three had progressive disease. Median time to progression for IRS-IV patients was 12 months for those treated with targeted therapy, 7 months for cytotoxic chemotherapy (N = 15), and 4 months for observation only (N = 6). CONCLUSION Localized ASPS has a good prognosis after gross total resection. ASPS is resistant to cytotoxic chemotherapy. Although there are no curative therapies for patients with metastatic disease, prolonged disease stabilization may be achieved with targeted therapies.
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Affiliation(s)
- Ricardo J Flores
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Douglas J Harrison
- Department of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Noah C Federman
- Division of Pediatric Hematology/Oncology, UCLA Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - Wayne L Furman
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Winston W Huh
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Emily G Broaddus
- Department of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mehmet F Okcu
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Rajkumar Venkatramani
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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Jagannathan JP, Tirumani SH, Ramaiya NH. Imaging in Soft Tissue Sarcomas: Current Updates. Surg Oncol Clin N Am 2018; 25:645-75. [PMID: 27591491 DOI: 10.1016/j.soc.2016.05.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Soft tissue sarcomas (STS) are heterogeneous malignant tumors that have nonspecific imaging features. A combination of clinical, demographic, and imaging characteristics can aid in the diagnosis. Imaging provides important information regarding the tumor extent, pretreatment planning, and surveillance of patients with STS. In this article, we illustrate the pertinent imaging characteristics of the commonly occurring STS and some uncommon sarcomas with unique imaging characteristics.
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Affiliation(s)
- Jyothi P Jagannathan
- Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Sree Harsha Tirumani
- Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Nikhil H Ramaiya
- Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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15
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Hei Y, Kang L, Yang X, Wang Y, Lu X, Li Y, Zhang W, Xiao L. Orbital alveolar soft part sarcoma: A report of 8 cases and review of the literature. Oncol Lett 2018; 15:304-314. [PMID: 29285193 PMCID: PMC5738708 DOI: 10.3892/ol.2017.7286] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 08/23/2017] [Indexed: 11/06/2022] Open
Abstract
Alveolar soft part sarcoma (ASPS) is a rare soft tissue neoplasm. The incidence of orbital involvement is the highest in ASPS arising in the head and neck region. However, limited information is available regarding its clinical characteristics. The present study presents the clinical manifestations, imaging findings, pathological features, treatment strategies and prognosis records of 8 cases of orbital ASPS over the last 15 years in a single hospital, along with a review of the literature. Included were 3 male and 5 female patients, with the median age at presentation being 9.5 years. The mean average largest tumour diameter was 3.6 cm. A total of 5 patients underwent surgical excision of the tumour, with 2 undergoing orbital exenteration and 1 undergoing partial orbital exenteration. In total, 6 patients received postoperative radiotherapy and 2 received chemotherapy. Upon follow-up, 6 patients were doing well with no evidence of recurrence or metastasis. Local recurrence developed in 2 patients, of whom 1 succumbed following withdrawal from treatment. According to the present series and the cases mentioned in the literature, orbital alveolar soft part sarcoma has characteristics distinct from those of alveolar soft part sarcoma which arises in other locations. Orbital alveolar soft part sarcoma presents itself in a younger population with a shorter course of disease, smaller tumour size, improved prognosis, a marked association with the extraocular muscles and with the Ki-67 proliferation index possibly associated with prognosis of the disease.
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Affiliation(s)
- Yan Hei
- Institute of Orbital Disease, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, P.R. China
| | - Li Kang
- Institute of Orbital Disease, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, P.R. China
| | - Xinji Yang
- Institute of Orbital Disease, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, P.R. China
| | - Yi Wang
- Institute of Orbital Disease, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, P.R. China
| | - Xiaozhong Lu
- Institute of Orbital Disease, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, P.R. China
| | - Yueyue Li
- Institute of Orbital Disease, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, P.R. China
| | - Wei Zhang
- Institute of Orbital Disease, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, P.R. China
| | - Lihua Xiao
- Institute of Orbital Disease, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, P.R. China
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16
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Tian L, Cui CY, Lu SY, Cai PQ, Xi SY, Fan W. Clinical presentation and CT/MRI findings of alveolar soft part sarcoma: a retrospective single-center analysis of 14 cases. Acta Radiol 2016; 57:475-80. [PMID: 26231949 DOI: 10.1177/0284185115597720] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 06/29/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Alveolar soft part sarcoma (ASPS) is a relatively rare malignant tumor and early diagnosis and appropriate treatment for ASPS are essential for a good prognosis. PURPOSE To retrospectively review the clinical presentation and computed tomography (CT) and magnetic resonance imaging (MRI) findings of ASPS so as to improve the accuracy of imaging diagnosis. MATERIAL AND METHODS Fourteen patients with pathologically proven ASPS were enrolled. Their clinical and imaging findings were retrospectively reviewed. RESULTS The median age of the patients was 29 years (range, 13-37 years). Most tumors were located in the soft tissues of the trunk and lower limbs. The median maximal diameter of the masses was 91 mm. Thirteen masses presented with ovoid or irregular shapes. Eleven masses had less clear boundaries. Compared with the adjacent muscles, the masses were isodense or hypodense on CT, hypo-, iso-, or hyperintense on T1-weighted images, and heterogeneous hyperintense on T2-weighted images. Intense enhancement was seen after contrast agent administration, with prominent intra- or peri-tumoral feeders on CT or flow voids on MRI. By the end of the last follow-up, 13 patients had distant metastasis and three patients had local recurrence. CONCLUSION ASPS should be included in the differential diagnosis when a bulky, heterogeneous soft tissue mass in the trunk and the lower limbs with intense enhancement after contrast administration and prominent intra- or peri-tumoral feeders on CT or flow voids on MRI is seen, particularly in young patients.
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Affiliation(s)
- Li Tian
- Department of Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
| | - Chun-Yan Cui
- Department of Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
| | - Su-Ying Lu
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
- Department of Oncology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
| | - Pei-Qiang Cai
- Department of Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
| | - Shao-Yan Xi
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
- Department of Pathology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
| | - Wei Fan
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
- Department of Nuclear Medcine, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
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17
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Paillard C, Coulomb A, Helfre S, Orbach D. [Alveolar soft part sarcoma in pediatric patients]. Bull Cancer 2015; 102:792-8. [PMID: 26235420 DOI: 10.1016/j.bulcan.2015.05.004] [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: 01/12/2015] [Revised: 05/27/2015] [Accepted: 05/28/2015] [Indexed: 10/23/2022]
Abstract
Alveolar soft part sarcoma, ASPS, is a rare malignant tumor, with preferential primary localization in limbs, usually occurring in adolescents and young adults. This sarcoma, well defined histologically and at molecular level, has an indolent course, but a high potential metastatic pulmonary and cerebral evolution, sometimes late. ASPS is characterized by an almost specific translocation t(X, 17)(p11;25) which creates a fusion protein, APSL-TFE3, acting as an aberrant transcription factor. An in-bloc resection of the primary tumor is the treatment of choice in cases of localized disease. Conventional chemotherapy is generally ineffective. The role of radiotherapy is discussed in case of micro- or macroscopical incomplete residue. It seems to reduce local recurrence, but did not influence overall survival. The 5 years survival rate in children, adolescents and young adults is close to 80% in case of localized disease but poorer in presence of metastases. Recently, systemic anti-tumoral treatments have been focused on the use of targeted therapies. Anti-angiogenic drugs and tyrosine kinase inhibitors are the most promising approaches, but require further study. Prognostic risk factors in the literature are age (>10Y), tumor size (>5cm) and presence of metastases. This article reviews the clinical manifestations, diagnosis modalities, radiographic characteristics and therapeutic strategy of this disease in the pediatric population.
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Affiliation(s)
- Catherine Paillard
- Hôpital Hautepierre, service d'hématologie et d'oncologie pédiatrique, avenue Molière, 67098 Strasbourg, France; Inserm UMR-S1109, université de Strasbourg, laboratoire d'immuno-rhumatologie moléculaire, 67098 Strasbourg, France.
| | - Aurore Coulomb
- Hôpital Armand-Trousseau-Assistance publique, service d'anatomie pathologique, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - Sylvie Helfre
- Institut Curie, service de radiothérapie, 26, rue d'Ulm, 75005 Paris, France
| | - Daniel Orbach
- Institut Curie, département d'oncologie pédiatrique adolescent jeune adulte, 26, rue d'Ulm, 75005 Paris, France
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18
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Imaging features of alveolar soft-part sarcoma: a report from Children's Oncology Group Study ARST0332. AJR Am J Roentgenol 2015; 203:1345-52. [PMID: 25415714 DOI: 10.2214/ajr.14.12462] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE There are few studies in the literature regarding the imaging features of alveolar soft-part sarcoma (ASPS). We performed a comprehensive assessment of the imaging characteristics of this rare tumor to determine whether there are features that suggest the diagnosis. MATERIALS AND METHODS Twenty-two subjects with ASPS underwent pretherapy imaging as part of enrollment in Children's Oncology Group protocol ARST0332 for the treatment of nonrhabdomyosarcoma soft-tissue sarcomas: 16 patients underwent MRI; three, CT; and three, both MRI and CT. Two radiologists retrospectively reviewed the imaging studies by consensus and recorded tumor location, size, contour, internal architecture, signal characteristics, presence of flow voids, and enhancement patterns. RESULTS The 12 females and 10 males in the study group ranged in age from 8 to 23 years 7 months (mean, 15 years 8 months). The most common anatomic site was the lower extremity (12/22, 55%) followed by the upper extremity (4/22, 18%). The maximal tumor diameter ranged from 2.3 to 20.0 cm (median, 5.9 cm). All tumors imaged with MRI had flow voids (19/19, 100%), and 19 (19/22, 86%) had large peripheral vessels, lobulated margins, and nodular internal architecture. Unenhanced T1-weighted MRI was available for 18 tumors: 14 (14/18, 78%) appeared slightly hyperintense to muscle. Of the 16 tumors imaged with contrast material, 11 (11/16, 69%) showed intense enhancement and five (5/16, 31%), moderate enhancement. Six tumors (6/16, 38%) had a thick enhancing peripheral rim with a nonenhancing center consistent with necrosis. CONCLUSION The imaging features of ASPS include flow voids, large peripheral vessels, internal nodularity, and lobulated margins. Contrast administration produces intense to moderate enhancement, sometimes with a thick enhancing peripheral rim around central necrosis. Extremity tumors with these imaging features in a child or young adult should suggest the diagnosis of ASPS.
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19
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Bisogno G, Ferrari A, Alaggio R, Orbach D. Treatment options for alveolar soft part sarcoma in pediatric patients. Expert Opin Orphan Drugs 2014. [DOI: 10.1517/21678707.2014.896191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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20
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Kim JM, Im SA, Oh SN, Chung NG. Alveolar soft part sarcoma arising from the kidney: imaging and clinical features. Korean J Radiol 2014; 15:381-5. [PMID: 24843244 PMCID: PMC4023058 DOI: 10.3348/kjr.2014.15.3.381] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 02/11/2014] [Indexed: 12/16/2022] Open
Abstract
Alveolar soft part sarcoma (ASPS) is an extremely rare malignant soft tissue sarcoma primarily affecting young patients. It usually occurs in the lower extremities, although it can occur in soft tissue anywhere in the body. However, to our knowledge, there has been no case of primary ASPS originating from the kidney in the literature. We herein present the imaging and clinical features of an ASPS which occurred in a 16-year-old male presented as a palpable mass in the left side of the abdomen.
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Affiliation(s)
- Jung Myung Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, Korea
| | - Soo Ah Im
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, Korea
| | - Soon Nam Oh
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, Korea
| | - Nak Gyun Chung
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, Korea
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Abstract
Soft tissue masses are frequently seen in children. Although most are benign or reactive, soft tissue sarcomas (STS)-both rhabdomyosarcoma (most common) and non-rhabdo STS, do occur in the extremities. Appropriate evaluation of extremity soft tissue tumors often includes a biopsy as the clinical and imaging features may not be enough to establish a definitive diagnosis. Much needs to be done for improving the treatment of these rare but often devastating sarcomas. Given the small numbers of these cases seen at various centers, collaborative efforts should be made to further our understanding and improve the management of these challenging cases.
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Affiliation(s)
- Mihir M Thacker
- Department of Orthopedic Surgery, Nemours - Alfred I duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, USA.
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