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Rekhi B, Santosh A, Rastogi S. A Rare Case of a Malignant Epithelioid Neoplasm With an Underlying Novel EWSR1::ZBT44 Fusion, Identified on Next-Generation Sequencing (NGS). Int J Surg Pathol 2024:10668969241246462. [PMID: 38646679 DOI: 10.1177/10668969241246462] [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: 04/23/2024]
Abstract
The clinicopathological spectrum of undifferentiated round cell sarcomas of bone and soft tissues is expanding after the 5th edition of the WHO classification. A 23-year-old male patient presented with a lump in his left thigh of 3 months' duration. Radiological examination revealed a well-defined, solid-cystic lobulated, soft tissue lesion in the proximal medial region of his left thigh, measuring 7.7 cm in the largest dimension. The referring diagnosis was an epithelioid sarcoma. Histopathological review of the tumor sections revealed a cellular tumor composed of malignant epithelioid to focally "rhabdoid-like" cells in a variable hyalinized and myxoid stroma with geographic areas of necrosis. In addition, there were areas reminiscent of hemangiopericytomatous vasculature. By immunohistochemistry, the tumor cells were diffusely positive for CD34, focally and distinctly for pan keratin (AE1/AE3). INI1/SMARCB1 and SMARCA4 (BRG1) were diffusely positive (normal). Next-generation sequencing with a wide sarcoma panel revealed EWSR1exon8::ZBT44exon4 fusion. The present example constitutes the first malignant epithelioid tumor with a hemangiopericytomatous growth pattern, exhibiting this rare fusion. The differential diagnoses of this tumor and their corresponding immunohistochemical profile are discussed. This example highlights the value of NGS in unraveling rare fusions and in differentiating these tumors from their several mimics.
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Affiliation(s)
- Bharat Rekhi
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute University, Mumbai, India
| | - Akhil Santosh
- Department of Medical Oncology, All Indian Institute of Medical Sciences, New Delhi, India
| | - Sameer Rastogi
- Department of Medical Oncology, All Indian Institute of Medical Sciences, New Delhi, India
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2
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Nocco SE, Linos K. Multiple Craniofacial Nodules: Answer. Am J Dermatopathol 2023; 45:147-148. [PMID: 36669083 DOI: 10.1097/dad.0000000000002361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Sarah E Nocco
- Department of Dermatology, Weill Cornell Medical College, New York, NY; and
| | - Konstantinos Linos
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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3
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Ugwuegbulem E, Hlaing SS, deFreitas G, McIntosh W, Patel D. Impending Doom: A Rare Case of Metastatic Myoepithelial Carcinoma. Cureus 2022; 14:e25785. [PMID: 35812540 PMCID: PMC9270191 DOI: 10.7759/cureus.25785] [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] [Accepted: 06/09/2022] [Indexed: 11/30/2022] Open
Abstract
Myoepithelial carcinoma is a rare malignant tumor arising from myoepithelial cells. The usual sites of occurrence are the oral cavity and pharynx with the majority of tumors arising from the salivary gland. However, there have been reported cases of myoepithelial carcinoma seen in the superficial soft tissue, upper respiratory tract, breast, skin, and GI tract. Deep soft tissue myoepithelial carcinoma is relatively uncommon. Due to the rarity of this malignancy, consensus on appropriate therapy remains sparse. However, complete resection and/or adjuvant chemotherapy and radiotherapy have been advocated for non-metastatic localized diseases. Sadly, the reported outcome in patients with metastatic disease remains dismal. In this case, we report a 79-year-old male incidentally found to have a deep soft tissue mass in the sacral area with a coexistent left axillary lymphadenopathy with biopsy and immunohistochemistry confirmation of metastatic myoepithelial carcinoma. He had a rapid clinical deterioration with subsequent fatality.
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De Virgilio-Salgado L, Torres-Lugo NJ, Olivella G, Watson-Pérez JM, Ramírez N, Bibiloni-Rodríguez J. Myoepithelial tumor in the popliteal area: A diagnostic dilemma. Int J Surg Case Rep 2022; 92:106884. [PMID: 35231742 PMCID: PMC8886036 DOI: 10.1016/j.ijscr.2022.106884] [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: 01/27/2022] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction and importance Myoepithelial tumors are under-recognized neoplasms that could be difficult to identify due to their rarity and limited comprehension. Their diverse morphology, varied cytologic features and heterogenous immunohistochemical characteristics create a significant diagnostic challenge. Case presentation We report the case of a 72-year-old-male patient who received conservative treatment during one year for a popliteal mass on the right knee that showed synovial hyperplasia (benign findings) at initial open tissue biopsy. New symptoms of popliteal area enlargement and discomfort required a second incisional biopsy to reach the diagnosis of a soft tissue myoepithelial tumor through tissue analysis and immunohistochemical staining. Clinical discussion The myoepithelial tumors represent a medical dilemma due to their heterogenic features requiring high level of suspicion and adequate immunohistochemical markers for their diagnosis. Conclusion Orthopaedic surgeons should be aware of the atypical presentation of these rare neoplasms to provide an early diagnosis and adequate management. Consider myoepithelial tumor within the differential of a soft tissue mass. Immunohistochemical markers are essential for diagnostic confirmation. Surgical resection with negative margins remains the mainstay of treatment. There is limited evidence regarding radiotherapy or chemotherapy effectiveness. This case highlights the deceiving nature and an unusual location of a myoepithelial tumor.
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Fiore M, Sambri A, Spinnato P, Zucchini R, Giannini C, Caldari E, Pirini MG, De Paolis M. The Biology of Synovial Sarcoma: State-of-the-Art and Future Perspectives. Curr Treat Options Oncol 2021; 22:109. [PMID: 34687366 PMCID: PMC8541977 DOI: 10.1007/s11864-021-00914-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2021] [Indexed: 12/22/2022]
Abstract
New molecular insights are being achieved in synovial sarcoma (SS) that can provide new potential diagnostic and prognostic markers as well as therapeutic targets. In particular, the advancement of research on epigenomics and gene regulation is promising. The concrete hypothesis that the pathogenesis of SS might mainly depend on the disruption of the balance of the complex interaction between epigenomic regulatory complexes and the consequences on gene expression opens interesting new perspectives. The standard of care for primary SS is wide surgical resection combined with radiation in selected cases. The role of chemotherapy is still under refinement and can be considered in patients at high risk of metastasis or in those with advanced disease. Cytotoxic chemotherapy (anthracyclines, ifosfamide, trabectedin, and pazopanib) is the treatment of choice, despite several possible side effects. Many possible drug-able targets have been identified. However, the impact of these strategies in improving SS outcome is still limited, thus making current and future research strongly needed to improve the survival of patients with SS.
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Affiliation(s)
- Michele Fiore
- Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Andrea Sambri
- Alma Mater Studiorum - University of Bologna, Bologna, Italy. .,IRCCS Azienda Ospedaliero Universitaria di Bologna, via Massarenti 9, 40138, Bologna, Italy.
| | | | | | | | - Emilia Caldari
- IRCCS Azienda Ospedaliero Universitaria di Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - Maria Giulia Pirini
- IRCCS Azienda Ospedaliero Universitaria di Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - Massimiliano De Paolis
- IRCCS Azienda Ospedaliero Universitaria di Bologna, via Massarenti 9, 40138, Bologna, Italy
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6
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Suster D, Miller JA, Pihan G, Mackinnon AC, Suster S. Expression patterns for Bcl-2, EMA, β-catenin, E-cadherin, PAX8, and MIB1 in thymomas. Mod Pathol 2021; 34:1831-1838. [PMID: 34135467 DOI: 10.1038/s41379-021-00839-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 11/09/2022]
Abstract
The expression of immunohistochemical markers has been extensively investigated in thymomas to assist in the differential diagnosis. We have studied six select markers to determine their utility in the evaluation of these tumors. A series of 126 thymomas including 33 type A, 27 type AB, 20 type B1, 22 type B2, and 24 type B3, were examined utilizing a tissue microarray (TMA) technique with antibodies to e-cadherin, β-catenin, PAX8, bcl-2, EMA, and MIB-1. Keratin AE1/AE3 and p63 were used for quality control. A significant finding was strong and consistent positivity for bcl-2 in type A (90%) and type AB (88.8%) thymoma, while 100% of B1, B2, and B3 were negative. The distribution of e-cadherin and β-catenin was not useful for differential diagnosis. E-cadherin and β-catenin were expressed in a high proportion of all the tumors (92-100%), except for B2 thymoma which showed only 45% expression. A significant increase in the expression of the MIB-1 proliferation marker (mean: 12.8% nuclear positivity) was also observed in B3 thymoma compared with the other histologic types. Statistical significance was confirmed using Kruskal's non-parameterized test for distribution. EMA was generally negative except for spindle cells in the fibrous septa in types A and AB thymoma. PAX8 showed less consistent nuclear staining than p63 and was only widely expressed in 55.7% of cases. Bcl-2 may serve as a useful marker to separate spindle cell thymomas (Type A and AB) from the other types, and the MIB1 proliferation index may be of use to differentiate type B2 from type B3 thymoma.
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Affiliation(s)
- David Suster
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - James A Miller
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - German Pihan
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - A Craig Mackinnon
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Saul Suster
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA.
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Kinoshita I, Kohashi K, Yamamoto H, Yamada Y, Inoue T, Higaki K, Teramoto N, Oshiro Y, Nakashima Y, Oda Y. Myxoepithelioid tumour with chordoid features: a clinicopathological, immunohistochemical and genetic study of 14 cases of SMARCB1/INI1-deficient soft-tissue neoplasm. Histopathology 2021; 79:629-641. [PMID: 33932047 DOI: 10.1111/his.14393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/21/2021] [Accepted: 04/27/2021] [Indexed: 11/27/2022]
Abstract
AIMS Complete loss of SMARCB1/INI1 in soft-tissue tumours such as malignant rhabdoid tumour, epithelioid sarcoma, myoepithelial tumour of soft tissue and extraskeletal myxoid chondrosarcoma is often associated with high-grade malignancy and poor prognosis. The diagnosis is sometimes challenging, owing to histological similarities, so careful differential diagnosis is required. Therefore, soft-tissue tumours with complete SMARCB1/INI1 loss could potentially include an unknown entity. METHODS AND RESULTS We analysed 160 cases of SMARCB1/INI1-deficient soft-tissue tumour, and found 14 cases that were not classifiable into already existing categories and had common clinical and histological features. These involved two male and 12 female patients, ranging in age from 20 years to 61 years. The tumours were located in the the puboinguinal region (n = 13) and pelvic cavity (n = 1). Histologically, the tumours showed relatively uniform epithelioid to spindle-shaped cells with myxoid stroma. All tumours showed immunoreactivity for brachyury, epithelial membrane antigen, and progesterone receptor, and 12 of 14 cases did so for oestrogen receptor. Variable positive staining for α-smooth muscle actin, S100 and glial fibrillary acidic protein (GFAP) was seen. NR4A3 and EWSR1 gene rearrangements were not detected in 13 and 11 examined cases, respectively. Clinical follow-up data for the 14 patients showed that 13 were alive without disease and one had been lost to follow-up; four patients developed local recurrence and/or metastases. CONCLUSION The designation 'myxoepithelioid tumour with choroid features' (METC) was proposed as a tumour with intermediate malignancy controllable with appropriate treatment, including the entity of myoepithelioma-like tumour of the vulvar region. METC represents a novel and independent subset that is histologically, biologically and clinically distinct from already existing SMARCB1/INI1-deficient soft-tissue tumours.
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Affiliation(s)
- Izumi Kinoshita
- Department of Anatomical Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenichi Kohashi
- Department of Anatomical Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hidetaka Yamamoto
- Department of Anatomical Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuichi Yamada
- Department of Anatomical Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeshi Inoue
- Department of Pathology, Osaka City General Hospital, Osaka, Japan
| | - Koichi Higaki
- Department of Diagnostic Pathology, St Mary's Hospital, Fukuoka, Japan
| | - Norihiro Teramoto
- Department of Pathology and Clinical Research, National Hospital Organisation Shikoku Cancer Centre, Matsuyama, Ehime, Japan
| | - Yumi Oshiro
- Department of Pathology, Matsuyama Red Cross Hospital, Matsuyama, Ehime, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshinao Oda
- Department of Anatomical Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Skálová A, Agaimy A, Vanecek T, Baněčková M, Laco J, Ptáková N, Šteiner P, Majewska H, Biernat W, Corcione L, Eis V, Koshyk O, Vondrák J, Michal M, Leivo I. Molecular Profiling of Clear Cell Myoepithelial Carcinoma of Salivary Glands With EWSR1 Rearrangement Identifies Frequent PLAG1 Gene Fusions But No EWSR1 Fusion Transcripts. Am J Surg Pathol 2021; 45:1-13. [PMID: 33027073 DOI: 10.1097/pas.0000000000001591] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Myoepithelial carcinoma of salivary glands is an underrecognized and challenging entity with a broad morphologic spectrum, including an EWSR1-rearranged clear cell variant. Myoepithelial carcinoma is generally aggressive with largely unknown genetic features. A retrospective review of Salivary Gland Tumor Registry in Pilsen searching for the key words "clear cell myoepithelial carcinoma," "hyalinizing clear cell," and "clear cell malignant myoepithelioma" yielded 94 clear cell myoepithelial carcinomas (CCMCs) for molecular analysis of EWSR1 rearrangement using fluorescence in situ hybridization (FISH). Tumors positive for EWSR1 gene rearrangement were tested by next-generation sequencing (NGS) using fusion-detecting panels. NGS results were confirmed by reverse-transcription polymerase chain reaction or by FISH. Twenty-six tumors originally diagnosed as CCMC (26/94, 27.6%) revealed split signals for EWSR1 by FISH. Six of these tumors (6/26, 23%) displayed amplification of the EWSR1 locus. Fifteen cases were analyzable by NGS, whereas 9 were not, and tissue was not available in 2 cases. None of the CCMCs with EWSR1 rearrangements detected by FISH had an EWSR1 fusion transcript. Fusion transcripts were detected in 6 cases (6/15, 40%), including LIFR-PLAG1 and CTNNB1-PLAG1, in 2 cases each, and CHCHD7-PLAG1 and EWSR1-ATF1 fusions were identified in 1 case each. Seven cases, including those with PLAG1 fusion, were positive for PLAG1 rearrangement by FISH, with notable exception of CHCHD7-PLAG1, which is an inversion not detectable by FISH. One single case with EWSR1-ATF1 fusion in NGS showed ATF1 gene rearrangement by FISH and was reclassified as clear cell carcinoma (CCC). In addition, another 4 cases revealed ATF1 rearrangement by FISH and were reclassified as CCC as well. Moreover, 12/68 (17%) CCMCs with intact EWSR1 gene were selected randomly and analyzed by NGS. PLAG1 fusions were found in 5 cases (5/12, 41.6%) with LIFR (2 cases), FGFR1 (2 cases), and CTNNB1 (1 case) as partner genes. Overall, PLAG1 gene rearrangements were detected in 10/38 (26%) tested cases. None of the tumors had SMARCB1 loss by immunohistochemistry as a possible explanation for the EWSR1 abnormalities in FISH. Novel findings in our NGS study suggest that EWSR1-FISH positive CCMC is a gene fusion-driven disease with frequent oncogenic PLAG1 fusions, including LIFR-PLAG1 and CTNNB1-PLAG1 in most cases. Productive EWSR1 fusions are found only in a minority of EWSR1-ATF1-rearranged cases, which were in part reclassifiable as CCCs. Detectable EWSR1-FISH abnormality in CCMCs without gene fusion perhaps represents a passenger mutation with minor or no oncologic effect.
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Affiliation(s)
- Alena Skálová
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University
- Bioptic Laboratory Ltd
| | - Abbas Agaimy
- Department of Pathology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), University Hospital of Erlangen, Erlangen, Germany
| | - Tomas Vanecek
- Molecular and Genetic Laboratory, Bioptic Laboratory Ltd, Pilsen
| | - Martina Baněčková
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University
- Bioptic Laboratory Ltd
| | - Jan Laco
- The Fingerland Department of Pathology, Charles University, Faculty of Medicine and University Hospital Hradec Kralove, Hradec Kralove
| | - Nikola Ptáková
- Molecular and Genetic Laboratory, Bioptic Laboratory Ltd, Pilsen
| | - Petr Šteiner
- Molecular and Genetic Laboratory, Bioptic Laboratory Ltd, Pilsen
| | - Hanna Majewska
- Department of Pathology, Warmia nad Mazury University, Olsztyn
| | - Wojciech Biernat
- Department of Pathology, Medical University of Gdansk, Gdansk, Poland
| | - Luigi Corcione
- Department of Pathology, University of Parma, Parma, Italy
| | - Václav Eis
- Department of Pathology, 3rd Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital, Prague
| | | | - Jan Vondrák
- Molecular and Genetic Laboratory, South Bohemian University, Ceske Budejovice, Czech Republic
| | - Michal Michal
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University
| | - Ilmo Leivo
- Institute of Biomedicine, University of Turku
- Department of Pathology, Turku University Hospital, Turku, Finland
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Borazjani R, Dehghanian A, Taheri N, Vosoughi AR. Benign soft-tissue myoepithelioma of the tip of the toe: a case report and literature review. CURRENT ORTHOPAEDIC PRACTICE 2020; 32:88-92. [DOI: 10.1097/bco.0000000000000956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Myoepithelioma is a rare tumor that mainly affects the salivary glands, with predilection to the parotid glands. A 36-year-old female patient presented with a slow-growing, painless mass on the tip of her right fourth toe that had started 2 yr before being referred to the outpatient orthopaedic clinic. The patient was unable to wear her usual shoes. On physical examination, a firm, non-tender, well-demarcated mass was palpated deeply on the tip of her right fourth toe. Excisional biopsy found a benign soft-tissue myoepithelioma. This study showed the importance of considering myoepithelioma tumor in differentials of the toe and foot masses to avoid misdiagnosis of this rare tumor.
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Affiliation(s)
- Roham Borazjani
- General Practitioner, Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amirreza Dehghanian
- Assistant Professor of Pathology, Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital and Molecular Pathology and Cytogenetic Division, Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Negar Taheri
- Assistant Professor of Pathology, Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Reza Vosoughi
- Associate Professor of Orthopedic Surgery, Orthopedic Foot and Ankle Surgeon, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Holley C, Breining T, Scheithauer M, Möller P, Barth TFE. [Primary extra-axial chondroid chordoma of the anterior nasal septum: case report of a rare chordoma with literature review]. HNO 2020; 69:221-228. [PMID: 33095325 DOI: 10.1007/s00106-020-00957-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2020] [Indexed: 12/16/2022]
Abstract
An 87-year-old patient reported a nodular, progressively enlarging mass of the anterior nasal septum leading to partial obstruction of the nostrils. The tumor showed no infiltration of the subcutis, bone, or paranasal sinuses in imaging or intraoperatively. Histological examination revealed a chondroid tumor with lobular growth and physaliferous cell morphology. Immunohistochemistry revealed a brachyury-positive tumor without EWSR1 rearrangement, leading to the diagnosis of a chondroid chordoma. The reported case demonstrates the differential diagnostic considerations pertaining to this rare tumor, which can also have an untypical and very rare extra-axial location. Review of the literature identified 34 primary extraosseous chordomas of the nose, nasopharynx, and paranasal sinuses, and allowed the nasal chordoma presented herein to be included in this group of extra-axial chordomas.
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Affiliation(s)
- C Holley
- Institut für Pathologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
| | - T Breining
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - M Scheithauer
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - P Möller
- Institut für Pathologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - T F E Barth
- Institut für Pathologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
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Rekhi B, Shetty O, Vora T, Gulia A, Bajpai J, Laskar S. Clinicopathologic, immunohistochemical, molecular cytogenetic profile with treatment and outcomes of 34 cases of Ewing sarcoma with epithelial differentiation, including 6 cases with "Adamantinoma-like" features, diagnosed at a single institution, India. Ann Diagn Pathol 2020; 49:151625. [PMID: 32932018 DOI: 10.1016/j.anndiagpath.2020.151625] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/06/2020] [Accepted: 09/05/2020] [Indexed: 12/29/2022]
Abstract
To analyze clinicopathological features, including treatment profile of 34 cases of Ewing sarcomas with epithelial differentiation, including 6 cases with adamantinoma-like features. EWSR1 gene rearrangement was tested by fluorescence in-situ hybridization. Thirty-four tumors occurred in 19 males and 15 females (M:F = 1.26:1), with age ranging from 7 to 61 years (average = 24.2); in extremities (17), pelvis (5), paraspinal region (6), head and neck region (3), abdomen (2) and lung (1). Prior to molecular testing, 20/34(58.8%) cases were unequivocally diagnosed as Ewing sarcomas. Histopathologically, the most commonly observed pattern was nesting-type, comprising malignant round cells, including adamantinoma-like features, seen in 6 tumors. Immunohistochemically, tumor cells were diffusely positive (cytoplasmic membranous staining) for CD99/MIC2 (34/34), Fli1 (30/30); focally for synaptophysin (4/16) (25%); variably positive for AE1/AE3(31/32)(96.8%), including diffuse immunoexpression in 4 cases; EMA(6/8) and p40(3/8). All 34 (100%) tumors, tested for EWSR1 rearrangement, displayed positive results. According to the treatment details (available in 24/34 cases, 70.5%), most patients (13/24)(54.1%) were treated with surgical resection and a specific chemotherapy(CT) regimen (neoadjuvant or adjuvant settings), including 7 patients, who received adjuvant radiotherapy. During follow-up (16 cases, 47%), 5 patients developed recurrences and 8 developed metastasis, including a single, who developed recurrence. Finally, 10 patients were alive-with-disease (2-22 months); 6 free-of-disease (5-36 months). This constitutes one of the largest documentation of these rare tumors from our subcontinent, which are diagnostically challenging; require molecular confirmation and associated with treatment implications.
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Affiliation(s)
- Bharat Rekhi
- Department of Surgical Pathology, Tata Memorial Hospital, Parel Homi Bhabha National Institute(HBNI) University, Mumbai, India; Division of Molecular Pathology, Tata Memorial Hospital, Parel Homi Bhabha National Institute(HBNI) University, Mumbai, India.
| | - Omshree Shetty
- Division of Molecular Pathology, Tata Memorial Hospital, Parel Homi Bhabha National Institute(HBNI) University, Mumbai, India
| | - Tushar Vora
- Department of Medical Oncology, Tata Memorial Hospital, Parel Homi Bhabha National Institute(HBNI) University, Mumbai, India
| | - Ashish Gulia
- Department of Surgical Oncology (Bone and Soft Tissues), Tata Memorial Hospital, Parel Homi Bhabha National Institute(HBNI) University, Mumbai, India
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Hospital, Parel Homi Bhabha National Institute(HBNI) University, Mumbai, India
| | - Siddhartha Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Parel Homi Bhabha National Institute(HBNI) University, Mumbai, India
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Meningioma-like Tumor of the Skin Revisited: A Distinct CD34+ Dermal Tumor With an Expanded Histologic Spectrum. Am J Surg Pathol 2020; 43:1518-1525. [PMID: 31490235 DOI: 10.1097/pas.0000000000001357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The term meningioma-like tumor of the skin (MLTS) was coined in 1993 to designate a particular whorled spindle cell superficial cutaneous tumor. No additional confirmed cases of this entity have been reported to date. Some authors have speculated that these cases might be cellular neurothekeomas. In order to delineate the histologic spectrum and the immunophenotype of this unusual tumor, we studied 5 cases, 2 previously unreported and the 3 original cases. The immunohistochemical findings of case 5, however, were limited to those from the original study. Clinically, the tumor presented as a reddish papule, plaque, or nodule, located in the extremities or trunk. The patient often referred to a recent growth of a longstanding lesion. Histologically, the characteristic whorled spindle and stellate dendritic cell population, commonly in a perivascular arrangement, and variable myxoid component, were consistently found in all cases. A prominent microvasculature was also a constant finding. The presence of large deciduoid cells was conspicuous in one case. A reticular pattern of multivacuolated cells giving a chordoma-like appearance was evident in another case. Tumor cells were diffusely positive for CD34 in all 4 cases studied, and negative for S-100, EMA, NKI-C3, CD68, and smooth muscle markers. No complete loss of retinoblastoma protein was found. No brachyury immunostaining was found in the case with chordoid features. No EWSR1 or NAB2-STAT6 gene fusions were found. From these findings, we demonstrate that MLTS is a distinct CD34 spindle cell benign dermal tumor, unrelated to cellular neurothekeoma, and exhibiting myxoid, deciduoid, or chordoma-like features.
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13
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Koyama R, Minagawa N, Maeda Y, Shinohara T, Hamada T. Metachronous Pancreatic and Thyroid Metastases from Primary Soft-Tissue Myoepithelioma in the Clavicular Region: A Case Report of a Long-Term Survivor. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e920702. [PMID: 31983728 PMCID: PMC6998795 DOI: 10.12659/ajcr.920702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patient: Male, 69-year-old Final Diagnosis: Metachronous pancreatic and thyroid metastases from primary soft tissue myoepithelioma Symptoms: None Medication:— Clinical Procedure: Surgery Specialty: Surgery
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Affiliation(s)
- Ryota Koyama
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Hokkaido, Japan
| | - Nozomi Minagawa
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Hokkaido, Japan
| | - Yoshiaki Maeda
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Hokkaido, Japan
| | - Toshiki Shinohara
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Hokkaido, Japan
| | - Tomonori Hamada
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Hokkaido, Japan
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14
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Jo VY. Soft Tissue Special Issue: Myoepithelial Neoplasms of Soft Tissue: An Updated Review with Emphasis on Diagnostic Considerations in the Head and Neck. Head Neck Pathol 2020; 14:121-131. [PMID: 31950472 PMCID: PMC7021888 DOI: 10.1007/s12105-019-01109-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/29/2019] [Indexed: 01/21/2023]
Abstract
Primary myoepithelial neoplasms of soft tissue have been shown to be related to their salivary gland counterparts, with which they often share morphologic, immunophenotypic, and molecular genetic features, such as the presence of PLAG1 rearrangement in both soft tissue mixed tumor and salivary pleomorphic adenoma. However, important distinctions remain between soft tissue and salivary myoepithelial neoplasms, namely differing criteria for malignancy. This review provides an overview of the current understanding of the clinicopathologic and molecular features of soft tissue myoepithelial neoplasms, including discussion of the similarities and differences between soft tissue and salivary counterparts and relevant diagnostic issues specific to head and neck pathology practice.
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Affiliation(s)
- Vickie Y. Jo
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
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15
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Nikiforchin A, Baron E, Sittig M, Gushchin V. Soft-Tissue Myoepithelioma of the Retroperitoneal Space Mimicking a Pancreatic Tumor: A Case Report and Literature Review. J Med Cases 2020; 11:16-21. [PMID: 34434330 PMCID: PMC8383676 DOI: 10.14740/jmc3407] [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: 12/20/2019] [Accepted: 01/04/2020] [Indexed: 11/24/2022] Open
Abstract
Soft-tissue myoepithelioma (STM) is an extremely rare benign tumor with predominant occurrence in head, neck, pelvic girdle and limbs. These tumors lack specific clinical and morphological features and can easily be confused with more common neoplasms. It may lead to incorrect diagnosis and management. Here, we present a clinical case of a young man with retroperitoneal STM which simulated a pancreatic tumor and required a distal pancreatectomy. Performed literature review highlights current data about clinical, morphologic, immunohistochemical and genetic evaluation, treatment and prognosis of STM.
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Affiliation(s)
- Andrei Nikiforchin
- Institute for Cancer Care, Mercy Medical Center, Baltimore, MD 21202, USA
| | - Ekaterina Baron
- Institute for Cancer Care, Mercy Medical Center, Baltimore, MD 21202, USA
| | - Michelle Sittig
- Institute for Cancer Care, Mercy Medical Center, Baltimore, MD 21202, USA
| | - Vadim Gushchin
- Institute for Cancer Care, Mercy Medical Center, Baltimore, MD 21202, USA
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16
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Komatsu M, Kawamoto T, Kanzawa M, Kawakami Y, Hara H, Akisue T, Kuroda R, Nakamura H, Hokka D, Jimbo N, Itoh T, Hirose T. A novel
EWSR1
‐
VGLL1
gene fusion in a soft tissue malignant myoepithelial tumor. Genes Chromosomes Cancer 2019; 59:249-254. [DOI: 10.1002/gcc.22823] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/01/2019] [Accepted: 11/04/2019] [Indexed: 01/06/2023] Open
Affiliation(s)
- Masato Komatsu
- Department of Diagnostic Pathology Kobe University Graduate School of Medicine Kobe Hyogo Prefecture Japan
| | - Teruya Kawamoto
- Department of Orthopedic Surgery Kobe University Graduate School of Medicine Kobe Hyogo Prefecture Japan
- Division of Orthopedic Surgery Kobe University International Clinical Cancer Research Center Kobe Hyogo Prefecture Japan
| | - Maki Kanzawa
- Department of Diagnostic Pathology Kobe University Graduate School of Medicine Kobe Hyogo Prefecture Japan
| | - Yohei Kawakami
- Department of Orthopedic Surgery Kobe University Graduate School of Medicine Kobe Hyogo Prefecture Japan
| | - Hitomi Hara
- Department of Orthopedic Surgery Kobe University Graduate School of Medicine Kobe Hyogo Prefecture Japan
| | - Toshihiro Akisue
- Department of Rehabilitation Science Kobe University Graduate School of Health Sciences Kobe Hyogo Prefecture Japan
| | - Ryosuke Kuroda
- Department of Orthopedic Surgery Kobe University Graduate School of Medicine Kobe Hyogo Prefecture Japan
| | - Hayate Nakamura
- Division of Thoracic Surgery, Department of Surgery Kobe University Graduate School of Medicine Kobe Hyogo Prefecture Japan
| | - Daisuke Hokka
- Division of Thoracic Surgery, Department of Surgery Kobe University Graduate School of Medicine Kobe Hyogo Prefecture Japan
| | - Naoe Jimbo
- Department of Diagnostic Pathology Kobe University Graduate School of Medicine Kobe Hyogo Prefecture Japan
| | - Tomoo Itoh
- Department of Diagnostic Pathology Kobe University Graduate School of Medicine Kobe Hyogo Prefecture Japan
| | - Takanori Hirose
- Department of Diagnostic Pathology Hyogo Cancer Center Akashi Hyogo Prefecture Japan
- Division of Pathology for Regional Communication Kobe University School of Medicine Kobe Hyogo Prefecture Japan
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17
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Rastrelli M, Del Fiore P, Damiani GB, Mocellin S, Tropea S, Spina R, Costa A, Cavallin F, Rossi CR. Myoepithelioma of the soft tissue: A systematic review of clinical reports. Eur J Surg Oncol 2019; 45:1520-1526. [DOI: 10.1016/j.ejso.2019.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/26/2019] [Accepted: 05/02/2019] [Indexed: 02/02/2023] Open
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18
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Abstract
Among the various genes that can be rearranged in soft tissue neoplasms associated with nonrandom chromosomal translocations, EWSR1 is the most frequent one to partner with other genes to generate recurrent fusion genes. This leads to a spectrum of clinically and pathologically diverse mesenchymal and nonmesenchymal neoplasms, variably manifesting as small round cell, spindle cell, clear cell or adipocytic tumors, or tumors with distinctive myxoid stroma. This review summarizes the growing list of mesenchymal neoplasms that are associated with EWSR1 gene rearrangements.
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Affiliation(s)
- Khin Thway
- Sarcoma Unit, Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK.
| | - Cyril Fisher
- Department of Musculoskeletal Pathology, Royal Orthopaedic Hospital NHS Foundation Trust, Robert Aitken Institute for Clinical Research, University of Birmingham, Birmingham B15 2TT, UK
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19
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Yun S, Kim SH, Cho HS, Choe G, Lee KS. EWSR1
-PBX3
fused myoepithelioma arising in metatarsal bone: Case report and review of the literature. Pathol Int 2019; 69:42-47. [DOI: 10.1111/pin.12746] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 11/05/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Sumi Yun
- Department of Diagnostic Pathology; Samkwang Medical Laboratories; 57 Baumoe-ro 41-gil Seocho-gu Seoul 06742 Republic of Korea
| | - Se Hyun Kim
- Division of Hematology and Medical Oncology; Department of Internal Medicine; Seoul National University Bundang Hospital; 173-82 Gumi-ro, Bundang-gu Seongnam-si Gyeonggi-do 13620 Republic of Korea
| | - Hwan Seong Cho
- Department of Orthopaedic Surgery; Seoul National University Bundang Hospital; 173-82 Gumi-ro, Bundang-gu Seongnam-si Gyeonggi-13620 Republic of Korea
| | - Gheeyoung Choe
- Department of Pathology; Seoul National University Bundang Hospital; 173-82 Gumi-ro, Bundang-gu Seongnam-si Gyeonggi-do 13620 Republic of Korea
| | - Kyu Sang Lee
- Department of Pathology; Seoul National University Bundang Hospital; 173-82 Gumi-ro, Bundang-gu Seongnam-si Gyeonggi-do 13620 Republic of Korea
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20
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Shelly D, Balraam KV, Mishra P, Sharma I, Sampath KS, Bharadwaj R. Myoepithelial carcinoma of soft tissue: A report of two cases. JOURNAL OF CANCER RESEARCH AND PRACTICE 2019. [DOI: 10.4103/jcrp.jcrp_22_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Rekhi B, Karmarkar S. Clinicocytopathological spectrum, including uncommon forms, of nine cases of chordomas with immunohistochemical results, including brachyury immunostaining: A single institutional experience. Cytopathology 2018; 30:229-235. [PMID: 30218622 DOI: 10.1111/cyt.12631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/30/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To present clinical and cytopathological features of nine cases of chordomas, diagnosed over 9 years and confirmed by brachyury (T) immunostaining. METHODS Conventional cytological smears, stained with Papanicolaou and May-Grünwald Giemsa, along with corresponding histopathological (n = 8) and immunostained sections (n = 8) were reviewed. Immunohistochemical staining was performed on tissue sections by polymer detection technique. RESULTS Nine tumours occurred in seven males and two females, with age ranging from 36 to 72 years (average = 58.7), in the sacrum (seven) and spine (two). On fine needle aspiration cytology, five cases were either diagnosed with or diagnosed with a suggestion of a chordoma, while three cases were diagnosed with chordoma as a differential diagnosis. On review, smears were moderately cellular, comprising myxoid stroma (9/9), epithelioid cells (9/9), physaliphorous cells (8/9), including binucleation (7/9), prominent nucleolisation (2/9), pleomorphic cells (2/9) and intranuclear inclusions (3/9). Immunohistochemically, tumour cells expressed cytokeratin (4/4), pan cytokeratin (4/4), epithelial membrane antigen (8/8), S100 protein (6/8) and brachyury (8/8). Five patients underwent surgical excision, including two who underwent adjuvant radiotherapy (RT) and four patients who underwent RT. During follow-up (n = 8), a single patient developed recurrence and another presented with metastatic lesions. Finally, five patients were alive with disease (7-53 months); a single patient was free of disease (4 months), and two patients died of disease; the latter cases displayed pleomorphic cells and intranuclear inclusions. CONCLUSIONS Chordomas can be primarily diagnosed by fine needle aspiration cytology in a typical clinicoradiological setting with a combination of key cytomorphological features. Pleomorphic cells and intranuclear inclusions are associated with a relatively aggressive subtype. An exact diagnosis has treatment implications and requires confirmation by brachyury immunostaining.
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Affiliation(s)
- Bharat Rekhi
- Department of Surgical Pathology, Tata Memorial Hospital, Mumbai, India
| | - Srushti Karmarkar
- Department of Surgical Pathology, Tata Memorial Hospital, Mumbai, India
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22
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Primary malignant myoepithelial tumor of long bone: Clinicopathological evaluation and literature review. JOURNAL OF CANCER RESEARCH AND PRACTICE 2018. [DOI: 10.1016/j.jcrpr.2018.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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23
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Abstract
RATIONALE Soft-tissue myoepithelioma is a rare neoplasm. It usually occurs in the distal or proximal extremities, but seldomly arises in the abdominal wall. PRESENTING CONCERNS OF THE PATIENT The patient is a 40-year-old woman who presented with a painless mass at the lateral abdominal wall for 6 months. Computed tomography scan revealed a lobulated and well-defined iso-density mass showing heterogeneously moderate enhancement. The mass exhibited intermediate T1 signal and obvious high T2 signal on magnetic resonance imaging. INTERVENTIONS The tumor was excised. Hematoxylin-eosin stain and immunohistochemical stain showed that the tumor was myoepithelioma. OUTCOMES The patient did not undergo chemotherapy and radiotherapy. No recurrence or metastasis was noted during the 1 year follow-up. LESSONS Radiologists should consider myoepithelioma in the differential diagnosis when finding a tumor in the abdominal wall.
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Affiliation(s)
| | | | | | - Hua Dai
- Department of Pathology, The First Affiliated Hospital of Nanchang University, Nangchang, Jiangxi, China
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24
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Khazeni K, LaBove H, Wilky B, Rosenberg AE, Paulus E, Chim H, Pearson JM, Yakoub D. Myoepithelial carcinoma or epithelioid sarcoma - A rare diagnosis with poor prognosis. A case report and review of literature. Int J Surg Case Rep 2018; 49:239-243. [PMID: 30053614 PMCID: PMC6077148 DOI: 10.1016/j.ijscr.2018.06.016] [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: 04/12/2018] [Revised: 06/10/2018] [Accepted: 06/20/2018] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Myoepithelial carcinoma and proximal-type epithelioid sarcoma of the vulva are two rare malignancies with known aggressive behavior. In addition to a similar clinical course, these two disease entities also have significant histologic and pathologic overlap. Given the rarity of these malignancies, there is limited literature on the appropriate treatment regimen. Nevertheless, there is a consensus that early surgical resection is beneficial in both cases. PRESENTATION We present a case of a patient who was initially diagnosed with myoepithelial carcinoma of the vulva with a differential later expanded to include possible epithelioid sarcoma. DISCUSSION We demonstrate the importance in early identification of a SMARCB1 deficiency. Additionally, we suggest an appropriate treatment regimen for these patients going forward. Specifically, we encourage consideration of bilateral superficial and deep inguinal lymphadenectomies. Furthermore, sarcoma based chemotherapy regimens in the appropriate clinical setting may be beneficial in treating SMARCB1 deficient tumors. Additionally, there are now clinical trials involving EZH2 Inhibitors which may offer benefit for similar patients going forward. CONCLUSION This case highlights the difficulty in making a definitive diagnosis, and the importance in identifying a SMARCB1 deficiency as it will affect treatment options and may allow for enrollment in ongoing clinical trials.
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Affiliation(s)
- Kristina Khazeni
- Department of Surgical Oncology, University of Miami, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA.
| | - Hannah LaBove
- Department of Surgical Oncology, University of Miami, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA.
| | - Breelyn Wilky
- Department of Hematology/Oncology, University of Miami, 1475 NW 12th Ave, Miami, FL, 33136, USA.
| | - Andrew E Rosenberg
- Department of Pathology, University of Miami, 1400 NW 12th Ave, Miami, FL, 33136, USA.
| | - Elizabeth Paulus
- Department of Surgical Oncology, University of Miami, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA.
| | - Harvey Chim
- Department of Plastic Surgery, University of Miami, 1120 NW 14th St, Miami, FL, 33136, USA.
| | - Joseph M Pearson
- Department of Gynecological Oncology, University of Miami, 1475 NW 12th Ave, Miami, FL, 33136, USA.
| | - Danny Yakoub
- Department of Surgical Oncology, University of Miami, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA.
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25
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Extra-axial chordoma: a clinicopathologic analysis of six cases. Virchows Arch 2018; 472:1015-1020. [DOI: 10.1007/s00428-018-2334-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/05/2018] [Accepted: 03/08/2018] [Indexed: 12/15/2022]
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26
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Case Reports in Oncological Medicine Myoepithelioma: A New Rearrangement Involving the LPP Locus in a Case of Multiple Bone and Soft Tissue Lesions. Case Rep Oncol Med 2018; 2018:3512847. [PMID: 29992069 PMCID: PMC5848058 DOI: 10.1155/2018/3512847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 12/10/2017] [Indexed: 01/24/2023] Open
Abstract
We report a case of multiple myoepithelioma with synchronous bone and soft tissue tumors, associated with a new genomic alteration of the LPP locus. The lesions occurred in the foot by presenting one lump in the plantar soft tissue, and three lesions were detected in the calcaneus and in the navicular bone. All tumors showed the double immunophenotype of epithelial markers and S100 protein expression. No rearrangement of the EWSR1 and FUS loci was detected as reported in myoepitheliomas. However, molecular karyotyping detected an unbalanced rearrangement of the LPP locus, not involving the HMGA2 locus, which is the most frequent translocation partner observed in benign mesenchymal tumors such as lipomas (of soft tissue as well as parosteal) and pulmonary chondroid hamartoma.
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27
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Kabarriti R, Quinn TJ, Ewart MR, Mehta KJ, Lomita C, Geller DS, Kalnicki S, Fox JL. Neoadjuvant radiation therapy for the management of myoepithelial carcinoma of the upper extremity. Int J Cancer 2017; 142:854-862. [PMID: 29023697 DOI: 10.1002/ijc.31101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 08/14/2017] [Accepted: 08/29/2017] [Indexed: 11/08/2022]
Abstract
Myoepithelial tumors of the soft tissue are a rare tumor displaying myoepithelial elements and lacking obvious ductal differentiation. The rarity of these precludes any evidence-based consensus regarding optimal management. Nevertheless, the current approach to these lesions begins with amputation or complete excision. The efficacy of neoadjuvant or adjuvant radiation therapy or chemotherapy has not been established. Here, we present the first report to the authors' knowledge of neoadjuvant radiation therapy for the treatment of this rare soft tissue neoplasm and review the management and outcomes of published cases of myoepithelial carcinoma. A patient with a soft tissue myoepithelial carcinoma that declined both amputation and chemotherapy was treated with neoadjuvant radiation therapy and wide surgical excision followed by a brachytherapy boost to the resected tumor bed. Neoadjuvant radiation therapy resulted in an excellent response with extensive treatment-related changes consisting predominantly of fibrosis, hyalinization and hemorrhage and only 10% residual viable myoepithelial carcinoma present in the surgical specimen.
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Affiliation(s)
- Rafi Kabarriti
- Department of Radiation Oncology, Albert-Einstein College of Medicine-Montefiore Medical Center, Bronx, NY
| | - Thomas J Quinn
- Department of Radiation Oncology, Albert-Einstein College of Medicine-Montefiore Medical Center, Bronx, NY
| | - Michelle R Ewart
- Department of Pathology, Albert-Einstein College of Medicine-Montefiore Medical Center, Bronx, NY
| | - Keyur J Mehta
- Department of Radiation Oncology, Albert-Einstein College of Medicine-Montefiore Medical Center, Bronx, NY
| | - Craig Lomita
- Department of Orthopaedic Surgery, Albert-Einstein College of Medicine-Montefiore Medical Center, Bronx, NY
| | - David S Geller
- Department of Orthopaedic Surgery, Albert-Einstein College of Medicine-Montefiore Medical Center, Bronx, NY
| | - Shalom Kalnicki
- Department of Radiation Oncology, Albert-Einstein College of Medicine-Montefiore Medical Center, Bronx, NY
| | - Jana L Fox
- Department of Radiation Oncology, Albert-Einstein College of Medicine-Montefiore Medical Center, Bronx, NY
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28
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Urbini M, Astolfi A, Indio V, Tarantino G, Serravalle S, Saponara M, Nannini M, Gronchi A, Fiore M, Maestro R, Brenca M, Dei Tos AP, Dagrada GP, Negri T, Pilotti S, Casali PG, Biasco G, Pession A, Stacchiotti S, Pantaleo MA. Identification of SRF-E2F1 fusion transcript in EWSR-negative myoepithelioma of the soft tissue. Oncotarget 2017; 8:60036-60045. [PMID: 28947952 PMCID: PMC5601120 DOI: 10.18632/oncotarget.17958] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 05/01/2017] [Indexed: 11/27/2022] Open
Abstract
Myoepithelial neoplasms (MN) are rare and not well-circumstanced entities displaying a heterogeneous spectrum of genetic abnormalities, including EWSR1, FUS and PLAG1 rearrangements. However, in the remaining MN no other fusion gene has been described and knowledge concerning secondary acquired molecular alterations is still poor. Therefore, we screened 5 cases of MN of the soft tissue by RNA sequencing with the aim of identifying novel fusion transcripts. A novel SRF-E2F1 fusion was detected in two cases: one was negative for other fusions while the other showed also the presence of FUS-KLF17. The fusion was validated through independent techniques and, in both cases, SRF-E2F1 was detected only in a subclone of the tumoral mass. SRF-E2F1 maintained the coding frame, thus leading to the translation of a chimeric protein containing the DNA-binding domain of SRF and the trans-activation domain of E2F1. Moreover, ectopical expression of SRF-E2F1 demonstrated that the chimeric transcript is functionally active and could affect tumor growth. Occurrence in two cases and biological relevance of the two genes involved suggest that the SRF-E2F1 fusion might become a helpful diagnostic tool. Further biologic studies are needed to better assess its role in MN biology.
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Affiliation(s)
- Milena Urbini
- "Giorgio Prodi" Cancer Research Center, University of Bologna, Bologna, Italy
| | - Annalisa Astolfi
- "Giorgio Prodi" Cancer Research Center, University of Bologna, Bologna, Italy
| | - Valentina Indio
- "Giorgio Prodi" Cancer Research Center, University of Bologna, Bologna, Italy
| | - Giuseppe Tarantino
- "Giorgio Prodi" Cancer Research Center, University of Bologna, Bologna, Italy
| | - Salvatore Serravalle
- Pediatric Hematology and Oncology Unit, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Maristella Saponara
- Department of Specialized, Experimental and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Margherita Nannini
- Department of Specialized, Experimental and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Alessandro Gronchi
- Department of Surgery, Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Marco Fiore
- Department of Surgery, Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Roberta Maestro
- Unit of Experimental Oncology 1, CRO Aviano National Cancer Institute, Aviano, Italy
| | - Monica Brenca
- Unit of Experimental Oncology 1, CRO Aviano National Cancer Institute, Aviano, Italy
| | | | - Gian Paolo Dagrada
- Department of Diagnostic Pathology and Laboratory, Laboratory of Experimental Molecular Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Tiziana Negri
- Department of Diagnostic Pathology and Laboratory, Laboratory of Experimental Molecular Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Silvana Pilotti
- Department of Diagnostic Pathology and Laboratory, Laboratory of Experimental Molecular Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Paolo Giovanni Casali
- Cancer Medicine Department, Adult Mesenchymal Tumour and Rare Cancer Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Guido Biasco
- "Giorgio Prodi" Cancer Research Center, University of Bologna, Bologna, Italy
| | - Andrea Pession
- "Giorgio Prodi" Cancer Research Center, University of Bologna, Bologna, Italy.,Pediatric Hematology and Oncology Unit, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Silvia Stacchiotti
- Cancer Medicine Department, Adult Mesenchymal Tumour and Rare Cancer Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Maria Abbondanza Pantaleo
- "Giorgio Prodi" Cancer Research Center, University of Bologna, Bologna, Italy.,Department of Specialized, Experimental and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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29
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Ibrahim S, Al-Turk B, Harris C, Al-Saffar F, Said S, Farsi M, Winder J, Landa C. Melanoma Masquerading as a Zosteriform Rash. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:537-540. [PMID: 28507284 PMCID: PMC5441273 DOI: 10.12659/ajcr.902377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Primary care physicians and internal medicine specialists frequently encounter a variety of rashes. Many of these cases look and feel typical of common entities, resulting in the potential for misdiagnosis. CASE REPORT This is a case of a zosteriform rash where the surprising true diagnosis of metastatic melanoma was confirmed with bedside skin punch biopsy. Possible mechanisms involve direct cutaneous injury, neuronal, and dorsal root ganglia involvement in metastases. CONCLUSIONS Skin biopsy is indispensable especially when there is a lack of clinical response or deterioration in the clinical condition. The pathophysiology of zosteriform metastasis is unclear.
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Affiliation(s)
- Saif Ibrahim
- Department of Cardiology, University of Florida, Jacksonville, FL, USA
| | - Bashar Al-Turk
- Department of Medicine, University of Florida, Jacksonville, FL, USA
| | - Ciel Harris
- Department of Medicine, University of Florida, Jacksonville, FL, USA
| | | | - Sayf Said
- Department of Medicine, Providence Hospital, Washington, DC, USA
| | - Maheera Farsi
- Department of Dermatology, Largo Medical Center, Largo, FL, USA
| | - Jeffrey Winder
- Department of Medicine, University of Florida, Jacksonville, FL, USA
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30
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Rekhi B, Kosemehmetoglu K, Tezel GG, Dervisoglu S. Clinicopathologic features and immunohistochemical spectrum of 11 cases of epithelioid malignant peripheral nerve sheath tumors, including INI1/SMARCB1 results and BRAF V600E
analysis. APMIS 2017; 125:679-689. [DOI: 10.1111/apm.12702] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 03/03/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Bharat Rekhi
- Department of Surgical Pathology; Tata Memorial Hospital; Mumbai India
| | | | - Gaye Guler Tezel
- Department of Pathology; Hacettepe University School of Medicine; Ankara Turkey
| | - Sergulen Dervisoglu
- Department of Pathology; Istanbul University; Capa School of Medicine; Istanbul Turkey
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Hoggard TM, Henderson-Jackson E, Bui MM, Caracciolo J, Teer JK, Yoder S, Binitie O, Gonzalez RJ, Brohl AS, Reed DR. Myoepithelial carcinoma with RB1 mutation: remarkable chemosensitivity to carcinoma of unknown origin therapy. BMC Cancer 2017; 17:250. [PMID: 28390395 PMCID: PMC5385017 DOI: 10.1186/s12885-017-3249-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 03/31/2017] [Indexed: 12/30/2022] Open
Abstract
Background Myoepithelial carcinoma of soft tissue is a rare, malignant neoplasm that is morphologically and immunophenotypically similar to its counterpart in salivary gland. It demonstrates myoepithelial differentiation, possessing both epithelial and myogenic characteristics. Thought to be chemotherapy insensitive, the optimal treatment regimen of this tumor has yet to be established and only a select few cases in the literature discuss treatment efficacy in detail. Case presentation Here we present a case of a young adult with metastatic myoepithelial carcinoma with an initial excellent response to systemic therapy utilizing carboplatin and paclitaxel with continued complete response after 3 years. The patient also underwent complete surgical excision and received adjuvant radiation to the primary site of disease. Exome sequencing revealed an inactivating mutation in RB1 which we believe to be the first such mutation to be reported in this cancer type. Conclusions Given increasing evidence suggesting RB1 loss is associated with responsiveness to conventional chemotherapies, particularly platinum-based regimens, we hypothesize that this genetic feature predisposed chemosensitivity in our patient’s tumor.
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Affiliation(s)
- Timothy M Hoggard
- University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd., Tampa, FL, 33612, USA
| | - Evita Henderson-Jackson
- Department of Anatomic Pathology, 12901 Bruce B Downs Blvd., Tampa, FL, 33612, USA.,Sarcoma Department, 12901 Bruce B Downs Blvd., Tampa, FL, 33612, USA
| | - Marilyn M Bui
- Department of Anatomic Pathology, 12901 Bruce B Downs Blvd., Tampa, FL, 33612, USA.,Sarcoma Department, 12901 Bruce B Downs Blvd., Tampa, FL, 33612, USA
| | - Jamie Caracciolo
- Department of Diagnostic Imaging, 12901 Bruce B Downs Blvd., Tampa, FL, 33612, USA
| | - Jamie K Teer
- Department of Biostatistics and Bioinformatics, 12901 Bruce B Downs Blvd., Tampa, FL, 33612, USA
| | - Sean Yoder
- Molecular Genomics Core Facility, 12901 Bruce B Downs Blvd., Tampa, FL, 33612, USA
| | - Odion Binitie
- Sarcoma Department, 12901 Bruce B Downs Blvd., Tampa, FL, 33612, USA.,Adolescent and Young Adult Program; H. Lee Moffitt Cancer Center and Research Institute, 12901 Bruce B Downs Blvd., Tampa, FL, 33612, USA
| | | | - Andrew S Brohl
- Sarcoma Department, 12901 Bruce B Downs Blvd., Tampa, FL, 33612, USA
| | - Damon R Reed
- Sarcoma Department, 12901 Bruce B Downs Blvd., Tampa, FL, 33612, USA. .,Chemical Biology and Molecular Medicine Program, 12901 Bruce B Downs Blvd., Tampa, FL, 33612, USA. .,Adolescent and Young Adult Program; H. Lee Moffitt Cancer Center and Research Institute, 12901 Bruce B Downs Blvd., Tampa, FL, 33612, USA.
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Thway K, Noujaim J, Thomas DM, Fisher C, Jones RL. Myoepithelial Carcinoma of the Paracecal Mesentery: Aggressive Behavior of a Rare Neoplasm at an Unusual Anatomic Site. Rare Tumors 2017; 9:6504. [PMID: 28458787 PMCID: PMC5379233 DOI: 10.4081/rt.2017.6504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 07/30/2016] [Accepted: 08/03/2016] [Indexed: 11/23/2022] Open
Abstract
Myoepithelial tumors of the soft tissues represent a rare group of neoplasms that vary in their clinical behavior, pathologic features and genetics. They are histopathologically typified by a myoepithelial immunohistochemical phenotype, of expression of one or more epithelial markers, S100 protein and smooth muscle actin. Because of their rarity and occurrence over a wide age range and at a variety of anatomic sites, they can be difficult to diagnose due to the lack of familiarity by physicians, which is compounded by their spectrum of histologic features and morphologic overlap with several other neoplasms. Recent genetic insights have aided classification, and it is increasingly understood that soft tissue myoepithelial neoplasms can be stratified into two distinct morphologic and genetic subgroups. We describe a case of a 44-year-old man who was diagnosed with a primary myoepithelial neoplasm of the paracecal mesentery, which showed aggressive local recurrence after four years. The tumor was composed of cords of ovoid cells within chondromyxoid stroma, and displayed a characteristic pancytokeratin, S100 protein and smooth muscle actin-positive myoepithelial immunoprofile. Primary myoepithelioma has not been previously described at this site, and this case highlights this varied family of tumors, emphasizes the need to consider myoepithelial tumor in the differential diagnoses of carcinoma variants occurring in the bowel or mesentery, and also adds to the number of reported myoepithelial neoplasms showing markedly aggressive behavior.
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Affiliation(s)
- Khin Thway
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London
| | | | - D Michael Thomas
- Department of Cellular Pathology, Maidstone and Tunbridge Wells NHS Trust, Kent, UK
| | - Cyril Fisher
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London
| | - Robin L Jones
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London
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Dadone B, Fontaine D, Mondot L, Cristofari G, Jouvet A, Godfraind C, Varlet P, Ranchère‐Vince D, Coindre J, Gastaud L, Baudoin C, Peyron A, Thyss A, Coutts M, Michiels J, Pedeutour F, Burel‐Vandenbos F. Meningeal SWI/SNF related, matrix‐associated, actin‐dependent regulator of chromatin, subfamily B member 1 (SMARCB1)‐deficient tumours: an emerging group of meningeal tumours. Neuropathol Appl Neurobiol 2016; 43:433-449. [DOI: 10.1111/nan.12364] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/22/2016] [Accepted: 10/12/2016] [Indexed: 12/12/2022]
Affiliation(s)
- B. Dadone
- Central Laboratory of Pathology of Nice University Hospital France
- Laboratory of Solid Tumors Genetics Nice University Hospital France
| | - D. Fontaine
- Department of Neurosurgery Nice University Hospital France
| | - L. Mondot
- Department of Radiology Nice University Hospital France
| | - G. Cristofari
- Institute for Research on Cancer and Aging of Nice (IRCAN) CNRS UMR 7284/INSERM U1081 University of Nice Sophia‐Antipolis Nice France
| | - A. Jouvet
- Department of Pathology and Neuropathology Groupement Hospitalier Est Lyon Bron France
| | - C. Godfraind
- Department of Pathology University Hospital of Clermont‐Ferrand Clermont‐Ferrand France
| | - P. Varlet
- Department of Neuropathology Sainte‐Anne Hospital Paris France
| | | | - J.‐M. Coindre
- Department of Pathology Institut Bergonié Bordeaux France
| | - L. Gastaud
- Department of Oncology Centre Antoine Lacassagne Nice France
| | - C. Baudoin
- Institute for Research on Cancer and Aging of Nice (IRCAN) CNRS UMR 7284/INSERM U1081 University of Nice Sophia‐Antipolis Nice France
| | - A.‐C. Peyron
- Laboratory of Solid Tumors Genetics Nice University Hospital France
- Institute for Research on Cancer and Aging of Nice (IRCAN) CNRS UMR 7284/INSERM U1081 University of Nice Sophia‐Antipolis Nice France
| | - A. Thyss
- Department of Oncology Centre Antoine Lacassagne Nice France
| | - M. Coutts
- Department of Pathology West Kent Cancer Centre Maidstone UK
| | - J.‐F. Michiels
- Central Laboratory of Pathology of Nice University Hospital France
| | - F. Pedeutour
- Laboratory of Solid Tumors Genetics Nice University Hospital France
- Institute for Research on Cancer and Aging of Nice (IRCAN) CNRS UMR 7284/INSERM U1081 University of Nice Sophia‐Antipolis Nice France
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Moussaly E, Nazha B, Kedia S, Chang Q, Forte F. Soft Tissue Myoepithelial Carcinoma of the Neck with Spinal Invasion. Rare Tumors 2016; 8:6485. [PMID: 27746887 PMCID: PMC5064303 DOI: 10.4081/rt.2016.6485] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 06/24/2016] [Accepted: 06/24/2016] [Indexed: 01/02/2023] Open
Abstract
Soft tissue myoepithelial neoplasms are a rare yet diverse group of tumors, ranging from benign to malignant lesions. Their presentation in the head and neck region is uncommon and represents a challenging diagnosis. Early identification of myoepithelial carcinoma is crucial given its more aggressive course compared to its benign counterpart, although the histopathological distinction between the two can be difficult. EWSR1 gene rearrangement is found in half the cases and has a speculative role in pathogenesis. Complete excision remains the treatment of choice. The roles of chemotherapy and radiation are unclear. We report the hospital course of a 33-year-old female who presented to our institution with a posterior neck mass with spinal invasion, diagnosed as myoepithelial cancer. A literature review of these rare tumors is discussed here.
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Affiliation(s)
- Elias Moussaly
- Department of Internal Medicine, North Shore LIJ Staten Island University Hospital , Staten Island, NY, USA
| | - Bassel Nazha
- Department of Internal Medicine, North Shore LIJ Staten Island University Hospital , Staten Island, NY, USA
| | - Shiksha Kedia
- Department of Hematology/Oncology, North Shore LIJ Staten Island University Hospital , Staten Island, NY, USA
| | - Qing Chang
- Department of Pathology, North Shore LIJ Staten Island University Hospital , Staten Island, NY, USA
| | - Frank Forte
- Department of Hematology/Oncology, North Shore LIJ Staten Island University Hospital , Staten Island, NY, USA
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36
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Primary intra-osseous myoepithelioma of phalanx mimicking an enchondroma. Skeletal Radiol 2016; 45:1453-8. [PMID: 27524490 DOI: 10.1007/s00256-016-2452-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/21/2016] [Accepted: 08/01/2016] [Indexed: 02/02/2023]
Abstract
Myoepitheliomas (MEs) are uncommon tumours of the soft tissue with an intermediate biological behaviour and uncertain differentiation. Primary intra-osseous MEs are rare and occur predominantly in the axial and proximal appendicular skeleton in middle-aged patients. The morphological variation of the tumour cells and stromal metaplasia may cause considerable diagnostic confusion, especially when it occurs in an unusual location. A wide panel of immunohistochemical markers is required to exclude other histological mimics. A 37-year-old male presented with a recurrent swelling in the right middle finger for 1-month duration. Radiographic images showed an expansile, lytic, intra-osseous lesion with high signal intensity on T2W fat-suppressed MR images in the proximal phalanx of the right middle finger without cortical breach, highly suggestive of an enchondroma. Histopathology revealed a lobulated tumour comprising of polygonal to spindle cells in groups and cords in a chondromyxoid stroma. No cellular atypia was noted. The tumour cells were immunopositive for epithelial membrane antigen (EMA), p63, S100 and smooth muscle actin (SMA), compatible with the diagnosis of an intraosseous ME. The proximal phalanx of the right middle finger was excised, revealing a similar tumour, and the patient has been on regular follow-up for the last 18 months without any recurrence. Primary intra-osseous MEs are extremely rare, and this is the second reported occurrence in small bones. A differential diagnosis of ME should be kept for enchondroma-like lesions of the bone for proper histopathological assessment and accurate diagnosis. Documentation of such cases and follow-up will enhance our understanding of their clinical course and prognosis.
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Expanding the Spectrum of Renal Tumors in Children: Primary Renal Myoepithelial Carcinomas With a Novel EWSR1-KLF15 Fusion. Am J Surg Pathol 2016; 40:386-94. [PMID: 26523541 DOI: 10.1097/pas.0000000000000545] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report the first 2 examples of primary renal myoepithelial carcinoma (MEC), both occurring in children. Both tumors had the unique morphologic features, immunophenotype, and EWSR1 gene rearrangements supporting the diagnosis. In keeping with the previous observations of an aggressive behavior in pediatric MEC, both cases presented with advanced local stage and distant metastases at the time of diagnosis. The EWSR1 translocation partner was identified as the Kruppel-like factor 15 (KLF15) gene in both tumors, and the novel EWSR1-KLF15 gene fusion transcripts were verified using reverse transcription polymerase chain reaction and Sanger dideoxy sequencing. So far, a role for KLF15 in carcinogenesis has not been established, in contrast to other members of the Kruppel-like family of transcription factors, and no rearrangements involving this gene have been documented to our knowledge. These findings expand the spectrum of pediatric renal tumors to include MEC. The characterization of novel EWSR1-KLF15 fusion transcripts carries important diagnostic implications, as well as clues to understand the pathogenesis of these neoplasms.
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Abstract
BACKGROUND Myoepithelioma of the soft tissues is a rare entity and little is known about how best to manage locally recurrent and high-grade disease. Here, we retrospectively examined outcomes of surgery, chemotherapy, and radiation therapy (RT) for treatment of low-grade and high-grade myoepithelioma of soft tissues. METHODS We reviewed 20 cases of myoepithelioma of soft tissues seen at Mayo Clinic between 1994 and 2014. The effect of histologic grade and therapies received on relapse and survival were assessed. RESULTS We identified 13 patients with low-grade disease and 7 patients with high-grade disease. We found that low-grade disease was frequently effectively managed with surgical resection alone, whereas high-grade disease frequently metastasized and was often fatal. The 5-year event-free survival was 88% (confidence interval, 46%-98%) for low-grade disease versus 36% (confidence interval, 7%-75%; P=0.04) for high-grade disease. The relapse rate in low-grade disease was 29% at 5 years versus 64% (P=0.04) in high-grade disease. No significant responses to chemotherapy were noted, however, excellent responses to perioperative RT were seen. CONCLUSIONS Surgery continues as the primary modality of treatment for myoepithelioma of soft tissues. Our study did not show a clear benefit of chemotherapy in the metastatic disease setting, but supports the use of perioperative RT in the management of high-grade disease; further investigation is warranted.
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Abstract
BACKGROUND Myoepithelial carcinoma was only recently recognized to occur primarily in soft tissue. Only a small number has been reported in children. OBSERVATION We report a rare case of myoepithelial carcinoma of the leg in a 4-month-old boy with a good response to chemotherapy initially. However, he presented secondarily during chemotherapy a local and metastatic progression. CONCLUSIONS The rarity of the tumor and unusual age of discovery have prompted us to report this case. Our case suggests that this disease can have an aggressive behavior. This is why we advise a rapid and correct diagnosis followed by an aggressive treatment.
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40
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Mourtzoukou D, Zaidi S, Jones RL, Fisher C, Thway K. Soft Tissue Myoepithelial Carcinoma Metastatic to the Cecum: Highlighting an Unusual Metastatic Pattern and the Need for Diagnostic Awareness. Rare Tumors 2016; 8:6086. [PMID: 27134707 PMCID: PMC4827644 DOI: 10.4081/rt.2016.6086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/25/2015] [Accepted: 10/25/2015] [Indexed: 11/23/2022] Open
Abstract
Myoepithelial neoplasms of the soft tissues are a rare, heterogeneous group of tumors for which classification continues to evolve. While well defined within salivary glands, they can also arise in viscera and soft tissues, where diagnosis is challenging due to the lack of clinical and pathological familiarity. We present the case of a 36 year old man with myoepithelial carcinoma arising as a primary tumor within the soft tissues of the neck, which metastasized to the cecum, causing intussusception. This spindle cell neoplasm showed the classic S100 protein, smooth muscle actin and pancytokeratin-positive immunoprofile. Metastasis of myoepithelial carcinoma to the cecum has not been previously described, and coupled with the spindle cell morphology, may cause significant diagnostic difficulty in the absence of clinical familiarity, particularly as there is morphologic overlap with spindle cell neoplasms arising more commonly in gastrointestinal sites, including gastrointestinal stromal tumor, leiomyosarcoma and sarcomatoid carcinoma.
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Affiliation(s)
| | - Shane Zaidi
- Sarcoma Unit, Royal Marsden Hospital , London, UK
| | | | - Cyril Fisher
- Sarcoma Unit, Royal Marsden Hospital , London, UK
| | - Khin Thway
- Sarcoma Unit, Royal Marsden Hospital , London, UK
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41
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Lai MC, Tan MH. Soft tissue myoepithelial cell carcinoma. Singapore Med J 2016; 57:166-7. [PMID: 26997168 DOI: 10.11622/smedj.2016058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Mun Chun Lai
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
| | - Mann Hong Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
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42
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Chebib I, Jo VY. Round cell sarcoma withCIC-DUX4gene fusion: Discussion of the distinctive cytomorphologic, immunohistochemical, and molecular features in the differential diagnosis of round cell tumors. Cancer Cytopathol 2016; 124:350-61. [DOI: 10.1002/cncy.21685] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/07/2015] [Accepted: 12/09/2015] [Indexed: 12/15/2022]
Affiliation(s)
- Ivan Chebib
- Department of Pathology, Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts
| | - Vickie Y. Jo
- James Homer Wright Pathology Laboratories, Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts
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Rekhi B, Joshi S, Panchwagh Y, Gulia A, Borges A, Bajpai J, Jambehekar NA, Pant V, Mandholkar M, Byregowda S, Puri A. Clinicopathological features of five unusual cases of intraosseous myoepithelial carcinomas, mimicking conventional primary bone tumours, including EWSR1 rearrangement in one case. APMIS 2016; 124:278-90. [PMID: 26768122 DOI: 10.1111/apm.12506] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 12/06/2015] [Indexed: 12/01/2022]
Abstract
Primary intraosseous myoepithelial tumours, including carcinomas are rare tumours. The concept of histopathological spectrum of these tumours is evolving. We describe clinicopathological and immunohistochemical features of five myoepithelial carcinomas, including molecular cytogenetic results in one case. There were five male patients within age-range of 8-40 years (median = 26). Four tumours occurred in the long bones, including two tumours, each, in the femur and fibula, respectively, while a single tumour occurred in the proximal phalanges. Tumour size (n = 3 cases) varied from 5.6 to 8.6 cm. On radiological imaging, most tumours appeared as expansile, lytic and destructive lesions. Two tumours appeared as sclerotic lesions. Two cases were referred with diagnoses of chondrosarcomas and a single case was referred with two different diagnoses, including an adamantinoma and an osteosarcoma. Histopathological examination in all these cases showed multinodular tumours comprising mostly polygonal cells, exhibiting moderate nuclear atypia and interspersed mitotic figures within a stroma containing variable amount of myxoid, chondroid, hyalinised and osteoid-like material. Three tumours revealed prominent squamous differentiation. By immunohistochemistry, tumour cells were positive for EMA (5/5), pan CK (AE1/AE3) (3/3), CK5/6 (4/4), CK MNF116 (1/1), S100 protein (5/5) and GFAP (3/5). The first tumour revealed EWSR1 rearrangement. The first patient, 10 months after tumour resection and a simultaneous lung metastatectomy, is free-of-disease (FOD). The second patient, 11 months after tumour resection is FOD. The third and fourth patients underwent wide resections and are on follow-up. The fifth patient underwent resections, including a lung metastatectomy. Primary intraosseous myoepithelial carcinomas are rare and mimic conventional primary bone tumours. Some primary intraosseous myoepithelial carcinomas display EWSR1 rearrangement. Squamous differentiation may be considered as an addition to their evolving histopathological spectrum. Immunohistochemical stains constitute as a necessary tool for arriving at the correct diagnosis in such cases, which has treatment implications. Surgical resection remains the treatment mainstay.
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Affiliation(s)
- Bharat Rekhi
- Department of Surgical Pathology, Tata Memorial Centre, Mumbai, India
| | - Sujit Joshi
- Department of Histopathology, Deenanath Mangeshkar Hospital, Pune, India
| | - Yogesh Panchwagh
- Department of Orthopaedic Oncology, Deenanath Mangeshkar Hospital, Pune, India.,Sancheti Institute for Orthopaedics and Rehabilitation, Pune, India
| | - Ashish Gulia
- Department of Surgical Oncology (Bone and Soft Tissues), Tata Memorial Centre, Mumbai, India
| | - Anita Borges
- Asian Institute of Oncology, Mumbai, India.,SRL Diagnostics Centre of Excellence: Histopathology, Mumbai, India
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | | | | | - Mahesh Mandholkar
- Department of Orthopaedic Oncology, Deenanath Mangeshkar Hospital, Pune, India
| | - Suman Byregowda
- Department of Surgical Oncology (Bone and Soft Tissues), Tata Memorial Centre, Mumbai, India
| | - Ajay Puri
- Department of Surgical Oncology (Bone and Soft Tissues), Tata Memorial Centre, Mumbai, India
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Abstract
Epithelioid sarcoma (ES) is a rare, aggressive soft-tissue neoplasm of uncertain differentiation, characterized by nodular aggregates of epithelioid cells, which are immunoreactive to cytokeratins (CKs) and epithelial membrane antigen, and often for CD34. It has a propensity for multifocal disease at presentation, local recurrence, and regional metastasis. These are aggressive neoplasms with particularly poor prognosis after regional or distant metastatic disease, for which surgical resection is still the mainstay of treatment, and options for patients with metastatic disease remain undefined. There are 2 distinct variants: classic ES, which typically presents as a subcutaneous or deep dermal mass in the distal extremities of young adults and comprises nodular distributions of relatively uniform epithelioid cells with central necrosis, and the proximal variant, which has a predilection for proximal limbs and limb girdles and the midline of the trunk, which is composed of sheets of larger, more atypical cells with variable rhabdoid morphology. Both classic and proximal-type ESs are associated with the loss of SMARCB1/INI1 protein expression, but appear otherwise molecularly relatively heterogeneous. We review classic and proximal-type ES, discussing morphology, immunohistochemical and genetic findings, the differential diagnosis, and the future potential for targeted therapies.
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45
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Wang G, Tucker T, Ng TL, Villamil CF, Hayes MM. Fine-needle aspiration of soft tissue myoepithelioma. Diagn Cytopathol 2015; 44:152-5. [PMID: 26644362 DOI: 10.1002/dc.23399] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 11/09/2015] [Accepted: 11/15/2015] [Indexed: 11/07/2022]
Abstract
Soft tissue myoepithelioma is a rare neoplasm composed of myoepithelial cells. We describe the cytologic features of a soft tissue myoepithelioma arising in the right lower chest wall in a 65-year-old woman. The fine-needle aspiration (FNA) smears showed round to oval, spindle, epithelioid, and plasmacytoid cells in the myxoid background. The nuclei were uniform, round to ovoid, with finely distributed chromatin and eosinophilic or pale cytoplasm, and resembled lobular carcinoma of breast. Ultrasound guided core biopsy showed the tumor cells had bland cytologic features, arranged in small cords, nests, and dissociated single cells, with no glandular differentiation or breast tissue seen. The tumor cells demonstrated immunoreactivity for cytokeratin (AE1/AE3) and glial fibrillary acidic protein, but were negative for estrogen receptor. Fluorescence in situ hybridization demonstrated the EWSR1 rearrangement, confirming the diagnosis of myoepithelioma.
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Affiliation(s)
- Gang Wang
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tracy Tucker
- Department of Pathology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
- Department of Pathology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Tony L Ng
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pathology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Carlos F Villamil
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pathology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Malcolm M Hayes
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pathology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
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Schneider N, Fisher C, Thway K. Ossifying fibromyxoid tumor: morphology, genetics, and differential diagnosis. Ann Diagn Pathol 2015; 20:52-8. [PMID: 26732302 DOI: 10.1016/j.anndiagpath.2015.11.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 11/30/2015] [Indexed: 01/17/2023]
Abstract
Ossifying fibromyxoid tumor (OFMT) is a soft tissue neoplasm of uncertain differentiation and intermediate (rarely metastasizing) biologic potential, with typical morphologic features, of an encapsulated, lobulated tumor comprising uniform polygonal cells within fibromyxoid stroma, which is surrounded by or contains metaplastic bone, classically as a peripheral rim of lamellar bone. Ossifying fibromyxoid tumor can arise at almost any site, although most frequently occurs within the extremities and trunk. Although most behave in a benign fashion, tumors can rarely show atypical or malignant features. It is now established that OFMTs represent translocation-associated tumors, with up to 85% associated with recurrent gene rearrangements, mostly involving the PHF1 gene (including in typical, atypical, and malignant neoplasms), with EP400-PHF1 in approximately 40% of tumors, and ZC3H7B-BCOR, MEAF6-PHF1, and EPC1-PHF1 fusions also described. Correct diagnosis is clinically important to ensure correct treatment and prognostication, both to avoid overdiagnosing OFMT as a malignant neoplasm such as osteosarcoma and also because of the propensity for aggressive behavior in a small number of OFMT. We review OFMT, with emphasis on the morphologic spectrum, recent molecular genetic findings, and the differential diagnosis.
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Affiliation(s)
- Nina Schneider
- Sarcoma Unit, Royal Marsden Hospital, London, United Kingdom
| | - Cyril Fisher
- Sarcoma Unit, Royal Marsden Hospital, London, United Kingdom
| | - Khin Thway
- Sarcoma Unit, Royal Marsden Hospital, London, United Kingdom.
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47
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Vroobel K, Gonzalez D, Wren D, Thompson L, Swansbury J, Fisher C, Thway K. Ancillary molecular analysis in the diagnosis of soft tissue tumours: reassessment of its utility at a specialist centre. J Clin Pathol 2015; 69:505-10. [DOI: 10.1136/jclinpath-2015-203380] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 10/23/2015] [Indexed: 12/13/2022]
Abstract
AimsThe histological diagnosis of soft tissue tumours (STTs) can be difficult, sometimes requiring a combination of morphology, immunophenotype and ancillary molecular tests. Many STTs are associated with characteristic genetic aberrations that can be assessed using fluorescence in situ hybridisation (FISH), reverse transcription-PCR (RT-PCR) or mutational analysis. We have previously assessed the practicality and sensitivity of using these modalities as part of the routine diagnosis of STT in paraffin-embedded material and now revisit the subject in light of further experience in this field.Methods200 consecutive cases from 2013 that had undergone FISH, RT-PCR or mutational analysis were assessed to evaluate their diagnostic utility compared with preliminary histological assessment.Results218 FISH, 91 RT-PCR and 43 mutational analysis tests were performed. Compared with the previous study, FISH for MDM2 amplification in possible well-differentiated/dedifferentiated liposarcomas, and mutational analysis for assessing KIT, PDGFR and BRAF mutations made up a large proportion of the workload (107 and 43 tests, respectively). As in the previous study, alveolar rhabdomyosarcoma showed the best FISH:RT-PCR concordance. Unlike previously, RT-PCR showed marginally higher sensitivity than FISH (78.9% and 76.9%), while continuing to demonstrate higher specificity (90.9% and 84.3%). RT-PCR again showed an increased failure rate (5.5%; 1% for FISH).ConclusionsWe demonstrate the continuing utility of RT-PCR and FISH for STT diagnosis, and that each has advantages in specific contexts. These ancillary molecular tests are important tools in both defining and excluding diagnoses of STT, which is crucial in determining prognosis and guiding appropriate management.
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Abstract
Primary myoepithelial neoplasms of soft tissue are uncommon, and have been increasingly characterized by clinicopathologic and genetic means. Tumors are classified as mixed tumor/chondroid syringoma, myoepithelioma, and myoepithelial carcinoma, and they share morphologic, immunophenotypic, and genetic features with their salivary gland counterparts. However, soft tissue myoepithelial tumors are classified as malignant based on the presence of cytologic atypia, in contrast to the criterion of invasive growth in salivary gland sites. This review discusses the clinicopathologic and morphologic characteristics, distinct variants, and currently known genetic alterations of myoepithelial neoplasms of soft tissue, skin, and bone.
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Affiliation(s)
- Vickie Y Jo
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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Hashmi AA, Khurshid A, Faridi N, Edhi MM, Khan M. A large mediastinal benign myoepithelioma effacing the entire hemithorax: case report with literature review. Diagn Pathol 2015; 10:100. [PMID: 26170201 PMCID: PMC4501044 DOI: 10.1186/s13000-015-0340-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 06/29/2015] [Indexed: 11/23/2022] Open
Abstract
Background Myoepithelial neoplasms, although sometimes encountered in soft tissues are described very rarely in mediastinum and lung. We reported a rare case of such a tumor which was very large in size and not connected to respiratory tree. Case presentation A 24 year old male presented with blunt chest pain and respiratory distress. A CT scan was performed which showed large heterogeneously enhancing soft tissue mass occupying the left hemithorax. It measures 18.5 X 15.8 X 7.6. Thoracotomy with excision of the tumor was done. Operative findings include multilobulated and nodular large glistening white tumor located in anterior mediastinum adherent to parietal pleura and effacing the pulmonary parenchyma. However tumor was not connected or seems to originate from trachea or lung. Microscopic sections show neoplastic lesion composed of nests, cords and trabeculae of small to medium sized cells with round nuclei and clear cytoplasm. Background showed myxoid appearance with areas of cartilaginous differentiation. Immunohistochemical expression of CKAE1/AE3, p63, ASMA, S100 and GFAP favored the diagnosis of benign myoepithelioma. Conclusion Myoepithelial tumors are rare soft tissue tumors thought to arise from stem cells capable of divergent differentiation and occur anywhere in the body. Histopathologic recognition of these tumors is essential as these tumors may behave in a benign fashion despite large sizes.
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Affiliation(s)
- Atif Ali Hashmi
- Department of Histopathology, Liaquat National Hospital and Medical College, Karachi, Pakistan. .,Intern, Liaquat National Hospital and Medical College, Karachi, Pakistan. .,Dhaka Medical College, Dhaka, Bangladesh.
| | - Amna Khurshid
- Department of Histopathology, Liaquat National Hospital and Medical College, Karachi, Pakistan. .,Intern, Liaquat National Hospital and Medical College, Karachi, Pakistan. .,Dhaka Medical College, Dhaka, Bangladesh.
| | - Naveen Faridi
- Department of Histopathology, Liaquat National Hospital and Medical College, Karachi, Pakistan. .,Intern, Liaquat National Hospital and Medical College, Karachi, Pakistan. .,Dhaka Medical College, Dhaka, Bangladesh.
| | - Muhammad Muzzammil Edhi
- Department of Histopathology, Liaquat National Hospital and Medical College, Karachi, Pakistan. .,Intern, Liaquat National Hospital and Medical College, Karachi, Pakistan. .,Dhaka Medical College, Dhaka, Bangladesh.
| | - Mehmood Khan
- Department of Histopathology, Liaquat National Hospital and Medical College, Karachi, Pakistan. .,Intern, Liaquat National Hospital and Medical College, Karachi, Pakistan. .,Dhaka Medical College, Dhaka, Bangladesh.
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Pendse AA, Dodd LG. Fine-needle-aspiration cytology of a proximal type epithelioid sarcoma: A case report. Diagn Cytopathol 2015; 43:859-62. [DOI: 10.1002/dc.23294] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 02/18/2015] [Accepted: 03/30/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Avani A. Pendse
- Resident in Anatomic and Clinical Pathology, Department of Pathology; University of North Carolina; Chapel Hill North Carolina
| | - Leslie G. Dodd
- Resident in Anatomic and Clinical Pathology, Department of Pathology; University of North Carolina; Chapel Hill North Carolina
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