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Angelico G, Salvatorelli L, Vecchio GM, Mazzucchelli M, Rosano GN, Poidomani S, Magro GG. Solitary fibrous tumor occurring at unusual sites: A clinico-pathological series of 31 cases with emphasis on its wide morphological spectrum. Pathol Res Pract 2024; 255:155207. [PMID: 38394808 DOI: 10.1016/j.prp.2024.155207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/27/2024] [Accepted: 02/11/2024] [Indexed: 02/25/2024]
Abstract
Solitary fibrous tumor (SFT) is a relatively rare mesenchymal fibroblastic tumor occurring most commonly in adults with no gender predilection. Although the pathological diagnosis of SFT is usually straightforward, some difficulties may occasionally arise mainly due to the wide morphological spectrum exhibited by this tumor. In the present paper we aimed to evaluate the unusual clinicopathological features in a series of 31 SFTs arising from parenchymal organs, superficial soft tissues and deep soft tissues. Our results emphasize that SFTs may occur anywhere, including unusual sites such as periosteum of the thoracic spine, mesorectal tissue, hepatic hilum, paravescial space, kidney and breast. Moreover, a wide morphological spectrum was observed in tumors included in our series. The most striking morphological features observed included: extensive lipomatous component, myxoid stromal changes, epithelioid cell component, metaplastic mature bone, neurofibroma-like, myxofibrosarcoma-like and pseudoalveolar-like areas. Additionally, multinucleated giant cells and sarcomatous dedifferentiation were also identified. Our paper emphasizes that SFT may occur in unusual anatomical locations and exhibits a wide morphological spectrum. Pathologists must be aware of these features to avoid confusion with other benign and malignant neoplasms that may show overlapping morphological features.
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Affiliation(s)
- Giuseppe Angelico
- Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Anatomic Pathology, University of Catania, 95123 Catania, Italy
| | - Lucia Salvatorelli
- Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Anatomic Pathology, University of Catania, 95123 Catania, Italy
| | - Giada Maria Vecchio
- Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Anatomic Pathology, University of Catania, 95123 Catania, Italy
| | - Manuel Mazzucchelli
- Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Anatomic Pathology, University of Catania, 95123 Catania, Italy
| | - Giovanni Nunzio Rosano
- Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Anatomic Pathology, University of Catania, 95123 Catania, Italy
| | - Simone Poidomani
- Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Anatomic Pathology, University of Catania, 95123 Catania, Italy
| | - Gaetano Giuseppe Magro
- Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Anatomic Pathology, University of Catania, 95123 Catania, Italy.
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Yao CC, Zhou J, Li X, Yang J, Chen G, Wei J, Fan QH, Gong QX. Prognostic analysis of extrameningeal solitary fibrous tumor using the modified Demicco model: a clinicopathologic study of 111 Chinese cases. Front Oncol 2024; 13:1272090. [PMID: 38239634 PMCID: PMC10796168 DOI: 10.3389/fonc.2023.1272090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/07/2023] [Indexed: 01/22/2024] Open
Abstract
Introduction Solitary fibrous tumor (SFT) represents a fibroblastic neoplasm exhibiting NAB2::STAT6 gene rearrangement, displaying diverse clinical manifestations, spanning from benign to malignant. To predict prognosis, the modified (four-variable) Demicco (mDemicco) model was introduced. This investigation aims to authenticate the mDemicco risk model's precision in Asian patients while investigating the clinicopathological and molecular factors linked to the prognosis of extrameningeal SFTs. Methods Clinicopathological data from 111 extrameningeal SFT cases in East China, covering the period from 2010 to 2020, were thoroughly analyzed. The tumors were classified using the mDemicco model. Immunohistochemical evaluation of P16 and P53, molecular detection of TP53 and TERT promoter mutation, and fluorescence in situ hybridization for CDKN2A gene alterations were performed. Statistical methods were utilized to assess the associations between clinicopathological or molecular factors and prognosis. Results Histologically, only one parameter, the mitotic count, exhibited a statistical correlation with progression-free survival (PFS) and overall survival (OS). During the Kaplan-Meier analysis, the variation in PFS among the different risk groups exhibited a notable trend towards statistical significance. Nevertheless, 3 out of 74 patients classified as low-risk SFTs and 7 out of 21 patients classified as intermediate-risk exhibited disease progression. Among the 5 patients with TP53 mutations and/or mutant-type P53 immunophenotype, 3 experienced disease progression, including 2 intermediate-risk patients. Additionally, among the 4 patients with TERT promoter mutations who were followed up, 3 showed progression, including 2 intermediate-risk patients. Moreover, it was observed that hemizygous loss of CDKN2A was detected in more than 30% of one case, yet the patient exhibited a favorable survival outcome. Conclusion The mDemicco risk model exhibits certain limitations when dealing with smaller tumor sizes, younger age groups, and occurrences of malignant and dedifferentiated SFTs. Furthermore, molecular factors, such as TP53 or TERT promoter mutations, may identify intermediate-risk SFTs with poorer prognoses.
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Affiliation(s)
- Chen-chen Yao
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Pathology, Women’s and Children’s Hospital Affiliated to Xiamen University (Xiamen Maternal and Child Health Care Hospital), Xiamen, China
| | - Jian Zhou
- National Health Commission(NHC) Contraceptives Adverse Reaction Surveillance Center, Nanjing, China
- Jiangsu Provincial Medical Key Laboratory of Fertility Protection and Health Technology Assessment, Nanjing, China
- Jiangsu Health Development Research Center, Nanjing, China
| | - Xiao Li
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Yang
- Department of Pathology, Affiliated Nanjing Drum Tower Hospital of Nanjing University School of Medicine, Nanjing, China
| | - Gang Chen
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jia Wei
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qin-he Fan
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qi-xing Gong
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Arcovito G, Caporalini C, Palomba A, Maggiore G, Franchi A. Sinonasal nodular fasciitis: report of a case with USP6 rearrangement. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:e153-e158. [PMID: 37735002 DOI: 10.1016/j.oooo.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/23/2023] [Accepted: 07/02/2023] [Indexed: 09/23/2023]
Abstract
Nodular fasciitis (NF) is a benign myofibroblastic proliferation characterized by rapid growth, a self-limiting course, and USP6 gene rearrangement. Although it can arise in the head and neck region, very few cases of NF involving the sinonasal tract have been reported to date. Herein we report a case of NF involving the nasal cavity presenting as a polypoid well-defined mass causing obstructive symptoms in a male with a history of multiple local surgeries. Although the mass had an unusual clinical presentation, the histopathologic and immunohistochemical findings were consistent with NF. Fluorescent in situ hybridization performed with break-apart probes flanking the USP6 locus on chromosome 17p13 revealed the presence of USP6 gene rearrangement. The patient remained free of disease 124 months after surgical treatment. Considering its remarkably benign behavior despite its alarming clinical and histologic features, the distinction of NF from sinonasal malignant tumors is essential.
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Affiliation(s)
- Giorgia Arcovito
- Section of Pathology, Department of Translational Research, University of Pisa, Italy
| | - Chiara Caporalini
- Pathology Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Annarita Palomba
- Histopathology and Molecular Diagnostic Unit, Careggi University Hospital, Florence, Italy
| | | | - Alessandro Franchi
- Section of Pathology, Department of Translational Research, University of Pisa, Italy.
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Yavas A, Tan J, Ozkan HS, Yilmaz F, Reid MD, Bagci P, Shi J, Shia J, Adsay V, Klimstra DS, Basturk O. Solitary Fibrous Tumor of the Pancreas: Analysis of 9 Cases With Literature Review. Am J Surg Pathol 2023; 47:1230-1242. [PMID: 37573546 PMCID: PMC10592360 DOI: 10.1097/pas.0000000000002108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Solitary fibrous tumor (SFT) has been increasingly reported in various anatomic sites. However, it is still extremely rare in the pancreas. Herein, we present the first series of primary pancreatic SFTs. Nine cases of primary pancreatic SFTs were analyzed. The mean age was 60 years (36 to 76 y) with no sex predilection. Six tumors were in the head, 3 were in the tail. On imaging studies, tumors were described as a hypervascular mass, 2 revealed cystic areas, and 3 were favored to be neuroendocrine tumors. On biopsy, 2 cases were diagnosed as atypical spindle cell tumor; one was misdiagnosed as suspicious for sarcoma, and another case as metastatic renal cell carcinoma. Two were diagnosed as low-grade sarcoma and low-grade stromal tumor on frozen sections. Grossly, tumors were well-demarcated with a median size of 4 cm (0.9 to 15 cm). Microscopically, they were composed of ovoid to spindle tumor cells with no significant mitotic activity and were arranged in alternating hypercellular and hypocellular areas. Staghorn-like vessels and entrapped pancreatic parenchyma were also detected within all tumors. Tumor cells revealed diffuse/strong nuclear STAT6 expression in 7 of 8, CD34 in 7 of 9, and bcl-2 in 4 of 4 tested cases. One tested tumor harbored NAB2 - STAT6 fusion. Eight patients with available follow-up data were free of disease at a mean follow-up of 76 months (3 to 189 mo). SFT should be considered in the differential diagnoses of mesenchymal neoplasms of the pancreas. Immunohistochemical nuclear STAT6 expression is a characteristic feature of SFT. Primary pancreatic SFTs seem to have favorable biological behavior in our series.
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Affiliation(s)
- Aslihan Yavas
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Hulya Sahin Ozkan
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Funda Yilmaz
- Department of Pathology, Ege University, Izmir, Turkey
| | - Michelle D Reid
- Department of Pathology, Emory University Hospital, Atlanta, GA, USA
| | - Pelin Bagci
- Department of Pathology, Marmara University, Istanbul, Turkey
| | - Jiaqi Shi
- Department of Pathology and Clinical Labs, University of Michigan, Ann Arbor, MI, USA
| | - Jinru Shia
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Volkan Adsay
- Department of Pathology, Koc University, Istanbul, Turkey
| | - David S. Klimstra
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Olca Basturk
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Bertoglio P, Querzoli G, Kestenholz P, Scarci M, La Porta M, Solli P, Minervini F. Surgery for Solitary Fibrous Tumors of the Pleura: A Review of the Available Evidence. Cancers (Basel) 2023; 15:4166. [PMID: 37627194 PMCID: PMC10453165 DOI: 10.3390/cancers15164166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/12/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
Solitary fibrous tumors of the pleura (pSFT) are a relatively rare neoplasms that can arise from either visceral or parietal pleura and may have different aggressive biological behaviors. Surgery is well known to be the cornerstone of the treatment for pSFT. We reviewed the existing literature, focusing on the role of surgery in the management and treatment of pSFT. All English-written literature has been reviewed, focusing on those reporting on the perioperative management and postoperative outcomes. Surgery for pSFT is feasible and safe in all experiences reported in the literature, but surgical approaches and techniques may vary according to the tumor dimensions, localization, and surgeons' skills. Long-term outcomes are good, with a 10-year overall survival rate of more than 70% in most of the reported experiences; on the other hand, recurrence may happen in up to 17% of cases, which occurs mainly in the first two years after surgery, but case reports suggest the need for a longer follow-up to assess the risk of late recurrence. Malignant histology and dimensions are the most recognized risk factors for recurrence. Recurrence might be operated on in select patients. Surgery is the treatment of choice in pSFT, but a radical resection and a careful postoperative follow-up should be carried out.
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Affiliation(s)
- Pietro Bertoglio
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40100 Bologna, Italy; (M.L.P.); (P.S.)
- Alma Mater Studiorum, University of Bologna, 40064 Bologna, Italy
| | - Giulia Querzoli
- Pathology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40100 Bologna, Italy;
| | - Peter Kestenholz
- Division of Thoracic Surgery, Cantonal Hospital of Lucerne, 6000 Lucerne, Switzerland; (P.K.); (F.M.)
| | - Marco Scarci
- Department of Thoracic Surgery, Imperial College Healthcare NHS Trust, London W2 1NY, UK;
| | - Marilina La Porta
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40100 Bologna, Italy; (M.L.P.); (P.S.)
| | - Piergiorgio Solli
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40100 Bologna, Italy; (M.L.P.); (P.S.)
| | - Fabrizio Minervini
- Division of Thoracic Surgery, Cantonal Hospital of Lucerne, 6000 Lucerne, Switzerland; (P.K.); (F.M.)
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Gerykova L, Vebr T, Kudelka L, Poczos P, Cesak T, Gabalec F, Hornychova H, Soukup J. Expression of neuroendocrine markers in meningeal and extrameningeal solitary fibrous tumours - a potential diagnostic pitfall. Hum Pathol 2023:S0046-8177(23)00105-3. [PMID: 37169096 DOI: 10.1016/j.humpath.2023.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 05/13/2023]
Abstract
Solitary fibrous tumours (SFTs) may show unusual morphologies and in such circumstances, unexpected immunoprofile can be misleading. Following an index case of myxoid meningeal SFT with neuroendocrine immunoprofile, we decided to assess a neuroendocrine profile in SFTs from various locations. The cohort of 9 meningeal and 28 extrameningeal SFTs was evaluated for CNS WHO grade (G1-G3) and four tiered Demicco risk stratification. Immunohistochemical detection of synaptophysin, chromogranin, INSM1, CD56, and CD57 was performed in each case and semiquantitatively assessed (0 - no expression; 1+ <10% positive; 2+ 11-50%; 3+ >51%); whole sections (meningeal SFTs) or tissue microarray (extrameningeal SFTs) were used for immunohistochemistry. The cohort included 13 men and 24 females. Meningeal SFTs included 5 WHO G1, 3 WHO G2 and 1 WHO G3 tumours. Extrameningeal SFTs included 21 low-risk, 4 intermediate risk and 2 high risk tumours. INSM1 immunoreactivity was observed in 12/37 cases (32%, 8 cases 1+, 3 cases 2+, 1 case 3+); synaptophysin was positive in 6/35 cases (19%, 5 cases 1+, 1 case 2+); CD56 was positive in 20/37 (54%, 16 cases 1+, 3 cases 2+ and 1 case 3+) and CD57 was expressed in 14/36 cases (39%, 5 cases 1+, 4 cases 2+ and 5 cases 3+). Chromogranin positivity was not observed. No significant association was observed between expression of neuroendocrine markers and tumour grade, Demicco risk group or meningeal and extrameningeal location. Extrapleural SFTs showed tendency for positivity of INSM1 (p=0.014, χ2) and CD57 (p=0.017, χ2), compared to pleural SFTs.
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Affiliation(s)
- Lucie Gerykova
- The Fingerland Department of Pathology, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Sokolska 581, Hradec Kralove, Czech Republic
| | - Tomas Vebr
- Department of Neurosurgery, Hospital Na Homolce, Roentgenova 37/2, 150 30, Prague 5, Prague, Czech Republic
| | - Libor Kudelka
- Department of Pathology, Ostrava Municipal Hospital, Nemocniční 898/20A728 80 Ostrava-Moravská Ostrava, Czech Republic
| | - Pavel Poczos
- Department of Neurosurgery, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Sokolska 581, Hradec Kralove, Czech Republic
| | - Tomas Cesak
- Department of Neurosurgery, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Sokolska 581, Hradec Kralove, Czech Republic
| | - Filip Gabalec
- 4th Department of Internal Medicine, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Sokolska 581, Hradec Kralove, Czech Republic
| | - Helena Hornychova
- The Fingerland Department of Pathology, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Sokolska 581, Hradec Kralove, Czech Republic
| | - Jiri Soukup
- The Fingerland Department of Pathology, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Sokolska 581, Hradec Kralove, Czech Republic; Department of Pathology, Military University Hospital Prague, U Vojenské nemocnice 1200,169 02, Prague 6, Prague, Czech Republic.
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7
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Huang A, Su M, Jing Y, He S, He X, Ma J, Liu H. Orbital Primary Solitary Fibrous Tumor: A Proposed Recurrence Risk Prediction Model Based on 92 Cases. Hum Pathol 2023:S0046-8177(23)00104-1. [PMID: 37127080 DOI: 10.1016/j.humpath.2023.04.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 05/03/2023]
Abstract
Orbital primary solitary fibrous tumors (OPSFTs) are rare. To further characterize the clinical and pathological features of OPSFTs, 92 cases of OPSFT were analyzed to develop a risk prediction model. OPSFTs were equally distributed between males (n = 45) and females (n = 47) with a mean patient age of 40.8 years (median 39 years; range 5-70 years) at initial diagnosis. The mean tumor size was 2.79 cm (median 2.5 cm). Microscopically, the tumor cells were irregularly arranged in spindle, ovoid, or round shapes with varying amounts of collagen and branching blood vessels. Immunohistochemical staining showed positive STAT6 nuclear expression in all cases, loss of CD34 expression in seven cases, and a mean Ki-67 label index of 5.25% (range 1%-30%). All patients were initially surgically resected and had a median follow-up of 99 months: 33 patients recurred, 6 of whom presented with multiple recurrences and 1 with distant metastases. A predictive model for the risk of recurrence based on tumor size, mitosis, Ki-67 label index, and dominant constituent cell (DCC) was developed based on our results. In conclusion, OPSFTs are rare but can be reliably diagnosed based on characteristic morphological features and STAT6 immunohistochemistry. The rate of local recurrence of orbital tumors tends to be higher than the rate of distant metastases, which can be predicted by a risk stratification model specific to orbital tumors. Long-term clinical follow-up is recommended as advanced disease is common.
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Affiliation(s)
| | - Mingyue Su
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | | | | | | | - Jianmin Ma
- Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Science Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Giner F, Machado I, Rubio-Martínez LA, López-Guerrero JA, Claramunt-Alonso R, Navarro S, Ferrández A, Mayordomo-Aranda E, Llombart-Bosch A. Intimal Sarcoma with MDM2/CDK4 Amplification and p16 Overexpression: A Review of Histological Features in Primary Tumor and Xenograft, with Immunophenotype and Molecular Profiling. Int J Mol Sci 2023; 24:ijms24087535. [PMID: 37108696 PMCID: PMC10141691 DOI: 10.3390/ijms24087535] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/12/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
Intimal sarcomas (IS) are rare malignant mesenchymal tumors arising in large blood vessels of the systemic and pulmonary circulation and also in the heart. They are morphologically similar to other spindle cell, poorly differentiated sarcomas. The prognosis is poor and depends mainly on surgical options. Three cases of IS were collected from two institutions. Clinical data were retrieved and histological study was performed. A wide immunohistochemical panel was analyzed. FISH of MDM2 gene was performed, and a molecular study with NGS was implemented in all cases. The mean age of our cases was 54 years. Histologically, the tumors presented a diffuse growth pattern with heterogeneous atypical epithelioid or spindle cells and extensive thrombosed areas. All cases presented intense immunoexpression for MDM2, CDK4, CD117, c-myc, PDGFRA, and p16. PDGFRA, HTERT, and pan-TRK gained expression, while p16 lost intensity, being weaker in both the local recurrences and xenografts. The three cases showed amplification of MDM2 by FISH. NGS analysis revealed amplifications in the CDK4, PDGFRA, and KIT genes, together with BRAF mutation and KRAS amplification. P16 was expressed in all cases, losing intensity in local recurrence and xenografts. Two new alterations, a BRAF mutation and a KRAS amplification, were detected by NGS in different tumors, opening up new therapeutic options for these patients.
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Affiliation(s)
- Francisco Giner
- Pathology Department, University of Valencia, 46010 Valencia, Spain
- Pathology Department, Hospital Universitari i Politècnic La Fe of Valencia, 46026 Valencia, Spain
| | - Isidro Machado
- Pathology Department, Instituto Valenciano de Oncología, 46009 Valencia, Spain
| | | | | | | | - Samuel Navarro
- Pathology Department, Hospital Clínic Universitari, 46010 Valencia, Spain
| | - Antonio Ferrández
- Pathology Department, Hospital Clínic Universitari, 46010 Valencia, Spain
| | - Empar Mayordomo-Aranda
- Pathology Department, Hospital Universitari i Politècnic La Fe of Valencia, 46026 Valencia, Spain
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Rottmann D, Abdulfatah E, Pantanowitz L. Molecular testing of soft tissue tumors. Diagn Cytopathol 2023; 51:12-25. [PMID: 35808975 PMCID: PMC10084007 DOI: 10.1002/dc.25013] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/27/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The diagnosis of soft tissue tumors is challenging, especially when the evaluable material procured is limited. As a result, diagnostic ancillary testing is frequently needed. Moreover, there is a trend in soft tissue pathology toward increasing use of molecular results for tumor classification and prognostication. Hence, diagnosing newer tumor entities such as CIC-rearranged sarcoma explicitly requires molecular testing. Molecular testing can be accomplished by in situ hybridization, polymerase chain reaction, as well as next generation sequencing, and more recently such testing can even be accomplished leveraging an immunohistochemical proxy. CONCLUSION This review evaluates the role of different molecular tests in characterizing soft tissue tumors belonging to various cytomorphologic categories that have been sampled by small biopsy and cytologic techniques.
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Affiliation(s)
- Douglas Rottmann
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Eman Abdulfatah
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Liron Pantanowitz
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
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10
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Evaluation of Alternative Risk Stratification Systems in a Large Series of Solitary Fibrous Tumors with Molecular Findings and Ki-67 Index Data: Do They Improve Risk Assessment? Int J Mol Sci 2022; 24:ijms24010439. [PMID: 36613891 PMCID: PMC9820154 DOI: 10.3390/ijms24010439] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022] Open
Abstract
The clinical evolution of solitary fibrous tumors (SFTs) is often uncertain and several risk stratification systems (RSS) have been proposed. The Demicco et al. RSS is the most frequently implemented. In this study we aim to validate two alternative RSS (Sugita et al. and G-Score) using results for the Demicco RSS from a previous study of 97 SFTs. In addition, we aim to determine whether reclassified cases had any distinctive molecular features. As the Sugita et al. system substitutes mitotic count with Ki-67 index we also investigated whether Ki-67 results for tissue microarrays are comparable to those obtained using whole tissue sections. In the present study we detected that many cases classified by Demicco RSS as low-risk were reclassified as intermediate risk using the new system (G-score RSS). Kaplan-Meier survival plots for G-Score RSS showed that the low-risk and intermediate-risk SFTs had a similar evolution that contrasted with the more aggressive high-risk group. Moreover, the similar evolution in both low and intermediate-risk groups occurred despite the G-score system being stricter in classifying low-risk tumors. We observed that Sugita RSS does not provide any better risk stratification in comparison with the Demicco RSS, and testing both RSS in our series produced similar Kaplan-Meier survival data. We found some discordant results when comparing whole sections and the corresponding tissue microarrays samples, finding the hotspot areas easier to locate in whole sections. Forty-one SFTs with initial low-risk assigned by the Demicco RSS were reclassified as intermediate-risk by G-score finding both TP53 and HTER mutations in four cases, only HTER mutation in 11 cases, and only TP53 mutation in 2 cases. All six cases of SFT classified as high-risk by both the Demicco and G-score RSS suffered recurrence/metastasis, and half showed both TP53 and HTER mutations. Five SFTs were categorized as low-risk by both Demicco and G-score, of which 4 cases revealed HTER mutation. Regarding the outcome of these 5 patients, two were lost to follow-up, and one of the remaining three patients suffered recurrence. We believe that although the presence of both TP53 and HTER mutations may confer or be related to poor evolution, the isolated presence of HTER mutation alone would not necessarily be related to poor outcome. The G-score RSS more accurately identified low-risk patients than the other two risk models evaluated in the present series. Late recurrence/metastasis may occasionally be observed even in low-risk SFTs categorized by stricter classification systems such as the G-score RSS. These findings support the possibility that additional, as yet unknown factors may influence the clinical evolution of SFTs. In conclusion, given the possibility of late recurrence, long-term follow-up is recommended for all SFT patients, even in cases classified as low risk by the stricter G-score system. An integration of clinical, radiological, pathological, and molecular findings may improve SFT risk stratification and better predict patient outcome.
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11
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Pourfarrokh N, Wang Y, Cleaves C, Zreik R, Leng B. Solitary Fibrous Tumor of Hard Palate: A Case Report and Literature Review. J Investig Med High Impact Case Rep 2022; 10:23247096221142275. [PMID: 36546664 PMCID: PMC9793056 DOI: 10.1177/23247096221142275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Solitary fibrous tumor (SFT) is a mesenchymal tumor accounting for less than 2% of soft tissue tumors and has variable clinical behavior. It can arise in many anatomical locations of the body and in rare occasions in the oral cavity mostly in buccal mucosa and tongue. To date, a handful of such cases have been reported in the hard palate. We present a case of SFT in the hard palate of a 32-year-old man and describe the tissue morphology, immunohistochemistry workup, and follow-up together with literature review.
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Affiliation(s)
| | - Yilun Wang
- Texas A&M University Health Science
Center, College Station, USA
| | | | - Riyam Zreik
- Baylor Scott & White Medical
Center–Temple, TX, USA
| | - Bing Leng
- Baylor Scott & White Medical
Center–Temple, TX, USA,Bing Leng, MD, PhD, Department of
Pathology, Baylor Scott & White Medical Center–Temple, 2401 S. 31st Street,
Temple, TX 76508, USA.
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12
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Zhang Q, Dong Y, Zhou M, Guo Y, Lou L, Qu Z, Zheng Y, Duan Y. INSM1 Expression in Mesenchymal Tumors and Its Clinicopathological Significance. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1580410. [PMID: 36531655 PMCID: PMC9750778 DOI: 10.1155/2022/1580410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 11/03/2022] [Accepted: 11/17/2022] [Indexed: 04/11/2024]
Abstract
BACKGROUND Insulinoma-associated protein 1 (INSM1) has been identified as a nuclear marker of neuroendocrine tumors. Although INSM1 appears to be a subtle and specific biomarker for neuroendocrine tumor, its expression and clinicopathological significance in mesenchymal tumors remain unclear. METHODS We analyzed INSM1 mRNA level in GEO database and conducted immunohistological staining to detect the expression of INSM1 on 576 mesenchymal tumors from pathology department of Tongji Hospital. RESULTS At transcription level, INSM1 expression in AITL (angioimmunoblastic T-cell lymphoma) was higher than their adjacent normal tissues as well as Hodgkin's lymphoma. Moreover, INSM1 expression in well-differentiated liposarcoma (WDLPS) was significantly higher than normal fat (P = 0.014) and dedifferentiated liposarcoma (DDLPS) (P = 0.0248). At protein level, the positive rate of INSM1 in AITL was 18/48 (47.4%), while in DDLPS was 9/20 (45%). INSM1 expression in AITL was significantly higher than Hodgkin's lymphoma (P = 0.008). And INSM1 expression in WDLPS was significantly lower than DDLPS (P = 0.015). CONCLUSION The combination of GEO data and immunohistochemistry data indicated that the expression level of INSM1 was higher in AITL compared with normal control, suggesting that INSM1 may be involved in pathogenesis of AITL. The abnormal expression of INSM1 was found in WDLPS, and the positive rate of INSM1 was higher in DDLPS than in WDLPS. INSM1 may be involved in the regulation of liposarcoma development. There were significant differences in the expression of INSM1 between AITL and Hodgkin's lymphoma and WDLPS and DDLPS. These findings may assist in the differential diagnosis of these tumors when common markers are difficult to identify, enriching the diagnostic index system of mesenchymal tumors.
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Affiliation(s)
- Qian Zhang
- Institute of Pathology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430000, China
- Department of Pathology, School of Basic Medical Science, Huazhong University of Science and Technology, Wuhan 430000, China
| | - Yuting Dong
- Institute of Pathology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430000, China
- Department of Pathology, School of Basic Medical Science, Huazhong University of Science and Technology, Wuhan 430000, China
| | - Meidong Zhou
- Institute of Pathology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430000, China
| | - Yujuan Guo
- Institute of Pathology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430000, China
- Department of Pathology, School of Basic Medical Science, Huazhong University of Science and Technology, Wuhan 430000, China
| | - Liping Lou
- Institute of Pathology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430000, China
| | - Zhiling Qu
- Institute of Pathology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430000, China
- Department of Pathology, School of Basic Medical Science, Huazhong University of Science and Technology, Wuhan 430000, China
| | - Yiyun Zheng
- Institute of Pathology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430000, China
- Department of Pathology, School of Basic Medical Science, Huazhong University of Science and Technology, Wuhan 430000, China
| | - Yaqi Duan
- Institute of Pathology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430000, China
- Department of Pathology, School of Basic Medical Science, Huazhong University of Science and Technology, Wuhan 430000, China
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13
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Shirakura T, Yamada Y, Nakata S, Asayama B, Seo Y, Tanikawa S, Kato T, Komoribayashi N, Kubo N, Monma N, Okura N, Tanaka S, Oda Y, Hirato J, Yokoo H, Nobusawa S. Analysis of clinicopathological features and NAB2-STAT6 fusion variants of meningeal solitary fibrous tumor with ectopic salivary gland components in the cerebellopontine angle. Virchows Arch 2022; 481:913-923. [PMID: 36056239 DOI: 10.1007/s00428-022-03403-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 12/14/2022]
Abstract
Solitary fibrous tumors (SFTs) are rare mesenchymal tumors that can occur at any location. Since the identification of specific NAB2-STAT6 fusion in SFTs, the fusion gene variants, NAB2 exon 4-STAT6 exon 2/3 and NAB2 exon 5/6/7-STAT6 exon 16/17/18, have been reported to be associated with clinicopathological features, and the latter variant is predominant in meningeal SFTs. SFTs developing in the salivary glands are rare, and more rarely, those involving ectopic salivary glands (ESGs) have been reported in the cerebellopontine angle (CPA); however, their characteristics remain not well understood. In this study, we performed a clinicopathological and molecular analysis of 3 cases of meningeal SFT with ESGs. All cases presented with an extra-axial mass in the CPA, which is a rarer location for intracranial ESGs compared to the sellar region. Histologically, except for the presence of ESGs, there was no significant difference between current cases and ordinary SFTs. The ESGs demonstrated no cellular atypia, and although the spindle tumor cells were immunopositive for STAT6, the ESGs were negative in all cases, supporting that the ESGs are non-neoplastic components. In 1 case, ESGs were found only in the primary tumor and disappeared in recurrence/dissemination. Of note, molecular analysis identified NAB2 exon 4-STAT6 exon 2 in all cases. In conclusion, our results suggest that ESGs particularly in the CPA may be associated with SFTs and that meningeal SFTs with ESGs may be associated with the minor fusion variant of NAB2-STAT6 in the intracranial lesions.
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Affiliation(s)
- Takahiro Shirakura
- Department of Human Pathology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Yuichi Yamada
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Nakata
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bunsho Asayama
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
| | - Yoshinobu Seo
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
| | - Satoshi Tanikawa
- Department of Cancer Pathology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
- Institute for Chemical Reaction Design and Discovery (WPI-ICReDD), Hokkaido University, Sapporo, Japan
| | - Takayuki Kato
- Department of Neurosurgery, Daiyukai General Hospital, Ichinomiya, Japan
| | - Nobukazu Komoribayashi
- Iwate Prefectural Advanced Critical Care and Emergency Center, Iwate Medical University, Yahaba, Japan
- Department of Neurosurgery, Japanese Red Cross Morioka Hospital, Morioka, Japan
| | - Naohiko Kubo
- Department of Neurosurgery, Japanese Red Cross Morioka Hospital, Morioka, Japan
| | - Nobuhiro Monma
- Department of Pathology, Japanese Red Cross Morioka Hospital, Morioka, Japan
| | - Naoki Okura
- Department of Radiology, School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Shinya Tanaka
- Department of Cancer Pathology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
- Institute for Chemical Reaction Design and Discovery (WPI-ICReDD), Hokkaido University, Sapporo, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Junko Hirato
- Department of Human Pathology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
- Department of Pathology, Public Tomioka General Hospital, Tomioka, Japan
| | - Hideaki Yokoo
- Department of Human Pathology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Sumihito Nobusawa
- Department of Human Pathology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.
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14
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Sánchez Fernández C, García Lagarto E, Rodríguez-Arias CA. Recurrent meningeal malignant tumor: Assessment of differences in the solitary fibrous tumor/hemangiopericytoma spectrum through a case report. NEUROCIRUGIA (ENGLISH EDITION) 2022; 33:371-376. [PMID: 36333095 DOI: 10.1016/j.neucie.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/14/2021] [Indexed: 06/16/2023]
Abstract
Solitary fibrous tumors (SFTs) are neoplasms that grow from mesenchymal fusiform cells. In the central nervous system, meninges are the common origin of these neoplasms. Although literature reports mostly SFT as benign neoplasm, malignancy data have been described in recurrences or metastatic lesions. Definitive diagnosis includes immunohistochemical profiles assessing cellular positivity for CD34, vimentin, CD99 and Bcl-2. Recent studies have demonstrated NAB2-STAT6 gene fusion as a distinct molecular feature of SFT with overexpression of the fusion protein NAB2-STAT6 in nuclei of these cells. Since several years, pathologists have grouped SFT and hemangiopericytomas (HPC) as different phenotypes of the same entity although both neoplasms do not share numerous features. This article, based on a case of a recurrent malignant SFT, aims to emphasize differences in the SFT/HPC spectrum due to the diagnostic, therapeutic and prognostic implications.
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Affiliation(s)
| | - Elena García Lagarto
- Department of Pathology, University Clinical Hospital of Valladolid, Valladolid, Spain
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15
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Napolitano A, Moura DS, Hindi N, Mondaza-Hernandez JL, Merino-Garcia JA, Ramos R, Dagrada GP, Stacchiotti S, Graziano F, Vincenzi B, Martin-Broto J. Expression of p53 as a biomarker of pazopanib efficacy in solitary fibrous tumours: translational analysis of a phase II trial. Ther Adv Med Oncol 2022; 14:17588359221116155. [PMID: 35965642 PMCID: PMC9364178 DOI: 10.1177/17588359221116155] [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: 10/11/2021] [Accepted: 07/11/2022] [Indexed: 11/28/2022] Open
Abstract
Background: Solitary fibrous tumours (SFT) are soft tissue sarcomas molecularly defined
by the presence of the NAB2::STAT6 intrachromosomal fusion gene. Recently, a
prospective phase II trial evaluating the role of the antiangiogenic
tyrosine kinase inhibitor pazopanib in SFT has been conducted
(NCT02066285). Methods: Here, we analysed the mRNA and protein expression levels of the tumour
suppressor and angiogenesis regulator p53 (TP53) in
pre-treatment tumour samples from 22 patients with low aggressive (or
typical) SFT and 28 patients with high aggressive (26 malignant and 2
dedifferentiated) SFT enrolled in the aforementioned pazopanib phase II
trial. These results were correlated with radiological progression-free
survival (PFS) and objective response. Univariate and multivariate Cox
regression analyses were also performed, including known clinic-pathological
prognostic factors. Results: Diffuse immunohistochemistry (IHC) expression of p53 was only found in
patients with aggressive SFT and was associated with significantly shorter
PFS [hazard ratio (HR): 4.39, 95% confidence interval (CI): 1.19–16.14).
TP53 mRNA levels were significantly higher in the low
aggressive SFT group. Only in the high aggressive SFT group, relatively
higher levels of TP53 were significantly associated with
shorter PFS (HR: 4.16, 95% CI: 1.46–11.89) as well as to a lower rate of
disease control following treatment with pazopanib. In the multivariate
analysis, the only independent prognostic factor in the whole cohort was
mitotic count. Conclusion: Diffuse p53 IHC expression and higher TP53 mRNA levels are
associated with worse prognosis in the subset of aggressive SFT patients
treated with pazopanib.
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Affiliation(s)
- Andrea Napolitano
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - David S Moura
- Health Research Institute Fundacion Jimenez Diaz, Universidad Autonoma de Madrid (IIS/FJD-UAM), Madrid, Spain
| | - Nadia Hindi
- Health Research Institute Fundacion Jimenez Diaz, Universidad Autonoma de Madrid (IIS/FJD-UAM), Madrid, Spain
| | - José L Mondaza-Hernandez
- Health Research Institute Fundacion Jimenez Diaz, Universidad Autonoma de Madrid (IIS/FJD-UAM), Madrid, Spain
| | - José A Merino-Garcia
- Instituto de Investigacion Sanitaria Fundacion Jimenez Diaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Rafael Ramos
- Department of Pathology, University Hospital Son Espases, Palma, Spain
| | - Gian Paolo Dagrada
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Stacchiotti
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Bruno Vincenzi
- Department of Medical Oncology, University Campus Bio-Medico, via Alvaro del Portillo 200, Rome 00128, Italy
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16
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Kazazian K, Demicco EG, de Perrot M, Strauss D, Swallow CJ. Toward Better Understanding and Management of Solitary Fibrous Tumor. Surg Oncol Clin N Am 2022; 31:459-483. [PMID: 35715145 DOI: 10.1016/j.soc.2022.03.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Solitary fibrous tumor (SFT) comprises a histologic spectrum of soft tissue neoplasms that are characterized by the unique NAB2-STAT6 gene fusion. Changes in diagnostic terminology and site-specific classification over the past few decades have resulted in a disjointed literature. Complete surgical excision with preservation of function remains the mainstay of treatment. New risk stratification systems including risk factors such as mitotic rate, age, tumor size, and presence of necrosis, among others, can be used to predict risk of recurrence or metastasis. Long-term follow-up after surgical resection is recommended. The clinical manifestations, diagnosis, management, and prognosis of SFT are reviewed here.
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Affiliation(s)
| | - Elizabeth G Demicco
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Marc de Perrot
- Department of Surgery, University of Toronto, Toronto, Canada; Division of Thoracic Surgery, Princess Margaret Cancer Centre/University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G2C4, Canada
| | - Dirk Strauss
- Sarcoma Unit, Department of Academic Surgery, Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, England
| | - Carol J Swallow
- Department of Surgery, University of Toronto, Toronto, Canada; Department of Surgical Oncology, Princess Margaret Cancer Centre/Mount Sinai Hospital, Toronto, Canada.
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17
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Devins KM, Young RH, Croce S, Burandt E, Bennett JA, Pesci A, Zannoni GF, Ip PPC, Nielsen GP, Oliva E. Solitary Fibrous Tumors of the Female Genital Tract: A Study of 27 Cases Emphasizing Nonvulvar Locations, Variant Histology, and Prognostic Factors. Am J Surg Pathol 2022; 46:363-375. [PMID: 34739418 DOI: 10.1097/pas.0000000000001829] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report 27 solitary fibrous tumors of the female genital tract emphasizing nonvulvar locations, variant histology, and prognostic factors. The patients ranged from 25 to 78 years (most were over 40), and tumors occurred in the vulva (7), vagina (2), cervix (2), corpus (6), fallopian tube/paratubal soft tissue (5), and ovary (5). They ranged from 1.5 to 39 (mean=10.5) cm and were typically solid, but 4 were predominantly cystic. All had a haphazard arrangement of spindled to ovoid cells, with most demonstrating alternating cellular and hypocellular areas and prominent vessels, but 13 lacked hypocellular areas, and 7 had focal diffuse growth with inconspicuous vasculature. Other patterns included corded (8), fascicular (5), trabecular (1), and nested (1). Microcysts (6), myxoid background (8), hyalinization (8), lipomatous differentiation (2), and multinucleated cells (6) were also present, and 10 tumors had necrosis. Vasculature included thin-walled branching "staghorn" (27), thick-walled (7), and hyalinized vessels (5) or dilated anastomosing vascular channels (3). Nuclear atypia ranged from mild (19), moderate (7), to severe (1), and mitoses from 0 to 24/10 HPF (mean=4). STAT6 was positive in all 25 tumors tested. One tumor showed dedifferentiation; the remainder were classified as benign (19) or malignant (7) based on mitotic rate (univariate stratification model) and as low risk (14), intermediate risk (8), or high risk (4) based on the Demicco multivariate risk stratification score. Follow-up (median=23 mo) was available for 16 patients. Six tumors recurred (2 intermediate risk, 3 high risk, and the dedifferentiated tumor), 5 in the abdomen; the dedifferentiated tumor metastasized to the lung. Multivariate risk stratification was superior to univariate classification, as 5 "benign" tumors were reclassified as intermediate risk using the multivariate model; of these, 2 recurred, and 1 patient died of disease. Upper female genital tract tumors occurred in older patients, were larger, and more frequently classified as high risk compared with those of the lower tract. A trend toward increased cellularity was also seen in the upper tract tumors. Only size (P=0.04), necrosis (P=0.04), and Demicco score (P=0.01) independently correlated with recurrence. Female genital tract solitary fibrous tumors demonstrate a wide range of variant morphologies and occur in diverse sites in addition to the vulva. Tumors were often misdiagnosed as other neoplasms; thus, awareness of solitary fibrous tumors occurring at these sites is crucial in prompting staining for STAT6 to establish this diagnosis. The Demicco risk stratification system effectively predicts behavior.
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Affiliation(s)
- Kyle M Devins
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Robert H Young
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Sabrina Croce
- Department of Pathology, Bergonié Institute, Bordeaux, France
| | - Eike Burandt
- Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Anna Pesci
- Department of Pathology, IRCCS Sacred Heart Hospital, Negrar-Verona
| | - Gian F Zannoni
- Department of Pathology, Catholic University of the Sacred Heart, Rome, Italy
| | - Philip P C Ip
- Department of Pathology, University of Hong Kong, Pokfulam, Hong Kong
| | - G Petur Nielsen
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Esther Oliva
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
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18
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Sugita S, Segawa K, Kikuchi N, Takenami T, Kido T, Emori M, Akiyama Y, Takada K, Hinotsu S, Hasegawa T. Prognostic usefulness of a modified risk model for solitary fibrous tumor that includes the Ki-67 labeling index. World J Surg Oncol 2022; 20:29. [PMID: 35105348 PMCID: PMC8805435 DOI: 10.1186/s12957-022-02497-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/23/2022] [Indexed: 12/17/2022] Open
Abstract
Background Predicting the prognosis of patients with solitary fibrous tumor (SFT) is often difficult. The prognostic risk models developed by Demicco et al. are now the standard for evaluating the risk of SFT metastasis in the current World Health Organization classification of soft tissue and bone tumors. Methods In this study, we examined the prognostic usefulness of a modified version of the Demicco risk models that replaces the mitotic count with the Ki-67 labeling index. We compared the three-variable and four-variable Demicco risk models with our modified risk models using Kaplan–Meier curves based on data for 43 patients with SFT. Results We found a significant difference in metastasis-free survival when patients were classified into low-risk and intermediate/high-risk groups using the three-variable (P = 0.022) and four-variable (P = 0.046) Demicco models. There was also a significant difference in metastasis-free survival between the low-risk and intermediate/high-risk groups when the modified three-variable (P = 0.006) and four-variable (P = 0.022) models were used. Conclusion Modified risk models that include the Ki-67 labeling index are effective for prediction of the prognosis in patients with SFT.
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Affiliation(s)
- Shintaro Sugita
- Department of Surgical Pathology, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, 060-8543, Japan
| | - Keiko Segawa
- Department of Surgical Pathology, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, 060-8543, Japan
| | - Noriaki Kikuchi
- Department of Surgical Pathology, Sunagawa City Medical Center, Sunagawa, Hokkaido, 073-0196, Japan
| | - Tomoko Takenami
- Department of Surgical Pathology, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, 060-8543, Japan
| | - Tomomi Kido
- Department of Surgical Pathology, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, 060-8543, Japan
| | - Makoto Emori
- Department of Orthopedic Surgery, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, 060-8543, Japan
| | - Yukinori Akiyama
- Department of Neurosurgery, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, 060-8543, Japan
| | - Kohichi Takada
- Department of Medical Oncology, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, 060-8543, Japan
| | - Shiro Hinotsu
- Department of Biostatistics and Data Management, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, 060-8543, Japan
| | - Tadashi Hasegawa
- Department of Surgical Pathology, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, 060-8543, Japan.
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19
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Nonaka H, Kandori S, Nitta S, Shiga M, Nagumo Y, Kimura T, Kawahara T, Negoro H, Hoshi A, Kojima T, Kawai K, Mathis BJ, Tamura T, Sato TA, Yamato M, Noguchi M, Nishiyama H. Case Report: Molecular Characterization of Aggressive Malignant Retroperitoneal Solitary Fibrous Tumor: A Case Study. Front Oncol 2022; 11:736969. [PMID: 35004271 PMCID: PMC8727594 DOI: 10.3389/fonc.2021.736969] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/22/2021] [Indexed: 12/11/2022] Open
Abstract
Solitary fibrous tumors (SFT) are mesenchymal neoplasms with a favorable prognosis usually originating from the visceral pleura. Rarely, they may occur at various extrapleural sites and show malignant behavior coupled with dedifferentiation. NAB2-STAT6 fusion gene and STAT6 nuclear expression are biomarkers for diagnosis of SFT in addition to CD34, Bcl-2, and CD99. Furthermore, several reports have shown specific NAB2-STAT6 fusion variants and loss of STAT6 protein expression are associated with malignancy. We report a rare case of retroperitoneal SFT which rapidly progressed to death within 35 days after admission. Autopsy found a primary tumor containing both benign and malignant histologies, with multiple metastatic sites similar to the malignant, dedifferentiated tumor. STAT6 was detected in the primary differentiated tumor but not in the primary dedifferentiated tumor or lung/liver metastases. However, the NAB2-STAT6 fusion gene (NAB2ex6/STAT6ex16 variant) was detected in the primary tumor and lung/liver metastases. Intriguingly, fusion gene expression at the transcriptional level was downregulated in the dedifferentiated tumors compared to the differentiated tumor. We further performed target DNA sequencing and found gene mutations in TP53, FLT3, and AR in the dedifferentiated tumors, with TP53 mutations especially found among them. We demonstrate that downregulation of NAB2-STAT6 fusion gene at the transcriptional level is associated with malignant SFT for the first time. Moreover, the present study supports the idea that TP53 mutations promote malignancy in SFTs.
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Affiliation(s)
- Haruna Nonaka
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shuya Kandori
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Satoshi Nitta
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masanobu Shiga
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoshiyuki Nagumo
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tomokazu Kimura
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takashi Kawahara
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiromitsu Negoro
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akio Hoshi
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takahiro Kojima
- Department of Urology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Koji Kawai
- Department of Urology, School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Bryan J Mathis
- International Medical Center, University of Tsukuba Affiliated Hospital, Tsukuba, Japan
| | - Takuro Tamura
- Research and Development Centre for Precision Medicine, University of Tsukuba, Tsukuba, Japan
| | - Taka-Aki Sato
- Research and Development Centre for Precision Medicine, University of Tsukuba, Tsukuba, Japan
| | - Mariko Yamato
- Department of Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masayuki Noguchi
- Department of Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroyuki Nishiyama
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Maleki Z, Nadella A, Nadella M, Patel G, Patel S, Kholová I. INSM1, a Novel Biomarker for Detection of Neuroendocrine Neoplasms: Cytopathologists’ View. Diagnostics (Basel) 2021; 11:diagnostics11122172. [PMID: 34943408 PMCID: PMC8700458 DOI: 10.3390/diagnostics11122172] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Insulinoma-associated protein 1 (INSM1) has been considered as a novel immunostain for neuroendocrine tumors (NETs) and is hypothesized to be more reliable than first-generation NET biomarkers, such as CGA (chromogranin A), SYP (synaptophysin) and CD56 (neural cell adhesion molecule). In this review, we summarize existing literature on INSM1′s reliability as an immunostain for detection of various NETs, its results in comparison to first-generation NET biomarkers, and its expression in both non-NETs and benign tissues/cells on cytology specimens (cell blocks/smears).
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Affiliation(s)
- Zahra Maleki
- Division of Cytopathology, Department of Pathology, The Johns Hopkins Hospital, The Johns Hopkins Medical Institution, Baltimore, MD 21218, USA
- Correspondence: ; Tel.: +1-410-955-1180
| | - Akash Nadella
- Department of Pathology, Johns Hopkins University, Baltimore, MD 21218, USA; (A.N.); (M.N.); (G.P.); (S.P.)
| | - Mohnish Nadella
- Department of Pathology, Johns Hopkins University, Baltimore, MD 21218, USA; (A.N.); (M.N.); (G.P.); (S.P.)
| | - Gopi Patel
- Department of Pathology, Johns Hopkins University, Baltimore, MD 21218, USA; (A.N.); (M.N.); (G.P.); (S.P.)
| | - Shivni Patel
- Department of Pathology, Johns Hopkins University, Baltimore, MD 21218, USA; (A.N.); (M.N.); (G.P.); (S.P.)
| | - Ivana Kholová
- Department of Pathology, Fimlab Laboratories, Tampere, Faculty of Medicine and Health Technology, Tampere University, 33100 Tampere, Finland;
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21
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Salguero-Aranda C, Martínez-Reguera P, Marcilla D, de Álava E, Díaz-Martín J. Evaluation of NAB2-STAT6 Fusion Variants and Other Molecular Alterations as Prognostic Biomarkers in a Case Series of 83 Solitary Fibrous Tumors. Cancers (Basel) 2021; 13:cancers13205237. [PMID: 34680383 PMCID: PMC8534228 DOI: 10.3390/cancers13205237] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 12/21/2022] Open
Abstract
Simple Summary A solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm that can arise at any body location. Local or distant recurrences occur in a significant proportion of cases, but these recurrences are difficult to predict using clinical or pathological features. A specific genetic alteration, the gene fusion NAB2-STAT6, is considered to be the defining driver mutation, and different fusion variants seem to account for specific clinical and pathological features, but their prognostic value remains controversial. We inspected a series of 83 SFTs with a high rate of recurrence to evaluate the clinical significance of several potential biomarkers in addition to gene fusion. Our findings confirm previous observations and uncover novel associations of molecular alterations with clinical features, adding additional evidence for their potential application as molecular biomarkers that are helpful to predict the course of the disease. Abstract Risk stratification of solitary fibrous tumor (SFT) patients based on clinicopathological features has limited efficacy, especially in predicting late relapse or metastasis. The hallmark alteration of SFT is the gene fusion NAB2-STAT6, whose prognostic value remains controversial. As biological knowledge of this entity has increased in recent years, new molecular alterations have emerged that could be helpful to refine current risk models. Here, we evaluated NAB2-STAT6 fusion variants and other molecular alterations in a series of 83 SFTs that are enriched in progressing cases. Gene fusion variants were identified by targeted RNA-seq in the whole series, whereas TERT promoter (pTERT) mutations were inspected by Sanger sequencing in a subset of 18 cases. Immunohistochemical assays were performed to assess BCOR and NTRK expression as well as P53 mutation status in 45, 44, and 44 cases, respectively. While confirming the associations of gene fusion variants with clinicopathological parameters, our results do not prove their prognostic value. Pan-TRK immunoexpresion correlated with recurrence/progression, P53 staining associated with higher mitotic counts, and pTERT mutations were enriched in cases with fatal outcome. An intriguing correlation was found for BCOR protein expression with gene fusion variants, size, and tumor location.
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Affiliation(s)
- Carmen Salguero-Aranda
- Instituto de Biomedicina de Sevilla, Department of Pathology, Hospital Univesitario Virgen del Rocío, CSIC-Universidad de Sevilla, 41013 Seville, Spain; (C.S.-A.); (P.M.-R.); (D.M.)
- Centro de Investigación Biomédica en Red de Cáncer, Instituto de Salud Carlos III (CB16/12/00361, CIBERONC-ISCIII), 28029 Madrid, Spain
- Department of Normal and Pathological Cytology and Histology, School of Medicine, University of Seville, 41004 Seville, Spain
| | - Paula Martínez-Reguera
- Instituto de Biomedicina de Sevilla, Department of Pathology, Hospital Univesitario Virgen del Rocío, CSIC-Universidad de Sevilla, 41013 Seville, Spain; (C.S.-A.); (P.M.-R.); (D.M.)
| | - David Marcilla
- Instituto de Biomedicina de Sevilla, Department of Pathology, Hospital Univesitario Virgen del Rocío, CSIC-Universidad de Sevilla, 41013 Seville, Spain; (C.S.-A.); (P.M.-R.); (D.M.)
| | - Enrique de Álava
- Instituto de Biomedicina de Sevilla, Department of Pathology, Hospital Univesitario Virgen del Rocío, CSIC-Universidad de Sevilla, 41013 Seville, Spain; (C.S.-A.); (P.M.-R.); (D.M.)
- Centro de Investigación Biomédica en Red de Cáncer, Instituto de Salud Carlos III (CB16/12/00361, CIBERONC-ISCIII), 28029 Madrid, Spain
- Department of Normal and Pathological Cytology and Histology, School of Medicine, University of Seville, 41004 Seville, Spain
- Correspondence: (E.d.Á.); (J.D.-M.)
| | - Juan Díaz-Martín
- Instituto de Biomedicina de Sevilla, Department of Pathology, Hospital Univesitario Virgen del Rocío, CSIC-Universidad de Sevilla, 41013 Seville, Spain; (C.S.-A.); (P.M.-R.); (D.M.)
- Centro de Investigación Biomédica en Red de Cáncer, Instituto de Salud Carlos III (CB16/12/00361, CIBERONC-ISCIII), 28029 Madrid, Spain
- Department of Normal and Pathological Cytology and Histology, School of Medicine, University of Seville, 41004 Seville, Spain
- Correspondence: (E.d.Á.); (J.D.-M.)
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22
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Vincek V, Kallis P, Vause A, Vincek E, Ilkovitch D, Motaparthi K. Cutaneous solitary fibrous tumor: Report of three cases with review of histopathological mimics. J Cutan Pathol 2021; 49:167-171. [PMID: 34569103 DOI: 10.1111/cup.14138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/13/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022]
Abstract
Solitary fibrous tumor (SFT) is a relatively uncommon spindle cell mesenchymal neoplasm that is most often based on the pleura but may rarely arise in extrapleural locations, including the skin. Herein, we describe three cases of cutaneous SFTs. SFT is characterized by epithelioid and spindle cells arranged in random patterns with focal prominent stromal collagen and pericytomatous vessels. Immunohistochemical evaluation is required for definitive distinction of SFT from other benign and malignant cutaneous spindle cell neoplasms. Although aggressive biologic behavior is uncommon, accurate diagnosis of it is required for prognostication and counseling. CD34, bcl-2, and CD99 stains are positive in SFT, but not specific. STAT6 is the most sensitive and specific immunohistochemical marker to confirm diagnosis of SFT.
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Affiliation(s)
- Vladimir Vincek
- Department of Dermatology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Penelope Kallis
- Department of Dermatology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Ava Vause
- The Frank H. Netter M.D. School of Medicine, Quinnipiac University, North Haven, Connecticut, USA
| | - Erik Vincek
- The Frank H. Netter M.D. School of Medicine, Quinnipiac University, North Haven, Connecticut, USA
| | | | - Kiran Motaparthi
- Department of Dermatology, College of Medicine, University of Florida, Gainesville, Florida, USA
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Recurrent meningeal malignant tumor: Assessment of differences in the solitary fibrous tumor/hemangiopericytoma spectrum through a case report. Neurocirugia (Astur) 2021. [DOI: 10.1016/j.neucir.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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24
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Evaristo G, Fiset PO, Kassouf W, Jung S, Brimo F, Ajise O. Metastatic malignant solitary fibrous tumor of urinary bladder. HUMAN PATHOLOGY: CASE REPORTS 2021. [DOI: 10.1016/j.ehpc.2021.200527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Machado I, Nieto Morales MG, Cruz J, Lavernia J, Giner F, Navarro S, Ferrandez A, Llombart-Bosch A. Solitary Fibrous Tumor: Integration of Clinical, Morphologic, Immunohistochemical and Molecular Findings in Risk Stratification and Classification May Better Predict Patient outcome. Int J Mol Sci 2021; 22:ijms22179423. [PMID: 34502329 PMCID: PMC8430583 DOI: 10.3390/ijms22179423] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 01/04/2023] Open
Abstract
Although solitary fibrous tumors (SFTs) have an unpredictable evolution, some specific clinicopathologic factors have been associated with the final outcome. We retrieved clinical, pathological and molecular data of 97 patients with a histological diagnosis of SFT and Signal transducer and activator of transcription 6 (STAT6) positivity. We retrospectively studied the pathological factors predictive of recurrence/metastasis and compared them with the clinical outcome. A wide immunohistochemical study and molecular analysis to detect NAB2/STAT6 gene fusion, tumor protein-53 (TP53) and/or (telomerase reverse transcriptase) TERT promotor mutation were performed. The risk of metastasis was calculated using the Demicco risk stratification system (RSS). The results were combined and examined to assess the accuracy of risk stratification and classification. The most common location was in non-extremities; 66% were located in soft tissue or subcutaneous areas and 92.8% in deep locations. On microscopic analysis, 38.1% of tumors revealed hypercellularity with a predominant patternless and/or hemangiopericytic growth pattern; 13.4% had ≥4 mitoses/10HPF; 16.5% showed necrosis, and almost half the tumors showed at least focal myxoid areas. Dedifferentiation was observed in three tumors. Immunomarker expression in SFTs was as follows: CD34 92.9%, CD99 57.1%, Bcl2 67.9%, neuroendocrine markers (at least 1) 25.7%, Desmin 14.3%, CK(AE1/AE3) 3%, Apoptotic Protease Activating Factor (APAF-1) 87% and finally Ki-67 ≥ 10% in 14.4%. The NAB2/STAT6 gene fusion was detected in 50 tumors. After a median follow-up of 90 months, 9.3% recurred, 11.3% metastasized, 10.3% died of disease and 76.2% were free of disease. TERT mutations were detected in 40.6% of the SFTs; the TP53 mutation was detected in 17%, and only 9.3% showed both mutations. According to the Demicco RSS, 6.1%, 11.3% and 82.4% of the tumors were classified as high, intermediate or low-risk of metastasis, respectively. All high-risk tumors had ≥4 mitoses/10HPF, necrosis, Ki-67 ≥ 10, HTER and/or TP53 mutation and poor evolution. The intermediate risk SFTs with worse evolution displayed the HTER mutation. Almost all low-risk tumors had a favorable evolution, although four showed at least one adverse factor (Ki-67 ≥ 10, ≥4 mitoses/10HPF or high tumor size) and had a worse evolution. An integration of clinical, morphologic, immunohistochemical and molecular findings may improve risk stratification and classification and better predict patient outcome. The unfavorable course seems to be more frequent in high-risk SFTs, although it is not exceptional in low-risk SFTs either; hence, a long-term follow-up is required independently of the assigned risk stratification score. The inclusion of molecular findings in risk stratification systems could improve the precision in the classification of SFTs, especially those of intermediate risk. Future studies will be required to determine the most effective way to incorporate molecular analyses into RSS on SFTs. The coexistence of several adverse factors such as ≥4 mitoses/10HPF, necrosis, Ki-67 ≥ 10%, mutations in HTER and/or p53 may suggest a closer clinical follow-up regardless of the histological appearance of the tumor.
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Affiliation(s)
- Isidro Machado
- Pathology Department, Instituto Valenciano de Oncología, 46009 Valencia, Spain;
- Patologika Laboratory, Pathology Department, Hospital Quiron-Salud, 46009 Valencia, Spain
- Correspondence:
| | | | - Julia Cruz
- Pathology Department, Instituto Valenciano de Oncología, 46009 Valencia, Spain;
| | - Javier Lavernia
- Department of Oncology, Instituto Valenciano de Oncología, 46009 Valencia, Spain;
| | - Francisco Giner
- Pathology Department, University Hospital “La Fe”, 46009 Valencia, Spain;
| | - Samuel Navarro
- Pathology Department, University of Valencia, 46009 Valencia, Spain; (S.N.); (A.F.); (A.L.-B.)
| | - Antonio Ferrandez
- Pathology Department, University of Valencia, 46009 Valencia, Spain; (S.N.); (A.F.); (A.L.-B.)
| | - Antonio Llombart-Bosch
- Pathology Department, University of Valencia, 46009 Valencia, Spain; (S.N.); (A.F.); (A.L.-B.)
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Prejac J, Dedić Plavetić N, Gotovac Jerčić K, Borovečki F. A first report of a rare TP53 variant associated with Li-Fraumeni syndrome manifesting as invasive breast cancer and malignant solitary fibrous tumor. World J Surg Oncol 2021; 19:254. [PMID: 34452612 PMCID: PMC8399826 DOI: 10.1186/s12957-021-02370-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/12/2021] [Indexed: 01/01/2023] Open
Abstract
Background Li-Fraumeni is a rare autosomal dominant cancer predisposition syndrome. The basis is a germline mutation of TP53 gene which encodes tumor suppressor protein resulting in early onset of tumors, most often breast cancer, soft tissue sarcomas, brain tumors, adrenocortical carcinomas, and leukemia. Case report We present a case of a young woman with a positive family history for cancer diagnosed with malignant solitary fibrous tumor and luminal B-like invasive breast cancer. Breast cancer and sarcomas account for the majority of tumors associated with Li-Fraumeni syndrome, yet solitary fibrous tumor is a rare clinical entity with no established guidelines for treatment. Even though both primary tumors were successfully resected, the sarcoma relapsed in the form of lung metastases. The NGS analysis revealed single nucleotide variant (c.1101-1G>A) in TP53 gene, affecting the acceptor splice site at intron 10. Until now, only one case of this genetic variant has been documented with conflicting interpretations of pathogenicity. Conclusions The knowledge of TP53 mutation status is essential since the management of these patients requires different approach to avoid excessive toxicity due to the risk of developing secondary malignancy. Using the clinical criteria to screen for affected individuals facilitates appropriate early genetic counseling of patients and their families. Following the American College of Medical Genetics criteria, we believe that the reported single nucleotide variant (c.1101-1G>A) in TP53 gene should be considered pathogenic. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-021-02370-8.
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Affiliation(s)
- Juraj Prejac
- Department of Oncology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.,School of Dental Medicine, University of Zagreb, Gundulićeva 5, 10000, Zagreb, Croatia
| | - Natalija Dedić Plavetić
- Department of Oncology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia. .,School of Medicine, University of Zagreb, Šalata 3, 10000, Zagreb, Croatia.
| | - Kristina Gotovac Jerčić
- Department of Neurology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Fran Borovečki
- Department of Neurology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.,Center for Translational and Clinical Research, Department for Functional Genomics, School of Medicine, University Hospital Centre Zagreb, University of Zagreb, Šalata 2, 10000, Zagreb, Croatia
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27
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Apra C, Guillemot D, Frouin E, Bouvier C, Mokhtari K, Kalamarides M, Pierron G. Molecular description of meningeal solitary fibrous tumors/hemangiopericytomas compared to meningiomas: two completely separate entities. J Neurooncol 2021; 154:327-334. [PMID: 34417711 DOI: 10.1007/s11060-021-03830-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 08/14/2021] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Meningeal solitary fibrous tumors (SFT), like all SFT, are defined by NAB2-STAT6 fusion and share clinicopathologic similarities with meningiomas, the most frequent meningeal tumors. Our aim is to establish the molecular identity of meningeal SFT and seek molecular prognostic factors. METHODS RNA sequencing and whole exome sequencing were performed in STAT6-positive SFT and grade 2-3 meningiomas, and data concerning other soft tissues tumors was obtained from the local database. Uniform manifold approximation and projection, individual gene expression and Gene Set Enrichment Analysis were performed. RESULTS RNA clustering shows that SFT share a common molecular signature, different from any other type of tumoral tissue. Meningeal SFT aggregate with other SFT, with no clinical or histological subgroup. Comparison of genes expressions suggests significant over-expressions of ZIC2, ZIC3, ZIC5, GABBR2, TP53 in CNS-SFT. The pathogenic TP53 c.743G>T variant, previously undescribed in SFT, was found in one sample of meningeal SFT during malignant progression. CONCLUSIONS Meningeal SFT are molecular counterparts of extra-meningeal SFT, completely separate from meningiomas. They might develop from the same tissues and benefit from the same treatments as SFT.
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Affiliation(s)
- Caroline Apra
- Sorbonne Université, Paris, France.
- Department of Neurosurgery, Pitié-Salpêtrière Hospital, 47-83 bd de l'Hôpital, 75013, Paris, France.
- Paris Brain Institute, INSERM U1127, CNRS, UMR7225, 47-83 bd de l'Hôpital, 75013, Paris, France.
| | - Delphine Guillemot
- Pole of Diagnostic and Theranostic Medecine, Institut Curie, 26 rue d'Ulm, 75005, Paris, France
| | - Eléonore Frouin
- Pole of Diagnostic and Theranostic Medecine, Institut Curie, 26 rue d'Ulm, 75005, Paris, France
| | - Corinne Bouvier
- Department of Pathology, APHM, CHU Timone, INSERM, MMG Aix Marseille University, Marseille, France
| | - Karima Mokhtari
- Department of Neurosurgery, Pitié-Salpêtrière Hospital, 47-83 bd de l'Hôpital, 75013, Paris, France
- Paris Brain Institute, INSERM U1127, CNRS, UMR7225, 47-83 bd de l'Hôpital, 75013, Paris, France
- Department of Neuropathology, Pitié-Salpêtrière Hospital, 47-83 bd de l'Hôpital, 75013, Paris, France
| | - Michel Kalamarides
- Sorbonne Université, Paris, France
- Department of Neurosurgery, Pitié-Salpêtrière Hospital, 47-83 bd de l'Hôpital, 75013, Paris, France
- Paris Brain Institute, INSERM U1127, CNRS, UMR7225, 47-83 bd de l'Hôpital, 75013, Paris, France
| | - Gaëlle Pierron
- Pole of Diagnostic and Theranostic Medecine, Institut Curie, 26 rue d'Ulm, 75005, Paris, France
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Kasajima A, Konukiewitz B, Schlitter AM, Weichert W, Bräsen JH, Agaimy A, Klöppel G. Mesenchymal/non-epithelial mimickers of neuroendocrine neoplasms with a focus on fusion gene-associated and SWI/SNF-deficient tumors. Virchows Arch 2021; 479:1209-1219. [PMID: 34350470 PMCID: PMC8724147 DOI: 10.1007/s00428-021-03156-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 12/24/2022]
Abstract
Mimickers of neuroendocrine neoplasms (NEN) include a number of important pitfall tumors. Here, we describe our experience with mesenchymal mimics of NENs to illustrate their spectrum and draw the attention particularly to a group of mesenchymal/non-epithelial neoplasms (MN) that combine epithelioid histology with neuroendocrine (NE-) features and peculiar genetic abnormalities. In a consultation series of 4498 cases collected between 2009 and 2021, 2099 neoplasms expressing synaptophysin and/or chromograninA were reviewed and analyzed. A total of 364 (18%) were diagnosed as non-NENs, while the remaining tumors were NEN. The group of mesenchymal/non-epithelial neoplasms with NE-features (MN-NE) included 31/364 (8%) cases. These mostly malignant neoplasms showed an epithelioid morphology. While all but one tumor expressed synaptophysin, mostly patchy, only 10/29 (34%) co-expressed chromograninA. A total of 13/31 (42%) of the MN-NE showed EWSR1-related gene fusions (6 Ewing sarcomas, 5 clear cell sarcomas, and 1 desmoplastic small round cell tumor, 1 neoplasm with FUS-CREM gene fusion) and 7 (23%) were SWI/SNF (SMARCB1 or SMARCA4)-deficient neoplasms. The remaining MN-NE included synovial sarcoma, sclerosing epithelioid mesenchymal neoplasm, melanoma, alveolar soft part sarcoma, solitary fibrous tumor, and chordoma. A total of 27/31 MN-NE were from the last 8 years, and 6 of them were located in the pancreas. Eleven MN-NE were initially diagnosed as neuroendocrine carcinomas (NECs). MN-NE with epithelioid features play an increasing role as mimickers of NECs. They mostly belong to tumors with gene fusions involving the EWSR1 gene, or with SWI/SNF complex deficiency. Synaptophysin expression is mostly patchy and chromograninA expression is infrequent in MN-NE of this series and data extracted from literature.
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Affiliation(s)
- Atsuko Kasajima
- Department of Pathology, Technical University Munich, Trogerstr. 18, 81675, Munich, Germany.
- The German Cancer Consortium (DKTK), Heidelberg, Germany.
| | - Björn Konukiewitz
- Department of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Anna Melissa Schlitter
- Department of Pathology, Technical University Munich, Trogerstr. 18, 81675, Munich, Germany
- The German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Wilko Weichert
- Department of Pathology, Technical University Munich, Trogerstr. 18, 81675, Munich, Germany
- The German Cancer Consortium (DKTK), Heidelberg, Germany
| | | | - Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander-University, Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Günter Klöppel
- Department of Pathology, Technical University Munich, Trogerstr. 18, 81675, Munich, Germany
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29
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Dridi M, Boutonnat J, Dumollard JM, Peoc’h M, Karpathiou G. INSM1 Expression in Chordomas. Am J Clin Pathol 2021; 156:334-339. [PMID: 33629710 DOI: 10.1093/ajcp/aqaa250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Chordomas are rare malignant tumors with a broad differential diagnosis, including chondrosarcomas and metastatic carcinomas. Recently, insulinoma-associated protein 1 (INSM1) has gained great interest regarding the diagnosis of neuroendocrine tumors but also extraskeletal myxoid chondrosarcomas. However, its expression in chordomas remains largely unknown. METHODS We retrospectively examined 57 chordomas for INSM1 expression. RESULTS INSM1 expression was found in only 5% of tumors. CONCLUSIONS This marker is rarely expressed in this type of tumor, raising questions about neuroendocrine differentiation.
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Affiliation(s)
- Maroa Dridi
- Pathology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Jean Boutonnat
- Pathology Department, University Hospital of Grenoble, Grenoble, France
| | - Jean Marc Dumollard
- Pathology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Michel Peoc’h
- Pathology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Georgia Karpathiou
- Pathology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
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30
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Bianchi G, Lana D, Gambarotti M, Ferrari C, Sbaraglia M, Pedrini E, Pazzaglia L, Sangiorgi L, Bartolotti I, Dei Tos AP, Scotlandi K, Righi A. Clinical, Histological, and Molecular Features of Solitary Fibrous Tumor of Bone: A Single Institution Retrospective Review. Cancers (Basel) 2021; 13:cancers13102470. [PMID: 34069378 PMCID: PMC8158730 DOI: 10.3390/cancers13102470] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/14/2021] [Accepted: 05/16/2021] [Indexed: 01/07/2023] Open
Abstract
Simple Summary Solitary fibrous tumors arising from the bone are an extremely rare event and only few cases have been previously described in the literature. It is characterized by a prominent, branched vascularization, with a thin and dilated vascular texture defined as “staghorn” and by the presence of the NAB2-STAT6 gene rearrangement, present in about 90% of cases and considered a pathognomonic feature. In the present study, we described our series of 24 cases of primary solitary fibrous tumor of the bone to find any clinical and molecular prognostic factors and to compare them with those currently used for soft tissue solitary fibrous tumor and to evaluate the risk stratification system proposed by Demicco, in order to understand whether this system was able to correctly predict the risk of local and distant metastatic relapse even in the case of solitary fibrous tumor of the bone. Abstract Primary solitary fibrous tumor (SFT) of the bone is extremely rare, with only few cases reported in the literature. We retrieved all cases of primary SFT of the bone treated at our institution and we assessed the morphology and the immunohistochemical and molecular features to investigate the clinical outcome of primary SFT of the bone and any clinical relevance of clinical and histological criteria of aggressiveness currently adopted for the soft tissues counterpart. Morphologically, 15 cases evidenced high cellularity, cytologic atypia, and foci of necrosis and were associated with more than 4 mitotic figures/10 HPF. Immunohistochemical analysis showed an expression of CD34 and of STAT6 immunopositivity in 95% and in 100% of cases, respectively. The presence of NAB2-STAT6 chimeric transcripts was found in 10 out of 12 cases in which RT-PCR analysis was feasible, whereas TERT promoter mutations analysis was feasible in 16 cases and only a C-to-T substitution in a heterozygous state was found in one DNA sample for the C228T genetic variant. P53 variants were assessed in 12 cases: 11 (91.6%) cases showed a variation, while in one case, no alteration was found. Disease-specific survival was 64% at 5 years and 49% at 10 years. Statistical analysis showed no correlation between survival and all the clinicopathological and molecular parameters evaluated. In conclusion, at difference to SFT of soft tissues, aggressive behavior of primary SFT of the bone seems to be independent from mitotic count or any other clinicopathological and molecular features.
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Affiliation(s)
- Giuseppe Bianchi
- Department of Orthopedic Oncology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.B.); (D.L.)
| | - Debora Lana
- Department of Orthopedic Oncology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.B.); (D.L.)
| | - Marco Gambarotti
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
| | - Cristina Ferrari
- Experimental Oncology Laboratory, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (C.F.); (L.P.); (K.S.)
| | - Marta Sbaraglia
- Department of Pathology, Azienda Ospedaliera di Padova, 35121 Padua, Italy;
| | - Elena Pedrini
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (E.P.); (L.S.); (I.B.)
| | - Laura Pazzaglia
- Experimental Oncology Laboratory, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (C.F.); (L.P.); (K.S.)
| | - Luca Sangiorgi
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (E.P.); (L.S.); (I.B.)
| | - Isabella Bartolotti
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (E.P.); (L.S.); (I.B.)
| | - Angelo Paolo Dei Tos
- Department of Medicine, University of Padua School of Medicine, 35121 Padua, Italy;
| | - Katia Scotlandi
- Experimental Oncology Laboratory, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (C.F.); (L.P.); (K.S.)
| | - Alberto Righi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
- Correspondence: ; Tel.: +39-051-636-6665
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Castanheira A, Vieira MJ, Pinto M, Dias C, Prada L, Macedo S, Fernandes MS, Vieira F, Soares P, Mota A, Lopes JM, Boaventura P. TERTp mutations and p53 expression in head and neck cutaneous basal cell carcinomas with different aggressive features. Sci Rep 2021; 11:10395. [PMID: 34001963 PMCID: PMC8129122 DOI: 10.1038/s41598-021-89906-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 05/04/2021] [Indexed: 02/07/2023] Open
Abstract
Cutaneous basal cell carcinoma (cBCC) is an economic burden to health services, due to its great morbidity and increasing incidence in old people. Infiltrative cBCCs and cBCCs with micronodular pattern are considered as more aggressive. The role of p53 expression and TERTp mutation on cBCC behavior remains to be clarified. We aimed to assess TERTp mutations and p53 expression in relation to the cBCC histological subtype in a cohort of patients referred to an ENT Department of a tertiary Hospital of Northern Portugal. We performed a retrospective clinicopathological and histological review of the head and neck cBCCs followed-up at the otorhinolaryngology department of Trás-os-Montes e Alto Douro hospital (January 2007–June 2018). We assessed TERTp mutations in 142 cBCCs and p53 protein expression, through immunohistochemistry, in 157 cBCCs. We detected TERTp mutations in 43.7% of cBCCs and p53 overexpression in 60.5% of cBCCs. We spotted association of p53 overexpression and TERTp mutation with necrosis. In the infitrative-growth pattern cBCCs, there was no significant association with the clinical and histological features evaluated, except for necrosis. In the indolent-growth cBCCs, we identified a significant association of TERTp mutation status with female sex, necrosis, multiple cBCCs, and p53 positive expression. Our results suggest that TERTp mutation may be useful to identify more aggressive features in the indolent-growth pattern cBCCs (nodular and superficial subtypes). Further studies with larger cohorts are warranted to clarify the relevance of TERTp mutation in cBCCs.
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Affiliation(s)
- António Castanheira
- Department of Otorhinolaryngology, Centro Hospitalar de Trás-Os-Montes e Alto Douro, Vila Real, Portugal.,FMUP-Faculty of Medicine, University of Porto, Porto, Portugal
| | - Maria João Vieira
- IPATIMUP-Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal
| | - Mafalda Pinto
- IPATIMUP-Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal
| | - Carolina Dias
- IPATIMUP-Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal
| | - Luísa Prada
- IPATIMUP-Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | - Sofia Macedo
- IPATIMUP-Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal
| | | | | | - Paula Soares
- FMUP-Faculty of Medicine, University of Porto, Porto, Portugal.,IPATIMUP-Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal
| | - Alberto Mota
- FMUP-Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Dermatology, Centro Hospitalar São João, Porto, Portugal
| | - José Manuel Lopes
- FMUP-Faculty of Medicine, University of Porto, Porto, Portugal.,IPATIMUP-Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal.,Department of Pathology, Centro Hospitalar São João, Porto, Portugal
| | - Paula Boaventura
- FMUP-Faculty of Medicine, University of Porto, Porto, Portugal. .,IPATIMUP-Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal. .,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal.
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Rodrigues MFSD, Tobouti PL, Molon AC, Sedassari BT, Nunes FD, Pinto DDS, de Sousa SCOM. Histopathological findings and immunohistochemical expression of the stem cell markers CD44, ALDH1, Bmi-1, and Nanog in oral solitary fibrous tumors. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 131:444-451. [PMID: 33610537 DOI: 10.1016/j.oooo.2020.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/25/2020] [Accepted: 11/08/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the histomorphologic presentation and the expression of stem cell-related markers in a series of oral solitary fibrous tumors (SFTs). STUDY DESIGN Histopathological variables and the expression of the standard stem cell markers CD34 and CD99, used for SFT diagnosis, as well as STAT6 were evaluated in 13 oral SFTs. The expression of the cancer stem cell markers CD44, ALDH1, Bmi-1, and Nanog and the tumor suppressor gene p16Ink4a were also investigated. RESULTS The majority of oral SFTs were circumscribed and characterized by a proliferation of spindle cells arranged in a hyalinized stroma. Only 2 oral SFTs showed >4 mitoses/10 high-power fields. Hypercellularity as well as nuclear and cellular pleomorphism were classified as low and moderate in most of the oral SFTs. All oral SFTs were positive for CD34, STAT6, CD44, ALDH1, Bmi-1, and p16Ink4a. CD99 and Nanog expression was observed in 11 and 10 oral SFT cases, respectively. CONCLUSION We suggest that STAT6 and ALDH1 have relevant diagnostic value. The expression of CD44, ALDH1, Bmi-1, and Nanog, which is observed in cancer stem cells, may confer advantages to oral SFT cells.
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Affiliation(s)
| | | | - Angela Cristina Molon
- Biophotonics Applied to Health Science, Nove de Julho University, São Paulo, Brazil.
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Abstract
The fifth edition of the World Health Organization Classification of Tumors of Soft Tissue and Bone was published in early 2020. The revisions reflect a consensus among an international expert editorial board composed of soft tissue and bone pathologists, geneticists, a medical oncologist, surgeon, and radiologist. The changes in the soft tissue tumor chapter notably include diverse, recently described tumor types (eg, atypical spindle cell/pleomorphic lipomatous tumor, angiofibroma of soft tissue, and CIC-rearranged sarcoma), new clinically significant prognostic information for a variety of existing entities (eg, dedifferentiated liposarcoma and solitary fibrous tumor), and a plethora of novel genetic alterations, some of practical diagnostic relevance (eg, NAB2-STAT6 in solitary fibrous tumor, FOSB rearrangements in epithelioid hemangioma and pseudomyogenic hemangioendothelioma, and SUZ12 or EED mutations in malignant peripheral nerve sheath tumor, leading to loss of H3K27 trimethylation). In this review, we highlight the major changes to the soft tissue chapter in the 2020 World Health Organization Classification, as well as the new chapter on undifferentiated small round cell sarcomas, with a focus on updates in diagnostic categories, prognostication, and novel markers. Recent discoveries in molecular genetics are also discussed, particularly those of immediate utility in differential diagnosis, including protein correlates detectable using immunohistochemistry.
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