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Li L, Ma XK, Gao Y, Wang DC, Dong RF, Yan J, Zhang R. Clinicopathological study of malignant peripheral nerve sheath tumors in the head and neck: Case reports and review of literature. World J Clin Cases 2023; 11:5910-5918. [PMID: 37727493 PMCID: PMC10506041 DOI: 10.12998/wjcc.v11.i25.5910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/20/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Malignant peripheral nerve sheath tumor (MPNST) is a rare and aggressive soft tissue sarcoma that poses a major diagnostic and therapeutic challenge. CASE SUMMARY We retrospectively reviewed patients with head and neck MPNSTs treated in our hospital from 2000 to 2021. The clinical features, pathological manifestations, treatments, and prognoses were summarized. We also reviewed the literature, focusing on MPNST in the mandible and maxilla. The study population consisted of five women and five men aged 22-75 years (mean age, 49 years). Of the 10 patients, 7 were initial cases and 3 were recurrent cases. All lesions were sporadic. The most common site was the mandible. The most frequently encountered symptoms were a progressive mass and local swelling. Complete or partial loss of trimethylation at lysine 27 of histone H3 (H3K27me3) was evident on staining in four of nine cases (one case was excluded due to lack of tissue for evaluation of loss of H3K27me3). The 2- and 5-year disease-specific survival rates were 86% and 43%, respectively. The average survival time was 64 mo. CONCLUSION MPNST is a highly malignant tumor with a poor prognosis, prone to a high risk of recurrence and distant metastasis. Complete surgical resection is the main treatment.
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Affiliation(s)
- Long Li
- Department of Oral Pathology, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing 100000, China
- Research Unit of Precision Pathologic Diagnosis in Tumors of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences, Beijing 100000, China
- Department of Oral Pathology, Xiangya Stomalogical Hospital & School of Stomatology, Central South University, Changsha 410078, Hunan Province, China
| | - Xiao-Kun Ma
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital of Soochow University, Suzhou Stomatological Hospital, Suzhou 215000, Jiangsu Province, China
| | - Yan Gao
- Department of Oral Pathology, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing 100000, China
- Research Unit of Precision Pathologic Diagnosis in Tumors of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences, Beijing 100000, China
| | - Dian-Can Wang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Peking University School and Hospital of Stomatology, Beijing 100000, China
| | - Rong-Fang Dong
- Department of Pathology, Beijing Jishuitan Hospital, Beijing 100000, China
| | - Jing Yan
- Department of Oral Pathology, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing 100000, China
- Research Unit of Precision Pathologic Diagnosis in Tumors of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences, Beijing 100000, China
| | - Ran Zhang
- Department of Oral Pathology, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing 100000, China
- Research Unit of Precision Pathologic Diagnosis in Tumors of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences, Beijing 100000, China
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Harvey A, Soukup JW, Bell CM. Feline maxillary sarcoma: clinicopathologic features of spindle cell sarcomas from the maxilla of 25 cats. J Feline Med Surg 2022; 24:e647-e654. [PMID: 36350718 PMCID: PMC10812361 DOI: 10.1177/1098612x221128260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
CASE SERIES SUMMARY Feline maxillary sarcomas are aggressive spindle cell neoplasms that occur within the maxilla, palate and upper lip of cats. This diagnosis includes fibrosarcoma and sarcomas with indeterminate histomorphology, excluding melanocytic tumors and sarcomas that can be differentiated by histomorphology. In this study of feline maxillary sarcomas in 25 cats, the cats' ages ranged from 4 to 16 years (median 12.5). These sarcomas presented as smooth thickenings or mass lesions of the gingiva and palate, often involving both the right and left quadrants of the maxilla. Radiographic bone loss was typically absent to mild at the time of diagnosis. Histologically, feline maxillary sarcomas were composed of spindle cells with varying amounts of fibrous stroma and mild inflammation. Metastasis was not documented for any cat in the study, although clinical staging was limited. Cats were often euthanized because of local recurrence following incomplete tumor excision and local tumor progression. Median survival time from the date of histologic diagnosis was 70 days (n = 12). RELEVANCE AND NOVEL INFORMATION Feline maxillary sarcomas are aggressive neoplasms that may be difficult to differentiate from a benign, reactive process or other types of spindle cell neoplasms. Our findings indicate that feline maxillary sarcoma has distinctive clinical and histopathologic features, and the information provided in this paper will facilitate early and specific diagnosis of this tumor.
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Affiliation(s)
- Alexandra Harvey
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI, USA
- Current address: Specialty Oral Pathology for Animals, LLC, Geneseo, IL, USA
| | - Jason W Soukup
- Department of Surgical Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Cynthia M Bell
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI, USA
- Current address: Specialty Oral Pathology for Animals, LLC, Geneseo, IL, USA
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Radiation-induced Sarcoma in the Head and Neck: Clinical, Imaging, Histopathological, and Therapeutic Characterization. PLASTIC AND RECONSTRUCTIVE SURGERY - GLOBAL OPEN 2022; 10:e4418. [PMID: 35923999 PMCID: PMC9287269 DOI: 10.1097/gox.0000000000004418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 04/20/2022] [Indexed: 11/25/2022]
Abstract
Radiation-induced head and neck sarcoma (RIHNS) is a rare and serious long-term complication of radiotherapy (RT), with poor prognosis and high morbidity and mortality. Diagnosis is based on immunohistochemistry and molecular biomarker analysis, and therapy is usually surgical. Other adjuvant therapies might be considered. This case report aimed to describe the clinical, imaging, histopathological, and therapeutic characteristics of a rare case of RIHNS in the mandible after 21 years of RT. A 68-year-old male patient underwent a partial left parotidectomy in 1995, was diagnosed with pleomorphic adenoma, and after recurrence of the lesion in 2000, underwent an ipsilateral total parotidectomy with adjuvant RT. In May 2021, he complained of an ulcerated nodular lesion on the tongue that extended toward the lower gingiva, associated with oral bleeding and difficulties with swallowing. After biopsy in the gingival margin and histopathological analysis, the diagnosis of high-grade spindle-cell sarcoma was established. Complete surgical resection with microsurgical reconstruction using a fibular osteomusculocutaneous free flap was performed. RIHNS could appear after a period of almost 20 years after RT. Surgical resection with reconstructive surgery was a reliable and feasible therapeutic option that showed favorable clinical results after an appropriate follow-up.
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Challenges in the management of head and neck sarcomas in a resource scarce setting: A review of 54 cases. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2022. [DOI: 10.1016/j.adoms.2022.100316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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An Atypical Presentation of Sinonasal Tract Alveolar Rhabdomyosarcoma in a Young Male Patient Submitted to Multimodality Treatment. Case Rep Oncol Med 2021; 2021:8401755. [PMID: 34754521 PMCID: PMC8572639 DOI: 10.1155/2021/8401755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/08/2021] [Indexed: 11/18/2022] Open
Abstract
Rhabdomyosarcoma (RMS), a malignant tumor derived from the neoplastic proliferation of striated skeletal muscle cells, is the most common pediatric soft tissue sarcoma. Its treatment is mainly based on neoadjuvant chemotherapy (QT+), surgical resection, and adjuvant radiotherapy (RT+). RT+ has shown satisfactory results for locoregional control of the disease, in spite of promoting local side effects. The present case report was aimed at describing the clinical and therapeutic characteristics and the management of complications resulting from multimodal therapy in a patient with an atypical presentation of RMS in the sinonasal tract. A 20-year-old Afro-descendant man complained of an expansive tumor lesion, with left eye proptosis that reduced visual acuity and caused severe regional pain. Imaging analysis showed an extensive and infiltrative lesion in the periorbital region, sinonasal tract, left maxilla, and orbital roof. According to the histopathological analysis, the diagnosis was established corresponding to parameningeal alveolar RMS that was unresectable. Treatment was initiated with three cycles of QT+ which showed partial response and later RT+. After completing half of the RT+ sessions, the patient showed a complete response with reduction in tumor volume and improvement in pain and local conditions. Side effects such as alopecia and dermatological changes induced by radiation were observed. Moreover, painful erythematous areas were observed in the region of the hard and soft palate, uvula, and oropharynx, compatible with Grade 2 mucositis lesions. After the cytological swab test, some of them were diagnosed as herpes simplex lesions; thickening and decrease in salivary flow were also found. A local drug therapy approach was instituted, and photobiomodulation was performed to manage oral complications. RT+ was shown to be effective in locoregional control of the disease; however, the early management of its undesirable effects on the surrounding tissues was required.
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Agaimy A, Skalova A, Franchi A, Alshagroud R, Gill AJ, Stoehr R, Baumhoer D, Bauer S. Ameloblastic fibrosarcoma: clinicopathological and molecular analysis of seven cases highlighting frequent BRAF and occasional NRAS mutations. Histopathology 2020; 76:814-821. [PMID: 31899815 DOI: 10.1111/his.14053] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/18/2019] [Accepted: 12/21/2019] [Indexed: 12/21/2022]
Abstract
AIMS Ameloblastic fibrosarcoma (AFS) is an aggressive odontogenic neoplasm featuring malignant mesenchymal stroma in addition to an ameloblastic epithelial component, and is hence considered to be the malignant counterpart of ameloblastic fibroma (AF). AFS is exceedingly rare, with <110 cases having been reported so far. Although BRAF mutations are recognised driver mutations in ameloblastoma, the molecular pathogenesis of AFS remains elusive. METHODS AND RESULTS We herein describe seven AFSs that were analysed, for the first time, for mutations in the BRAF-NRAS pathway. The patients were four females and three males aged 23-57 years (median, 26 years). Three tumours developed after one or multiple recurrences of AF (4-20 years after initial diagnosis), two showed transition from AF-like bland areas, and two developed de novo. All patients were treated with surgery; adjuvant chemotherapy was given to one patient. At the last follow-up, five patients were alive and well (19-344 months). The remainder were lost to follow-up. Histological examination showed variable sarcomatous overgrowth with varying degrees of atypia and increased mitotic activity. The epithelial component varied greatly according to the degree of sarcomatous overgrowth. Molecular testing revealed BRAF V600E mutations in five cases and NRAS p.Gln61Lys mutation in one case. One tumour was wild-type. CONCLUSION To our knowledge, this is the first study on BRAF/NRAS mutations in AFS. Given the activity of RAF and MEK inhibitors across different cancers harbouring V600E mutations, our data strongly suggest that all AFS cases should be genetically tested, and that targeted treatment approaches for this extremely rare sarcoma subtype should be clinically investigated.
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Affiliation(s)
- Abbas Agaimy
- Institute of Pathology, University Hospital, Erlangen, Germany
| | - Alena Skalova
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Plzen, Czech Republic
| | - Alessandro Franchi
- Department of Translational Research, School of Medicine, University of Pisa, Pisa, Italy
| | - Rana Alshagroud
- Department of Oral Medicine and Diagnostic Science, King Saud University, Riyadh, Saudi Arabia
| | - Anthony J Gill
- Sydney Medical School University of Sydney, St Leonards, NSW, Australia.,Cancer Diagnosis and Pathology Group, Kolling Institute, St Leonards, NSW, Australia.,NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Robert Stoehr
- Institute of Pathology, University Hospital, Erlangen, Germany
| | - Daniel Baumhoer
- Department of Pathology, University Hospital Basel, Basel, Switzerland
| | - Sebastian Bauer
- Sarcoma Centre, Western German Cancer Centre, University of Duisburg-Essen Medical School, Essen, Germany
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Schwitzer D, Kim R, Williams F, Hammer D. Spindle Cell Sarcoma of the Maxilla: A Rare Entity, Case Report, and Review of the Literature. J Oral Maxillofac Surg 2020; 78:1334-1342. [PMID: 32147227 DOI: 10.1016/j.joms.2020.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/03/2020] [Accepted: 02/03/2020] [Indexed: 10/25/2022]
Abstract
Spindle cell sarcoma (SCS) is a malignancy, with the most recent Surveillance, Epidemiology, and End Results (SEER) data citing a total of 250 reported cases occurring in the head and neck. Of these cases, none originated in the maxillofacial hard tissue. To the best of our knowledge, only 2 cases of primary osseous SCS of the maxillofacial region have been reported. These cases were not accounted for in the SEER data. The diagnosis of SCS requires its differentiation from other sarcomas and spindle cell neoplasms. Therefore, a comprehensive review to reinforce its inclusion in oral and maxillofacial surgeons' differential diagnosis for osseous neoplastic pathology is desired. In the present case report, we have described a maxillary SCS in a patient with an initial diagnosis of a spindle cell lesion of uncertain biologic behavior. We reviewed the data for SCS, including the epidemiologic data, diagnostic challenges, clinical and radiographic presentations, prognostic indicators, and treatment.
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Affiliation(s)
- David Schwitzer
- Resident, Department of Oral and Maxillofacial Surgery, Parkland Memorial Hospital, UT Southwestern Medical Center, Dallas, TX.
| | - Roderick Kim
- Director of Research and Assistant Fellowship Director, Division of Maxillofacial Oncology and Reconstructive Surgery, John Peter Smith Hospital, Fort Worth, TX
| | - Fayette Williams
- Faculty, Division and Fellowship Director, Division of Maxillofacial Oncology and Reconstructive Surgery, John Peter Smith Hospital, Fort Worth, TX
| | - Daniel Hammer
- Fellow, Division of Maxillofacial Oncology and Reconstructive Surgery, John Peter Smith Hospital, Fort Worth, TX
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