Proximal-type epithelioid sarcoma-a rare soft tissue sarcoma of thigh in a child

Primary proximal epithelioid sarcoma of the lung: A case report and review of the literature

Epithelioid sarcoma (ES) is a rare mesenchymal tumor that can be divided into proximal/axial type and classical/distal type. Primary proximal epithelioid sarcoma of the lung is extremely rare. So far, no more than five cases have been reported. We reported a case of primary pulmonary ES and reviewed the literature to summarize its clinicopathological features. A 51-year-old man presented with hemoptysis and cough. Chest computed tomography (CT) showed a nodule located in the apical and posterior segments of the left upper lobe of the lung. The patient underwent a lobectomy, and a pathologic diagnosis of epithelioid sarcoma was made. Histologically, most tumors are composed of epithelioid cells with evidence of bidirectional expression of epithelium and mesenchyma. The SMARCB1 stain of tumor cells was negative, and a pathogenic mutation of SMARCB1 p.E115* (exon 3) were identified by the next-generation sequencing. Two months after surgery, positron emission tomography/computed tomography (PET/CT) indicated tumor recurrence, and the patient received a round of adjuvant chemotherapy combined with immunotherapy. After 11 months of follow-up, the patient died. We reported in detail the primary proximal epithelioid sarcoma of the lung treated with immunotherapy for the first time, providing ideas for diagnosis and treatment.

Primary pleural epithelioid sarcoma of the proximal type: a diagnostic and therapeutic challenge

Epithelioid sarcoma (ES) is an uncommon soft tissue neoplasm first described in 1970. It is a unique soft tissue neoplasm of adolescents and younger adults which usually presents as a subcutaneous and deep dermal mass in the distal portions of the extremities. The proximal-type variant of this rare soft tissue neoplasm was only recently reported. The proximal form typically arise in proximal extremities and in the deep parts of pelvis, perineum and genital tract. The proximal type variant has distinct histological characteristics and aggressive clinical course as compared to the distal ES. Inactivation of INI1 has been reported in both distal and proximal variants and can help to make the diagnosis. Furthermore, the proximal variant has a possible association with malignant rhabdoid neoplasm. We describe here a case of primary pleural ES of the proximal type and highlight its diagnostic and therapeutic challenges.

Primary proximal epithelioid sarcoma of the lung successfully treated with pneumonectomy and adjuvant chemotherapy

Primary sarcomas of the lung and proximal epithelial sarcomas (PESs) are extremely rare. Inactivation of INI1 has been found in the majority of epithelioid sarcoma (ES). We report the third known case of a primary PES of the lung along with immunohistochemical data. A 41-year-old man with HIV infection, on highly active antiretroviral therapy, presented with haemoptysis, shortness of breath and progressive weight loss for 2 months. He was eventually diagnosed with stage IIA cT2bN0M0 grade-2 primary PES of the lung. This patient underwent pneumonectomy and adjuvant chemotherapy with ifosfamide and doxorubicin. He remains in remission 36 months since diagnosis. Our case stands to help other clinicians as treatment of such rare cases is often reliant on case reports. We also posit a possible pathogenic mechanism given a history of HIV infection in this patient. The association of INI1 mutation with other atypical sarcomas in patients with HIV infection merits further evaluation.