Cytogenetic findings in a primary leiomyosarcoma of the prostate

A Review of the Literature on Primary Leiomyosarcoma of the Prostate Gland

Primary leiomyosarcoma of the prostate (PLSOP) is rare, with less than 200 cases reported so far. PLSOPs present with lower urinary tract symptoms, haematuria, and perineal pain; may or may not be associated with a history of previous treatment for adenocarcinoma of prostate by means of radiotherapy and or hormonal treatment; may afflict children and adult male. Examination may reveal benign enlarged prostate and hard enlarged mass. PLSOPs may be diagnosed by histological examination findings of spindle-shaped carcinoma cells in prostate specimens. Immunohistochemical staining tends to be positive for vimentin, CD44, smooth muscle actin, and calponin, focally positive for desmin, and at times positive for keratin. They stain negatively for PSA, S-100, CD34, CD117, and cytokeratin. Cytogenetic study on primary leiomyosarcoma of the prostate gland may show clonal chromosomal rearrangement involving Chromosomes 2, 3, 9, 11, and 19. On the whole the prognosis is poor. Surgery with or without chemotherapy would appear to be the mainstay of treatment for PLSOPs that are operable, but generally there is no consensus opinion on the best therapeutic approach. Most cases of PLSOPs are diagnosed in an advanced stage of the disease. A global multicenter trial is required to find therapies that would improve the prognosis.

Leiomyosarcoma of the prostate: case report and review of 54 previously published cases

Prostate leiomyosarcoma is an extremely rare and highly aggressive neoplasm that accounts for less than 0.1% of primary prostate malignancies. We present a patient with primary leiomyosarcoma of the prostate and review 54 cases reported in the literature to discuss the clinical, diagnostic and therapeutic aspects of this uncommon tumor. Median survival was estimated at 17 months (95% C.I. 20.7–43.7 months) and the 1-, 3-, and 5-year actuarial survival rates were 68%, 34%, and 26%, respectively. The only factors predictive of long-term survival were negative surgical margins and absence of metastatic disease at presentation. A multidisciplinary approach is necessary for appropriate management of this dire entity.

Pictorial review: Unusual tumours involving the prostate: radiological-pathological findings

The appearance of several unusual tumours in the prostate has resulted in questions being raised concerning their histogenesis; moreover, some of these tumours have prognoses that are quite unlike those of prostatic adenocarcinoma. Unusual neoplasms involving the prostate have been described in recent years, including mucinous cystadenocarcinoma, neuroendocrine cancer, lymphoma, spindle cell neoplasm, squamous cell carcinoma and transitional cell carcinoma. Radiological findings can overlap, and play limited roles in the diagnoses of these entities. However, knowledge of the radiological findings in these conditions can be helpful in making differential diagnoses. Images of prostate lesions using several imaging modalities, including transrectal ultrasound, MRI and CT, as well as available pathological images of such lesions, are presented in this article.

Submandibular synovial sarcoma with t(X;18) and synovial sarcoma of the toe with additional cytogenetic abnormalities: presentation of two cases and review of the literature

We report cytogenetic findings from fine-needle aspiration samples of two synovial sarcoma patients. The cases are of interest because (1) one case is of a rare site (submandibular region) of the head and neck, and (2) the other is a patient with synovial sarcoma of the toe showing additional cytogenetic abnormalities along with t(X;18). The literature of this tumor is reviewed.

The prostatic gland: malignancies other than adenocarcinomas

Many rare variants of prostatic carcinoma have been described and characterized in recent years. Accurate diagnosis of these variants is necessary in order to determine appropriate therapy. Unusual tumors arising in the prostate raise questions of histogenesis, and may carry a better or worse prognosis than typical adenocarcinoma. Virtually the entire spectrum of cellular differentiation has been observed within prostatic epithelium, and rare neoplasms exhibit these unusual forms of differentiation as the chief component of the tumor. Except in sarcoma (marked prostatic enlargement), imaging plays a limited role in the diagnoses of these entities. Biopsy and histologic diagnoses are essential and the role of imaging is restricted to the evaluation of locoregional and distant spread of the disease.

Chromosomal clues to the development of prostate tumors

BACKGROUND

Cytogenetic, molecular cytogenetic, and molecular studies of prostate cancer have revealed an enormous amount of data regarding chromosomal loci that are aberrant in prostate tumors.

METHODS

These data have been compared and condensed in this review to determine which chromosomes and chromosome sites have been most frequently reported.

RESULTS

Loss of the Y chromosome, gain of 7, 8, and X, and interstitial deletions on 6q, 7q, 8p, 10q, 13q, 16q, 17q, and 18q are the most prevalent.

CONCLUSIONS

A potential model for genetic control of tumor progression is presented, as are data regarding the evaluation of a new series of tumors.

Cytogenetic abnormalities in primary bronchopulmonary leiomyosarcoma of childhood

Primary bronchopulmonary leiomyosarcoma (PBLMS) is a rare malignant neoplasm in all age groups and only 10 pediatric cases of PBLMS have been reported. This report presents cytogenetic findings of a PBLMS from an 8-year-old boy. Tumor diagnosis was established by using routine histopathology, immunohistochemistry, and electron microscopy. The karyotype was highly complex, demonstrating consistent structural abnormalities of chromosomes 1, 5, 6, and 7, relative gain of chromosomes 2 and 11, and relative loss of chromosomes 9, 19, 20, and 22, along with the presence of multiple marker chromosomes. Cytogenetic results of previously reported leiomyosarcomas are reviewed and compared with the present case.

Recurrent chromosome changes in two adult fibrosarcomas

Cytogenetic analysis of two adult fibrosarcomas revealed clonal chromosomal rearrangements including unbalanced translocations between chromosomes 2 and 19, with the same segment, 2q21-qter, translocated onto 19p13 in one tumor and 19q13 in another; and partial monosomy of 10q due to add(10)(q22) and del(10)(q22q25) seen in one tumor each. This is the first description of nonrandom chromosomal changes in adult fibrosarcoma.

Cytogenetic analysis of a leiomyosarcoma of the kidney

Nonepithelial malignant renal tumors are very rare, comprising approximately 2-3% of all malignant renal tumors. We were able to culture and subsequently karyotype a leiomyosarcoma (LMS) of the kidney that showed the following representative karyotype: 84,XY,add(X)(q25),-Y,add(1)(p11),dic(1;20) (p34;q13.3),-5,-6,dup(6)(q24),i(7)(p10),add(8)(p11),-9,-11,add(13)(p11), -15,-15 , add(17)(q24)x2,-18,-19,-21,-22,-22, +mar1(?hsr),+mar2,+2mar. A clonal add(1)(q11) was also evident. The DNA index was 1.9. Our results as compared with data from the literature suggest that LMS of the kidney has most cytogenetic aberrations reported to be characteristic of LMS, especially those located in the abdomen, and that different genetic mechanisms of initiation and progression appear to play a role in LMS of similar histology but from different anatomic sites.

Clonal chromosomal aberrations in a leiomyosarcoma of the sinonasal tract

We report the first cytogenetic analysis of a leiomyosarcoma of the sinonasal tract, a rare neoplasm. Karyotypic analysis showed near-triploid and near-tetraploid modal chromosome numbers with extensive structural and numerical aberrations. Three consistent structural changes, including i(6p), der(10)ins(10;1)(q26;q23q44), and der(12)t(1;12)(q11;q24) were observed in most cells. A der(11)t(11;?)(p15;?) was observed in 14 of 20 cells. Clonal structural rearrangements, including i(1q), del(2)(q37), der(3)t(3;?)(p25;?), del(4)(q31), del(7)(q32), der(12)t(12;?)(p12;?), der(15), del(21)(q22), and der(X) were each observed in a few cells. Numerical changes, including trisomies for chromosomes 2-5, 7, 9, 11, 15, 17, 18, and 20 and monosomies 10 and 12 were observed. Comparison of our findings to those of leiomyosarcomas at different sites showed trisomies 7 and 20 and rearrangements of 11p12-p15 and 21q22.

Analysis of prostatic tumor cultures using fluorescence in-situ hybridization (FISH)

Analysis of ten primary prostatic tumor cultures using fluorescence in-situ hybridization (FISH) with pericentromeric probes for chromosomes 7, 8, 10, 16, 17, and 18 revealed aneusomies in nine of these specimens. Classical cytogenetics by G-banding indicated that only four of those same ten specimens had any (but not consistent) clonal abnormalities. This preliminary study suggests that aneusomy is a common event in early-stage prostatic tumors, and also supports the notion that multiple chromosomes are involved. In combination with routine cytogenetic analysis, FISH is thus likely to be a powerful tool in the evaluation of prostatic cancer.

Recurrent chromosome aberrations in abdominal smooth muscle tumors

Short-term cultures of four abdominal smooth muscle tumors, three leiomyosarcomas and one leiomyoma, were analyzed cytogenetically. A low-grade malignant, epithelioid leiomyosarcoma had a normal karyotype. The other two leiomyosarcomas had abnormal karyotypes; one was near-diploid, and the other was near-triploid. Structural rearrangements of the short arm of chromosome 16 and monosomies of chromosomes 14, 15, and 22 were observed in both tumors. When our cases and previously published abdominal leiomyosarcomas are viewed in conjunction, loss of chromosomes 14, 15, and 22 are the most frequent abnormalities. The leiomyoma, the second cytogenetically abnormal nonuterine leiomyoma reported to date, had a hyperdiploid karyotype with a chromosome number of 56 and structural rearrangements of chromosomes 9, 14, and 19. The only aberrations similar to those observed in the previously reported esophageal leiomyoma were trisomies of chromosomes 7 and 8.

Ring (13)(p11q34) as the sole abnormality in a leiomyosarcoma of the small bowel

Cytogenetic investigation of a recurrent leiomyosarcoma of the small bowel from a 45-year-old woman revealed a r(13)(p11q34) as the sole abnormality in a majority of the cells analyzed. In addition to one cell with a normal karyotype, five cells showed loss of chromosome 13, presumably the r(13) marker. The presence of the r(13) as the sole abnormality suggests that alteration of genes on this chromosome could have played a role in the pathogenesis of this tumor.

Complex karyotypic changes, including rearrangements of 12q13 and 14q24, in two leiomyosarcomas

Cytogenetic investigation of short-term cultures from two leiomyosarcomas revealed complex karyotypic changes in both cases. The first tumor, a subcutaneous leiomyosarcoma of the knee, had the karyotype 70-80,XY, +X, +Y, +1, +1, +2, +2, +3, +3, +4, +4, +7, +7, +8, +8, +9, +10, +15, +15, +16, +16, +18, +19, +20, +21, +21, +22, +22,t(?;5)(5;21)(?;q35p11;q11), t(?;5)(5;21)(?;q35p11;q11), +del(11)(q22),der(13)t(12;13)(q13;q22),der(14)t(9;14)(p11;p11), +14p+, +t(20;?)(q13;?), +t(20;?)(q13;?), +2 mar. A polyploidized clone with 120-150 chromosomes was also observed. DNA flow cytometry revealed only one abnormal peak, corresponding to a DNA index of 1.76. The other tumor, a uterine leiomyosarcoma, had the karyotype 61-67, X, -X, +1, +3, +5, +6, +7, +8, +9, +12, +13, +15, +t(1;1)(p32;q32), +der(1)t(1;8)(p13;q11), +del(2)(p11), +del(2)(q22), +del(2)(q22), +del(3)(p13), +i(5p),t(8;14)(q24;q24), +der(8)t(8;14) (q24;q24), +del(10)(p12),der(11)t(11;15)(p15;q11),t(16;?)(p13;?),t(16;?)(q24;?), der dic(17) (17pter----cen----17q25::hsr::17q25----cen----17pte r), +t(19;?)(p13;?), +der dic(20)(20pter----cen----20q12::hsr::20q12----cen----+ ++20pter), +mar. The DNA index was 1.59. The finding in these leiomyosarcomas of rearrangements of the same regions of chromosomes 12 and 14 that are involved in the tumor-specific t(12;14)(q14-15;q23-24) of uterine leiomyoma indicates that the same genes in 12q and 14q might be important in the pathogenesis of benign and malignant smooth muscle tumors.

Uterine leiomyoma cytogenetics

Uterine leiomyoma--a benign smooth muscle tumor--has recently been found to contain tumor-specific chromosome aberrations. Although only normal karyotypes were detected in 50 to 80% of cytogenetically investigated tumors, 104 leiomyomas with karyotypic aberrations have already been reported. At least four cytogenetically abnormal subgroups have been identified thus far, characterized by rearrangements of 6p, del(7)(q21.2q31.2), +12, and t(12;14)(q14-15;q23-24). The remaining abnormal tumors have had various nonrecurrent anomalies. Secondary karyotypic rearrangements, sometimes including ring chromosomes, have been found in one-third and reflect clonal evolution. Occasional leiomyomas have contained multiple numerical and structural rearrangements. Though benign, these cytogenetically grossly aberrant tumors often displayed more atypical histological features than are usually seen in leiomyoma. Multiple leiomyomas have been investigated from 69 patients, with detection of chromosome anomalies in at least two separate tumors from the same uterus in ten cases. In half of these patients unrelated aberrations were found in different leiomyomas from the same uterus. On other occasions the aberrations were identical, indicating that although some uterine leiomyomas originate independently, others may develop by intra-myometrial spreading from a common neoplastic clone. Some common features are discernible between the karyotypic pictures of uterine leiomyoma and angioleiomyoma; rearrangements of 6p, 13q, and 21q have been described in both tumor types. The cytogenetic similarities so far detected between leiomyoma and the malignant muscle tumors--leiomyosarcoma and rhabdomyosarcoma--are few and may be fortuitous. The cytogenetic profiles of leiomyoma and lipoma are strikingly similar; both tumor types have nonrandom rearrangements of 12q13-15, t(12;14) in leiomyoma and t(3;12) in lipoma, as well as variant rearrangements of the same 12q segment. Both also have cytogenetic subgroups characterized by changes in 6p and ring chromosomes. Finally, karyotypic similarities exists also between leiomyoma and pleomorphic adenoma of the salivary gland, which includes a subset of tumors with anomalies of 12q13-15, and with myxoid liposarcoma, which has t(12;16)(q13;p11) as a tumor-specific rearrangement.

Chromosome rearrangements in two uterine sarcomas

Cytogenetic analysis of short-term cultures from two uterine sarcomas revealed clonal chromosome abnormalities in both cases. A locally recurrent mixed mesodermal tumor had the karyotype 61,XX,+2,+3,+del(5)(q11),+6,+7,+del(7)(q32),+8,+8,+8,+10, -11,-11,+der(11)t(1;11)(q12;p15),+der(11)t(1;11)(q12;p15),+der(11)t(1;11)(q12;p15),+del(12)(q14q21),+13,+15,del(17)(q23),+20. The other tumor, a lung metastasis from a uterine leiomyosarcoma, had several karyotypically abnormal clones. Two of them consisted of highly aberrant cells with modal chromosome numbers of 82 and 153, respectively, but because of insufficient quality the complex anomalies could not be identified. Various chromosomal changes that included translocations, deletions, insertions, and numerical rearrangements (always with extra chromosome 7 material) were identified in pseudo- or near-diploid cells, resulting in nine additional cytogenetically abnormal clones.

Three possible cytogenetic subgroups of leiomyosarcoma

Cytogenetic analysis was performed on short-term cultured tumor cells from ten patients diagnosed as having leiomyosarcoma. Of these, five tumors from five unrelated patients had clonal chromosome abnormalities. The combined data from this report and previous studies on leiomyosarcomas indicate that at least three subtypes may be identified chromosomally within leiomyosarcomas. One subtype is characterized by a hypodiploid chromosome number ranging from 41 to 43 and a common chromosome pattern of monosomies of chromosomes specific to this subgroup, including partial monosomy of the short arm of chromosome 1 (1p13----pter), monosomy 18, and consistent monosomy 22. In contrast to the previous subtype, for the pathogenesis of which the "tumor suppressor gene" hypothesis may be suggested, another subtype was characterized by a pseudodiploid chromosome number associated with simple reciprocal translocations; so far, these translocations are unique to individual tumors, the pathogenesis of which may involve a translocation-mediated gene deregulation pathway. A third subtype contained tumors with heterogeneous karyotypic findings.

Cytogenetics of undifferentiated nasopharyngeal carcinoma xenografts from southern Chinese

Three undifferentiated nasopharyngeal carcinoma (NPC) tumour lines were successfully established from fresh biopsy material injected s.c. into athymic mice and passaged for many generations. These xenografts were found to be free of infiltrating lymphoid cells and remained undifferentiated up to passage 30. They were designated NPC/HK2117 (Xeno-1), NPC/HK1915 (Xeno-2) and NPC/HK1530 (Xeno-3), respectively. Passage 16 from Xeno-1, passage 1 from Xeno-2 and passage 14 from Xeno-3 were studied cytogenetically using G-banding with the trypsin-Giemsa method. Two xenografts were hyperdiploid with chromosome modal numbers ranging from 49 to 76, and one was hypodiploid with modal numbers ranging from 28 to 38. Five marker chromosomes have been identified with involvement of chromosomes 1, 3, 11, 12 and 17. Marker chromosomes derived from chromosomes 12q, 1q and 3q were consistent in one of the 2 xenografts successfully G-banded, and chromosomes 12, 11 and 17 were consistent in another. Three out of the 6 markers involve 12q13----qter. An abnormal chromosome 3 with most of the p arm deleted was also observed.

Cytogenetic observations in a human gastric leiomyosarcoma

The chromosomes of a human gastric leiomyosarcoma were studied in preparations from short-term cultures. The tumor had a triploid-near-triploid modal population characterized by extensive numerical and structural changes. Of these deviations, del(1)(p12-13), monosomy 14, and underrepresentation of chromosomes 18 and 22 were abnormalities in common with two of the three previously studied leiomyosarcomas of the small bowel.

Consistent chromosome changes in leiomyosarcoma

Karyotypic analysis of a leiomyosarcoma of the retroperitoneum revealed some structural and numerical changes. Review of the literature showed that some of these changes, namely involvement of 1p13 and 11p13 and monosomy 9, 18 and 22 seemed to occur frequently. These changes could be characteristic of leiomyosarcoma and define a cytogenetic subgroup within this tumor entity.

Chromosome abnormalities in leiomyosarcomas

Short-term cultures from seven soft tissue leiomyosarcomas were investigated cytogenetically. Sufficient mitoses for chromosome analysis were obtained in six cases, four of which had only normal karyotypes. In one tumor, an intramuscular leiomyosarcoma of the lower arm, a variety of nonclonal structural and numerical aberrations were found in two thirds of the metaphases. Another tumor, a subcutaneous leiomyosarcoma of the knee, had clonal abnormalities resulting in the karyotype 46,X,der(X)t(X;4)(:Xq26----cen----Xp22::4q23----4qter) , del(4)(q23)/47,X,der(X)t(X;4),del(4)(q23), + 20. Flow cytofluorometric measurements of the DNA content in the six leiomyosarcomas successfully karyotyped revealed diploid values in five tumors. The leiomyosarcoma displaying numerous nonclonal changes had two cytofluorometric peaks, 1.01 and 1.39, indicating that the metaphases available for cytogenetic study cannot have been fully representative of the tumor stemline.

3p involvement in a renal cell carcinoma in von Hippel-Lindau syndrome. Region of tumor breakpoint clustering on 3p?

The cytogenetic findings in a renal cell carcinoma from a patient with von Hippel-Lindau syndrome are reported. Of the two consistent changes, one was a dicentric chromosome evolving from an unbalanced translocation between the proximal part of the short arm of chromosome 3 and the distal segment of the long arm of the X chromosome.

t(10;17) as the sole chromosome change in a uterine leiomyosarcoma

A cytogenetic analysis in a primary uterine leiomyosarcoma revealed a t(10;17) as the only chromosome change. This finding is discussed in relation to cytogenetic analyses on uterine leiomyomas and leiomyosarcomas reported previously.

A specific translocation, t(12;14)(q14-15;q23-24), characterizes a subgroup of uterine leiomyomas

We have cytogenetically investigated short-term cultures initiated from 34 uterine leiomyomas, all of which were histologically completely benign. Clonal chromosome abnormalities were detected in five cases, a normal female complement in 22, whereas, in the remaining seven tumors no karyotype could be established. Apparently identical reciprocal translocations, t(12;14)(q14-15;q23-24), were found as the sole abnormality in four tumors. The fifth abnormal case contained a t(2;14)(p11;p11). We conclude that chromosome aberrations may be found in myomas of the uterus, and that t(12;14)(q14-15;q23-24) characterizes a subset of these tumors.

Clonal chromosome rearrangements in a uterine myoma

A cytogenetic study of a myoma of uterus with extensive hyaline, myxoid, and cystic degeneration revealed a clonal karyotype with a complex structural rearrangement involving chromosomes #3, #12, #14, #17, and #22. The modal chromosome number of the tumor was 45 due to monosomy #22. Analysis of seven additional myomas of the uterus including five tumors with typical histology and two with degenerative changes showed no clonal abnormalities. Single metaphases with a trisomy and a translocation were detected in two tumors. We conclude that although many uterine myomas appear to have normal karyotypes, clonal chromosome abnormalities are present in some of these tumors.

Familial double testicular tumors: identical chromosome changes in seminoma and embryonal carcinoma of the same testis

An identical abnormal chromosome, i(12p), and a marker chromosome of unknown origin were seen in 2 tumors of different histology (seminoma and embryonal carcinoma) in the same testis. A younger brother of the patient also had undergone orchiectomy for 2 seminomas in the left testis 2 years previously. These findings are discussed in relation to the possible cellular background of testicular tumors and their genetic parameters.

Cytogenetic findings in leiomyosarcoma of the small bowel

A cytogenetic study of a leiomyosarcoma of the small bowel revealed numerical and structural chromosome changes. Several of these changes, in particular the loss of one chromosome #14, #15, #18, and #22, and del(1)(p12p13) have been reported previously in an unrelated leiomyosarcoma of the small bowel. We suggest that these or part of these findings could be characteristic of leiomyosarcoma of the small bowel.

Translocation t(4;11)(q35;p13) in an adrenocortical carcinoma

Chromosome studies were performed on an adrenocortical carcinoma extending into the kidney. The following karyotype was present in all metaphases: 46,XX,t(4;11)(q35;p13). Two metaphases with an additional del(1)(q23) were found. The results are briefly discussed in relation to specific karyotypic changes in cancer, in general, and to those of adrenocortical tumors, in particular.