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Medina-Ceballos E, Pemintel-Cussi JJ, Heras-Morán B, González-Muñoz JF, Navarro S. Rare mediastinal small round cell melanoma with synovial sarcoma-like immunophenotype: A potential diagnostic pitfall. Pathol Res Pract 2024; 262:155517. [PMID: 39151249 DOI: 10.1016/j.prp.2024.155517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 07/09/2024] [Accepted: 08/05/2024] [Indexed: 08/19/2024]
Abstract
Melanoma can pose a significant diagnostic challenge due to the high variability in histological morphology and expression of non-melanocytic immunomarkers. We present a case of a 47-year-old male with an aggressive mediastinal neoplasm and disseminated disease posing several diagnostic challenges. Multiple biopsies were submitted from different anatomic locations and during multiple time points showing an undifferentiated round cell tumor (URCT) with synovial sarcoma-like immunophenotype. SS18::SSX fusion was sought through NGS study for diagnostic confirmation. NGS results revealed NRAS and CDKN2A mutations and absence of fusions, resulting in a new review of the histologic material with a broader immunohistochemical panel, finding strong positivity to melanic antibodies. This case is an illustrative example of a malignant melanoma with small round cell morphology showing aberrant expression of CD99, BCL2, TLE1 and SS18-SSX antibodies exposing a potentially hazardous pitfall highlighting the importance of a wide differential diagnosis and the role of confirmational studies with molecular tests.
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Affiliation(s)
- Emilio Medina-Ceballos
- Pathology Department, Hospital Clínico Universitario de Valencia, Valencia 46010, Spain.
| | - Juan José Pemintel-Cussi
- Pathology Department, Hospital Universitario de Ciudad Real, Ciudad Real, Castilla la Mancha 13005, Spain
| | - Begoña Heras-Morán
- Pathology Department, Hospital Clínico Universitario de Valencia, Valencia 46010, Spain
| | | | - Samuel Navarro
- Pathology Department, Hospital Clínico Universitario de Valencia, Valencia 46010, Spain; Pathology Department, University of Valencia, Valencia 46010, Spain; Cancer CIBER (CIBERONC), Madrid, Spain
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Mazibrada J, Jayatunge N, Domecq C, Witkowski L, Croce S, Foulkes WD, McCluggage WG. Unusual Aspects of Small Cell Carcinoma of the Ovary of Hypercalcaemic Type: Retained SMARCA4 Immunohistochemical Staining and Positive Staining With TLE1. Am J Surg Pathol 2023; 47:1261-1266. [PMID: 37345679 DOI: 10.1097/pas.0000000000002088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Small cell carcinoma of the ovary of hypercalcaemic type (SCCOHT) is a rare and aggressive ovarian neoplasm that is most common in the second and third decades. Molecular studies have established inactivating SMARCA4 alterations as the driver of SCCOHT, these being present in over 95% of these neoplasms. SMARCA4 alterations almost always result in loss of immunoreactivity with SMARCA4 (BRG1) antibody, and this is an extremely useful adjunct in the diagnosis of SCCOHT. Herein, we report 7 cases of SCCOHT (2 from the same patient) with retention of nuclear immunoreactivity with SMARCA4, but with SMARCA4 alterations identified on molecular testing. All cases exhibited loss of SMARCA2 (BRM) immunoreactivity. In addition, following the identification of diffuse TLE1 immunoreactivity in one of these cases (which did not exhibit an SS18 gene rearrangement characteristic of synovial sarcoma), we stained a total of 63 cases of SCCOHT (14 on whole tissue sections: 49 on tissue microarray) with this marker and 7 of 14 (50%) and 22 of 49 (45%) were positive on whole sections and tissue microarray, respectively. Most cases were focally positive but occasional cases exhibited diffuse immunoreactivity. Our observations highlight the importance of SMARCA2 immunohistochemical staining and molecular testing in suspected cases of SCCOHT that exhibit retained SMARCA4 immunoreactivity. Th common expression of TLE1 in these neoplasms represents a potential diagnostic pitfall since synovial sarcoma may be considered in the differential, especially in cases with retained SMARCA4 immunohistochemistry.
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Affiliation(s)
- Jasenka Mazibrada
- Department of Pathology, Norfolk and Norwich University Hospital, Norwich
| | - Nishani Jayatunge
- Department of Pathology, Norfolk and Norwich University Hospital, Norwich
| | - Celine Domecq
- Cancer Research Program and the SCCOHT/SMARCA4 Registry and Biobank, Research Institute of the McGill University Health Centre, Montreal
| | - Leora Witkowski
- Cancer Research Program and the SCCOHT/SMARCA4 Registry and Biobank, Research Institute of the McGill University Health Centre, Montreal
- Departments of Human Genetics
- Medicine
- Oncology, McGill University, Montréal, QC, Canada
| | - Sabrina Croce
- Department of Biopathology, Institute Bergonié, Comprehensive Cancer Center, Bordeaux, France
| | - William D Foulkes
- Cancer Research Program and the SCCOHT/SMARCA4 Registry and Biobank, Research Institute of the McGill University Health Centre, Montreal
- Departments of Human Genetics
- Medicine
- Oncology, McGill University, Montréal, QC, Canada
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, UK
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Jeffus SK, Meena N, Lindberg M. Expression of TLE1 in a Carcinoid Tumor of the Lung With Spindle Cell Morphology-A Potential Diagnostic Pitfall. Appl Immunohistochem Mol Morphol 2023; 31:644-647. [PMID: 37668410 DOI: 10.1097/pai.0000000000001154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 08/04/2023] [Indexed: 09/06/2023]
Abstract
Tumors of the lung with a spindle cell morphology require consideration of many entities in the differential diagnosis, including metastases. Ancillary immunohistochemical stains but also molecular studies are typically required to arrive at the proper diagnosis. We present a case of a 71-year-old woman with multiple lung nodules, mediastinal lymphadenopathy, and a history of uterine cancer who underwent endobronchial ultrasound-guided fine needle aspiration and biopsy of the lung and mediastinal lymph nodes. A sampling of the lung lesion showed a cytologically bland neoplasm with spindle cell morphology, lacking necrosis or brisk mitotic activity. In conjunction with the cytomorphology, strong and diffuse Transducin-like enhancer of split 1 (TLE1) reactivity in the tumor cells initially raised the diagnosis of synovial sarcoma; however, subsequent results of additional testing showed strong and diffuse expression with AE1/AE3, CK 8/18, TTF-1, synaptophysin and chromogranin and focal or negative staining with a large number of other antibodies. This warranted a diagnosis of a carcinoid tumor. This is the first report of TLE1 staining in a carcinoid tumor of the lung. Therefore, when evaluating tumors of the lung with spindle cell morphology in which the differential diagnosis may include both carcinoid tumor and synovial sarcoma, TLE1 expression should be interpreted with caution and in conjunction with an expanded immunohistochemical staining panel.
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Affiliation(s)
- Susanne K Jeffus
- Department of Pathology, University of Arkansas for Medical Sciences
| | - Nikhil Meena
- Department of Internal Medicine, Division of Pulmonology and Critical Care, Little Rock, AR
| | - Matthew Lindberg
- Department of Pathology, University of Arkansas for Medical Sciences
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Zhong LL, Huang GX, Xian LY, Wei ZC, Tang ZP, Chen QY, Chen H, Tang F. Novel characteristics for immunophenotype, FISH pattern and molecular cytogenetics in synovial sarcoma. Sci Rep 2023; 13:7954. [PMID: 37193761 DOI: 10.1038/s41598-023-34983-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 05/10/2023] [Indexed: 05/18/2023] Open
Abstract
As a rare and highly aggressive soft tissue sarcoma, the new immunophenotype, atypical FISH pattern and relevant molecular cytogenetics of synovial sarcoma (SS) remain less known, although it is characteristically represented by a pathognomonic chromosomal translocation t (X; 18) (p11.2; q11.2). Methodologically, the morphology was retrospectively analysed by using H&E staining, and immunohistochemical features were investigated by using markers that have been recently applied in other soft tissue tumors. Moreover, FISH signals for SS18 and EWSR-1 break-apart probes were examined. Finally, cytogenetic characteristics were analysed via RT-PCR and Sanger sequencing. Consequently, nine out of thirteen cases that were histologically highly suspected as SS were finally identified as SS via molecular analysis. Histologically, nine SS cases were divided into monophasic fibrous SS (4/9), biphasic SS (4/9) and poorly differentiated SS (1/9). Immunohistochemically, SOX-2 immunostaining was positive in eight cases (8/9) and PAX-7 immunostaining was diffusely positive in the epithelial component of biphasic SS (4/4). Nine cases showed negative immunostaining for NKX3.1 and reduced or absent immunostaining for INI-1. Eight cases showed typically positive FISH signalling for the SS18 break-apart probe, whereas one case exhibited an atypical FISH pattern (complete loss of green signalling, case 2). Furthermore, the SS18-SSX1 and SS18-SSX2 fusion genes were identified in seven cases and two cases, respectively. The fusion site in 8 out of 9 cases was common in the literature, whereas the fusion site in case 2 was involved in exon 10 codon 404 in SS18 and exon 7 codon 119 in SSX1 (which has not been previously reported), which notably corresponded to the complete loss of green signalling in the FISH pattern. Additionally, FISH analysis of the EWSR-1 gene in nine SS cases demonstrated aberrant signalling in three cases that were recognized as a monoallelic loss of EWSR-1 (1/9), an amplification of EWSR-1 (1/9) and a translocation of EWSR-1 (1/9). In conclusion, SS18-SSX fusion gene sequencing is obligatory for a precise diagnosis of SS when dealing with a confusing immunophenotype and atypical or aberrant FISH signalling for SS18 and EWSR-1 detection.
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Affiliation(s)
- Ling Ling Zhong
- Department of Pathology, The 924th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Guangxi Key Laboratory of Metabolic Diseases Research, Guilin, 541002, Guangxi, China
- Guangxi Key Laboratory of Glucose and Lipid Metabolic Diseases, The Second Affiliated Hospital of Guilin Medical University, Guilin, 541199, Guangxi, China
| | - Gao Xiang Huang
- Department of Pathology, The 924th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Guangxi Key Laboratory of Metabolic Diseases Research, Guilin, 541002, Guangxi, China
| | - Li Ying Xian
- Department of Pathology and Laboratory Medicine, Dongguan Affiliated Hospital of Southern Medical University, Dongguan, 523059, Guangdong, China
| | - Zong Chen Wei
- Department of Pathology, The 924th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Guangxi Key Laboratory of Metabolic Diseases Research, Guilin, 541002, Guangxi, China
| | - Zhi Ping Tang
- Department of Pathology, The 924th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Guangxi Key Laboratory of Metabolic Diseases Research, Guilin, 541002, Guangxi, China
| | - Qiu Yue Chen
- Department of Pathology, The 924th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Guangxi Key Laboratory of Metabolic Diseases Research, Guilin, 541002, Guangxi, China
| | - Hao Chen
- Department of Pathology, The 924th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Guangxi Key Laboratory of Metabolic Diseases Research, Guilin, 541002, Guangxi, China
| | - Fang Tang
- Department of Pathology, The 924th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Guangxi Key Laboratory of Metabolic Diseases Research, Guilin, 541002, Guangxi, China.
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Kumar S, Rahul K, Tewarson V, Kumar B, Hakim MZ, Kumar S, Singh SK. Cardiac synovial sarcoma masquerading as effusive constrictive pericarditis. Indian J Thorac Cardiovasc Surg 2023; 39:300-304. [PMID: 37124594 PMCID: PMC10140245 DOI: 10.1007/s12055-022-01461-9] [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: 09/18/2022] [Revised: 12/11/2022] [Accepted: 12/15/2022] [Indexed: 02/12/2023] Open
Abstract
Primary cardiac synovial sarcoma is a rare entity, arising from the pericardium or the chambers of the heart. It presents in the 4th decade of life with a striking male predisposition. We describe an unusual case of a 22-year-old female who presented with complaints of dyspnoea on exertion, palpitations, and chest pain. Trans-thoracic echocardiography was suggestive of a cystic pericardial mass with pericardial effusion anterior and lateral to the right ventricle. Computed tomography scan (CT scan) revealed thick-walled predominantly cystic lesion over the left ventricle with gross pericardial effusion with internal septations. These findings were suggestive of an infected pericardial cyst. Upon surgery, an adherent mass in the pericardial cavity was found which was not separable from the right heart structures, the great vessels, and the left ventricle. Biopsy was taken, histopathology was suggestive of spindle cell neoplasm, and an immunohistochemistry analysis revealed Transducin-like enhancer of split 1 (TLE 1)-positive malignant spindle cell tumour likely synovial sarcoma. After surgery, the patient received serial adjuvant chemo-radiation therapy. The synovial sarcoma masqueraded as effusive constrictive pericarditis, due to which it eluded preoperative diagnosis.
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Affiliation(s)
- Sarvesh Kumar
- Department of Cardiovascular and Thoracic Surgery, King George’s Medical University, Shahmina Road, Lucknow, 226003 India
| | - Kumar Rahul
- Department of Cardiovascular and Thoracic Surgery, King George’s Medical University, Shahmina Road, Lucknow, 226003 India
| | - Vivek Tewarson
- Department of Cardiovascular and Thoracic Surgery, King George’s Medical University, Shahmina Road, Lucknow, 226003 India
| | - Bhupendra Kumar
- Department of Cardiovascular and Thoracic Surgery, King George’s Medical University, Shahmina Road, Lucknow, 226003 India
| | - Mohammad Zeeshan Hakim
- Department of Cardiovascular and Thoracic Surgery, King George’s Medical University, Shahmina Road, Lucknow, 226003 India
| | - Shobhit Kumar
- Department of Cardiovascular and Thoracic Surgery, King George’s Medical University, Shahmina Road, Lucknow, 226003 India
| | - Sushil K. Singh
- Department of Cardiovascular and Thoracic Surgery, King George’s Medical University, Shahmina Road, Lucknow, 226003 India
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Qureshi MB, Tariq MU, Abdul-Ghafar J, Chundriger Q, Ud Din N. Diagnostic Utility of TLE1 (Transducer-Like Enhancer of Split 1) in Distinguishing Synovial Sarcoma from Mimicking Tumors. Int J Gen Med 2021; 14:9173-9179. [PMID: 34880656 PMCID: PMC8646225 DOI: 10.2147/ijgm.s343767] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/18/2021] [Indexed: 11/30/2022] Open
Abstract
Background Synovial sarcoma (SS) is a high-grade spindle cell tumor that accounts for 5% to 10% of soft tissue sarcomas. The majority originate from the deep intramuscular soft tissues of extremities with common sites including knee, ankle and feet. Immunohistochemical (IHC) stain TLE1 (transducer-like enhancer of split 1) is a potent diagnostic marker for distinguishing SS from mimicking tumors. Methodology The study was performed on 177 tumor cases, including 89 SS and 88 non-synovial sarcoma (N-SS) cases which were diagnosed at Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, from July 2019 to June 2020. Hematoxylin and eosin (H&E) and IHC stained glass slides of these cases were reviewed. TLE1 expression was assessed based on the Remmele scoring system. Results Eighty-nine cases of SS and 88 cases of N-SS were included in the study. SS cases included 42 (47.2%) monophasic subtype, 6 (6.7%) biphasic subtype and 41 (46.1%) poorly differentiated subtype. Major tumor types in N-SS cases were 27 (30.7%) Ewing sarcoma (ES), 13 (14.8%) leiomyosarcoma, 10 (11.4%) undifferentiated sarcoma (US), 8 (9.1%) fibrosarcomatous dermatofibrosarcoma protuberans and 7 (8%) malignant peripheral nerve sheath tumor cases. Mean patients’ age for SS cases was 26.14 years and for N-SS cases was 32.64 years. All 89 SS cases showed positive TLE1 expression. Out of 88 N-SS cases, 71 (80.7%) were TLE1 negative and 17 (19.3%) showed positive expression. Conclusion This study shows that TLE1 is a very sensitive and relatively specific IHC marker for SS. TLE1 expression can be observed in other soft tissue sarcomas but diffuse strong TLE1 expression is highly specific for SS. The diagnosis should not solely rely on TLE1 expression and morphologic features but should include soft tissue specific lineage markers to avoid misdiagnosis.
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Affiliation(s)
- Madiha Bilal Qureshi
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Usman Tariq
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Jamshid Abdul-Ghafar
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan
| | - Qurratulain Chundriger
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Nasir Ud Din
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Synovial sarcoma with overwhelming glandular (adenocarcinoma-like) component: A case report and review of the literature. Pathol Res Pract 2021; 222:153418. [PMID: 33819897 DOI: 10.1016/j.prp.2021.153418] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 11/23/2022]
Abstract
Synovial sarcoma is an uncommon tumor of soft tissue, characterized by a specific SS18-SSX1/2/4 fusion gene. It is generally a lesion composed of monomorphic spindle cells, and can sometimes show variable epithelial differentiation. Here, we present the case of a young woman with a synovial sarcoma of the abdominal wall that showed an overwhelming (>90 %) epithelial glandular component mimicking adenocarcinoma, and only rare spindled areas. The diagnosis was confirmed by detection of targeted fusion transcripts associated with synovial sarcoma. We review the literature pertaining to synovial sarcoma, and we show that this case is only the sixth molecularly proven epithelial predominant synovial sarcoma in the literature. This report emphasizes the importance of molecular approaches in modern soft tissue pathology. Recognition of synovial sarcoma with predominant glandular component is imperative in order to avoid misdiagnosis of the tumor as metastatic adenocarcinoma, another type of sarcoma with epithelial differentiation, or a carcinoma with a sarcomatous component (sarcomatoid carcinoma), all of which have markedly different clinical management.
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8
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He H, Yang L, Peng Y, Liu L, Liu L, Xue Q, Gao S. The value of multidisciplinary team (MDT) management in the diagnosis and treatment of primary intrathoracic synovial sarcomas: a single-center experience. J Thorac Dis 2021; 13:600-612. [PMID: 33717533 PMCID: PMC7947479 DOI: 10.21037/jtd-20-2887] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Synovial sarcoma (SS) is a rare malignant soft tissue tumor. Primary intrathoracic SS is extremely rare, with limited diagnosis and treatment experiences. The aim of our study was to retrospectively study the clinicopathological characteristics, treatment and prognosis of primary intrathoracic SS and the impact of multidisciplinary team (MDT) management in diagnosis and treatment on patient prognosis. Methods The clinical and pathological characteristics, treatment, survival and prognosis of patients with primary intrathoracic SS admitted to the National Cancer Center from January 1999 to December 2018, as well as MDT intervention during diagnosis and treatment, were retrospectively analyzed. Results Thirteen patients were enrolled, including 7 (53.8%) males and 6 (46.3%) females, with primary intrathoracic SS in the lung (8/13, 61.5%), mediastinum (4/13, 30.8%) and pleura (1/13, 7.7%) as confirmed by morphological observation, immunohistochemical (IHC) staining and fluorescence in situ hybridization (FISH). Overall, 10/13 (76.9%) patients underwent surgery, and 6/10 (60.0%) received postoperative adjuvant therapy. Only 23.1% of patients received nonsurgical therapy. The MDT discussed and managed seven patients before and/or after surgery and one patient who did not undergo surgery. The estimated 3- and 5-year overall survival (OS) rates were 50.0% and 30.0%, respectively. Patients who were managed by an MDT had a longer median OS time than those who were not (46.0 vs. 18.0 months). Age (P=0.018), tumor location (P=0.029), and Ki-67 (P=0.020) were found to be significantly related to OS. Conclusions Monophasic morphology and fusion gene characteristics are the main features for the diagnosis of primary intrathoracic SS. MDT management can help obtain accurate diagnoses and provide reasonable therapeutic options.
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Affiliation(s)
- Huayu He
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Yang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue Peng
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Liu
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Liu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Xue
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Vijayan S, Mohammed AP, Kulkarni MS, Rao SK. Monophasic spindle cell myxoid synovial sarcoma of the hand: promising results with marginal resection. BMJ Case Rep 2021; 14:14/1/e238366. [PMID: 33509874 PMCID: PMC7845715 DOI: 10.1136/bcr-2020-238366] [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: 01/30/2023] Open
Abstract
Synovial sarcomas are deep-seated, genetically distinct, malignant neoplasms seen in young adults, with a male preponderance. They have unusual clinical and pathological presentation and mimic many other sarcomas and carcinomas, making the diagnosis quite challenging. Although four variants are identified, occurrence in the hand is extremely rare and leads to significant morbidity. There is a high incidence of local recurrence and distant metastasis within the first 2 years. We report the case of an elderly woman with monophasic spindle cell synovial sarcoma who presented with painless swelling in her palm and underwent local excision of the neoplasm. At 2-year follow-up, she remains totally asymptomatic with normal function of the hand. We also attempt to give an overview about monophasic spindle cell synovial sarcoma with the differentials, which would help surgeons in prompt diagnosis and appropriate management.
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Affiliation(s)
- Sandeep Vijayan
- Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Afsal P Mohammed
- General Medicine, Dr TMA Pai Hospital, Udupi, Melaka-Manipal Medical College, Manipal Academy of Higher Education, Udupi, Karnataka, India
| | - Mahesh Suresh Kulkarni
- Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sharath Kumar Rao
- Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Tran V, Slavin J. Soft Tissue Tumour Pathology. Sarcoma 2021. [DOI: 10.1007/978-981-15-9414-4_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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11
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Lee YJ, Choi S, Kwon SY, Lee Y, Lee JK, Heo EY, Chung HS, Kim DK. A Genome-Wide Association Study in Early COPD: Identification of One Major Susceptibility Loci. Int J Chron Obstruct Pulmon Dis 2020; 15:2967-2975. [PMID: 33235445 PMCID: PMC7680157 DOI: 10.2147/copd.s269263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/23/2020] [Indexed: 12/20/2022] Open
Abstract
Background Identifying the genetic basis of airflow limitation is one of the most interesting issues for understanding chronic obstructive pulmonary disease (COPD) pathophysiology. Several studies have shown that some genetic variants associated with COPD have been identified in genome-wide association study (GWAS), especially in patients with moderate to severe COPD; genetic susceptibility for airflow limitation in the early COPD phase has not been widely studied. Objective We investigated the genetic variants in early COPD. Methods The present study analyzed Gene-environment interaction and phenotype (GENIE) cohort that included participants who received health screening examination. The association between single nucleotide polymorphism (SNP) and susceptibility to early COPD (FEV1 predicted ≥50% and FEV1/FVC <0.7) was tested. Results A total of 130 patients with early COPD and 3478 controls (1700 ever smokers and 1778 never smokers) were recruited. When compared with the total controls, certain SNPs (rs2818103, rs875033, rs9354627, rs34552148) on chromosome 6 were included at the top of our list (p= 5.6 × 10–7 ~9.6 × 10–6) although they did not reach genome-wide significance. When compared with the never smoker controls, two SNPs (rs2857210, rs2621419) of the HLA-DQB2 gene class were persistently associated with susceptibility to early COPD. Conclusion Certain SNPs located on chromosome 6 or the HLA-DQB2 gene were the top-scoring SNPs for the association with susceptibility to early COPD in the Korean GENIE cohort.
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Affiliation(s)
- Ye-Jin Lee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - SeungHo Choi
- Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul 135-984 Korea
| | - Sung-Youn Kwon
- Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul 135-984 Korea
| | - Yunhwan Lee
- Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul 135-984 Korea
| | - Jung Kyu Lee
- Division of Pulmonary and Critical Care Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Eun Young Heo
- Division of Pulmonary and Critical Care Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hee Soon Chung
- Division of Pulmonary and Critical Care Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Deog Kyeom Kim
- Division of Pulmonary and Critical Care Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Synovial Sarcoma: A Complex Disease with Multifaceted Signaling and Epigenetic Landscapes. Curr Oncol Rep 2020; 22:124. [PMID: 33025259 DOI: 10.1007/s11912-020-00985-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW Aside from a characteristic SS18-SSX translocation identified in almost all cases, no genetic anomalies have been reliably isolated yet to drive the pathogenesis of synovial sarcoma. In the following review, we explore the structural units of wild-type SS18 and SSX, particularly as they relate to the transcriptional alterations and cellular pathway changes imposed by SS18-SSX. RECENT FINDINGS Native SS18 and SSX contribute recognizable domains to the SS18-SSX chimeric proteins, which inflict transcriptional and epigenetic changes through selective protein interactions involving the SWI/SNF and Polycomb chromatin remodeling complexes. Multiple oncogenic and developmental pathways become altered, collectively reprogramming the cellular origin of synovial sarcoma and promoting its malignant transformation. Synovial sarcoma is characterized by complex epigenetic and signaling landscapes. Identifying the operational pathways and concomitant genetic changes induced by SS18-SSX fusions could help develop tailored therapeutic strategies to ultimately improve disease control and patient survivorship.
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Sotiriou S, Kotoula V, Raptou G, Pantelaion V, Hytiroglou P. Primary Subcutaneous Spindle Cell Synovial Sarcoma: First Reported Case. Am J Dermatopathol 2020; 42:384-386. [DOI: 10.1097/dad.0000000000001497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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El Beaino M, Jupiter DC, Assi T, Rassy E, Lazar AJ, Araujo DM, Lin PP. Diagnostic Value of TLE1 in Synovial Sarcoma: A Systematic Review and Meta-Analysis. Sarcoma 2020; 2020:7192347. [PMID: 32322158 PMCID: PMC7166261 DOI: 10.1155/2020/7192347] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/06/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Synovial sarcoma can present morphologically in multiple forms, including biphasic and monophasic subtypes. As a result, the histological diagnosis can sometimes be challenging. Transducin-Like Enhancer 1 (TLE1) is a transcriptional corepressor that normally is involved in embryogenesis and hematopoiesis but is also expressed in certain tumors. This systematic review examines the potential role of TLE1 as a diagnostic biomarker for the synovial sarcoma. Materials and Methods. A literature review and meta-analysis were conducted using the electronic databases Pubmed, the Cochrane Library, and Google Scholar. Thirteen studies met our eligibility criteria and were selected for in-depth analysis. RESULTS The mean sensitivity and specificity of TLE1 in detecting synovial sarcoma were 94% (95% CI 91%-97%) and 81% (95% CI 72%-91%), respectively, when all studies were aggregated together. The mean positive predictive value (PPV) of TLE1 was 75% (95% CI 62%-87%), whereas the negative predictive value (NPV) was 96% (95% CI 93%-98%). CONCLUSION TLE1 is a sensitive and specific marker for synovial sarcoma that can aid in its diagnosis. Due to its involvement in several relevant signaling pathways, TLE1 might have direct relevance to the pathophysiology of the disease.
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Affiliation(s)
- Marc El Beaino
- Department of Orthopaedic Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
| | - Daniel C. Jupiter
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX, USA
| | - Tarek Assi
- Department of Cancer Medicine, Gustave Roussy Institute, F-94805 Villejuif, France
| | - Elie Rassy
- Department of Cancer Medicine, Gustave Roussy Institute, F-94805 Villejuif, France
| | - Alexander J. Lazar
- Departments of Pathology & Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dejka M. Araujo
- Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Patrick P. Lin
- Department of Orthopaedic Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Qureshi MB, Uddin N, Tariq MU, Raheem A, Pervez S. Frequency of Transducer-like Enhancer of Split 1 Immunohistochemical Expression in Synovial Sarcoma: An Institution-based Cross-sectional Study. Cureus 2019; 11:e6357. [PMID: 31938642 PMCID: PMC6952034 DOI: 10.7759/cureus.6357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Soft-tissue sarcomas comprise a diverse group of sarcomas with characteristic histologic features. However, histology alone is not adequate for a definitive diagnosis for many tumors. In such cases, immunohistochemistry (IHC) plays a key role in determining the line of differentiation and exact characterization. Transducer-like enhancer of split 1 (TLE1) has been recently described as a novel marker for synovial sarcoma (SS). Its high sensitivity and specificity make it a potential marker that distinguishes SS from histologic mimics such as malignant peripheral nerve sheath tumor (MPNST), Ewing's sarcoma (ES), and fibrosarcomatous dermatofibrosarcoma protuberans (FS-DFSP). The objective of our study was to assess the frequency of TLE1 immunohistochemical expression on SS cases of various subtypes. Methods This cross-sectional study was conducted at the Department of Histopathology, Aga Khan University, Karachi, Pakistan from February 3, 2018 to February 10, 2019. Tissue samples of 89 SS cases were selected for this study. Tumor sections were stained with hematoxylin and eosin (H&E), cytokeratin AEI/AE3 (CKAE1/AE3), epithelial membrane antigen (EMA), and TLE1 immunohistochemical stain. TLE1 expression was assessed based on the Remmele scoring system. Results Tissue samples of 89 SS cases were processed for the study. Mean (±) standard deviation (SD) of age was 25 (±7.36) years. Male:female ratio was 1.1:1. Of the 89 SS cases, 42 (47.2%) were monophasic, six (6.7%) were biphasic, and 41 (46.1%) were poorly differentiated. All the 89 cases showed positivity for TLE1 immunostain: 86 (96.6%) cases showed strong positivity, one (1.1%) case showed moderate expression, and two (2.2%) showed weak positivity. Conclusion This study shows that TLE1 is a highly sensitive immunostain for SS irrespective of the histologic type. However, it may show weak-to-moderate staining in poorly differentiated types. No statistically significant association was seen with respect to age group, gender, or type of SS.
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Affiliation(s)
- Madiha B Qureshi
- Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, PAK
| | - Nasir Uddin
- Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, PAK
| | | | - Ahmed Raheem
- Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, PAK
| | - Shahid Pervez
- Pathology and Laboratory Medicine, Aga Khan University Hospital , Karachi, PAK
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Dermawan JKT, Policarpio‐Nicolas MLC. Cytological findings of monophasic synovial sarcoma presenting as a lung mass: report of a case and review of the literature. Diagn Cytopathol 2019; 47:948-955. [DOI: 10.1002/dc.24218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/19/2019] [Accepted: 05/22/2019] [Indexed: 12/13/2022]
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The Utility of NKX2.2 and TLE1 Immunohistochemistry in the Differentiation of Ewing Sarcoma and Synovial Sarcoma. Appl Immunohistochem Mol Morphol 2019; 27:174-179. [DOI: 10.1097/pai.0000000000000573] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Huang GX, Chen QY, Zhong LL, Chen H, Zhang HP, Liu XF, Tang F. Primary malignant gastrointestinal neuroectodermal tumor occurring in the ileum with intra-abdominal granulomatous nodules: A case report and review of the literature. Oncol Lett 2019; 17:3899-3909. [PMID: 30930990 PMCID: PMC6425295 DOI: 10.3892/ol.2019.10060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 01/31/2019] [Indexed: 12/26/2022] Open
Abstract
Malignant gastrointestinal neuroectodermal tumors (GNETs) are rare aggressive malignant neoplasms that exclusively occur within the wall of the gastrointestinal tract. The GNET was first described as an ‘osteoclast-rich tumor of the gastrointestinal tract with features resembling clear cell sarcoma (CCS) of soft parts’ in 2003. Although the GNET shares certain histological features with CCS, it is characterized by a lack of melanocytic differentiation and the presence of non-tumoral osteoclast-like giant cells (OLGCs). The present study reports a case of a GNET of the ileum with intra-abdominal granulomatous nodules, an uncommon accompanying finding, and summarizes the current literature. A 30-year-old woman presented with the symptoms of intestinal obstruction, and a mass was found within the ileum wall. Multiple grey-white nodules were found adhering to the omentum and serosa of the ileum. Histologically, the tumor was located in the muscularis propria and infiltrated the mucosa and the serosa. Tumor cells presented with oval or polygonal nuclei and prominent nucleoli, and were predominantly arranged in nested and pseudopapillary patterns, with the presence of cluster of differentiation (CD)68-positive, scattered OLGC. Immunohistochemically, it was determined that the tumor cells expressed Vimentin, CD56, S-100 and transcription factor SOX-10, while being negative for pan-cytokeratin, cytokeratin (CK)7, CK20, synaptophysin, chromogranin-A, CD117, anoctamin-1, CD34, human melanoma black-45, Melan-A, smooth muscle actin, CD3 and CD20 expression. Ewing sarcoma breakpoint region 1 gene rearrangement was identified by fluorescence in situ hybridization analysis. Ultrastructurally, no typical melanosomes were identified. In addition, the intra-abdominal grey-white nodules were microscopically identified as chronic granulomatous inflammation. The patient received four cycles of adjuvant chemotherapy following routine tumor resection. Due to its rarity and histological similarity with other neoplasms, unfamiliarity with the features of GNETs by surgical pathologists can easily lead to a misdiagnosis. Therefore, comprehensive assessments, including morphology and ancillary studies, are required for an accurate diagnosis of GNET.
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Affiliation(s)
- Gao-Xiang Huang
- Department of Pathology, 924th (181st) Hospital of The People's Liberation Army, Guangxi Key Laboratory of Metabolic Diseases Research, Guilin, Guangxi 541002, P.R. China
| | - Qiu-Yue Chen
- Department of Pathology, 924th (181st) Hospital of The People's Liberation Army, Guangxi Key Laboratory of Metabolic Diseases Research, Guilin, Guangxi 541002, P.R. China
| | - Ling-Ling Zhong
- Department of Pathology, 924th (181st) Hospital of The People's Liberation Army, Guangxi Key Laboratory of Metabolic Diseases Research, Guilin, Guangxi 541002, P.R. China
| | - Hao Chen
- Department of Pathology, 924th (181st) Hospital of The People's Liberation Army, Guangxi Key Laboratory of Metabolic Diseases Research, Guilin, Guangxi 541002, P.R. China
| | - Hai-Peng Zhang
- Department of Pathology, 924th (181st) Hospital of The People's Liberation Army, Guangxi Key Laboratory of Metabolic Diseases Research, Guilin, Guangxi 541002, P.R. China
| | - Xiao-Fen Liu
- Department of Pathology, 924th (181st) Hospital of The People's Liberation Army, Guangxi Key Laboratory of Metabolic Diseases Research, Guilin, Guangxi 541002, P.R. China
| | - Fang Tang
- Department of Pathology, 924th (181st) Hospital of The People's Liberation Army, Guangxi Key Laboratory of Metabolic Diseases Research, Guilin, Guangxi 541002, P.R. China
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Duncan VE, Wicker JA, Kelly DR, Li R. TLE1 Expression in Malignant Rhabdoid Tumor and Atypical Teratoid/Rhabdoid Tumor. Pediatr Dev Pathol 2018; 21:522-527. [PMID: 29490565 DOI: 10.1177/1093526618761720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Malignant rhabdoid tumors (MRT; atypical teratoid/rhabdoid tumor [ATRT] in the central nervous system) are aggressive tumors in infants and children which can overlap with other sarcomas, such as synovial sarcoma (SS). The gold standard for SS diagnosis is characterization of the t(X;18) chromosomal translocation. However, stratification of cases for molecular analysis is not always straightforward or feasible. Recent literature suggests transducer-like enhancer of split 1 (TLE1) protein expression may distinguish SS from certain histologic mimics; however, this has not been investigated in MRT and ATRT. We stained whole-tissue sections of 18 archived cases of MRT and ATRT with TLE1. Nuclear expression was scored using a 4-tiered (0, 1+, 2+, and 3+) scale describing staining intensity, extent, or combination of both. The majority of MRT and ATRT cases showed some TLE1 immunoreactivity (n = 16; 89% for ≥1 + staining); 14 (78%) of total cases showed ≥2 + positivity using any of the 3 scoring systems. Over half (n = 10; 56%) of cases showed ≥2 + staining; 4 (22%) cases showed 3 + strong and diffuse TLE1 staining measured by all scoring systems in agreement. Although still of potential use, we urge caution in the interpretation of TLE1 when the differential diagnosis includes both SS and MRT or ATRT.
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Affiliation(s)
- Virginia E Duncan
- 1 Department of Pathology, Seattle Children's Hospital, Seattle, Washington
| | - Jason A Wicker
- 2 Department of Pathology, Children's of Alabama, Birmingham, Alabama
- 3 Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
| | - David R Kelly
- 2 Department of Pathology, Children's of Alabama, Birmingham, Alabama
- 3 Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rong Li
- 2 Department of Pathology, Children's of Alabama, Birmingham, Alabama
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Morrell TJ, Xiong Y, Deng A, Dresser K, O’Donnell P, Cornejo KM. Expression of TLE1 in Malignant Melanoma With Spindle Cell Morphology: A Potential Diagnostic Pitfall. Int J Surg Pathol 2018; 27:259-262. [DOI: 10.1177/1066896918805137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objectives. Transducer-like enhancer of split 1 (TLE1) immunohistochemistry is widely used as a biomarker of synovial sarcoma. Spindle cell or desmoplastic melanoma can morphologically mimic synovial sarcoma. The aim of this study was to investigate the expression of TLE1 in melanomas with a spindle cell morphology. Methods. A search of the surgical pathology files resulted in 57 cases of melanomas diagnosed with a spindle cell or desmoplastic component. After review, 8 cases had no definitive dermal spindle cell component and 7 cases had insufficient tissue remaining and were excluded from the study. A total of 42 melanomas were examined for TLE1 immunohistochemistry using a mouse monoclonal antibody (Cell Marque, clone 1F5). Strength and percentage of nuclear TLE1 positivity was graded on a scale from 0 to 3+. Staining for TLE1 was considered positive for 2 to 3+ and negative for 0 to 1+. Results. Nuclear TLE1 expression was identified in 24 (57%) of the 42 melanoma cases with spindle cell morphology (2+, n = 14; 3+, n = 10). TLE1 was considered negative in 18 cases (43%), of which most contained weak staining (1+, n = 14 [33%]) and only a small subset did not show any staining (0, n = 4 [10%]). Conclusion. TLE1 frequently highlights melanomas with spindle cell morphology and is a potential diagnostic pitfall. Therefore, when evaluating spindle cell tumors in which the differential may include both a melanoma and synovial sarcoma, TLE1 expression should be interpreted with caution and in conjunction with an immunohistochemical panel.
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Affiliation(s)
- Travis J. Morrell
- University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA
| | - Yiqin Xiong
- University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA
| | - April Deng
- University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA
| | - Karen Dresser
- University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA
| | - Patrick O’Donnell
- University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA
| | - Kristine M. Cornejo
- University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
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Brassesco MS, Pezuk JA, Cortez MA, Bezerra Salomão K, Scrideli CA, Tone LG. TLE1 as an indicator of adverse prognosis in pediatric acute lymphoblastic leukemia. Leuk Res 2018; 74:42-46. [PMID: 30286331 DOI: 10.1016/j.leukres.2018.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 06/27/2018] [Accepted: 09/22/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Acute lymphoblastic leukemia (ALL) is the most common type of cancer in children, and despite the high rate of cure (over 80%) it still has a big impact on morbidity and mortality. The Transducin-like enhancer of split 1 (TLE1), a transcriptional corepressor, has been described as dysregulated and recently emerged as a tumor marker in several cancer types, including hematologic malignancies. METHODS In the present study TLE1 gene expression was evaluated by RT-qPCR. A total of 60 consecutive pathological ALL samples and 8 normal bone marrow samples were included. Associations between TLE1 levels and clinicopathological features were estimated using Mann-Whitney tests. RESULTS TLE1 mRNA levels were significantly diminished in ALL samples when compared to normal counterparts (fold change -1.45, p-value 0.039). Lower TLE1 expression levels were associated with poorer prognostic features such as age at diagnosis (<1 or >9 years-old), absence of the Common Acute Lymphoblastic Leukemia Antigen (CALLA) and high white cell count. Considering immunophenotype, decreased expression of TLE1 was only evident for T-cell ALL, what was validated using gene expression profiling data available in public repositories. No associations with event or overall survival were observed. However, TLE1 expression was statistically different between patients who achieved complete clinical remission (CCR) from those that relapsed or died. CONCLUSION These data are of particular interest and give support for a plausible role of TLE1 as a tumor suppressor in T-cell ALL. Moreover, the prognostic value of this corepressor may assist ALL treatment stratification and suggest the need of alternative regimens.
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Affiliation(s)
- María Sol Brassesco
- Department of Biology, Faculty of Philosophy, Sciences and Letters at Ribeirao Preto, Brazil.
| | - Julia Alejandra Pezuk
- Department of Pharmacy and Department of Biotechnology and Health Innovation, Anhanguera University of Sao Paulo, UNIAN/SP, Brazil
| | - Maria Angelica Cortez
- Experimental Radiation Oncology, The University of Texas, MD Anderson Cancer Center, USA
| | - Karina Bezerra Salomão
- Department of Pediatrics, Ribeirao Preto Medical School, University of Sao Paulo, Brazil
| | | | - Luiz Gonzaga Tone
- Department of Pediatrics, Ribeirao Preto Medical School, University of Sao Paulo, Brazil
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Chebib I, Jo VY. Application of ancillary studies in soft tissue cytology using a pattern‐based approach. Cancer Cytopathol 2018; 126 Suppl 8:691-710. [DOI: 10.1002/cncy.22030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/22/2018] [Accepted: 05/22/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Ivan Chebib
- James Homer Wright Pathology Laboratories Massachusetts General Hospital Boston Massachusetts
- Harvard Medical School Boston Massachusetts
| | - Vickie Y. Jo
- Department of Pathology Brigham and Women’s Hospital Boston Massachusetts
- Harvard Medical School Boston Massachusetts
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Pleural malignant mesothelioma versus pleuropulmonary synovial sarcoma: a clinicopathological study of 22 cases with molecular analysis and survival data. Pathology 2018; 50:629-634. [PMID: 30170702 DOI: 10.1016/j.pathol.2018.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/14/2018] [Accepted: 06/25/2018] [Indexed: 01/02/2023]
Abstract
The aim of this study was to carry out a comparative analysis by transducin-like enhancer of split 1 (TLE1) immunohistochemistry and molecular analysis of SYT-SSX, for 16 pleural predominantly sarcomatoid mesotheliomas and six cases of pleuropulmonary synovial sarcoma (five pleural in distribution only, with one case of a predominantly subpleural upper lobe synovial sarcoma), all of which were solely or predominantly monophasic. Our comparison included survival and some clinical data. We consider that the following points emerged from this study.
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25
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Vig T, Thomas M, Pai R, Tirkey A, Janakiraman R. Primary Synovial Sarcoma arising from gingivo-buccal sulcus harbouring SS18-SSX2 positive fusion transcript: The 1st reported case in English literature. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 119:220-223. [DOI: 10.1016/j.jormas.2017.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 11/12/2017] [Accepted: 12/28/2017] [Indexed: 11/29/2022]
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Zayed H, Petersen I. Stem cell transcription factor SOX2 in synovial sarcoma and other soft tissue tumors. Pathol Res Pract 2018; 214:1000-1007. [PMID: 29773426 DOI: 10.1016/j.prp.2018.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 05/01/2018] [Accepted: 05/02/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND SOX2 has gained considerable interest as a pluripotency inducing gene. Co-transfection of SOX2 together with NANOG, KLF4 and c-MYC into adult fibroblasts was able to generate pluripotent stem cells. SOX2 has been reported to be expressed in synovial sarcoma, a tumor being characterized by the SS18-SSX gene fusion forming part of the SWI/SNF chromatin remodeling complex that affects histone methylation. The role of SOX2 in this tumor type as well as other soft tissue tumor entities however is still poorly characterized. We analyzed SOX2 protein expression in soft tissue tumors. Alongside we tested Histone H3 expression (H3K27me3) in SOX2 positive cases to investigate this epigenetic mark and its correlation with the SOX2 status and clinicopathological parameters. METHODOLOGY In total, 60 samples of synovial sarcomas from the reference center for soft tissue tumors at the institute of pathology of the Jena University hospital were included into the study along with 343 other tissue tumors. Protein analysis was done by immunohistochemistry of tissue microarrays. All synovial sarcoma cases were confirmed by molecular testing using SS18 FISH break apart probes. RESULTS SOX2 reactivity was detectable in 35 synovial sarcoma cases (58.3%) while 25 (41.7%) were negative. Only 13 cases of the other 343 soft tissue tumors, varying from nodular fasciitis to undifferentiated pleomorphic sarcoma, revealed a SOX2 expression, 12 out of these were undifferentiated high grade sarcoma. There was no obvious correlation with the clinicopathological data. H3K27me3 immunohistochemistry of the synovial sarcoma cases revealed a high statistically significant correlation between SOX2 and H3K27me3 expression (p < 0,0005, Chi square test). Similar to SOX2, there was no correlation between H3K27me3 expression and tumor grade. Six SOX2 positive synovial sarcoma cases were analyzed by FISH using a SOX2/CEN3 dual color FISH probe. None of these cases revealed an amplification of the SOX2 gene. CONCLUSION The data confirms previous studies reporting SOX2 and H3K27me3 expression in synovial sarcoma and reveals that both biomarkers are related to each other. It strengthens the notion that the tumor type is driven by epigenetic processes similar to those that are operating in pluripotent stem cells. The relevance of these parameters in the pathway pathology of synovial sarcoma, i.e. the timing and dosing of SOX2 and H3K27me3 expression initiated by the SS18-SSX driver mutation together with the interplay of these events with other signaling pathways, cellular mechanisms and additional mutations in tumor progression, will require further studies.
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Affiliation(s)
- Heba Zayed
- Institute of Pathology, Jena University Hospital, Germany; National Cancer Institute, Cairo University, Egypt
| | - Iver Petersen
- Institute of Pathology, Jena University Hospital, Germany.
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Transducing-Like Enhancer of Split 1: A Potential Immunohistochemical Marker for Glomus Tumor. Am J Dermatopathol 2018. [PMID: 28632567 DOI: 10.1097/dad.0000000000000705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Glomus tumors (GTs) are rare, perivascular soft tissue tumors. Although GTs are usually found in the subcutaneous tissue, they may be detected in extracutaneous sites and mucosal areas. Transducing-like enhancer of split 1 (TLE1) is a highly useful immunohistochemical marker, which basically helps in differential diagnosis of synovial sarcoma. Based on a coincidental detection of TLE1 in one GT case, we studied 26 additional GT cases to establish the importance and distribution of TLE1 in GTs. Of 24 subcutaneous GTs, 22 (91.6%) were positive for TLE1 antibody and the remaining 2 mucosal GTs were negative. Of the 22 positive cases, 10 showed strong nuclear positivity. There was no difference between the subtypes of the GTs. Although TLE1 expression is significantly correlated to SS18 (SYT) rearrangements in synovial sarcomas, the fluorescence in situ hybridization analyses of the GTs showed no evidence of translocation involving this locus. TLE1 is a potential immunohistochemical marker for GTs, but further studies are required to confirm this finding.
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28
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Painful Skin Nodule on the Finger of a 59-Year-Old: Answer. Am J Dermatopathol 2018; 40:299-300. [PMID: 29561330 DOI: 10.1097/dad.0000000000000765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Monti P, Barnes D, Adrian AM, Rasotto R. Synovial cell sarcoma in a dog: A misnomer-Cytologic and histologic findings and review of the literature. Vet Clin Pathol 2018; 47:181-185. [DOI: 10.1111/vcp.12590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Paola Monti
- Dick White Referrals; DWR Diagnostics; Cambridgeshire UK
| | - Darren Barnes
- Dick White Referrals; DWR Diagnostics; Cambridgeshire UK
| | - Anna M. Adrian
- Dick White Referrals; DWR Diagnostics; Cambridgeshire UK
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McGrath S, Tortorici M, Drouin L, Solanki S, Vidler L, Westwood I, Gimeson P, Van Montfort R, Hoelder S. Structure-Enabled Discovery of a Stapled Peptide Inhibitor to Target the Oncogenic Transcriptional Repressor TLE1. Chemistry 2017; 23:9577-9584. [PMID: 28326635 PMCID: PMC5575474 DOI: 10.1002/chem.201700747] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Indexed: 12/05/2022]
Abstract
TLE1 is an oncogenic transcriptional co-repressor that exerts its repressive effects through binding of transcription factors. Inhibition of this protein-protein interaction represents a putative cancer target, but no small-molecule inhibitors have been published for this challenging interface. Herein, the structure-enabled design and synthesis of a constrained peptide inhibitor of TLE1 is reported. The design features the introduction of a four-carbon-atom linker into the peptide epitope found in many TLE1 binding partners. A concise synthetic route to a proof-of-concept peptide, cycFWRPW, has been developed. Biophysical testing by isothermal titration calorimetry and thermal shift assays showed that, although the constrained peptide bound potently, it had an approximately five-fold higher Kd than that of the unconstrained peptide. The co-crystal structure suggested that the reduced affinity was likely to be due to a small shift of one side chain, relative to the otherwise well-conserved conformation of the acyclic peptide. This work describes a constrained peptide inhibitor that may serve as the basis for improved inhibitors.
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Affiliation(s)
- Sally McGrath
- The Institute of Cancer ResearchDivision of Cancer Therapeutics UnitCancer Research UK Cancer Therapeutics Unit15 Cotswold Road, SuttonSurreySM2 5NGUK
| | - Marcello Tortorici
- The Institute of Cancer ResearchDivision of Cancer Therapeutics UnitCancer Research UK Cancer Therapeutics Unit15 Cotswold Road, SuttonSurreySM2 5NGUK
| | - Ludovic Drouin
- The Institute of Cancer ResearchDivision of Cancer Therapeutics UnitCancer Research UK Cancer Therapeutics Unit15 Cotswold Road, SuttonSurreySM2 5NGUK
| | - Savade Solanki
- The Institute of Cancer ResearchDivision of Cancer Therapeutics UnitCancer Research UK Cancer Therapeutics Unit15 Cotswold Road, SuttonSurreySM2 5NGUK
| | - Lewis Vidler
- The Institute of Cancer ResearchDivision of Cancer Therapeutics UnitCancer Research UK Cancer Therapeutics Unit15 Cotswold Road, SuttonSurreySM2 5NGUK
| | - Isaac Westwood
- The Institute of Cancer ResearchDivision of Cancer Therapeutics UnitCancer Research UK Cancer Therapeutics Unit15 Cotswold Road, SuttonSurreySM2 5NGUK
| | - Peter Gimeson
- Malvern Instruments Nordic ABVallongatan 1Uppsala752 28Sweden
| | - Rob Van Montfort
- Cancer Research (UK) Cancer Therapeutics UnitDivision of Cancer TherapeuticsDivision of Structural BiologyThe Institute of Cancer Research15 Cotswold Road, SuttonSurreySM2 5NGUK
| | - Swen Hoelder
- The Institute of Cancer ResearchDivision of Cancer Therapeutics UnitCancer Research UK Cancer Therapeutics Unit15 Cotswold Road, SuttonSurreySM2 5NGUK
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John I, Bartlett DL, Rao UNM. Radiation-Induced Glandular Malignant Peripheral Nerve Sheath Tumor. Int J Surg Pathol 2017; 25:635-639. [PMID: 28530162 DOI: 10.1177/1066896917710718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Malignant peripheral nerve sheath tumors (MPNSTs) are aggressive soft-tissue tumors. They can occur in patients with neurofibromatosis type-1 (NF-1) or as sporadic tumors. Only 10% of MPNSTs are radiation induced. Divergent differentiation in MPNSTs can occur in 15% of cases and may include cartilage, bone, skeletal muscle, blood vessels, and very rarely well-formed glands, the latter typically described in NF-1-associated MPNSTs. We report an exceedingly rare case of radiation induced glandular MPNST arising in a neurofibroma of the femoral nerve in a patient previously irradiated for endometrial carcinoma.
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Affiliation(s)
- Ivy John
- 1 University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Uma N M Rao
- 1 University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Fulciniti F, Barizzi J, Martin V, Tarallo V, Ermanni S. Synovial sarcoma metastatic to the parotid gland: A possible pitfall in salivary gland fine needle aspiration cytology. Report of a case with immunocytochemical and fluorescence in situ hybridization findings. Diagn Cytopathol 2017; 45:834-836. [PMID: 28421710 DOI: 10.1002/dc.23725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 03/21/2017] [Accepted: 03/30/2017] [Indexed: 11/11/2022]
Abstract
We report one case of metastatic synovial sarcoma (SS) to the parotid gland in a 93-year-old male. The patient had undergone upper left pulmonary lobectomy with mediastinal lymphadenectomy for SS of the lung 5 years before. The cytopathologic presentation and the immunocytochemical findings on the FNA sample were suggestive of a spindle cell myoepithelioma, while a SYT rearrangement was identified by a FISH performed on a cytological smear of the lesion. The diagnosis was further confirmed also by positive immunocytochemical expression of TLE1 on a section from the obtained cell block. The cytologic and immunophenotypic findings are shortly discussed in view of the reported immunophenotypic inconsistency of SS and of its differential diagnosis with spindle cell myoepithelioma of the salivary glands.The importance of the recently described TLE1 staining and its close correlation to SYT rearrangement is briefly discussed.
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Affiliation(s)
| | | | - Vittoria Martin
- Istituto Cantonale di Patologia, Locarno, Switzerland.,Molecular Pathology Laboratory, Istituto Cantonale di Patologia, Locarno, Switzerland
| | | | - Stefano Ermanni
- ENT Department, Ospedale Regionale di Mendrisio, Mendrisio, Switzerland
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Dantey K, Schoedel K, Yergiyev O, McGough R, Palekar A, Rao UNM. Ossifying fibromyxoid tumor: a study of 6 cases of atypical and malignant variants. Hum Pathol 2016; 60:174-179. [PMID: 27816723 DOI: 10.1016/j.humpath.2016.10.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 09/30/2016] [Accepted: 10/14/2016] [Indexed: 11/25/2022]
Abstract
Ossifying fibromyxoid tumors (OFMT) of soft parts are rare, slow-growing tumors that have potential for local recurrence and may metastasize. While OFMT originally was considered benign, several cases of malignant OFMT have been documented. There is no universally accepted risk stratification, although this study emphasizes the importance of utilizing histology, immunohistochemistry and FISH in establishing the diagnosis. Herein, we describe six cases of atypical and malignant OFMT with differences in morphologic features, 5 of which display the proposed morphological criteria for malignancy. The patients were mostly male (M=5, F=1) with an age range of 33-69 years. The tumors arose from the extremities (3 cases), the shoulder (1 case), the head and neck area (1 case), and the paraspinal area (1 case). One tumor had high grade and overtly sarcomatous changes, while another invaded the underlying clavicle. Two cases showed cytological atypia and necrosis. Fluorescence in situ hybridization (FISH) detected rearrangement of the PHF1 gene in 5 cases. All cases were positive for EAAT4 and actin by immunohistochemistry, while negative for desmin. Three tumors were immunoreactive for S100 protein. INI-1 immunohistochemical staining was conserved in all but 2 cases in which a mosaic loss of expression was noted. All but two patients are currently alive and free of disease.
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Affiliation(s)
- Kossivi Dantey
- Department of Pathology Presbyterian Shadyside Hospitals, University of Pittsburgh Medical center, 5230 Centre Avenue, Pittsburgh, PA, 15232, USA
| | - Karen Schoedel
- Department of Pathology Presbyterian Shadyside Hospitals, University of Pittsburgh Medical center, 5230 Centre Avenue, Pittsburgh, PA, 15232, USA
| | - Oleksandr Yergiyev
- Department of Pathology Presbyterian Shadyside Hospitals, University of Pittsburgh Medical center, 5230 Centre Avenue, Pittsburgh, PA, 15232, USA
| | - Richard McGough
- Department of Orthopaedic Surgery, University of Pittsburgh Medical center, 5230 Centre Avenue, Pittsburgh, PA, 15232, USA
| | - Alka Palekar
- Department of Pathology Presbyterian Shadyside Hospitals, University of Pittsburgh Medical center, 5230 Centre Avenue, Pittsburgh, PA, 15232, USA
| | - Uma N M Rao
- Department of Pathology Presbyterian Shadyside Hospitals, University of Pittsburgh Medical center, 5230 Centre Avenue, Pittsburgh, PA, 15232, USA.
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Loss of H3K27me3 Expression Is a Highly Sensitive Marker for Sporadic and Radiation-induced MPNST. Am J Surg Pathol 2016; 40:479-89. [PMID: 26645727 DOI: 10.1097/pas.0000000000000564] [Citation(s) in RCA: 183] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Most malignant peripheral nerve sheath tumors (MPNSTs) exhibit combined inactivation of NF1, CDKN2A, and polycomb repressive complex 2 component genes (Embryonic Ectoderm Development [EED] and Suppressor of Zeste 12 [SUZ12]). Mutations in EED and SUZ12 induce loss of trimethylation at lysine 27 of histone 3 (H3K27me3), with subsequent aberrant transcriptional activation of polycomb repressive complex 2-repressed homeobox master regulators. These findings prompted us to investigate the performance of an anti-H3K27me3 monoclonal antibody clone C36B11 as an immunohistochemical marker for MPNSTs. We assessed the C36B11 reactivity pattern in a pathologically and genetically well-characterized cohort of 68 MPNSTs, spanning various clinical presentations, such as type 1 neurofibromatosis (NF1), radiotherapy, and sporadic MPNSTs. We found that 69% (n=47) of all MPNSTs demonstrated loss of H3K27me3 expression, with 42 (61%) showing complete loss and 5 (7%) showing partial loss, whereas 31% (n=21) retained H3K27me3 expression. Among the NF1-related high-grade MPNSTs, 60% demonstrated loss of expression. In contrast, the majority of both sporadic (95%) and radiotherapy-related (91%) MPNSTs showed loss of H3K27me3 expression. Two of the 3 low-grade MPNSTs and all neurofibromas showed retained expression. Furthermore, all 5 epithelioid MPNSTs retained H3K27me3 labeling. The specificity of H3K27me3 loss as a marker for MPNSTs was studied by testing a large spectrum of lesions included in MPNST differential diagnosis, such as spindle/desmoplastic melanomas, synovial sarcomas, myoepithelial tumors, and other mesenchymal neoplasms, all of which retained expression of H3K27me3. We conclude that immunohistochemical analysis of H3K27me3 has good sensitivity and robust specificity for the diagnosis of MPNST, particularly outside of NF1 clinical history, which represents the most challenging diagnostic setting.
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Atef A, Alrashidy M. Transducer-like Enhancer of Split 1 as a Novel Immuno- histochemical Marker for Diagnosis of Synovial Sarcoma. Asian Pac J Cancer Prev 2016; 16:6545-8. [PMID: 26434872 DOI: 10.7314/apjcp.2015.16.15.6545] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Synovial sarcoma is a mesenchymal neoplasm that accounts for around 10% of all soft tissue sarcomas. The diagnosis of synovial sarcoma can be a challenging task, particularly with small biopsy specimens. AIM We investigated transducer-like enhancer of split 1 (TLE1), monoclonal antibody, expression by immunohistochemical analysis in a group of 74 synovial sarcoma cases, 20 cases of MPNST, 12 cases of neurofibroma, 15 cases of schwannoma, 5 cases of MFH, 10 cases of lieomyosarcoma and 10 cases of solitary fibrous tumor. MATERIALS AND METHODS Whole tissue sections were examined: (39 biphasic and 35 monophasic). Nuclear immunoreactivity was scored as negative (<5% of cells positive), 1+(mild /5-25%), 2+ (moderate/25-50%), and 3+ (strong >50%). RESULTS Overall, 71 (96%) of 74 synovial sarcomas were positive for TLE1, including 37 biphasic (95%) and 34 monophasic (97%) tumors. Other spindle cell tumors showed very low or absent staining of TLE1. CONCLUSIONS We conclude that TLE1 is a sensitive marker and can be a useful diagnostic marker for synovial sarcoma, particularly the monophasic forms.
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Affiliation(s)
- Aliaa Atef
- Pathology Department,Faculty of Medicine, Tanta University, Egypt E-mail :
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Lan T, Chen H, Xiong B, Zhou T, Peng R, Chen M, Ye F, Yao J, He X, Wang Y, Zhang H. Primary pleuropulmonary and mediastinal synovial sarcoma: a clinicopathologic and molecular study of 26 genetically confirmed cases in the largest institution of southwest China. Diagn Pathol 2016; 11:62. [PMID: 27401493 PMCID: PMC4939734 DOI: 10.1186/s13000-016-0513-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Accepted: 07/07/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Primary pleuropulmonary and mediastinal synovial sarcomas (PPMSSs) are extremely rare. The authors present the largest series in an Asian population. METHODS Between 2000 and 2015, 26 genetically confirmed PPMSSs were included. The clinicopathologic features of all of the cases were reviewed. Immunohistochemical staining was carried out using the following antibodies: TLE1, cytokeratin (AE1/AE3), EMA, CD99, Bcl-2, CK7, CD34, S-100 protein, and Ki-67. The chromosomal translocation t(X;18)(p11.2;q11.2) was detected by fluorescence in situ hybridization (FISH) and reverse transcription polymerase chain reaction (RT-PCR). We compared the clinical, pathologic, immunohistochemical, and molecular features of this series with that of the previous series and soft tissue synovial sarcomas. RESULTS This series included 17 males and nine females. The median age was 36.5 years (range, 16-72 years). The tumors involved the lung (76.9 %), pleura (15.4 %), and mediastinum (7.7 %). The median tumor size was 6 cm (range 2.3 ~ 24 cm). The majority of the tumors were well-circumscribed. The tumors were classified as monophasic (84.6 %), biphasic (3.8 %), and poorly differentiated (11.5 %) types. The tumors were graded as French Federation of Cancer Centers (FNCLCC) grade 2 (62.5 %) and FNCLCC 3 (37.5 %). Diffuse immunostaining for TLE1, BCL-2, and CD99 was identified in 91.7, 95.7, and 56.0 % of the tumors, respectively. Focal positivity was seen with EMA (84.6 %), CK7 (55.6 %), cytokeratin (AE1/AE3) (68.0 %), CD34 (5.0 %), and S-100 protein (21.7 %). A high Ki-67 index (≥10 %) was observed in 91.3 % of the tumors. The fusion transcripts included SS18-SSX1 (15/22, 68.2 %), SS18-SSX2 including variants (6/22, 27.3 %), and SS18-SSX4 (1/22, 4.5 %) fusions. The remaining four cases showed positivity for SS18 rearrangement by FISH. Surgical excision of tumors or lobectomy were performed in 20 patients, and seven of the patients underwent adjuvant therapy. Clinical follow-up was available in 73.1 % cases, with a median follow-up of 12.0 months. The median survival time was 14.5 months. Tumor resection (p = 0.024) and no residual tumor (p = 0.004) were associated with an improved overall survival time. CONCLUSIONS PPMSS is a highly aggressive neoplasm. Extensive surgical resection of the tumor and more effective adjuvant therapy should be advocated. PPMSS must be differentiated from similar diseases.
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Affiliation(s)
- Ting Lan
- />Department of Pathology, West China Hospital, Sichuan University, Guoxuexiang 37, 610041 Chengdu, Sichuan China
| | - Huijiao Chen
- />Department of Pathology, West China Hospital, Sichuan University, Guoxuexiang 37, 610041 Chengdu, Sichuan China
| | - Bo Xiong
- />Department of Pathology, West China Hospital, Sichuan University, Guoxuexiang 37, 610041 Chengdu, Sichuan China
| | - Tingqing Zhou
- />Department of Pathology, Mianyang People’s Hospital, Mianyang, Sichuan China
| | - Ran Peng
- />Department of Pathology, West China Hospital, Sichuan University, Guoxuexiang 37, 610041 Chengdu, Sichuan China
| | - Min Chen
- />Department of Pathology, West China Hospital, Sichuan University, Guoxuexiang 37, 610041 Chengdu, Sichuan China
| | - Feng Ye
- />Laboratory of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Jin Yao
- />Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Xin He
- />Department of Pathology, West China Hospital, Sichuan University, Guoxuexiang 37, 610041 Chengdu, Sichuan China
| | - Yaqin Wang
- />Department of Pathology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan China
| | - Hongying Zhang
- />Department of Pathology, West China Hospital, Sichuan University, Guoxuexiang 37, 610041 Chengdu, Sichuan China
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Regulation of Ripply1 expression in MDCK organoids. Biochem Biophys Res Commun 2015; 468:337-42. [DOI: 10.1016/j.bbrc.2015.10.099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 10/20/2015] [Indexed: 02/06/2023]
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Ito J, Asano N, Kawai A, Yoshida A. The diagnostic utility of reduced immunohistochemical expression of SMARCB1 in synovial sarcomas: a validation study. Hum Pathol 2015; 47:32-7. [PMID: 26520417 DOI: 10.1016/j.humpath.2015.09.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 08/26/2015] [Accepted: 09/04/2015] [Indexed: 01/04/2023]
Abstract
Synovial sarcoma is a malignant mesenchymal neoplasm of uncertain histogenesis, characterized by a specific SS18-SSX fusion. The diagnosis of synovial sarcoma can be challenging based on morphology and conventional immunohistochemistry alone, and identification of the fusion gene by molecular genetics may be necessary for diagnosis. Several recent studies have demonstrated the diagnostic utility of the reduced expression of SMARCB1 in synovial sarcomas as measured using immunohistochemistry. Therefore, we undertook a validation study using synovial sarcomas and other spindle or round cell tumors that could enter differential diagnosis of monophasic or poorly differentiated synovial sarcomas. Among 36 synovial sarcomas that were successfully evaluated, the expression of SMARCB1 was diffusely reduced in 33 cases (92%) at variable degrees. In contrast, the expression of SMARCB1 was not reduced in any of the 93 evaluable non-synovial sarcoma tumors (5 thymomas, 5 sarcomatoid mesotheliomas, 10 schwannomas, 9 mesenchymal chondrosarcomas, 20 solitary fibrous tumors, 19 Ewing sarcomas, and 25 malignant peripheral nerve sheath tumors). A few schwannomas and malignant peripheral nerve sheath tumors showed mosaic or complete loss of SMARCB1 expression. Reduced expression of SMARCB1 immunoreactivity was therefore found to be highly sensitive and specific for synovial sarcoma, and can be useful for rapidly and accurately confirming the diagnosis of synovial sarcoma. This reduction in SMARCB1 expression likely reflects the BAF47 ejection mechanism of the SS18-SSX fusion product and can therefore be viewed as an indirect visualization of this fusion product.
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Affiliation(s)
- Junko Ito
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, 104-0045 Japan
| | - Naofumi Asano
- Division of Rare Cancer Research, National Cancer Center Research Institute, Tokyo, 104-0045 Japan; Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-0016 Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, 104-0045 Japan; Rare Cancer Center, National Cancer Center Hospital, Tokyo, 104-0045 Japan
| | - Akihiko Yoshida
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, 104-0045 Japan; Rare Cancer Center, National Cancer Center Hospital, Tokyo, 104-0045 Japan.
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Petersen I, Warth A. [Lung cancer. Developments, concepts and preview of the new WHO classification]. DER PATHOLOGE 2015; 35:547-56. [PMID: 25366371 DOI: 10.1007/s00292-014-1915-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The diagnostics of pulmonary neoplasms has considerably changed in recent years. Based on large-scale molecular characterization studies and the development of targeted therapies, precise morphological, immunohistochemical and molecular pathological tumor subtyping is now of utmost importance for evidence-based treatment decisions. This review highlights recent developments in morphological and immunohistochemical subtyping of pulmonary neoplasms, concepts of tumor progression and provides a preview of relevant changes of the forthcoming new WHO classification, which is expected to be published in 2015. It becomes apparent that a 3-step diagnostic procedure based on morphology, immunohistochemistry and molecular pathology is important to meet the requirements of an increasingly more complex, interdisciplinary care of lung cancer patients and to allow reliable, clinically meaningful tumor diagnosis.
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Affiliation(s)
- I Petersen
- Institut für Pathologie, Universitätsklinikum Jena, Ziegelmühlenweg 1, 07743, Jena, Deutschland,
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40
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Petersen I, Warth A. Lung cancer: developments, concepts, and specific aspects of the new WHO classification. J Cancer Res Clin Oncol 2015. [PMID: 26197868 DOI: 10.1007/s00432-015-2004-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Diagnostic methods and algorithms for the diagnosis of pulmonary neoplasms have considerably changed over the recent years. Based on large-scale molecular characterization studies and the development of targeted therapies, precise morphological, immunohistochemical, and molecular pathological tumor subtyping is now of utmost importance for evidence-based treatment decisions. Changes of diagnostic concepts initially referred to biopsies and cytology specimens but are now also transferred to resection specimens. METHODS This review is focused on recent developments in morphological and immunohistochemical subtyping of pulmonary neoplasms and concepts of tumor progression. It also provides perspectives on relevant changes of diagnostic concepts within the context of the new WHO classification. CONCLUSION It becomes apparent that a three-step diagnostic concept based on morphology, immunohistochemistry, and molecular pathology is important to meet the requirements of an increasingly more complex, interdisciplinary care of lung cancer patients and to allow for reliable, clinically meaningful tumor diagnoses.
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Affiliation(s)
- Iver Petersen
- Institute of Pathology, University Hospital Jena, Ziegelmühlenweg 1, 07743, Jena, Germany.
| | - Arne Warth
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research, Heidelberg, Germany
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Kampmann E, Altendorf-Hofmann A, Gibis S, Lindner LH, Issels R, Kirchner T, Knösel T. VEGFR2 predicts decreased patients survival in soft tissue sarcomas. Pathol Res Pract 2015; 211:726-30. [PMID: 26298629 DOI: 10.1016/j.prp.2015.04.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/01/2015] [Accepted: 04/24/2015] [Indexed: 11/27/2022]
Abstract
AIMS Tyrosine kinases are promising targets for personalized medicine, and new drugs are currently in phase 2 and phase 3 clinical trials. However, expression analysis of tyrosine kinases as predictive biomarkers is still not a standard approach. Furthermore, only limited studies have investigated the expression of tyrosine kinase receptors on the protein level. In this study, we analysed a well-characterised group of soft tissue sarcomas for different tyrosine kinase receptors and correlated the results with clinicopathological parameters, including survival. METHODS 275 soft tissue sarcomas of our Sarcoma center at the Ludwig-Maximilians-University (LMU) were reinvestigated and categorized according to the current WHO classification system. The tumor collective included undifferentiated pleomorphic sarcomas (n=81), leiomyosarcomas (n=50), synovial sarcomas (n=27), liposarcomas (n=51), angiosarcomas (n=43) and other soft tissue sarcomas (n=23). RESULTS On protein levels, high expression of VEGFR1 was detected immunohistochemically in 61%, VEGFR2 (KDR) in 11%, VEGFR3 in 64%, PDGFRA in 42% and PDGFRB in 73%. High expression of VEGFR1-3 and PDGFRB was significantly correlated with higher grading (G2 vs G3, p<0.05), and high VEGFR2 was significantly correlated with decreased patients' survival (p<0.001). CONCLUSIONS Tyrosine kinase receptors showed a distinct expression pattern in soft tissue sarcomas. High expression of VEGFR2 (KDR) is significantly associated with decreased patients' survival. High VEGFR 1-3 and PDGFRB are significantly correlated with higher tumor grading. Protein signatures might be evaluated before targeted therapy to give a rationale for an eligible personalized therapy.
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Affiliation(s)
- Eric Kampmann
- Department of Internal Medicine III, Ludwig-Maximilians-University (LMU), Munich, Germany
| | | | - Sebastian Gibis
- Department of Internal Medicine III, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Lars H Lindner
- Department of Internal Medicine III, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Rolf Issels
- Department of Internal Medicine III, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Thomas Kirchner
- Institute of Pathology, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Thomas Knösel
- Institute of Pathology, Ludwig-Maximilians-University (LMU), Munich, Germany.
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Lin G, Doyle LA. An update on the application of newly described immunohistochemical markers in soft tissue pathology. Arch Pathol Lab Med 2015; 139:106-21. [PMID: 25549147 DOI: 10.5858/arpa.2014-0488-ra] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT During the last 5 to 10 years, significant progress has been made in the molecular characterization of soft tissue tumors, predominantly with the identification of recurrent translocations or amplification of certain genes in different tumor types. Alongside this, translational efforts have identified many novel and diagnostically useful immunohistochemical markers for many of these tumor types. OBJECTIVE This article reviews a select group of recently described immunohistochemical markers of particular use in the evaluation of mesenchymal neoplasms; the underlying biology of the protein product, practical utility, and limitations of each marker are discussed in detail. DATA SOURCES Literature review, authors' research data, and personal practice experience serve as sources. CONCLUSIONS There are many diagnostically useful immunohistochemical markers to help confirm the diagnosis of many different soft tissue tumor types, some of which have reduced the need for additional, and more costly, studies, such as fluorescence in situ hybridization. However, no one marker is 100% specific for a given tumor, and knowledge of potential pitfalls and overlap in patterns of staining among other tumor types is crucial to ensure the appropriate application of these markers in clinical practice.
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Affiliation(s)
- George Lin
- From the Department of Laboratory Medicine, Geisinger Medical Center, Danville, Pennsylvania (Dr Lin); and the Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (Dr Doyle)
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43
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Smith SM, Coleman J, Bridge JA, Iwenofu OH. Molecular diagnostics in soft tissue sarcomas and gastrointestinal stromal tumors. J Surg Oncol 2015; 111:520-31. [PMID: 25772665 DOI: 10.1002/jso.23882] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 12/11/2014] [Indexed: 12/17/2022]
Abstract
Soft tissue sarcomas are rare malignant heterogenous tumors of mesenchymal origin with over fifty subtypes. The use of hematoxylin and eosin stained sections (and immunohistochemistry) in the morphologic assessment of these tumors has been the bane of clinical diagnosis until recently. The last decade has witnessed considerable progress in the understanding and application of molecular techniques in refining the current understanding of soft tissue sarcomas and gastrointestinal stromal tumors beyond the limits of traditional approaches. Indeed, the identification of reciprocal chromosomal translocations and fusion genes in some subsets of sarcomas with potential implications in the pathogenesis, diagnosis and treatment has been revolutionary. The era of molecular targeted therapy presents a platform that continues to drive biomarker discovery and personalized medicine in soft tissue sarcomas and gastrointestinal stromal tumors. In this review, we highlight how the different molecular techniques have enhanced the diagnosis of these tumors with prognostic and therapeutic implications.
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Affiliation(s)
- Stephen M Smith
- Department of Pathology & Laboratory Medicine, Wexner Medical Center at The Ohio State University, Columbus, Ohio
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Vedana M, Fuenfschilling M, Tzankov A, Zellweger T. Primary synovial cell sarcoma of the kidney: case report and review of the literature. Case Rep Oncol 2015; 8:128-32. [PMID: 25873878 PMCID: PMC4376929 DOI: 10.1159/000379740] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Synovial cell sarcoma (SCS) of the kidney is a rare tumor entity with a poor prognosis. Morphologic and immunohistochemical characteristics may overlap with other more common neoplasms of the kidney. Therefore, the diagnosis of primary renal SCS not only requires the exclusion of similar tumor types, but also a confirmation of SYT-SSX gene fusion using molecular techniques. The treatment comprises radical surgery, and, depending on age and health status, adjuvant chemotherapy in selected patients. Here, we present an elderly SCS patient in whom straightforward radical surgical treatment resulted in a sustained complete remission; it allowed us to perform a literature survey focusing on current diagnostic tools for SCS.
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Affiliation(s)
- Marc Vedana
- Department of Urology, St. Claraspital, Basel, Switzerland
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45
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Wang J, Thway K. Clear Cell Sarcoma–like Tumor of the Gastrointestinal Tract: An Evolving Entity. Arch Pathol Lab Med 2015; 139:407-412. [DOI: 10.5858/arpa.2013-0547-rs] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Clear cell sarcoma–like tumor of the gastrointestinal tract (CCSLGT) is a rare malignant neoplasm that occurs in the wall of the small bowel, stomach, or large bowel, predominantly in young adults. It is an aggressive neoplasm that frequently presents with metastatic disease and has a high mortality rate. Histologically, it is usually composed of medium-sized primitive ovoid or epithelioid cells with pale or clear cytoplasm that are arranged in sheets or in papillary or alveolar architectures. Clear cell sarcoma–like tumor of the gastrointestinal tract is positive for S100 protein, invariably negative for melanocyte-specific markers and is often also positive for neuroendocrine markers. The etiology of CCSLGT is unknown, but many studies have shown associations with EWSR1-CREB1 gene fusions and, less frequently, with EWSR1-ATF1 fusions. Here, we discuss the current status of CCSLGT, including histologic, immunophenotypic, and molecular findings.
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Affiliation(s)
- Jayson Wang
- From the Department of Histopathology, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Khin Thway
- From the Department of Histopathology, The Royal Marsden NHS Foundation Trust, London, United Kingdom
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Wong NACS, Campbell F, Shepherd NA. Abdominal monophasic synovial sarcoma is a morphological and immunohistochemical mimic of gastrointestinal stromal tumour. Histopathology 2015; 66:974-81. [PMID: 25346074 DOI: 10.1111/his.12593] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 10/17/2014] [Indexed: 12/12/2022]
Abstract
AIMS Synovial sarcomas may arise within retroperitoneal or pelvic tissues or, more rarely, within the luminal gastrointestinal tract. This case series aims to demonstrate how such primary abdominal synovial sarcomas may particularly mimic gastrointestinal stromal tumour (GIST) on both morphological and immunohistochemical grounds. METHODS AND RESULTS Four cases of primary abdominal synovial sarcoma were reviewed morphologically and with immunohistochemistry, fluorescence in-situ hybridization with an SS18 break-apart probe, and KIT/PDGFRA mutation analysis. The four patients comprised two males and two females, with a median age of 42 years (range: 17-59 years). Two synovial sarcomas arose within the stomach, one within the small-intestine mesentery, and the fourth within the retroperitoneum. All four tumours showed only a monophasic spindle cell component in the tissues available for review. All four tumours showed DOG1 immunopositivity, and three coexpressed CD117. Three tested cases did not show activating KIT or PDGFRA mutations, whereas all four cases showed chromosomal rearrangement of SS18. CONCLUSIONS A diagnosis of synovial sarcoma should be considered particularly if an abdominal spindle cell neoplasm shows a haemangiopericytomatous pattern and diffuse CD99 and CD56 immunopositivity. A confident distinction between abdominal synovial sarcoma and GIST requires KIT/PDGFRA mutation analyses and specific molecular testing for synovial sarcoma.
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Affiliation(s)
| | - Fiona Campbell
- Department of Pathology, Royal Liverpool University Hospital, Liverpool, UK
| | - Neil A Shepherd
- Gloucestershire Cellular Pathology Laboratory, Cheltenham General Hospital, Cheltenham, UK
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Morgan SS, Cranmer LD. Vorinostat synergizes with ridaforolimus and abrogates the ridaforolimus-induced activation of AKT in synovial sarcoma cells. BMC Res Notes 2014; 7:812. [PMID: 25406429 PMCID: PMC4247709 DOI: 10.1186/1756-0500-7-812] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 10/31/2014] [Indexed: 11/13/2022] Open
Abstract
Background Curative treatments for patients with metastatic synovial sarcoma (SS) do not exist, and such patients have a poor prognosis. We explored combinations of molecularly-targeted and cytotoxic agents to identify synergistic treatment combinations in SS cells. Methods Two SS cell lines (HS-SY-II and SYO-I) were treated with single agents or combinations of molecularly targeted therapies (HDAC inhibitor, vorinostat; mTOR inhibitor, ridaforolimus) and cytotoxic agents. After 72 hours, cell viability was measured using the MTS cell proliferation assay. Combination Indices (CI) were calculated to determine whether each combination was synergistic, additive, or antagonistic. Western Blot analysis assessed alterations in total and phospho-AKT protein levels in response to drug treatment. Results We determined the single-agent IC50 for ridaforolimus, vorinostat, doxorubicin, and melphalan in HS-SY-II and SYO-I. Synergism was apparent in cells co-treated with ridaforolimus and vorinostat: CI was 0.28 and 0.63 in HS-SY-II and SYO-I, respectively. Ridaforolimus/doxorubicin and ridaforolimus/melphalan exhibited synergism in both cell lines. An additive effect was observed with combination of vorinostat/doxorubicin in both cell lines. Vorinostat/melphalan was synergistic in HS-SY-II and additive in SYO-I. Western blot analysis demonstrated that ridaforolimus increased pAKT-ser473 levels; this effect was abrogated by vorinostat co-treatment. Conclusions The combination of ridaforolimus and vorinostat demonstrates in vitro synergism in SS. Addition of vorinostat abrogated ridaforolimus-induced AKT activation. Since AKT activation is a possible mechanism of resistance to mTOR inhibitors, adding vorinostat (or another HDAC inhibitor) may be a route to circumvent AKT-mediated resistance to mTOR inhibitors.
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Affiliation(s)
| | - Lee D Cranmer
- The University of Arizona Cancer Center, 1515 N, Campbell Avenue, Tucson, AZ 85724-5024, USA.
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Agaimy A. [Value of core needle biopsy in preoperative diagnostics of soft tissue tumors: possibilities and limitations]. DER PATHOLOGE 2014; 35 Suppl 2:189-97. [PMID: 25394967 DOI: 10.1007/s00292-014-2010-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The differential diagnosis of soft tissue swellings encompasses a variety of benign, intermediate, low-grade malignant and high-grade neoplastic lesions in addition to tumor-like reactive processes. As treatment of these heterogeneous conditions varies greatly from conservative observation and simple local excision up to extensive radical surgical resection, treatment decisions are based mainly on a precise preoperative histological diagnosis on limited biopsy material. Even for clinically unequivocal sarcomas, the importance of the preoperative histological diagnosis has been increasingly emphasized as different therapeutic regimens have been established for different sarcoma types and the indications for preoperative treatment is influenced by the tumor grade and by the entity itself. Other factors positively influencing the increasing use of core needle biopsy for preoperative tumor diagnosis in soft tissue pathology are the availability of modern high-resolution imaging modalities as well as the establishment of several new second generation immunohistochemical markers and the discovery of entity-specific translocations detected by fluorescence in situ hybridization (FISH) in several sarcoma subtypes. In this review it will be shown that a targeted approach for processing core needle biopsies oriented towards the characteristic topographical, demographic, cytomorphological and architectural features of soft tissue lesions facilitates a precise diagnosis of soft tissue neoplasms in most cases. However, profound knowledge of the different aspects of soft tissue tumor diagnostics and familiarity with the frequent as well as the less common and rare tumor entities and variants is a prerequisite for appropriate interpretation of core needle biopsy findings and for selecting a limited but well-suited marker panel. The utilization of modern immunohistochemistry and/or FISH methods is highly useful for establishing the diagnosis of rare and unusual neoplasms in core needle biopsies.
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Affiliation(s)
- A Agaimy
- Pathologisches Institut, Universitätsklinikum Erlangen, Krrankenhausstr. 8-10, 91054, Erlangen, Deutschland,
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Knösel T, Altendorf-Hofmann A, Lindner L, Issels R, Hermeking H, Schuebbe G, Gibis S, Siemens H, Kampmann E, Kirchner T. Loss of p16(INK4a) is associated with reduced patient survival in soft tissue tumours, and indicates a senescence barrier. J Clin Pathol 2014; 67:592-8. [DOI: 10.1136/jclinpath-2013-202106] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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