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Kokkali S, Boukovinas I, de Bree E, Koumarianou A, Georgoulias V, Kyriazoglou A, Tsoukalas N, Memos N, Papanastassiou J, Stergioula A, Tsapakidis K, Loga K, Duran-Moreno J, Papanastasopoulos P, Vassos N, Kontogeorgakos V, Athanasiadis I, Mahaira L, Dimitriadis E, Papachristou DJ, Agrogiannis G. The Impact of Expert Pathology Review and Molecular Diagnostics on the Management of Sarcoma Patients: A Prospective Study of the Hellenic Group of Sarcomas and Rare Cancers. Cancers (Basel) 2024; 16:2314. [PMID: 39001377 PMCID: PMC11240402 DOI: 10.3390/cancers16132314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 06/15/2024] [Accepted: 06/20/2024] [Indexed: 07/16/2024] Open
Abstract
Precise classification of sarcomas is crucial to optimal clinical management. In this prospective, multicenter, observational study within the Hellenic Group of Sarcoma and Rare Cancers (HGSRC), we assessed the effect of expert pathology review, coupled with the application of molecular diagnostics, on the diagnosis and management of sarcoma patients. Newly diagnosed sarcoma patients were addressed by their physicians to one of the two sarcoma pathologists of HGSRC for histopathological diagnostic assessment. RNA next-generation sequencing was performed on all samples using a platform targeting 86 sarcoma gene fusions. Additional molecular methods were performed in the opinion of the expert pathologist. Therefore, the expert pathologist provided a final diagnosis based on the histopathological findings and, when necessary, molecular tests. In total, 128 specimens from 122 patients were assessed. Among the 119 cases in which there was a preliminary diagnosis by a non-sarcoma pathologist, there were 37 modifications in diagnosis (31.1%) by the sarcoma pathologist, resulting in 17 (14.2%) modifications in management. Among the 110 cases in which molecular tests were performed, there were 29 modifications in diagnosis (26.4%) through the genomic results, resulting in 12 (10.9%) modifications in management. Our study confirms that expert pathology review is of utmost importance for optimal sarcoma diagnosis and management and should be assisted by molecular methods in selected cases.
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Affiliation(s)
- Stefania Kokkali
- Oncology Unit, 2nd Department of Medicine, Medical School, Hippocratio General Hospital of Athens, National and Kapodistrian University of Athens, V. Sofias 114, 11527 Athens, Greece
| | - Ioannis Boukovinas
- Oncology Department, Bioclinic of Thessaloniki, 54622 Thessaloniki, Greece;
| | - Eelco de Bree
- Department of Surgical Oncology, University Hospital of Heraklion, 71110 Heraklion, Greece;
| | - Anna Koumarianou
- Hematology Oncology Unit, Fourth Department of Internal Medicine, School of Medicine, National Kapodistrian University of Athens, 12462 Athens, Greece;
| | | | - Anastasios Kyriazoglou
- Medical Oncology Unit, Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Nikolaos Tsoukalas
- Department of Oncology, 401 General Military Hospital of Athens, 11525 Athens, Greece;
| | - Nikolaos Memos
- 2nd Department of Surgery, School of Medicine, Aretaieion Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - John Papanastassiou
- Department of Orthopedic Oncology, “Agioi Anargyroi” General Hospital, 14564 N.Kifisia, Greece;
| | - Anastasia Stergioula
- Department of Radiation Oncology, “Iaso” Hospital, 15123 Marousi, Greece;
- Department of Tomotherapy-Stereotactic Radiosurgery “Iatropolis”, 15231 Chalandri, Greece
| | | | - Konstantia Loga
- Department of Medical Oncology, School of Medicine, Faculty of Health Sciences, Papageorgiou Hospital, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece;
| | - Jose Duran-Moreno
- Hellenic Group of Sarcoma and Rare Cancers, G. Theologou 5, 11471 Athens, Greece;
| | | | - Nikolaos Vassos
- Division of Surgical Oncology and Thoracic Surgery, Mannheim University Medical Center, University of Heidelberg, 68167 Mannheim, Germany;
- Department of Surgical Oncology, Athens Medical Center, 15125 Athens, Greece
| | - Vasileios Kontogeorgakos
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Ilias Athanasiadis
- Oncology Department, Hygeia Athens Private Hospital, 15123 Maroussi, Greece;
| | - Luiza Mahaira
- Department of Genetics, Saint Savvas Cancer Hospital, 11522 Athens, Greece; (L.M.); (E.D.)
| | - Efthymios Dimitriadis
- Department of Genetics, Saint Savvas Cancer Hospital, 11522 Athens, Greece; (L.M.); (E.D.)
| | - Dionysios J. Papachristou
- Unit of Bone and Soft Tissue Studies, Department of Histology and Histopathology, School of Medicine, University of Patras, 26504 Patras, Greece;
| | - George Agrogiannis
- Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece;
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2
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Dehner CA, Lazar AJ, Chrisinger JSA. Updates on WHO classification for small round cell tumors: Ewing sarcoma vs. everything else. Hum Pathol 2024; 147:101-113. [PMID: 38280658 DOI: 10.1016/j.humpath.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/16/2024] [Accepted: 01/22/2024] [Indexed: 01/29/2024]
Abstract
The WHO Classification of Soft Tissue and Bone Tumours currently recognizes four categories of undifferentiated small round cell sarcoma: Ewing sarcoma, round cell sarcoma with EWSR1-non-ETS fusions including NFATc2 and PATZ1, CIC-rearranged sarcoma, and sarcoma with BCOR genetic alterations. These neoplasms frequently pose significant diagnostic challenges due to rarity and overlapping morphologic and immunohistochemical findings. Further, molecular testing, with accompanying pitfalls, may be needed to establish a definitive diagnosis. This review summarizes the clinical, histologic, immunohistochemical, and molecular features of these neoplasms. In addition, differential diagnosis and areas of uncertainty and ongoing investigation are discussed.
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MESH Headings
- Humans
- Sarcoma, Ewing/genetics
- Sarcoma, Ewing/pathology
- Sarcoma, Ewing/classification
- Sarcoma, Ewing/chemistry
- Bone Neoplasms/pathology
- Bone Neoplasms/genetics
- Bone Neoplasms/classification
- Sarcoma, Small Cell/genetics
- Sarcoma, Small Cell/pathology
- Sarcoma, Small Cell/classification
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/analysis
- World Health Organization
- Diagnosis, Differential
- Immunohistochemistry
- Soft Tissue Neoplasms/pathology
- Soft Tissue Neoplasms/genetics
- Soft Tissue Neoplasms/classification
- RNA-Binding Protein EWS/genetics
- Repressor Proteins/genetics
- Gene Rearrangement
- Proto-Oncogene Proteins/genetics
- Predictive Value of Tests
- Phenotype
- Genetic Predisposition to Disease
- Oncogene Proteins, Fusion/genetics
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Affiliation(s)
- Carina A Dehner
- Department of Anatomic Pathology and Laboratory Medicine, Indiana University, 635 Barnhill Drive, Indianapolis, IN, 46202, USA.
| | - Alexander J Lazar
- Department of Pathology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA; Department of Genomic Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - John S A Chrisinger
- Department of Pathology and Immunology, Division of Anatomic and Molecular Pathology, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA.
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3
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Rekhi B, Santosh A, Rastogi S. A Rare Case of a Malignant Epithelioid Neoplasm With an Underlying Novel EWSR1::ZBT44 Fusion, Identified on Next-Generation Sequencing (NGS). Int J Surg Pathol 2024:10668969241246462. [PMID: 38646679 DOI: 10.1177/10668969241246462] [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: 04/23/2024]
Abstract
The clinicopathological spectrum of undifferentiated round cell sarcomas of bone and soft tissues is expanding after the 5th edition of the WHO classification. A 23-year-old male patient presented with a lump in his left thigh of 3 months' duration. Radiological examination revealed a well-defined, solid-cystic lobulated, soft tissue lesion in the proximal medial region of his left thigh, measuring 7.7 cm in the largest dimension. The referring diagnosis was an epithelioid sarcoma. Histopathological review of the tumor sections revealed a cellular tumor composed of malignant epithelioid to focally "rhabdoid-like" cells in a variable hyalinized and myxoid stroma with geographic areas of necrosis. In addition, there were areas reminiscent of hemangiopericytomatous vasculature. By immunohistochemistry, the tumor cells were diffusely positive for CD34, focally and distinctly for pan keratin (AE1/AE3). INI1/SMARCB1 and SMARCA4 (BRG1) were diffusely positive (normal). Next-generation sequencing with a wide sarcoma panel revealed EWSR1exon8::ZBT44exon4 fusion. The present example constitutes the first malignant epithelioid tumor with a hemangiopericytomatous growth pattern, exhibiting this rare fusion. The differential diagnoses of this tumor and their corresponding immunohistochemical profile are discussed. This example highlights the value of NGS in unraveling rare fusions and in differentiating these tumors from their several mimics.
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Affiliation(s)
- Bharat Rekhi
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute University, Mumbai, India
| | - Akhil Santosh
- Department of Medical Oncology, All Indian Institute of Medical Sciences, New Delhi, India
| | - Sameer Rastogi
- Department of Medical Oncology, All Indian Institute of Medical Sciences, New Delhi, India
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4
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Murphy J, Resch EE, Leland C, Meyer CF, Llosa NJ, Gross JM, Pratilas CA. Clinical outcomes of patients with CIC-rearranged sarcoma: a single institution retrospective analysis. J Cancer Res Clin Oncol 2024; 150:112. [PMID: 38436779 PMCID: PMC10912249 DOI: 10.1007/s00432-024-05631-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/24/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE CIC-rearranged sarcomas represent a type of undifferentiated small round cell sarcoma (USRCS) characterized by poor survival, rapid development of chemotherapy resistance, and high rates of metastasis. We aim to contribute to the growing body of knowledge regarding diagnosis, treatment, clinical course, and outcomes for these patients. METHODS This case series investigates the clinical courses of ten patients with CIC-rearranged sarcoma treated at the Johns Hopkins Hospital from July 2014 through January 2024. Clinical data were retrospectively extracted from electronic medical records. RESULTS Patients ranged from 10 to 67 years of age at diagnosis, with seven patients presenting with localized disease and three with metastatic disease. Tumors originated from soft tissues of various anatomic locations. Mean overall survival (OS) was 22.1 months (10.6-52.2), and mean progression-free survival (PFS) was 16.7 months (5.3-52.2). Seven patients received intensive systemic therapy with an Ewing sarcoma-directed regimen or a soft tissue sarcoma-directed regimen. Three patients experienced prolonged disease-free survival without systemic treatment. CONCLUSION Most patients in this case series demonstrated aggressive clinical courses consistent with those previously described in the literature, although we note a spectrum of clinical outcomes not previously reported. The diversity of clinical courses underscores the need for an improved understanding of individual tumor biology to enhance clinical decision-making and patient prognosis. Despite its limitations, this article broadens the spectrum of reported clinical outcomes, providing a valuable addition to the published literature on this rare cancer.
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Affiliation(s)
- Jacob Murphy
- Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, USA
| | - Erin E Resch
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 1650 Orleans St, Baltimore, MD, 21287, USA
| | - Christopher Leland
- Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, USA
- Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, USA
| | - Christian F Meyer
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 1650 Orleans St, Baltimore, MD, 21287, USA
| | - Nicolas J Llosa
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 1650 Orleans St, Baltimore, MD, 21287, USA
| | - John M Gross
- Department of Pathology, Johns Hopkins University School of Medicine, 401 N Broadway, Baltimore, MD, 21231, USA
| | - Christine A Pratilas
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 1650 Orleans St, Baltimore, MD, 21287, USA.
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5
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Xiao C, Ren C. Primary intraspinal capicua transcriptional repressor-rearranged sarcoma with adjacent vertebral bone destruction: The imaging diagnostic clues. Asian J Surg 2024; 47:1203-1204. [PMID: 37973481 DOI: 10.1016/j.asjsur.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023] Open
Affiliation(s)
- Cuiping Xiao
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
| | - Cuiping Ren
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
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6
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Bakaric A, Cironi L, Praz V, Sanalkumar R, Broye LC, Favre-Bulle K, Letovanec I, Digklia A, Renella R, Stamenkovic I, Ott CJ, Nakamura T, Antonescu CR, Rivera MN, Riggi N. CIC-DUX4 Chromatin Profiling Reveals New Epigenetic Dependencies and Actionable Therapeutic Targets in CIC-Rearranged Sarcomas. Cancers (Basel) 2024; 16:457. [PMID: 38275898 PMCID: PMC10814785 DOI: 10.3390/cancers16020457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
CIC-DUX4-rearranged sarcoma (CDS) is a rare and aggressive soft tissue tumor that occurs most frequently in young adults. The key oncogenic driver of this disease is the expression of the CIC-DUX4 fusion protein as a result of chromosomal rearrangements. CIC-DUX4 displays chromatin binding properties, and is therefore believed to function as an aberrant transcription factor. However, the chromatin remodeling events induced by CIC-DUX4 are not well understood, limiting our ability to identify new mechanism-based therapeutic strategies for these patients. Here, we generated a genome-wide profile of CIC-DUX4 DNA occupancy and associated chromatin states in human CDS cell models and primary tumors. Combining chromatin profiling, proximity ligation assays, as well as genetic and pharmacological perturbations, we show that CIC-DUX4 operates as a potent transcriptional activator at its binding sites. This property is in contrast with the repressive function of the wild-type CIC protein, and is mainly mediated through the direct interaction of CIC-DUX4 with the acetyltransferase p300. In keeping with this, we show p300 to be essential for CDS tumor cell proliferation; additionally, we find its pharmacological inhibition to significantly impact tumor growth in vitro and in vivo. Taken together, our study elucidates the mechanisms underpinning CIC-DUX4-mediated transcriptional regulation.
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Affiliation(s)
- Arnaud Bakaric
- Clinical Pathology Service, Department of Diagnostics, Geneva University Hospital, 1205 Geneva, Switzerland
| | - Luisa Cironi
- Pediatric Hematology-Oncology Research Laboratory, Woman-Mother-Child Department, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Viviane Praz
- Platform Genomics Technologies, Center for Integrative Genomics, Faculty of Biology and Medicine, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Rajendran Sanalkumar
- Experimental Pathology Service, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland (I.S.)
- Department of Cell and Tissue Genomics, Genentech. Inc., South San Francisco, CA 94103, USA
| | - Liliane C. Broye
- Experimental Pathology Service, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland (I.S.)
| | - Kerria Favre-Bulle
- Experimental Pathology Service, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland (I.S.)
| | - Igor Letovanec
- Department of Histopathology, Central Institute, Valais Hospital, 1951 Sion, Switzerland
| | - Antonia Digklia
- Department of Oncology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Raffaele Renella
- Pediatric Hematology-Oncology Research Laboratory, Woman-Mother-Child Department, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Ivan Stamenkovic
- Experimental Pathology Service, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland (I.S.)
| | - Christopher J. Ott
- Massachusetts General Hospital Cancer Center, Charlestown, MA 02129, USA; (C.J.O.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Takuro Nakamura
- Institute of Medical Science, Tokyo Medical University, Tokyo 160-0023, Japan
| | - Cristina R. Antonescu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Miguel N. Rivera
- Massachusetts General Hospital Cancer Center, Charlestown, MA 02129, USA; (C.J.O.)
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Nicolò Riggi
- Experimental Pathology Service, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland (I.S.)
- Department of Cell and Tissue Genomics, Genentech. Inc., South San Francisco, CA 94103, USA
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7
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Wei Y, Zhang Z, Long C, Huang X, Tang W, Mo X, Liu J. Case Report: Colon malignant tumor caused by retroperitoneal small round cell undifferentiated sarcoma. Front Oncol 2023; 13:1212475. [PMID: 38179167 PMCID: PMC10764574 DOI: 10.3389/fonc.2023.1212475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 11/27/2023] [Indexed: 01/06/2024] Open
Abstract
Small round cell undifferentiated sarcoma is a rare and highly invasive group of malignant bone and soft tissue tumors, often associated with a high misdiagnosis rate. The patient in this case was a 34-year-old male who presented with a two-month history of abdominal pain that worsened over the past two weeks. Elevated levels of tumor markers CA19-9 and CA72-4 were observed. Imaging revealed a substantial, well-vascularized mass in the lower left abdomen, located in the posterior abdominal cavity, invading the descending colon and the root of the small mesentery, and infiltrating the serous layer. The lesion was extensively resected without any postoperative complications. Microscopic examination indicated a combination of mucinous adenocarcinoma (approximately 30%) and small round cell undifferentiated sarcoma (approximately 70%). The patient was followed up for six months, and one month after surgery, a recurrence of the tumor was observed in the left paracolonic sulcus area, with metastases to the abdominal wall, peritoneum, and medial iliac muscles. Chemotherapy and targeted therapy were administered, and the patient currently survives with the presence of tumors. Small round cell undifferentiated sarcoma is an uncommon and highly invasive tumor, and clinical surgeons need to raise their awareness and realize to the maximum extent possible that this disease can be described through a multi-modal combination of immunohistochemistry and genetic test to improve diagnostic accuracy and reduce missed diagnoses. Further research in the field of biology is necessary to explore targeted drugs specifically suitable for this disease.
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Affiliation(s)
- Yuqin Wei
- Guangxi Medical University, Nanning, China
| | - Zhiyong Zhang
- Department of General Surgery, Zhuzhou Central Hospital, Zhuzhou, China
| | - Chenyan Long
- Division of Colorectal & Anal Surgery, Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Xiaoliang Huang
- Division of Colorectal & Anal Surgery, Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Weizhong Tang
- Division of Colorectal & Anal Surgery, Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Xianwei Mo
- Division of Colorectal & Anal Surgery, Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Jungang Liu
- Division of Colorectal & Anal Surgery, Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
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8
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Walker V, Jin DX, Millis SZ, Nasri E, Corao-Uribe DA, Tan AC, Fridley BL, Chen JL, Seligson ND. Gene partners of the EWSR1 fusion may represent molecularly distinct entities. Transl Oncol 2023; 38:101795. [PMID: 37797367 PMCID: PMC10593575 DOI: 10.1016/j.tranon.2023.101795] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/28/2023] [Indexed: 10/07/2023] Open
Abstract
EWSR1 fusions are highly promiscuous and are associated with unique malignancies, clinical phenotypes, and molecular subtypes. However, rare fusion partners (RFP) of EWSR1 has not been well described. Here, we conducted a cross-sectional, retrospective study of 1,140 unique tumors harboring EWSR1 fusions. We identified 64 unique fusion partners. RFPs were identified more often in adults than children. Alterations in cell cycle control and DNA damage response genes as driving the differences between fusion partners. Potentially clinically actionable genomic variants were more prevalent in tumors harboring RFP than common fusions. While the data presented here is limited, tumors harboring RFP of EWSR1 may represent molecularly distinct entities and may benefit from further molecular testing to identify targeted therapeutic options.
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Affiliation(s)
- Victoria Walker
- Department of Pharmacotherapy and Translational Research, The University of Florida, Jacksonville, FL, USA
| | - Dexter X Jin
- Foundation Medicine Inc, Cambridge, Massachusetts, USA
| | | | - Elham Nasri
- Department of Pathology, The University of Florida, Gainesville, Florida, USA
| | - Diana A Corao-Uribe
- Department of Pathology, Nemours Children's Health, Wilmington, Delaware, USA
| | - Aik Choon Tan
- Huntsman Cancer Institute, Departments of Oncological Sciences and Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Brooke L Fridley
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - James L Chen
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA; Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
| | - Nathan D Seligson
- Department of Pharmacotherapy and Translational Research, The University of Florida, Jacksonville, FL, USA; Center for Pharmacogenomics and Translational Research, Nemours Children's Health, Jacksonville, Florida, USA.
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9
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Rekhi B, Rumdee R, Shetty O. Clinicopathological features of five cases of CIC::DUX4 positive sarcomas, including literature review. Ann Diagn Pathol 2023; 65:152153. [PMID: 37167753 DOI: 10.1016/j.anndiagpath.2023.152153] [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: 04/09/2023] [Revised: 04/25/2023] [Accepted: 05/01/2023] [Indexed: 05/13/2023]
Abstract
According to the recent World Health Organization (WHO) classification, CIC-rearranged sarcomas, including CIC::DUX4-positive sarcomas constitute an aggressive subtype of undifferentiated round cell sarcomas. There is a single study on these tumors from our subcontinent. We present clinicopathological features of 5 additional cases of this tumor entity, including literature review. Thirty-nine undifferentiated round cell sarcomas, excluding Ewing sarcomas (ES), were tested for CIC::DUX4 fusion, including Type I (165 base pair size) and II (230 bp) by reverse transcription-polymerase chain reaction. Twenty-five of those tumors were tested for EWSR1 gene rearrangement, 5 for SS18 and 4 for SS18::SSX fusion, and were negative for those tests. Five tumors (12.8 %) were positive for CIC::DUX4(Type II) fusion. Five CIC:: DUX4-positive sarcomas occurred in 4 males and one female; of 25-43 years of age, in soft tissues, including thigh (n = 2), chest wall (n = 1), iliac region (n = 1) and foot (n = 1). Tumor size varied from 2.2 to 19 cm. Microscopically, the tumors were predominantly composed of nodules and sheets of malignant round to epithelioid cells, including "rhabdoid-like" (n = 2) and spindle-shaped (n = 2) with eosinophilic to vacuolated cytoplasm (4/5), distinct nucleoli (4/5), brisk mitoses, focal myxoid to hyalinised stroma (4/5) and necrosis (5/5). Immunohistochemically, tumor cells were positive for WT1 (5/5), calretinin (3/4), pan-keratin (1/4), CD99/MIC2 ("dot-like" to cytoplasmic membranous) (4/4), while negative for desmin (0/4), S100P (0/4), and NKX2.2 (0/5). INI1/SMARCB1 was retained (3/3). All patients underwent excision with adjuvant radiotherapy and chemotherapy (Ewing sarcoma regimen). A single patient developed recurrence, and 2 developed pulmonary metastasis, including one with brain metastasis. CIC:: DUX4-positive sarcomas are ultra-rare tumors, that mainly occur in the soft tissues and in young adult patients. Histopathologically, these tumors display a wide spectrum, including round to epithelioid cells, variable amount of cytoplasmic vacuolization and myxoid stroma with necrosis. Immunohistochemically, these tumors express WT1 and calretinin. Despite adjuvant therapies, these tumors have dismal outcomes, especially in large-sized tumors. CIC::DUX4-positive sarcomas need to be differentiated from their histopathological mimics, including ES, in view of significant treatment-related implications.
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Affiliation(s)
- Bharat Rekhi
- Department of Pathology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India; Division of Molecular Pathology and Translational Medicine, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India; Homi Bhabha National Institute (HBNI) University, Parel, Mumbai, Maharashtra, India.
| | - Rachna Rumdee
- Division of Molecular Pathology and Translational Medicine, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Omshree Shetty
- Division of Molecular Pathology and Translational Medicine, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
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10
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Wood GE, Graves LA, Rubin EM, Reed DR, Riedel RF, Strauss SJ. Bad to the Bone: Emerging Approaches to Aggressive Bone Sarcomas. Am Soc Clin Oncol Educ Book 2023; 43:e390306. [PMID: 37220319 DOI: 10.1200/edbk_390306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Bone sarcomas are rare heterogeneous tumors that affect patients of all ages including children, adolescent young adults, and older adults. They include many aggressive subtypes and patient groups with poor outcomes, poor access to clinical trials, and lack of defined standard therapeutic strategies. Conventional chondrosarcoma remains a surgical disease, with no defined role for cytotoxic therapy and no approved targeted systemic therapies. Here, we discuss promising novel targets and strategies undergoing evaluation in clinical trials. Multiagent chemotherapy has greatly improved outcomes for patients with Ewing sarcoma (ES) and osteosarcoma, but management of those with high-risk or recurrent disease remains challenging and controversial. We describe the impact of international collaborative trials, such as the rEECur study, that aim to define optimal treatment strategies for those with recurrent, refractory ES, and evidence for high-dose chemotherapy with stem-cell support. We also discuss current and emerging strategies for other small round cell sarcomas, such as CIC-rearranged, BCOR-rearranged tumors, and the evaluation of emerging novel therapeutics and trial designs that may offer a new paradigm to improve survival in these aggressive tumors with notoriously bad (to the bone) outcomes.
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Affiliation(s)
- Georgina E Wood
- Department of Oncology, University College London Hospitals NHS Trust, UCL Cancer Institute, London, United Kingdom
| | - Laurie A Graves
- Division of Hematology/Oncology, Department of Pediatrics, Duke University, Durham, NC
| | - Elyssa M Rubin
- Division of Oncology, Children's Hospital of Orange County, Orange, CA
| | - Damon R Reed
- Department of Individualized Cancer Management, Moffitt Cancer Center, Tampa, FL
| | - Richard F Riedel
- Division of Medical Oncology, Department of Medicine, Duke Cancer Institute, Durham, NC
| | - Sandra J Strauss
- Department of Oncology, University College London Hospitals NHS Trust, UCL Cancer Institute, London, United Kingdom
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