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Sharma AE, Wepy CB, Chapel DB, Maccio L, Irshaid L, Al-Ibraheemi A, Dickson BC, Nucci MR, Crum CP, Fletcher CDM, Kolin DL. Ewing Sarcoma of the Female Genital Tract: Clinicopathologic Analysis of 21 Cases With an Emphasis on the Differential Diagnosis of Gynecologic Round Cell, Spindle, and Epithelioid Neoplasms. Am J Surg Pathol 2024:00000478-990000000-00340. [PMID: 38708674 DOI: 10.1097/pas.0000000000002232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Ewing sarcoma is an uncommon neoplasm considered in the differential diagnosis of tumors with "small round cell" morphology, but its occurrence in the gynecologic tract has only been sporadically documented. Herein, we describe the largest cohort of Ewing sarcoma localized to the female genital tract to date, and emphasize their clinicopathologic resemblance to more common gynecologic neoplasms. Ewing sarcoma (n=21) was retrospectively identified from 5 institutions. The average patient age was 35 (range 6-61) years. Tumor sites included uterus (n=8), cervix (n=4), vulva (n=5), vagina (n=1), broad ligament (n=1), inguinal area (n=1), and pelvis (n=1). Nine of 18 cases in which slides were available for review demonstrated only classic round cell morphology, with the remainder showing a variable combination and prominence of variant ovoid/spindle or epithelioid appearance. Tumors showed diffuse membranous reactivity for CD99 (20/20) and were positive for NKX2.2 (8/8, diffuse) and cyclin D1 (7/7, of which 3/7 were patchy/multifocal and 4/7 were diffuse). They were negative for ER (0/6) and CD10 (0/6). Three cases were initially diagnosed as endometrial stromal sarcomas. EWSR1 rearrangement was confirmed in 20/21 by fluorescence in situ hybridization (n=15) and/or sequencing (n=8). Of the eight tumors that underwent sequencing, 6 harbored FLI1, 1 ERG, and 1 FEV as the fusion partner. Of 11 patients with available follow-up, 5 died of disease, 1 developed lung metastases and 5 are alive with no evidence of disease. Ewing sarcoma of the gynecologic tract is a rare, aggressive entity that shares some morphologic and immunohistochemical features with other more common gynecologic neoplasms. In addition to the typical round cell appearance, variant spindled/ovoid to epithelioid morphology may also be observed and should prompt consideration of this entity with appropriate immunohistochemical and/or molecular studies.
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Affiliation(s)
- Aarti E Sharma
- Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Cindy B Wepy
- Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - David B Chapel
- Department of Pathology, University of Michigan Hospital, Ann Arbor, MI
| | - Livia Maccio
- Unit of Surgical Pathology, Santa Chiara Hospital, Trento, Italy
| | - Lina Irshaid
- Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Alyaa Al-Ibraheemi
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Brendan C Dickson
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Marisa R Nucci
- Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Christopher P Crum
- Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - David L Kolin
- Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Tang Y, Lu X, Zhan R. Renal CIC-LEUTX rearranged sarcoma with multiple pulmonary metastases: a case report and literature review. BMC Nephrol 2023; 24:354. [PMID: 38036973 PMCID: PMC10691010 DOI: 10.1186/s12882-023-03404-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND CIC-rearranged sarcomas (CRS) are a group of heterogeneous tumors which mostly occur in the soft tissues of limbs and trunk, and are highly invasive with poor prognosis. Here, we describe a rare case of CRS that occurred in the left kidney with a CIC-LEUTX rearrangement. CASE PRESENTATION A 45-year-old male was admitted to hospital with a dry cough for more than two months without obvious cause. Physical examination and laboratory tests revealed no notable abnormality. The CT scan demonstrated a mass in the left kidney and multiple nodules in both lungs. The percutaneous core needle biopsy showed similar histomorphology and immunophenotype of small round cell malignant tumors. Genetic test revealed a CIC-LEUTX gene fusion. CONCLUSIONS We present a rare primary renal CRS with multiple pulmonary metastases, and LEUTX is confirmed as the fusion partner of CIC gene for the first time in a renal case.
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Affiliation(s)
- Ying Tang
- Department of Pathology, Suzhou Ninth People's Hospital, Soochow University, Ludang Road 2666#, Wujiang District, Suzhou, 215200, Jiangsu, China
| | - Xialiang Lu
- Department of Pathology, Suzhou Ninth People's Hospital, Soochow University, Ludang Road 2666#, Wujiang District, Suzhou, 215200, Jiangsu, China
| | - Rui Zhan
- Department of Pathology, Suzhou Ninth People's Hospital, Soochow University, Ludang Road 2666#, Wujiang District, Suzhou, 215200, Jiangsu, China.
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3
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Wu Q, He Y. A case report of CIC-DUX4 fusion-positive sarcoma in the pelvic cavity with targeted next-generation sequencing results. Front Oncol 2022; 12:1018992. [PMID: 36591446 PMCID: PMC9798229 DOI: 10.3389/fonc.2022.1018992] [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: 08/24/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
CIC-DUX4 fusion-positive sarcoma is a subtype of undifferentiated small round cell sarcoma that is rarely reported. As far as we know, less than 200 cases have been reported worldwide to date. The clinicopathologic characteristics of this kind of tumor are non-specific, which makes it difficult to be diagnosed. Therefore, more cases are required to enrich the diagnosis and treatment experience. Here, we present a 17-year-old Asian girl diagnosed with CIC-DUX4 fusion-positive sarcoma after targeted next-generation sequencing. Her clinical manifestation was abdominal pain. Furthermore, a mass in the pelvic cavity and massive ascites were found after an imaging examination. After resection, the mass was sent to the pathology department for a definite diagnosis, and the micromorphology showed an undifferentiated sarcoma with massive necrosis. The tumor cells were round to spindle with clear to eosinophilic cytoplasm and vesicular nuclei. Rhabdoid cells and myxoid mesenchyme were focally shown. Immunohistochemical staining showed diffusely positive for vimentin, cyclin D1, Fli-1, and WT-1 and very focally positive for CD99. Moreover, the targeted next-generation sequencing also revealed other genetic changes in this tumor including LongInDel of POLE, copy number variation of CD79, low tumor mutational burden, and microsatellite stability. With a follow-up time of 6 months, the patient survived the disease and received chemotherapy routinely. This report presented a rare primary site CIC-DUX4 fusion-positive sarcoma (CDS) and revealed novel genetic changes that enrich the manifestation, histology, and cytogenetic scales of this rare sarcoma. In addition, we have summarized the clinicopathologic characteristics of this tumor by reviewing the literature to have a better understanding of CIC-DUX4 fusion-positive sarcomas, which may be helpful for diagnosis and treatment.
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Affiliation(s)
- Qian Wu
- Department of Pathology, West China Second Hospital of Sichuan University, Chengdu, Sichuan, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China,NHC Key Laboratory of Chronobiology (Sichuan University), Chengdu, Sichuan, China
| | - Ying He
- Department of Pathology, West China Second Hospital of Sichuan University, Chengdu, Sichuan, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China,NHC Key Laboratory of Chronobiology (Sichuan University), Chengdu, Sichuan, China,*Correspondence: Ying He,
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4
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Dundr P, Drozenová J, Matěj R, Bártů M, Němejcová K, Robová H, Rob L, Hojný J, Stružinská I. Desmoplastic Small Round Cell Tumor of the Uterus: A Report of Molecularly Confirmed Case with EWSR1-WT1 Fusion. Diagnostics (Basel) 2022; 12:diagnostics12051184. [PMID: 35626339 PMCID: PMC9140206 DOI: 10.3390/diagnostics12051184] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 11/16/2022] Open
Abstract
We report a case of a 49-year-old female with desmoplastic small round cell tumor of the uterus (DSRCT). Histologically, in some areas the tumor showed typical features with ample desmoplastic stroma, while in other areas the tumor cells diffusely infiltrated myometrium with only focal desmoplastic reaction. Immunohistochemically, the tumor cells showed diffuse positivity for desmin, CD56, CD57, EMA and cyclin D1. Focal positivity was present for antibodies against cytokeratin AE1/3, BerEP4, NSE, IFITM1 and CD10. The WT-1 antibody (against the N-terminus) showed cytoplasmic positivity in some tumor cells, while the nuclei were negative. P53 expression was wild-type. The Ki-67 index (MIB1 antibody) was about 55%. Other markers examined including transgelin, myogenin, synaptophysin, chromogranin, h-caldesmon, PAX8, and CD117 were all negative. NGS analysis revealed a fusion transcript of the EWSR1 and WT1 genes. DSRCT of the uterus is a rare neoplasm, as only two cases have been reported so far. However, only one of these cases was examined molecularly with a confirmation of the characteristic EWSR1-WT1 fusion. We report a second case of molecularly confirmed DSRCT of the uterus and discuss its clinical features, differential diagnosis and the significance of molecular testing.
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Affiliation(s)
- Pavel Dundr
- Department of Pathology, First Faculty of Medicine, General University Hospital in Prague, Charles University, 12808 Prague, Czech Republic; (R.M.); (M.B.); (K.N.); (J.H.); (I.S.)
- Correspondence:
| | - Jana Drozenová
- Department of Pathology, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, 10034 Prague, Czech Republic;
| | - Radoslav Matěj
- Department of Pathology, First Faculty of Medicine, General University Hospital in Prague, Charles University, 12808 Prague, Czech Republic; (R.M.); (M.B.); (K.N.); (J.H.); (I.S.)
- Department of Pathology, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, 10034 Prague, Czech Republic;
- Department of Pathology and Molecular Medicine, Third Faculty of Medicine, Thomayer Hospital, Charles University, 14059 Prague, Czech Republic
| | - Michaela Bártů
- Department of Pathology, First Faculty of Medicine, General University Hospital in Prague, Charles University, 12808 Prague, Czech Republic; (R.M.); (M.B.); (K.N.); (J.H.); (I.S.)
| | - Kristýna Němejcová
- Department of Pathology, First Faculty of Medicine, General University Hospital in Prague, Charles University, 12808 Prague, Czech Republic; (R.M.); (M.B.); (K.N.); (J.H.); (I.S.)
| | - Helena Robová
- Department of Obstetrics and Gynecology, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, 10034 Prague, Czech Republic; (H.R.); (L.R.)
| | - Lukáš Rob
- Department of Obstetrics and Gynecology, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, 10034 Prague, Czech Republic; (H.R.); (L.R.)
| | - Jan Hojný
- Department of Pathology, First Faculty of Medicine, General University Hospital in Prague, Charles University, 12808 Prague, Czech Republic; (R.M.); (M.B.); (K.N.); (J.H.); (I.S.)
| | - Ivana Stružinská
- Department of Pathology, First Faculty of Medicine, General University Hospital in Prague, Charles University, 12808 Prague, Czech Republic; (R.M.); (M.B.); (K.N.); (J.H.); (I.S.)
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Connolly EA, Bhadri VA, Wake J, Ingley KM, Lewin J, Bae S, Wong DD, Long AP, Pryor D, Thompson SR, Strach MC, Grimison PS, Mahar A, Bonar F, Maclean F, Hong A. Systemic treatments and outcomes in CIC-rearranged Sarcoma: A national multi-centre clinicopathological series and literature review. Cancer Med 2022; 11:1805-1816. [PMID: 35178869 PMCID: PMC9041083 DOI: 10.1002/cam4.4580] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/13/2022] [Accepted: 01/15/2022] [Indexed: 12/26/2022] Open
Abstract
CIC‐rearranged sarcoma is a recently established, ultra‐rare, molecularly defined sarcoma subtype. We aimed to further characterise clinical features of CIC‐rearranged sarcomas and explore clinical management including systemic treatments and outcomes.
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Affiliation(s)
- Elizabeth A Connolly
- Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Vivek A Bhadri
- Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Crown Princess Mary Cancer Centre, Westmead, Sydney, New South Wales, Australia
| | - Johnathon Wake
- Crown Princess Mary Cancer Centre, Westmead, Sydney, New South Wales, Australia
| | | | - Jeremy Lewin
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Susie Bae
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Daniel D Wong
- Anatomical Pathology, PathWest, QEII Medical Centre, Perth, Western Australia, Australia
| | - Anne P Long
- Sir Charles Gardiner Hospital, Perth, Western Australia, Australia
| | - David Pryor
- Princess Alexandra Hospital, Brisbane, Australia
| | - Stephen R Thompson
- Prince of Wales Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Madeleine C Strach
- Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter S Grimison
- Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Fiona Bonar
- Anatomical Pathology, Douglass Hanly Moir Pathology, Sonic Healthcare, Macquarie Park, New South Wales, Australia
| | - Fiona Maclean
- Anatomical Pathology, Douglass Hanly Moir Pathology, Sonic Healthcare, Macquarie Park, New South Wales, Australia
| | - Angela Hong
- Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Vieira AC, Xavier CB, Vieira TD, Carvalho FM, Scaranti M, Munhoz RR, Carvalho JP. CIC-DUX4 rearranged uterine cervix round-cell sarcoma exhibiting near-complete pathologic response following radiation and neoadjuvant chemotherapy: A case report. Gynecol Oncol Rep 2021; 36:100745. [PMID: 33850994 PMCID: PMC8022141 DOI: 10.1016/j.gore.2021.100745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/04/2021] [Indexed: 12/31/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Jesus Paula Carvalho
- Oncology Center, Hospital Sírio-Libanês, São Paulo, Brazil.,Discipline of Gynecology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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