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Wang XT, Fang R, Zhang RS, Ye SB, Li R, Wang X, Pan R, Liu C, Chen JY, Zhao M, Teng XD, Yu WJ, Li YJ, Wang FH, Zhang JG, Yang QC, Zhang YS, Lu ZF, Ma HH, Zhou XJ, Xia QY, Rao Q. Malignant melanotic Xp11 neoplasms exhibit a clinicopathologic spectrum and gene expression profiling akin to alveolar soft part sarcoma: a proposal for reclassification. J Pathol 2020; 251:365-377. [PMID: 32418203 DOI: 10.1002/path.5470] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/28/2020] [Accepted: 05/11/2020] [Indexed: 12/20/2022]
Abstract
The classification of the distinct group of mesenchymal neoplasms, first described as 'Xp11 translocation perivascular epithelioid cell tumor (PEComa)' and for which the term 'melanotic Xp11 neoplasm' or 'Xp11 neoplasm with melanocytic differentiation' has recently been proposed, remains challenging and controversial. We collected 27 melanotic Xp11 neoplasms, the largest series to date, for a comprehensive evaluation. Fourteen of the cases, together with eight alveolar soft part sarcomas (ASPS), nine conventional PEComas and a control group of seven normal tissues were submitted to RNA sequencing. Follow-up available in 22 patients showed 5-year overall survival and 5-year disease-free survival of 47.6 and 35.7%, respectively, which were similar to ASPS and significantly worse than conventional PEComa. Univariate analysis of location (occurring in the kidney versus not kidney), infiltrative growth pattern, nuclear pleomorphism, mitotic activity ≥2/50 high-power fields (HPF), necrosis and lymphovascular invasion were found to be associated with overall survival and/or disease-free survival. Multivariate analysis identified that location was the only factor found to independently correlate with disease-free survival. More importantly, RNA sequencing-based clustering analysis segregated melanotic Xp11 neoplasm and ASPS from other tumors, including conventional PEComa and Xp11 translocation renal cell carcinoma, and formed a compact cluster representative of the largely similar expression signature. Here we clearly define the true biologic nature of melanotic Xp11 neoplasms which are distinctive malignant mesenchymal tumors, rather than simply PEComa variants with occasionally unpredictable behavior. Meanwhile, melanotic Xp11 neoplasm and ASPS more likely represent phenotypic variants of the same entity, which is distinct from conventional PEComa and Xp11 translocation renal cell carcinoma. Based on these important findings, melanotic Xp11 neoplasm might be reclassified into a distinctive entity together with ASPS, independent from PEComa, in future revisions of the current WHO categories of tumors of soft tissue and bone for the improved reclassification. © 2020 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Xiao-Tong Wang
- Department of Pathology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China
| | - Ru Fang
- Department of Pathology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China
| | - Ru-Song Zhang
- Department of Pathology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China
| | - Sheng-Bing Ye
- Department of Pathology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China
| | - Rui Li
- Department of Pathology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China
| | - Xuan Wang
- Department of Pathology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China
| | - Rui Pan
- Department of Pathology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China
| | - Chong Liu
- Department of Pathology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, PR China
| | - Jie-Yu Chen
- Department of Pathology, The Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, PR China
| | - Ming Zhao
- Department of Pathology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, PR China
| | - Xiao-Dong Teng
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China
| | - Wen-Juan Yu
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Yu-Jun Li
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Feng-Hua Wang
- Department of Pathology, Guangzhou Women and Children's Medical Center, Guangzhou, PR China
| | - Jian-Guo Zhang
- Department of Pathology, The Affiliated Hospital of Nantong University, Nantong, PR China
| | - Qi-Chang Yang
- Department of Pathology, The Second Affiliated Hospital of Nantong University, Nantong, PR China
| | - Yong-Sheng Zhang
- Department of Pathology, The Second Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Zhen-Feng Lu
- Department of Pathology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China
| | - Heng-Hui Ma
- Department of Pathology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China
| | - Xiao-Jun Zhou
- Department of Pathology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China
| | - Qiu-Yuan Xia
- Department of Pathology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China
| | - Qiu Rao
- Department of Pathology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China
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