1
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A. Jacobo J. Central nervous system tumors of uncertain differentiation. World Neurosurg X 2024; 22:100349. [PMID: 38455248 PMCID: PMC10918257 DOI: 10.1016/j.wnsx.2024.100349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 12/05/2023] [Accepted: 02/21/2024] [Indexed: 03/09/2024] Open
Abstract
Background The 2021 World Health Organization classification for brain tumors introduced several new entities and categories.Tumors of uncertain differentiation are a new subcategory that includes the intracranial mesenchymal tumor, FET-CREB fusion-positive; the CIC-rearranged sarcoma; and the Primary intracranial sarcoma, DICER1-mutant. Methods A search was made in Pubmed and Google Scholar to include all articles with the term "uncertain differentiation", "Mesenchymal, non-meningothelial", "FET-CREB fusion positive", "DICER1-mutant sarcoma" and "CIC-Rearranged sarcoma" in their title. These articles were reviewed to draft a concise review on this subject. Results This review on CNS non-meningothelial mesenchymal tumors is meant to provide an update with diagnostic, prognostic, and therapeutic implications. Conclusion Tumors of uncertain differentiation include a variety of mesenchymal, non-meningothelial tumors that have distinct molecular characteristics and consequently behave in a very particular matter.Given that these tumors have been described only recently, there is still an important lack of information regarding the most appropriate treatment and prognosis.
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Affiliation(s)
- Javier A. Jacobo
- Neuro-Oncology Unit, Center for the Treatment and Investigation About Cancer (CTIC), Bogotá, Colombia
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2
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Andreiuolo F, Ferrone CK, Rajan S, Perry A, Guney E, Cham E, Giannini C, Toland A, Willard N, de Souza AS, Dazelle K, Chung HJ, Singh O, Conway K, Coley N, Dampier C, Abdullaev Z, Pratt D, Cimino PJ, Quezado M, Aldape K. Molecular and clinicopathologic characteristics of CNS embryonal tumors with BRD4::LEUTX fusion. Acta Neuropathol Commun 2024; 12:42. [PMID: 38500181 PMCID: PMC10946093 DOI: 10.1186/s40478-024-01746-7] [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: 01/24/2024] [Accepted: 02/19/2024] [Indexed: 03/20/2024] Open
Abstract
Central nervous system (CNS) embryonal tumors are a heterogeneous group of high-grade malignancies, and the increasing clinical use of methylation profiling and next-generation sequencing has led to the identification of molecularly distinct subtypes. One proposed tumor type, CNS tumor with BRD4::LEUTX fusion, has been described. As only a few CNS tumors with BRD4::LEUTX fusions have been described, we herein characterize a cohort of 9 such cases (4 new, 5 previously published) to further describe their clinicopathologic and molecular features. We demonstrate that CNS embryonal tumor with BRD4::LEUTX fusion comprises a well-defined methylation class/cluster. We find that patients are young (4 years or younger), with large tumors at variable locations, and frequently with evidence of leptomeningeal/cerebrospinal fluid (CSF) dissemination. Histologically, tumors were highly cellular with high-grade embryonal features. Immunohistochemically, 5/5 cases showed synaptophysin and 4/5 showed OLIG2 expression, thus overlapping with CNS neuroblastoma, FOXR2-activated. DNA copy number profiles were generally flat; however, two tumors had chromosome 1q gains. No recurring genomic changes, besides the presence of the fusion, were found. The LEUTX portion of the fusion transcript was constant in all cases assessed, while the BRD4 portion varied but included a domain with proto-oncogenic activity in all cases. Two patients with clinical follow up available had tumors with excellent response to chemotherapy. Two of our patients were alive without evidence of recurrence or progression after gross total resection and chemotherapy at 16 and 33 months. One patient relapsed, and the last of our four patients died of disease one month after diagnosis. Overall, this case series provides additional evidence for this as a distinct tumor type defined by the presence of a specific fusion as well as a distinct DNA methylation signature. Studies on larger series are required to further characterize these tumors.
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Affiliation(s)
- Felipe Andreiuolo
- Department of Pathology, Rede D'Or, Rio de Janeiro, RJ, Brazil
- D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil
- Department of Pathology, Instituto Estadual Do Cérebro Paulo Niemeyer, Rio de Janeiro, RJ, Brazil
| | - Christina K Ferrone
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr., Room 2S235, Bethesda, MD, 20892, USA
| | - Sharika Rajan
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr., Room 2S235, Bethesda, MD, 20892, USA
| | - Arie Perry
- Department of Pathology, University of California, San Francisco, San Francisco, CA, USA
| | - Ekin Guney
- Department of Pathology, University of California, San Francisco, San Francisco, CA, USA
| | - Elaine Cham
- Department of Pathology, University of California, San Francisco, San Francisco, CA, USA
| | - Caterina Giannini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Angus Toland
- Department of Pathology, University of Colorado Hospital, Aurora, CO, USA
| | - Nicholas Willard
- Department of Pathology, University of Colorado Hospital, Aurora, CO, USA
| | | | - Karen Dazelle
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr., Room 2S235, Bethesda, MD, 20892, USA
| | - Hye-Jung Chung
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr., Room 2S235, Bethesda, MD, 20892, USA
| | - Omkar Singh
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr., Room 2S235, Bethesda, MD, 20892, USA
| | - Kyle Conway
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas Coley
- Diagnostic Pathology Medical Group, Inc., Sacramento, CA, USA
| | - Christopher Dampier
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr., Room 2S235, Bethesda, MD, 20892, USA
| | - Zied Abdullaev
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr., Room 2S235, Bethesda, MD, 20892, USA
| | - Drew Pratt
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr., Room 2S235, Bethesda, MD, 20892, USA
| | - Patrick J Cimino
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Martha Quezado
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr., Room 2S235, Bethesda, MD, 20892, USA
| | - Kenneth Aldape
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr., Room 2S235, Bethesda, MD, 20892, USA.
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3
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Makise N, Yoshida A. CIC-Rearranged Sarcoma. Surg Pathol Clin 2024; 17:141-151. [PMID: 38278603 DOI: 10.1016/j.path.2023.06.003] [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] [Indexed: 01/28/2024]
Abstract
CIC-rearranged sarcoma is a rare type of small round cell sarcoma. The tumors often affect the deep soft tissues of patients in a wide age range. They are highly aggressive, respond poorly to chemotherapy, and have a worse outcome than Ewing sarcoma. CIC-rearranged sarcoma has characteristic and recognizable histology, including lobulated growth, focal myxoid changes, round to epithelioid cells, and minimal variation of nuclear size and shape. Nuclear ETV4 and WT1 expression are useful immunohistochemical findings. CIC fusion can be demonstrated using various methods; however, even next-generation sequencing suffers from imperfect sensitivity, especially for CIC::DUX4.
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Affiliation(s)
- Naohiro Makise
- Division of Surgical Pathology, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba-shi, Chiba, 260-8717, Japan
| | - Akihiko Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan; Rare Cancer Center, National Cancer Center, Tokyo, Japan.
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4
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Shaheen A, Bauman G, Cacciotti C, Zelcer S, Ramadan S. Methylation and Molecular Profiling to Aid in Diagnosis and Radiation Treatment for an Intracranial Ewing Sarcoma in a Pediatric Patient: A Case Report. Adv Radiat Oncol 2024; 9:101352. [PMID: 38405311 PMCID: PMC10885575 DOI: 10.1016/j.adro.2023.101352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/09/2023] [Indexed: 02/27/2024] Open
Affiliation(s)
- Amber Shaheen
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University London, Ontario, Canada
| | - Glenn Bauman
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre & Western University, London, Ontario, Canada
| | - Chantel Cacciotti
- Division of Hematology/Oncology, Department of Pediatrics, London Health Sciences Centre & Western University, London, Ontario, Canada
| | - Shayna Zelcer
- Division of Hematology/Oncology, Department of Pediatrics, London Health Sciences Centre & Western University, London, Ontario, Canada
| | - Sherif Ramadan
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre & Western University, London, Ontario, Canada
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5
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Hobday SB, Mady LJ, Jacobson AM, Rassekh CH. CIC-DUX4 Sarcoma Involving the Skull Base: A Rare Presentation and Review of the Literature. J Neurol Surg Rep 2023; 84:e124-e128. [PMID: 37842548 PMCID: PMC10575739 DOI: 10.1055/a-2166-5688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 12/23/2022] [Indexed: 10/17/2023] Open
Abstract
Background CIC-DUX4 sarcoma is a rare, aggressive tumor that is difficult to diagnose. Although it is closely related to Ewing's sarcoma, each is a distinct pathologic entity and both have been previously reported in the skin, lymph nodes, and viscera. We report the first description of CIC-DUX4 involving the posterior cranial fossa and review the distinctive symptomatology, morphology, immunoprofile, and genetic signature that differentiate this rare tumor. Case Report A 32-year-old man presented with an enlarging right lateral neck mass, progressive hoarseness, and orofacial pain. Biopsy revealed a high-grade undifferentiated malignant neoplasm. Imaging demonstrated an 8-cm mass in the right neck extending to the skull base and abutting the carotid sheath, in addition to pulmonary nodules and pelvic lymphadenopathy. Despite initial response to chemotherapy, he experienced disease progression and underwent surgical resection, radical neck dissection, and brachytherapy. Definitive pathologic diagnosis was achieved with next-generation sequencing. Within weeks of treatment, he developed symptoms reflecting progression of disease involving the neck, posterior cranial fossa, and lung. Adjuvant chemotherapy was planned, but the patient succumbed to his disease prior to initiation of further therapy. Conclusion CIC-DUX4 sarcomas are uncommon and can progress rapidly. Diagnosis requires either fluorescence in situ hybridization or next-generation sequencing. Due to its rarity, there is no standard-of-care treatment for this tumor and further investigations are needed to understand disease behavior and develop targeted therapeutic modalities.
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Affiliation(s)
- Sara B. Hobday
- Department of Otorhinolaryngology – Head and Neck Surgery at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Leila J. Mady
- Department of Otorhinolaryngology – Head and Neck Surgery at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Alec M. Jacobson
- Department of Pathology and Laboratory Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Christopher H. Rassekh
- Department of Otorhinolaryngology – Head and Neck Surgery at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
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6
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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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7
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Ferrari A, Brennan B, Casanova M, Corradini N, Berlanga P, Schoot RA, Ramirez-Villar GL, Safwat A, Guillen Burrieza G, Dall’Igna P, Alaggio R, Lyngsie Hjalgrim L, Gatz SA, Orbach D, van Noesel MM. Pediatric Non-Rhabdomyosarcoma Soft Tissue Sarcomas: Standard of Care and Treatment Recommendations from the European Paediatric Soft Tissue Sarcoma Study Group (EpSSG). Cancer Manag Res 2022; 14:2885-2902. [PMID: 36176694 PMCID: PMC9514781 DOI: 10.2147/cmar.s368381] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/13/2022] [Indexed: 11/23/2022] Open
Abstract
This paper describes the standard of care for patients with non-rhabdomyosarcoma soft tissue sarcomas (NRSTS) and the therapeutic recommendations developed by the European paediatric Soft tissue sarcoma Study Group (EpSSG). NRSTS form a very mixed group of mesenchymal extraskeletal malignancies. Their rarity, heterogeneity, and aggressiveness make the management of children and adolescents with these tumors complex and challenging. The overall cure rate for patients with NRSTS is around 70%, but survival depends on several prognostic variables, such as histotype and tumor grade, extent of disease and stage, tumor size, and tumor site. While surgery remains the mainstay of treatment for most of these tumors, a multimodal therapeutic approach including radiotherapy and chemotherapy is required in many cases. The EpSSG NRSTS 2005 study was the first prospective protocol tailored specifically to NRSTS. Together with the ARST0332 study developed by the North-American Soft Tissue Sarcoma Committee of the Children's Oncology Group (COG), the EpSSG NRSTS 2005 study currently represents the benchmark for these tumors, establishing risk-adapted standards of care. The EpSSG has developed common treatment recommendations for the large group of adult-type NRSTS (including synovial sarcoma), and specific treatment recommendations for other particular adult-type histologies (ie, alveolar soft-part sarcoma, clear cell sarcoma and dermatofibrosarcoma protuberans); other highly malignant tumors with a biology and clinical behavior differing from those of adult-type NRSTS (ie, rhabdoid tumors and desmoplastic small round cell tumor); and soft tissue tumors of intermediate malignancy (ie desmoid-type fibromatosis, inflammatory myofibroblastic tumors, and infantile fibrosarcoma). New effective drugs are needed for patients whose NRSTS carries the worst prognosis, ie, those with unresectable tumors, metastases at diagnosis, or relapsing disease. Progress in this area relies on our ability to develop international integrated prospective collaborations, both within existing pediatric oncology networks and, importantly, between the communities of specialists treating pediatric and adult sarcoma.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Bernadette Brennan
- Pediatric Oncology, Royal Manchester Children’s Hospital, Manchester, UK
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Nadege Corradini
- Department of Pediatric Oncology, Institut d’Hematologie et d’Oncologie Pédiatrique/Centre, Léon Bérard, Lyon, France
| | - Pablo Berlanga
- Department of Pediatric and Adolescent Oncology, Gustave-Roussy, Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Reineke A Schoot
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | | | - Akmal Safwat
- Oncology Department and Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Gabriela Guillen Burrieza
- Surgical Oncology and Neonatal Surgery, Pediatric Surgery Department, Hospital Infantil Universitari Vall d’Hebron, Barcelona, Spain
| | - Patrizia Dall’Igna
- Department of Emergencies and Organ Transplantation, Pediatric Surgery, University of Bari, Bari, Italy
| | - Rita Alaggio
- Pathology Department, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Lisa Lyngsie Hjalgrim
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Andrea Gatz
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Daniel Orbach
- SIREDO Oncology Center, Institut Curie, PSL University, Paris, France
| | - Max M van Noesel
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
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8
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Wong YP, Buckley K, Iwenofu OH, Singhi A, Kahwash SB, Arnold CA, Tan GC, Arnold MA. Selective Immunoreactivity for WT1 Carboxy-Terminus Distinguishes Desmoplastic Small Round Cell Tumor From its Histologic Mimics. Pediatr Dev Pathol 2022; 25:504-510. [PMID: 35488420 DOI: 10.1177/10935266221088151] [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] [Indexed: 11/17/2022]
Abstract
Desmoplastic small round cell tumor (DSRCT) is an aggressive pediatric round cell sarcoma containing a characteristic EWSR1-WT1 gene fusion. In the absence of genetic data, distinguishing DSRCT from other small round cell tumors of childhood can be problematic due to overlapping histologic and immunohistochemical features. We studied the utility of immunohistochemistry with antibodies targeting both the amino-terminal and carboxy-terminal regions of the Wilms tumor-1 (WT1) protein in differentiating these groups of tumors. The study cohort included 33 cases of genetically confirmed pediatric round cell tumors (10 DSRCTs, 12 Wilms tumors, 10 Ewing sarcomas, and 1 CIC-rearranged sarcoma). Immunoreactivities and immunolocalization of both the WT1 amino-terminus and carboxy-terminus were scored and documented. All DSRCTs displayed selective reactivity for only the WT1 carboxy-terminus (10/10), while dual immunoreactivity for both the WT1 carboxy-terminus (12/12) and amino-terminus antibodies (12/12) were characteristic of Wilms tumors. CIC-rearranged sarcoma showed variable WT1 nuclear immunopositivity (1/1, 1/1) and Ewing sarcomas were consistently WT1-negative for both the WT1 amino-terminus (0/10) and carboxy-terminus (0/10). Dual WT1 amino-terminus and carboxy-terminus immunohistochemistry remains a helpful diagnostic tool in discriminating intraabdominal small round cell tumors, which serves as an adjunct to the genetic information in preventing misdiagnosis.
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Affiliation(s)
- Yin Ping Wong
- Department of Pathology, Faculty of Medicine, 458203Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Kaila Buckley
- Department of Pathology, 2647The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - O Hans Iwenofu
- Department of Pathology, 2647The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Aatur Singhi
- Department of Pathology, 6614University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Samir B Kahwash
- Department of Pathology, 2647The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Department of Pathology and Laboratory Medicine, 2650Nationwide Children's Hospital, Columbus OH, USA
| | - Christina A Arnold
- Department of Pathology and Laboratory Medicine, 2932Children's Hospital of Colorado, Aurora, CO, USA
| | - Geok Chin Tan
- Department of Pathology, Faculty of Medicine, 458203Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.,Department of Pathology and Laboratory Medicine, 2650Nationwide Children's Hospital, Columbus OH, USA
| | - Michael A Arnold
- Department of Pathology and Laboratory Medicine, 2932Children's Hospital of Colorado, Aurora, CO, USA.,Department of Pathology, 1878University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
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9
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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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10
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Chang PY, Liao CH, Peng YJ, Hsu YC. CIC-DUX4 sarcoma: A case report and review of the literature. JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.4103/jmedsci.jmedsci_241_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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11
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Zhang M, Yang Y, Guan X, Yao X, Guo Y, He L. Primary cardiac CIC-rearranged undifferentiated sarcoma in an infant. Pediatr Investig 2021; 5:313-317. [PMID: 34938974 PMCID: PMC8666930 DOI: 10.1002/ped4.12264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Cardiac neoplasms are particularly rare in children, and the majority of these tumors are benign. Approximately 10% of cardiac neoplasms are malignant, including soft tissue sarcomas and lymphomas. Cardiac tumors could also be metastases. Primitive EWSR1-negative round or spindle cell undifferentiated sarcoma harboring CIC gene translocation is a highly aggressive malignancy mainly occurring in soft tissues. However, it has not yet been described in the heart. CASE PRESENTATION We report a sarcoma that arose from the right ventricle in a 1-year-old girl. Histologically, it was composed of closely arranged small round or oval undifferentiated cells with fibrovascular separation, hyaline degeneration, and geographical necrosis. Immunohistochemically, the neoplastic cells exhibited focal membrane positivity for CD99 and diffuse positivity for WT1 and ETV4. Fluorescent in situ hybridization analysis showed EWSR1-negative but CIC-positive split signals. The breakpoint was also confirmed by whole genome sequencing. CONCLUSION Based on morphological, immunohistochemical and molecular findings, this cardiac mass was diagnosed as CIC-rearranged sarcoma.
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Affiliation(s)
- Meng Zhang
- Department of PathologyBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Yeran Yang
- Beijing Key Laboratory for Pediatric Diseases of OtolaryngologyHead and Neck SurgeryMOE Key Laboratory of Major Diseases in ChildrenBeijing Pediatric Research InstituteBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
- Beijing Advanced Innovation Center for Big Data‐Based Precision MedicineBeihang University & Capital Medical UniversityBeijingChina
| | - Xiaoxing Guan
- Department of PathologyBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Xingfeng Yao
- Department of PathologyBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Yongli Guo
- Beijing Key Laboratory for Pediatric Diseases of OtolaryngologyHead and Neck SurgeryMOE Key Laboratory of Major Diseases in ChildrenBeijing Pediatric Research InstituteBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
- Beijing Advanced Innovation Center for Big Data‐Based Precision MedicineBeihang University & Capital Medical UniversityBeijingChina
| | - Lejian He
- Department of PathologyBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
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12
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Mocciaro E, Runfola V, Ghezzi P, Pannese M, Gabellini D. DUX4 Role in Normal Physiology and in FSHD Muscular Dystrophy. Cells 2021; 10:3322. [PMID: 34943834 PMCID: PMC8699294 DOI: 10.3390/cells10123322] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/10/2021] [Accepted: 11/23/2021] [Indexed: 12/12/2022] Open
Abstract
In the last decade, the sequence-specific transcription factor double homeobox 4 (DUX4) has gone from being an obscure entity to being a key factor in important physiological and pathological processes. We now know that expression of DUX4 is highly regulated and restricted to the early steps of embryonic development, where DUX4 is involved in transcriptional activation of the zygotic genome. While DUX4 is epigenetically silenced in most somatic tissues of healthy humans, its aberrant reactivation is associated with several diseases, including cancer, viral infection and facioscapulohumeral muscular dystrophy (FSHD). DUX4 is also translocated, giving rise to chimeric oncogenic proteins at the basis of sarcoma and leukemia forms. Hence, understanding how DUX4 is regulated and performs its activity could provide relevant information, not only to further our knowledge of human embryonic development regulation, but also to develop therapeutic approaches for the diseases associated with DUX4. Here, we summarize current knowledge on the cellular and molecular processes regulated by DUX4 with a special emphasis on FSHD muscular dystrophy.
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Affiliation(s)
| | | | | | | | - Davide Gabellini
- Gene Expression and Muscular Dystrophy Unit, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, 20132 Milano, Italy; (E.M.); (V.R.); (P.G.); (M.P.)
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13
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Barresi S, Giovannoni I, Rossi S, Stracuzzi A, Quacquarini D, Cafferata B, Piscitelli D, De Leonardis F, Marzullo A, Alaggio R. A novel BRD4-LEUTX fusion in a pediatric sarcoma with epithelioid morphology and diffuse S100 expression. Genes Chromosomes Cancer 2021; 60:647-652. [PMID: 34041805 DOI: 10.1002/gcc.22974] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/18/2021] [Accepted: 05/18/2021] [Indexed: 01/31/2023] Open
Abstract
Malignant epithelioid soft tissue tumors encompass a wide spectrum of lesions. Among them, Epithelioid Malignant Peripheral Nerve Sheath Tumors (MPNST) constitute a distinct subgroup, accounting for <5% of all MPNST. Epithelioid MPNST are infrequently associated with neurofibromatosis type 1, occasionally arise in a schwannoma and show diffuse S100 and CD34 expression, often combined with INI-1 loss. However, the molecular mechanisms underlying the tumorigenesis of epithelioid MPNST remain largely unknown. We describe a case of a 10-year-old girl with an epithelioid malignancy of the orbit. The tumor proved positive for S100, CD34 and SOX10, and, although INI-1 expression was maintained, the overall features suggested the possibility of an epithelioid MPNST, arising in an unusual location. NGS analysis revealed a novel in-frame BRD4-LEUTX fusion gene. LEUTX plays an important role in embryonal genome activation and its expression is mostly suppressed postnatally. We were able to detect increased levels of LEUTX transcript in the tumor, indicating that BRD4-LEUTX fusion leads to LEUTX re-activation. To our knowledge, this fusion has never been reported previously. Whether the current case represents an example of epithelioid MPNST or a distinct tumor entity remains to be determined.
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Affiliation(s)
- Sabina Barresi
- Pathology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Isabella Giovannoni
- Pathology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sabrina Rossi
- Pathology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandra Stracuzzi
- Pathology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Denise Quacquarini
- Pathology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Barbara Cafferata
- Pathology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Domenico Piscitelli
- Pathology Unit, Department of Emergency and Transplantation (DETO), University of Bari, Bari, Italy
| | - Francesco De Leonardis
- Department of Pediatric Oncology and Hematology, University Hospital of Policlinico, Bari, Italy
| | - Andrea Marzullo
- Pathology Unit, Department of Emergency and Transplantation (DETO), University of Bari, Bari, Italy
| | - Rita Alaggio
- Pathology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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14
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Toward a Personalized Therapy in Soft-Tissue Sarcomas: State of the Art and Future Directions. Cancers (Basel) 2021; 13:cancers13102359. [PMID: 34068344 PMCID: PMC8153286 DOI: 10.3390/cancers13102359] [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: 03/27/2021] [Revised: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 12/18/2022] Open
Abstract
Soft-tissue sarcomas are rare tumors characterized by pathogenetic, morphological, and clinical intrinsic variability. Median survival of patients with advanced tumors are usually chemo- and radio-resistant, and standard treatments yield low response rates and poor survival results. The identification of defined genomic alterations in sarcoma could represent the premise for targeted treatments. Summarizing, soft-tissue sarcomas can be differentiated into histotypes with reciprocal chromosomal translocations, with defined oncogenic mutations and complex karyotypes. If the latter are improbably approached with targeted treatments, many suggest that innovative therapies interfering with the identified fusion oncoproteins and altered pathways could be potentially resolutive. In most cases, the characteristic genetic signature is discouragingly defined as "undruggable", which poses a challenge for the development of novel pharmacological approaches. In this review, a summary of genomic alterations recognized in most common soft-tissue sarcoma is reported together with current and future therapeutic opportunities.
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15
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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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16
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Abstract
Undifferentiated sarcomas of soft tissue and bone have been defined as tumors with no identifiable morphologic, immunohistochemical, or molecular features indicating tumor cell origin. In young patients, these tumors frequently have a round or spindle cell morphology. Recently described recurrent translocations within this category have led to the recognition of new molecular subtypes of round cell sarcomas, and several of them have a more aggressive clinical course and less chemosensitivity. Because these "newcomers" are diagnosed based on their molecular characteristics, molecular investigation is key in the diagnosis and optimal treatment of these challenging tumors.
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Affiliation(s)
- Anita Nagy
- Division of Pathology, Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Burton Wing, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
| | - Gino R Somers
- Pathology, Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Burton Wing, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
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17
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Donthi D, Malik P, Prenshaw KL, Hong H. A Rare Case of Round Cell Sarcoma with CIC-DUX4 Mutation Mimicking a Phlegmon: Review of Literature. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e925683. [PMID: 32873768 PMCID: PMC7491946 DOI: 10.12659/ajcr.925683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Patient: Male, 33-year-old Final Diagnosis: CIC-DUX mutation sarcoma Symptoms: Mass in abdomen Medication:— Clinical Procedure: — Specialty: Oncology • Pathology
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Affiliation(s)
- Deepak Donthi
- Department of Pathology and Laboratory Medicine, Vidant Medical Center/East Carolina University, Greenville, NC, USA
| | - Preeti Malik
- Department of Public Health, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Karyn L Prenshaw
- Department of Pathology and Laboratory Medicine, Vidant Medical Center/East Carolina University, Greenville, NC, USA
| | - Heng Hong
- Department of Pathology and Laboratory Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
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18
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Sedighim S, Burke J, Schneider D, Kamdjou T, Diaz-Perez JA, Trent J, Möller M. CIC-rearranged round cell (Ewing-like) sarcoma of the uterus: Review of the literature. Gynecol Oncol Rep 2020; 33:100592. [PMID: 32529020 PMCID: PMC7280761 DOI: 10.1016/j.gore.2020.100592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/15/2020] [Accepted: 05/27/2020] [Indexed: 12/13/2022] Open
Abstract
CIC-rearranged round cell sarcoma (CRS) is a rare entity that presents in various anatomical locations and involves deep soft-tissue structures and skin. Although commonly confused with and clinically similar to Ewing sarcoma (ES), investigators have recently shown that this unique condition maintains morphologic and pathologic features that are distinct from ES. In this report, we present and discuss a case of CRS of the uterus, the first of its kind to be reported in the English-language literature. We urge the scientific community to continue its investigations in elucidating the features of this entity, as young women who suffer from this condition have dismal prognoses and currently do not have access to therapeutic options for cure.
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Affiliation(s)
- Shaina Sedighim
- University of Miami, Miller School of Medicine, Miami, FL, United States
- Corresponding author at: University of Miami, Miller School of Medicine, 1600 NW 10th Ave, Miami, FL 33136, United States.
| | - Jonathan Burke
- University of Miami, Miller School of Medicine, Miami, FL, United States
| | - Douglas Schneider
- University of California, Irvine School of Medicine, Orange, CA, United States
| | - Talia Kamdjou
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Julio A. Diaz-Perez
- University of Miami, Miller School of Medicine Department of Pathology, Miami, FL, United States
| | - Jonathan Trent
- University of Miami, Miller School of Medicine Department of Hematology and Oncology, Miami, FL, United States
| | - Mecker Möller
- University of Miami, Miller School of Medicine, Miami, FL, United States
- University of Miami, Miller School of Medicine Department Surgery, Division of Surgical Oncology, Miami, FL, United States
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19
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Breakthrough Technologies Reshape the Ewing Sarcoma Molecular Landscape. Cells 2020; 9:cells9040804. [PMID: 32225029 PMCID: PMC7226764 DOI: 10.3390/cells9040804] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/21/2020] [Accepted: 03/24/2020] [Indexed: 12/14/2022] Open
Abstract
Ewing sarcoma is a highly aggressive round cell mesenchymal neoplasm, most often occurring in children and young adults. At the molecular level, it is characterized by the presence of recurrent chromosomal translocations. In the last years, next-generation technologies have contributed to a more accurate diagnosis and a refined classification. Moreover, the application of these novel technologies has highlighted the relevance of intertumoral and intratumoral molecular heterogeneity and secondary genetic alterations. Furthermore, they have shown evidence that genomic features can change as the tumor disseminates and are influenced by treatment as well. Similarly, next-generation technologies applied to liquid biopsies will significantly impact patient management by allowing the early detection of relapse and monitoring response to treatment. Finally, the use of these novel technologies has provided data of great value in order to discover new druggable pathways. Thus, this review provides concise updates on the latest progress of these breakthrough technologies, underscoring their importance in the generation of key knowledge, prognosis, and potential treatment of Ewing Sarcoma.
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