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Tse JLK, Ng JHY. GLI1-Altered Soft Tissue Tumor in the Tongue-A Case Report and Literature Review. Int J Surg Pathol 2024; 32:1204-1208. [PMID: 38166443 DOI: 10.1177/10668969231216986] [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: 01/04/2024]
Abstract
Background: Soft tissue tumors with fusions or amplifications of the GLI1 gene have distinctive molecular characteristics and have recently been considered a unique pathological entity, thus named "GLI1-altered soft tissue tumors." It is a rare mesenchymal neoplasm that involves soft tissues at any site. Case presentation: We report an example of this condition in a 13-year-old Chinese male patient who presented with a mass in the tongue. The tumor was multilobulated; the tumor cells were arranged in nests and sheets, had a rich, delicate fibrovascular network, and were separated by a hyalinized fibrous stroma. The tumor cells were epithelioid to ovoid, with variable eosinophilic to pale vacuolated cytoplasm and round to oval nuclei. Immunostaining revealed that the tumor cells were positive for CDK4 and CD56. Fluorescence in situ hybridization (FISH) for GLI1 translocation was positive, with a high level of amplification of the translocated segment. Literature review: We present a comprehensive literature review of this condition, focusing on its clinical presentation, histological features, immunohistochemical profile, molecular characteristics, and prognosis.
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Affiliation(s)
- Jenny Lik-Ka Tse
- Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Joshua Hoi-Yan Ng
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
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2
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Cloutier JM, Kerr DA. GLI1-Altered Mesenchymal Tumors. Surg Pathol Clin 2024; 17:13-24. [PMID: 38278602 DOI: 10.1016/j.path.2023.06.004] [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
GLI1-altered mesenchymal tumors comprise an emerging group of neoplasms characterized by fusions or amplifications involving GLI1, a gene that encodes a key regulator of the Hedgehog signaling pathway. In recent years, tumors with GLI1 alterations have been reported across a variety of anatomic sites and a broad age range. Although these tumors can exhibit a wide morphologic spectrum and a variable immunophenotype, they frequently present with monomorphic ovoid cells arranged in distinctive nests with a rich, arborizing vascular network. Recent evidence indicates that they have the potential to metastasize, which suggests that they may be best considered a sarcoma.
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Affiliation(s)
- Jeffrey M Cloutier
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA; Dartmouth Geisel School of Medicine, 1 Rope Ferry Road, Hanover, NH 03755, USA. https://twitter.com/@JCloutierMD
| | - Darcy A Kerr
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA; Dartmouth Geisel School of Medicine, 1 Rope Ferry Road, Hanover, NH 03755, USA.
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Kerr DA, Cloutier JM, Margolis M, Mata DA, Rodrigues Simoes NJ, Faquin WC, Dias-Santagata D, Chopra S, Charville GW, Wangsiricharoen S, Lazar AJ, Wang WL, Rosenberg AE, Tse JY. GLI1-Altered Mesenchymal Tumors With ACTB or PTCH1 Fusion: A Molecular and Clinicopathologic Analysis. Mod Pathol 2024; 37:100386. [PMID: 37992966 DOI: 10.1016/j.modpat.2023.100386] [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: 08/01/2023] [Revised: 10/04/2023] [Accepted: 10/31/2023] [Indexed: 11/24/2023]
Abstract
Mesenchymal tumors with GLI1 fusions or amplifications have recently emerged as a distinctive group of neoplasms. The terms GLI1-altered mesenchymal tumor or GLI1-altered soft tissue tumor serve as a nosological category, although the exact boundaries/criteria require further elucidation. We examined 16 tumors affecting predominantly adults (median age: 40 years), without sex predilection. Several patients had tumors of longstanding duration (>10 years). The most common primary site was soft tissue (n = 9); other sites included epidural tissue (n = 1), vertebra (n = 1), tongue (n = 1), hard palate (n = 1), and liver (n = 1). Histologically, the tumors demonstrated multinodular growth of cytologically uniform, ovoid-to-epithelioid, occasionally short spindled cells with delicate intratumoral vasculature and frequent myxoid stroma. Mitotic activity ranged from 0 to 8 mitoses/2 mm2 (mean 2). Lymphovascular invasion/protrusion of tumor cells into endothelial-lined vascular spaces was present or suspected in 6 cases. Necrosis, significant nuclear pleomorphism, or well-developed, fascicular spindle-cell growth were absent. Half demonstrated features of the newly proposed subset, "distinctive nested glomoid neoplasm." Tumors were consistently positive for CD56 (n = 5/5). A subset was stained with S100 protein (n = 7/13), SMA (n = 6/13), keratin (n = 2/9), EMA (n = 3/7), and CD99 (n = 2/6). Tumors harbored ACTB::GLI1 (n = 15) or PTCH1::GLI1 (n = 1) fusions. The assays used did not capture cases defined by GLI1 amplification. We also identified recurrent cytogenetic gains (1q, 5, 7, 8, 12, 12q13.2-ter, 21, and X). For patients with available clinical follow-up (n = 8), half were disease free. Half demonstrated distant metastases (lungs, bone, or soft tissue). Of cases without follow-up (n = 8), 2 were known recurrences, and 1 was presumed metastasis. Our results imply a more aggressive biological potential than currently reported. Given the possibility for metastasis and disease progression, even in cytologically bland, nested tumors, close clinical surveillance, akin to that for sarcoma management, may be indicated. The term GLI1-altered mesenchymal tumor with malignant potential is proposed.
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Affiliation(s)
- Darcy A Kerr
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Dartmouth Geisel School of Medicine, Hanover, New Hampshire.
| | - Jeffrey M Cloutier
- Department of Pathology, MD Anderson Cancer Center, Houston, TX; Now with Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Now with Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | | | | | | | - William C Faquin
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Dora Dias-Santagata
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Shefali Chopra
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Gregory W Charville
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | | | | | - Wei-Lien Wang
- Department of Pathology, MD Anderson Cancer Center, Houston, TX
| | - Andrew E Rosenberg
- Department of Pathology, University of Miami and Miller School of Medicine, Miami, Florida
| | - Julie Y Tse
- Foundation Medicine, Inc., Cambridge, Massachusetts
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4
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Zeng Y, Yao H, Jiang X, Tang X, Wang X. GLI1-altered Mesenchymal Tumor Involving the Duodenum: Case Report and Literature Review. Int J Surg Pathol 2023; 31:1538-1547. [PMID: 36855297 DOI: 10.1177/10668969231157782] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
GLI1-altered mesenchymal tumor is an emerging entity with distinctive clinicopathologic features. It shows a distinctive monomorphic round to epithelioid morphology, nested to trabecular pattern of growth, and S100+/SOX10-/SMA-immunophenotype. We report an example of this entity arising in the duodenum. A 31-year-old man presented with anemia for 1 year, a mass in the duodenal bulb was found for 9 days. Histopathologic examination revealed the tumor with distinct multilobulated architecture, a monomorphic appearance of round to epithelioid cells arranged in papillary structures, nests, cords, solid, reticular patterns, and hyalinized stroma surrounding a rich capillary network. The neoplastic cells had amphophilic to light eosinophilic or clear cytoplasm, uniform round nuclei with fine chromatin and inconspicuous nucleoli. Immunohistochemical analysis revealed strong positivity for vimentin, S100, CD56, CyclinD1, and negativity for SOX10, SMA, melan-A, HMB-45, synaptophysin, and a variety of other markers. Based on the morphology and immunophenotype, molecular studies were performed, which revealed the presence of an ACTB::GLI1 fusion transcript, confirming the diagnosis of GLI1-altered mesenchymal tumor.
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Affiliation(s)
- Ying Zeng
- Department of Pathology, Chongqing General Hospital, Chongqing, China
| | - Hui Yao
- Department of Pathology, Chongqing General Hospital, Chongqing, China
| | - Xin Jiang
- Department of Pathology, Chongqing General Hospital, Chongqing, China
| | - Xuefeng Tang
- Department of Pathology, Chongqing General Hospital, Chongqing, China
| | - Xue Wang
- Department of Pathology, Chongqing General Hospital, Chongqing, China
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Rezaee N, Cohen B, Eno C, Shon W. Primary Cutaneous Epithelioid Mesenchymal Tumor With a Novel ATP2B4::GLI1 Gene Fusion. Am J Dermatopathol 2023; 45:642-645. [PMID: 37506273 DOI: 10.1097/dad.0000000000002497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
ABSTRACT GLI1 gene alterations (rearrangement or amplification) have been found in several bone and soft tissue tumors including pericytic tumors, gastric plexiform fibromyxoma, gastroblastoma, and a various group of epithelioid tumors with regional recurrence or distant metastasis. In this article, we describe a case of primary cutaneous epithelioid mesenchymal tumor harboring hitherto not reported ATP2B4::GLI1 gene fusion. A 42-year-old man presented with a growing firm lesion on the left postauricular scalp. Microscopically, the shave biopsy specimen revealed a dermal-based nodular proliferation of relatively monotonous epithelioid cells with round to ovoid nuclei and pale eosinophilic cytoplasm, accompanied by prominent stromal vasculature. Significant cytologic atypia, necrosis, and mitotic activity were absent. The tumor cells were partially positive for CD34 and S-100 protein, but were negative for other markers, including SOX-10, keratins, and myogenic markers. An ATP2B4::GLI1 gene fusion was identified by next-generation sequencing. Array CGH was also performed, but it did not show relevant chromosomal copy number changes. Awareness of this rare cutaneous tumor, and thus, reporting of additional cases is necessary for further delineating its full clinicopathologic spectrum.
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Affiliation(s)
- Neda Rezaee
- Departments of Pathology and Laboratory Medicine, and
| | - Brandon Cohen
- Dermatology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Celeste Eno
- Departments of Pathology and Laboratory Medicine, and
| | - Wonwoo Shon
- Departments of Pathology and Laboratory Medicine, and
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GLI1-altered epithelioid soft tissue tumor: A newly described entity with a predilection for the tongue. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:e14-e22. [PMID: 35165054 DOI: 10.1016/j.oooo.2021.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/11/2021] [Accepted: 10/06/2021] [Indexed: 12/21/2022]
Abstract
A novel subset of epithelioid soft tissue tumors with GLI1 gene fusions or amplifications has recently been characterized. Histologically, these tumors typically exhibit multinodular or plexiform growth of ovoid, round to epithelioid neoplastic cells, with a distinctive nested architecture separated by a rich delicate arborizing vascular network. The immunoprofile is variable and nonspecific, indicating no definitive line of differentiation. GLI1-altered epithelioid soft tissue tumor is considered to be a low-grade sarcoma; however, with a limited number of cases reported, the biologic behavior of this entity is unclear. Interestingly, these tumors frequently occur in the head and neck, with a clear predilection for the tongue. To date, 11 cases of lingual GLI1-altered epithelioid soft tissue tumors have been reported in the English literature, and none showed evidence of recurrence or metastasis. Herein, we report an additional case of lingual GLI1-altered epithelioid soft tissue tumor harboring GLI1 fusion in a 56-year-old man with regional nodal metastasis and distant metastasis to increase the awareness of this entity among oral pathologists and clinicians. An accumulation of similar cases is mandatory to clarify biological behaviors and also for the development of new therapeutic strategies.
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Liu J, Mao R, Lao IW, Yu L, Bai Q, Zhou X, Wang J. GLI1-altered mesenchymal tumor: a clinicopathological and molecular analysis of ten additional cases of an emerging entity. Virchows Arch 2021; 480:1087-1099. [PMID: 34779913 DOI: 10.1007/s00428-021-03224-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 12/14/2022]
Abstract
We report 10 additional cases of GLI1-altered mesenchymal tumor to further delineate its clinicopathological and molecular spectrum. There were seven males and three females with a median age of 31 years (range 1.3 ~ 75 years). Five tumors arose in the oral cavity, one each in the stomach, uterine cervix, elbow, groin, and thigh. Histologically, all cases except one were composed of monomorphic round to epithelioid cells showing an infiltrative multinodular growth pattern. The neoplastic cells were surrounded by a rich network of capillary vessels. Vessel invasion or subendothelial protrusion into the vascular space was commonly present. One tumor developed regional lymph node metastasis. The remaining case showed a predominantly spindle cell tumor. By immunohistochemistry, most tumors showed diffuse staining of CD56 (8/8) with variable expression of S100 protein (7/8). In three tumors harboring amplified genes, strong and diffuse nuclear staining of MDM2 (2/3) and CDK4 (3/3) were noted. Next-generation sequencing (NGS) studies revealed GLI1 fusions in 7 cases and GLI1 amplification in 2 cases, which were validated by fluorescence in situ hybridization (FISH) analysis in the majority of cases. One case did not show fusion gene by RNA-seq, but FISH revealed both amplification and break-apart of GLI1 gene. Follow-up information showed local recurrences in two patients. All other patients remained disease-free at the last follow-up. Our study further demonstrates that mesenchymal tumors with GLI1 alterations represent a distinctive clinicopathological entity. Although the tumor has a propensity for the tongue, it can also arise in somatic soft tissues as well as in visceral organs. Based on the characteristic morphological features and genomic profiles, we propose the term "GLI1-altered mesenchymal tumor" to describe this emerging entity.
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Affiliation(s)
- Jiahan Liu
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Rongjun Mao
- Department of Pathology, Foshan Hospital of Chinese Traditional Medicine, Guangdong Province, Foshan, 528000, China
| | - I Weng Lao
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Lin Yu
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Qianming Bai
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Xiaoyan Zhou
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Jian Wang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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Rollins BT, Cassarino DS, Lindberg M. Primary cutaneous epithelioid mesenchymal neoplasm with ACTB-GLI1 fusion: a case report. J Cutan Pathol 2021; 49:284-287. [PMID: 34643288 DOI: 10.1111/cup.14152] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/29/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
Mesenchymal tumors harboring GLI1 gene abnormalities are a rare but distinctive group of neoplasms whose clinicopathologic features are currently evolving. In particular, examples of this tumor with ACTB-GLI1 gene fusion, tentatively termed ACTB-GLI1 epithelioid mesenchymal neoplasm (EMN), show a distinctive monomorphic round-to-epithelioid morphology, nested to trabecular pattern of growth, and S100+/SOX10-/SMA- immunophenotype. We report the first case of this entity arising exclusively in the skin. A 69-year-old man with no prior history of neoplasia presented with a 1.5-cm raised lesion on the left buttock. Histopathologic examination revealed a diffuse dermal proliferation of small, monomorphic, round-to-ovoid cells with hyperchromatic nuclei, focally enlarged nucleoli, and minimal eosinophilic to clear-staining cytoplasm. These cells were arranged in confluent nests and trabeculae in a background of fibrocollagenous to focally myxoid stroma. Immunohistochemical analysis revealed strong positivity for S100 and CD56, and negativity for SOX-10, SMA, Melan-A, HMB-45, and a variety of other markers. Based on the morphology and immunophenotype, molecular studies were performed, which revealed the presence of an ACTB-GLI1 fusion transcript, confirming the diagnosis. Given the morphologic overlap of this tumor with other cutaneous round cell neoplasms and its potential for malignant behavior, ACTB-GLI1 EMN is an important entity for pathologists to recognize.
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Affiliation(s)
- Benjamin T Rollins
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | - Matthew Lindberg
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Arslan ME, Li H, Fu Z, Jennings TA, Lee H. Plexiform fibromyxoma: Review of rare mesenchymal gastric neoplasm and its differential diagnosis. World J Gastrointest Oncol 2021; 13:409-423. [PMID: 34040702 PMCID: PMC8131905 DOI: 10.4251/wjgo.v13.i5.409] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/22/2021] [Accepted: 04/26/2021] [Indexed: 02/06/2023] Open
Abstract
Plexiform fibromyxoma (PF) is a very rare mesenchymal neoplasm of the stomach that was first described in 2007 and was officially recognized as a subtype of gastric mesenchymal neoplasm by World Health Organization (WHO) in 2010. Histologically, PF is characterized by a plexiform growth of bland spindle to ovoid cells embedded in a myxoid stroma that is rich in small vessels. The lesion is usually paucicellular. While mucosal and vascular invasion have been documented, no metastasis or malignant transformation has been reported. Its pathogenesis is largely unknown and defining molecular alterations are not currently available. There are other mesenchymal tumors arising in the gastrointestinal tract that need to be differentiated from PF given their differing biologic behaviors and malignant potential. Histologic mimics with spindle cells include gastrointestinal stromal tumor, smooth muscle tumor, and nerve sheath tumor. Histologic mimics with myxoid stroma include myxoma and aggressive angiomyxoma. Molecular alterations that have been described in a subset of PF may be seen in gastroblastoma and malignant epithelioid tumor with glioma-associated oncogene homologue 1 (GLI1) rearrangement. The recent increase in publications on PF reflects growing recognition of this entity with expansion of clinical and pathologic findings in these cases. Herein we provide a review of PF in comparison to other mesenchymal tumors with histologic and molecular resemblance to raise the awareness of this enigmatic neoplasm. Also, we highlight the challenges pathologists face when the sample is small, or such rare entity is encountered intraoperatively.
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Affiliation(s)
- Mustafa Erdem Arslan
- Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY 12208, United States
| | - Hua Li
- Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY 12208, United States
| | - Zhiyan Fu
- Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY 12208, United States
| | - Timothy A Jennings
- Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY 12208, United States
| | - Hwajeong Lee
- Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY 12208, United States
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