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Fujiwara T, Kunisada T, Nakata E, Mitsuhashi T, Ozaki T, Kawai A. Factors associated with survival in patients with clear cell sarcoma. Bone Joint J 2023; 105-B:1216-1225. [PMID: 37907082 DOI: 10.1302/0301-620x.105b11.bjj-2022-0743.r3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Aims Clear cell sarcoma (CCS) of soft-tissue is a rare melanocytic subtype of mesenchymal malignancy. The aim of this study was to investigate the clinical and therapeutic factors associated with increased survival, stratified by clinical stage, in order to determine the optimal treatment. Methods The study was a retrospective analysis involving 117 patients with histologically confirmed CCS, between July 2016 and November 2017, who were enrolled in the Bone and Soft Tissue Tumour Registry in Japan. Results The five- and ten-year survival rates were 41% (95% confidence interval (CI) 29 to 52) and 37% (95% CI 25 to 49), respectively. On multivariable analysis, the size of the tumour of > 10 cm (p = 0.006), lymph node metastasis at the time of diagnosis (p < 0.001), distant metastases at the time of diagnosis (p < 0.001), and no surgery for the primary tumour (p = 0.019) were independently associated with a poor survival. For N0M0 CCS (n = 68), the development of distant metastases was an independent prognostic factor for survival (early (< 12 months), hazard ratio (HR) 116.78 (95% CI 11.69 to 1,166.50); p < 0.001; late (> 12 months), HR 14.79 (95% CI 1.66 to 131.63); p = 0.016); neoadjuvant/adjuvant chemotherapy (p = 0.895) and/or radiotherapy (p = 0.216) were not significantly associated with survival. The five-year cumulative incidence of local recurrence was 19% (95% CI 8 to 35) and the size of the tumour was significantly associated with an increased rate of local recurrence (p = 0.012). For N1M0 CCS (n = 18), the risk of mortality was significantly lower in patients who underwent surgery for both the primary tumour and lymph node metastases (HR 0.03 (95% CI 0.00 to 0.56); p = 0.020). For M1 CCS (n = 31), excision of the primary tumour was independently associated with better survival (HR 0.26 (95% CI 0.09 to 0.76); p = 0.013). There was no significant difference in survival between the different types of systemic treatment (p = 0.523). Conclusion Complete excision of the primary tumour and lymph nodes is associated with a better survival in patients with CCS. Systemic treatment appears to provide limited benefits, demonstrating a pressing need for novel systemic agents.
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Affiliation(s)
- Tomohiro Fujiwara
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Toshiyuki Kunisada
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Eiji Nakata
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Toshiharu Mitsuhashi
- Centre for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology, National Cancer Centre Hospital, Tokyo, Japan
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Boșoteanu M, Cristian M, Așchie M, Baz RA, Zielonka AM, Cozaru GC, Boșoteanu LA. The Malignant Gastrointestinal Neuroectodermal Tumor (GNET): A Distinct Entity and the Challenging Differential Diagnosis with Mesenchymal, Lymphoid, and Melanic Tumors: A Case Report and Brief Review of the Literature. Diagnostics (Basel) 2023; 13:diagnostics13061131. [PMID: 36980439 PMCID: PMC10047330 DOI: 10.3390/diagnostics13061131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023] Open
Abstract
(1) Background: A malignant gastrointestinal neuroectodermal tumor (GNET) is an ultra-rare primary neoplasm with a distinctive histopathological, immunohistochemical, molecular, and ultramicroscopic profile, synonymous terminology with clear cell sarcoma-like tumor of the gastrointestinal tract. This case report aims to describe a case of GNET with challenging mesenchymal, lymphoid, and melanic tumor differential diagnosis. (2) Case presentation: We discuss the case of a 67-year-old male patient who presented with diffuse abdominal pain, intermittent lack of intestinal transit, and frequent episodes of nausea, followed by segmental resection of the jejunum and sigmoid colon. The patient had no relevant medical history. The surgical specimen underwent immunohistochemical staining and morphological evaluation. (3) Results: Histopathological analysis reveals a moderately homogeneous polyhedral-epithelioid and spindle cell neoplastic proliferation with a zonal discohesive pattern and extensive and focal fasciculated architecture. Twenty monoclonal antibodies were used for immunostaining, which allowed GNET to be diagnosed on the basis of the tumoral immune profile, characterized by positive reactivity of S100, SOX10, and CD 56. (4) Conclusions: The poor prognosis of GNET is highlighted in the present study, along with the vital importance of differential diagnosis issues with mesenchymal, lymphoid, and melanic tumors, which make the diagnosis difficult for both pathologists and clinicians.
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Affiliation(s)
- Mădălina Boșoteanu
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania
- Department of Clinical Pathology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
- Department of Pathology, “Ovidius” Clinical Hospital, 905900 Constanta, Romania
| | - Miruna Cristian
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania
- Department of Clinical Pathology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology—CEDMOG, “Ovidius” University of Constanta, 900591 Constanta, Romania
- Institute of Doctoral Studies, School of Medicine, “Ovidius” University of Constanta, 900573 Constanta, Romania
- Correspondence: (M.C.); (R.A.B.); Tel.: +40-735-868-090 (M.C.)
| | - Mariana Așchie
- Department of Clinical Pathology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology—CEDMOG, “Ovidius” University of Constanta, 900591 Constanta, Romania
- Academy of Medical Sciences, 030167 Bucharest, Romania
| | - Radu Andrei Baz
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania
- Department of Radiology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
- Correspondence: (M.C.); (R.A.B.); Tel.: +40-735-868-090 (M.C.)
| | | | - Georgeta Camelia Cozaru
- Department of Clinical Pathology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology—CEDMOG, “Ovidius” University of Constanta, 900591 Constanta, Romania
| | - Luana Andreea Boșoteanu
- Institute of Doctoral Studies, School of Medicine, “Ovidius” University of Constanta, 900573 Constanta, Romania
- Dermatology Department, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
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Chen G, Sun S, Du Z, Sun Y, Pan Z, Che X, Xie R. Intra-Extracranial Primary Clear Cell Sarcoma: The First Report and Review of the Literature. World Neurosurg 2019; 126:e1140-e1146. [PMID: 30880192 DOI: 10.1016/j.wneu.2019.02.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Clear cell sarcoma (CCS) is a rare malignant soft tissue tumor with poor prognosis owing to metastasis and insensitive response to chemotherapy and radiotherapy. METHODS We first searched PubMed and Embase using the terms "clear cell sarcoma," "malignant melanoma of soft tissue," "head," and "neck." In the 15 articles selected for literature review, only 27% (4/15) of patients were diagnosed with primary CCS of the head. Pathologically, those tumors arose from either the scalp or the superficial temporal fascia, but none invaded the skull and brain. Next, the search was performed in the same database using the terms "clear cell sarcoma," "malignant melanoma of soft tissue," and "bone," and only 24 articles were selected. RESULTS In the case reported here, a 36-year-old woman was found to have a palpable mass located at the left temporal-occipital region, and surgical finding confirmed the invasion into the skull and the brain. The diagnosis of primary CCS was made because of the detection of t(12;22)(q13;q12) in >50% of tumor cells by fluorescence in situ hybridization, and metastasis to the lymph nodes and lungs was discovered by postoperative positron emission tomography-computed tomography. CONCLUSIONS To the best of our knowledge, this is the first case of primary central nervous system CCS. Primary CCS may involve the skull and should be one of the differential diagnoses for intra-extracranial communicating tumors. Further research on biological characteristics and molecular targeted therapy of CCS are needed to improve its poor prognosis.
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Affiliation(s)
- Gong Chen
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Shifeng Sun
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Zunguo Du
- Department of Pathology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yirui Sun
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhiguang Pan
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoming Che
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Rong Xie
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.
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Frikh R, Oumakhir S, Chahdi H, Oukabli M, Albouzidi A, Baba N, Hjira N, Boui M. [Soft tissue melanoma: a clinical case]. Pan Afr Med J 2018. [PMID: 29515725 PMCID: PMC5837147 DOI: 10.11604/pamj.2017.28.107.10316] [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] [Indexed: 11/11/2022] Open
Abstract
Le mélanome des tissus mous a été décrit en 1965 par Enzinger sous le nom de sarcome à cellules claires. En 1983, Chung et Enzinger le rebaptisent mélanome des parties molles en raison de similitudes immunohistochimiques avec le mélanome. Nous rapportons un cas de cette forme rare de mélanome, chez un jeune homme de 22 ans qui avait une lésion molluscoïde de la cheville sans signes cliniques de malignité, et dont l’examen histologique a permis de retenir ce diagnostic.
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Affiliation(s)
- Rachid Frikh
- Service de Dermatologie, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
| | - Siham Oumakhir
- Service de Dermatologie, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
| | - Hafsa Chahdi
- Service d'Anatomie Pathologique, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
| | - Mohammed Oukabli
- Service d'Anatomie Pathologique, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc.,Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Abderrahmane Albouzidi
- Service d'Anatomie Pathologique, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc.,Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Noureddine Baba
- Service de Dermatologie, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
| | - Naoufal Hjira
- Service de Dermatologie, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc.,Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Mohammed Boui
- Service de Dermatologie, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc.,Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
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Rosai J. Clear Cell Sarcoma and Osteoclast-Rich Clear Cell Sarcoma-Like Tumor of the Gastrointestinal Tract: One Tumor Type or Two? Melanoma or Sarcoma? Int J Surg Pathol 2016; 13:309-11. [PMID: 16273185 DOI: 10.1177/106689690501300401] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Cornillie J, van Cann T, Wozniak A, Hompes D, Schöffski P. Biology and management of clear cell sarcoma: state of the art and future perspectives. Expert Rev Anticancer Ther 2016; 16:839-45. [PMID: 27253849 DOI: 10.1080/14737140.2016.1197122] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Clear cell sarcoma (CCS) is an aggressive tumor, typically developing in tendons or aponeuroses. The outcome of this orphan disease is poor, with 5-year and 10-year survival rates of localized CCS around 60-70% and 40-50%. Once the disease has metastasized, it is usually fatal due to its chemotherapy-resistant nature. Systemic treatment options are poorly standardized and the use of chemotherapy is based on weak scientific evidence. AREAS COVERED In this review, we systematically discuss the current scientific evidence for the systemic treatment of CCS, including tyrosine kinase inhibitors, immunotherapy and MET inhibitors. Expert commentary: Recent insights in the biology of CCS have identified new potential therapeutic targets, which should be tested in prospective clinical trials. Whenever possible, patients with metastatic CCS should be included in clinical trials with good biological rationale. Innovative trial methodology and new regulatory mechanisms are required to provide patients with uncommon cancers with active drugs.
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Affiliation(s)
- Jasmien Cornillie
- a Laboratory of Experimental Oncology, Department of Oncology, KU Leuven and Department of General Medical Oncology , University Hospitals Leuven, Leuven Cancer Institute , Leuven , Belgium
| | - Thomas van Cann
- a Laboratory of Experimental Oncology, Department of Oncology, KU Leuven and Department of General Medical Oncology , University Hospitals Leuven, Leuven Cancer Institute , Leuven , Belgium
| | - Agnieszka Wozniak
- a Laboratory of Experimental Oncology, Department of Oncology, KU Leuven and Department of General Medical Oncology , University Hospitals Leuven, Leuven Cancer Institute , Leuven , Belgium
| | - Daphne Hompes
- b Department of Surgical Oncology , KU Leuven and University Hospitals Leuven , Leuven , Belgium
| | - Patrick Schöffski
- a Laboratory of Experimental Oncology, Department of Oncology, KU Leuven and Department of General Medical Oncology , University Hospitals Leuven, Leuven Cancer Institute , Leuven , Belgium
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Henderson-Jackson EB, Bui MM. Molecular Pathology of Soft-Tissue Neoplasms and Its Role in Clinical Practice. Cancer Control 2016; 22:186-92. [PMID: 26068763 DOI: 10.1177/107327481502200209] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Soft-tissue neoplasms embody a histologically diverse group of mesenchymal tumors. Oftentimes the histopathological diagnosis of soft-tissue tumors is challenging due to overlapping pathological features. METHODS We reviewed the current and most importantly known recurrent or tumor-specific genetic abnormalities involving soft-tissue tumors, focusing on how they are useful in working up differential diagnoses and the relevance of potentially targeted therapies. RESULTS Molecular diagnostic tools have shown great advantage as an aid in the differentiation between different soft-tissue tumor entities, providing a potential avenue in the identification of novel therapeutic targets. Gastrointestinal stromal tumor is a well-known example of a soft-tissue tumor with a successful, molecularly driven treatment with response rates of more than 80% in stable disease and partial remission. Classifying soft-tissue neoplasms by their molecular genetic pathology has been considered as molecular testing becomes more integrated into various diagnostic and prognostic algorithms. CONCLUSIONS Molecular pathology provides a unique opportunity for pathologists to play a crucial role in the multidisciplinary care of patients with sarcoma. These opportunities include but are not limited to the appropriate triage of tissue for molecular testing and the integration of molecular testing results, with histological and immunohistochemical findings providing actionable information for the diagnosis, prognosis, and choice of therapeutic modality.
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8
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Yoon JH, Baek YS, Jeon J, Oh CH, Song HJ. Dual-color, break-apart fluorescencein situhybridization probe for distinguishing clear cell sarcoma of soft tissue from malignant melanoma. Int J Dermatol 2014; 53:1464-7. [DOI: 10.1111/j.1365-4632.2011.05009.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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9
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Tanaka Y, Yoshimasu T, Oura S, Hirai Y, Kawago M, Okamura Y. Primary clear-cell sarcoma in the mediastinum. Case Rep Oncol 2014; 7:306-9. [PMID: 24932172 PMCID: PMC4049018 DOI: 10.1159/000363180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report a case of primary clear-cell sarcoma (CCS) in the mediastinum. In October 2011, a 63-year-old man was admitted to our hospital for surgical resection. The tumor was completely excised by video-assisted thoracoscopic surgery. The tumor was well encapsulated and did not invade the pleura. Histological examination led to a final diagnosis of primary CCS in the mediastinum. The patient remains alive without evidence of recurrence at 15 months after surgery.
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Affiliation(s)
- Yumi Tanaka
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama, Japan
| | - Tatsuya Yoshimasu
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama, Japan
| | - Shoji Oura
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama, Japan
| | - Yoshimitsu Hirai
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama, Japan
| | - Mitsumasa Kawago
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama, Japan
| | - Yoshitaka Okamura
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama, Japan
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Bridge JA. The role of cytogenetics and molecular diagnostics in the diagnosis of soft-tissue tumors. Mod Pathol 2014; 27 Suppl 1:S80-97. [PMID: 24384855 DOI: 10.1038/modpathol.2013.179] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 07/19/2013] [Indexed: 12/11/2022]
Abstract
Soft-tissue sarcomas are rare, comprising <1% of all cancer diagnoses. Yet the diversity of histological subtypes is impressive with >100 benign and malignant soft-tissue tumor entities defined. Not infrequently, these neoplasms exhibit overlapping clinicopathologic features posing significant challenges in rendering a definitive diagnosis and optimal therapy. Advances in cytogenetic and molecular science have led to the discovery of genetic events in soft-tissue tumors that have not only enriched our understanding of the underlying biology of these neoplasms but have also proven to be powerful diagnostic adjuncts and/or indicators of molecular targeted therapy. In particular, many soft-tissue tumors are characterized by recurrent chromosomal rearrangements that produce specific gene fusions. For pathologists, identification of these fusions as well as other characteristic mutational alterations aids in precise subclassification. This review will address known recurrent or tumor-specific genetic events in soft-tissue tumors and discuss the molecular approaches commonly used in clinical practice to identify them. Emphasis is placed on the role of molecular pathology in the management of soft-tissue tumors. Familiarity with these genetic events provides important ancillary testing for pathologists to include in their diagnostic armamentarium.
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Affiliation(s)
- Julia A Bridge
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
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11
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Dal Cin P, Qian X, Cibas ES. The marriage of Cytology and Cytogenetics. Cancer Cytopathol 2013; 121:279-90. [DOI: 10.1002/cncy.21270] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 11/12/2012] [Indexed: 12/16/2022]
Affiliation(s)
- Paola Dal Cin
- Department of Pathology; Brigham and Women's Hospital and Harvard Medical School; Boston Massachusetts
| | - Xiaohua Qian
- Department of Pathology; Brigham and Women's Hospital and Harvard Medical School; Boston Massachusetts
| | - Edmund S. Cibas
- Department of Pathology; Brigham and Women's Hospital and Harvard Medical School; Boston Massachusetts
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Yamada K, Ohno T, Aoki H, Semi K, Watanabe A, Moritake H, Shiozawa S, Kunisada T, Kobayashi Y, Toguchida J, Shimizu K, Hara A, Yamada Y. EWS/ATF1 expression induces sarcomas from neural crest-derived cells in mice. J Clin Invest 2013; 123:600-10. [PMID: 23281395 DOI: 10.1172/jci63572] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 11/01/2012] [Indexed: 12/17/2022] Open
Abstract
Clear cell sarcoma (CCS) is an aggressive soft tissue malignant tumor characterized by a unique t(12;22) translocation that leads to the expression of a chimeric EWS/ATF1 fusion gene. However, little is known about the mechanisms underlying the involvement of EWS/ATF1 in CCS development. In addition, the cellular origins of CCS have not been determined. Here, we generated EWS/ATF1-inducible mice and examined the effects of EWS/ATF1 expression in adult somatic cells. We found that forced expression of EWS/ATF1 resulted in the development of EWS/ATF1-dependent sarcomas in mice. The histology of EWS/ATF1-induced sarcomas resembled that of CCS, and EWS/ATF1-induced tumor cells expressed CCS markers, including S100, SOX10, and MITF. Lineage-tracing experiments indicated that neural crest-derived cells were subject to EWS/ATF1-driven transformation. EWS/ATF1 directly induced Fos in an ERK-independent manner. Treatment of human and EWS/ATF1-induced CCS tumor cells with FOS-targeted siRNA attenuated proliferation. These findings demonstrated that FOS mediates the growth of EWS/ATF1-associated sarcomas and suggest that FOS is a potential therapeutic target in human CCS.
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Affiliation(s)
- Kazunari Yamada
- Department of Orthopedic Surgery, Regeneration and Advanced Medical Science, Gifu University Graduate School of Medicine, Gifu, Japan
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Nakayama S, Yokote T, Iwaki K, Hirata Y, Akioka T, Miyoshi T, Takayama A, Nishiwaki U, Masuda Y, Tsuji M, Hanafusa T. Co-expression of multiple cytokines and their receptors in primary clear cell sarcoma of the pubic bone with features of a small round cell tumor. Int J Immunopathol Pharmacol 2012; 25:799-804. [PMID: 23058034 DOI: 10.1177/039463201202500330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
We present the case of an 81-year-old man with primary clear cell sarcoma (CCS) of the pubic bone with an associated aggressive clinical course. The patient's laboratory tests showed marked leukocytosis, elevated levels of C-reactive protein and multiple cytokines, including interleukin-6 (IL-6) and granulocyte colony-stimulating factor (G-CSF). Histological examination showed monomorphic small cells predominantly arranged as a diffuse sheet with morphological features of a small round cell tumor (SRCT). Immunohistochemical staining indicated that the tumor cells were positive for HMB45, S100, Melan A, IL-6, IL-6 receptor, G-CSF, and G-CSF receptor and negative for cytokeratin (AE1/AE3) and epithelial membrane antigen. To the best of our knowledge, this is the first case report of aggressive primary CCS of the pubic bone with features of SRCT showing the production and co-expression of multiple cytokines and their receptors. Thus, we suggest that proliferation through an IL-6- and G-CSF-associated autocrine mechanism may play an important role in the aggressive clinical course and poor prognosis of some CCSs showing features of SRCT.
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Affiliation(s)
- S Nakayama
- Department of Internal Medicine (I), Osaka Medical College, Osaka, Japan.
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Abstract
The rapid growth of tissue-based molecular pathology has changed the practice of the surgical pathologist signing out soft tissue tumors. This information is presented in a practical and succinct manner focusing on clinically validated findings that have diagnostic or therapeutic relevance. The approach is morphologically based and focuses on differential diagnoses and clinical scenarios. Molecular techniques can be an invaluable ancillary tool.
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Affiliation(s)
- Robin D LeGallo
- Department of Pathology, University of Virginia Health System, 1215 Lee Street, HEP 3064, Charlottesville, VA 22908, USA.
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Nakayama S, Yokote T, Iwaki K, Akioka T, Miyoshi T, Hirata Y, Takayama A, Nishiwaki U, Masuda Y, Tsuji M, Hanafusa T. A rare case of primary clear cell sarcoma of the pubic bone resembling small round cell tumor: an unusual morphological variant. BMC Cancer 2012; 12:538. [PMID: 23170958 PMCID: PMC3517754 DOI: 10.1186/1471-2407-12-538] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 11/19/2012] [Indexed: 11/18/2022] Open
Abstract
Background Clear cell sarcoma (CCS) and malignant melanoma share overlapping immunohistochemistry with regard to the melanocytic markers HMB45, S100, and Melan-A. However, the translocation t(12; 22)(q13; q12) is specific to CCS. Therefore, although these neoplasms are closely related, they are now considered to be distinct entities. However, the translocation is apparently detectable only in 50%–70% of CCS cases. Therefore, the absence of a detectable EWS/AFT1 rearrangement may occasionally lead to erroneous exclusion of a translocation-negative CCS. Therefore, histological assessment is essential for the correct diagnosis of CCS. Primary CCS of the bone is exceedingly rare. Only a few cases of primary CCS arising in the ulna, metatarsals, ribs, radius, sacrum, and humerus have been reported, and primary CCS arising in the pubic bone has not been reported till date. Case presentation We present the case of an 81-year-old man with primary CCS of the pubic bone. Histological examination of the pubic bone revealed monomorphic small-sized cells arranged predominantly as a diffuse sheet with round, hyperchromatic nuclei and inconspicuous nucleoli. The cells had scant cytoplasm, and the biopsy findings indicated small round cell tumor (SRCT). Immunohistochemical staining revealed the tumor cells to be positive for HMB45, S100, and Melan-A but negative for cytokeratin (AE1/AE3) and epithelial membrane antigen. To the best of our knowledge, this is the first case report of primary CCS of the pubic bone resembling SRCT. This ambiguous appearance underscores the difficulties encountered during the histological diagnosis of this rare variant of CCS. Conclusion Awareness of primary CCS of the bone is clinically important for accurate diagnosis and management when the tumor is located in unusual locations such as the pubic bone and when the translocation t(12; 22)(q13; q12) is absent.
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Affiliation(s)
- Shoko Nakayama
- Department of Internal Medicine I, Osaka Medical College, 2-7 Daigakumachi, Takatsuki City, Osaka 569-0801, Japan.
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17
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D'Amico FE, Ruffolo C, Romeo S, Massani M, Dei Tos AP, Bassi N. Clear cell sarcoma of the ileum: report of a case and review of the literature. Int J Surg Pathol 2011; 20:401-6. [PMID: 22207412 DOI: 10.1177/1066896911428073] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Clear cell sarcoma of the gastrointestinal tract (CCS-GI) is an extremely rare and aggressive tumor, which often mimics other neoplastic processes. Because of this feature, its real incidence may have been underestimated, especially in the past when genetic tests were less available than nowadays. To date, less then 30 cases have been described in the literature on the GI tract. CASE PRESENTATION We report the case of a 69-year-old woman who presented with active rectal bleeding. After a negative colonoscopy, the patient underwent a video-capsule endoscopy. The latter detected an ileal mass that was surgically resected. The microscopic appearance was consistent with a malignant mesenchymal neoplasm; immunohistochemistry was positive for S100 protein, CD56, and INI1. Fluorescence in situ hybridization showed a translocation involving the EWSR1 (Ewing sarcoma 1) gene region. All these findings were consistent with a CCS-GI. CONCLUSION Herein we present a case of CCS-GI, discuss its clinical and pathological features, and review the literature on the subject.
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Affiliation(s)
- Francesco E D'Amico
- II Department of Surgery (IV unit), Regional Hospital Ca' Foncello, Treviso, Italy.
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18
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Thornton E, Krajewski KM, O'Regan KN, Giardino AA, Jagannathan JP, Ramaiya N. Imaging features of primary and secondary malignant tumours of the sacrum. Br J Radiol 2011; 85:279-86. [PMID: 22167504 DOI: 10.1259/bjr/25247602] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Malignant tumours of the sacrum may be primary or secondary. While sacral metastases are frequently encountered, a diagnostic dilemma can present when there is a single sacral bone tumour with no history or evidence of malignancy elsewhere in the body. Familiarity with the imaging features and clinical presentations of primary malignant bone tumours is helpful in narrowing the differential. This pictorial review will illustrate with both common and uncommon malignant sacral tumours CT, MRI and positron emission tomography/CT, highlighting the specific features of each.
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Affiliation(s)
- E Thornton
- Department of Imaging, Dana Farber Cancer Institute, Boston, MA 02115, USA.
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19
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Liu X, Zhang H, Dong Y. Primary clear cell sarcoma of humerus: case report. World J Surg Oncol 2011; 9:163. [PMID: 22151733 PMCID: PMC3256123 DOI: 10.1186/1477-7819-9-163] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Accepted: 12/09/2011] [Indexed: 11/25/2022] Open
Abstract
We report a case of primary clear cell sarcoma occurring in the humerus. A 20 year old girl was referred to our hospital two years ago with painless swelling of the soft tissue surrounding the proximal right humerus. The conventional radiographic image showed an ill-defined, aggressive, osteolytic lesion associated with a partial cortical defect of the proximal right humerus. Magnetic resonance imaging found an irregularly shaped extraosseous mass extending from the proximal shaft of the right humerus, penetrating through the destroyed bone and invading the biceps brachii. After preoperative chemotherapy, a total tumor resection, internal fixation and bone cement implantation were performed. Histological studies of the resected tumor found that fibrous septa divided into well-defined nests and polygonal and fusiform cells with clear cytoplasm. Immunohistochemical studies demonstrated strong positive cytoplasmic staining with S-100 and scattered positivity with HMB-45. These findings led to a final, definitive diagnosis of clear cell sarcoma of the humerus. After routine postoperative chemotherapy, a 2-year follow-up showed no metastasis. Our findings in this report point out that primary clear cell sarcoma can originate from within the humerus and that limb salvage surgery can obtain a good result.
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Affiliation(s)
- Xudong Liu
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China
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20
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Song JS, Choi J, Kim JH, Jang SJ, Cho KJ. Diagnostic utility of EWS break-apart fluorescence in situ hybridization in distinguishing between non-cutaneous melanoma and clear cell sarcoma. Pathol Int 2010; 60:608-13. [PMID: 20712646 DOI: 10.1111/j.1440-1827.2010.02570.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Clear cell sarcoma (CCS) is a rare soft tissue sarcoma with morphological similarities to malignant melanoma (MM), but with a distinct genetic background that includes the chromosomal translocation t(12;22)(q13;q12). Clear cell sarcoma is often misdiagnosed as MM because of similarities in target locations and immunophenotypes. Eighteen cases with MM in non-cutaneous sites were subjected to fluorescence in situ hybridization (FISH) to assess EWS gene breakage. Tissue microarrays were constructed using formalin-fixed, paraffin-embedded tissue and the EWSR1 (22q12) dual-color, break-apart rearrangement probe (Vysis) was used. Two patients were classified as CCS with EWS gene rearrangement, with a mean of 67.5% positive cells per sample according to break-apart FISH. The remaining 16 patients lacked break-apart signals of the EWS gene. The presence of type 1 (EWS exon 8-ATF1 exon 4) fusion transcripts was confirmed in FISH-positive patients by RT-PCR. Retrospective analysis revealed that the masses were located in the foot and buttock, respectively. Morphologically, tumor cells were not typical for those of CCS or MM. Break-apart FISH is an accurate and convenient method for differentiating between MM and CCS. Molecular detection of EWS gene rearrangement, either by break-apart FISH or RT-PCR, is mandatory in subjects with melanotic tumors of soft tissue.
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Affiliation(s)
- Joon Seon Song
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea
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21
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Abstract
Clear cell sarcoma (CCS) is a high grade soft tissue sarcoma with a distinct molecular profile. Gastrointestinal CCS is very rare and most reported cases are in adults. We describe a 10-year-old female with a 4-month history of anemia who later developed fever, weight loss and abdominal pain. She was subsequently found to have a large infiltrative gastric mass. A diagnosis of CCS was confirmed by molecular and cytogenetic studies. This case illustrates the necessity of a multimodal approach, particularly the use of molecular studies, in the diagnostic evaluation of rare tumors presenting in unusual sites.
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Affiliation(s)
- Joanne P Lagmay
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA.
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22
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Clear Cell Sarcoma of Soft Tissue Metastatic to the Ovaries: A Heretofore Unreported Occurrence. Int J Gynecol Pathol 2009; 28:234-8. [DOI: 10.1097/pgp.0b013e31818d10a8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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23
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Shao L, Singh V, Cooley L. Angiomatoid fibrous histiocytoma with t(2;22)(q33;q12.2) and EWSR1 gene rearrangement. Pediatr Dev Pathol 2009; 12:143-6. [PMID: 18666823 DOI: 10.2350/08-04-0460.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Accepted: 07/22/2008] [Indexed: 01/14/2023]
Abstract
Angiomatoid fibrous histiocytoma (AFH) is a rare soft tissue tumor of low malignant potential. The tumor is mostly seen in the deep dermis and subcutis of the lower extremities in children and young adults. Histologically, the tumor forms lobulated sheets of plump round to spindle cells surrounded by a fibrous pseudocapsule and lymphoid cuff. The cytogenetic and molecular hallmarks of AFH are not well defined. Only 4 of 30 reported cases of AFH have had karyotypic information. We present a case of AFH in the inguinal region of a 12-year-old girl. The tumor showed characteristic histological features, t(2;22)(q33;q12.2), and EWSR gene rearrangement by fluorescence in situ hybridization.
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Affiliation(s)
- Lei Shao
- Department of Pathology, Children's Mercy Hospitals and Clinics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA.
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24
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Krishnan B, Khanna G, Clohisy D. Gene translocations in musculoskeletal neoplasms. Clin Orthop Relat Res 2008; 466:2131-46. [PMID: 18566876 PMCID: PMC2493006 DOI: 10.1007/s11999-008-0342-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Accepted: 05/22/2008] [Indexed: 01/31/2023]
Abstract
UNLABELLED Establishing the best diagnosis for musculoskeletal neoplasms requires a multidisciplinary approach using clinical, radiographic, and histologic analyses. Despite this rigorous approach, establishing accurate diagnoses and prognoses remains challenging. Improved diagnostic methods are expected as unique molecular signals for specific bone and soft tissue cancers are identified. We performed a systematic review of the best available evidence to explore three major applications of molecular genetics that will best benefit clinical management of musculoskeletal neoplasms: diagnostic, prognostic, and therapeutic applications. The specific questions addressed in this systematic review are: (1) What sets of histopathologic sarcoma subtypes will benefit from molecular evaluation and diagnosis? (2) What molecular methods are best applied to histopathologic sarcomas to distinguish between major subtypes? (3) How do the molecular patterns discovered on genetic diagnosis affect prognosis of certain sarcomas? (4) Which sarcoma translocations can benefit from an improved response and outcome using existing and forthcoming pharmacogenetic approaches targeting molecular events? This review summarizes recent advances in molecular genetics that are available and will soon be available to clinicians to better predict outcomes and subsequently help make future treatment decisions. LEVEL OF EVIDENCE Level IV, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Balaji Krishnan
- Department of Orthopaedic Surgery, University of Minnesota—Twin Cities, 420 Delaware Street SE, MMC 492, Minneapolis, MN 55455 USA
| | - Gaurav Khanna
- Department of Orthopaedic Surgery, University of Minnesota—Twin Cities, 420 Delaware Street SE, MMC 492, Minneapolis, MN 55455 USA
| | - Denis Clohisy
- Department of Orthopaedic Surgery, University of Minnesota—Twin Cities, 420 Delaware Street SE, MMC 492, Minneapolis, MN 55455 USA
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25
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Gastrointestinal melanoma or clear cell sarcoma? Molecular evaluation of 7 cases previously diagnosed as malignant melanoma. Am J Surg Pathol 2008; 32:858-66. [PMID: 18408594 DOI: 10.1097/pas.0b013e31815b8288] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Clear cell sarcoma (CCS) is a rare tumor classically associated with the tendons and aponeuroses of distal extremities of young adults. CCS and malignant melanoma (MM) share immunohistochemical profiles and ultrastructural features, but classic CCS has characteristic morphology with low mitotic activity and minimal pleomorphism. Occasional cases show pleomorphism, high mitotic index, and/or melanin pigmentation, making CCS indistinguishable from MM based on morphology. However, CCS is genetically distinct owing to its consistent association with a t(12;22)(q13;q12) chromosomal translocation, leading to the formation of the EWS/ATF1 fusion transcript. This translocation has never been documented in cutaneous melanoma, and thus is regarded as specific for CCS. Recent evidence suggests that primary "malignant melanomas" in unusual anatomic sites, most notably the gastrointestinal (GI) tract, may be CCS. This is supported by 11 cases of primary GI CCS with the t(12;22) translocation. We used reverse-transcription polymerase chain reaction and fluorescence in situ hybridization to examine whether a proportion of cases diagnosed as MM of the GI tract in patients without a history of cutaneous MM actually represent primary GI CCS. In total, we examined 7 cases: Four with no prior history of MM, 2 with histories of cutaneous MM, and 1 with an anal MM. All 4 cases for which there was no history of cutaneous/mucosal MM harbored the EWS/ATF1 fusion transcript. We report the largest series of GI CCS and have shown that molecular studies may be warranted in cases that otherwise seem to represent MM of unusual primary locations.
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26
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Curry CV, Dishop MK, Hicks MJ, Naeem R, Reed JA, López-Terrada DH. Clear cell sarcoma of soft tissue: diagnostic utility of fluorescence in situ hybridization and reverse transcriptase polymerase chain reaction. J Cutan Pathol 2008; 35:411-7. [DOI: 10.1111/j.1600-0560.2007.00821.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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27
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Abstract
Methodologies employed in the rapidly developing field of soft tissue sarcoma molecular testing focus primarily on diagnosis using chromosomal translocations and the resulting fusion transcripts. Molecular prognostic testing holds promise in this complex group of rare mesenchymal malignancies, but results are preliminary and require further confirmation. Analysis of activating KIT mutations in gastrointestinal stromal tumors is currently being used in management of patient therapy.
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Affiliation(s)
- Alexander J F Lazar
- Department of Pathology and Sarcoma Research Center, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030-4009, USA.
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28
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Rivera JC, Lesimple T, Garin E, Laurent JF, Watier E, Hu W. Malignant melanoma of soft parts. A "non plastic surgeon's land"? ANN CHIR PLAST ESTH 2007; 53:361-4. [PMID: 17602816 DOI: 10.1016/j.anplas.2007.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Accepted: 04/22/2007] [Indexed: 10/23/2022]
Abstract
Malignant melanoma of soft parts (MMSP) (or "clear cell sarcoma") is a very rare tumour that shows up without primitive skin involvement (except in subcutaneous prolongations of deep tumours), mostly predominant in the extremities of young adults. Eight files of MMSP were studied retrospectively. The mean patient is a male of 35 years old affected in an extremity (four upper, three lower and one gluteal), according to classical descriptions. The importance of radical surgery in these cases has been extensively established. Confronted with these cases, the plastic surgeon must be aware of the specifics of this rare entity to ensure its proper inclusion in his clinical suspicion. Just in case.
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Affiliation(s)
- J C Rivera
- Service de chirurgie plastique, CHU de Rennes, France; Service de chirurgie plastique, CHU de Brest, 1, boulevard Tanguy-Prigent, 29200 Brest, France.
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29
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Zamiati S, Miyara K, Karkouri M. [Unusual soft tissue tumor]. Ann Pathol 2007; 26:459-61. [PMID: 17255909 DOI: 10.1016/s0242-6498(06)70758-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Soumaya Zamiati
- Laboratoire d'Anatomie Pathologique, CHU Ibn Rochd, Quartier des hôpitaux, Casablanca, Maroc.
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30
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Dim DC, Cooley LD, Miranda RN. Clear Cell Sarcoma of Tendons and Aponeuroses: A Review. Arch Pathol Lab Med 2007; 131:152-6. [PMID: 17227118 DOI: 10.5858/2007-131-152-ccsota] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2006] [Indexed: 12/18/2022]
Abstract
Abstract
Clear cell sarcoma of tendons and aponeuroses, also referred to as malignant melanoma of soft parts, is a rare malignancy derived from neural crest cells. It usually presents in the distal lower extremities of young adults, frequently attached to tendons or aponeuroses. It behaves like a high-grade soft tissue sarcoma and is associated with poor overall survival. Magnetic resonance imaging studies of the lesion reveal T1 hypointensity, T2 hyperintensity, and gadolinium uptake. Grossly, the tumor is usually circumscribed with a histologic pattern of uniform polygonal to fusiform cells with clear to pale eosinophilic cytoplasm divided into variably sized clusters by fibrous septa. Immunohistochemical studies in most cases show that the neoplastic cells are positive with HMB-45 and react with antibody against S100 protein. Most cases show a reciprocal cytogenetic translocation t(12;22)(q13;q12) that creates a unique chimeric fusion EWSR1/ATF1 gene transcript. Metastasis occurs mainly to regional lymph nodes and lungs. Poor prognostic indicators include a tumor size equal to or more than 5 cm, presence of metastasis, and necrosis. The mainstay of treatment is wide excision of the tumor. The use of sentinel lymph node biopsy may become an important procedure in detecting occult regional metastasis and guiding the extent of surgery. The beneficial effects of adjuvant chemotherapy and radiotherapy have not been fully evaluated. This article provides a short overview of the current knowledge of clear cell sarcoma of tendons and aponeuroses.
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MESH Headings
- Activating Transcription Factor 1
- Antigens, Neoplasm
- Calmodulin-Binding Proteins/genetics
- DNA-Binding Proteins/genetics
- Diagnosis, Differential
- Humans
- Melanoma-Specific Antigens
- Neoplasm Proteins/metabolism
- Neoplasms, Connective Tissue/diagnosis
- Neoplasms, Connective Tissue/genetics
- Neoplasms, Connective Tissue/metabolism
- Neoplasms, Connective Tissue/pathology
- Neoplasms, Connective Tissue/therapy
- Nuclear Proteins/genetics
- Prognosis
- RNA-Binding Protein EWS
- RNA-Binding Proteins/genetics
- Regulatory Factor X Transcription Factors
- S100 Proteins/metabolism
- Sarcoma, Clear Cell/diagnosis
- Sarcoma, Clear Cell/genetics
- Sarcoma, Clear Cell/metabolism
- Sarcoma, Clear Cell/pathology
- Sarcoma, Clear Cell/therapy
- Tendons/pathology
- Transcription Factors
- Translocation, Genetic
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Affiliation(s)
- Daniel C Dim
- Department of Pathology, University of Missouri at Kansas City School of Medicine/Truman Medical Center, 2301 Holmes St, Kansas City, MO 64108-2677, USA
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31
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Waugh MS, Dash RC, Turner KC, Dodd LG. Desmoplastic small round cell tumor: Using FISH as an ancillary technique to support cytologic diagnosis in an unusual case. Diagn Cytopathol 2007; 35:516-20. [PMID: 17636487 DOI: 10.1002/dc.20669] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Desmoplastic small round cell tumor is a rare and aggressive neoplasm that predominantly affects young males. In almost all cases, a reciprocal translocation is present resulting in the fusion of the Ewing sarcoma gene with the Wilms' tumor gene. Here we describe an unusual case occurring in a 59-year-old male, in which fluorescence in situ hybridization (FISH) was used in conjunction with immunohistochemical studies to confirm the diagnosis. To our knowledge, this is the first reported case of using FISH as an ancillary technique to confirm the cytologic diagnosis of this tumor.
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Affiliation(s)
- Michael S Waugh
- Division of Cytopathology, Department of Pathology, Duke University Health System, Durham, North Carolina 27710, USA.
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32
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Kazakos CJ, Galanis VG, Giatromanolaki A, Verettas DAJ, Sivridis E. Clear cell sarcoma of the scapula. A case report and review of the literature. World J Surg Oncol 2006; 4:48. [PMID: 16893467 PMCID: PMC1555585 DOI: 10.1186/1477-7819-4-48] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2006] [Accepted: 08/07/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clear cell sarcoma of tendons and aponeuroses (CCSTA) appears usually in the extremities and rarely in the trunk. CASE PRESENTATION We present an unusual case of CCSTA overlying the scapular region and with secondary osseous extension in the lower scapula. The patient underwent a wide local excision with removal of the tumor and the lower two thirds of the scapula. He had no local recurrences but he developed lung metastases after 5 months in spite of postoperative chemotherapy. He finally died ten months later. CONCLUSION The patients with CCSTA have a variable unpredictable course. Despite treatment the overall prognosis is poor.
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Affiliation(s)
- Constantinos J Kazakos
- Department of Orthopedics, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Vasilios G Galanis
- Department of Orthopedics, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Alexandra Giatromanolaki
- Department of Pathology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dennis-Alexander J Verettas
- Department of Orthopedics, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Efthimios Sivridis
- Department of Pathology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
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33
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Granville L, Hicks J, Popek E, Dishop M, Tatevian N, Lopez-Terrada D. Visceral clear cell sarcoma of soft tissue with confirmation by EWS-ATF1 fusion detection. Ultrastruct Pathol 2006; 30:111-8. [PMID: 16517477 DOI: 10.1080/01913120500406400] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Clear cell sarcoma of soft tissue (CCS-ST) is a rare malignant neoplasm characterized by a tumor-defining translocation [t(12;22) (q13;q12)], resulting in the EWS-ATF1 gene fusion. An extremely limited number of visceral CCS-ST cases have been reported in the literature. Here the authors report a visceral CCS-ST in a Hispanic adolescent male with a large infiltrative mass involving the small bowel. The tumor was evaluated by light microscopy, immunocytochemistry, electron microscopy, cytogenetics, and molecular genetics. The tumor cells were strongly positive for S-100 protein, but negative for HMB-45. Rare premelanosomes were identified only after an extensive search with electron microscopy. Cytogenetics showed a characteristic t(12;22)(q13;q12) for CCS-ST with isochromosome 18q and trisomy 22. An EWS exon 8 sense primer and an antisense ATF1 primer were employed for detection of the CCS-ST tumor-defining EWS-ATF1 translocation, using reverse transcriptase-polymerase chain reaction techniques (RT-PCR), and the fusion gene breakpoint underwent DNA sequencing. This tumor is exceptional, because it is the first visceral CCS-ST that has been confirmed by RT-PCR and DNA sequencing. This case also illustrates the necessity of a multimodal approach to tumor diagnosis, and the utility of cytogenetics and molecular pathology in confirming the diagnosis of CCS-ST and eliminating conventional metastatic or primary visceral malignant melanoma as a consideration.
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MESH Headings
- Adolescent
- Anemia, Iron-Deficiency/diagnosis
- Biomarkers, Tumor/metabolism
- Cytogenetic Analysis
- DNA, Neoplasm/analysis
- Diagnosis, Differential
- Fatal Outcome
- Humans
- Intestinal Neoplasms/genetics
- Intestinal Neoplasms/metabolism
- Intestinal Neoplasms/pathology
- Male
- Melanoma/diagnosis
- Melanoma/secondary
- Oncogene Proteins, Fusion/genetics
- Oncogene Proteins, Fusion/metabolism
- Reverse Transcriptase Polymerase Chain Reaction
- Sarcoma, Clear Cell/genetics
- Sarcoma, Clear Cell/metabolism
- Sarcoma, Clear Cell/pathology
- Sequence Analysis, DNA
- Soft Tissue Neoplasms/genetics
- Soft Tissue Neoplasms/metabolism
- Soft Tissue Neoplasms/pathology
- Transcription Factors/genetics
- Transcription Factors/metabolism
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Affiliation(s)
- Laura Granville
- Department of Pathology, Texas Children's Hospital, Baylor, College of Medicine, Houston, Texas 77030-2313, USA
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34
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Somers GR, Viero S, Nathan PC, Teshima I, Pereira C, Zielenska M. Association of the t(12;22)(q13;q12) EWS/ATF1 rearrangement with polyphenotypic round cell sarcoma of bone: a case report. Am J Surg Pathol 2006; 29:1673-9. [PMID: 16327442 DOI: 10.1097/01.pas.0000176434.19197.c1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The t(12;22)(q13;q12) chromosomal rearrangement results in an EWS/ATF1 fusion transcript and is associated with clear cell sarcoma (CCS). CCS is an uncommon tumor arising in tendons and aponeuroses of the extremities and shows evidence of melanocytic differentiation at the light microscopic, immunohistochemical, and/or ultrastructural level. Only 5 cases have been reported to arise in bone, none of which had molecular confirmation of the diagnosis. The current report describes a 7-year-old girl with a primary round cell sarcoma of the left humerus showing polyphenotypic differentiation on immunohistochemical analysis. Antibodies directed at melanocytic antigens were negative, and there was no evidence of melanocytic differentiation by light microscopy or ultrastructural analysis. Cytogenetic analysis revealed rearrangement of the EWS locus within 22q12. RT-PCR and sequence analysis revealed the presence of a fusion transcript bringing together exon 7 of EWS with exon 5 of ATF1, consistent with a type 2 transcript reported in association with CCS. However, given the lack of morphologic features usually present in CCS, a diagnosis of polyphenotypic round cell sarcoma was made. This tumor thus expands the spectrum of neoplasms associated with the t(12;22)(q13;q12) rearrangement.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Base Sequence
- Biopsy
- Child
- Chromosomes, Human, Pair 12
- Chromosomes, Human, Pair 22
- Cytogenetic Analysis
- DNA, Neoplasm/analysis
- Disease-Free Survival
- Exons
- Female
- Follow-Up Studies
- Humans
- Humerus/diagnostic imaging
- Humerus/pathology
- Humerus/surgery
- Immunohistochemistry
- Lymph Node Excision
- Magnetic Resonance Imaging
- Molecular Sequence Data
- Neoplasm Staging
- Oncogene Proteins, Fusion/chemistry
- Oncogene Proteins, Fusion/genetics
- Radiography
- Radionuclide Imaging
- Reverse Transcriptase Polymerase Chain Reaction
- Sarcoma, Clear Cell/diagnosis
- Sarcoma, Clear Cell/diagnostic imaging
- Sarcoma, Clear Cell/drug therapy
- Sarcoma, Clear Cell/genetics
- Sarcoma, Clear Cell/pathology
- Sarcoma, Clear Cell/surgery
- Sarcoma, Clear Cell/ultrastructure
- Sequence Analysis, DNA
- Time Factors
- Translocation, Genetic
- Treatment Outcome
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Affiliation(s)
- Gino R Somers
- Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.
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35
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Patel RM, Downs-Kelly E, Weiss SW, Folpe AL, Tubbs RR, Tuthill RJ, Goldblum JR, Skacel M. Dual-color, break-apart fluorescence in situ hybridization for EWS gene rearrangement distinguishes clear cell sarcoma of soft tissue from malignant melanoma. Mod Pathol 2005; 18:1585-90. [PMID: 16258500 DOI: 10.1038/modpathol.3800503] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Clear cell sarcoma of soft tissue (malignant melanoma of soft parts) is a soft tissue sarcoma with melanocytic differentiation that typically occurs in the tendons and aponeuroses of young adults. As demonstrated by cytogenetics and reverse-transcriptase polymerase chain reaction, between 70% and over 90% of clear cell sarcomas have a t(12;22) translocation, fusing the EWS and ATF1 genes on chromosomes 22q12 and 12q13, respectively. Identification of this translocation distinguishes clear cell sarcoma from histologic mimics, most importantly conventional malignant melanoma. We report our experience with a commercially available, dual-color, break-apart fluorescence in situ hybridization (FISH) probe, which allows detection of EWS (22q12) gene rearrangement in formalin-fixed, paraffin-embedded tissues. Histologically and immunophenotypically well-characterized cases of clear cell sarcoma (n = 10) and malignant melanoma (n = 32) were evaluated with a 22q12 dual-color, break-apart probe (Vysis, Downer's Grove, IL, USA), which spans the known common breakpoints in the EWS gene on chromosome 22 (introns 7-10). Signals from tumor cell nuclei were counted under a fluorescence microscope and the presence of red-green break-apart signals was recorded. Of the clear cell sarcoma cases, seven of 10 showed evidence of an EWS gene rearrangement with a mean of 81.6% positive cells per sample (range: 60-95%). All cases of malignant melanoma (n = 32) showed virtually absent break-apart signals in the EWS gene (less than 4% cells per case). FISH detects EWS gene rearrangement in a substantial proportion of clear cell sarcomas, with excellent specificity. Importantly, EWS FISH is negative in malignant melanoma, a clinically dissimilar tumor, which may closely mimic clear cell sarcoma histologically and immunohistochemically. As the studied probe can be utilized in routinely processed tissue, FISH provides an excellent alternative to reverse-transcriptase polymerase chain reaction in cases where fresh tissue is unavailable.
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Affiliation(s)
- Rajiv M Patel
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA 30355, USA.
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36
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Wong CW, Fan YS, Chan TL, Chan ASW, Ho LC, Ma TKF, Yuen ST, Leung SY. BRAF and NRAS mutations are uncommon in melanomas arising in diverse internal organs. J Clin Pathol 2005; 58:640-4. [PMID: 15917418 PMCID: PMC1770697 DOI: 10.1136/jcp.2004.022509] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2004] [Indexed: 01/22/2023]
Abstract
BACKGROUND Malignant melanoma arising from different body compartments may be associated with differing aetiological factors and clinical behaviour, and may manifest diverse molecular genetic profiles. Although many studies have focused on cutaneous melanoma, little is known of mucosal and other types of melanoma. In particular, malignant melanoma of soft parts is different from other melanomas in many respects, yet manifests a common melanocytic differentiation. Mutation of BRAF is now known to be common in cutaneous melanomas, and raises possible new therapeutic options of anti-RAF treatment for these patients. Few data are available for non-cutaneous melanomas. AIMS To study the incidence of BRAF and NRAS mutations in melanomas arising in diverse internal organs. METHODS Fifty one melanomas from various internal organs were investigated for BRAF and NRAS mutation by direct DNA sequencing. RESULTS BRAF and NRAS mutations were found in two and five mucosal melanomas arising from the aerodigestive and female genital tracts (n = 36). Their occurrence is mutually exclusive, giving a combined mutation incidence rate of 19.4% in mucosal melanomas. Both BRAF and NRAS mutations were absent in malignant melanoma of soft parts (n = 7). BRAF mutation was also absent in uveal melanoma (n = 6), but was seen in two of five cutaneous melanomas. The incidence of BRAF or combined BRAF/NRAS mutations in all non-cutaneous groups was significantly lower than published rates for cutaneous melanomas. CONCLUSION Each melanoma subtype may have a unique oncogenetic pathway of tumour development, and only a small fraction of non-cutaneous melanomas may benefit from anti-RAF treatment.
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Affiliation(s)
- C W Wong
- Department of Pathology, University of Hong Kong, Queen Mary Hospital, Hong Kong
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Hersekli MA, Ozkoc G, Bircan S, Akpinar S, Ozalay M, Tuncer I, Tandogan RN. Primary clear cell sarcoma of rib. Skeletal Radiol 2005; 34:167-70. [PMID: 15592669 DOI: 10.1007/s00256-004-0801-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2004] [Revised: 04/13/2004] [Accepted: 04/13/2004] [Indexed: 02/02/2023]
Abstract
Clear cell sarcoma (malignant melanoma of soft tissues) is a very rare soft tissue neoplasm. It generally arises in tendons and aponeuroses. Although metastasis of malignant melanoma to bone is not uncommon, primary clear cell sarcoma of bone is an extremely rare neoplasm. To our knowledge five cases have been reported in the English literature. We present a case of primary clear cell sarcoma of bone in a 28-year-old woman arising in the left ninth rib. We treated the patient with total excision of the mass and postoperative radiotherapy. The patient is alive and well without local recurrence or distant metastasis at 33 months after surgery.
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Affiliation(s)
- Murat Ali Hersekli
- Department of Orthopedics and Traumatology, Baskent University Medical Faculty, Adana, Turkey.
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Panagopoulos I, Mertens F, Isaksson M, Mandahl N. Absence of mutations of the BRAF gene in malignant melanoma of soft parts (clear cell sarcoma of tendons and aponeuroses). ACTA ACUST UNITED AC 2005; 156:74-6. [PMID: 15588860 DOI: 10.1016/j.cancergencyto.2004.04.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2004] [Revised: 04/14/2004] [Accepted: 04/14/2004] [Indexed: 12/13/2022]
Abstract
Malignant melanoma of soft parts (MMSP), also called clear cell sarcoma of tendons and aponeuroses, is cytogenetically characterized by the t(12;22)(q13;q12) resulting in the chimeric EWSR1/ATF1 gene. MMSP shares a number of morphologic, histologic, and immunohistochemical features with malignant melanoma of the skin, causing diagnostic difficulties in the distinction between MMSP and metastatic malignant melanoma with an unknown primary site. Recently, a high incidence of activating mutations in the kinase domain of the BRAF gene has been reported in malignant melanoma of the skin. The most common mutation (V599E) is the T1796A substitution in exon 15, leading to an exchange of valine for glutamic acid at position 599. Because of the extensive clinical, histologic, and immunohistochemic similarities with melanoma, we decided to analyze whether MMSP also has mutations in the BRAF gene. Eight MMSP with an EWSR1/ATF1 chimeric transcript, one soft tissue metastasis of a malignant melanoma of the skin, and one malignant melanoma cell line were examined. Both conventional melanomas had the exon 15 T1796A (V599E) mutation, but none of the MMSP was found to harbor any mutation in exon 11 or 15 of the BRAF gene. Our data further emphasize that MMSP and conventional malignant melanoma develop through different genetic pathways.
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Affiliation(s)
- Ioannis Panagopoulos
- Department of Clinical Genetics, Lund University Hospital, S-221 85 Lund, Sweden.
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Kato N, Mizuno O, Tamura A, Yamanaka Y, Tanimura S, Minakawa H. Clear cell sarcoma associated with multiple pulmonary metastases with structural and numerical karyotypic changes. Clin Exp Dermatol 2004; 29:614-6. [PMID: 15550135 DOI: 10.1111/j.1365-2230.2004.01615.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cytogenetic analysis was performed on a specimen from a pulmonary metastasis of clear cell sarcoma originated on the right ankle of a 53-year-old Japanese woman. It revealed near-triploid with several numerical changes including abnormalities in the copy number of chromosomes 7, 8, and 22, and structural abnormalities of chromosome 22 and others. This is a minor case which showed the multiple abnormalities of chromosomes in the absence of a t (12;22) translocation.
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Affiliation(s)
- N Kato
- Department of Dermatology and Clinical Research Institute, Hokkaido Cancer Center, Sapporo, Japan.
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Henkle CT, Hawkins AL, McCarthy EF, Griffin CA. Clear cell sarcoma case report: complex karyotype including t(12;22) in primary and metastatic tumor. ACTA ACUST UNITED AC 2004; 149:63-7. [PMID: 15104285 DOI: 10.1016/s0165-4608(03)00295-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2003] [Revised: 07/03/2003] [Accepted: 07/16/2003] [Indexed: 10/26/2022]
Abstract
Clear cell sarcoma (CCS) is a rare and aggressive tumor, arising mainly in the soft tissue of the extremities in young adults. A distinctive chromosomal translocation, t(12;22)(q13;q12), has been found in most reported cases. We performed cytogenetic analyses on a primary and subsequent metastatic CCS that contained the t(12;22), along with other complex karyotypic changes. G-banding chromosome analysis was supplemented by spectral karyotyping (SKY), a 24-color chromosome-paint FISH technique, thus allowing identification of three marker chromosomes, unbalanced translocations, and other complex abnormalities. Four of these involved additional copies and structural abnormalities of chromosome 8. Clarifying such secondary karyotypic changes in CCS may prove valuable to the understanding of tumor cell biology and clinical behavior.
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MESH Headings
- Chromosome Aberrations
- Chromosomes, Human, Pair 12/genetics
- Chromosomes, Human, Pair 22/genetics
- Chromosomes, Human, Pair 8/genetics
- Humans
- In Situ Hybridization, Fluorescence
- Karyotyping
- Lung Neoplasms/genetics
- Lung Neoplasms/secondary
- Lymphatic Metastasis
- Male
- Middle Aged
- Sarcoma, Clear Cell/genetics
- Sarcoma, Clear Cell/secondary
- Soft Tissue Neoplasms/genetics
- Soft Tissue Neoplasms/pathology
- Translocation, Genetic/genetics
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Affiliation(s)
- Carol T Henkle
- Department of Pathology, The Johns Hopkins University School of Medicine, Carnegie 367, 600 North Wolfe Street, Baltimore, MD 21287, USA
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Choi JH, Gu MJ, Kim MJ, Bae YK, Choi WH, Shin DS, Cho KH. Primary clear cell sarcoma of bone. Skeletal Radiol 2003; 32:598-602. [PMID: 14513295 DOI: 10.1007/s00256-003-0683-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2003] [Revised: 07/14/2003] [Accepted: 07/17/2003] [Indexed: 02/02/2023]
Abstract
Clear cell sarcoma is a rare soft tissue sarcoma of young adults with melanocytic differentiation. It occurs predominantly in the soft tissue of extremities, typically involving tendons and aponeuroses. Primary clear cell sarcoma of bone is extremely rare. We report a case of primary clear cell sarcoma of the right first metatarsal in a 48-year-old woman and provide a literature review of the entity.
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Affiliation(s)
- J H Choi
- Department of Pathology, College of Medicine, Yeungnam University 317-1, Daemyung-Dong, Nam-Gu, 705-717 Daegu City, South Korea.
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Teixeira MR, Ribeiro FR, Cerveira N, Torres L, Amaro T, Henrique R, Lopes C. Karyotypic divergence and convergence in two synchronous lung metastases of a clear cell sarcoma of tendons and aponeuroses with t(12;22)(q13;q12) and type 1 EWS/ATF1. CANCER GENETICS AND CYTOGENETICS 2003; 145:121-5. [PMID: 12935923 DOI: 10.1016/s0165-4608(03)00063-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Clear cell sarcoma of tendons and aponeuroses (CCS) is an uncommon malignancy characterized by a t(12;22)(q13;q12) causing a fusion of the EWS and ATF1 genes. We describe the cytogenetic and molecular genetic analyses of two lung metastases from a CCS patient. Both lesions presented the defining t(12;22) and a type 1 EWS/ATF1 chimeric transcript. The additional cytogenetic changes present in the two lesions allowed us to obtain some insight into the pathogenetic basis of disease progression. Four related clones were identified in the right lung metastasis, permitting a partial reconstitution of the stepwise clonal evolution, whereas the left lung metastasis presented yet another subclone. The comparison of the two karyotypes enabled us to pinpoint which changes occurred in the primary tumor and which emerged independently after the two metastases had been established. We conclude that both clonal divergence and convergence may be operative during tumor progression of CCS.
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Affiliation(s)
- Manuel R Teixeira
- Department of Genetics, Portuguese Oncology Institute, Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal.
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Sandberg AA. Cytogenetics and molecular genetics of bone and soft-tissue tumors. AMERICAN JOURNAL OF MEDICAL GENETICS 2002; 115:189-93. [PMID: 12407700 DOI: 10.1002/ajmg.10691] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The cytogenetic and molecular findings in bone and soft-tissue sarcomas are summarized. A table presenting all such tumors, with their specific translocations and the genes involved, is included, along with a list of those tumors that most likely result from a stepwise process of numerous genetic changes.
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Affiliation(s)
- Avery A Sandberg
- Department of DNA Diagnostics, St. Joseph's Hospital and Medical Center, 350 West Thomas Road, Phoenix, AZ 85013, USA.
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Panagopoulos I, Mertens F, Dêbiec-Rychter M, Isaksson M, Limon J, Kardas I, Domanski HA, Sciot R, Perek D, Crnalic S, Larsson O, Mandahl N. Molecular genetic characterization of the EWS/ATF1 fusion gene in clear cell sarcoma of tendons and aponeuroses. Int J Cancer 2002; 99:560-7. [PMID: 11992546 DOI: 10.1002/ijc.10404] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Clear cell sarcoma (CCS) is a rare malignant soft tissue tumor particularly associated with tendons and aponeuroses. The cytogenetic hallmark is the translocation t(12;22)(q13;q12) resulting in a chimeric EWS/ATF1 gene in which the 3'-terminal part of EWS at 22q is replaced by the 3'-terminal part of ATF1 at 12q. To date, only 13 cases of CCS have been analyzed for fusion genes at the transcription level, and there is no information about the breakpoints at the genomic level. In the present study, we describe the molecular genetic characteristics of CCS from 10 patients. Karyotypes were obtained from 10 cases, 7 of which showed the characteristic t(12;22). As an initial step in the characterization of the EWS/ATF1 and ATF1/EWS chimeras, we constructed an exon/intron map of the ATF1 gene. The entire ATF1 gene spanned >40 kb and was composed of 7 exons. Intron 3, in which most of the genomic breakpoints occurred, was to a large extent (83%) composed of repetitive elements. RT-PCR amplified EWS/ATF1 cDNA fragments in all patients and ATF1/EWS cDNA fragments in 6 of 10 patients. Four types of EWS/ATF1 chimeric transcript, designated types 1-4, were identified. The most frequent chimeric transcript (type 1) was an in-frame fusion of exon 8 of EWS with exon 4 of ATF1. This was the only chimeric transcript in 5 patients but found together with other variants in 3 tumors. The type 2 transcript of EWS/ATF1, an in-frame fusion of exon 7 of EWS with exon 5 of ATF1, was detected in 4 patients, as the only transcript in 1 case and together with other variants in 3 cases. An in-frame fusion of exon 10 of EWS with exon 5 of ATF1 (type 3) was found in 1 patient as the only transcript, and an out-of-frame fusion of EWS exon 7 with ATF1 exon 7 (type 4) was detected in 1 patient together with type 1 and type 2 transcripts. Sequencing of the amplified ATF1/EWS cDNA fragments showed in 5 patients that ATF1 exon 3 was fused with EWS exon 10, resulting in an out-of-frame chimeric transcript. In 1 case, nt 428 of ATF1 (exon 4) was fused with EWS exon 8; at the junction, there was an insertion of 4 nucleotides, also resulting in an out-of-frame transcript. Genomic extra long PCR and sequence analysis mapped the genomic breakpoints to introns 7, 8 and 9 of EWS and intron 3 and exon 4 of ATF1. While a simple end-to-end fusion was observed in 2 cases, additional nucleotides were found at the junctions in 2 other cases. In addition, topoisomerase I consensus sequences were found close to the junctions, suggesting that this enzyme may participate in the genesis of the EWS/ATF1 fusion.
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MESH Headings
- Adolescent
- Adult
- Base Sequence
- Child
- Chromosomes, Human, Pair 12
- Chromosomes, Human, Pair 22
- Cloning, Molecular
- DNA Mutational Analysis
- Female
- Humans
- Introns
- Male
- Middle Aged
- Molecular Sequence Data
- Oncogene Proteins, Fusion/biosynthesis
- Oncogene Proteins, Fusion/genetics
- Reverse Transcriptase Polymerase Chain Reaction
- Sarcoma, Clear Cell/genetics
- Sarcoma, Clear Cell/metabolism
- Soft Tissue Neoplasms/genetics
- Soft Tissue Neoplasms/metabolism
- Tendons/pathology
- Transcription Factors
- Translocation, Genetic
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Affiliation(s)
- Ioannis Panagopoulos
- Department of Clinical Genetics, Lund University Hospital, SE-221 85 Lund, Sweden.
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Sandberg AA, Bridge JA. Updates on the cytogenetics and molecular genetics of bone and soft tissue tumors. Mesothelioma. CANCER GENETICS AND CYTOGENETICS 2001; 127:93-110. [PMID: 11425448 DOI: 10.1007/3-540-30792-3_7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Affiliation(s)
- A A Sandberg
- Department of DNA Diagnostics, St. Joseph's Hospital and Medical Center, 350 West Thomas Road, Phoenix, AZ 85013, USA.
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