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Dunaj P, Żukowska E, Czarnecka AM, Krotewicz M, Borkowska A, Chmiel P, Świtaj T, Rutkowski P. Lymphadenectomy in the treatment of sarcomas - indications and technique. Oncol Rev 2024; 18:1413734. [PMID: 39737200 PMCID: PMC11683405 DOI: 10.3389/or.2024.1413734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 11/22/2024] [Indexed: 01/01/2025] Open
Abstract
Sarcomas are a rare type of malignancy with limited treatment options so far. This analysis aimed to describe the impact of lymphadenectomy on treating sarcoma patients. Sarcomas characterized by lymphatic spread are rare. For this reason, lymphadenectomy is not a procedure that is performed frequently. However, there are histological subtypes that spread more frequently through lymphatic vessels, such as rhabdomyosarcoma (RMS), epithelioid sarcoma (ES), clear cell sarcoma (CCS), and angiosarcoma. On the other hand, synovial sarcoma (SS) is not characterized by an increased tendency to lymphogenous metastases. In our study, we focus on these subtypes of sarcomas. The relationship between lymphadenectomy results and the subsequent prognosis of the patients was investigated. Metastases in the lymph nodes are diagnosed synchronously with distant metastases or when the primary tumor is detected. At the same time, despite lymphadenectomy, sarcoma patients developed further distant metastases. Currently, lymphadenectomy is not a routinely recommended method of treatment for patients with sarcomas. Most often, its potential use is indicated in the case of epithelioid sarcoma, clear cell sarcoma, and rhabdomyosarcoma after a previous positive sentinel lymph node biopsy (SLNB) result. Multicenter randomized prospective clinical trials on the role of lymphadenectomy in the treatment of sarcomas are needed.
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Affiliation(s)
- Piotr Dunaj
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
- Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Ewa Żukowska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
- Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Anna M. Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Maria Krotewicz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Aneta Borkowska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Paulina Chmiel
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
- Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Świtaj
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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Chmiel P, Krotewicz M, Szumera-Ciećkiewicz A, Bartnik E, Czarnecka AM, Rutkowski P. Review on Lymph Node Metastases, Sentinel Lymph Node Biopsy, and Lymphadenectomy in Sarcoma. Curr Oncol 2024; 31:307-323. [PMID: 38248105 PMCID: PMC10814427 DOI: 10.3390/curroncol31010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/17/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Soft tissue sarcomas (STS) originating from connective tissue rarely affect the lymph nodes. However, involvement of lymph nodes in STS is an important aspect of prognosis and treatment. Currently, there is no consensus on the diagnosis and management of lymph node metastases in STS. The key risk factor for nodal involvement is the histological subtype of sarcoma. Radiological and pathological evaluation seems to be the most effective method of assessing lymph nodes in these neoplasms. Thus, sentinel lymph node biopsy (SLNB), which has been shown to be valuable in the management of melanoma or breast cancer, may also be a beneficial diagnostic option in some high-risk STS subtypes. This review summarizes data on the risk factors and clinical characteristics of lymph node involvement in STS. Possible management and therapeutic options are also discussed.
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Affiliation(s)
- Paulina Chmiel
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.C.); (M.K.); (P.R.)
| | - Maria Krotewicz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.C.); (M.K.); (P.R.)
| | - Anna Szumera-Ciećkiewicz
- Department of Pathology, Maria Sklodowska Curie National Research Institute of Oncology, 02-781 Warsaw, Poland;
| | - Ewa Bartnik
- Institute of Genetics and Biotechnology, Faculty of Biology, University of Warsaw, 02-106 Warsaw, Poland;
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, 02-106 Warsaw, Poland
| | - Anna M. Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.C.); (M.K.); (P.R.)
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.C.); (M.K.); (P.R.)
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Scaglioni MF, Meroni M, Fuchs B. Combination of four pedicled flaps for multilayer reconstruction of massive pelvic defect: A case report. Microsurgery 2023; 43:842-846. [PMID: 37088915 DOI: 10.1002/micr.31051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/01/2023] [Accepted: 04/14/2023] [Indexed: 04/25/2023]
Abstract
Tumors affecting the perineal region are a subtle and difficult to diagnose type of malignancy. In particular, soft tissue sarcomas (STS) may be already very large at time of diagnosis, thus impairing a normal life. In such severe cases, debulking surgery is the only possibility to offer the patient an acceptable quality of life again. These procedures inevitably result in massive defects. Depending on the affected area, there are different reconstructive options available so far, and sometimes a combination of multiple flaps is required. With the present report, we would like to share our experience with a complex genital and perineal defect. A 75-year-old patient presenting a massive epithelioid sarcoma in the ischio-rectal and anal fossae underwent a surgical excision with safe margins, which included the resection of the external genitalia, the pubis, and the rectum. The end result of this procedure was a massive defect measuring 31 cm (length) × 8 cm (width) × 6 cm (depth). To accomplish the requirements of this particular case we planned to utilize mostly the nearby tissues. The reconstruction was performed layer by layer. We resorted to a pedicled chimeric anterolateral thigh (ALT) flap measuring 8 cm × 6 cm, with a large amount of the vastus lateralis (20 cm × 8 cm) to fill the deeper defect, and a duplicated fascia lata (20 cm × 6 cm) to restore the abdominal support of the pubis. Then the external coverage was completed combining a pedicled superficial circumflex (SCIP) flap measuring 9 cm × 8 cm, a pedicled gracilis flap measuring 27 cm × 4 cm and a pedicled posteromedial thigh (PMT) flap measuring 22 cm × 8 cm harvested in vertical fashion. The postoperative course was uneventful, and at 6 months follow up the reconstructive result was successful with a stable soft tissue coverage and no complaints from the patient. With the present case report, we would like to show the importance of mastering different reconstructive procedures, whose combination might be the only solution to cover very large and complex defects.
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Affiliation(s)
- Mario F Scaglioni
- Department of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Matteo Meroni
- Department of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Bruno Fuchs
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Department of Orthopedic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
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4
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Tan YL, Ong W, Tan JH, Kumar N, Hallinan JTPD. Epithelioid Sarcoma of the Spine: A Review of Literature and Case Report. J Clin Med 2023; 12:5632. [PMID: 37685699 PMCID: PMC10488709 DOI: 10.3390/jcm12175632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/24/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
Epithelioid sarcoma is a rare malignant mesenchymal tumor that represents less than 1% of soft-tissue sarcomas. Despite its slow growth, the overall prognosis is poor with a high rate of local recurrence, lymph-node spread, and hematogenous metastasis. Primary epithelioid sarcoma arising from the spine is extremely rare, with limited data in the literature. We review the existing literature regarding spinal epithelioid sarcoma and report a case of epithelioid sarcoma arising from the spinal cord. A 54 year old male presented with a 1-month history of progressive left upper-limb weakness and numbness. Magnetic resonance imaging (MRI) of the spine showed an enhancing intramedullary mass at the level of T1 also involving the left T1 nerve root. Systemic radiological examination revealed no other lesion at presentation. Surgical excision of the mass was performed, and histology was consistent with epithelioid sarcoma of the spine. Despite adjuvant radiotherapy, there was aggressive local recurrence and development of intracranial metastatic spread. The patient died of the disease within 5 months from presentation. To the best of our knowledge, spinal epithelioid sarcoma arising from the spinal cord has not yet been reported. We review the challenges in diagnosis, surgical treatment, and oncologic outcome of this case.
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Affiliation(s)
- Yi Liang Tan
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore; (W.O.); (J.T.P.D.H.)
| | - Wilson Ong
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore; (W.O.); (J.T.P.D.H.)
| | - Jiong Hao Tan
- University Spine Centre, Department of Orthopaedic Surgery, National University Health System, 1E, Lower Kent Ridge Road, Singapore 119228, Singapore; (J.H.T.); (N.K.)
| | - Naresh Kumar
- University Spine Centre, Department of Orthopaedic Surgery, National University Health System, 1E, Lower Kent Ridge Road, Singapore 119228, Singapore; (J.H.T.); (N.K.)
| | - James Thomas Patrick Decourcy Hallinan
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore; (W.O.); (J.T.P.D.H.)
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
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5
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Mahmood LA, Thornburg LL, Katzman PJ, Akhtar RB. Epithelioid sarcoma with placental metastasis in a pregnant adolescent female: Case report. Pediatr Blood Cancer 2023; 70:e29978. [PMID: 36184838 DOI: 10.1002/pbc.29978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Laila A Mahmood
- Pediatric Palliative Care Program, Children's National Medical Center, Washington, District of Columbia, USA.,Division of Hematology, Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, District of Columbia, USA
| | - Loralei L Thornburg
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal medicine. University of Rochester Medical Center, Rochester, New York, USA
| | - Philip J Katzman
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Razia B Akhtar
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Zhang D, Hu J, Liu Z, Wu H, Cheng H, Li C. Prognostic nomogram in patients with epithelioid sarcoma: A SEER-based study. Cancer Med 2022; 12:3079-3088. [PMID: 36073670 PMCID: PMC9939116 DOI: 10.1002/cam4.5230] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/03/2022] [Accepted: 08/23/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The prognostic factors for patients with epithelial sarcoma remain unclear. The study aims to develop a practical clinical nomogram that predicts prognosis in patients with ES using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS We extracted clinical data from 2004 to 2015 from the SEER database about patients with ES. All patients were randomly divided into training cohort and validation cohort. Kaplan-Meier analyses were used to compare outcomes between different subgroups. In order to estimate the chance of survival for patients with ES, we developed a nomogram. Nomogram performance was evaluated by discrimination and calibration. Additionally, an analysis of decision curves was conducted to evaluate the clinical usefulness of this newly developed model. RESULTS In the primary cohort,320 met the inclusion criteria to be entered into this study. The median OS was 66.000 months (range 34.704 to 94.296 months), and the 1-, 3-, and 5-year OS rates were 70.7%, 56.1%, and 50.4%, respectively. For the validation cohort, we studied 136 consecutive patients. Age, primary site, grade, AJCC (American Joint Committee on Cancer) T, AJCC M, and surgery were included in the nomogram. The C-index values for the training set and validation set were 0.817 and 0.832, respectively. The calibration plots showed good agreement between the prediction and the observation. Based on the clinical decision curve, the model has a good clinical net benefit for ES patients. CONCLUSIONS It is the first study that developed an effective survival prediction model for patients with ES. Using this nomogram can assist in clinical decision-making as it has satisfactory accuracy. Even so, additional external validation is needed.
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Affiliation(s)
- Di Zhang
- Department of Orthopedics, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Jintao Hu
- Department of Urology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Zhuojie Liu
- Department of Orthopedics, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Haoyu Wu
- Department of Orthopedics, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - HanWen Cheng
- Department of Orthopedics, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Chunhai Li
- Department of Orthopedics, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
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Del Savio E, Maestro R. Beyond SMARCB1 Loss: Recent Insights into the Pathobiology of Epithelioid Sarcoma. Cells 2022; 11:cells11172626. [PMID: 36078034 PMCID: PMC9454995 DOI: 10.3390/cells11172626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
Epithelioid sarcoma (ES) is a very rare and aggressive mesenchymal tumor of unclear origin and uncertain lineage characterized by a prevalent epithelioid morphology. The only recurrent genetic alteration reported in ES as yet is the functional inactivation of SMARCB1 (SWI/SNF-related matrix-associated actin-dependent regulator of chromatin subfamily B member 1), a key component of the SWI/SNF (SWItch/Sucrose Non-Fermentable) chromatin remodeling complexes. How SMARCB1 deficiency dictates the clinicopathological characteristics of ES and what other molecular defects concur to its malignant progression is still poorly understood. This review summarizes the recent findings about ES pathobiology, including defects in chromatin remodeling and other signaling pathways and their role as therapeutic vulnerabilities.
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Lan H, Chai W, Gong F, Jia G. Epithelioid leiomyosarcoma of the vulva: report of a rare case and literature review. J Int Med Res 2022; 50:3000605221090473. [PMID: 35410510 PMCID: PMC9009142 DOI: 10.1177/03000605221090473] [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: 11/17/2022] Open
Abstract
Leiomyosarcoma of the vulva is a rare soft tissue sarcoma that accounts for
approximately 1% of all primary vulvar neoplasms, but it is the most common type
of vulvar sarcoma. It usually originates from the smooth muscle within erectile
tissue or blood vessel walls, the round ligament, the dartos muscle or the
arrector pili muscle. No treatment algorithms have been established to date.
Surgical resection is preferred for vulvar leiomyosarcoma. Currently, the
recommended surgical method is extensive local resection with a safe surgical
margin of at least 2 cm. The use of chemoradiotherapy for vulvar sarcoma remains
controversial. This case report describes a 39-year-old female that underwent
resection of a vulvar mass in January 2019. Postoperative pathological
examination indicated that it was an epithelioid leiomyosarcoma. She presented
with tumour recurrence after 43 days. Based on the diagnosis, radical right
vulvectomy with a tumour margin of 2 cm was performed. The tumour margin was
negative. The patient refused to undergo auxiliary radiotherapy and
chemotherapy. The follow-up findings do not indicate any signs of recurrence. In
order to avoid recurrence, vulvar epithelioid leiomyosarcomas should be
completely resected with a margin of 2 cm at the time of first occurrence.
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Affiliation(s)
- Honghe Lan
- Department of Gynaecology and Obstetrics, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Wei Chai
- Department of Gynaecology and Obstetrics, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Fengyan Gong
- Department of Gynaecology and Obstetrics, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Guifeng Jia
- Department of Gynaecology and Obstetrics, The First Hospital of Jilin University, Changchun, Jilin Province, China
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Russi S, Sgambato A, Bochicchio AM, Zoppoli P, Aieta M, Capobianco AML, Ruggieri V, Zifarone E, Falco G, Laurino S. CHIR99021, trough GSK-3β Targeting, Reduces Epithelioid Sarcoma Cell Proliferation by Activating Mitotic Catastrophe and Autophagy. Int J Mol Sci 2021; 22:11147. [PMID: 34681807 PMCID: PMC8538073 DOI: 10.3390/ijms222011147] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/06/2021] [Accepted: 10/12/2021] [Indexed: 12/11/2022] Open
Abstract
Epithelioid sarcoma (ES) is a rare disease representing <1% of soft tissue sarcomas. Current therapies are based on anthracycline alone or in combination with ifosfamide or other cytotoxic drugs. ES is still characterized by a poor prognosis with high rates of recurrence. Indeed, for years, ES survival rates have remained stagnant, suggesting that conventional treatments should be revised and improved. New therapeutic approaches are focused to target the key regulators of signaling pathways, the causative markers of tumor pathophysiology. To this end, we selected, among the drugs to which an ES cell line is highly sensitive, those that target signaling pathways known to be dysregulated in ES. In particular, we found a key role for GSK-3β, which results in up-regulation in tumor versus normal tissue samples and associated to poor prognosis in sarcoma patients. Following this evidence, we evaluated CHIR99021, a GSK-3 inhibitor, as a potential drug for use in ES therapy. Our data highlight that, in ES cells, CHIR99021 induces cell cycle arrest, mitotic catastrophe (MC) and autophagic response, resulting in reduced cell proliferation. Our results support the potential efficacy of CHIR99021 in ES treatment and encourage further preclinical and clinical studies.
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Affiliation(s)
- Sabino Russi
- IRCCS CROB—Referral Cancer Center of Basilicata, 85028 Rionero in Vulture, Italy; (S.R.); (A.S.); (A.M.B.); (P.Z.); (M.A.); (A.M.L.C.); (V.R.); (E.Z.); (S.L.)
| | - Alessandro Sgambato
- IRCCS CROB—Referral Cancer Center of Basilicata, 85028 Rionero in Vulture, Italy; (S.R.); (A.S.); (A.M.B.); (P.Z.); (M.A.); (A.M.L.C.); (V.R.); (E.Z.); (S.L.)
| | - Anna Maria Bochicchio
- IRCCS CROB—Referral Cancer Center of Basilicata, 85028 Rionero in Vulture, Italy; (S.R.); (A.S.); (A.M.B.); (P.Z.); (M.A.); (A.M.L.C.); (V.R.); (E.Z.); (S.L.)
| | - Pietro Zoppoli
- IRCCS CROB—Referral Cancer Center of Basilicata, 85028 Rionero in Vulture, Italy; (S.R.); (A.S.); (A.M.B.); (P.Z.); (M.A.); (A.M.L.C.); (V.R.); (E.Z.); (S.L.)
| | - Michele Aieta
- IRCCS CROB—Referral Cancer Center of Basilicata, 85028 Rionero in Vulture, Italy; (S.R.); (A.S.); (A.M.B.); (P.Z.); (M.A.); (A.M.L.C.); (V.R.); (E.Z.); (S.L.)
| | - Alba Maria Lucia Capobianco
- IRCCS CROB—Referral Cancer Center of Basilicata, 85028 Rionero in Vulture, Italy; (S.R.); (A.S.); (A.M.B.); (P.Z.); (M.A.); (A.M.L.C.); (V.R.); (E.Z.); (S.L.)
| | - Vitalba Ruggieri
- IRCCS CROB—Referral Cancer Center of Basilicata, 85028 Rionero in Vulture, Italy; (S.R.); (A.S.); (A.M.B.); (P.Z.); (M.A.); (A.M.L.C.); (V.R.); (E.Z.); (S.L.)
- UOC Clinical Pathology, Altamura Hospital, 70022 Altamura, Italy
| | - Emanuela Zifarone
- IRCCS CROB—Referral Cancer Center of Basilicata, 85028 Rionero in Vulture, Italy; (S.R.); (A.S.); (A.M.B.); (P.Z.); (M.A.); (A.M.L.C.); (V.R.); (E.Z.); (S.L.)
| | - Geppino Falco
- Department of Biology, University of Naples Federico II, 80133 Naples, Italy
- Biogem—Istituto di Biologia e Genetica Molecolare, 83031 Ariano Irpino, Italy
| | - Simona Laurino
- IRCCS CROB—Referral Cancer Center of Basilicata, 85028 Rionero in Vulture, Italy; (S.R.); (A.S.); (A.M.B.); (P.Z.); (M.A.); (A.M.L.C.); (V.R.); (E.Z.); (S.L.)
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10
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Uncommon and peculiar soft tissue sarcomas: Multidisciplinary review and practical recommendations. Spanish Group for Sarcoma research (GEIS -GROUP). Part II. Cancer Treat Rev 2021; 99:102260. [PMID: 34340159 DOI: 10.1016/j.ctrv.2021.102260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 12/14/2022]
Abstract
Among all Soft Tissue sarcomas there are some subtypes with low incidence and/or peculiar clinical behaviour, that need to be consider separately. Most of them are orphan diseases, whose biological characteristics imply a clearly different diagnostic and therapeutic approach from other more common sarcoma tumors. We present a brief and updated multidiciplinary review, focused on practical issues, aimed at helping clinicians in decision making. In this second part we review these subtypes: Alveolar Soft Part Sarcoma, Epithelioid Sarcoma, Clear Cell Sarcoma, Desmoplastic Small Round Cell Tumor, Rhabdoid Tumor, Phyllodes Tumor, Tenosynovial Giant Cell Tumors, Myoepithelial Tumor, Perivascular Epithelioid Cell Neoplasms (PEComas), Extraskeletal Myxoid Chondrosarcoma, NTRK-fusions Sarcomas. Most of them present their own radiological and histopathological feautures, that are essential to know in order to achieve early diagnosis. In some of them, molecular diagnosis is mandatory, not only in the diagnosis, but also to plan the treatment. On the other hand, and despite the low incidence, a great scientific research effort has been made to achieve new treatment opportunities for these patients even with approved indications. These include new treatments with targeted therapies and immunotherapy, which today represent possible therapeutic options. It is especially important to be attentive to new and potential avenues of research, and to promote the conduct of specific clinical trials for rare sarcomas.
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11
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Kungwengwe G, Clancy R, Vass J, Slade R, Sandhar S, Dobbs TD, Bragg TWH. Preoperative versus Post-operative Radiotherapy for Extremity Soft tissue Sarcoma: a Systematic Review and Meta-analysis of Long-term Survival. J Plast Reconstr Aesthet Surg 2021; 74:2443-2457. [PMID: 34266806 DOI: 10.1016/j.bjps.2021.05.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/27/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The role of perioperative radiotherapy in the management of resectable extremity soft tissue sarcoma (ESTS) is widely recognised for local tumour control, wound complications (WC) and long-term function. However, debate continues regarding its implications on long-term survival. This study aimed to determine whether the timing of perioperative radiotherapy affects long-term survival outcomes in adults with ESTS. METHODS A systematic literature search of MEDLINE, EMBASE, Web of Science and Cochrane was performed. The primary outcome measure was the pooled hazard ratio (HR) at 95% confidence intervals. Secondary outcomes and subgroup analyses were presented as cumulative odds ratios (OR). A random-effects, generic inverse variance method and sensitivity analysis were performed to minimise heterogeneity. RESULTS Six studies (n = 4192 patients) were identified. Time-to-event analysis demonstrated a statistically significant advantage in post-operative radiotherapy for overall survival (HR 1.15 and p = 0.05). Combined HRs for disease-free (1.25 and p = 0.22) and disease-specific (1.06 and p = 0.43) survival also favoured post-operative radiotherapy but did not achieve statistical significance. Post-operative radiotherapy was shown to confer an overall (OR 1.19 and p = 0.01), disease-free (OR 1.19 and p = 0.01) and disease-specific (OR 1.19 and p = 0.01) survival advantage on subgroup analysis. This survival benefit was best observed at three years in the disease-free survival comparison (OR 1.55 and p = 0.003). Preoperative radiotherapy was associated with more WC (OR 2.74 and p<0.00001). CONCLUSIONS Pooled analysis of published literature suggests that post-operative radiotherapy confers a significant long-term survival advantage with fewer WC. Further large multicentre randomised controlled trials with long-term follow-up are required to determine the optimal perioperative radiotherapy regime in adult ESTS.
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Affiliation(s)
- Garikai Kungwengwe
- The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK.
| | | | - Johanne Vass
- The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | | | - Simarjit Sandhar
- Queen Charlotte's & Chelsea Hospital, Imperial College NHS Trust, London, UK
| | - Thomas D Dobbs
- The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK; Reconstructive Surgery & Regenerative Medicine Research Group, Swansea, UK
| | - Thomas W H Bragg
- The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
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12
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Li YT, Luo WG, Zhang HY. Epithelioid sarcoma of the parapharyngeal space: A case report. Rare Tumors 2021; 13:20363613211016121. [PMID: 34046153 PMCID: PMC8135212 DOI: 10.1177/20363613211016121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/19/2021] [Indexed: 11/30/2022] Open
Abstract
Epithelioid sarcoma (ES) was first described by Enzinger in 1970. It is a rare variant of soft tissue sarcoma with a 5-year overall survival (OS) rate of 50%. Here, we reported a case of epithelioid sarcoma in the parapharyngeal space of an adult, resulting in a favorable prognosis after chemotherapy and radiation therapy. A 34-year-old female who complained of pharynx pain and discomfort was suspected of having a tumor in the right parapharyngeal space by CT scan. Excision biopsy suggested epithelioid sarcoma. Clinical and radiological studies did not reveal tumor distant metastasis in the patient. After excisional biopsy, the patient underwent chemotherapy and external beam radiation treatment. She has remained alive for 2 years and 7 months without recurrence since her last treatment. In this paper, we also provide a detailed review of the role of radiotherapy in the treatment of epithelioid sarcoma in previously reported cases.
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Affiliation(s)
- Yun-Tian Li
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, P.R. China
| | - Wen-Guang Luo
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, P.R. China
| | - Hong-Yan Zhang
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, P.R. China
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Kinoshita I, Kohashi K, Yamamoto H, Yamada Y, Inoue T, Higaki K, Teramoto N, Oshiro Y, Nakashima Y, Oda Y. Myxoepithelioid tumour with chordoid features: a clinicopathological, immunohistochemical and genetic study of 14 cases of SMARCB1/INI1-deficient soft-tissue neoplasm. Histopathology 2021; 79:629-641. [PMID: 33932047 DOI: 10.1111/his.14393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/21/2021] [Accepted: 04/27/2021] [Indexed: 11/27/2022]
Abstract
AIMS Complete loss of SMARCB1/INI1 in soft-tissue tumours such as malignant rhabdoid tumour, epithelioid sarcoma, myoepithelial tumour of soft tissue and extraskeletal myxoid chondrosarcoma is often associated with high-grade malignancy and poor prognosis. The diagnosis is sometimes challenging, owing to histological similarities, so careful differential diagnosis is required. Therefore, soft-tissue tumours with complete SMARCB1/INI1 loss could potentially include an unknown entity. METHODS AND RESULTS We analysed 160 cases of SMARCB1/INI1-deficient soft-tissue tumour, and found 14 cases that were not classifiable into already existing categories and had common clinical and histological features. These involved two male and 12 female patients, ranging in age from 20 years to 61 years. The tumours were located in the the puboinguinal region (n = 13) and pelvic cavity (n = 1). Histologically, the tumours showed relatively uniform epithelioid to spindle-shaped cells with myxoid stroma. All tumours showed immunoreactivity for brachyury, epithelial membrane antigen, and progesterone receptor, and 12 of 14 cases did so for oestrogen receptor. Variable positive staining for α-smooth muscle actin, S100 and glial fibrillary acidic protein (GFAP) was seen. NR4A3 and EWSR1 gene rearrangements were not detected in 13 and 11 examined cases, respectively. Clinical follow-up data for the 14 patients showed that 13 were alive without disease and one had been lost to follow-up; four patients developed local recurrence and/or metastases. CONCLUSION The designation 'myxoepithelioid tumour with choroid features' (METC) was proposed as a tumour with intermediate malignancy controllable with appropriate treatment, including the entity of myoepithelioma-like tumour of the vulvar region. METC represents a novel and independent subset that is histologically, biologically and clinically distinct from already existing SMARCB1/INI1-deficient soft-tissue tumours.
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Affiliation(s)
- Izumi Kinoshita
- Department of Anatomical Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenichi Kohashi
- Department of Anatomical Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hidetaka Yamamoto
- Department of Anatomical Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuichi Yamada
- Department of Anatomical Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeshi Inoue
- Department of Pathology, Osaka City General Hospital, Osaka, Japan
| | - Koichi Higaki
- Department of Diagnostic Pathology, St Mary's Hospital, Fukuoka, Japan
| | - Norihiro Teramoto
- Department of Pathology and Clinical Research, National Hospital Organisation Shikoku Cancer Centre, Matsuyama, Ehime, Japan
| | - Yumi Oshiro
- Department of Pathology, Matsuyama Red Cross Hospital, Matsuyama, Ehime, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshinao Oda
- Department of Anatomical Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Shi CJ, Xu SM, Li CW, Tian Z, Wang LZ, Hu YH, Xia RH, Zhang ZY, Li J. Epithelioid sarcoma: A clinicopathological study of 12 head and neck cases. Oral Dis 2021; 28:1519-1527. [PMID: 33751732 DOI: 10.1111/odi.13835] [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: 12/13/2020] [Revised: 02/14/2021] [Accepted: 02/28/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the clinicopathological features of epithelioid sarcoma presenting in head and neck region (HNES) and elucidate diagnostic key points and treatment options for HNES. MATERIALS AND METHODS A total of 12 HNES cases were collected in our department from 2010 to 2020. Their clinical information and pathological features were documented, and relevant follow-up was performed. Immunohistochemistry was carried to analyze the protein markers of HNES. RESULTS Of the 12 HNES cases, 10 were primary tumors and 2 were metastasized from foot and shoulder, respectively. The patients with primary tumors were significantly younger than those with metastasized ones (22.7 vs 41.5, p = .0157), and male patients outnumbered female patients (3:1). Of all HNES cases, 9 were classic subtype, and 3 were proximal subtype. HNES patients had a poor prognosis, with 5-year overall survival of 41.5% and 5-year relapse-free survival of 22.5%. A loss of INI1 was identified as the hallmark of HNES with 83.3% (10/12) of HNES cases presenting as EZH2 positive. CONCLUSIONS HNES is more prevalent at younger ages and in males, has a poor prognosis, and exhibits a greater proportion of classic subtype than proximal subtype. EZH2 inhibitor has therapeutic potential in HNES.
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Affiliation(s)
- Chao-Ji Shi
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Center for Stomatology, National Clinical Research Center for Oral Diseases, Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Stomatology &, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Sheng-Ming Xu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Center for Stomatology, National Clinical Research Center for Oral Diseases, Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Stomatology &, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Chu-Wen Li
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Center for Stomatology, National Clinical Research Center for Oral Diseases, Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Stomatology &, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Zhen Tian
- Department of Oral Pathology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li-Zhen Wang
- Department of Oral Pathology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu-Hua Hu
- Department of Oral Pathology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong-Hui Xia
- Department of Oral Pathology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhi-Yuan Zhang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Center for Stomatology, National Clinical Research Center for Oral Diseases, Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Stomatology &, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Jiang Li
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Stomatology &, Shanghai Research Institute of Stomatology, Shanghai, China.,Department of Oral Pathology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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15
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Ran W, Tang W, Duan J, Qing J, Zhai Z. An Extremely Rare Epithelioid Sarcoma Arising from the Infratemporal Fossa: A Case Report and Literature Review. Curr Med Imaging 2021; 17:798-806. [PMID: 33397242 DOI: 10.2174/1573405616666210104111946] [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: 03/29/2020] [Revised: 10/04/2020] [Accepted: 11/12/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Epithelioid sarcoma (ES) is a rare histopathological type of soft tissue sarcoma. They are subcutaneous soft tissue masses that tend to arise in extremity sites (the classic type, formerly referred to as distal type) or proximal midline region of the body (the proximal type), such as the perineum, genital tract, and pelvis. The head and neck regions are rarely affected by ES, but the infratemporal fossa (ITF) is extremely rare. ES involving the ITF has not been reported before in literature. In this paper, the imaging features of ES were reviewed in detail, and the anatomical structure and epidemiology of ITF were briefly introduced. SOURCES We performed a systematic search from 3 databases, CNKI(China National Knowledge Internet), FMRS(Foreign Medical Literature Retrieval Service, Shenzhen METSTR Technology CO., Led. China), and PubMed, to obtain literature from January 1970 to July 2020. Epithelioid sarcoma, head and neck regions, infratemporal fossa, diagnostic imaging, anatomy, MRI, and CT were used as keywords for advanced retrieval. A study had to be found eligible for inclusion to be closely related to ES and/or ITF. A total of 129 related pieces of literature were retrieved successfully, of which 37 were closely related to this study. The case report in this article is from the Affiliated Hospital of North Sichuan Medical College. The present study was approved by the institutional review board of the Affiliated Hospital of North Sichuan Medical College and a written informed consent for the publication of the case was obtained from the patient. CASE PRESENTATION A 33-year-old man accidentally found a slowly growing, painless mass in the left cheek more than a month ago. On plain computed tomography (CT) scan of the outpatient department, an oval slightly low-density mass with well-defined and uniform boundary in the infratemporal fossa was revealed, and on the contrast-enhanced scan, it was homogeneous and moderately enhanced. Initially, the CT appearance favored benign lesions. However, the possibility of a malignant tumor can not be excluded completely. Finally, the patient was referred to the inpatient department a tumor arose from IF and underwent a selective operation. The tumor was completely removed. Histologic findings were compatible with epithelioid sarcoma. Post-operatively, the patient received 2 cycles of radiotherapy, and there was no evidence of recurrence after 6 months follow- up. CONCLUSION The imaging manifestations of ES are various. The anatomic structure of ITF is complex and the pathological types are various. It should be very careful in the qualitative diagnosis of tumors from the ITF, and advanced imaging techniques will be useful in imaging diagnosis.
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Affiliation(s)
- Weiming Ran
- Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63# Wenhua Road, Shunqing District, Nanchong 637000, Sichuan, China
| | - Wei Tang
- Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63# Wenhua Road, Shunqing District, Nanchong 637000, Sichuan, China
| | - Junyan Duan
- Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63# Wenhua Road, Shunqing District, Nanchong 637000, Sichuan, China
| | - Jiao Qing
- Department of Pathology, Affiliated Hospital of North Sichuan Medical College, 63# Wenhua Road, Shunqing District, Nanchong 637000, Sichuan, China
| | - Zhaohua Zhai
- Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63# Wenhua Road, Shunqing District, Nanchong 637000, Sichuan, China
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Persitz J, Beit Ner E, Chechik I, Keren T, Avisar E. Epithelioid sarcoma of the hand: a wolf in sheep's clothing. J Plast Surg Hand Surg 2020; 55:96-104. [PMID: 33176534 DOI: 10.1080/2000656x.2020.1838914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Epithelioid sarcoma (ES) of the hand is a rare, aggressive cutaneous malignancy with high rates of recurrence, metastases and mortality. With an incidence rate of 0.4 cases/y per one million population, which compromise for approximately 1-1.4% of all soft tissue sarcoma, ES accounts for 10% of soft tissues sarcomas of the hand and foot. Its aggressiveness and propensity to spread and metastases without being noticed, makes it unique and potentially lethal. Missed or delayed diagnosis are often encountered as this tumor can mimic variety of different entities and due to the infrequent nature of this lesion, treatment options are still controversial. The authors provide systemic review of the current literature on epidemiology, etiology, pathogenesis, management and outcomes of this disease as well as a case presentation and a proposed treatment algorithm. The choice of treatment option depends on disease characteristics, staging at presentation, regional lymph node involvement, comorbidities and performance status of the patient. Emphasis on a multidisciplinary coordinated care is crucial as early diagnosis and treatment can decrease morbidity and mortality rates.
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Affiliation(s)
- Jonathan Persitz
- The Hand and Upper Extremity Surgery Unit, Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Tzrifin, Israel
| | - Eran Beit Ner
- Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Tzrifin, Israel
| | - Igal Chechik
- Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Tzrifin, Israel
| | - Timoret Keren
- The Hand and Upper Extremity Surgery Unit, Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Tzrifin, Israel
| | - Erez Avisar
- The Hand and Upper Extremity Surgery Unit, Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Tzrifin, Israel
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17
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Epithelioid Sarcoma-From Genetics to Clinical Practice. Cancers (Basel) 2020; 12:cancers12082112. [PMID: 32751241 PMCID: PMC7463637 DOI: 10.3390/cancers12082112] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 11/20/2022] Open
Abstract
Epithelioid sarcoma is a mesenchymal soft tissue sarcoma often arising in the extremities, usually in young adults with a pick of incidence at 35 years of age. Epithelioid sarcoma (ES) is characterized by the loss of SMARCB1/INI1 (integrase interactor 1) or other proteins of the SWI/SNF complex. Two distinct types, proximal and distal, with varying biology and treatment outcomes, are distinguished. ES is known for aggressive behavior, including a high recurrence rate and regional lymph node metastases. An optimal long-term management strategy is still to be defined. The best treatment of localized ES is wide surgical resection. Neo-adjuvant or adjuvant radiotherapy may be recommended, as it reduces the local recurrence rate. Sentinel lymph node biopsy should be considered in ES patients. Patients with metastatic ES have a poor prognosis with an expected median overall survival of about a year. Doxorubicin-based regimens are recommended for advanced ES. Tazemetostat, an EZH2 methyltransferase, has shown promising results in ES patients. Novel therapies, including immunotherapy, are still needed.
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18
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Regalbuto A, Tudosie A, Klenotic E. A metastatic distal-type epithelioid sarcoma: Case report and review. Int J Surg Case Rep 2020; 71:144-146. [PMID: 32450373 PMCID: PMC7256202 DOI: 10.1016/j.ijscr.2020.04.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/04/2020] [Accepted: 04/28/2020] [Indexed: 11/25/2022] Open
Abstract
Epithelioid Sarcoma is a rare soft tissue tumor with an aggressive nature. Certain biomarker positivity or negativity can help distinguish from other tumors. SMARCB1 loss is predominant in most Epithelioid Sarcomas. Wide surgical excision is main treatment, but biomarker-targeted therapy is growing.
Introduction Epithelioid sarcoma is known as one of the rarest types of sarcomas and was identified as its own diagnosis by Dr. Franz Enzinger in 1970 after his realization of its massive overlap with many other diseases. This tumor has an aggressive clinical course with high recurrence and metastasis rates. Presentation of case This report will detail the case of a 39-year-old male who was diagnosed with Epithelioid Sarcoma and later succumbed to this disease. Discussion This report will emphasize epithelioid sarcoma morphology and immunohistochemistry with discussions on predisposition, prognostic factors, and current options for treatment modalities. Conclusion Future studies are needed to determine clear predisposition and screening practices; however modern pharmaceuticals have shown hopes of optimizing the course of this cancer.
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Affiliation(s)
- Avalon Regalbuto
- Ohio University Heritage College of Osteopathic Medicine, Cleveland, 4180 Warrensville Center Road, Warrensville Heights, OH 44122, United States.
| | - Andrew Tudosie
- Ohio University Heritage College of Osteopathic Medicine, Cleveland, 4180 Warrensville Center Road, Warrensville Heights, OH 44122, United States
| | - Eveline Klenotic
- Lake Health West Medical Center, 36000 Euclid Ave, Willoughby, OH 44094, United States
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Frezza AM, Sbaraglia M, Lo Vullo S, Baldi GG, Simeone N, Frenos F, Campanacci D, Stacchiotti S, Pasquali S, Callegaro D, Gambarotti M, Barisella M, Palomba A, Mariani L, Casali PG, Dei Tos AP, Gronchi A. The natural history of epithelioid sarcoma. A retrospective multicentre case-series within the Italian Sarcoma Group. Eur J Surg Oncol 2020; 46:1320-1326. [PMID: 32307188 DOI: 10.1016/j.ejso.2020.03.215] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/11/2020] [Accepted: 03/23/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION This case-series is aimed to describe the natural history of epithelioid sarcoma (ES) and to provide insights into the differential clinical behaviour of its two variants ("classic-type" and "proximal-type"). The value of a subtype-adapted grading system based on pathological features is explored. METHODS Data from consecutive, primary, localised, INI1-deleted ES operated at three Italian sarcoma reference centres (1995-2015) were included. Centralised pathological review was performed. Classic-type ES was broken down into "high-grade" and "low-grade", according to number of mitoses, evidence of necrosis and nuclear atypia. Five- and 10-year overall survival (OS) and crude cumulative incidence (CCI) of local recurrence (LR) and distant metastasis (DM) were estimated. RESULTS Fifty-two patients were included. 5- and 10-year OS estimates were 70% and 47% in the whole series, 57% and 37% in patients with proximal-type ES, 77% and 54% in patients with classic-type ES (P = 0.02). In classic-type ES, 5- and 10-year OS was higher for low-grade (95% and 72%, respectively) than high-grade tumours (P = 0.002). 5- and 10-year CCI estimates for LR were 21% and 33% in the whole series. 5- and 10-year CCI estimates for DM were 35% and 39% in the whole series, both 28% in classic-type ES, 47% and 59% in proximal-type ES (P = 0.03). CONCLUSIONS Suffering from a proximal- or a classic-type is the stronger predictor of outcome in patients with localised ES, with proximal-type ES patients having lower survival due to a higher tendency toward metastatic spreading. However, the "high-grade" classic-type ES was associated with outcomes close to proximal-type ES.
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Affiliation(s)
- Anna Maria Frezza
- Department of Medical Oncology, IRCCS Fondazione Istituto Nazionale Tumori, Milan, Italy.
| | - Marta Sbaraglia
- Department of Pathology, Padua University Hospital, Padua, Italy
| | - Salvatore Lo Vullo
- Unit of Clinical Epidemiology and Trial Organization, IRCCS Fondazione Istituto Nazionale Tumori, Milan, Italy
| | | | - Noemi Simeone
- Department of Medical Oncology, IRCCS Fondazione Istituto Nazionale Tumori, Milan, Italy
| | - Filippo Frenos
- Department of Orthopaedic Oncology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Domenico Campanacci
- Department of Orthopaedic Oncology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Silvia Stacchiotti
- Department of Medical Oncology, IRCCS Fondazione Istituto Nazionale Tumori, Milan, Italy
| | - Sandro Pasquali
- Sarcoma Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Dario Callegaro
- Sarcoma Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Gambarotti
- Department of Surgical Pathology, IRCCS-Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Marta Barisella
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Annarita Palomba
- Department of Pathology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Luigi Mariani
- Unit of Clinical Epidemiology and Trial Organization, IRCCS Fondazione Istituto Nazionale Tumori, Milan, Italy
| | - Paolo G Casali
- Department of Medical Oncology, IRCCS Fondazione Istituto Nazionale Tumori, Milan, Italy; University of Milan, Department of Oncology and Hemato-oncology, Milan, Italy
| | | | - Alessandro Gronchi
- Sarcoma Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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20
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Hwang SO, Lee SH, Lee HB. Epithelioid sarcoma associated with neurofibromatosis type I. Arch Craniofac Surg 2020; 21:41-44. [PMID: 32126619 PMCID: PMC7054192 DOI: 10.7181/acfs.2019.00640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 12/16/2019] [Indexed: 11/29/2022] Open
Abstract
In general, patients with neurofibromatosis type I have a higher risk than those with other types of neurofibromatosis of developing soft-tissue sarcomas related to the nervous system. We here present a 42-year-old man with neurofibromatosis type I who developed a protruding mass over only 2 weeks. The histopathological diagnosis was epithelioid sarcoma. Epithelioid sarcomas are rare and, to the best of our knowledge, no epithelioid sarcomas have been reported in patients with neurofibromatosis type I. Radical excision of the primary lesion was performed and postoperative radiotherapy and chemotherapy administered, as is recommended for epithelioid sarcoma. Our case emphasizes that patients with neurofibromatosis type I may develop malignant tumors
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Affiliation(s)
- Sung Oh Hwang
- Department of Plastic and Reconstructive Surgery, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Soo Hyang Lee
- Department of Plastic and Reconstructive Surgery, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Han Byul Lee
- Department of Plastic and Reconstructive Surgery, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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21
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Abstract
Background and objectives: Epithelioid sarcoma (ES) is an aggressive malignancy scarcely reported on due to its rarity. This study is a review of its traits and features of prognosis and survival by analyzing both the literature and a national cancer database.Methods: Data were acquired from both the Survival, Epidemiology, and End Results database and literature. 1, 5, and 10-year Disease Specific Survival rates and hazard ratios (HR) were determined. Data were split into pre-2000 (<2000) and post-2000 (>2000) groups. Overall survival, recurrence, and metastasis rates were obtained.Results: Ninety hundred and ninety eight and 992 cases of ES were identified from the database and literature, respectively. Age, anatomical site, grade, TNM staging, treatment modality and year of diagnosis were demonstrated to be independent predictors of survival. Overall 5- and 10-year survival were 60.4% and 50.2%, respectively. Overall recurrence and metastasis rates were 63.4% and 40.3%. Using cases diagnosed prior to 2000 as reference, those diagnosed after 2000 had a worse prognosis (HR: 1.55).Conclusions: We report using the largest cohort of ES to date. Despite ES's often dismal prognosis, there are factors associated with better outcomes. A worsening survival over the years warrants further investigation into this sarcoma.
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Affiliation(s)
- Samer T. Elsamna
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Kamil Amer
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Omar Elkattawy
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Kathleen S. Beebe
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
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22
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Duran-Moreno J, Kontogeorgakos V, Koumarianou A. Soft tissue sarcomas of the upper extremities: Maximizing treatment opportunities and outcomes. Oncol Lett 2019; 18:2179-2191. [PMID: 31404317 PMCID: PMC6676724 DOI: 10.3892/ol.2019.10575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/04/2019] [Indexed: 02/07/2023] Open
Abstract
Soft tissue sarcomas (STS) are rare tumors; they do not even equate to 1% of all malignant tumor cases. One-fifth of all STS occur in the upper extremities, where epithelioid sarcoma, synovial sarcoma, clear cell sarcoma and malignant fibrohistiocytoma are the most frequent subtypes. Surgical resection is the cornerstone of treatment. However, accomplishment of optimal oncological and functional results of STS of the upper extremities may represent a challenge for hand surgeons, due to the complex anatomy. In several cases, preoperative therapies are needed to facilitate tumor resection and improve the oncological outcome. Oligometastatic disease may also be a challenging scenario as curative strategies can be applied. Radiotherapy and chemotherapy are commonly used for this purpose albeit with conflicting evidence. Novel drug combinations have also been approved in the metastatic setting, further improving the quality of life and survival of eligible patients. Thus, prior to any approach, every case should be individually discussed in sarcoma centers with specialized multidisciplinary tumor boards. The aim of the present review was to gather the multidisciplinary experiences of the available therapeutic strategies for STS of the upper extremities.
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Affiliation(s)
- Jose Duran-Moreno
- Hematology Oncology Unit, Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, 'Attikon' University General Hospital, Athens 12462, Greece
| | - Vasileios Kontogeorgakos
- Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, 'Attikon' University General Hospital, Athens 12462, Greece
| | - Anna Koumarianou
- Hematology Oncology Unit, Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, 'Attikon' University General Hospital, Athens 12462, Greece
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23
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Romolo H, Andinata B, Aisiyah D, Budiluhur A. Sternal reconstruction for primary sternal tumor in a post-coronary artery bypass grafting surgery patient. SAGE Open Med Case Rep 2019; 7:2050313X19847801. [PMID: 31105953 PMCID: PMC6503599 DOI: 10.1177/2050313x19847801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 04/10/2019] [Indexed: 11/23/2022] Open
Abstract
Epithelioid sarcoma is a very rare tumor, comprising less than 1% of all soft
tissue sarcoma. Due to its rarity and benign presentation, it is often
misdiagnosed. We present a case of epithelioid sarcoma mimicking coronary artery
bypass grafting post-operative keloid. Current literature suggests the
management for epithelioid sarcoma to include surgery and adjuvant radiation. In
this patient, chest wall reconstruction was done using titanium mesh and muscle
flaps. Post-operative radiation was given and computerized tomography scan was
evaluated 3 months after reconstruction.
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Affiliation(s)
- Harvey Romolo
- Department of Cardiac, Vascular and Thoracic Surgery, Dharmais National Cancer Center, DKI Jakarta, Indonesia
| | - Bob Andinata
- Department of Oncologic Surgery, Dharmais National Cancer Center, DKI Jakarta, Indonesia
| | - Dewi Aisiyah
- Department of Plastic and Reconstruction Surgery, Dharmais National Cancer Center, DKI Jakarta, Indonesia
| | - Ati Budiluhur
- Department of Cardiac, Vascular and Thoracic Surgery, Dharmais National Cancer Center, DKI Jakarta, Indonesia
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24
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Spunt SL, Francotte N, De Salvo GL, Chi YY, Zanetti I, Hayes-Jordan A, Kao SC, Orbach D, Brennan B, Weiss AR, van Noesel MM, Million L, Alaggio R, Parham DM, Kelsey A, Randall RL, McCarville MB, Bisogno G, Hawkins DS, Ferrari A. Clinical features and outcomes of young patients with epithelioid sarcoma: an analysis from the Children's Oncology Group and the European paediatric soft tissue Sarcoma Study Group prospective clinical trials. Eur J Cancer 2019; 112:98-106. [PMID: 30954717 DOI: 10.1016/j.ejca.2019.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/06/2019] [Accepted: 02/02/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Data on the clinical features, optimal treatment and outcomes of paediatric patients with epithelioid sarcoma (ES) are limited and mostly retrospective. METHODS A subset analysis of ES patients < 30 years of age enrolled on two international prospective clinical trials conducted between 7/2005 and 11/2015 was performed. Risk-adapted therapy was based on tumour diameter, histologic grade, extent of surgery and presence/absence of metastases and included surgery ± radiotherapy for all patients with the addition of ifosfamide/doxorubicin chemotherapy for intermediate-/high-risk patients. Response to therapy, event-free and overall survival and pattern and predictors of treatment failure were evaluated. RESULTS Sixty-three ES patients (median age 13.1 years, 52% male) were eligible. Clinical features included the following: 68% extremity, median tumour diameter 3.5 cm, 56% high histologic grade, 14% nodal metastases, 14% distant metastases. Thirty-four low-risk patients underwent surgery (n = 30) or surgery/radiotherapy (n = 4); 16 intermediate-risk and 13 high-risk patients received chemotherapy ± surgery ± radiotherapy. Partial response was observed in 11/22 (50%) patients receiving neoadjuvant therapy. Events were local recurrence (n = 10) and distant recurrence (n = 15); estimated 5-year survival was 86.4%, 63.5% and 0%, respectively, for low-, intermediate- and high-risk patients. Locoregional nodal involvement, invasive tumour, high grade and lesser extent of resection predicted event-free survival in patients without metastases. CONCLUSIONS Most low-risk ES patients who have undergone an adequate resection fare well without adjuvant therapy. Large tumour size, high histologic grade, tumour invasiveness, inadequate tumour resection and metastatic disease predict poorer outcomes in higher risk ES patients, for whom more effective therapies are needed. CLINICAL TRIAL REGISTRATION COG ARST0332: ClinicalTrials.gov Identifier NCT00346164, EpSSG NRSTS 2005: European Union Drug Regulating Authorities Clinical Trials No. 2005-001139-31.
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Affiliation(s)
- Sheri L Spunt
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Nadine Francotte
- Department of Pediatrics, CHC-Clinique de l'Esperance, rue Saint Nicolas, Montegnee, Belgium
| | - Gian Luca De Salvo
- Clinical Research Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Yueh-Yun Chi
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Ilaria Zanetti
- Hematology Oncology Division, Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | - Andrea Hayes-Jordan
- Department of Pediatric Surgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Simon C Kao
- Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Daniel Orbach
- SIREDO Oncology Center (Care Innovation and Research for Children and AYA with Cancer), PSL Research University, Institut Curie, Paris, France
| | - Bernadette Brennan
- Department of Pediatric Oncology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Aaron R Weiss
- Department of Pediatrics, Maine Medical Center, Portland, ME, USA
| | - Max M van Noesel
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Lynn Million
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Rita Alaggio
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - David M Parham
- Department of Pathology and Laboratory Medicine, USC Keck School of Medicine and Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Anna Kelsey
- Department of Paediatric Histopathology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - R Lor Randall
- Department of Orthopedic Surgery, University of California Davis School of Medicine, Sacramento, CA, USA
| | - M Beth McCarville
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Gianni Bisogno
- Hematology Oncology Division, Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | - Douglas S Hawkins
- Hematology/Oncology, Seattle Children's Hospital, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
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25
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Primary Epithelioid Sarcoma of Orbit: A Case Report and Review of the Literature. Case Rep Oncol Med 2018; 2018:3989716. [PMID: 30652038 PMCID: PMC6311860 DOI: 10.1155/2018/3989716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 11/27/2018] [Indexed: 11/30/2022] Open
Abstract
Epithelioid sarcoma is a rare high-grade malignancy identified by Enzinger in 1970. It accounts for 1% of all reported soft tissue sarcomas and presents most commonly in distal upper extremities in young adults with a male predominance. At this time, there are only 5 previously reported cases of primary epithelioid sarcoma of the orbit. We present a primary orbital epithelioid sarcoma case of a patient who underwent orbital exenteration followed by external beam radiation treatment. Because the literature is limited, this is to our knowledge the largest descriptive analysis of cases of orbital epithelioid sarcoma. We also provide a detailed review of all the previously reported primary orbital epithelioid sarcoma cases, as well as a discussion on the use of postoperative radiation therapy for patients with epithelioid sarcoma. Surgical resection followed by adjuvant radiation therapy appears to be a safe option for local treatment of this rare malignancy, but further future studies are needed of this rare clinical situation in order to better understand and optimize treatment for patients with orbital epithelioid sarcoma.
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26
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Rajeev LK, Asati V, Mallekavu SB, Babu KG, Champka G. Epithelioid Sarcoma Presenting as Recurrent Thumb Ulcer: A Lesson to Learn. Indian J Med Paediatr Oncol 2018. [DOI: 10.4103/ijmpo.ijmpo_87_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AbstractEpithelioid sarcoma (ES) first described by Enzinger in 1970,1 is a rare soft-tissue sarcoma typically presenting as a subcutaneous or deep dermal mass in distal portions of the extremities of adolescents and young adults. They are frequently mistaken for ulcers, abscesses, or infected warts that fail medical management. Patients often develop multiple local recurrences of long duration, with subsequent metastases in 30%–50% of cases.2 We here report a case of left thumb ES that presented as an ulcer and subsequently metastasized to the forearm, arm, axillary lymph nodes, and lungs.
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Affiliation(s)
| | - Vikas Asati
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Suresh Babu Mallekavu
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - K Govind Babu
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - G Champka
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
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27
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Van-de-Velde V, Kravvas G, Ali G, Biswas A, Naysmith L. A solitary and tender acral papule in a young patient. Clin Exp Dermatol 2018; 43:630-632. [PMID: 29748978 DOI: 10.1111/ced.13567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2017] [Indexed: 11/27/2022]
Affiliation(s)
- V Van-de-Velde
- Department of Dermatology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - G Kravvas
- Department of Dermatology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - G Ali
- Department of Dermatology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A Biswas
- Department of Pathology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - L Naysmith
- Department of Dermatology, Royal Infirmary of Edinburgh, Edinburgh, UK
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28
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Sambri A, Bianchi G, Cevolani L, Donati D, Abudu A. Can radical margins improve prognosis in primary and localized epithelioid sarcoma of the extremities? J Surg Oncol 2018; 117:1204-1210. [PMID: 29266231 DOI: 10.1002/jso.24955] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 11/14/2017] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Epithelioid sarcoma (ES) has a tendency to locally recur, spread proximally, and metastasize, in particular to lymphnodes and lungs. The aim of this report is to study the role of surgery and the extent of margins required for optimal management of patients with localized epithelioid sarcoma of the extremities. MATERIAL AND METHODS We retrospectively evaluated 77 patients affected by ES of the extremities treated at two different Institutions. RESULTS Twenty-two patients had metastasis at diagnosis. Estimated survival was 65.5% at 5 years and 50.9% at 10 years, with a better prognosis in patients with localized disease at diagnosis (P < 0.001). Among patients with localized disease, a significantly better survival was found in patients with primary tumors in which radical surgical margins were achieved (P = 0.043). Among 47 patients presenting with primary tumors, local recurrence-free rate was 72.9% at 5 years, and 61.9% at 10 years, with a better local control achieved in patients with radical margins were achieved (P = 0.026). DISCUSSION We believe that the best approach to improve both local control and survival is to aim for radical margins in patients with primary tumors. Therefore, the best chance for cure is if the first treatment is the right treatment, which we believe to be radical margins.
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Affiliation(s)
- Andrea Sambri
- Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Bianchi
- Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Cevolani
- Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide Donati
- Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
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Rajeev LK, Asati V, Babu S, Babu G, Champaka G. Epithelioid Sarcoma Presenting as Recurrent Thumb Ulcer: a Lesson to Learn. Indian J Surg Oncol 2018; 9:251-253. [PMID: 29887710 DOI: 10.1007/s13193-018-0727-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 01/18/2018] [Indexed: 11/30/2022] Open
Abstract
Epithelioid sarcoma first described by Enzinger (Cancer 26:1029-41, 1970) is a rare soft-tissue sarcoma typically presenting as a subcutaneous or deep dermal mass in distal portions of the extremities of adolescents and young adults. They are frequently mistaken for ulcers, abscesses, or infected warts that fail medical management. Patients often develop multiple local recurrences of long duration, with subsequent metastases in 30 to 50% of cases (Chase and Enzinger (Am J Surg Pathol 9:241-63, 1985)). We here report a case of left thumb epithelioid sarcoma that presented as an ulcer and subsequently metastasized to forearm, arm, axillary lymph nodes, and lungs.
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Affiliation(s)
- L K Rajeev
- 1Department of Medical Oncology, Kidwai Memorial Institute of Oncology, 214, Men's Hostel, Bangalore, 560029 India
| | - Vikas Asati
- 1Department of Medical Oncology, Kidwai Memorial Institute of Oncology, 214, Men's Hostel, Bangalore, 560029 India
| | - Suresh Babu
- 1Department of Medical Oncology, Kidwai Memorial Institute of Oncology, 214, Men's Hostel, Bangalore, 560029 India
| | - Govind Babu
- 1Department of Medical Oncology, Kidwai Memorial Institute of Oncology, 214, Men's Hostel, Bangalore, 560029 India
| | - G Champaka
- 2Department of Pathology, Kidwai Memorial Institute of Oncology, Bangalore, India
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30
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Touati N, Schöffski P, Litière S, Judson I, Sleijfer S, van der Graaf WT, Italiano A, Isambert N, Gil T, Blay JY, Stark D, Brodowicz T, Marréaud S, Gronchi A. European Organisation for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group Experience with Advanced/Metastatic Epithelioid Sarcoma Patients Treated in Prospective Trials: Clinical Profile and Response to Systemic Therapy. Clin Oncol (R Coll Radiol) 2018; 30:448-454. [PMID: 29550245 DOI: 10.1016/j.clon.2018.02.065] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/23/2018] [Accepted: 01/23/2018] [Indexed: 12/01/2022]
Abstract
AIMS Epithelioid sarcoma is a soft tissue sarcoma associated with a high rate of local recurrence after wide resection and high incidence of distant metastasis. Little is known about the clinical course and response to systemic treatments in epithelioid sarcoma patients. We carried out a retrospective analysis of clinical data from epithelioid sarcoma patients to provide a reference for the design of future epithelioid sarcoma-specific studies. PATIENTS AND METHODS Data from patients with epithelioid sarcoma entered in prospective multi-sarcoma phase II/III trials were pooled: EORTC trial 62012 (doxorubicin versus doxorubicin/ifosfamide), 62043 (pazopanib), 62072 (pazopanib versus placebo) and 62091 (doxorubicin versus trabectedin). Patients had either a local or a centrally confirmed diagnosis of epithelioid sarcoma, had inoperable/metastatic disease at study entry and were eligible for the according trial. Response was assessed according to RECIST 1.1. Progression-free survival (PFS) and overall survival were calculated from date of entry. RESULTS Among 976 patients with advanced sarcomas, 27 epithelioid sarcoma patients (2.8%) were eligible for the analysis (17 men, median age at diagnosis 50 years, range 19-72). Eighteen (66.7%) received chemotherapy as first-line treatment (five doxorubicin, eight doxorubicin/ifosfamide, two pazopanib, three trabectedin) and nine (33.3%) received pazopanib as second line or later. The primary tumour was located in the lower extremity (n = 8; 29.6%), upper extremity (n = 5; 18.5%), retro/intra-abdominal (n = 4; 14.8%) and in other locations (n = 10; 37.0%). At entry, metastases were mainly found in lung (n = 17; 63%), lymph nodes (n = 9; 33.3%), bone (n = 8; 29.6%) and soft tissue (n = 7; 25.9%). The best response for first-line patients was four partial responses (22.2%), 10 stable disease (55.6%) and four progressive disease (22.2%). In subsequent lines, pazopanib achieved one partial response (11.1%), four stable disease (44.4%) and four progressive disease (44.4%). All patients but one progressed on treatment. The median PFS and overall survival were 3.8 (95% confidence interval 2.2-4.8) and 10.8 months (95% confidence interval 8.1-21.3), respectively. Five patients were still alive at the time of the according trial analysis. CONCLUSION With all limitations of such a rare disease and small data set, objective response and survival outcomes are similar in epithelioid sarcoma to non-selected sarcoma populations. The clinical testing of novel systemic treatments for epithelioid sarcoma remains an unmet medical need and a high priority.
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Affiliation(s)
- N Touati
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium.
| | - P Schöffski
- Department of General Medical Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - S Litière
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - I Judson
- Royal Marsden Hospital, London, UK
| | - S Sleijfer
- Erasmus MC - Cancer Institute, Rotterdam, the Netherlands
| | - W T van der Graaf
- The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | | | - N Isambert
- Centre Georges-François Leclerc, Dijon, France
| | - T Gil
- Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - J Y Blay
- Centre Léon Bérard, Lyon, France
| | - D Stark
- Leeds Teaching Hospitals NHS Trust, St James University Hospital, Leeds, UK
| | - T Brodowicz
- Medical University Vienna, General Hospital, Vienna, Austria
| | - S Marréaud
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - A Gronchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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31
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Epithelioid sarcomas: How important is loco-regional control? Eur J Surg Oncol 2017; 43:1746-1752. [DOI: 10.1016/j.ejso.2017.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/25/2017] [Accepted: 07/11/2017] [Indexed: 11/22/2022] Open
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32
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Outani H, Imura Y, Tanaka T, Takenaka S, Oshima K, Hamada K, Kakunaga S, Joyama S, Naka N, Kudawara I, Ueda T, Araki N, Yoshikawa H. Clinical outcomes of patients with epithelioid sarcomas: impact and management of nodal metastasis. Int J Clin Oncol 2017; 23:181-188. [DOI: 10.1007/s10147-017-1179-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 08/05/2017] [Indexed: 11/28/2022]
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33
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Kim C, Yoo KH, Kim MH, Chon HJ, Lee SI, Lee HJ, Koh S, Lee HY, Lee HR, Kim KS, Choi YD, Rha SY, Lee SJ, Kim HS. Different subtypes of epithelioid sarcoma and their clinical implication: long-term multi-institutional experience with a rare sarcoma. APMIS 2017; 125:223-229. [PMID: 28233450 DOI: 10.1111/apm.12656] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 12/13/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Chan Kim
- Medical Oncology; CHA Bundang Medical Center; CHA University; Seongnam-si Korea
| | - Kwai Han Yoo
- Division of Hematology and Oncology; Department of Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Min Hwan Kim
- Division of Medical Oncology; Department of Internal Medicine; Yonsei Cancer Center; Yonsei University College of Medicine; Seoul Korea
| | - Hong Jae Chon
- Medical Oncology; CHA Bundang Medical Center; CHA University; Seongnam-si Korea
| | - Soon Il Lee
- Division of Hematology-Oncology; Department of Medicine; Dankook University College of Medicine; Cheonan Korea
| | - Hyo Jin Lee
- Department of Internal Medicine; School of Medicine Chungnam National University; Daejeon Korea
| | - Sujin Koh
- Department of Hematology and Oncology; Ulsan University Hospital; University of Ulsan College of Medicine; Ulsan Korea
| | - Ha Yeon Lee
- Division of Hematology-Oncology; Department of Internal Medicine; Kyunghee University Hospital at Gangdong; Seoul Korea
| | - Hye Ran Lee
- Division of Hematology/Oncology; Department of Internal Medicine; Inje University Ilsan Paik Hospital; Goyang Korea
| | - Kyung Sik Kim
- Department of Surgery; Yonsei University College of Medicine; Seoul Korea
| | - Young Deuk Choi
- Department of Urology; Yonsei University College of Medicine; Seoul Korea
| | - Sun Young Rha
- Division of Medical Oncology; Department of Internal Medicine; Yonsei Cancer Center; Yonsei University College of Medicine; Seoul Korea
| | - Su Jin Lee
- Division of Hematology and Oncology; Department of Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Hyo Song Kim
- Division of Medical Oncology; Department of Internal Medicine; Yonsei Cancer Center; Yonsei University College of Medicine; Seoul Korea
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Lv L, Xu P, Shi Y, Hao J, Hu C, Zhao B. Imaging features of soft tissue epithelioid angiosarcoma in the lower extremity: A case report. Oncol Lett 2016; 11:3457-3460. [PMID: 27123135 DOI: 10.3892/ol.2016.4407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 12/10/2015] [Indexed: 02/03/2023] Open
Abstract
Epithelioid angiosarcomas are extremely rare malignant tumors formed from endothelial cells. The majority of studies reporting these tumors have been concerned with the clinical and pathological aspects, with limited reporting of radiological diagnosis. The aim of the present study was to provide a reference to improve understanding of diagnosis, treatment choice and prognosis assessment of epithelioid angiosarcoma. The current study reports the case of a 44-year-old woman with epithelioid angiosarcoma located in the deep soft tissue of the lower extremities. Physical examination of the right thigh revealed a palpable hard mass and movement was clearly restricted and painful. X-ray, computed tomography (CT) scans and magnetic resonance imaging (MRI) were used to evaluate the imaging features of the tumor. Using X-ray and CT scanning, an inhomogenous tumor with osteolytic osseous destruction was observed. MRI revealed that the bordering skeletal muscles were infiltrated. The patient was treated with palliative surgery and chemotherapy, but succumbed to disease 1 year later.
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Affiliation(s)
- Lulu Lv
- Department of Computed Tomography and Magnetic Resonance Imaging, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Peng Xu
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu 221006, P.R. China
| | - Yibing Shi
- Department of Computed Tomography and Magnetic Resonance Imaging, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Jingming Hao
- Department of Computed Tomography and Magnetic Resonance Imaging, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Chunai Hu
- Department of Computed Tomography and Magnetic Resonance Imaging, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Baozhong Zhao
- Department of Computed Tomography and Magnetic Resonance Imaging, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
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35
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Abstract
Epithelioid sarcoma (ES) is a rare, aggressive soft-tissue neoplasm of uncertain differentiation, characterized by nodular aggregates of epithelioid cells, which are immunoreactive to cytokeratins (CKs) and epithelial membrane antigen, and often for CD34. It has a propensity for multifocal disease at presentation, local recurrence, and regional metastasis. These are aggressive neoplasms with particularly poor prognosis after regional or distant metastatic disease, for which surgical resection is still the mainstay of treatment, and options for patients with metastatic disease remain undefined. There are 2 distinct variants: classic ES, which typically presents as a subcutaneous or deep dermal mass in the distal extremities of young adults and comprises nodular distributions of relatively uniform epithelioid cells with central necrosis, and the proximal variant, which has a predilection for proximal limbs and limb girdles and the midline of the trunk, which is composed of sheets of larger, more atypical cells with variable rhabdoid morphology. Both classic and proximal-type ESs are associated with the loss of SMARCB1/INI1 protein expression, but appear otherwise molecularly relatively heterogeneous. We review classic and proximal-type ES, discussing morphology, immunohistochemical and genetic findings, the differential diagnosis, and the future potential for targeted therapies.
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36
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Noujaim J, Thway K, Bajwa Z, Bajwa A, Maki RG, Jones RL, Keller C. Epithelioid Sarcoma: Opportunities for Biology-Driven Targeted Therapy. Front Oncol 2015; 5:186. [PMID: 26347853 PMCID: PMC4538302 DOI: 10.3389/fonc.2015.00186] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 08/03/2015] [Indexed: 12/31/2022] Open
Abstract
Epithelioid sarcoma (ES) is a soft tissue sarcoma of children and young adults for which the preferred treatment for localized disease is wide surgical resection. Medical management is to a great extent undefined, and therefore for patients with regional and distal metastases, the development of targeted therapies is greatly desired. In this review, we will summarize clinically relevant biomarkers (e.g., SMARCB1, CA125, dysadherin, and others) with respect to targeted therapeutic opportunities. We will also examine the role of EGFR, mTOR, and polykinase inhibitors (e.g., sunitinib) in the management of local and disseminated disease. Toward building a consortium of pharmaceutical, academic, and non-profit collaborators, we will discuss the state of resources for investigating ES with respect to cell line resources, tissue banks, and registries so that a roadmap can be developed toward effective biology-driven therapies.
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Affiliation(s)
| | | | - Zia Bajwa
- Children's Cancer Therapy Development Institute , Fort Collins, CO , USA
| | - Ayeza Bajwa
- Children's Cancer Therapy Development Institute , Fort Collins, CO , USA
| | - Robert G Maki
- Adult and Paediatric Sarcoma Program, Tisch Cancer Institute, Mount Sinai School of Medicine , New York, NY , USA
| | | | - Charles Keller
- Children's Cancer Therapy Development Institute , Fort Collins, CO , USA
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37
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Hompland I, Rizvi SMH, Winge M, Norum OJ, Bjerkehagen B, Ringen HO, Taksdal I, Mørk NJ, Hall KS. [A boy with a wound on his finger that would not heal]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2015; 135:445-8. [PMID: 25761032 DOI: 10.4045/tidsskr.14.0759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- Ivar Hompland
- Avdeling for kreftbehandling Oslo universitetssykehus, Radiumhospitalet
| | | | - Mona Winge
- Seksjon for overekstremitets- og mikrokirurgi Ortopedisk avdeling Oslo universitetssykehus, Rikshospitalet
| | - Ole-Jacob Norum
- Seksjon for onkologisk ortopedi Ortopedisk avdeling Oslo universitetssykehus, Radiumhospitalet
| | - Bodil Bjerkehagen
- Seksjon for barnekreft, øre-nese-hals, sarkom, nevro og hematopatologi. Avdeling for patologi Oslo universitetssykehus, Radiumhospitalet
| | - Hanne Osnes Ringen
- Seksjon for overekstremitets- og mikrokirurgi Ortopedisk avdeling Oslo universitetssykehus, Rikshospitalet
| | - Ingeborg Taksdal
- Enhet for onkologisk radiologi Avdeling for radiologi og nukleærmedisin Oslo universitetssykehus, Radiumhospitalet
| | - Nils-Jørgen Mørk
- Seksjon for hudsykdommer Oslo universitetssykehus, Rikshospitalet
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Asano N, Yoshida A, Ogura K, Kobayashi E, Susa M, Morioka H, Iwata S, Ishii T, Hiruma T, Chuman H, Kawai A. Prognostic Value of Relevant Clinicopathologic Variables in Epithelioid Sarcoma: A Multi-Institutional Retrospective Study of 44 Patients. Ann Surg Oncol 2015; 22:2624-32. [PMID: 25663591 PMCID: PMC4521088 DOI: 10.1245/s10434-014-4294-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Indexed: 02/05/2023]
Abstract
Background Epithelioid sarcoma (ES) is an extremely rare soft tissue sarcoma. Recently, the proximal variant has been reported to be a more aggressive subtype; however, as most reports of ES have involved small case series, the actual prognostic implications remain unclear. We investigated the clinicopathological features of patients with ES to identify the prognostic factors that influence survival. Methods We retrospectively analyzed the clinicopathological features of 44 patients with ES who had been treated at our institutions between 1991 and 2011. Among these patients, 26 were diagnosed histologically as having classic-type ES, whereas the remaining 18 had proximal-type ES. Thirty-three of the patients, all without distant metastases, underwent curative surgery, and the remaining 11 with distant metastases (M1) received palliative treatment. Results The proximal subtype was significantly correlated with a proximal tumor location, distant metastases at presentation, presence of rhabdoid cells, a higher tumor grade, and vascular invasion. The overall survival (OS) rate at 5 years for the 44 patients was 45 %. A superficial tumor location and lymph node metastases (N1) at presentation were independently predictive of local recurrence-free survival (LRFS), and N1 and M1 tumors were independently predictive of distant metastasis-free survival and OS, respectively. The proximal subtype was associated with unfavorable LRFS and OS, although not to a statistically significant degree. Conclusions Proximal-type ES has significantly more aggressive clinicopathological features than classic-type ES, and lymph node or distant metastasis has the most critical impact on prognosis.
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Affiliation(s)
- Naofumi Asano
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
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39
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microRNAs and Soft Tissue Sarcomas. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 889:179-99. [DOI: 10.1007/978-3-319-23730-5_10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Abstract
BACKGROUND Sarcomas count among the very rare malignancies of the orbit. Epithelioid sarcomas typically occur in the subcutaneous tissue of younger patients; an affected orbit constitutes a rarity. OBJECTIVES Only three cases of this extremely rare disease of the orbit, which is associated with marked aggressiveness and a very poor prognosis, have been analysed in the worldwide current literature. PATIENT AND METHODS We present a case report together with a literature review. A rapidly progressing painful proptosis with visual loss occurred in a 30-year-old patient. Imaging and invasive diagnostic procedures were initiated as a consequence of this. RESULTS Diagnostic imaging revealed an infiltrative process of the right orbit. Following endonasal decompression of the orbit and probe acquisition, histological and immunohistochemical tests showed the presence of a proximal type epithelioid sarcoma. Therapy consisted of orbit exenteration together with implantation of titanium miniplates for orbital prosthesis. During the course of disease, osseous metastases developed. The patient died during palliative chemotherapy, 14 months after the initial diagnosis. CONCLUSION Epithelioid sarcomas are extremely rare, difficult to treat tumours in the head and neck region. The associated mortality rates are high. Aggressive surgical therapy with intensive follow-up is recommended. The prognosis depends upon the resection status.
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Affiliation(s)
- M Thranitz
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Plastische Operationen, Städtisches Klinikum Dessau, Auenweg 38, 06847, Dessau-Roßlau, Deutschland
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41
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Fujiwara T, Kunisada T, Takeda K, Uotani K, Yoshida A, Ochiya T, Ozaki T. MicroRNAs in soft tissue sarcomas: overview of the accumulating evidence and importance as novel biomarkers. BIOMED RESEARCH INTERNATIONAL 2014; 2014:592868. [PMID: 25165708 PMCID: PMC4139009 DOI: 10.1155/2014/592868] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 07/09/2014] [Indexed: 12/11/2022]
Abstract
Sarcomas are distinctly heterogeneous tumors and a variety of subtypes have been described. Although several diagnostic explorations in the past three decades, such as identification of chromosomal translocation, have greatly improved the diagnosis of soft tissue sarcomas, the unsolved issues, including the limited useful biomarkers, remain. Emerging reports on miRNAs in soft tissue sarcomas have provided clues to solving these problems. Evidence of circulating miRNAs in patients with soft tissue sarcomas and healthy individuals has been accumulated and is accelerating their potential to develop into clinical applications. Moreover, miRNAs that function as novel prognostic factors have been identified, thereby facilitating their use in miRNA-targeted therapy. In this review, we provide an overview of the current knowledge on miRNA deregulation in soft tissue sarcomas, and discuss their potential as novel biomarkers and therapeutics.
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Affiliation(s)
- Tomohiro Fujiwara
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 7008558, Japan
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama 7008558, Japan
| | - Toshiyuki Kunisada
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 7008558, Japan
- Department of Medical Materials for Musculoskeletal Reconstruction, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 7008558, Japan
| | - Ken Takeda
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 7008558, Japan
- Department of Intelligent Orthopaedic System, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 7008558, Japan
| | - Koji Uotani
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 7008558, Japan
| | - Aki Yoshida
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 7008558, Japan
| | - Takahiro Ochiya
- Division of Molecular and Cellular Medicine, National Cancer Center Research Institute, Tokyo 1040045, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 7008558, Japan
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Guy JB, Trone JC, Chargari C, Falk AT, Khodri M, Magné N. Epithelioid hemangioendothelioma of the spine treated with RapidArc volumetric-modulated radiotherapy. Med Dosim 2014; 39:242-5. [PMID: 24833300 DOI: 10.1016/j.meddos.2014.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 01/24/2014] [Accepted: 03/19/2014] [Indexed: 02/04/2023]
Abstract
Radiotherapy for epithelioid hemangioendothelioma (EHE) using volumetric intensity-modulated arc radiotherapy (VMAT). A 48-year-old woman was referred for curative irradiation of a vertebral EHE after failure of surgery. A comparison between VMAT and conventional conformal tridimensional (3D) dosimetry was performed and potential advantage of VMAT for sparing critical organs from irradiation's side effects was discussed. The total delivered dose on the planning target volume was 54 Gy in 27 fractions. The patient was finally treated with VMAT. The tolerance was excellent. There was no acute toxicity, including no increase in pain. With a follow-up of 18 months, no delayed toxicity was reported. The clinical response consisted of a decrease in the dorsal pain. The Dmax for the spinal cord was reduced from 55 Gy (3D-radiotherapy [RT]) (which would be an unacceptable dose to the spine because of the risk of myelopathy) to 42.8 Gy (VMAT), which remains below the recommended dose threshold (45 Gy). The dose delivered to 20% of organ volume (D20) was reduced from 47 Gy (3D-RT) to 3 Gy (VMAT) for the spinal cord. The study shows that VMAT allows the delivery of curative treatment for vertebral EHEs because of critical organ sparing.
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Affiliation(s)
- Jean-Baptiste Guy
- Department of Radiotherapy, Institut de Cancérologie de la Loire, St Priest en Jarez, France
| | - Jane-Chloé Trone
- Department of Radiotherapy, Institut de Cancérologie de la Loire, St Priest en Jarez, France
| | - Cyrus Chargari
- Department of Radiation Oncology, HIA du Val de Grâce, Paris, France
| | | | - Mustapha Khodri
- Department of Physics, Institut de Cancérologie de la Loire, St Priest en Jarez, France
| | - Nicolas Magné
- Department of Radiotherapy, Institut de Cancérologie de la Loire, St Priest en Jarez, France.
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Abstract
The study of sarcoma pathology is a rapidly evolving field. The continued refinement of classic diagnostic techniques in conjunction with the molecular diagnostics has resulted in an abundance of data regarding this diverse and rare group of tumors. We anticipate that cutting edge technology including next generation sequencing will continue to further our understanding of saromagenesis and enable more precise classification and diagnosis of sarcomas in the future.
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Kim W, Fournier A, Thomazeau H, Ropars M. [Reconstruction of the thumb for an epithelioid sarcoma using a kite flap. A case report]. ACTA ACUST UNITED AC 2013; 32:345-9. [PMID: 24075501 DOI: 10.1016/j.main.2013.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 08/07/2013] [Accepted: 08/11/2013] [Indexed: 11/30/2022]
Abstract
Epithelioid sarcoma is a rare lesion usually involving extremities. We report the case of a patient presenting with an epithelioid sarcoma of the dorsal aspect of the thumb. Surgical treatment consisted in a wide resection, arthrodesis of the metacarpophalangeal joint of the thumb and skin coverage with a kite flap. This case report illustrates a rare diagnosis potentially encountered by hand surgeons and the possible use of a kite flap in a non-traumatic context.
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Affiliation(s)
- W Kim
- Unité du membre supérieur, service de chirurgie orthopédique, centre hospitalier et universitaire Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
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45
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Levy A, Le Péchoux C, Terrier P, Bouaita R, Domont J, Mir O, Coppola S, Honoré C, Le Cesne A, Bonvalot S. Epithelioid Sarcoma: Need for a Multimodal Approach to Maximize the Chances of Curative Conservative Treatment. Ann Surg Oncol 2013; 21:269-76. [DOI: 10.1245/s10434-013-3247-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Indexed: 11/18/2022]
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Sullivan LM, Folpe AL, Pawel BR, Judkins AR, Biegel JA. Epithelioid sarcoma is associated with a high percentage of SMARCB1 deletions. Mod Pathol 2013; 26:385-92. [PMID: 23060122 PMCID: PMC3556344 DOI: 10.1038/modpathol.2012.175] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
SMARCB1 gene alterations were first described in highly malignant rhabdoid tumors of the kidney, brain (atypical teratoid/rhabdoid tumor) and soft tissue. An increasing number of tumors have now shown loss of SMARCB1 protein expression by immunohistochemistry, including the majority of epithelioid sarcomas. However, investigations of SMARCB1 gene alterations in epithelioid sarcoma have produced conflicting results. The aim of this study was to evaluate SMARCB1 status using Sanger sequencing of the coding region and multiplex ligation-dependent probe amplification, a rapid and sensitive method for detecting intragenic deletions and duplications, which has not been used in previous studies. Twenty-one epithelioid sarcomas of both classical and proximal type were selected for SMARCB1 gene testing and SMARCB1 immunohistochemistry. Nineteen of 21 (90%) epithelioid sarcomas were SMARCB1 negative by immunohistochemistry. Twelve of the 19 (63%) had adequate DNA recovery for evaluation. Ten of 12 (83%) tumors showed homozygous deletions of the gene. Two cases showed heterozygous deletions and polymorphisms, but no sequence mutations. These results confirm the high frequency of SMARCB1 deletions in epithelioid sarcoma and show that multiplex ligation-dependent probe amplification is a reliable method for detection of deletions in these cases, which can be performed on formalin-fixed, paraffin-embedded tissue. Given the high percentage of SMARCB1 alterations in epithelioid sarcoma, these findings argue against using SMARCB1 gene deletion as a tool in distinguishing them from malignant rhabdoid tumors.
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Affiliation(s)
- Lisa M. Sullivan
- Department of Pathology and Laboratory Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA USA
| | - Andrew L. Folpe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Bruce R. Pawel
- Department of Pathology and Laboratory Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA USA
| | - Alexander R. Judkins
- Department of Pathology and Laboratory Medicine, Children’s Hospital Los Angeles, Keck School of Medicine University of Southern California, Los Angeles, CA USA
| | - Jaclyn A. Biegel
- Department of Pathology and Laboratory Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA USA,Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA USA
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48
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Guzzetta AA, Montgomery EA, Lyu H, Hooker CM, Meyer CF, Loeb DM, Frassica D, Weber KL, Ahuja N. Epithelioid sarcoma: one institution's experience with a rare sarcoma. J Surg Res 2012; 177:116-22. [PMID: 22575361 DOI: 10.1016/j.jss.2012.04.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Revised: 03/25/2012] [Accepted: 04/11/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Epithelioid sarcomas (ES) are extremely rare soft tissue sarcomas. As such, their clinical behavior and response to treatment are poorly described in the literature. METHODS We queried the centralized cancer registry and pathology archives at the Johns Hopkins Medical Institution and identified 22 patients with a diagnosis of ES. We excluded two patients because of inadequate data. A pathologist reviewed patient charts and reexamined available histological slides. This study was performed with institutional review board approval. RESULTS The median age at diagnosis was 27.8 y; most patients (75%) were male. Regional lymph node metastases were present in 10% of patients at presentation. The majority of tumors (57.9%) recurred and 35% recurred more than once, although the number of recurrences did not affect survival (P = 0.48). Patients did not experience a decrease in time to recurrence with increasing number of resections. The median time between resection and recurrence was 1.23 y and the maximum was 18.8 y. Median overall survival was 56.2 mo and 5-y survival was 92%. CONCLUSIONS Our study reveals that ES is an extremely rare tumor with a protracted and recurrent course, but overall survival may be more favorable than in the past. Patients benefit from aggressive and repeated resection. Epithelioid sarcoma is unique because it metastasizes to regional nodal basins. Extended surveillance is indicated, because recurrences can appear after decades of quiescence.
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Affiliation(s)
- Angela A Guzzetta
- Department of Surgery, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
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Livi L, Shah N, Paiar F, Fisher C, Judson I, Moskovic E, Thomas M, Harmer C. Treatment of epithelioid sarcoma at the royal marsden hospital. Sarcoma 2011; 7:149-52. [PMID: 18521379 PMCID: PMC2395532 DOI: 10.1080/13577140310001644760] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Purpose: The aim of this study was to assess treatment and outcome with respect to clinical and pathological features. Patients and methods: Thirty-nine patients were identified (range 7–66 years, mean 23). Initial treatment comprised local
excision in 11 patients and wide excision in 14. Post-operative external beam radiotherapy was prescribed in 22 patients
with a total dose of 60 Gy, delivered in two phases. Results: The cause-specific survival for the entire group was 79, 63, 56 and 45% at 1, 3, 5 and 10 years, respectively. A distal
limb location was associated with a better prognosis than proximal limb location (P = 0.04). Conclusions: Our data favour treatment with wide functional excision followed by radical dose radiotherapy in attempt to
minimize risk of local recurrence, especially when primary tumours are bigger than 3 cm. Our data also suggest the same
treatment for local recurrence, when technically possible, to avoid amputation.
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Affiliation(s)
- L Livi
- Radiotherapy Department Florence University Florence Italy
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50
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Sakharpe A, Lahat G, Gulamhusein T, Liu P, Bolshakov S, Nguyen T, Zhang P, Belousov R, Young E, Xie X, Rao P, Hornick JL, Lazar AJ, Pollock RE, Lev D. Epithelioid sarcoma and unclassified sarcoma with epithelioid features: clinicopathological variables, molecular markers, and a new experimental model. Oncologist 2011; 16:512-22. [PMID: 21357725 DOI: 10.1634/theoncologist.2010-0174] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Epithelioid sarcoma (ES) and unclassified sarcoma with epithelioid features (USEF) are clinically and therapeutically unresolved. We compared ES and USEF patients' clinical behavior, treatment, outcome, and molecular marker expression. Furthermore, preclinical ES study models were developed to enable comprehensive benchside investigations. PATIENTS AND METHODS A database of ES and USEF patients (n = 116) treated since 1992 was created. A clinically annotated ES-USEF tissue microarray (TMA) was assayed for tumor-related markers. Newly established human and commercially available ES cell lines were characterized and tested in vivo. RESULTS ES and USEF patients presenting with localized disease exhibited 22% and 25% local recurrence rates, 35% and 19% nodal metastasis rates, and 41% and 53% distant metastasis rates (median follow-up, 54 months and 39 months, respectively). The 5- and 10-year disease-specific survival rates were 88% and 43% and 52% and 42% (ES and USEF, respectively). TMA immunohistochemistry identified integrase interactor (INI)-1 loss, cancer antigen 125, and p53 nuclear expression as significantly more common in ES than USEF cases. Both cell lines preserved ES morphological and biochemical characteristics in vitro and in vivo; loss of INI-1 was shown to occur in both lines. CONCLUSIONS Enhanced knowledge of ES and USEF clinical behavior, marker expression, and molecular determinants, extended via experimental models, will hopefully accelerate development of urgently needed effective targeted therapies for ES and USEF.
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Affiliation(s)
- Aniket Sakharpe
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas 77054, USA
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