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Kumar A, Joshi P, K SC, Singh B, Deori A, Sharda P, Ravi B, Syed A. Pectoralis major muscle sarcoma masquerading breast lesion: A rare case report with review of literature. Radiol Case Rep 2023; 18:1282-1285. [PMID: 36691414 PMCID: PMC9860174 DOI: 10.1016/j.radcr.2022.12.042] [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: 07/27/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023] Open
Abstract
Pectoralis major muscle sarcomas are extremely rare and can mimic breast lesion clinically. We report a case of poorly differentiated sarcoma of the pectoralis major muscle in a 63-year-old woman of south east Asian ethnicity presenting with a progressively increasing right breast lump. Mammography, ultrasonography (US), contrast-enhanced computed tomography, and biopsy were done to make the final diagnosis. Complete surgical excision was planned but deferred due to pulmonary metastasis, and the patient was treated with palliative chemotherapy. Clinical examination may be confusing but radiological and pathological investigations provide detailed information about the location and the extent of the disease and a definitive tissue diagnosis can only be made on histopathology which will be helpful in preoperative planning and further treatment of the patient.
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Affiliation(s)
- Anamika Kumar
- Integrated Breast Care Centre, All India Institute of Medical Sciences, Rishikesh, 249203, India
- Corresponding author.
| | - Pranjali Joshi
- Integrated Breast Care Centre, All India Institute of Medical Sciences, Rishikesh, 249203, India
| | - Satish Chaitanya K
- Integrated Breast Care Centre, All India Institute of Medical Sciences, Rishikesh, 249203, India
| | - Bhagyashree Singh
- Department of Pathology, Government Medical College, Haldwani, Uttarakhand, India
| | - Ananya Deori
- Integrated Breast Care Centre, All India Institute of Medical Sciences, Rishikesh, 249203, India
| | - Prateek Sharda
- Integrated Breast Care Centre, All India Institute of Medical Sciences, Rishikesh, 249203, India
| | - Bina Ravi
- Integrated Breast Care Centre, All India Institute of Medical Sciences, Rishikesh, 249203, India
| | - Anjum Syed
- Integrated Breast Care Centre, All India Institute of Medical Sciences, Rishikesh, 249203, India
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Li W, Zhang S, Fan W, Li D, Tian H, Che D, Yu L, Gao S, Liu Y. Sonographic imaging features of alveolar soft part sarcoma: Case series and literature review. Medicine (Baltimore) 2022; 101:e31905. [PMID: 36401473 PMCID: PMC9678532 DOI: 10.1097/md.0000000000031905] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Alveolar soft part sarcoma (ASPS) is a rare tumor but potentially fatal condition. Understanding the imaging and clinical features of ASPS is of certain value for preoperative qualitative diagnosis and clinical treatment of tumors. Nevertheless, there have been only 11 documented case reports describing the sonographic features in the English literature. METHODS Three patients with confirmed ASPS occurring primarily in the limbs were enrolled in this study. Complete surgical excision was performed with conservative limb function. We pay particular attention to the ultrasonographic features and performed a literature review of ASPS cases. RESULTS With regular surveillance, one patient had no symptom recurrence and two developed lung and/or breast metastasis later. The specific sonographic findings were heterogeneous hypoechoic, well-circumscribed, and lobulated or round contours on grayscale images, abundant flow signals of intratumoral and extratumoral tubular structures on color Doppler images. CONCLUSION SUBSECTIONS Its low incidence rate and lack of characteristic clinical manifestations often result in misdiagnosis of ASPS. The specific sonographic findings may add useful diagnostic information.
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Affiliation(s)
- Wenxue Li
- Department of Ultrasound, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Shanshan Zhang
- Department of Ultrasound, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Wenting Fan
- Department of Ultrasound, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Diancheng Li
- Department of Ultrasound, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Hui Tian
- Department of Ultrasound, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Dongdong Che
- Department of Ultrasound, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Lei Yu
- Department of Ultrasound, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Shuang Gao
- Department of Ultrasound, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Yiqun Liu
- Department of Ultrasound, Peking University People’s Hospital, Beijing, People’s Republic of China
- * Correspondence: Yiqun Liu, Department of Ultrasound, Peking University People’s Hospital, 11 Xizhimen South Street, Beijing 100044, People’s Republic of China (e-mail: )
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Wu J, Brinker DA, Haas M, Montgomery EA, Argani P. Primary Alveolar Soft Part Sarcoma (ASPS) of the Breast. Int J Surg Pathol 2016; 13:81-5. [PMID: 15735860 DOI: 10.1177/106689690501300112] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Alveolar soft part sarcoma (ASPS) is a rare neoplasm that most commonly presents in the lower extremities. Although ASPS has distinctive histologic features, it may cause diagnostic problems when it arises in unusual locations. To our knowledge, only 1 case of ASPS arising within the breast has previously been reported. Here, we report a second case of primary mammary ASPS. The patient was a 44-year-old woman who presented with a breast mass. Needle biopsy was performed, yielding a polygonal cell lesion with abundant, predominantly xanthomatous cytoplasm. The cells labeled strongly for the histiocytic marker CD68, suggesting a benign macrophage-rich lesion. However, the unusual nature of the lesion as well as the prominence of nucleoli prompted suggestion for an excision. The excision more clearly revealed the lesion's alveolar architecture and demonstrated cells with more eosinophilic cytoplasm, along with the xanthomatous cells. The diagnosis of ASPS was confirmed by electron microscopy, which revealed characteristic membranebound rhomboidal crystals, as well as by nuclear labeling for TFE3 protein by immunohistochemistry. With this report, we confirm the utility of a novel immunohistochmical technique for the identification of an ASPS presenting in an unusual locale.
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Affiliation(s)
- Julie Wu
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21231-2410, USA
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Giordano G, D'Adda T, Varotti E, Crovini G, Silini EM. Primary alveolar soft part sarcoma of uterine corpus: a case report with immunohistochemical, ultrastructural study and review of literature. World J Surg Oncol 2016; 14:24. [PMID: 26837430 PMCID: PMC4736659 DOI: 10.1186/s12957-016-0780-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/26/2016] [Indexed: 12/02/2022] Open
Abstract
Background Alveolar soft part sarcoma (ASPS) is a rare mesenchymal malignancy. ASPS usually occurs most commonly in the deep soft tissues of the thigh and buttock or the head and neck regions. ASPS that originate from the uterine corpus are even more rare, with only 10 previous cases reported in the English literature. Case presentation In our case, the alveolar features were completely lost and the tumour shows a solid, non-alveolar pattern and the nuclei have marked variation in nuclear size, and multinucleation. The correct pathological diagnosis has been made by immuno- histochemical and ultrastructural features, which rvealed overexpression of TFE3 and peculiar cytoplasmic crystalline inclusions. In this paper, an additional case of primary ASPS of uterine corpus is reported with immunohistochemical, ultrastructural study and review of literature in the effort to delineate its clinical and pathological features. In this unusual site, the diagnosis can be problematic because ASPS can mimic other primary or metastatic uterine neoplasms. Conclusions Thus, in this unusual presentation an essential diagnostic marker is the nuclear over-expression of TFE3 as well as ultrastructural study, which reveals the presence of peculiar cytoplasmic crystalline inclusions.
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Affiliation(s)
- Giovanna Giordano
- Department of Biomedical, Biotechnological and Translational Sciences, Pathological Anatomy and Histology Unit, Faculty of Medicine, University of Parma, Via Antonio Gramsci, 14, 43126, Parma, Italy.
| | - Tiziana D'Adda
- Department of Biomedical, Biotechnological and Translational Sciences, Pathological Anatomy and Histology Unit, Faculty of Medicine, University of Parma, Via Antonio Gramsci, 14, 43126, Parma, Italy
| | - Elena Varotti
- Department of Biomedical, Biotechnological and Translational Sciences, Pathological Anatomy and Histology Unit, Faculty of Medicine, University of Parma, Via Antonio Gramsci, 14, 43126, Parma, Italy
| | - Giuseppe Crovini
- Department of Gynaecology and Obstetrics, Hospital of Fidenza, Parma, Italy
| | - Enrico Maria Silini
- Department of Biomedical, Biotechnological and Translational Sciences, Pathological Anatomy and Histology Unit, Faculty of Medicine, University of Parma, Via Antonio Gramsci, 14, 43126, Parma, Italy
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Williams A, Bartle G, Sumathi VP, Meis JM, Mangham DC, Grimer RJ, Kindblom LG. Detection of ASPL/TFE3 fusion transcripts and the TFE3 antigen in formalin-fixed, paraffin-embedded tissue in a series of 18 cases of alveolar soft part sarcoma: Useful diagnostic tools in cases with unusual histological features. Virchows Arch 2011; 458:291-300. [DOI: 10.1007/s00428-010-1039-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Accepted: 12/29/2010] [Indexed: 10/18/2022]
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Primary alveolar soft part sarcoma of vertebra: a case report and literature review. Skeletal Radiol 2009; 38:825-9. [PMID: 19347336 DOI: 10.1007/s00256-009-0696-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 03/15/2009] [Accepted: 03/23/2009] [Indexed: 02/02/2023]
Abstract
Alveolar soft part sarcoma (ASPS) is a rare malignant soft tissue tumor, which rarely occurs in bone. We present a case of ASPS in a 23-year-old man with a 2-month history of back pain. Computed tomography scanning and magnetic resonance images demonstrated a destructive process in the 12th thoracic vertebra associated with a unilateral soft tissue mass. The tumor showed evidence of hypervascularity on MRI; it obviously was enhanced on T1-weighted images after injection of Gd-GDPA, and signal voids were shown on all pulse sequences which may help to differentiate ASPS from other tumors of the vertebra. We believe that this is the first case of ASPS arising in a vertebra.
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Pang LJ, Chang B, Zou H, Qi Y, Jiang JF, Li HA, Hu WH, Chen YZ, Liu CX, Zhang WJ, Li F. Alveolar Soft Part Sarcoma: A Bimarker Diagnostic Strategy Using TFE3 Immunoassay and ASPL-TFE3 Fusion Transcripts in Paraffin-Embedded Tumor Tissues. ACTA ACUST UNITED AC 2008; 17:245-52. [DOI: 10.1097/pdm.0b013e31815d68d7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bu X, Bernstein L. A proposed explanation for female predominance in alveolar soft part sarcoma. Cancer 2005; 103:1245-53. [PMID: 15693033 DOI: 10.1002/cncr.20899] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Alveolar soft-part sarcoma (ASPS) is a rare malignant soft tissue tumor with both clinically and morphologically distinct features. It often involves the extremities of adolescents and young adults and shows a predilection for females. Recently, ASPS was found to have a nonreciprocal der(17)t(X;17) translocation with the corresponding fusion gene located in chromosome 17. Because females have an extra X-chromosome, their likelihood of developing an X;autosome translocation is theoretically double that of males, and thus, this extra X-chromosome is a likely explanation for female predominance of ASPS. METHODS The authors used data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry program, which included 87 ASPS cases (33 males and 54 females), and published ASPS cases, which included 317 cases (121 males and 196 females), to test our hypothesis. The authors compared the observed proportion of female cases with that expected under the two X-chromosomes-double-risk hypothesis including the consideration of X-inactivation status. RESULTS The hypothesis that the fusion gene is not subject to X-inactivation is supported by data (P = 0.6, 0.24, and 0.20 for SEER cases, published cases, and their combination, respectively). In contrast, the competing hypothesis that the fusion gene is subject to X-inactivation is rejected (P = 0.007, < 0.00001, and < 0.00001 for SEER cases, published cases, and their combination, respectively). CONCLUSIONS Therefore, the authors found a statistical association between the female predominance observed in ASPS and female possession of an extra X-chromosome/noninactivation of the ASPS X;autosome translocation fusion gene.
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Affiliation(s)
- Xiangdong Bu
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
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Sanjuan X, Sobel ME, Yang J, Merino MJ. Alveolar soft part sarcoma: the role of prognostic markers. Ann Diagn Pathol 2000; 4:135-42. [PMID: 10919382 DOI: 10.1016/s1092-9134(00)90035-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Alveolar soft part sarcoma (ASPS) is a rare malignant neoplasm characterized by slow growth and indolent behavior. The role of proliferative markers and tumor suppressor genes is unknown in these tumors. To investigate their potential role in diagnosis and prognosis, we studied 13 cases of primary ASPS and 14 metastases and correlated them with clinicopathologic parameters. Immunohistochemistry was performed with anti-p53 and anti-Ki-67 antibodies. Polymerase chain reaction after tumor microdissection was performed to search for possible loss of heterozygosity in chromosomes 1p, 9p, 17q, 22q, and TP53 to identify possible changes that may clarify the histogenesis of these tumors. Four of five (80%) primary ASPS cases were positive for Ki-67 and all of them developed later metastases. One patient whose tumor did not stain for Ki-67 remained free of disease for 9 years. Eleven of 13 (85%) metastases were positive for Ki-67; however, there was no correlation with final outcome. All the primary ASPS cases analyzed for p53 yielded negative results, but two (15%) of 13 metastases were weakly positive. There was no correlation of these markers with prognosis or clinicopathologic parameters. No loss of heterozygosity was found except in one of nine (11%) informative metastases for D1S165 (at 1p36). Our preliminary data suggest that Ki-67-positive immunostaining may be a prognostic indicator for the development of metastases in ASPS.
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Affiliation(s)
- X Sanjuan
- Laboratory of Pathology and the Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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