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Dashti NK, Jebastin Thangaiah J, Gliem T, Knutson D, Kloft-Nelson S, Armstrong SM, Bakhshwin A, Greipp P, Fritchie KJ. MDM2 Amplification Status in a Cohort of Well-Characterized Myxofibrosarcoma: A Clinicopathologic Analysis of 22 Tumors. Int J Surg Pathol 2024; 32:478-485. [PMID: 37501528 DOI: 10.1177/10668969231186930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Myxofibrosarcomas (MFS) present as slowly enlarging superficial masses in elderly patients. Even though these tumors fail to exhibit a distinct immunophenotype, diagnosis is straightforward when they present in subcutaneous tissue. Intramuscular MFS, however, are more challenging to diagnose as the differential also includes dedifferentiated liposarcoma with myxoid features. The vast majority of dedifferentiated liposarcomas show MDM2 amplification, whereas limited data exists as to the MDM2 status of MFS. We sought to explore the rate of MDM2 amplification in cases of classic MFS. Our archives were searched for MFS; only subcutaneous well-sampled resections were included. FISH for MDM2 amplification was performed on each tumor. A cohort of myxoid dedifferentiated liposarcoma resections was studied for comparison. Twenty-two MFS arose in patients aged 44 to 85 years. All tumors contained an infiltrative population of atypical cells embedded in a myxoid stroma with curvilinear blood vessels. MDM2 amplification by FISH was identified in 3 (of 22; 14%) tumors. Available follow up on 17 patients (range 1-96 months; median 13 months) revealed 6 patients with local recurrence and 1 with distant metastasis. Of 3 patients with MDM2- amplified MFS, 1 experienced recurrence and died of unrelated causes, while the second was alive without disease 12 months after diagnosis. Even though the rate of MDM2 amplification by FISH in MFS appears to be low, a subset of cases may show this genetic alteration, which pathologists should be aware of to avoid misclassification as myxoid dedifferentiated liposarcomas. Further studies are necessary to determine if amplification status adds prognostic value.
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Affiliation(s)
- Nooshin K Dashti
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Troy Gliem
- Division of Laboratory Genetics and Genomics, Mayo Clinic, Rochester, MN, USA
| | - Darlene Knutson
- Division of Laboratory Genetics and Genomics, Mayo Clinic, Rochester, MN, USA
| | - Sara Kloft-Nelson
- Division of Laboratory Genetics and Genomics, Mayo Clinic, Rochester, MN, USA
| | - Susan M Armstrong
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ahmed Bakhshwin
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Patricia Greipp
- Division of Laboratory Genetics and Genomics, Mayo Clinic, Rochester, MN, USA
| | - Karen J Fritchie
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
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Kawaguchi K, Kohashi K, Sagiyama K, Hashisako M, Nabeshima A, Setsu N, Endo M, Iwasaki T, Nakashima Y, Oda Y. Low-grade central osteosarcoma with extraosseous dedifferentiation: a rare case. Skeletal Radiol 2024:10.1007/s00256-024-04647-x. [PMID: 38467824 DOI: 10.1007/s00256-024-04647-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/01/2024] [Accepted: 03/05/2024] [Indexed: 03/13/2024]
Abstract
Low-grade central osteosarcoma (LGCOS), which arises from the intramedullary cavity of the metaphysis of long bones, occasionally exhibits extraosseous spread. Approximately 10-30% of patients with LGCOS exhibit dedifferentiation, but it is rare to experience a primary tumor with a dedifferentiated component. A 38-year-old female patient presented with right knee pain for two months. Imaging studies revealed a bone mass with extraosseous involvement. Wide resection was performed, and pathologic examination led to the diagnosis of LGCOS with a dedifferentiated extraosseous lesion. A single defect in the bone cortex constituted the boundary between the low- and high-grade components. The extraosseous high-grade component included more tumor cells with p53 overexpression and more murine double minute 2 (MDM2) copies compared with the low-grade component. These genetic mutations and copy number alterations can be associated with malignant transformation of LGCOS.
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Affiliation(s)
- Kengo Kawaguchi
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Kenichi Kohashi
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Koji Sagiyama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Higashi-Ku, Fukuoka, Japan
| | - Mikiko Hashisako
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Akira Nabeshima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Nokitaka Setsu
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Makoto Endo
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Takeshi Iwasaki
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
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Chiu CY, Lin TP, Hang JF, Huang HE, Kao TH, Shen SH. Retroperitoneal dedifferentiated liposarcoma with rare heterologous low-grade osteosarcoma: A case report. Radiol Case Rep 2024; 19:1073-1077. [PMID: 38229602 PMCID: PMC10789934 DOI: 10.1016/j.radcr.2023.11.085] [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: 09/12/2023] [Revised: 11/21/2023] [Accepted: 11/30/2023] [Indexed: 01/18/2024] Open
Abstract
Dedifferentiated liposarcoma is a high-grade entity developed from a preexisting or recurrent well-differentiated liposarcoma, and rarely, it may contain divergent differentiation. We presented the case of a 39-year-old woman with retroperitoneal dedifferentiated liposarcoma with heterologous low-grade osteosarcoma, possessing a special pattern of tumoral calcification.
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Affiliation(s)
- Chin-Yu Chiu
- Radiology Department, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Tzu-Ping Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jen-Fan Hang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsuen-En Huang
- Division of Interventional Radiology, Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzu-Hang Kao
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shu-Huei Shen
- Division of Interventional Radiology, Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Taiwan Radiological Society (TRS)
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Muylaert F, De Kock L, Creytens D, Verstraete K, Coopman R. High-grade osteosarcoma arising in DCIA flap reconstruction after a prior resection of maxillar cemento-ossifying fibroma: A case report. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101591. [PMID: 37558180 DOI: 10.1016/j.jormas.2023.101591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/11/2023]
Abstract
Cemento-ossifying fibroma is a rare benign odontogenic tumour of the tooth-bearing jaws. Its concomitant occurrence with osteosarcoma, a malignant maxillofacial bone tumour, has never been described before. We present an uncommon case of a 43-year-old woman in whom a cemento-ossifying fibroma in the right maxilla was treated by resection and reconstruction using a deep circumflex iliac artery flap. During surgical prosthetic rehabilitation one-year post-operative, an osteosarcoma extending from the contralateral maxilla was coincidentally discovered in the deep circumflex iliac artery flap. The aim of this case report is to raise awareness on the extremely rare but possible simultaneous and independent occurrence of a cemento-ossifying fibroma and an osteosarcoma.
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Affiliation(s)
- Frances Muylaert
- Department of Oro-Maxillofacial, Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium.
| | - Lisa De Kock
- Department of Oro-Maxillofacial, Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium
| | - David Creytens
- Department of Pathology, Ghent University Hospital, Ghent, Belgium; Department of Diagnostic Sciences and Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
| | - Koenraad Verstraete
- Department of Diagnostic Sciences and Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium; Head of Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Renaat Coopman
- Department of Oro-Maxillofacial, Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium; Department of Diagnostic Sciences and Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
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Al-Ansari N, Samuel SM, Büsselberg D. Unveiling the Protective Role of Melatonin in Osteosarcoma: Current Knowledge and Limitations. Biomolecules 2024; 14:145. [PMID: 38397382 PMCID: PMC10886489 DOI: 10.3390/biom14020145] [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: 12/13/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 02/25/2024] Open
Abstract
Melatonin, an endogenous neurohormone produced by the pineal gland, has received increased interest due to its potential anti-cancer properties. Apart from its well-known role in the sleep-wake cycle, extensive scientific evidence has shown its role in various physiological and pathological processes, such as inflammation. Additionally, melatonin has demonstrated promising potential as an anti-cancer agent as its function includes inhibition of tumorigenesis, induction of apoptosis, and regulation of anti-tumor immune response. Although a precise pathophysiological mechanism is yet to be established, several pathways related to the regulation of cell cycle progression, DNA repair mechanisms, and antioxidant activity have been implicated in the anti-neoplastic potential of melatonin. In the current manuscript, we focus on the potential anti-cancer properties of melatonin and its use in treating and managing pediatric osteosarcoma. This aggressive bone tumor primarily affects children and adolescents and is treated mainly by surgical and radio-oncological interventions, which has improved survival rates among affected individuals. Significant disadvantages to these interventions include disease recurrence, therapy-related toxicity, and severe/debilitating side effects that the patients have to endure, significantly affecting their quality of life. Melatonin has therapeutic effects when used for treating osteosarcoma, attributed to its ability to halt cancer cell proliferation and trigger apoptotic cell death, thereby enhancing chemotherapeutic efficacy. Furthermore, the antioxidative function of melatonin alleviates harmful side effects of chemotherapy-induced oxidative damage, aiding in decreasing therapeutic toxicities. The review concisely explains the many mechanisms by which melatonin targets osteosarcoma, as evidenced by significant results from several in vitro and animal models. Nevertheless, if further explored, human trials remain a challenge that could shed light and support its utility as an adjunctive therapeutic modality for treating osteosarcoma.
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Affiliation(s)
- Nojoud Al-Ansari
- Department of Medical Education, Weill Cornell Medicine-Qatar, Education City, Qatar Foundation, Doha P.O. Box 24144, Qatar;
| | - Samson Mathews Samuel
- Department of Physiology and Biophysics, Weill Cornell Medicine-Qatar, Education City, Qatar Foundation, Doha P.O. Box 24144, Qatar
| | - Dietrich Büsselberg
- Department of Physiology and Biophysics, Weill Cornell Medicine-Qatar, Education City, Qatar Foundation, Doha P.O. Box 24144, Qatar
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Creytens D, Muylaert F, De Kock L, Verstraete K, Coopman R. High-grade osteosarcoma arising in dcia flap reconstruction after a prior resection of maxillar cemento-ossifying fibroma. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101760. [PMID: 38184197 DOI: 10.1016/j.jormas.2024.101760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 12/26/2023] [Accepted: 01/04/2024] [Indexed: 01/08/2024]
Affiliation(s)
- David Creytens
- Department of Pathology, Ghent University Hospital, Ghent, Belgium; Department of Diagnostic Sciences and Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
| | - Frances Muylaert
- Department of Oro-Maxillofacial, Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Lisa De Kock
- Department of Oro-Maxillofacial, Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Koenraad Verstraete
- Department of Diagnostic Sciences and Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium; Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Renaat Coopman
- Department of Diagnostic Sciences and Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium; Department of Oro-Maxillofacial, Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium.
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7
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Khal AA, Aiba H, Righi A, Gambarotti M, Atherley O'Meally AO, Manfrini M, Donati DM, Errani C. Diagnostic challenges in low-grade central osteosarcoma. Bone Joint J 2024; 106-B:99-106. [PMID: 38160683 DOI: 10.1302/0301-620x.106b1.bjj-2023-0531.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Aims Low-grade central osteosarcoma (LGCOS), a rare type of osteosarcoma, often has misleading radiological and pathological features that overlap with those of other bone tumours, thereby complicating diagnosis and treatment. We aimed to analyze the clinical, radiological, and pathological features of patients with LGCOS, with a focus on diagnosis, treatment, and outcomes. Methods We retrospectively analyzed the medical records of 49 patients with LGCOS (Broder's grade 1 to 2) treated between January 1985 and December 2017 in a single institute. We examined the presence of malignant features on imaging (periosteal reaction, cortical destruction, soft-tissue invasion), the diagnostic accuracy of biopsy, surgical treatment, and oncological outcome. Results Based on imaging, 35 of 49 patients (71.4%) exhibited malignant features. Overall, 40 of 49 patients (81.6%) had undergone a biopsy before en-bloc resection: 27 of 40 patients (67.5%) were diagnosed on the first biopsy, which was more accurate when carried out by open rather than needle biopsy (91.3% vs 35.3% diagnostic accuracy, respectively; p < 0.001). Of the 40 patients treated by en-bloc resection, surgical margins were wide in 38 (95.0%) and marginal in two (5.0%). Furthermore, nine of 49 patients (18.4%) underwent curettage (intralesional margin) without previous biopsy. All patients with a positive margin developed local recurrence. Distant metastases occurred in five of 49 patients (10.2%). The mean five-year overall survival (OS) and distant relapse-free survival (D-RFS) were 89.3% (SD 5.1%) and 85.7% (SD 5.5%), respectively. Univariate analysis showed that the occurrence of distant metastasis was a poor prognostic factor for OS (hazard ratio 11.54, 95% confidence interval (CI) 1.92 to 69.17; p < 0.001). Local recurrence was a poor prognostic factor for D-RFS (HR 8.72, 95% CI 1.69 to 45.0; p = 0.002). Conclusion The diagnosis of LGCOS can be challenging because it may present with non-malignant features and has a low diagnostic accuracy on biopsy. If precisely diagnosed, LGCOS can be successfully treated by surgical excision with wide margins.
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Affiliation(s)
- Adyb A Khal
- III Clinica di Ortopedia e Traumatologia a prevalente indirizzo oncologico, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Paediatric Orthopaedics, AP-HM Timone Enfants, Marseille, France
- Department of Orthopedics and Traumatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Hisaki Aiba
- III Clinica di Ortopedia e Traumatologia a prevalente indirizzo oncologico, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Orthopaedics Surgery, Nagoya City University, Nagoya, Japan
| | - Alberto Righi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Gambarotti
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Ahmed O Atherley O'Meally
- III Clinica di Ortopedia e Traumatologia a prevalente indirizzo oncologico, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Manfrini
- III Clinica di Ortopedia e Traumatologia a prevalente indirizzo oncologico, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide M Donati
- III Clinica di Ortopedia e Traumatologia a prevalente indirizzo oncologico, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Costantino Errani
- III Clinica di Ortopedia e Traumatologia a prevalente indirizzo oncologico, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Yamagata K, Ishibashi-Kanno N, Bukawa H. RE: High-grade osteosarcoma arising in DCIA flap reconstruction after a prior resection of maxillar cemento-ossifying fibroma: A case report. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101636. [PMID: 37716700 DOI: 10.1016/j.jormas.2023.101636] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 09/18/2023]
Affiliation(s)
- Kenji Yamagata
- Department of Oral and Maxillofacial Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Naomi Ishibashi-Kanno
- Department of Oral and Maxillofacial Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hiroki Bukawa
- Department of Oral and Maxillofacial Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
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Mejbel HA, Siegal GP, Wei S. Periosteal Fasciitis With Unusual Radiologic Features Harboring a Novel STAG1::USP6 Fusion Gene. Int J Surg Pathol 2023; 31:1387-1392. [PMID: 36694417 DOI: 10.1177/10668969221150369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Periosteal fasciitis is a subtype of nodular fasciitis originating from the periosteum. The diagnosis can be challenging and requires radiologic-pathologic correlation. Advances in molecular analysis confirmed that nodular fasciitis and its related lesions harbor a USP6 gene rearrangement with one of the several potential partners. Herein, we report a case of periosteal fasciitis with metaplastic bone formation detected incidentally during a radiologic survey for breast carcinoma. Radiologic examination revealed a 2.4 cm, heterogeneous, avidly enhancing lesion of the right femoral distal metaphysis concerning for low-grade periosteal chondrosarcoma. Histological examination of a core needle biopsy revealed a tumor composed of bland spindle cells with myofibroblastic and osteoblastic phenotypes admixed with immature bone and cartilaginous elements. Molecular analysis revealed a novel STAG1::USP6 fusion that helped arrive at the right diagnosis and further expands the molecular profile of USP6-associated neoplasms.
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Affiliation(s)
- Haider A Mejbel
- Departments of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gene P Siegal
- Departments of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
- Departments of Genetics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shi Wei
- Departments of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Pathology & Laboratory Medicine, University of Kansas School of Medicine, Kansas City, KS, USA
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Bahceci DH, Grenert JP, Jordan RCK, Horvai AE. Genomic Profiling of the Craniofacial Ossifying Fibroma by Next-Generation Sequencing. Head Neck Pathol 2023; 17:722-730. [PMID: 36928741 PMCID: PMC10513971 DOI: 10.1007/s12105-022-01523-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/27/2022] [Indexed: 03/18/2023]
Abstract
BACKGROUND Ossifying fibroma (OF) of the craniofacial skeleton is a fibro-osseous lesion characterized by various patterns of bone formation in a cellular fibroblastic stroma. The molecular landscape of OF remains mostly unknown. There are a few known pathogenic abnormalities in OF, including HRPT2 mutations in conventional OF and SATB2 translocations in juvenile psammomatoid OF. On the other hand, conflicting reports exist regarding MDM2 gene amplification and chromosomal copy number alterations (CNA) in OF. METHODS Surgically removed biopsies and curettage specimens from OF patients were obtained. Clinical, radiographic, and pathologic features of tumors were reviewed. Genomic DNA was extracted from formalin-fixed, paraffin-embedded blocks of tumor tissue. Capture-based DNA next-generation sequencing targeting the coding regions 529 cancer genes and select introns was performed. RESULTS We identified 17 OF cases from 8 male and 8 female patients with mean age of 22 years (range 1-58 years). Nine case occurred in the gnathic bones and 8 in the extragnathic craniofacial bones. These cases included 3 juvenile psammomatoid OF, 6 conventional OF and 8 juvenile trabecular OF. Large-scale CNAs were present in 6 of 17 cases. Seven cases (41%) had focal amplifications including FOSB (n = 2, 11%), FOS (n = 4, 23%), COL1A1 (n = 4, 23%) and TBX3 (n = 5, 29%). Three cases (17%) had pathogenic CDC73 mutations. No cases showed focal MDM2 amplification. CONCLUSIONS Here, we provided a comprehensive molecular characterization of OF that reveals a heterogeneous genetic profile with occasional large-scale CNAs (n = 6, 35%). FOS, FOSB, and TBX3 genes that regulate AP-1 transcriptional complex are frequently altered in OF (n = 7, 41%), chiefly in juvenile trabecular OF. These genes encode transcription factors that act as downstream effectors of the MAP kinase signaling pathway. MDM2 amplification is an exceedingly rare event in OF, if present at all, so identification of this event should continue to raise concern for low-grade gnathic osteosarcoma. In summary, our findings suggest that OF represents a heterogeneous group of tumors at the genetic level but dysregulation of the AP-1 pathway may play a role in pathogenesis of juvenile trabecular OF.
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Affiliation(s)
- Dorukhan H Bahceci
- Department of Pathology, University of California at San Francisco, San Francisco, CA, 94143, USA
| | - James P Grenert
- Department of Pathology, University of California at San Francisco, San Francisco, CA, 94143, USA
| | - Richard C K Jordan
- Department of Pathology, University of California at San Francisco, San Francisco, CA, 94143, USA
| | - Andrew E Horvai
- Department of Pathology, University of California at San Francisco, 1825 4Th Street, Room M2354, San Francisco, CA, 94158, USA.
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11
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Samargandi R. Unusual Site of a Bizarre Parosteal Osteochondromatous Proliferation (Nora's Lesion) Involving the Scapula: First Case Report and Review of the Literature. Cureus 2023; 15:e38980. [PMID: 37197299 PMCID: PMC10184724 DOI: 10.7759/cureus.38980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2023] [Indexed: 05/19/2023] Open
Abstract
Bizarre parosteal osteochondromatous proliferation (BPOP), also known as Nora's lesion, is a rare benign surface lesion of bone that typically occurs in the hands and feet. We report herein the first case of BPOP occurring in an unusual location, specifically the scapula of a 29-year-old male patient. The lesion exhibited features mimicking those of a peripheral chondrosarcoma because of its atypical location in the axial skeleton and the presence of calcification, which indicates the presence of cartilaginous matrix. Treatment involved a wide surgical resection, and histopathological examination confirmed the diagnosis of BPOP of the bone. At a five-year follow-up, there was no evidence of local recurrence.
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Affiliation(s)
- Ramy Samargandi
- Orthopedic Surgery Department, College of Medicine, University of Jeddah, Jeddah, SAU
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12
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Szymczuk V, Taylor J, Boyce AM. Craniofacial Fibrous Dysplasia: Clinical and Therapeutic Implications. Curr Osteoporos Rep 2023; 21:147-153. [PMID: 36849642 PMCID: PMC11087144 DOI: 10.1007/s11914-023-00779-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE OF REVIEW This study aims to review diagnosis, potential complications, and clinical management in craniofacial fibrous dysplasia. RECENT FINDINGS Fibrous dysplasia (FD) is a rare mosaic disorder in which normal bone and marrow are replaced with expansile fibro-osseous lesions. Disease presents along a broad spectrum and may be associated with extraskeletal features as part of McCune-Albright syndrome (MAS). The craniofacial skeleton is one of the most commonly impacted areas in FD, and its functional and anatomical complexities create unique challenges for diagnosis and management. This review summarizes current approaches to diagnosis and management in FD/MAS, with emphasis on the clinical and therapeutic implications for the craniofacial skeleton.
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Affiliation(s)
- Vivian Szymczuk
- Metabolic Bone Disorders Unit, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
- Pediatric Endocrinology Inter-Institute Training Program, National Institute of Child Health and Development, National Institutes of Health, Bethesda, MD, USA
| | - Jocelyn Taylor
- Metabolic Bone Disorders Unit, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - Alison M Boyce
- Metabolic Bone Disorders Unit, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA.
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Chen C, He X, Chen M, Du T, Qin W, Jing W, Zhang H. Diagnostic value of MDM2 RNA in situ hybridization for low-grade osteosarcoma: Consistency comparison of RNA in situ hybridization, fluorescence in situ hybridization, and immunohistochemistry. Virchows Arch 2023:10.1007/s00428-023-03530-9. [PMID: 36977943 DOI: 10.1007/s00428-023-03530-9] [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: 11/21/2022] [Revised: 01/18/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023]
Abstract
Detection of MDM2 gene amplification via fluorescence in situ hybridization (FISH) and MDM2 overexpression by immunohistochemistry (IHC) have been utilized for the diagnosis of low-grade osteosarcoma (LGOS). The aim of this study was to evaluate the diagnostic value of MDM2 RNA in situ hybridization (RNA-ISH) and compare this assay with MDM2 FISH and IHC in distinguishing LGOS from its histologic mimics. MDM2 RNA-ISH, FISH and IHC were performed on nondecalcified samples of 23 LGOSs and 52 control cases. Twenty (20/21, 95.2%) LGOSs were MDM2-amplified, and two cases failed in FISH. All control cases were MDM2-nonamplified. All 20 MDM2-amplified LGOSs and one MDM2-nonamplified LGOS harboring TP53 mutation and RB1 deletion showed positivity for RNA-ISH. Fifty of the 52 (96.2%) control cases were negative for RNA-ISH. The diagnostic sensitivity and specificity of MDM2 RNA-ISH were 100.0% and 96.2%, respectively. Nineteen of the 23 LGOSs were evaluated by MDM2 RNA-ISH and FISH in decalcified samples simultaneously. All decalcified LGOSs failed in FISH and most samples (18/19) were no staining in RNA-ISH. Fifteen (15/20, 75%) MDM2-amplified LGOSs were positive for IHC and 96.2% (50/52) of control cases were negative. The sensitivity of RNA-ISH (100%) was higher than that of IHC (75%). In conclusion, MDM2 RNA-ISH has great value for the diagnosis of LGOS, with excellent consistency with FISH and better sensitivity than IHC. Acid decalcification still has an adverse impact on RNA. Some MDM2-nonamplified tumors may show positivity for MDM2 RNA-ISH, which needs to be analyzed comprehensively in combination with clinicopathological features.
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Affiliation(s)
- Chen Chen
- Department of Pathology, West China Hospital, Sichuan University, GuoXueXiang 37, Chengdu, 610041, Sichuan, China
| | - Xin He
- Department of Pathology, West China Hospital, Sichuan University, GuoXueXiang 37, Chengdu, 610041, Sichuan, China
| | - Min Chen
- Department of Pathology, West China Hospital, Sichuan University, GuoXueXiang 37, Chengdu, 610041, Sichuan, China
| | - Tianhai Du
- Department of Pathology, West China Hospital, Sichuan University, GuoXueXiang 37, Chengdu, 610041, Sichuan, China
| | - Weiji Qin
- Department of Pathology, West China Hospital, Sichuan University, GuoXueXiang 37, Chengdu, 610041, Sichuan, China
| | - Wenyi Jing
- Department of Pathology, West China Hospital, Sichuan University, GuoXueXiang 37, Chengdu, 610041, Sichuan, China
| | - Hongying Zhang
- Department of Pathology, West China Hospital, Sichuan University, GuoXueXiang 37, Chengdu, 610041, Sichuan, China.
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Osteogenic sarcomas of the hands: A case series with emphasis in its peculiarities and literature review. Pathol Res Pract 2023; 242:154326. [PMID: 36716613 DOI: 10.1016/j.prp.2023.154326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
AIM To present our experience on osteosarcomas of the hands and review the existing literature pertaining osteosarcomas in this extremely rare location. METHODS and results: Seven cases of osteosarcomas of the hands were reviewed, and a literature search of all primary osteosarcomas of the hands was performed. All tumors occurred in adults (mean age, 41 years) and were located mainly around the metacarpophalangeal joints. All patients presented with localized long-lasting pain as main symptom. The mean size at diagnosis was 33 mm. Three tumors were low-grade central osteosarcomas, 1 low-grade central chondroblastoma-like osteosarcoma and 3 high-grade osteosarcomas. All tumors were positive for mouse double-minute 2 homolog (MDM2) immunohistochemistry. Three cases yielded results with fluorescence in-situ amplification for MDM2 (12q15)/CEP12. At last follow-up, one patient with a high-grade osteosarcoma was dead of disease. The literature review revealed similar demographic and site distribution of osteosarcomas within the hands than our series and an unusually high proportion of low-grade central and parosteal osteosarcomas when compared to the proportion of these infrequent neoplasms in the whole skeleton. CONCLUSIONS osteosarcomas of hands present in older individuals compared to the population affected by conventional osteosarcomas of all sites. Importantly from a diagnostic, therapeutic and prognostic points of view, around 40% of osteosarcomas of the hands are low-grade osteosarcomas of the central or parosteal types.
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Zhao F, Zhang X, Pan Q, Ye X, Yu M, Li Z, Wang H. Temporal bone osteoblastoma involving temporomandibular joint diagnosed as simple disc disorders: A case report. Front Surg 2023; 9:1033342. [PMID: 36684216 PMCID: PMC9852635 DOI: 10.3389/fsurg.2022.1033342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/26/2022] [Indexed: 01/07/2023] Open
Abstract
Background Osteoblastoma is quite rare in the oromaxillo-facial region, while the mandible is always the predilection. However, in our case, the lesion was located in the left temporal articular tubercle, involving the adjacent skull base, which is extremely rare in the literature. Case reports It had been diagnosed as the most common temporomandibular joint disorder in the local hospital before the patient came to our department, mainly due to the primary symptom, that was, the patient got pain in the left temporomandibular joint area while opening the mouth. However, we found a mass of bone lesions at the left temporal articular tubercle in MRI and cone beam CT, and it turned out to be an osteoblastoma after surgery. The patient's primary symptom disappeared after recovering from the surgery, and there have been no indications of complication or recurrence up to now. Conclusion Osteoblastoma is very rare in the temporomandibular joint region. It could easily miss the possibility of a benign tumor due to its unusual location and confusing chief complaint in this case. Our report provides experience in the identification of osteoblastoma in rare sites.
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Pacheco M, Guzmán R, Bonilla P. Dedifferentiated Low-Grade Osteosarcoma, Outcome with or Without Chemotherapy: A Systematic Review. Orthop Res Rev 2023; 15:79-89. [PMID: 37143718 PMCID: PMC10153403 DOI: 10.2147/orr.s404146] [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: 01/20/2023] [Accepted: 04/18/2023] [Indexed: 05/06/2023] Open
Abstract
The treatment of low-grade osteosarcomas is surgical resection with wide margins. In instances of dedifferentiation, a therapeutic paradigm similar to that of conventional high-grade osteosarcoma has not been adequately evaluated in these neoplasms. The main objective of this review was to define whether the addition of chemotherapy to surgical treatment has an impact on the survival of patients with dedifferentiated low-grade osteosarcomas. Secondary objectives were to observe the degree of histological response to neoadjuvant chemotherapy and to describe the percentage of de novo dedifferentiation. A systematic search of articles including dedifferentiated low-grade osteosarcomas, published between 1980 and 2022 was carried out in the PubMed, Cochrane and Scielo databases. A qualitative synthesis of the results was performed. Twenty-three articles comprising 117 patients were included. The survival of patients treated with surgery alone and surgery with chemotherapy was not statistically significant between the two groups. A good histological response was seen in 20% of specimens treated with neoadjuvant chemotherapy. De novo dedifferentiation was seen in approximately a fifth of low-grade osteosarcomas. The evidence available suggests that the addition of chemotherapy does not have an impact on the survival of patients with low-grade dedifferentiated osteosarcomas.
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Affiliation(s)
- Marina Pacheco
- Department of Pathology, Complejo Hospitalario Metropolitano CSS, Social Security Fund, Panama, Panama
- Sistema Nacional de Investigación; Secretaria Nacional de Ciencia, Tecnologia e Innovación, Panama, Panama
- Correspondence: Marina Pacheco, Departamento de Patología, Complejo Hospitalario Metropolitano Dr. Arnulfo Arias Madrid CSS, Avenida José de Fábrega y Simón Bolivar, Bella Vista, Panama, Panama, Tel +507 503 6219, Email
| | - Rodolfo Guzmán
- Department of Pathology, Hospital San Juan de Dios CCSS, San Jose, Costa Rica
| | - Patricia Bonilla
- Department of Orthopedics, Hospital del Niño Dr. José Renán Esquivel, Panama, Panama
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Han SM, Wu Y, Wen JX, Wu TH, Sun T, Yu BH, Wu WJ, Gao BL. Intramedullary Well-differentiated Osteosarcoma: Imaging and Pathologic Findings in 17 Patients. Curr Med Imaging 2022; 18:1453-1461. [PMID: 34951370 DOI: 10.2174/1573405618666211222160039] [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: 04/15/2021] [Revised: 10/15/2021] [Accepted: 10/25/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Intramedullary well-differentiated osteosarcoma (IMWDOS) is rare and may easily be misdiagnosed. OBJECTIVE This study aimed at investigating the clinical, imaging, and pathological features of IMWDOS for correct diagnosis. MATERIALS AND METHODS Seventeen patients with IMWDOS were enrolled, and their clinical, imaging, and pathological data were analyzed. RESULTS Total 13 males and 4 females aged 19-55 years (mean 36. 1) were selected. The lesion was located at long bones in 16 patients and the second region of the acetabulum in one patient. Except for three patients with limited areas of lesions, all the other patients had a wide distribution of tumor, and the lesion in long bones involved the metaphysis area with possible extension towards the diaphysis. In imaging, the lesion usually had an unclear boundary with the destruction of bone cortex, uneven thickness of the bone cortex, thick and coarse trabecula in the lesion, but few periosteal reactions and soft tissue masses. The lesion was histologically composed of spindle cells with slight atypia. Follow-up was performed 2-101 months (mean 31.9m) in 14 cases, 10 years in one case, and 26 years in the remaining two. At follow-up, 12 patients (12/17 or 70.6%) who had a complete resection, including amputation (n=2), wide excision (n=8), and endoprosthetic replacement (n=2), showed no recurrence or metastasis. Among five patients who underwent curettage, three (3/17 or 17.6%) had recurrent lesions, leading to death in two of them, and the third one died during post-operation chemotherapy. CONCLUSION Intramedullary well-differentiated osteosarcoma tends to occur at the metaphysis of long bones, especially at the distal femur. Histological, clinical, and imaging findings lack specific characteristics and should be examined collectively to reach a correct diagnosis. The prognosis of patients with complete lesion resection is good, while incomplete lesion curettage or resection will lead to recurrence and transformation into a highly malignant tumor.
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Affiliation(s)
- Shu-Man Han
- Department of Radiology, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, Hebei Province, China
| | - Yuan Wu
- Hebei Provincial Gucheng County Hospital, Hengshui, Hebel Province, China
| | - Jin-Xu Wen
- Department of Radiology, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, Hebei Province, China
| | - Tian-Hao Wu
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, Hebei Province, 050051, China
| | - Tao Sun
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, Hebei Province, 050051, China
| | - Bao-Hai Yu
- Department of Radiology, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, Hebei Province, China
| | - Wen-Juan Wu
- Department of Radiology, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, Hebei Province, China
| | - Bu-Lang Gao
- Shijiazhuang People's Hospital, 9 Fangbei Road, Shijiazhuang, Hebei Province, 050011, China
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18
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Suster D. Spindle cell tumors of the mediastinum. Ann Diagn Pathol 2022; 60:152018. [DOI: 10.1016/j.anndiagpath.2022.152018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 07/18/2022] [Indexed: 11/01/2022]
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19
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Toland AMS, Lam SW, Varma S, Wang A, Howitt BE, Kunder CA, Kerr DA, Szuhai K, Bovée JVMG, Charville GW. GRM1 Immunohistochemistry Distinguishes Chondromyxoid Fibroma From its Histologic Mimics. Am J Surg Pathol 2022; 46:1407-1414. [PMID: 35650682 PMCID: PMC9481662 DOI: 10.1097/pas.0000000000001921] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Chondromyxoid fibroma (CMF) is a rare benign bone neoplasm that manifests histologically as a lobular proliferation of stellate to spindle-shaped cells in a myxoid background, exhibiting morphologic overlap with other cartilaginous and myxoid tumors of bone. CMF is characterized by recurrent genetic rearrangements that place the glutamate receptor gene GRM1 under the regulatory control of a constitutively active promoter, leading to increased gene expression. Here, we explore the diagnostic utility of GRM1 immunohistochemistry as a surrogate marker for GRM1 rearrangement using a commercially available monoclonal antibody in a study of 230 tumors, including 30 CMF cases represented by 35 specimens. GRM1 was positive by immunohistochemistry in 97% of CMF specimens (34/35), exhibiting moderate to strong staining in more than 50% of neoplastic cells; staining was diffuse (>95% of cells) in 25 specimens (71%). Among the 9 CMF specimens with documented exposure to acid decalcification, 4 (44%) exhibited diffuse immunoreactivity (>95%) for GRM1, whereas all 15 CMF specimens (100%) with lack of exposure to decalcification reagents were diffusely immunoreactive ( P =0.003). High GRM1 expression at the RNA level was previously observed by quantitative reverse transcription polymerase chain reaction in 9 CMF cases that were also positive by immunohistochemistry; low GRM1 expression was observed by quantitative reverse transcription polymerase chain reaction in the single case of CMF that was negative by immunohistochemistry. GRM1 immunohistochemistry was negative (<5%) in histologic mimics of CMF, including conventional chondrosarcoma, enchondroma, chondroblastoma, clear cell chondrosarcoma, giant cell tumor of the bone, fibrous dysplasia, chondroblastic osteosarcoma, myoepithelial tumor, primary aneurysmal bone cyst, brown tumor, phosphaturic mesenchymal tumor, CMF-like osteosarcoma, and extraskeletal myxoid chondrosarcoma. These results indicate that GRM1 immunohistochemistry may have utility in distinguishing CMF from its histologic mimics.
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Affiliation(s)
- Angus M. S. Toland
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Suk Wai Lam
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sushama Varma
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Aihui Wang
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Brooke E. Howitt
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Christian A. Kunder
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Darcy A. Kerr
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Karoly Szuhai
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Gregory W. Charville
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
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20
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Dedifferentiation in low-grade osteosarcoma: a Japanese Musculoskeletal Oncology Group (JMOG) study. Int J Clin Oncol 2022; 27:1758-1766. [PMID: 35932377 DOI: 10.1007/s10147-022-02223-8] [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: 04/15/2022] [Accepted: 07/16/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Low-grade osteosarcomas, namely parosteal osteosarcoma (POS) and low-grade central osteosarcoma (LGCOS), occasionally dedifferentiate into high-grade malignancy, referred to as dedifferentiation in low-grade osteosarcoma (DLOS). This study aimed to elucidate the clinicopathologic features of DLOS, which are poorly described to date due to the extreme rarity of the disease. METHODS A total of 33 patients with DLOS were included. Clinical characteristics, including the diagnostic accuracy of tumor biopsy, multimodal treatments, and clinical course, were retrospectively reviewed. Univariate analysis was performed to identify prognostic factors associated with overall survival (OS) and metastasis-free survival (MFS). RESULTS The tumor subtypes comprised 10 cases (30.3%) of LGCOS and 23 cases (69.7%) of POS. The timing of dedifferentiation was synchronous in 25 (75.8%) and metachronous in 8 (24.2%) patients. The rates of preoperative diagnosis of DLOS were 40.0% and 65.4% for core needle biopsy and incisional biopsy, respectively. All patients underwent surgery and 25 patients received perioperative chemotherapy. Of the 13 patients who received neoadjuvant chemotherapy, 11 exhibited a poor histological response. The 5-year OS and MFS rates were 88.1% and 77.7%, respectively. Univariate analysis revealed that local recurrence was associated with poor OS (P < 0.01) and MFS (P < 0.01). Perioperative chemotherapy did not affect OS or MFS. CONCLUSIONS The diagnostic accuracy of tumor biopsy for DLOS was lower than that for bone sarcomas, as reported previously. In contrast to conventional osteosarcomas with high chemosensitivity, both histological responses and survival analysis revealed low efficacy of chemotherapy for DLOS.
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21
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Bahceci DH, Jordan RCK, Horvai AE. MDM2 Gene Amplification and Expression of MDM2 and CDK4 are Rare in Ossifying Fibroma of Craniofacial Bones. Head Neck Pathol 2022; 16:991-997. [PMID: 35546651 PMCID: PMC9729456 DOI: 10.1007/s12105-022-01454-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/04/2022] [Indexed: 12/16/2022]
Abstract
Ossifying fibroma of the craniofacial bones is a fibro-osseous lesion characterized by varied patterns of bone formation in a fibroblastic stroma. Ossifying fibroma is a putatively benign lesion with no reports of malignant transformation or metastasis. Differentiation from other fibro-osseous lesions can be challenging necessitating synthesis of clinical, radiological and pathological findings. The molecular pathogenesis of ossifying fibroma is poorly understood but recent studies have reported MDM2 gene amplification and chromosomal copy number changes in a subset of ossifying fibromas. MDM2 amplification in ossifying fibroma, if true, presents a diagnostic problem because this genetic event, at least among craniofacial fibro-osseous lesions, was previously considered specific for low-grade osteosarcoma. In the present study, we investigated the utility of MDM2 and CDK4 immunohistochemistry, and fluorescence in situ hybridization for MDM2 gene amplification, in the diagnosis of 44 craniofacial bone ossifying fibromas. Focal MDM2 and CDK4 nuclear immunoreactivity was found in 11 and 1 ossifying fibromas, respectively, but none demonstrated MDM2 amplification by fluorescence in situ hybridization. A single tumor displayed MDM2 amplification without nuclear immunoreactivity to either MDM2 or CDK4. Our data suggest that while focal MDM2 and CDK4 nuclear expression may be detected in a minority of ossifying fibromas, this expression does not correlate with MDM2 amplification. In addition, MDM2 amplification is extremely rare in ossifying fibroma so the detection of this genetic abnormality should continue to raise concern for osteosarcoma.
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Affiliation(s)
- Dorukhan H Bahceci
- Department of Pathology, University of California at San Francisco, San Francisco, CA, 94143, USA
| | - Richard C K Jordan
- Department of Pathology, University of California at San Francisco, San Francisco, CA, 94143, USA
| | - Andrew E Horvai
- Department of Pathology, University of California at San Francisco, San Francisco, CA, 94143, USA.
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22
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Kaur H, Kala S, Sood A, Mridha AR, Kakkar A, Yadav R, Mishra S, Mishra D. Role of MDM2, CDK4, BCL2, Parafibromin and Galectin 1 in Differentiating Osteosarcoma from its Benign Fibro-osseous Lesions. Head Neck Pathol 2022; 16:728-737. [PMID: 35220546 PMCID: PMC9424414 DOI: 10.1007/s12105-022-01434-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/18/2022] [Indexed: 11/30/2022]
Abstract
Benign fibro-osseous lesions (BFOLs) are a diverse group of lesions showing considerable degree of overlap with low grade osteosarcoma (LGOS). Further, de-differentiated osteosarcoma (DOS) is usually indistinguishable from conventional high-grade OS (COS) if LGOS foci are not identified. Thus, there is a need for adjunctive immunohistochemical markers to differentiate OS from benign FOLs as well as DOS from COS. This study evaluated the role of immunohistochemical expression of MDM2, CDK4, parafibromin, BCL-2 and Galectin-1 (Gal-1) in accurate characterization of benign FOLs and in differentiating them from OS. From our archives, we retrieved 101 tissue samples which were diagnosed as osteosarcoma (OS) /ossifying fibroma (OF) / fibrous dysplasia (FD) or fibrous hyperplasia (FH) and examined their immunohistochemical staining pattern with the aforementioned antibodies. MDM2 showed 100% specificity for diagnosing OS. CDK4 and Gal-1 showed linear increase in immunoexpression from benign BFOLs to OS. BCL-2 showed equivocal immunopositivity in OF and OS, but the positivity was higher than that observed in FD. The highest immunoexpression for parafibromin was seen in FD followed by OF and OS cases. Thus, MDM2 is most specific, and Gal-1 is most sensitive of all the markers studied in differentiating OS from benign mimics. Combination of these two markers can be used as an adjunct to conventional imaging and microscopy in accurate characterization of these lesions. Further MDM2 overexpression can differentiate DOS and COS.
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Affiliation(s)
- Harpreet Kaur
- Department of Oral Pathology and Microbiology, Centre for Dental Education and Research, All India Institute of Medical Sciences, Delhi, India
| | - Sunny Kala
- Department of Oral Pathology and Microbiology, Centre for Dental Education and Research, All India Institute of Medical Sciences, Delhi, India
| | - Anubhuti Sood
- Department of Oral Pathology and Microbiology, Centre for Dental Education and Research, All India Institute of Medical Sciences, Delhi, India
| | - Asit Ranjan Mridha
- Department of Pathology, All India Institute of Medical Sciences, Delhi, India
| | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, Delhi, India
| | - Rahul Yadav
- Department of Oral and Maxillofacial Surgery, Centre for Dental Education and Research, All India Institute of Medical Sciences, Delhi, India
| | - Shashwat Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, Delhi, India
| | - Deepika Mishra
- Department of Oral Pathology and Microbiology, Centre for Dental Education and Research, All India Institute of Medical Sciences, Delhi, Pin 110029, India.
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Les lésions ostéoformatrices et les réarrangements des gènes FOS. Ann Pathol 2022; 42:208-213. [DOI: 10.1016/j.annpat.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 01/07/2022] [Accepted: 01/07/2022] [Indexed: 11/18/2022]
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Noncanonical roles of p53 in cancer stemness and their implications in sarcomas. Cancer Lett 2022; 525:131-145. [PMID: 34742870 DOI: 10.1016/j.canlet.2021.10.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 09/24/2021] [Accepted: 10/25/2021] [Indexed: 12/25/2022]
Abstract
Impairment of the prominent tumor suppressor p53, well known for its canonical role as the "guardian of the genome", is found in almost half of human cancers. More recently, p53 has been suggested to be a crucial regulator of stemness, orchestrating the differentiation of embryonal and adult stem cells, suppressing reprogramming into induced pluripotent stem cells, or inhibiting cancer stemness (i.e., cancer stem cells, CSCs), which underlies the development of therapy-resistant tumors. This review addresses these noncanonical roles of p53 and their implications in sarcoma initiation and progression. Indeed, dysregulation of p53 family proteins is a common event in sarcomas and is associated with poor survival. Additionally, emerging studies have demonstrated that loss of wild-type p53 activity hinders the terminal differentiation of mesenchymal stem cells and leads to the development of aggressive sarcomas. This review summarizes recent findings on the roles of aberrant p53 in sarcoma development and stemness and further describes therapeutic approaches to restore normal p53 activity as a promising anti-CSC strategy to treat refractory sarcomas.
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Dedifferentiated Low-Grade Central Osteosarcoma of the Mandible. Case Rep Dent 2022; 2022:9321728. [PMID: 35096429 PMCID: PMC8799357 DOI: 10.1155/2022/9321728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/10/2022] [Indexed: 11/24/2022] Open
Abstract
We present the first, to our knowledge, case of a dedifferentiated low-grade central osteosarcoma (LCOS) of the mandible. A 48-year-old Japanese woman underwent enucleation under general anesthesia after a diagnosis of ossifying fibroma. At the second recurrence, the pathological diagnosis after biopsy was of sarcoma with MDM2(+) and CDK4(+) immunohistochemical staining results. Hemimandibulotomy, supraomohyoid neck dissection, and free-flap reconstruction with a rectus abdominal flap were performed. A retrospective reevaluation of the first specimen with additional immunohistochemical staining for MDM2 and CDK4 yielded a final diagnosis of dedifferentiated LCOS. The patient showed no recurrence or lung metastasis 3 years after the final surgery.
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de Guimarães JA, Chahud F, Boasquevisque GS, Cruz AAVE. Computed tomography and magnetic resonance imaging of an unusual intraconal orbital osteoma. Orbit 2022; 42:343-346. [PMID: 34974797 DOI: 10.1080/01676830.2021.2012206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We report the case of a 64-year-old male patient with a 5 month history of proptosis, motility limitation and vision loss in OD. Visual acuity (VA) was 20/200 in OD and 20/20 in OS. CT showed a large, round, intraconal lesion, with bony density and no apparent connection to adjacent orbital walls. MRI showed a T1-weighted hypointense lesion surrounded by a contrast enhancing capsule. The orbital tumor was excised through a lateral orbitotomy revealing a nodular, round, osseous structure. Histological examination disclosed well-formed lamellar bone trabeculae, with no necrosis or mitosis figures. Immunohistochemical staining was negative for MDM2 and CDK4. After 3 years, there was no evidence of tumor recurrence and VA had improved to 20/30. Intraconal osteomas with no clear attachment to orbital walls are extremely rare. We are aware of a few reported cases in the lid, hand, thigh, tongue, pterygopalatine fossa and brain. To the authors' knowledge, this is the first report in English literature of an orbital intraconal osteoma without any visible relation to the orbital walls.
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Affiliation(s)
- Juliana Albano de Guimarães
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, School of Medicine of Ribeirão Preto-University of São Paulo, São Paulo, Brazil
| | - Fernando Chahud
- Department of Pathology, School of Medicine of Ribeirão Preto-University of São Paulo, São Paulo, Brazil
| | | | - Antônio Augusto Velasco E Cruz
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, School of Medicine of Ribeirão Preto-University of São Paulo, São Paulo, Brazil
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Hoshi I, Abe R, Onodera K, Ohashi Y, Kawai T, Miyamoto I, Chiba T, Takeda Y, Yamada H. Osteosarcoma of the Mandible in an Elderly Patient. Case Rep Dent 2022; 2022:2622551. [PMID: 35342653 PMCID: PMC8947915 DOI: 10.1155/2022/2622551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/23/2022] [Indexed: 02/08/2023] Open
Abstract
Osteosarcoma is a malignant tumor in which the cancerous cells produce an osteoid matrix or mineralized bone. Jaw bones are affected in 6% of all osteosarcomas and are the fourth most common site of origin. Surgical treatment of osteosarcoma in elderly patients is rarely reported. Here, we report successful treatment of osteosarcoma arising in the mandible of a 90-year-old man. The patient was referred to our institution for diagnosis and treatment of an oral lesion. Intraoral examination revealed that a hard mass measuring 35 × 27 mm was located on the floor of the oral cavity, attached to the bone, and its growth displaced the tongue posteriorly. Therefore, he experienced difficulty in speech and swallowing. Biopsy of the mandibular mass was suspicious for chondrosarcoma. Preoperative examination did not detect critical risks for general anesthesia or surgery. Based on a clinical diagnosis of a malignant bone tumor of the mandible, segmental mandibular resection with reconstruction using a titanium plate was performed. Surgical site infection occurred on postoperative day 12, which was resolved by drainage, local irrigation, and administration of antibiotics. There was no delirium or cardiovascular or pulmonary complications. Surgery resolved the patient's difficulties in speech and swallowing. There was no evidence of tumor recurrence or metastasis 4 years after surgery. This case showed that it was not necessary to exclude surgical treatment merely because the patient was 90 years old. Indications for surgery should be determined individually to improve the patient's quality of life.
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Affiliation(s)
- Isao Hoshi
- 1Division of Oral and Maxillofacial Surgery, Department of Reconstructive Oral and Maxillofacial Surgery, School of Dentistry, Iwate Medical University, Morioka 020-8505, Japan
| | - Ryosuke Abe
- 2Department of Oral and Maxillofacial Surgery, Iwate Prefectural Central Hospital, Morioka 020-0066, Japan
| | - Kei Onodera
- 1Division of Oral and Maxillofacial Surgery, Department of Reconstructive Oral and Maxillofacial Surgery, School of Dentistry, Iwate Medical University, Morioka 020-8505, Japan
| | - Yu Ohashi
- 1Division of Oral and Maxillofacial Surgery, Department of Reconstructive Oral and Maxillofacial Surgery, School of Dentistry, Iwate Medical University, Morioka 020-8505, Japan
| | - Tadashi Kawai
- 1Division of Oral and Maxillofacial Surgery, Department of Reconstructive Oral and Maxillofacial Surgery, School of Dentistry, Iwate Medical University, Morioka 020-8505, Japan
| | - Ikuya Miyamoto
- 1Division of Oral and Maxillofacial Surgery, Department of Reconstructive Oral and Maxillofacial Surgery, School of Dentistry, Iwate Medical University, Morioka 020-8505, Japan
| | - Toshimi Chiba
- 3Division of Internal Medicine, Department of Oral Medicine, Iwate Medical University, Morioka 020-8505, Japan
| | - Yasunori Takeda
- 4Division of Clinical Pathology, Department of Oral and Maxillofacial Reconstructive Surgery, School of Dentistry, Iwate Medical University, Morioka 020-8505, Japan
| | - Hiroyuki Yamada
- 1Division of Oral and Maxillofacial Surgery, Department of Reconstructive Oral and Maxillofacial Surgery, School of Dentistry, Iwate Medical University, Morioka 020-8505, Japan
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Haefliger S, Andrei V, Baumhoer D. Update of Key Clinical, Histological and Molecular Features of Malignant Bone Tumours Arising in the Craniofacial Skeleton. Front Oncol 2022; 12:954717. [PMID: 35875137 PMCID: PMC9301068 DOI: 10.3389/fonc.2022.954717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/15/2022] [Indexed: 02/05/2023] Open
Abstract
The craniofacial skeleton is a highly complex and specialized anatomic region containing and protecting the brain and sensory organs. Bone sarcomas arising here comprise a heterogeneous group of tumours, some of which differ in their biological behaviour compared to their peripheral counterparts. The reasons for this seem to lie, at least partially, in the embryonal development of the craniofacial bones. For reaching the correct diagnosis as the cornerstone of optimal personalised treatment planning, a multidisciplinary team of specialists, including pathologists, radiologists, oncologists, and head and neck surgeons needs to be involved. The most common tumours arising in the craniofacial bones are bone-forming tumours, cartilage-forming tumours, fibro-osseous lesions, giant cell-rich lesions, and notochordal tumours. While morphology remains the backbone for the diagnosis, the last decade has witnessed tremendous advances in the molecular characterization of tumours, and molecular testing is increasingly becoming a part of the diagnostic process. The integration of these new molecular markers into the diagnostic approach has undoubtedly increased the diagnostic accuracy and objectivity, and holds great promise to also identify new therapeutic targets for precision medicine in the future. Examples include HEY1-NCOA2 in mesenchymal chondrosarcoma, IDH1/2 mutations in chondrosarcoma and TFCP2 rearrangements in rhabdomyosarcoma. In this article, key clinical, histological and molecular features of malignant bone tumours arising in the craniofacial region are discussed, with a special focus on the differential diagnosis and prognostic considerations.
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de Pinieux G. 2012–2022 : dix années d’importantes avancées en pathologie tumorale ostéo-articulaire. Ann Pathol 2022; 42:199-201. [DOI: 10.1016/j.annpat.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 11/28/2022]
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Owosho AA, Ladeji AM, Adesina OM, Adebiyi KE, Olajide MA, Okunade T, Palmer J, Kehinde T, Vos JA, Cole G, Summersgill KF. SATB2 and MDM2 Immunoexpression and Diagnostic Role in Primary Osteosarcomas of the Jaw. Dent J (Basel) 2021; 10:dj10010004. [PMID: 35049602 PMCID: PMC8775091 DOI: 10.3390/dj10010004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 02/06/2023] Open
Abstract
Primary osteosarcomas of the jaw (OSJ) are rare, accounting for 6% of all osteosarcomas. This study aims to determine the value of SATB2 and MDM2 immunohistochemistry (IHC) in differentiating OSJ from other jawbone mimickers, such as benign fibro-osseous lesions (BFOLs) of the jaw or Ewing sarcoma of the jaw. Certain subsets of osteosarcoma harbor a supernumerary ring and/or giant marker chromosomes with amplification of the 12q13-15 region, including the murine double-minute type 2 (MDM2) and cyclin-dependent kinase 4 (CDK4) genes. Special AT-rich sequence-binding protein 2 (SATB2) is an immunophenotypic marker for osteoblastic differentiation. Cases of OSJ, BFOLs (ossifying fibroma and fibrous dysplasia) of the jaw, and Ewing sarcoma of the jaw were retrieved from the Departments of Oral Pathology and Oral Medicine, Faculty of Dentistry, Obafemi Awolowo University and Lagos State University College of Medicine, Nigeria. All OSJ retrieved showed histologic features of high-grade osteosarcoma. IHC for SATB2 (clone EP281) and MDM2 (clone IF2), as well as fluorescence in situ hybridization (FISH) for MDM2 amplification, were performed on all cases. SATB2 was expressed in a strong intensity and diffuse staining pattern in all cases (11 OSJ, including a small-cell variant, 7 ossifying fibromas, and 5 fibrous dysplasias) except in Ewing sarcoma, where it was negative in neoplastic cells. MDM2 was expressed in a weak to moderate intensity and scattered focal to limited diffuse staining pattern in 27% (3/11) of cases of OSJ and negative in all BFOLs and the Ewing sarcoma. MDM2 amplification was negative by FISH in interpretable cases. In conclusion, the three cases of high-grade OSJs that expressed MDM2 may have undergone transformation from a low-grade osteosarcoma (LGOS). SATB2 is not a dependable diagnostic marker to differentiate OSJ from BFOLs of the jaw; however, it could serve as a valuable diagnostic marker in differentiating the small-cell variant of OSJ from Ewing sarcoma of the jaw, while MDM2 may be a useful diagnostic marker in differentiating OSJ from BFOLs of the jaw, especially in the case of an LGOS or high-grade transformed osteosarcoma.
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Affiliation(s)
- Adepitan A. Owosho
- Missouri School of Dentistry and Oral Health, A.T. Still University, Kirksville, MO 63501, USA;
- Correspondence: ; Tel.: +1-660-626-2843
| | - Adeola M. Ladeji
- Department of Oral Pathology and Oral Medicine, Faculty of Dentistry, Lagos State University, Lagos 101233, Nigeria; (A.M.L.); (K.E.A.); (M.A.O.)
| | - Olufunlola M. Adesina
- Department of Oral Medicine and Oral Pathology, Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.M.A.); (T.O.)
| | - Kehinde E. Adebiyi
- Department of Oral Pathology and Oral Medicine, Faculty of Dentistry, Lagos State University, Lagos 101233, Nigeria; (A.M.L.); (K.E.A.); (M.A.O.)
| | - Mofoluwaso A. Olajide
- Department of Oral Pathology and Oral Medicine, Faculty of Dentistry, Lagos State University, Lagos 101233, Nigeria; (A.M.L.); (K.E.A.); (M.A.O.)
| | - Toluwaniyin Okunade
- Department of Oral Medicine and Oral Pathology, Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.M.A.); (T.O.)
| | - Jacob Palmer
- Missouri School of Dentistry and Oral Health, A.T. Still University, Kirksville, MO 63501, USA;
| | - Temitope Kehinde
- Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University, Morgantown, WV 26506, USA; (T.K.); (J.A.V.)
| | - Jeffrey A. Vos
- Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University, Morgantown, WV 26506, USA; (T.K.); (J.A.V.)
| | - Grayson Cole
- Department of Diagnostic Sciences, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA; (G.C.); (K.F.S.)
| | - Kurt F. Summersgill
- Department of Diagnostic Sciences, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA; (G.C.); (K.F.S.)
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Abstract
Diagnosis of osteosarcoma can be challenging because of its diverse histological patterns and the lack of diagnostic biomarkers for most examples. This review summarizes the key pathologic findings of osteosarcoma subtypes (high-grade central, parosteal, low-grade central, periosteal, high-grade surface, and secondary) with an emphasis on describing and illustrating histological heterogeneity to help general pathologists. Differential diagnoses are listed for each entity, and histological subtype and distinguishing features, including molecular genetic findings (eg, MDM2, IDH, H3F3A, FOS, and USP6), are discussed. The review also covers recently established and emerging concepts and controversies regarding osteosarcoma.
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Affiliation(s)
- Akihiko Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
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32
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Savvidou O, Papakonstantinou O, Lakiotaki E, Zafeiris I, Melissaridou D, Korkolopoulou P, Papagelopoulos PJ. Surface bone sarcomas: an update on current clinicopathological diagnosis and treatment. EFORT Open Rev 2021; 6:905-917. [PMID: 34760290 PMCID: PMC8559567 DOI: 10.1302/2058-5241.6.210064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Surface bone sarcomas are rare malignant bone tumours. Osseous and cartilaginous surface bone sarcomas are the most common, with parosteal and periosteal osteosarcomas, periosteal chondrosarcomas and secondary peripheral chondrosarcomas being the most frequent. Their clinical symptoms are non-specific and include pain for several months, swelling and limited range of motion of the adjacent joints. Prompt diagnosis is important, as biological behaviour, imaging and histopathologic characteristics, treatment and prognosis differ considerably from their conventional intramedullary counterparts. Moreover, their imaging characteristics are not infrequently non-characteristic and may be misinterpreted as juxtacortical benign lesions leading to incorrect diagnosis and treatment, with life-threatening repercussions. Molecular studies and histopathological sampling are essential for accurate diagnosis. There are still numerous issues regarding the biology, pathophysiology and treatment options of these entities due to their rarity.
Cite this article: EFORT Open Rev 2021;6:905-917. DOI: 10.1302/2058-5241.6.210064
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Affiliation(s)
- Olga Savvidou
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece.,These authors contributed equally to this manuscript
| | - Olympia Papakonstantinou
- Second Department of Radiology, National and Kapodistrian University of Athens, Medical School, Attikon University General Hospital, Athens, Greece.,These authors contributed equally to this manuscript
| | - Eleftheria Lakiotaki
- First Department of Pathology, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.,These authors contributed equally to this manuscript
| | - Ioannis Zafeiris
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Dimitra Melissaridou
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Pinelopi Korkolopoulou
- First Department of Pathology, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.,Co-senior authors
| | - Panayiotis J Papagelopoulos
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece.,Co-senior authors
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Abstract
Fibrous and fibro-osseous tumors are some of the most common benign lesions involving bones. Although many of the histomorphologic features of these tumors overlap significantly, an interdisciplinary approach helps to consolidate the classification of these tumors. Herein, the clinical, radiologic, and pathologic features of lesions within these categories are described.
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Affiliation(s)
- Ivan Chebib
- James Homer Wright Pathology Laboratories, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - Connie Y Chang
- Division of Musculoskeletal Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Santiago Lozano-Calderon
- Department of Orthopaedic Oncology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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Tsujisaka R, Nakayama R, Sekita T, Asano N, Kikuta K, Oguro S, Takeuchi K, Sasaki A, Okita H, Nakamura M, Matsumoto M. Dedifferentiated Osteosarcoma of the Distal Ulna: A Case Report. Case Rep Oncol 2021; 14:1228-1236. [PMID: 34703440 PMCID: PMC8460975 DOI: 10.1159/000518266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 06/23/2021] [Indexed: 11/28/2022] Open
Abstract
Osteosarcoma is the most common malignant primary bone tumor that occurs most frequently in the second decade of life but rarely in patients over 40 years of age. The most common primary sites of osteosarcoma are the distal femur followed by proximal tibia and proximal humerus, and involvement of the wrist is extremely rare. Moreover, dedifferentiated osteosarcoma is also a rare condition that progresses to high-grade osteosarcoma from low-grade osteosarcoma, usually central low-grade osteosarcoma or parosteal osteosarcoma that bears MDM2 and/or CDK4 gene amplifications. We herein report an extremely rare case of dedifferentiated osteosarcoma arising in the distal ulna of an adult over 40 years of age. The patient was a 46-year-old man with a 2-month history of pain in his left swollen wrist. The initial radiological findings suggested a benign bone tumor in the distal ulna, and the lesion was marginally excised at the nearby hospital. Although the pathological diagnosis at the nearby hospital suggested a benign cartilaginous tumor, the tumor recurred in an aggressive manner 8 months after the initial surgery. The patient was referred to our hospital, and an incisional biopsy showed a high-grade osteosarcoma. The primary tumor was retrospectively re-evaluated at our hospital and diagnosed as low-grade osteosarcoma. Since neoadjuvant chemotherapy failed to shrink the tumor, the patient had to undergo below the elbow amputation to cure the disease. Although the tumor was negative for MDM2 nor CDK4, the definitive diagnosis of dedifferentiated osteosarcoma was made according to the clinical course and the histological findings. Lung metastases were found 10 months after the amputation, which were successfully treated by neoadjuvant chemotherapy and surgery. The patient has been doing well with no evidence of disease for 1 year and 6 months. Surprisingly, the literature review revealed that many low-grade osteosarcomas of the distal ulna progressed to high-grade dedifferentiated osteosarcomas. One should bear in mind that the diagnosis and treatment for bone-forming tumors of the distal ulna should be made very carefully because, although rare, it is possible that the tumor may initially appear as a benign or low-grade malignant tumor and may progress to high-grade osteosarcoma.
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Affiliation(s)
- Ryosuke Tsujisaka
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Robert Nakayama
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tetsuya Sekita
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Naofumi Asano
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kazutaka Kikuta
- Department of Musculoskeletal Oncology and Orthopaedic Surgery, Tochigi Cancer Center, Tochigi, Japan
| | - Sota Oguro
- Department of Diagnostic Radiology, Tohoku University Hospital, Miyagi, Japan
| | - Katsuhito Takeuchi
- Division of Orthopaedic Surgery, Kawasaki Municipal Ida Hospital, Kanagawa, Japan
| | - Aya Sasaki
- Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan.,Department of Pathology and Laboratory Medicine, Tokyo Dental College Ichikawa General Hospital, Tokyo, Japan
| | - Hajime Okita
- Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Chung RT, Montejo JD, Kerr DA, Hong J. Juvenile psammomatoid ossifying fibroma of the parietal bone and review of calvarial presentations: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2021; 2:CASE21361. [PMID: 35855183 PMCID: PMC9265227 DOI: 10.3171/case21361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/19/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Juvenile psammomatoid ossifying fibroma (JPOF) is an uncommon benign fibro-osseous lesion that only rarely presents in the calvaria. OBSERVATIONS The authors reported a case of JPOF in the left parietal bone of a 20-year-old patient and reviewed the 27 other cases of JPOF occurring in the calvaria as reported in the literature. LESSONS JPOF rarely presents in the calvaria, and because diagnosis is a histopathologic one, clinicians should consider this entity when presented with a lytic, expansile mass on imaging. Little is known about the molecular mechanisms driving development of JPOF. MDM2 amplification may play a role, although this was not seen in the case presented herein.
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Affiliation(s)
- Robert T. Chung
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; and
| | | | | | - Jennifer Hong
- Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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36
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Copy number alteration profiling facilitates differential diagnosis between ossifying fibroma and fibrous dysplasia of the jaws. Int J Oral Sci 2021; 13:21. [PMID: 34188021 PMCID: PMC8242074 DOI: 10.1038/s41368-021-00127-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 11/22/2022] Open
Abstract
Ossifying fibroma (OF) and fibrous dysplasia (FD) are two fibro-osseous lesions with overlapping clinicopathological features, making diagnosis challenging. In this study, we applied a whole-genome shallow sequencing approach to facilitate differential diagnosis via precise profiling of copy number alterations (CNAs) using minute amounts of DNA extracted from morphologically correlated microdissected tissue samples. Freshly frozen tissue specimens from OF (n = 29) and FD (n = 28) patients were obtained for analysis. Lesion fibrous tissues and surrounding normal tissues were obtained by laser capture microdissection (LCM), with ~30–50 cells (5 000–10 000 µm2) per sample. We found that the rate of recurrent CNAs in OF cases was much higher (44.8%, 13 of 29) than that in FD cases (3.6%, 1 of 28). Sixty-nine percent (9 of 13) of the CNA-containing OF cases involved segmental amplifications and deletions on Chrs 7 and 12. We also identified eight CNA-associated genes (HILPDA, CALD1, C1GALT1, MICALL2, PHF14, AIMP2, MDM2, and CDK4) with amplified expression, which was consistent with the copy number changes. We further confirmed a jaw lesion with a previous uncertain diagnosis due to its ambiguous morphological features and the absence of GNAS mutation as OF based on the typical Chr 12 amplification pattern in its CNA profile. Moreover, analysis of a set of longitudinal samples collected from an individual with a cellular lesion in suspicion of OF at the first surgery, recurrence and the latest malignant transformation revealed identical CNA patterns at the three time points, suggesting that copy number profiling can be used as an important tool to identify borderline lesions or lesions with malignant potential. Overall, CNA profiling of fibro-osseous lesions can greatly improve differential diagnosis between OF and FD and help predict disease progression.
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Ossifying Fibromas of the Head and Neck Region: A Clinicopathological Study of 45 Cases. Head Neck Pathol 2021; 16:248-256. [PMID: 34184157 PMCID: PMC9018917 DOI: 10.1007/s12105-021-01350-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/19/2021] [Indexed: 10/21/2022]
Abstract
Ossifying fibromas of the head and neck region are classified as cemento-ossifying fibroma (COF) (odontogenic origin), and two types of juvenile ossifying fibromas: juvenile trabecular ossifying fibroma (JTOF), and juvenile psammomatous ossifying fibroma (JPOF). The potential for recurrence in JTOF and JPOF and the discovery of newer molecular signatures necessitates accurate histological classification. Over 12 years (2005-2017), a total of 45 patients with 51 tumours were retrieved and reviewed for clinic-pathological features from the archives of a tertiary care oncology centre. Of 45 cases, COF, JTOF and JPOF comprised 13 (28.9%), 11 (24.4%) and 18 (40%) cases respectively. Three cases were unclassifiable. M: F ratio was 1:3.3, 1.1:1, 2:1 for COF, JTOF and JPOF respectively with an age range of 6-66 years (mean: 24.6, median; 18.1 years). The most common site for COF was mandible, for JTOF was maxilla, and for JPOF was ethmoid sinus. One case of mixed JTOF and JPOF histology was seen. Aneurysmal bone cyst-like areas were seen in 26.6% of cases, most commonly in JPOF. Follow up was available in 23 cases, and ranged from 4 to 207 months. Three cases of JPOF had a recurrence and one patient with JTOF had residual disease after surgery. One case of COF demonstrated increased parathyroid hormone levels. COF, JTOF, and JPOF are clinically, radiologically and histologically distinct entities. Surgical resection is the mainstay of treatment. JPOF has a higher incidence of recurrence as compared to JTOF and COF and hence needs a more aggressive follow-up.
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38
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Brčić I, Rosenberg AE. Pathology of pleomorphic/undifferentiated and dedifferentiated bone neoplasms. Semin Diagn Pathol 2021; 38:163-169. [PMID: 34049746 DOI: 10.1053/j.semdp.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/01/2021] [Accepted: 04/09/2021] [Indexed: 11/11/2022]
Abstract
Primary malignant bone tumors are uncommon and their accurate classification requires careful correlation of clinical, radiological, and pathologic findings. It is a heterogeneous group of tumors with a wide spectrum of morphology and their biological potential can be of low- or high-grade, depending on their risk for developing metastases. Over the past several decades, the classification of bone sarcomas has remained largely constant. However, some of the tumors have been reclassified and several new entities have emerged. In this review, we will focus on pleomorphic fibrosarcoma/UPS and dedifferentiated bone tumors, discuss their key diagnostic features, differential diagnosis, and their relation to prognosis.
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Affiliation(s)
- Iva Brčić
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Andrew E Rosenberg
- Department of Pathology and Laboratory Medicine, Division of Bone and Soft tissue, University of Miami, Sylvester Comprehensive Cancer Center, and Jackson Memorial Hospitals, Miami, FL, USA.
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39
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Soluk-Tekkesin M, Sinanoglu A, Selvi F, Cakir Karabas H, Aksakalli N. The importance of clinical and radiological findings for the definitive histopathologic diagnosis of benign fibro-osseous lesions of the jaws: Study of 276 cases. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:364-371. [PMID: 33878496 DOI: 10.1016/j.jormas.2021.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/07/2021] [Accepted: 04/14/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE Benign fibro-osseous lesions (BFOLs) are heterogeneous intraosseous disease processes sharing overlapping histopathologic features and demonstrate a wide range of biological behavior. The aim of this study is to highlight the importance of clinical and radiological findings for the definitive histopathologic diagnosis of benign fibro-osseous lesions of the jaws. MATERIALS AND METHODS This is a cross-sectional retrospective study evaluating the three main groups of BFOLs: Cemento-osseous dysplasia, ossifying fibromas, and fibrous dysplasia. Previously diagnosed BFOL cases were searched for thoroughly from the archives of Istanbul University, Institute of Oncology, Department of Tumor Pathology in between 2005 and 2015. Clinical and radiological data of these cases were identified and recorded. The histopathologic features were reevaluated from the H&E-stained slides. RESULTS A total of 276 BFOL cases were identified and reevaluated for the study. The most common BFOL type was cemento-osseous dysplasia (n = 135), followed by cemento-ossifying fibroma (n = 77), fibrous dysplasia (n = 53) and juvenile ossifying fibroma (n = 11). The female/male ratio was 3.4:1 with a strong predilection for the 4th decade (n = 102). The mandible (n = 209) was the predominantly affected jaw. Prominent osteoblastic rimming around the bony lesion was commonly observed for cemento-ossifying fibroma (n = 60/77), followed by cemento-osseous dysplasia (n = 23/135). Predominant ossification patterns showed some differences among the groups. The most common radiological feature was the mixed radiolucent/radiopaque internal structure. CONCLUSION Our results document various clinical, radiological and histopathologic findings of BFOLs. Even some histopathologic differences are observed, clinical and radiographic correlation is mandatory prior to the definitive histopathologic diagnosis of BFOLs for the prevention of possible misdiagnoses or inappropriate treatments.
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Affiliation(s)
- Merva Soluk-Tekkesin
- Istanbul University, Institute of Oncology, Department of Tumour Pathology, Istanbul, Turkey.
| | - Alper Sinanoglu
- Kocaeli University, Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, Kocaeli, Turkey
| | - Firat Selvi
- Istanbul University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul, Turkey
| | - Hulya Cakir Karabas
- Istanbul University, Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, Istanbul, Turkey
| | - Nihan Aksakalli
- Istanbul University, Institute of Oncology, Department of Tumour Pathology, Istanbul, Turkey
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Sciot R. MDM2 Amplified Sarcomas: A Literature Review. Diagnostics (Basel) 2021; 11:diagnostics11030496. [PMID: 33799733 PMCID: PMC8001728 DOI: 10.3390/diagnostics11030496] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 01/10/2023] Open
Abstract
Murine Double Minute Clone 2, located at 12q15, is an oncogene that codes for an oncoprotein of which the association with p53 was discovered 30 years ago. The most important function of MDM2 is to control p53 activity; it is in fact the best documented negative regulator of p53. Mutations of the tumor suppressor gene p53 represent the most frequent genetic change in human cancers. By overexpressing MDM2, cancer cells have another means to block p53. The sarcomas in which MDM2 amplification is a hallmark are well-differentiated liposarcoma/atypical lipomatous tumor, dedifferentiated liposarcoma, intimal sarcoma, and low-grade osteosarcoma. The purpose of this review is to summarize the typical clinical, histopathological, immunohistochemical, and genetic features of these tumors.
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Affiliation(s)
- Raf Sciot
- Department of Pathology, University Hospital, University of Leuven, 3000 Leuven, Belgium
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41
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Molecular Genetics in the Multidisciplinary Management of Sarcoma. Sarcoma 2021. [DOI: 10.1007/978-981-15-9414-4_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Yen CC, Chen TH, Hung GY. Chemotherapy for osteosarcoma: Literature review and experience of Taipei veterans general hospital. JOURNAL OF CANCER RESEARCH AND PRACTICE 2021. [DOI: 10.4103/jcrp.jcrp_24_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Tran V, Slavin J. Bone Tumour Pathology. Sarcoma 2021. [DOI: 10.1007/978-981-15-9414-4_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Wang XQ, Wang XQ, Hsu ATYW, Goytain A, Ng TLT, Nielsen TO. A Rapid and Cost-Effective Gene Expression Assay for the Diagnosis of Well-Differentiated and Dedifferentiated Liposarcomas. J Mol Diagn 2020; 23:274-284. [PMID: 33346147 DOI: 10.1016/j.jmoldx.2020.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/26/2020] [Accepted: 11/17/2020] [Indexed: 12/22/2022] Open
Abstract
Histologic examination neither reliably distinguishes benign lipomas from atypical lipomatous tumor/well-differentiated liposarcoma, nor dedifferentiated liposarcoma from other pleomorphic sarcomas, entities with different prognoses and management. Molecular confirmation of pathognomonic 12q13-15 amplifications leading to MDM2 overexpression is a diagnostic gold standard. Currently the most commonly used assay for this purpose is fluorescence in situ hybridization (FISH), but this is labor intensive. This study assessed whether newer NanoString-based technology could allow for more rapid and cost-efficient diagnosis of liposarcomas on standard formalin-fixed tissues through gene expression. Leveraging large-scale transcriptome data from The Cancer Genome Atlas, 20 genes were identified, most from the 12q13-15 amplicon, that distinguish dedifferentiated liposarcoma from other sarcomas and can be measured within a single NanoString assay. Using 21 cases of histologically ambiguous low-grade adipocytic tumors with available MDM2 amplification status, a machine learning-based analytical pipeline was built that assigns a given sample as negative or positive for liposarcoma based on quantitative gene expression. The effectiveness of the assay was validated on an independent set of 100 sarcoma samples (including 40 incident prospective cases), where histologic examination was considered insufficient for clinical diagnosis. The NanoString assay had a 93% technical success rate, and an accuracy of 97.8% versus an MDM2 amplification FISH gold standard. NanoString had a considerably faster turnaround time and was cheaper than FISH.
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Affiliation(s)
- Xiu Q Wang
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Genetic Pathology Evaluation Centre, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Xue Q Wang
- Genetic Pathology Evaluation Centre, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anika T Y W Hsu
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Genetic Pathology Evaluation Centre, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Angela Goytain
- Genetic Pathology Evaluation Centre, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tony L T Ng
- Genetic Pathology Evaluation Centre, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, BC, Canada
| | - Torsten O Nielsen
- Genetic Pathology Evaluation Centre, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, BC, Canada.
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Farah BL, Sittampalam K. Two cases of parosteal osteosarcoma with unusual histological and molecular features. Pathology 2020; 53:654-658. [PMID: 33272695 DOI: 10.1016/j.pathol.2020.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 11/18/2022]
Affiliation(s)
| | - Kesavan Sittampalam
- Department of Anatomical Pathology, Division of Pathology, Singapore General Hospital, Singapore.
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Xu G, Yamamoto N, Hayashi K, Takeuchi A, Miwa S, Igarashi K, Taniguchi Y, Araki Y, Yonezawa H, Morinaga S, Tsuchiya H. Atypical and incomplete pulmonary hypertrophic osteoarthropathy in the left distal femur: a case report. BMC Surg 2020; 20:293. [PMID: 33228609 PMCID: PMC7685659 DOI: 10.1186/s12893-020-00959-6] [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: 04/16/2020] [Accepted: 11/12/2020] [Indexed: 11/21/2022] Open
Abstract
Background Pulmonary hypertrophic osteoarthropathy (PHO) is a rare paraneoplastic syndrome that mainly occurs in patients with lung cancer. Most symptoms occur symmetrically, and unilateral symptoms without clubbing are infrequent. This report presents the case of a rare atypical symptom that was highly suspected of being PHO. Case presentation A 77-year-old woman with swelling and severe pain in the left femur for 2 months was referred to our hospital. Radiography revealed a remarkably osteogenic thickening and sclerotic lesion in her distal femur. Preliminary diagnoses of malignant bone tumor and hematological tumor were made based on laboratory test results, radiological examination, and clinical manifestation. A needle biopsy was performed, which ruled out the diagnosis of malignant bone tumors. A low-grade bone tumor was still suspected. After that, en bloc resection was performed, followed by replacement of the femur with a mega-prosthesis. Pathological analysis revealed no malignant tumor cells, and immunohistochemical staining for CDK4 and MDM2 yielded negative results. Meanwhile, pulmonary large cell carcinoma was identified on biopsy. Based on published studies, a diagnosis of atypical PHO was made according to clinical and imaging manifestations. Conclusions This is an infrequent case of PHO with unilateral symptoms in the left femur. When clinical manifestations and radiological findings are inconsistent with the pathological results, the possibility of benign lesions with malignant clinical manifestations or imaging features should be carefully considered.
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Affiliation(s)
- Gang Xu
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Norio Yamamoto
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Katsuhiro Hayashi
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Akihiko Takeuchi
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Shinji Miwa
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Kentaro Igarashi
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Yuta Taniguchi
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Yoshihiro Araki
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hirotaka Yonezawa
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Sei Morinaga
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
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van der Waal I. Professional diagnostic delay in osteosarcomas of the jaws. Med Oral Patol Oral Cir Bucal 2020; 25:e834-e837. [PMID: 33125360 PMCID: PMC7648920 DOI: 10.4317/medoral.24334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/08/2020] [Indexed: 11/14/2022] Open
Abstract
A series of 20 consecutive patients with an osteosarcoma of the jaws has been evaluated with regard to possible professional diagnostic delay. When set at an arbitrarily chosen period beyond three months, professional delay occurred in 15 patients, the mean being 21 months and the median 11 months. In five of the 15 patients a wrong diagnosis has been rendered on the biopsy specimen, being fibrous dysplasia (2x), osteoma (2x) and, in case of palatomaxillary swelling, pleomorphic adenoma (1x). In the other ten patients the initial clinicoradiographic features were misleading and apparently not indicative of a malignancy, except for one patient in whom a distinct widening of the periodontal ligament, as expressed on a periapical film, has been overlooked or not properly interpreted. It has not been possible to assess the possible influence of the delayed diagnosis on the prognosis. Key words:Osteosarcoma of the jaws, diagnostic delay.
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Affiliation(s)
- I van der Waal
- Department of Oral and Maxillofacial Surgery/Pathology Amsterdam University Medical Center/ Academic Center for Dentistry (ACTA) P.O. Box 7057, 1007MB, Amsterdam, the Netherlands
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Diagnostic Utility and Limitations of Immunohistochemistry of p16, CDK4, and MDM2 and Automated Dual-color In Situ Hybridization of MDM2 for the Diagnosis of Challenging Cases of Dedifferentiated Liposarcoma. Appl Immunohistochem Mol Morphol 2020; 27:758-763. [PMID: 31145104 DOI: 10.1097/pai.0000000000000677] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The diagnosis of dedifferentiated liposarcoma (DDLPS) is challenging when an atypical lipomatous tumor component is absent or obscure. To analyze the utility and limitations of ancillary techniques, we studied 11 cases of DDLPS in challenging conditions and 17 cases of nonlipogenic high-grade sarcomas with immunohistochemistry (IHC) for p16, CDK4, and MDM2 and automated dual-color in situ hybridization (DISH) for MDM2 amplification. All DDLPS specimens lacked clear lipogenic components and were immunoreactive for p16, CDK4, and MDM2. DISH analyses also revealed high-level amplification of MDM2 in all DDLPS. In contrast, among nonlipogenic sarcomas, p16, CDK4, and MDM2 were expressed in 8, 9, and 3 cases, respectively. MDM2 amplification was detected in 3 of 8 studied. The MDM2-amplified tumors were the same as the MDM2-immunoreactive tumors. After careful reevaluation of these 3 sarcomas, 2 were reclassified as DDLPS because small areas of lipogenic components were detected in the original specimens. The respective sensitivities and specificities of these markers were as follows: p16 IHC (100% and 60%), CDK4 IHC (100% and 53.3%), MDM2 IHC (100% and 93.3%), and MDM2 DISH (100% and 83.3%). The results of MDM2 IHC completely coincided with those of MDM2 DISH. The present study confirmed the substantial utility of MDM2 IHC and MDM2 DISH in the diagnosis of DDLPS, especially when lipogenic components were indistinct compared with IHC for p16 and CDK4. Furthermore, automated DISH was more practical than fluorescent in situ hybridization.
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Clinicopathologic study of 6 cases of epithelioid osteoblastoma of the jaws with immunoexpression analysis of FOS and FOSB. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:191-199. [PMID: 32482537 DOI: 10.1016/j.oooo.2020.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/06/2020] [Accepted: 03/08/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to describe the clinicopathologic features of a series of gnathic epithelioid osteoblastomas. As high levels of Proto-oncogene c-Fos proteins resulting from FOS-FOSB translocation were recently demonstrated in osteoblastomas, we also evaluated the immunoexpression of these proteins. STUDY DESIGN Records of all cases of epithelioid osteoblastoma of the jaws were retrieved from oral pathology services, and their clinicopathologic and immunohistochemical data were collected. Immunohistochemistry was also performed by using anti-FOS and anti-FOSB antibodies. RESULTS Six cases of epithelioid osteoblastomas were obtained, 4 in men and 2 in women, and they were mainly located in the posterior body of the mandible (n = 4). Radiographically, the tumors showed mixed radiolucent and radiopaque images, most with poorly defined margins. Microscopically, large epithelioid cells with eccentrically located nuclei predominated among osteoid and immature bone trabeculae. Sharp delineation from adjacent normal bone was observed in all cases. FOS immunostaining was diffuse and strong in the cytoplasm and nucleus of neoplastic cells in all cases, whereas FOSB was only focally positive, with few epithelioid osteoblasts showing nuclear staining. CONCLUSIONS Although epithelioid osteoblastomas of the jaws are locally aggressive, widespread metastasis does not occur, and, as with conventional osteoblastomas, there is wide expression of the FOS protein.
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