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Zhu J, Cao X, Chen L, Song J, Shen Z, Yu Y. Report of a giant invasive, wall-penetrating cardiac lipoma. J Cardiothorac Surg 2024; 19:600. [PMID: 39385190 PMCID: PMC11462687 DOI: 10.1186/s13019-024-03035-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 08/30/2024] [Indexed: 10/12/2024] Open
Abstract
BACKGROUND Cardiac lipoma, a seldom-encountered benign tumor positioned beneath the endocardium, has the potential to impair electrophysiological functions. Diagnosis is principally based on imaging modalities. The uniqueness of this case lies in the tumor's extension both internally and externally within the right atrium, rendering it of special interest. From a clinical standpoint, surgical removal is commonly advocated, wherein early intervention is pivotal in improving patients' long-term prognoses. CASE PRESENTATION A 35-year-old male was admitted to the hospital for treatment subsequent to the identification of a cardiac mass two days prior. Initial diagnostic assessments, encompassing CT scans and echocardiography, identified a space-occupying lesion within the heart. The patient underwent surgical excision of the cardiac tumor, utilizing mild hypothermic extracorporeal circulation via femoral vessel access. Intraoperative findings revealed adipose-like tissue of a "dumbbell-shaped" configuration situated both within and external to the right atrium, measuring approximately 8 cm*9 cm internally and 7 cm*6 cm externally, with the extracardiac mass being marginally larger. Postoperative pathological analysis confirmed a cardiac lipoma diagnosis. A follow-up echocardiogram conducted three months post-surgery exhibited no notable abnormalities. The patient is under continuous observation to monitor for any recurrence or potential long-term complications. CONCLUSION In this case report, we detail with precision a rare cardiac pathology manifested by an expansive infiltrative lipoma that pervades the endocardial and epicardial layers of the right atrium. After thorough preoperative diagnostic workup and evaluation, we contend that surgical intervention represents the optimal therapeutic approach for managing such conditions, with the goal of preemptively reducing the likelihood of cardiac compression or intracardiac obstruction.
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Affiliation(s)
- Jingze Zhu
- Department of Cardiovascular Surgery of the First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Xiangyu Cao
- Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Lei Chen
- Department of Cardiovascular Surgery of the First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Junjie Song
- Department of Cardiovascular Surgery of the First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Zhenya Shen
- Department of Cardiovascular Surgery of the First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, 215123, China.
- Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, Suzhou, Jiangsu, 215123, China.
| | - Yunsheng Yu
- Department of Cardiovascular Surgery of the First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, 215123, China.
- Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, Suzhou, Jiangsu, 215123, China.
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2
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Becker AK, Puladi B, Xie K, Cassataro A, Götzl R, Hölzle F, Beier JP, Knüchel-Clarke R, Braunschweig T. HER3 (ERBB3) amplification in liposarcoma - a putative new therapeutic target? World J Surg Oncol 2024; 22:131. [PMID: 38760830 PMCID: PMC11100077 DOI: 10.1186/s12957-024-03406-5] [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: 02/29/2024] [Accepted: 05/07/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Liposarcomas are among the most common mesenchymal malignancies. However, the therapeutic options are still very limited and so far, targeted therapies had not yet been established. Immunotherapy, which has been a breakthrough in other oncological entities, seems to have no efficacy in liposarcoma. Complicating matters further, classification remains difficult due to the diversity of morphologies and nonspecific or absent markers in immunohistochemistry, leaving molecular pathology using FISH or sequencing as best options. Many liposarcomas harbor MDM2 gene amplifications. In close relation to the gene locus of MDM2, HER3 (ERBB3) gene is present and co-amplification could occur. Since the group of HER/EGFR receptor tyrosine kinases and its inhibitors/antibodies play a role in a broad spectrum of oncological diseases and treatments, and some HER3 inhibitors/antibodies are already under clinical investigation, we hypothesized that in case of HER3 co-amplifications a tumor might bear a further potential therapeutic target. METHODS We performed FISH analysis (MDM2, DDIT3, HER3) in 56 archived cases and subsequently performed reclassification to confirm the diagnosis of liposarcoma. RESULTS Next to 16 out of 56 cases needed to be re-classified, in 20 out of 54 cases, a cluster-amplification of HER3 could be detected, significantly correlating with MDM2 amplification. Our study shows that the entity of liposarcomas show specific molecular characteristics leading to reclassify archived cases by modern, established methodologies. Additionally, in 57.1% of these cases, HER3 was cluster-amplified profusely, presenting a putative therapeutic target for targeted therapy. CONCLUSION Our study serves as the initial basis for further investigation of the HER3 gene as a putative therapeutic target in liposarcoma.
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Affiliation(s)
| | - Behrus Puladi
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, 52074, Aachen, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Aachen, Germany
| | - Kunpeng Xie
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, 52074, Aachen, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Aachen, Germany
| | - Angela Cassataro
- Institute of Pathology, University Hospital RWTH Aachen, 52074, Aachen, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Aachen, Germany
| | - Rebekka Götzl
- Department of Plastic, Hand Surgery - Burn Center, University Hospital RWTH Aachen, 52074, Aachen, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Aachen, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, 52074, Aachen, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Aachen, Germany
| | - Justus P Beier
- Department of Plastic, Hand Surgery - Burn Center, University Hospital RWTH Aachen, 52074, Aachen, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Aachen, Germany
| | - Ruth Knüchel-Clarke
- Institute of Pathology, University Hospital RWTH Aachen, 52074, Aachen, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Aachen, Germany
| | - Till Braunschweig
- Institute of Pathology, University Hospital RWTH Aachen, 52074, Aachen, Germany.
- Institute of Pathology, Faculty of Medicine, LMU Munich, Thalkirchner Strasse 36, 80337, Munich, Germany.
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3
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Du A, Wang H, Dai J, Dong Q, Yuan G, Pan Y. Case report: a case report of excision of giant lipoma in the posterior neck. Front Oncol 2024; 14:1395130. [PMID: 38800402 PMCID: PMC11116667 DOI: 10.3389/fonc.2024.1395130] [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: 03/06/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024] Open
Abstract
Lipomas, benign tumors originating from the anomalous proliferation of adipocytes, predominantly emerge in regions rich in adipose tissue. However, their presence in the head and neck areas remains rare, constituting approximately 13% of all diagnosed lipoma cases. This study presents a case involving a substantial subcutaneous lipoma located at the posterior neck, measuring about 20 cm × 19 cm × 10 cm. The patient presented with swelling and pain in the back of the neck. And the considerable dimensions of this lipoma significantly impacted the patient's quality of life and aesthetic appearance. Concurrently, the patient exhibited symptoms indicative of degenerative cervical spine disease and cervical disc herniation. After admission, a comprehensive examination, including ultrasound, CT scan, and MRI, was conducted. Given the clinical complexity, the decision for surgical intervention was deemed essential. The surgical strategy entailed a meticulous total excision of the tumor through an incision made in the posterior cross-neck, coupled with the strategic removal of excess skin. To facilitate wound healing, postoperative management included the use of negative pressure drainage. Pathological examination conclusively identified the mass as a lipoma. Postoperative follow-ups indicated successful recovery, as evidenced by the restoration of the neck's aesthetic contour and the complete resolution of the previously observed restrictions in sagittal neck movement.
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Affiliation(s)
- Aichao Du
- The Second Clinical Medical College of Lanzhou University, Lanzhou, China
- Gansu Provincial Key Laboratory of Neurology, Lanzhou, China
| | - Hongyu Wang
- The Second Clinical Medical College of Lanzhou University, Lanzhou, China
- Gansu Provincial Key Laboratory of Neurology, Lanzhou, China
| | - Junqiang Dai
- The Second Clinical Medical College of Lanzhou University, Lanzhou, China
- Gansu Provincial Key Laboratory of Neurology, Lanzhou, China
- Department of Neurosurgery, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Qiang Dong
- Gansu Provincial Key Laboratory of Neurology, Lanzhou, China
- Department of Neurosurgery, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Guoqiang Yuan
- The Second Clinical Medical College of Lanzhou University, Lanzhou, China
- Gansu Provincial Key Laboratory of Neurology, Lanzhou, China
| | - Yawen Pan
- The Second Clinical Medical College of Lanzhou University, Lanzhou, China
- Gansu Provincial Key Laboratory of Neurology, Lanzhou, China
- Department of Neurosurgery, The Second Hospital of Lanzhou University, Lanzhou, China
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4
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Ariffen NA, Ornellas AA, Alves G, Shana'ah AM, Sharma S, Kankel S, Jamali E, Theis B, Liehr T. Amplification of different satellite-DNAs in prostate cancer. Pathol Res Pract 2024; 256:155269. [PMID: 38522124 DOI: 10.1016/j.prp.2024.155269] [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: 01/31/2024] [Revised: 03/11/2024] [Accepted: 03/20/2024] [Indexed: 03/26/2024]
Abstract
In various solid tumors and corresponding cell lines, prior research has identified acquired copy number variations (CNVs) encompassing centromeric satellite-DNA sequences. This observation emerged from the application of centromeric probes (satellite-DNA) as controls in molecular cytogenetic investigations and diagnostics, although these accounts were largely anecdotal. In this study, we conducted a systematic screening for satellite-DNA sequence amplification in 31 prostate cancer (PCa) samples, a prevalent malignancy in men characterized by discernible molecular cytogenetic aberrations. Notably, PCa-typical genetic aberrations, such as TMPRSS2-ERG gene rearrangements and PTEN deletion, were identified in 12 and 6 out of the 31 PCa samples, respectively. Overall, PCa exhibited genomic instability marked by chromosomal gain or loss of signals across nearly all tested satellite-DNA regions, with particular emphasis on the Y-chromosome (18/31 cases). Remarkably, 5/12 PCa samples representing more advanced metastatic cancer displayed amplification of one or two satellite DNA stretches each, being detectable as blocks analogous to homogenously staining regions. Notably, these stretches included α-satellite DNA derived from chromosomes 2, 3, 4, 15, and 20, as well as satellite-III DNAs (D1Z1 and DYZ1). These findings align with recent discoveries indicating that α-satellite DNAs are expressed as long-non-coding RNAs in advanced cancer, particularly in the context of PCa.
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Affiliation(s)
- Nurul Aida Ariffen
- Jena University Hospital, Friedrich Schiller University, Institute of Human Genetics, Jena, Germany; Laboratory, Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia
| | | | - Gilda Alves
- Circulating Biomarkers Laboratory, Faculty of Medical Sciences, Department of General Pathology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Ahmad Moay Shana'ah
- Jena University Hospital, Friedrich Schiller University, Institute of Human Genetics, Jena, Germany
| | - Samiha Sharma
- Jena University Hospital, Friedrich Schiller University, Institute of Human Genetics, Jena, Germany
| | - Stefanie Kankel
- Jena University Hospital, Friedrich Schiller University, Institute of Human Genetics, Jena, Germany
| | - Elena Jamali
- Jena University Hospital, Friedrich Schiller University, Institute of Human Genetics, Jena, Germany
| | - Bernhard Theis
- Jena University Hospital, Friedrich Schiller University, Institute of Forensic Medicine, Section Pathology, Jena, Germany
| | - Thomas Liehr
- Jena University Hospital, Friedrich Schiller University, Institute of Human Genetics, Jena, Germany.
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5
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Mori T, Iwasaki T, Sonoda H, Kawaguchi K, Tomonaga T, Furukawa H, Sato C, Shiraishi S, Taguchi K, Tamiya S, Yoneda R, Oshiro Y, Matsunobu T, Abe C, Kuboyama Y, Ueki N, Kohashi K, Yamamoto H, Nakashima Y, Oda Y. DDIT3-amplified or low-polysomic pleomorphic sarcomas without MDM2 amplification: Clinicopathological review and immunohistochemical profile of nine cases. Hum Pathol 2024; 145:56-62. [PMID: 38401716 DOI: 10.1016/j.humpath.2024.02.007] [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: 11/09/2023] [Revised: 02/17/2024] [Accepted: 02/20/2024] [Indexed: 02/26/2024]
Abstract
Several high-grade pleomorphic sarcoma cases that cannot be classified into any existing established categories have been reported. These cases were provisionally classified into undifferentiated pleomorphic sarcoma (UPS). Some dedifferentiated liposarcoma (DDLS) cases may also have been classified into the UPS category due to the absence of MDM2 amplification or an atypical lipomatous tumor/well-differentiated liposarcoma component. We retrieved and reviewed 77 high-grade pleomorphic sarcoma cases, initially diagnosed as UPS in 66 cases and DDLS in 11 cases. Fluorescence in situ hybridization (FISH) analyses of DDIT3 and MDM2 were performed for available cases. Of the cases successfully subjected to DDIT3 FISH (n = 56), nine (7 UPS and 2 DDLS) showed DDIT3 amplification but no MDM2 amplification. Two UPS cases showed both telomeric (5') and centromeric (3') amplification of DDIT3 or low polysomy of chromosome 12, whereas 5 UPS and 2 DDLS cases showed 5'-predominant DDIT3 amplification. Histopathologically, all cases showed UPS-like proliferation of atypical pleomorphic tumor cells. Immunohistochemically, only one case showed focal nuclear positivity for DDIT3, supporting the previous finding that DDIT3 expression was not correlated with DDIT3 amplification. All three cases with focal MDM2 expression involved 5'-predominant amplification, two of which showed DDLS-like histological features. The majority of cases (7/9) showed decreased expression in p53 staining, suggesting that DDIT3 amplification regulates the expression of TP53 like MDM2. From a clinicopathological perspective, we hypothesize that DDIT3-amplified sarcoma, especially with 5'-predominant amplification, can be reclassified out of the UPS category.
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Affiliation(s)
- Taro Mori
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeshi Iwasaki
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroki Sonoda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kengo Kawaguchi
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takumi Tomonaga
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Furukawa
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Chiaki Sato
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Sakura Shiraishi
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenichi Taguchi
- Department of Pathology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Sadafumi Tamiya
- Department of Pathology, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Reiko Yoneda
- Department of Pathology, Hamanomachi Hospital, Fukuoka, Japan
| | - Yumi Oshiro
- Department of Pathology, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Tomoya Matsunobu
- Department of Orthopaedic Surgery, Kyushu Rosai Hospital, Fukuoka, Japan
| | - Chie Abe
- Department of Diagnostic Pathology, Fukuokahigashi Medical Center, Fukuoka, Japan
| | - Yusuke Kuboyama
- Department of Pathology, Oita Red Cross Hospital, Oita, Japan
| | - Nozomi Ueki
- Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kenichi Kohashi
- Department of Humanpathology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hidetaka Yamamoto
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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6
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Lavernia J, Claramunt R, Romero I, López-Guerrero JA, Llombart-Bosch A, Machado I. Soft Tissue Sarcomas with Chromosomal Alterations in the 12q13-15 Region: Differential Diagnosis and Therapeutic Implications. Cancers (Basel) 2024; 16:432. [PMID: 38275873 PMCID: PMC10814159 DOI: 10.3390/cancers16020432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
The chromosomal region 12q13-15 is rich in oncogenes and contains several genes involved in the pathogenesis of various mesenchymal neoplasms. Notable genes in this region include MDM2, CDK4, STAT6, DDIT3, and GLI1. Amplification of MDM2 and CDK4 genes can be detected in various mesenchymal and nonmesenchymal neoplasms. Therefore, gene amplification alone is not entirely specific for making a definitive diagnosis and requires the integration of clinical, radiological, morphological, and immunohistochemical findings. Neoplasms with GLI1 alterations may exhibit either GLI1 rearrangements or amplifications of this gene. Despite the diagnostic implications that the overlap of genetic alterations in neoplasms with changes in genes within the 12q13-15 region could create, the discovery of coamplifications of MDM2 with CDK4 and GLI1 offers new therapeutic targets in neoplasms with MDM2/CDK4 amplification. Lastly, it is worth noting that MDM2 or CDK4 amplification is not exclusive to mesenchymal neoplasms; this genetic alteration has also been observed in other epithelial neoplasms or melanomas. This suggests the potential use of MDM2 or CDK4 inhibitors in neoplasms where alterations in these genes do not aid the pathological diagnosis but may help identify potential therapeutic targets. In this review, we delve into the diagnosis and therapeutic implications of tumors with genetic alterations involving the chromosomal region 12q13-15, mainly MDM2, CDK4, and GLI1.
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Affiliation(s)
- Javier Lavernia
- Oncology Unit, Instituto Valenciano de Oncología, 46009 Valencia, Spain;
| | - Reyes Claramunt
- Laboratory of Molecular Biology, Instituto Valenciano de Oncología, 46009 Valencia, Spain; (R.C.); (J.A.L.-G.)
| | - Ignacio Romero
- Oncology Unit, Instituto Valenciano de Oncología, 46009 Valencia, Spain;
| | - José Antonio López-Guerrero
- Laboratory of Molecular Biology, Instituto Valenciano de Oncología, 46009 Valencia, Spain; (R.C.); (J.A.L.-G.)
| | | | - Isidro Machado
- Pathology Department, University of Valencia, 46010 Valencia, Spain;
- Pathology Department, Instituto Valenciano de Oncología, 46010 Valencia, Spain
- CIBERONC Cancer, 28029 Madrid, Spain
- Patologika Laboratory, Hospital Quiron-Salud, 46010 Valencia, Spain
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7
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Foreman SC, Llorián-Salvador O, David DE, Rösner VKN, Rischewski JF, Feuerriegel GC, Kramp DW, Luiken I, Lohse AK, Kiefer J, Mogler C, Knebel C, Jung M, Andrade-Navarro MA, Rost B, Combs SE, Makowski MR, Woertler K, Peeken JC, Gersing AS. Development and Evaluation of MR-Based Radiogenomic Models to Differentiate Atypical Lipomatous Tumors from Lipomas. Cancers (Basel) 2023; 15:cancers15072150. [PMID: 37046811 PMCID: PMC10093205 DOI: 10.3390/cancers15072150] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/10/2023] [Accepted: 03/27/2023] [Indexed: 04/08/2023] Open
Abstract
Background: The aim of this study was to develop and validate radiogenomic models to predict the MDM2 gene amplification status and differentiate between ALTs and lipomas on preoperative MR images. Methods: MR images were obtained in 257 patients diagnosed with ALTs (n = 65) or lipomas (n = 192) using histology and the MDM2 gene analysis as a reference standard. The protocols included T2-, T1-, and fat-suppressed contrast-enhanced T1-weighted sequences. Additionally, 50 patients were obtained from a different hospital for external testing. Radiomic features were selected using mRMR. Using repeated nested cross-validation, the machine-learning models were trained on radiomic features and demographic information. For comparison, the external test set was evaluated by three radiology residents and one attending radiologist. Results: A LASSO classifier trained on radiomic features from all sequences performed best, with an AUC of 0.88, 70% sensitivity, 81% specificity, and 76% accuracy. In comparison, the radiology residents achieved 60–70% accuracy, 55–80% sensitivity, and 63–77% specificity, while the attending radiologist achieved 90% accuracy, 96% sensitivity, and 87% specificity. Conclusion: A radiogenomic model combining features from multiple MR sequences showed the best performance in predicting the MDM2 gene amplification status. The model showed a higher accuracy compared to the radiology residents, though lower compared to the attending radiologist.
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Affiliation(s)
- Sarah C. Foreman
- Department of Radiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Oscar Llorián-Salvador
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
- Department of Informatics, Bioinformatics and Computational Biology—i12, Technische Universität München, Boltzmannstr. 3, 85748 Munich, Germany
- Institute of Organismic and Molecular Evolution, Johannes Gutenberg University Mainz, Hanns-Dieter-Hüsch-Weg 15, 55128 Mainz, Germany
| | - Diana E. David
- Department of Informatics, Bioinformatics and Computational Biology—i12, Technische Universität München, Boltzmannstr. 3, 85748 Munich, Germany
| | - Verena K. N. Rösner
- Department of Radiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Jon F. Rischewski
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Munich (LMU), Marchioninistrasse 15, 81377 Munich, Germany
| | - Georg C. Feuerriegel
- Department of Radiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Daniel W. Kramp
- Department of Radiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Ina Luiken
- Department of Radiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Ann-Kathrin Lohse
- Department of Radiology, University Hospital Munich (LMU), Marchioninistrasse 15, 81377 Munich, Germany
| | - Jurij Kiefer
- Department of Plastic Surgery, University Hospital Freiburg, University of Freiburg, Hugstetterstraße 55, 79106 Freiburg im Breisgau, Germany
| | - Carolin Mogler
- Institute of Pathology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Carolin Knebel
- Department of Orthopedics and Sport Orthopedics, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Matthias Jung
- Department of Radiology, University Hospital Freiburg, University of Freiburg, Hugstetterstraße 55, 79106 Freiburg im Breisgau, Germany
| | - Miguel A. Andrade-Navarro
- Institute of Organismic and Molecular Evolution, Johannes Gutenberg University Mainz, Hanns-Dieter-Hüsch-Weg 15, 55128 Mainz, Germany
| | - Burkhard Rost
- Department of Informatics, Bioinformatics and Computational Biology—i12, Technische Universität München, Boltzmannstr. 3, 85748 Munich, Germany
| | - Stephanie E. Combs
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Marcus R. Makowski
- Department of Radiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Klaus Woertler
- Department of Radiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Jan C. Peeken
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
- Helmholtz Zentrum München, Deutsches Forschungszentrum für Umwelt und Gesundheit, Institute of Radiation Medicine Neuherberg, 85764 Munich, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, 69120 Heidelberg, Germany
| | - Alexandra S. Gersing
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Munich (LMU), Marchioninistrasse 15, 81377 Munich, Germany
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8
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Gambella A, Bertero L, Rondón-Lagos M, Verdun Di Cantogno L, Rangel N, Pitino C, Ricci AA, Mangherini L, Castellano I, Cassoni P. FISH Diagnostic Assessment of MDM2 Amplification in Liposarcoma: Potential Pitfalls and Troubleshooting Recommendations. Int J Mol Sci 2023; 24:ijms24021342. [PMID: 36674856 PMCID: PMC9863600 DOI: 10.3390/ijms24021342] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
MDM2 amplification represents the leading oncogenic pathway and diagnostic hallmark of liposarcoma, whose assessment is based on Fluorescence In Situ Hybridization (FISH) analysis. Despite its diagnostic relevance, no univocal interpretation criteria regarding FISH assessments of MDM2 amplification have been established so far, leading to several different approaches and potential diagnostic misinterpretations. This study aims to address the most common issues and proposes troubleshooting guidelines for MDM2 amplification assessments by FISH. We retrospectively retrieved 51 liposarcomas, 25 Lipomas, 5 Spindle Cell Lipoma/Pleomorphic Lipomas, and 2 Atypical Spindle Cell Lipomatous Tumors and the corresponding MDM2 FISH analysis. We observed MDM2 amplification in liposarcomas cases only (43 out of 51 cases) and identified three MDM2-amplified patterns (scattered (50% of cases), clustered (14% of cases), and mixed (36% of cases)) and two nonamplified patterns (low number of signals (82% of cases) and polysomic (18% of cases)). Based on these data and published evidence in the literature, we propose a set of criteria to guide MDM2 amplification analysis in liposarcoma. Kindled by the compelling importance of MDM2 assessments to improve diagnostic and therapeutic liposarcoma management, these suggestions could represent the first step to develop a univocal interpretation model and consensus guidelines.
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Affiliation(s)
- Alessandro Gambella
- Division of Liver and Transplant Pathology, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy
| | - Luca Bertero
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy
| | - Milena Rondón-Lagos
- School of Biological Sciences, Universidad Pedagógica y Tecnológica de Colombia, Tunja 150003, Colombia
| | - Ludovica Verdun Di Cantogno
- Department of Laboratory Medicine, Azienda Ospedaliera Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Nelson Rangel
- Departamento de Nutrición y Bioquímica, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá 110231, Colombia
| | - Chiara Pitino
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy
| | | | - Luca Mangherini
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy
| | | | - Paola Cassoni
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy
- Correspondence: ; Tel.: +39-011-633-5588
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9
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Rottmann D, Abdulfatah E, Pantanowitz L. Molecular testing of soft tissue tumors. Diagn Cytopathol 2023; 51:12-25. [PMID: 35808975 PMCID: PMC10084007 DOI: 10.1002/dc.25013] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/27/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The diagnosis of soft tissue tumors is challenging, especially when the evaluable material procured is limited. As a result, diagnostic ancillary testing is frequently needed. Moreover, there is a trend in soft tissue pathology toward increasing use of molecular results for tumor classification and prognostication. Hence, diagnosing newer tumor entities such as CIC-rearranged sarcoma explicitly requires molecular testing. Molecular testing can be accomplished by in situ hybridization, polymerase chain reaction, as well as next generation sequencing, and more recently such testing can even be accomplished leveraging an immunohistochemical proxy. CONCLUSION This review evaluates the role of different molecular tests in characterizing soft tissue tumors belonging to various cytomorphologic categories that have been sampled by small biopsy and cytologic techniques.
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Affiliation(s)
- Douglas Rottmann
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Eman Abdulfatah
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Liron Pantanowitz
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
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10
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Chromosomal Heteromorphisms and Cancer Susceptibility Revisited. Cells 2022; 11:cells11203239. [PMID: 36291106 PMCID: PMC9600968 DOI: 10.3390/cells11203239] [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: 09/09/2022] [Revised: 10/10/2022] [Accepted: 10/10/2022] [Indexed: 11/21/2022] Open
Abstract
Chromosomal heteromorphisms (CHs) are a part of genetic variation in man. The past literature largely posited whether CHs could be correlated with the development of malignancies. While this possibility seemed closed by end of the 1990s, recent data have raised the question again on the potential influences of repetitive DNA elements, the main components of CHs, in cancer susceptibility. Such new evidence for a potential role of CHs in cancer can be found in the following observations: (i) amplification and/or epigenetic alterations of CHs are routinely reported in tumors; (ii) the expression of CH-derived RNA in embryonal and other cells under stress, including cancer cells; (iii) the expression of parts of CH-DNA as long noncoding RNAs; plus (iv) theories that suggest a possible application of the “two-hit model” for euchromatic copy number variants (CNVs). Herein, these points are discussed in detail, which leads to the conclusion that CHs are by far not given sufficient consideration in routine cytogenetic analysis, e.g., leukemias and lymphomas, and need more attention in future research settings including solid tumors. This heightened focus may only be achieved by approaches other than standard sequencing or chromosomal microarrays, as these techniques are at a minimum impaired in their ability to detect, if not blind to, (highly) repetitive DNA sequences.
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11
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Karameh M, Golomb M, Yarkoni M, Rudis E, Keidar Haran T, Shadafny N, Cohen D, Beeri R, Gilon D, Asleh R, Durst R. Giant Intracardiac Lipoma: A Case Report and the Role of Multimodality Cardiac Imaging. Cureus 2022; 14:e29565. [PMID: 36312694 PMCID: PMC9595577 DOI: 10.7759/cureus.29565] [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] [Accepted: 09/25/2022] [Indexed: 11/19/2022] Open
Abstract
Cardiac lipomas, especially ones originating from the left ventricle, are extremely rare. They may be asymptomatic or may present with various non-specific symptoms. Herein, we report a case of a giant lipoma of the left ventricle, with frequent ventricular premature beats on electrocardiogram. An echocardiogram demonstrated a large hyperechoic mass occupying a significant portion of the left ventricle. We further describe the diagnostic workup utilizing multimodality cardiac imaging and treatment options. Cardiac MRI demonstrated fat suppression, and cardiac CT showed a homogenous low-attenuation mass suggesting lipomatous matter. The mass was subsequently surgically removed for pathology examination in order to rule out liposarcoma. Histopathology demonstrated mature adipocytes, entrapped myocytes with hypertrophy, and interstitial fibrosis foci confirming the diagnosis of lipoma.
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12
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Segi N, Nakashima H, Ando K, Machino M, Ito S, Matsumoto A, Koshimizu H, Tomita H, Nojima T, Imagama S. Paraplegia due to spinal epidural lipoma without spinal dysraphism in an adolescent patient: a case report. NAGOYA JOURNAL OF MEDICAL SCIENCE 2022; 84:656-663. [PMID: 36237883 PMCID: PMC9529617 DOI: 10.18999/nagjms.84.3.656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/22/2021] [Indexed: 11/23/2022]
Abstract
We report the case of a rare lipoma arising in the epidural space of a 14-year-old boy without spinal dysraphism. Lipomas are rare in pediatric soft tissue tumors, accounting for only about 4% of cases. The incidence of an intraspinal epidural lipoma without spinal dysraphism is extremely rare in pediatric patients. In this case, the patient had progressive motor deficits in the lower extremities and difficulty in urination and defecation. Magnetic resonance imaging showed an extradural tumor compressing the spinal cord at the T3-T7 level. Because of the progressive neurological deficits, we performed an emergency surgery. The tumor was completely resected en bloc, and histopathology revealed mature adipose tissue with fibrous septa, diagnosed as atypical lipomatous tumor / well-differentiated liposarcoma. The patient fully recovered and there was no tumor recurrence for 6 years since the surgery. However, re-examination using fluorescence in situ hybridization after 6 years of surgery changed the diagnosis to lipoma as no amplification of murine double-minute type 2 oncogene was observed. In liposarcoma, histopathological diagnosis using fluorescence in situ hybridization is mandatory. Our case illustrates that immunohistochemical diagnosis alone can be misleading. Hence, prompt surgery is required for progressive neuropathy.
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Affiliation(s)
- Naoki Segi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaaki Machino
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sadayuki Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akiyuki Matsumoto
- Department of Orthopedic Surgery, Okazaki City Hospital, Okazaki, Japan
| | - Hiroyuki Koshimizu
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyuki Tomita
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takayuki Nojima
- Department of Pathology, Kanazawa University Hospital, Kanazawa, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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13
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Wilcock DM, McMurtry V, Coleman JF, Kim JT, Khalili P, Deftereos G, Albertson D, Gulbahce EH, Liu T, Sirohi D. Histopathological Correlation of Chromosome 12 Polysomy by Fluorescence in Situ Hybridization in Adipocytic Neoplasms. Int J Surg Pathol 2022; 30:734-742. [PMID: 35261272 DOI: 10.1177/10668969221085289] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Identification of MDM2 amplification by fluorescence in situ hybridization is an important diagnostic tool for evaluation of adipocytic neoplasms. Rarely, neoplasms can show increased copies of MDM2 and CEP12 probes (polysomy) without amplification (MDM2/CEP12 ratio <2.0). While noted in the literature, this finding has not been the focus of any study to date. Methods: Consecutive cases were retrospectively screened for increased copies of MDM2 and CEP12 and were classified as: high polysomy (ratio<2.0, CEP12≥10.0), low polysomy (ratio<2.0, but >0.5, CEP12≥4.0 but <9.9), and CEP12 amplification (ratio≤0.5, CEP12 > 4.0). H&E slides were classified by a pathologist into diagnostic categories based on morphology without knowledge of MDM2 amplification result. Correlations between chromosome 12 polysomy and histological features in the same region of the tumor were investigated. Results: There were 19 (0.7%) high polysomy, 52 (2.0%) low polysomy and 3 (0.1%) CEP12 amplification cases identified in the 2541 cases screened. While low polysomy was seen across benign and malignant adipocytic tumors and other sarcomas, high level polysomy was primarily seen in liposarcomas, both atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDLPS) and dedifferentiated liposarcoma (DDLPS). No lipomas were high polysomy. Conclusion: Polysomy is an uncommon, but distinct, finding in adipocytic neoplasms found across the spectrum of benign to malignant with little insight into the pathophysiology or prognosis. While low polysomy is also observed in benign adipocytic neoplasms, high polysomy is almost always seen in malignant adipocytic neoplasms and is uncommon in benign adipocytic neoplasms.
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Affiliation(s)
- Diane M Wilcock
- The Institute for Experimental Pathology® , ARUP Laboratories, Salt Lake City, UT
| | - Valarie McMurtry
- The Institute for Experimental Pathology® , ARUP Laboratories, Salt Lake City, UT.,14434University of Utah and ARUP Laboratories, Salt Lake City, UT
| | - Joshua F Coleman
- The Institute for Experimental Pathology® , ARUP Laboratories, Salt Lake City, UT.,14434University of Utah and ARUP Laboratories, Salt Lake City, UT
| | - Jong Taek Kim
- The Institute for Experimental Pathology® , ARUP Laboratories, Salt Lake City, UT.,14434University of Utah and ARUP Laboratories, Salt Lake City, UT
| | - Parisa Khalili
- The Institute for Experimental Pathology® , ARUP Laboratories, Salt Lake City, UT.,14434University of Utah and ARUP Laboratories, Salt Lake City, UT
| | - Georgios Deftereos
- The Institute for Experimental Pathology® , ARUP Laboratories, Salt Lake City, UT.,14434University of Utah and ARUP Laboratories, Salt Lake City, UT
| | - Daniel Albertson
- The Institute for Experimental Pathology® , ARUP Laboratories, Salt Lake City, UT.,14434University of Utah and ARUP Laboratories, Salt Lake City, UT
| | - Evin H Gulbahce
- The Institute for Experimental Pathology® , ARUP Laboratories, Salt Lake City, UT.,14434University of Utah and ARUP Laboratories, Salt Lake City, UT
| | - Ting Liu
- The Institute for Experimental Pathology® , ARUP Laboratories, Salt Lake City, UT.,14434University of Utah and ARUP Laboratories, Salt Lake City, UT
| | - Deepika Sirohi
- The Institute for Experimental Pathology® , ARUP Laboratories, Salt Lake City, UT.,14434University of Utah and ARUP Laboratories, Salt Lake City, UT
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14
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Radiomics of Musculoskeletal Sarcomas: A Narrative Review. J Imaging 2022; 8:jimaging8020045. [PMID: 35200747 PMCID: PMC8876222 DOI: 10.3390/jimaging8020045] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/31/2022] [Accepted: 02/10/2022] [Indexed: 12/23/2022] Open
Abstract
Bone and soft-tissue primary malignant tumors or sarcomas are a large, diverse group of mesenchymal-derived malignancies. They represent a model for intra- and intertumoral heterogeneities, making them particularly suitable for radiomics analyses. Radiomic features offer information on cancer phenotype as well as the tumor microenvironment which, combined with other pertinent data such as genomics and proteomics and correlated with outcomes data, can produce accurate, robust, evidence-based, clinical-decision support systems. Our purpose in this narrative review is to offer an overview of radiomics studies dealing with Magnetic Resonance Imaging (MRI)-based radiomics models of bone and soft-tissue sarcomas that could help distinguish different histotypes, low-grade from high-grade sarcomas, predict response to multimodality therapy, and thus better tailor patients’ treatments and finally improve their survivals. Although showing promising results, interobserver segmentation variability, feature reproducibility, and model validation are three main challenges of radiomics that need to be addressed in order to translate radiomics studies to clinical applications. These efforts, together with a better knowledge and application of the “Radiomics Quality Score” and Image Biomarker Standardization Initiative reporting guidelines, could improve the quality of sarcoma radiomics studies and facilitate radiomics towards clinical translation.
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15
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Asano Y, Miwa S, Yamamoto N, Hayashi K, Takeuchi A, Igarashi K, Yonezawa H, Araki Y, Morinaga S, Nojima T, Ikeda H, Tsuchiya H. A scoring system combining clinical, radiological, and histopathological examinations for differential diagnosis between lipoma and atypical lipomatous tumor/well-differentiated liposarcoma. Sci Rep 2022; 12:237. [PMID: 34997060 PMCID: PMC8742117 DOI: 10.1038/s41598-021-04004-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/13/2021] [Indexed: 02/07/2023] Open
Abstract
This study evaluated the diagnostic accuracy of clinical, radiological, and histopathological examinations for differential diagnosis between atypical lipomatous tumor (ALT)/well-differentiated liposarcoma (WDLS) and lipoma, and aimed to develop a new combined scoring system for the preoperative diagnosis of ALT/WDLS. Eighty-nine lipomas and 56 ALT/WDLS were included and their clinical characteristics, magnetic resonance imaging (MRI) findings, histological findings by hematoxylin and eosin (HE) staining were investigated. Then, univariate and multivariate logistic regression analyses were performed for the findings, and a combined scoring system consisted of predictive factors of ALT/WDLS was developed. The univariate and multivariate logistic regression analyses revealed that tumor location (lower extremity), deep site, size (> 11 cm), thick septa (> 2 mm), enhancement of septa or nodular lesions, and lipoblasts were significantly different for the diagnosis of ALT/WDLS. We developed a combined scoring system based on the six predictive factors (total 0-16 points, the cutoff was 9 points). The area under the curve was 0.945, and sensitivity was 87.6% and specificity was 91.1% by the receiver operating characteristics curve. This combined scoring system does not require special equipment and reagents such as fluorescence in situ hybridization (FISH), and anyone can use it easily in many medical institutions with high diagnostic accuracy.
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Affiliation(s)
- Yohei Asano
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa city, Ishikawa, 920-8641, Japan
| | - Shinji Miwa
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa city, Ishikawa, 920-8641, Japan
| | - Norio Yamamoto
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa city, Ishikawa, 920-8641, Japan.
| | - Katsuhiro Hayashi
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa city, Ishikawa, 920-8641, Japan
| | - Akihiko Takeuchi
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa city, Ishikawa, 920-8641, Japan
| | - Kentaro Igarashi
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa city, Ishikawa, 920-8641, Japan
| | - Hirotaka Yonezawa
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa city, Ishikawa, 920-8641, Japan
| | - Yoshihiro Araki
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa city, Ishikawa, 920-8641, Japan
| | - Sei Morinaga
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa city, Ishikawa, 920-8641, Japan
| | - Takayuki Nojima
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa city, Ishikawa, 920-8641, Japan.,Department of Pathology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa city, Ishikawa, 920-8641, Japan
| | - Hiroko Ikeda
- Department of Pathology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa city, Ishikawa, 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa city, Ishikawa, 920-8641, Japan
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16
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The Utility of Chest Imaging for Surveillance of Atypical Lipomatous Tumors. Sarcoma 2021; 2021:4740924. [PMID: 34671190 PMCID: PMC8523289 DOI: 10.1155/2021/4740924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022] Open
Abstract
Background Unlike other soft tissue sarcomas, atypical lipomatous tumors (ALTs) are thought to have a low propensity for metastasis. Despite this, a standard of care for pulmonary metastasis (PM) surveillance has not been established. This study aimed to evaluate the utility of chest imaging for PM surveillance following ALT excision. Methods This was a multi-institution, retrospective review of all patients with primary ALTs of the extremities or superficial torso who underwent excision between 2006 and 2018. Minimum follow-up was two years. Long-term survival was evaluated using the Kaplan-Meier method. Results 190 patients with ALT were included. Average age was 61.7 years and average follow-up was 58.6 months (24 to 180 months). MDM2 testing was positive in 88 patients (46.3%), and 102 (53.7%) did not receive MDM2 testing. 188 patients (98.9%) had marginal excision, and 127 (66.8%) had marginal or positive margins. Patients received an average of 0.9 CT scans and 1.3 chest radiographs over the surveillance period. 10-year metastasis-free survival was 100%, with no documented deaths from disease. Conclusions This study suggests that chest imaging does not have a significant role in PM surveillance following ALT excision, but advanced local imaging and chest surveillance may be considered in cases of local recurrence or concern for dedifferentiation.
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17
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Pei J, Flieder DB, Talarchek JN, Cooper HS, Patchefsky AS, Wei S. Clinical Application of Chromosome Microarray Analysis in the Diagnosis of Lipomatous Tumors. Appl Immunohistochem Mol Morphol 2021; 29:592-598. [PMID: 33734108 DOI: 10.1097/pai.0000000000000923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/27/2021] [Indexed: 11/25/2022]
Abstract
Well-differentiated liposarcoma/atypical lipomatous tumor (WDLS/ALT) and dedifferentiated liposarcoma (DDLS) have characteristic supernumerary ring and giant marker chromosomes involving the chromosomal region 12q13-15 which contains MDM2 (12q15), CDK4 (12q14.1), HMGA2 (12q14.3), YEATS4 (12q15), CPM (12q15), and FRS2 (12q15). Detecting MDM2 amplification by fluorescence in situ hybridization (FISH) is considered to be the gold standard for the diagnosis of WDLS/ALT and DDLS. In this study, formalin fixed paraffin embedded clinical specimens (16 liposarcomas and 19 benign lipomatous tumors) were used to detect MDM2 amplification and other chromosomal alterations in WDLS/ALT and DDLS by single nucleotide polymorphism-based chromosome microarray (CMA). All 16 liposarcomas showed MDM2 amplification with a MDM2/cep12 ratio from 2.4 to 8.4 by CMA. Ten (62.5%) of these cases had CDK4/cep12 ratio ≥2.0. All the cases without CDK4 amplification were from the thigh. The MDM2/cep12 ratio of all the benign lipomatous tumors (19/19) was within the normal limits. Twenty-one of the 35 benign lipomatous tumors and liposarcomas were also tested for MDM2 amplification by FISH. All the FISH results were consistent with the CMA results (100%). Along with MDM2 amplification, all 16 liposarcomas (100%) also showed amplification of YEATS4, CPM and FRS2. Only 11 of 16 (69%) cases showed HMGA2 amplification. In conclusion, this study demonstrated that CMA on routine formalin fixed paraffin embedded tissue is a sensitive and specific clinical test for detection of MDM2 gene amplification. Moreover, CMA allows simultaneous detection of genomic changes of interest including CDK4 and others, which provides enriched information for diagnosing lipomatous tumors.
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Affiliation(s)
- Jianming Pei
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, PA
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18
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Total endoscopic left ventricle lipoma removal. J Cardiothorac Surg 2021; 16:218. [PMID: 34348760 PMCID: PMC8335990 DOI: 10.1186/s13019-021-01602-y] [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: 05/26/2021] [Accepted: 07/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Left ventricle (LV) lipoma is a very rare, benign cardiac tumor. Due to its rarity, LV lipoma is often misdiagnosed. Aspecific symptoms such as murmurs, arrhythmias, memory loss and palpitation may occur due to the mass effect. Case presentation We report a case report of a 42 year old woman who was found to have left ventricle mass after check-up for arrhytmia. By a fully endoscopic approach, the mass was successfully resected from the left ventricle without the need for sternotomy. Conclusion Total endoscopic removal of left ventricle lipoma’s can be done safely and has several advantages to conventional sternotomy. Larger studies are needed to confirm this hypothesis.
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19
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Radner M, van Luttikhuizen JL, Bartels S, Bublitz J, Grote I, Rieger L, Christgen H, Stark H, Werlein C, Lafos M, Steinemann D, Lehmann U, Christgen M, Kreipe H. Chromosome 2q gain and epigenetic silencing of GATA3 in microglandular adenosis of the breast. J Pathol Clin Res 2021; 7:220-232. [PMID: 33382535 PMCID: PMC8073017 DOI: 10.1002/cjp2.195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/06/2020] [Accepted: 11/20/2020] [Indexed: 01/30/2023]
Abstract
Microglandular adenosis (MGA) represents a rare neoplasm of the mammary gland, which in a subset of cases may be associated with triple-negative breast cancer (BC). The biology of MGA is poorly understood. In this study, eight MGA cases (n = 4 with and n = 4 without associated BC) were subjected to a comprehensive characterization using immunohistochemistry, genome-wide DNA copy number (CN) profiling, fluorescence in situ hybridization (FISH), next-generation sequencing (NGS), and DNA methylation profiling using 850 K arrays and bisulfite pyrosequencing. Median patient age was 61 years (range 57-76 years). MGA lesions were estrogen receptor (ER)-negative, progesterone receptor-negative, HER2-negative, and S100-positive. DNA CN alterations (CNAs) were complex or limited to few gains and losses. CN gain on chromosome 2q was the most common CNA and was validated by FISH in five of eight cases. NGS demonstrated an average of two mutations per case (range 0-5) affecting 10 different genes (ARID1A, ATM, CTNNB1, FBXW7, FGFR2, MET, PIK3CA, PMS2, PTEN, and TP53). CNAs and mutations were similar in MGA and adjacent BC, indicating clonal relatedness. DNA methylation profiling identified aberrant hypermethylation of CpG sites within GATA3, a key transcription factor required for luminal differentiation. Immunohistochemistry showed regular GATA3 protein expression in the normal mammary epithelium and in ER-positive BC. Conversely, GATA3 was reduced or lost in all MGA cases tested (8/8). In conclusion, MGA is characterized by common CN gain on chromosome 2q and loss of GATA3. Epigenetic inactivation of GATA3 may provide a new clue to the peculiar biology of this rare neoplasia.
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Affiliation(s)
- Martin Radner
- Institute of PathologyHannover Medical SchoolHannoverGermany
| | | | - Stephan Bartels
- Institute of PathologyHannover Medical SchoolHannoverGermany
| | - Janin Bublitz
- Department of Human GeneticsHannover Medical SchoolHannoverGermany
| | - Isabel Grote
- Institute of PathologyHannover Medical SchoolHannoverGermany
| | - Luisa Rieger
- Institute of PathologyHannover Medical SchoolHannoverGermany
| | | | - Helge Stark
- Institute of PathologyHannover Medical SchoolHannoverGermany
| | | | - Marcel Lafos
- Institute of PathologyHannover Medical SchoolHannoverGermany
| | - Doris Steinemann
- Department of Human GeneticsHannover Medical SchoolHannoverGermany
| | - Ulrich Lehmann
- Institute of PathologyHannover Medical SchoolHannoverGermany
| | | | - Hans Kreipe
- Institute of PathologyHannover Medical SchoolHannoverGermany
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20
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Muir LD, Woelfle JD, Schowinsky J, Wilky BA. High grade sarcoma presenting as multifocal recurrent seromas after inguinal hernia repair: A case report. Rare Tumors 2020; 12:2036361320975746. [PMID: 33489055 PMCID: PMC7809524 DOI: 10.1177/2036361320975746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/02/2020] [Indexed: 12/02/2022] Open
Abstract
In this report, we describe a 54-year-old male with cystic retroperitoneal sarcoma extending through the inguinal canal. Patient initially underwent inguinal hernia repair with mesh placement for suspected cord lipoma, after which he developed recurrent loculated retroperitoneal fluid collections refractory to multiple attempts at drain placement and laparotomy. Twenty-nine months after initial surgery, patient was referred to our institution on suspicion of malignancy. Pathology of resections taken during subsequent laparotomy showed foci of malignant cells interspersed throughout reactive proliferations. Follow-up immunohistochemistry confirmed high-grade sarcoma, likely atypical liposarcoma, but was unable to definitively establish subtype. Despite en bloc resection and gemcitabine/docetaxel chemotherapy, local progression continued, and patient was enrolled in clinical trials of doxorubicin with dual immune checkpoint blockade. This case suggests that sarcoma should be considered as a differential diagnosis of retroperitoneal or inguinal mass unresponsive to treatment; and highlights the difficulty of subtyping and managing cystic retroperitoneal sarcoma.
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Affiliation(s)
- Lorne D Muir
- Rocky Vista University College of Osteopathic Medicine, Parker, CO, USA
| | - Joshua D Woelfle
- Rocky Vista University College of Osteopathic Medicine, Parker, CO, USA
| | | | - Breelyn A Wilky
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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21
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Tamkus S, Gusho CA, Colman MW, Miller I, Gitelis S, Blank AT. A single institutional experience treating adipocytic tumors: incidence, disease-related outcomes, and the clinical significance of MDM2 analysis. Orthop Rev (Pavia) 2020; 12:8818. [PMID: 33312490 PMCID: PMC7726827 DOI: 10.4081/or.2020.8818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/16/2020] [Indexed: 11/23/2022] Open
Abstract
Adipocytic tumors exist either as a benign or malignant form. The benign variant, lipoma, is composed of normal fat tissue. Lipomas typically develop from superficial fat cells beneath the skin or mucous membranes. Liposarcoma, the malignant counterpart, often develops in deeper tissues and is the most commonly diagnosed Soft Tissue Sarcoma (STS), comprising at least 20% of adult STS. However, malignant tumors of fatty origin exist as a spectrum of diagnoses, each carrying a unique risk of recurrence, metastasis, and longterm survival. The World Health Organization classifies liposarcomas into five categories: i) Atypical Lipomatous Tumors/Well Differentiated (ALT/WD); Ii) Dedifferentiated (ALT/DD); Iii) Myxoid; Iv) Round cell; and v) Pleomorphic. Lipomatous tumors often exhibit different immunohistochemical patterns. Benign lipomas are distinguished by the absence of Murine Double-Minute 2 (MDM2) amplification. Similarly, ALT/WD, classically defined as a low-grade and locally aggressive tumor, demonstrates consistent patterns of MDM2 amplification. Some studies suggest 10% of ALT/WD progress to the highgrade DD form, with others report a dedifferentiation rate of as high as 20% for primary ALT/WD based on location. The ALT/DD subtype is aggressive and has a high capacity to metastasize. While the mechanism of pathogenesis of ALT/DD metastasis is unknown, previous studies suggest that increased MDM2 amplification may play a role. This study sought to evaluate a single institutional experience treating the entire spectrum of lipomatous tumors and describe utilization patterns of MDM2 testing. The group hypothesized: i) Atypical Lipomatous Tumors (ALT), which include ALT/DD and ALT/WD, would exhibit a higher rate of local recurrence than lipomas with no significantly increased incidence of metastases; and ii) at least 50% of our MDM2 testing of ALT would prove positive for the MDM2 overamplification. This study retrospectively reviewed 105 cases (66 lipomas, 27 ALTs, 12 liposarcomas) of patients who underwent lipomatous tumor excision at our institution from 2013 to 2017. Twenty-five tumors (6 lipomas, 18 ALT, 1 liposarcoma) were tested for MDM2 amplification. Three of the tested tumors recurred (2 ALT, 1 liposarcoma), and each exhibited MDM2 overamplification. Five tumors (5 liposarcoma) developed late metastases. These data suggest that although ALT is associated with a higher rate of local recurrence, metastases are quite rare. Additionally, the data demonstrate a high rate of positive MDM2 testing (76%) based on clinical and imaging characteristics of the tumors.
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Affiliation(s)
- Saule Tamkus
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center; and Midwest Orthopedics at Rush, Chicago, IL
| | - Charles A Gusho
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center; and Midwest Orthopedics at Rush, Chicago, IL
| | - Matthew W Colman
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center; and Midwest Orthopedics at Rush, Chicago, IL
| | - Ira Miller
- Department of Pathology, Rush University Medical Center at Rush, Chicago, IL, USA
| | - Steven Gitelis
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center; and Midwest Orthopedics at Rush, Chicago, IL
| | - Alan T Blank
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center; and Midwest Orthopedics at Rush, Chicago, IL
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Pressney I, Khoo M, Endozo R, Ganeshan B, O'Donnell P. Pilot study to differentiate lipoma from atypical lipomatous tumour/well-differentiated liposarcoma using MR radiomics-based texture analysis. Skeletal Radiol 2020; 49:1719-1729. [PMID: 32424704 DOI: 10.1007/s00256-020-03454-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/19/2020] [Accepted: 04/22/2020] [Indexed: 02/07/2023]
Abstract
AIMS This pilot study aims to determine if tumour heterogeneity assessed using magnetic resonance imaging (MRI) radiomics-based texture analysis (TA) can differentiate between lipoma and atypical lipomatous tumour (ALT)/well-differentiated liposarcoma (WDL). MATERIALS AND METHODS Thirty consecutive ALT/WDLs and 30 lipomas were included in the study, cases diagnosed both histologically and with murine double minute 2 (MDM2) gene amplification by fluorescence in situ hybridisation (FISH) in excision specimens. Multiple patient, MRI and MRTA factors were assessed. Heterogeneity was evaluated using a filtration-histogram technique-based textural analysis on single axial proton density (PD) and coronal T1-W images of the most homogenously fatty component of the lesion. RESULTS Thirty-three percent of the diagnoses of ALT/WDL vs lipoma were confirmed using FISH MDM2 analysis. ALT/WDLs were statistically different from lipomas in location (site in the body and depth from skin surface) and fat content, with p values of 0.021, 0.001, and 0.021 respectively. Nine of 36 (25%) texture parameters had significant differences between ALT/WDLs and lipomas on axial PD MRTA, with the most significant results at medium and coarse texture scales particularly mean intensity (p = 0.003) at SSF = 6, and kurtosis (p = 0.012) at SSF = 5. A cut-off value of < 304 for coarse-filtered texture on axial PD MRI identified ALT from lipoma with a sensitivity and specificity of 70% (AUC = 0.73, p = 0.003). CONCLUSIONS Texture heterogeneity quantified at fine, medium, and coarse texture scales are significant differentiators of lipoma and ALT/WDL with the difference particularly marked in medium and coarse texture scales for two MR TA parameters: mean and kurtosis.
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Affiliation(s)
- Ian Pressney
- Clinical Radiology, Royal National Orthopaedic Hospital, Stanmore, UK. .,Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
| | - Michael Khoo
- Clinical Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Raymond Endozo
- Nuclear Medicine, University College Hospital, London, UK
| | | | - Paul O'Donnell
- Clinical Radiology, Royal National Orthopaedic Hospital, Stanmore, UK.,Institute of Orthopaedics and Musculoskeletal Science, University College, London, London, UK
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23
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Nardo L, Abdelhafez YG, Acquafredda F, Schirò S, Wong AL, Sarohia D, Maroldi R, Darrow MA, Guindani M, Lee S, Zhang M, Moawad AW, Elsayes KM, Badawi RD, Link TM. Qualitative evaluation of MRI features of lipoma and atypical lipomatous tumor: results from a multicenter study. Skeletal Radiol 2020; 49:1005-1014. [PMID: 31965239 DOI: 10.1007/s00256-020-03372-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/25/2019] [Accepted: 01/01/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The objectives of the study are (1) to distinguish lipoma (L) from atypical lipomatous tumor (ALT) using MRI qualitative features, (2) to assess the value of contrast enhancement, and (3) to evaluate the reproducibility and confidence level of radiological readings. MATERIALS AND METHODS Patients with pathologically proven L or ALT, who underwent MRI within 3 months from surgical excision were included in this retrospective multicenter international study. Two radiologists independently reviewed MRI centrally. Impressions were recorded as L or ALT. A third radiologist was consulted for discordant readings. The two radiologists re-read all non-contrast sequences; impression was recorded; then post-contrast images were reviewed and any changes were recorded. RESULTS A total of 246 patients (135 females; median age, 59 years) were included. ALT was histopathologically confirmed in 70/246 patients. In multivariable analysis, in addition to the lesion size, deep location, proximal lower limb lesions, demonstrating incomplete fat suppression, or increased architectural complexity were the independent predictive features of ALT; but not the contrast enhancement. Post-contrast MRI changed the impression in a total of 5 studies (3 for R1 and 4 for R2; 2 studies are common); all of them were incorrectly changed from Ls to ALTs. Overall, inter-reader kappa agreement was 0.42 (95% CI 0.39-0.56). Discordance between the two readers was statistically significant for both pathologically proven L (p < 0.001) and ALT (p = 0.003). CONCLUSION Most qualitative MR imaging features can help distinguish ALTs from BLs. However, contrast enhancement may be limited and occasionally misleading. Substantial discordance on MRI readings exists between radiologists with a relatively high false positive and negative rates.
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Affiliation(s)
- Lorenzo Nardo
- Department of Radiology, University of California Davis, 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA.
| | - Yasser G Abdelhafez
- Department of Radiology, University of California Davis, 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA
| | | | - Silvia Schirò
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.,Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Andrew L Wong
- Department of Radiology, University of California Davis, 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA
| | - Dani Sarohia
- Department of Radiology, University of California Davis, 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA
| | - Roberto Maroldi
- Scienze Radiologiche, Università degli Studi di Brescia, Brescia, Italy
| | - Morgan A Darrow
- Pathology and Laboratory Medicine, University of California Davis, Sacramento, CA, USA
| | - Michele Guindani
- Department of Statistics, University of California, Irvine, CA, USA
| | - Sonia Lee
- Department of Radiological Sciences, University of California, Irvine, CA, USA
| | - Michelle Zhang
- Department of Diagnostic Radiology, McGill University Health Center, Montreal, Canada
| | - Ahmed W Moawad
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Khaled M Elsayes
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ramsey D Badawi
- Department of Radiology, University of California Davis, 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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24
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Yao X, Ghert M, Dickson BC, Popovic S, Purgina BM, Verma S, Werier J, Kandel RA. An evidence-based guideline on the application of molecular testing in the diagnosis, prediction of prognosis, and selection of therapy in non-GIST soft tissue sarcomas. Cancer Treat Rev 2020; 85:101987. [PMID: 32092619 DOI: 10.1016/j.ctrv.2020.101987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 02/06/2023]
Abstract
AIMS To make recommendations on the indications for molecular testing regarding the diagnosis, prediction of prognosis, and treatment selection in adult patients with s oft tissue sarcomas (STS) excluding gastrointestinal stromal tumour. MATERIALS AND METHODS This guideline was developed by the Cancer Care Ontario's Program in Evidence-Based Care (PEBC) and the Sarcoma Disease Site Group (DSG). The medline, embase, and Cochrane Library databases, main guideline websites, abstracts of relevant annual meetings, and PROSPERO databases were searched (January 2005 to October 2016). Internal and external reviews were conducted, with final approval by the PEBC and the Sarcoma DSG. RESULTS Based on the available evidence, we made three S trong Recommendations, 14 Recommendations, 9 Qualified Statements, and seven No Recommendations. The three Strong Recommendations include: i) MDM2 amplification by fluorescence in situ hybridization (FISH) is recommended as a sensitive and specific test to differentiate patients with atypical lipomatous tumour/well-differentiated liposarcoma, or dedifferentiated liposarcoma from lipoma or other STS in the differential diagnosis; ii) SS18 (SYT) break-apart by FISH or SS18-SSX (SYT-SSX) fusion by reverse transcription-polymerase chain reaction is recommended as a sensitive and specific test to differentiate patients with synovial sarcoma from other sarcomas; iii) CTNNB1 S45F mutation by polymerase chain reaction is recommended as a prognostic factor for poor recurrence-free survival in patients with desmoid tumours. CONCLUSION This guideline may serve as a framework for the thoughtful implementation of molecular studies at cancer centres and other jurisdictions. Some of the recommendations may need to be updated when new evidence appears in the future.
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Affiliation(s)
- Xiaomei Yao
- Program in Evidence-Based Care, Cancer Care Ontario, Department of Oncology, McMaster University, Hamilton, Ontario, Canada.
| | - Michelle Ghert
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.
| | - Brendan C Dickson
- Division of Orthopedic Surgery, Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada.
| | - Snezana Popovic
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario.
| | - Bibianna M Purgina
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada.
| | - Shailendra Verma
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada.
| | - Joel Werier
- Division of Orthopedic Surgery, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada.
| | - Rita A Kandel
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.
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25
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MDM2 RNA In Situ Hybridization for the Diagnosis of Atypical Lipomatous Tumor: A Study Evaluating DNA, RNA, and Protein Expression. Am J Surg Pathol 2020; 43:446-454. [PMID: 30520819 DOI: 10.1097/pas.0000000000001199] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The distinction of atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDL) from its benign counterpart, lipoma, may represent a challenge. MDM2 DNA amplification is used as the gold standard as MDM2 immunohistochemistry lacks specificity and sensitivity. Herein, we investigate the diagnostic utility of MDM2 RNA in situ hybridization (RNA-ISH) and compare the test with MDM2 immunohistochemistry and MDM2 DNA fluorescence in situ hybridization (FISH) in benign and malignant lipomatous neoplasms. We evaluated 109 neoplasms including 27 lipomas, 25 spindle cell lipomas, 32 ALTs/WDLs, and 25 dedifferentiated liposarcomas (DDL). The validation cohort included 14 lipoma-like neoplasms that lacked unequivocal features of ALT/WDL and in which MDM2 immunohistochemistry was either equivocal, negative or falsely positive. Immunohistochemistry, automated RNA-ISH and DNA-FISH for MDM2 were performed. Tumors with diffuse nuclear staining or >50 dots per cell on RNA-ISH were considered positive. All lipomas and lipoma variants were negative for RNA-ISH while all ALTs/WDLs and DDLs were positive. Eighty percent (24/30) and 92% (22/24) of ALTs/WDLs and DDLs were positive for MDM2 immunohistochemistry. Lipomas and its variants were negative for MDM2 amplification; 92% and 100% of ALTs/WDLs and DDLs showed MDM2 DNA amplification. The mean percentage of ALT/WDL tumor cells showing MDM2 RNA-ISH positivity was 73% compared with 24% on MDM2 immunohistochemistry. RNA-ISH correctly classified all 10 ALTs/WDLs and all 4 lipomas in the validation cohort. The performance of MDM2 RNA-ISH and MDM2 DNA-FISH are equivalent. MDM2 RNA-ISH can be of diagnostic value in histologically challenging lipomatous neoplasms. The automated MDM2 RNA-ISH assay should allow for more widespread use of MDM2 testing and for a more sensitive and specific diagnosis of ALT/WDL.
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26
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Lali BS, Kini H, Chakraborti S, Kini J, Suresh PK. Analysis of Dedifferentiated Liposarcomas Emphasizing the Diagnostic Dilemmas. Indian J Med Paediatr Oncol 2020. [DOI: 10.4103/ijmpo.ijmpo_129_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Introduction: Dedifferentiated liposarcoma (DDLPS) is defined as a progression of well-differentiated liposarcoma (WDLPS) to another nonlipogenic sarcoma. Since a variety of heterologous sarcomas can be encountered in dedifferentiation, clinical dilemmas arise. The present study analyzed the role of clinicopathologic and immunohistochemical (IHC) features in the diagnosis of DDLPS and its differentiation from mimics. Materials and Methods: A retrospective and prospective study was conducted wherein all cases of liposarcoma from 2012 to 2017 were reviewed. DDLPS cases were identified among pleomorphic lesions. Clinical and histopathological details for these cases were retrieved from medical records section and department archives. Histomorphology and immunohistochemistry (MDM2, S100, and Ki-67) were analyzed for these cases. Results: Among 37 cases of liposarcomas reviewed, DDLPS was diagnosed in 12 cases (32.4%). Mean age of the patients was 54.3 years with equal gender distribution (M:F =1:1.2). Two patients had recurrent tumors. Most were retroperitoneal (58.3%) with mean duration of symptoms being 8.7 months. Mean tumor dimension was 17.5 cm. High-grade dedifferentiated component was most common (83.3%) with only one case each (8.3%) of low-grade and homologous dedifferentiation. Undifferentiated pleomorphic sarcoma was the frequent nonlipogenic sarcoma. MDM2 overexpression was detected in 100%, focal S100 positivity seen in 66.6%, and mean Ki-67 labeling index was 24. Conclusion: DDLPS exhibits aggressive clinical behavior. Adequate sampling, correlation to clinical details, demonstration of transition from WDLPS to DDLPS aid in narrowing the differentials. Immunostaining with MDM2 helps in definite categorization and S100 highlights lipoblasts, when they are not easily identifiable. MDM2, CDK4, and p16 IHC panel is recommended in all cases and fluorescence in situ hybridization analysis where IHC is noncontributory.
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Affiliation(s)
- Bhagat Singh Lali
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Hema Kini
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Shrijeet Chakraborti
- Department of Cellular Pathology, Leighton Hospital, Mid Cheshire NHS Foundation Trust Hospitals, Crewe, England
| | - Jyoti Kini
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Pooja K Suresh
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India
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27
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Knebel C, Neumann J, Schwaiger BJ, Karampinos DC, Pfeiffer D, Specht K, Lenze U, von Eisenhart-Rothe R, Rummeny EJ, Woertler K, Gersing AS. Differentiating atypical lipomatous tumors from lipomas with magnetic resonance imaging: a comparison with MDM2 gene amplification status. BMC Cancer 2019; 19:309. [PMID: 30943944 PMCID: PMC6448188 DOI: 10.1186/s12885-019-5524-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 03/26/2019] [Indexed: 02/07/2023] Open
Abstract
Background To evaluate the diagnostic value of MR imaging for the differentiation of lipomas and atypical lipomatous tumors (ALT) in comparison with histology and MDM2 amplification status. Methods Patients with well-differentiated lipomatous tumors (n = 113), of which 66 were diagnosed as lipoma (mean age 53 years (range, 13–82); 47% women) and 47 as atypical lipomatous tumor (ALT; mean age 60 years (range, 28–88); 64% women), were included into this study using histology and MDM2 amplification status by fluorescence in situ hybridization (FISH) as standard of reference. Preoperative MR images were retrospectively assessed by two radiologists for the following imaging features: maximum tumor diameter (mm) as well as the affected compartment (intramuscular, intermuscular or subcutaneous), septa (absent, thin (< 2 mm) or thick septa (> 2 mm) with nodular components); contrast enhancing areas within the lipomatous tumor (< 1/3 of the tumor volume, > 1/3 of the tumor volume); Results Of the 47 patients with ALT, 40 (85.1%) presented thick septa (> 2 mm) and this finding significantly increased the likelihood of ALT (OR 6.24, 95% CI 3.36–11.59; P < 0.001). The likelihood of ALT was increased if the tumor exceeded a maximum diameter of 130.0 mm (OR 2.74, 95% CI 1.82–4.11, P < 0.001). The presence of contrast enhancement in lipomatous tumors significantly increased the likelihood of ALT (Odds ratio (OR) 2.95, 95% confidence interval (CI) 2.01–4.31; P < 0.001). Of the lipomas, 21.1% were located subcutaneously, 63.6% intramuscularly and 15.2% intermuscularly. On the other hand, none of the ALTs were located subcutaneously, the majority was located intermuscularly (87.3%) and a small number of ALTs was located intramuscularly (12.7%). Conclusions Our results suggest that using specific morphological MR imaging characteristics (maximum tumor diameter, thick septa and contrast enhancement) and the information on the localization of the lipomatous tumor, a high sensitivity and substantial specificity can be achieved for the diagnosis of lipomas and ALTs.
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Affiliation(s)
- Carolin Knebel
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Strasse 22, 81675, Munich, Germany.
| | - Jan Neumann
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Benedikt J Schwaiger
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Dimitris C Karampinos
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Daniela Pfeiffer
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Katja Specht
- Institute of Pathology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Ulrich Lenze
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Ernst J Rummeny
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Klaus Woertler
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Alexandra S Gersing
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
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28
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Mantilla JG, Ricciotti RW, Chen EY, Liu YJ, Hoch BL. Amplification of DNA damage-inducible transcript 3 (DDIT3) is associated with myxoid liposarcoma-like morphology and homologous lipoblastic differentiation in dedifferentiated liposarcoma. Mod Pathol 2019; 32:585-592. [PMID: 30420727 DOI: 10.1038/s41379-018-0171-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/04/2018] [Indexed: 12/27/2022]
Abstract
Dedifferentiated liposarcoma is defined as progression of atypical lipomatous tumor/well-differentiated liposarcoma to a higher grade usually non-lipogenic sarcoma, with amplification of 12q13-15. This region contains several genes involved in liposarcoma pathogenesis, including MDM2, CDK4, and DDIT3. While the former two are thought of as the main drivers in dedifferentiated liposarcoma, DDIT3 is typically rearranged in myxoid liposarcoma. Overexpression of DDIT3, along with MDM2 and CDK4, may contribute to the pathogenesis of dedifferentiated liposarcoma by interfering with adipocytic differentiation. Dedifferentiated liposarcoma with DDIT3 amplification has not been well characterized. In this study we evaluate the presence of DDIT3 amplification in 48 cases of dedifferentiated liposarcoma by cytogenomic microarray analysis and its correlation with demographic, clinical, and morphologic characteristics. Data from The Cancer Genome Atlas were also evaluated to determine a relationship between DDIT3 amplification and prognostic outcomes. Of the 48 cases, 16 (33%) had amplification of DDIT3; these patients were on average 11 years younger than patients without DDIT3 amplification (P < 0.05). Myxoid liposarcoma-like morphologic features were identified in 12/16 (75%) cases with DDIT3 amplification and in 7/32 (22%) cases without amplification (P < 0.05). Homologous lipoblastic differentiation was seen in 6/16 (38%) cases with DDIT3 amplification and 2/32 (6%) cases without it (P < 0.05). There was no significant correlation between DDIT3 amplification and tumor location, disease-specific or recurrence-free survival, and distant metastasis. DDIT3 amplification appears to interfere with the adipogenic molecular program and plays a role in inducing or maintaining a lipogenic phenotype in dedifferentiated liposarcoma. From a diagnostic standpoint, it is important to consider DDIT3-amplified dedifferentiated liposarcoma in the differential diagnosis of myxoid liposarcoma, particularly in small biopsies. Further studies evaluating the significance of DDIT3 amplification in the pathogenesis of dedifferentiated liposarcoma, as well as a potential predictor of tumor behavior in well-differentiated liposarcoma, are needed.
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Affiliation(s)
- Jose G Mantilla
- Department of Pathology, University of Washington, Seattle, WA, USA
| | | | - Eleanor Y Chen
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Yajuan J Liu
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Benjamin L Hoch
- Department of Pathology, University of New Mexico, Albuquerque, NM, USA.
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29
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Perkins AR, Macaulay RJB, Bui MM, Bridge JA, Etame AB. A Frontal Dural-Based Lesion in a 63-Year Old Male. Brain Pathol 2019; 29:301-302. [PMID: 30821029 DOI: 10.1111/bpa.12682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ashley R Perkins
- Department of Pathology and Cell Biology, University of South Florida, Tampa, FL
| | | | - Marilyn M Bui
- Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, FL
| | - Julia A Bridge
- Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, FL.,Department of Pathology/Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Arnold B Etame
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL
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30
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Abstract
Adipocytic neoplasms include a diversity of both benign tumors (lipomas) and malignancies (liposarcomas), and each tumor type is characterized by its own unique molecular alterations driving tumorigenesis. Work over the past 30 years has established the diagnostic utility of several of these characteristic molecular alterations (e.g. MDM2 amplification in well- and dedifferentiated liposarcoma, FUS/EWSR1-DDIT3 gene fusions in myxoid liposarcoma, RB1 loss in spindle cell/pleomorphic lipoma). More recent studies have focused on additional molecular alterations which may have therapeutic or prognostic impact. This review will summarize several of the important molecular findings in adipocytic tumors that have been described over the past 10 years.
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Affiliation(s)
- Elizabeth G Demicco
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
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31
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32
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Liu J, Li R, Liao X, Jiang W. Comprehensive Bioinformatic Analysis Genes Associated to the Prognosis of Liposarcoma. Med Sci Monit 2018; 24:7329-7339. [PMID: 30317246 PMCID: PMC6198710 DOI: 10.12659/msm.913043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Liposarcoma is the most common type of soft tissue sarcoma, but its molecular mechanism is poorly defined. This study aimed to identify genes crucial to the pathogenesis of liposarcoma and to explore their functions, related pathways, and prognostic value. MATERIAL AND METHODS Differentially expressed genes (DEGs) in the GSE59568 dataset were screened. Gene Ontology (GO) enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis were conducted to investigate the DEGs at the functional level. Protein-protein interaction (PPI) networks and module analysis were applied to identify hub genes from among the DEGs. The GSE30929 dataset was used to validate the relationship between hub genes and the distant recurrence-free survival (DRFS) of liposarcoma patients using Cox model analysis. RESULTS A total of 1111 DEGs were identified. GO and KEGG pathway analysis indicated that the DEGs were mainly associated with lipopolysaccharides and pathways in cancer. The PPI network and module analysis identified 10 hub genes from the DEG network. The Cox model identified 3 genes (NIP7, RPL10L, and MCM2) significantly associated with DRFS. The risk score calculated by the Cox model of the NIP7-RPL10L-MCM2 signature could largely predict the 1-, 3-, and 5-year DRFS of liposarcoma patients, and the prognostic value was even higher for subtypes of liposarcoma. CONCLUSIONS This study identified genes that might play critical roles in liposarcoma pathogenesis as well as a 3-gene-based signature that could be used as a candidate prognostic biomarker for patients with liposarcoma.
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Affiliation(s)
- Jianwei Liu
- Department of Osteology, The Third Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Rong Li
- Department of Osteology, The Third Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Xiwen Liao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Weiping Jiang
- Department of Osteology, The Third Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
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Tan SY, Szymanski LJ, Galliani C, Parham D, Zambrano E. Solitary Fibrous Tumors in Pediatric Patients: A Rare and Potentially Overdiagnosed Neoplasm, Confirmed by STAT6 Immunohistochemistry. Pediatr Dev Pathol 2018; 21:389-400. [PMID: 29228868 DOI: 10.1177/1093526617745431] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Pathological diagnosis of solitary fibrous tumor (SFT) in the pediatric population is challenging, as it occurs uncommonly in this age-group and resembles other spindle cell neoplasms. SFT contains a NAB2-STAT6 fusion gene, which can be reliably detected using STAT6 immunohistochemistry. Positive staining is highly sensitive and specific. We sought to investigate the utility of STAT6 immunohistochemistry, to show how commonly SFT was historically recognized at 3 academic pediatric institutions, to reclassify them when appropriate, and to demonstrate features of major mimics of SFT. Our series included cases with a previous diagnosis of SFT or for which SFT was among key considerations, from 3 major academic pediatric hospitals seen over the past 30 years. Of 18 tumors identified, only 3 tumors from 2 patients demonstrated positive STAT6 staining as well as the typical histology and immunophenotype seen in SFT. The remaining 15 tumors were reclassified based on morphology, additional immunohistochemistry and fluorescence in situ hybridization as desmoid-type fibromatosis (3 tumors), nerve sheath/neural tumors (3 tumors), low-grade fibromyxoid sarcoma, medallion-like dermal fibroma, poorly differentiated Sertoli cell tumor, nodular/proliferative fasciitis, calcifying fibrous tumor, aneurysmal bone cyst of soft tissue, STAT6-negative SFT with adipocytic differentiation, undifferentiated small round blue cell tumor, and scar (1 tumor each). Our study confirms that SFT is rare in the pediatric population and that it is potentially overdiagnosed. STAT6 immunohistochemistry is recommended to confirm the diagnosis of SFT in the pediatric population.
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Affiliation(s)
- Serena Y Tan
- 1 Department of Pathology, Stanford University Medical Center, Stanford, California
| | - Linda J Szymanski
- 2 Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California
| | - Carlos Galliani
- 3 Department of Pathology, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | - David Parham
- 2 Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California
| | - Eduardo Zambrano
- 1 Department of Pathology, Stanford University Medical Center, Stanford, California
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Vargas AC, Selinger C, Satgunaseelan L, Cooper WA, Gupta R, Stalley P, Brown W, Soper J, Schatz J, Boyle R, Thomas DM, Tattersall MH, Bhadri V, Maclean F, Bonar SF, Scolyer RA, Karim RZ, McCarthy SW, Mahar A, O'Toole SA. FISH analysis of selected soft tissue tumors: Diagnostic experience in a tertiary center. Asia Pac J Clin Oncol 2018; 15:38-47. [DOI: 10.1111/ajco.12980] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 03/29/2018] [Indexed: 12/20/2022]
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Molecular analyses in the diagnosis and prediction of prognosis in non-GIST soft tissue sarcomas: A systematic review and meta-analysis. Cancer Treat Rev 2018; 66:74-81. [DOI: 10.1016/j.ctrv.2018.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 04/10/2018] [Accepted: 04/20/2018] [Indexed: 12/14/2022]
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Asif A, Mushtaq S, Hassan U, Akhtar N, Hussain M, Azam M, Qazi R. Fluorescence in Situ Hybridization (FISH) for Differential Diagnosis of Soft Tissue Sarcomas. Asian Pac J Cancer Prev 2018; 19:655-660. [PMID: 29580035 PMCID: PMC5980837 DOI: 10.22034/apjcp.2018.19.3.655] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Introduction: Soft tissue sarcomas are rare tumors comprising 1 percent of solid malignancies. The latest edition of WHO soft tissue pathology lists 94 benign and malignant soft tissue tumors. Many of these show a large degree of morphological overlap. Immunohistochemistry has been shown to be reliable in many cases for differential diagnosis of lesions, although cytogenetic tests are considered the gold standard for many entities.Fluorescence in-situ hybridization (FISH) is a cytogenetic technique that uses fluorescent probes that bind to only those parts of the chromosome which have a high degree of sequence complementarity. Many soft tissue tumors show recurrent genetic mutations that are now being used as diagnostic markers. Knowledge of the molecular identity allows prediction of behavior, prognosis and treatment response. Objective: The aim of this study was to identify genetic mutations in soft tissue sarcomas using FISH testing and to assess correlations with histological diagnosis. Material and methods: A total of 25 cases of different soft tissue sarcomas diagnosed on histology with the help of immunohistochemical staining and for which FISH studies were requested were included in this study. Three pathologists with a special interest in soft tissue sarcomas reviewed the cases. FISH tests for EWS, the X:18 translocation, FOXO1 and MDM2 were respectively applied for 8 cases of Ewing sarcoma, 8 cases of synovial sarcoma, 2 cases of rhabdomyosarcoma and 7 cases of dedifferentiated liposarcoma and atypical lipomatous tumors/well differentiated liposarcomas. Results: EWS gene fusion was detected in 7 out of 8 cases of Ewing sarcoma and the X: 18 translocation was positive in 3 of the 8 cases of synovial sarcoma. FOXO1 was not detected in either of the two rhabdomyosarcomas. MDM2 by FISH was detected in only one out of 5 cases of atypical lipomatous tumors and 1 out of 2 dedifferentiated liposarcomas. Conclusion: FISH is a useful adjunct in the diagnostic assessment of different types of soft tissue sarcomas. It is easy to set up, is relatively inexpensive and has the ability to diagnose sarcomas with great accuracy, especially in cases which can not be accurately classified even after thorough histological and immunohistochemical evaluation. It may play a very important role in the accurate diagnosis and correct management of patients.
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Affiliation(s)
- Amna Asif
- Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. Emaile:
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Patel RB, Li T, Liao Z, Jaldeepbhai JA, Perera HAPNV, Muthukuda SK, Dhirubhai DH, Singh V, Du X, Yang J. Recent translational research into targeted therapy for liposarcoma. Stem Cell Investig 2017; 4:21. [PMID: 28447036 DOI: 10.21037/sci.2017.02.09] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 02/19/2017] [Indexed: 12/18/2022]
Abstract
Liposarcomas (LPS) are among the most common soft tissue sarcomas, originating from adipocytes. Treatment for LPS typically involves surgical resection and radiation therapy, while the use of conventional cytotoxic chemotherapy for unresectable or metastatic LPS remains controversial. This review summarizes the results of recent translational research and trials of novel therapies targeting various genetic and molecular aberrations in different subtypes of LPS. Genetic aberrations such as the 12q13-15 amplicon, genetic amplification of MDM2, CDK4, TOP2A, PTK7, and CHEK1, point mutations in CTNNB1, CDH1, FBXW7, and EPHA1, as the fusion of FUS-DDIT3/EWSR1-DDIT3 are involved in the pathogenesis LPS and represent potential therapeutic candidates. Tyrosine kinase inhibitors targeting MET, AXL, IGF1R, EGFR, VEGFR2, PDGFR-β and Aurora kinase are effective in certain types of LPS. Abnormalities in the PI3K/Akt signaling pathway deregulation of C/EBP-α and its partner PPAR-γ, and the interaction between calreticulin (CRT) and CD47 are also promising therapeutic targets. These promising new approaches may help to supplement existing treatments for LPS.
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Affiliation(s)
- Rashi Bharat Patel
- International Medical School, Tianjin Medical University, Tianjin 300061, China.,Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| | - Ting Li
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China.,National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| | - Zhichao Liao
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China.,National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| | - Jivani Aakash Jaldeepbhai
- International Medical School, Tianjin Medical University, Tianjin 300061, China.,Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| | - H A Pavanika N V Perera
- International Medical School, Tianjin Medical University, Tianjin 300061, China.,Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| | - Sujani Kaushalya Muthukuda
- International Medical School, Tianjin Medical University, Tianjin 300061, China.,Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| | - Dholiya Hardeep Dhirubhai
- International Medical School, Tianjin Medical University, Tianjin 300061, China.,Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| | - Vaibhav Singh
- International Medical School, Tianjin Medical University, Tianjin 300061, China.,Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| | - Xiaoling Du
- Department of Diagnostics, Tianjin Medical University, Tianjin 300061, China
| | - Jilong Yang
- International Medical School, Tianjin Medical University, Tianjin 300061, China.,Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China.,National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
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Primary orbital synovial sarcoma: A clinicopathologic review with a differential diagnosis and discussion of molecular genetics. Surv Ophthalmol 2017; 62:227-236. [DOI: 10.1016/j.survophthal.2016.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 09/03/2016] [Accepted: 09/09/2016] [Indexed: 12/13/2022]
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Zhang G, Lanigan CP, Goldblum JR, Tubbs RR, Downs-Kelly E. Automated Bright-Field Dual-Color In Situ Hybridization for MDM2: Interobserver Reproducibility and Correlation With Fluorescence In Situ Hybridization in a Series of Soft Tissue Consults. Arch Pathol Lab Med 2017; 140:1111-5. [PMID: 27684983 DOI: 10.5858/arpa.2015-0249-oa] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT -Atypical lipomatous tumors/well-differentiated liposarcomas contain alterations in the 12q13-15 region resulting in amplification of MDM2 and nearby genes. Identifying MDM2 amplification is a useful ancillary test, as the histologic mimics of atypical lipomatous tumors/well-differentiated liposarcomas have consistently shown a lack of MDM2 amplification. OBJECTIVE -To assess the interobserver reproducibility of a bright-field assay for MDM2 amplification (dual-color, dual-hapten in situ hybridization [DDISH]) among reviewers with varying degrees of experience with the assay and to assess the concordance of MDM2 DDISH with MDM2 fluorescence in situ hybridization (FISH). DESIGN -In total, 102 cases were assessed in parallel for MDM2 by FISH and DDISH. MDM2 amplification was defined as an MDM2 to chromosome 12 ratio of 2.0 or greater, whereas an MDM2 to chromosome 12 ratio of less than 2 was nonamplified. Fluorescence in situ hybridization was scored in the routine clinical laboratory and DDISH was evaluated by 3 different pathologists blinded to the final diagnosis and FISH results. RESULTS -Fluorescence in situ hybridization categorized 27 cases (26%) as MDM2 amplified and 75 cases (74%) as nonamplified; the consensus DDISH diagnosis was 98% concordant with FISH. Agreement between MDM2 DDISH by each reviewer and MDM2 FISH was highly concordant (99%, 98%, and 98%, respectively, for reviewers 1, 2 and 3). The κ agreement of the 3 reviewers scoring DDISH was excellent (κ = 0.949, 0.95, and 0.95, respectively, for reviewers 1, 2, and 3). CONCLUSIONS -This study highlights excellent concordance between DDISH and FISH in MDM2 copy number assessment. Moreover, excellent interobserver reproducibility of the DDISH assay was found among reviewers with varying levels of experience evaluating bright-field assays.
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Affiliation(s)
- Gloria Zhang
- From the Departments of Anatomic Pathology (Drs Zhang and Goldblum) and Molecular Pathology (Mr Lanigan and Dr Tubbs), Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio; and the Department of Pathology, Huntsman Cancer Center, University of Utah, Salt Lake City (Dr Downs-Kelly)
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40
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D'Souza J, Shah R, Abbass A, Burt JR, Goud A, Dahagam C. Invasive Cardiac Lipoma: a case report and review of literature. BMC Cardiovasc Disord 2017; 17:28. [PMID: 28088193 PMCID: PMC5237479 DOI: 10.1186/s12872-016-0465-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 12/29/2016] [Indexed: 11/26/2022] Open
Abstract
Background Cardiac lipomas are rare benign tumors of the heart. They are usually asymptomatic and are thus most often diagnosed on autopsies. Symptoms, when present, depend upon the location within the heart. Typical locations are the endocardium of the right atrium and the left ventricle. Diagnostic modality of choice is cardiac MRI. Treatment guidelines have not yet been established due to the very low prevalence of these tumors and are thus guided by the patient’s symptomatology. Case presentation We describe a case of an invasive cardiac lipoma, wherein the initial symptom of the patient was shortness of breath. Although the echocardiogram visualized the tumor in the right atrium, a cardiac MRI was performed for better tissue characterization. The MRI revealed a large, fat containing, septated mass in the right atrium with invasion into the inter-atrial septum and inferior cavoatrial junction. There was also invasion of the coronary sinus along the inferior and left lateral aspect of the posterior atrioventricular groove. Although the mass appeared to represent a lipoma by imaging characteristics, the unusual extension into the coronary sinus led to consideration of a low-grade liposarcoma in the differential. Thus a pre-operative biopsy was performed along with MDM2 gene amplification to rule out a liposarcoma preceding surgical excision. Conclusion Cardiac lipomas are well-characterized on cardiac MRI, which is the diagnostic modality of choice. Typical locations are the right atrium and the left ventricle. However, in those with atypical features such as invasion of the coronary sinus, pre-operative biopsy for histopathologic confirmation is imperative to exclude well-differentiated liposarcoma. Our patient with a simple lipoma underwent partial resection to relieve symptoms. We discuss prognosis and treatment of symptomatic cardiac lipomas.
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Affiliation(s)
- Jason D'Souza
- Department of Internal Medicine, Florida Hospital, 2501 N. Orange Ave, Ste-235, Orlando, FL, 32804, USA.
| | - Rajesh Shah
- Department of Cardiology, Florida Hospital, 251 Maitland Ave #116, Altamonte Sp, FL, 32701, USA
| | - Aamer Abbass
- Department of Internal Medicine, Florida Hospital, 2501 N. Orange Ave, Ste-235, Orlando, FL, 32804, USA
| | - Jeremy R Burt
- Department of Radiology, Florida Hospital, 601 E. Rollins, Orlando, FL, 32803, USA
| | - Aditya Goud
- Department of Internal Medicine, MedStar Health, 9000 Franklin square drive, Baltimore, MD, 21237, USA
| | - Chanukya Dahagam
- Department of Internal Medicine, MedStar Health, 9000 Franklin square drive, Baltimore, MD, 21237, USA
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Errani C, Cocchi S, Ali N, Chehrassan M, Righi A, Gambarotti M, Mavrogenis AF, Vanel D, Donati D. Recurrence After Marginal Excision for Atypical Lipomatous Tumors Versus Lipomas of the Extremities. Orthopedics 2016; 39:e610-4. [PMID: 27322173 DOI: 10.3928/01477447-20160610-02] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 11/25/2015] [Indexed: 02/03/2023]
Abstract
This study reviewed the medical records of 90 patients with lipomas (47 patients) and atypical lipomatous tumors (ALT)/well-differentiated liposarcomas (WDL) (43 patients) of the extremities treated from 2006 to 2012. All patients had preoperative biopsy and postoperative histologic analysis of the tumors; surgical margins were marginal in all cases. Histologic sections of the tissue blocks from the excised specimens were re-reviewed for all patients; a consensus with postoperative histologic analysis was confirmed. Molecular chromosome analysis was performed on fluorescence in situ hybridization in tissue sections from the tissue blocks in all cases for the purpose of this study; a ratio greater than 2 was considered to represent murine double-minute 2 (MDM2) amplification consistent with a diagnosis of ALT/WDL. Mean follow-up was 52 months (range, 14-96 months). Local recurrence and metastasis rates and the relationship of patient age and sex with tumor size and location were evaluated. None of the patients with lipomas experienced local recurrence compared with 6 patients (13.9%) with ALT/WDL who experienced local recurrence within a mean of 48 months (range, 33-96 months); this difference was statistically significant. None of the patients in either group experienced metastasis prior to the study period. Local recurrence did not correlate statistically with patient age or sex, or with tumor size or location. [Orthopedics. 2016; 39(4):e610-e614.].
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Wong DD, Low IC, Peverall J, Robbins PD, Spagnolo DV, Nairn R, Carey-Smith RL, Wood D. MDM2/CDK4 gene amplification in large/deep-seated 'lipomas': incidence, predictors and clinical significance. Pathology 2016; 48:203-9. [PMID: 27020493 DOI: 10.1016/j.pathol.2016.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 11/26/2015] [Accepted: 12/06/2015] [Indexed: 11/30/2022]
Abstract
This study of 140 cases assessed the incidence of MDM2/CDK4 gene amplification in lipomatous neoplasms with histological features of a lipoma but which were of clinical concern due to large size (≥50 mm) and/or deep-seated (subfascial) location. Univariate and multivariate statistical analyses were used to identify clinical, radiological and pathological predictors of gene amplification. Differences in local recurrence rates between amplified and non-amplified cases were assessed using survival analysis. The findings indicate that the incidence of MDM2/CDK4 amplification in this setting is low at 5% (95%CI 1.4-8.6%). Variables associated with amplification on univariate analysis were tumour site (thigh, p = 0.004), size (>100 mm, p = 0.033) and presence of equivocal atypia (p = 0.001). Independent predictors on multivariate analysis were size (OR 3.9, 95%CI 1.4-11.3, p = 0.012) and presence of equivocal atypia (OR 12.5, 95%CI 1.9-80.3, p = 0.008). There was no significant difference in local recurrence rates between amplified and non-amplified cases (p = 0.461) based on a median follow-up time of 31 months. Assessment for MDM2/CDK4 amplification, therefore, should be considered in 'lipomas' which are >100 mm in size, show equivocal atypia and arise in the thigh. However, the clinical significance of gene amplification in this setting is unclear and requires confirmation in larger studies.
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Affiliation(s)
- Daniel D Wong
- Department of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, WA, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, WA, Australia.
| | - Irene C Low
- Department of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, WA, Australia
| | - Joanne Peverall
- Department of Diagnostic Genomics, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, WA, Australia
| | - Peter D Robbins
- Department of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, WA, Australia
| | - Dominic V Spagnolo
- Department of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, WA, Australia
| | - Robert Nairn
- Department of Radiology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | | | - David Wood
- Perth Orthopaedic Institute, Nedlands, WA, Australia
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Salinas-Souza C, De Andrea C, Bihl M, Kovac M, Pillay N, Forshew T, Gutteridge A, Ye H, Amary MF, Tirabosco R, Toledo SRC, Baumhoer D, Flanagan AM. GNAS mutations are not detected in parosteal and low-grade central osteosarcomas. Mod Pathol 2015; 28:1336-42. [PMID: 26248895 DOI: 10.1038/modpathol.2015.91] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 06/09/2015] [Accepted: 06/15/2015] [Indexed: 11/08/2022]
Abstract
Parosteal osteosarcoma, low-grade central osteosarcoma, and fibrous dysplasia share similar histological features that may pose a diagnostic challenge. The detection of GNAS mutations in primary bone tumors has been useful in clinical practice for diagnosing fibrous dysplasia. However, the recent report of GNAS mutations being detected in a significant proportion of parosteal osteosarcoma challenges the specificity of this mutation. As the number of cases reported in this study was small we set out to determine if these results could be reproduced. We studied 97 formalin-fixed paraffin-embedded low-grade osteosarcomas from 90 patients including 62 parosteal osteosarcomas, of which MDM2 amplification was detected in 79%, 11 periosteal osteosarcomas and 24 low-grade central osteosarcoma samples. The mutational status of GNAS was analyzed in codons p.R201, p.Q227, and other less common GNAS alterations by bidirectional Sanger sequencing and/or next generation sequencing using the Life Technologies Ion Torrent platform. GNAS mutations were not detected in any of the low-grade osteosarcomas from which informative DNA was extracted. Our findings therefore support prior observations that GNAS mutations are highly specific for fibrous dysplasia and occur rarely, if ever, in parosteal and other low-grade osteosarcomas.
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Affiliation(s)
- Carolina Salinas-Souza
- UCL Advanced Diagnostics Molecular Profiling Laboratory, Sarah Cannon-UCL Laboratories, UCL Cancer Institute, London, UK
- Pediatric Oncology Institute/Federal University of São Paulo, São Paulo, Brazil
| | - Carlos De Andrea
- UCL Advanced Diagnostics Molecular Profiling Laboratory, Sarah Cannon-UCL Laboratories, UCL Cancer Institute, London, UK
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, UK
| | - Michel Bihl
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Michal Kovac
- Bone Tumour Reference Centre, University Hospital Basel, Basel, Switzerland
| | - Nischalan Pillay
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, UK
- UCL Cancer Institute, London, UK
| | | | | | - Hongtao Ye
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, UK
| | - M Fernanda Amary
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, UK
- UCL Cancer Institute, London, UK
| | - Roberto Tirabosco
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, UK
| | | | - Daniel Baumhoer
- Bone Tumour Reference Centre, University Hospital Basel, Basel, Switzerland
| | - Adrienne M Flanagan
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, UK
- UCL Cancer Institute, London, UK
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Kalimuthu SN, Tilley C, Forbes G, Ye H, Lehovsky K, Pillay N, Seddon BM, O'Donnell P, Pollock R, Tirabosco R, Amary MF, Flanagan AM. Clinical outcome in patients with peripherally-sited atypical lipomatous tumours and dedifferentiated liposarcoma. JOURNAL OF PATHOLOGY CLINICAL RESEARCH 2015; 1:106-12. [PMID: 27499897 PMCID: PMC4858133 DOI: 10.1002/cjp2.12] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 12/29/2014] [Indexed: 12/13/2022]
Abstract
The reported incidence of local recurrence of peripheral atypical lipomatous tumours is highly variable and is likely to reflect the different inclusion criteria of cases, and the design of previous studies. We aimed to study the incidence of local recurrence of 90 cases of atypical lipomatous tumours and an additional 18 cases of de novo dedifferentiated liposarcoma. All tumours were diagnosed on the basis of MDM2 amplification: all patients had their first treatment in the same specialist sarcoma unit and were followed for a minimum of 60 months. The tumours were diagnosed between 1997 and 2009 and followed until the end of 2014. Seventy cases (78%) of atypical lipomatous tumours were located in the thigh (mean size 195 mm on presentation). Eight atypical lipomatous tumours (8.9%) recurred locally, of which 50% recurred after 60 months. The only two tumours with intralesional excisions recurred. Seven of the eight recurrent tumours were detected by the patient by self‐examination. One case recurred a second time as a dedifferentiated liposarcoma. Seventeen per cent of the de novo dedifferentiated liposarcomas recurred within 60 months of presentation. Extending the study period revealed that atypical lipomatous tumour could recur up to 40 years after the first surgery. Furthermore, of 26 tumours that recurred in the extended study, 27% recurred more than once, and three of the seven that recurred more than once transformed into a dedifferentiated liposarcoma. We recommend that, following post‐operative wound care, patients with atypical lipomatous tumour are referred back to their general practitioner for follow up, but that in the event of a suspected recurrence they have rapid access back to the specialist unit using a ‘supported discharge’ scheme. In the event of an intralesional excision and if a lesion recurs, patients are followed in a specialist unit at regular intervals: whether MRI scanning is a valuable means of monitoring such patients is unclear and requires an evidence base
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Affiliation(s)
- Sangeetha N Kalimuthu
- Department of HistopathologyRoyal National Orthopaedic Hospital NHS TrustStanmoreMiddlesexUK; Department(s) of HistopathologyRadiologySurgery and OncologyLondon Sarcoma ServiceRoyal National Orthopaedic Hospital NHS Trust and University College London Hospitals Foundation TrustLondonUK
| | - Charles Tilley
- Department of HistopathologyRoyal National Orthopaedic Hospital NHS TrustStanmoreMiddlesexUK; Department(s) of HistopathologyRadiologySurgery and OncologyLondon Sarcoma ServiceRoyal National Orthopaedic Hospital NHS Trust and University College London Hospitals Foundation TrustLondonUK
| | - Georgina Forbes
- Department of HistopathologyRoyal National Orthopaedic Hospital NHS TrustStanmoreMiddlesexUK; Department(s) of HistopathologyRadiologySurgery and OncologyLondon Sarcoma ServiceRoyal National Orthopaedic Hospital NHS Trust and University College London Hospitals Foundation TrustLondonUK
| | - Hongtao Ye
- Department of HistopathologyRoyal National Orthopaedic Hospital NHS TrustStanmoreMiddlesexUK; Department(s) of HistopathologyRadiologySurgery and OncologyLondon Sarcoma ServiceRoyal National Orthopaedic Hospital NHS Trust and University College London Hospitals Foundation TrustLondonUK
| | - Katie Lehovsky
- Department of HistopathologyRoyal National Orthopaedic Hospital NHS TrustStanmoreMiddlesexUK; Department(s) of HistopathologyRadiologySurgery and OncologyLondon Sarcoma ServiceRoyal National Orthopaedic Hospital NHS Trust and University College London Hospitals Foundation TrustLondonUK
| | - Nischalan Pillay
- Department of HistopathologyRoyal National Orthopaedic Hospital NHS TrustStanmoreMiddlesexUK; Department(s) of HistopathologyRadiologySurgery and OncologyLondon Sarcoma ServiceRoyal National Orthopaedic Hospital NHS Trust and University College London Hospitals Foundation TrustLondonUK; Research Department of PathologyUCL Cancer InstituteHuntley StreetLondonUK
| | - Beatrice M Seddon
- Department(s) of HistopathologyRadiologySurgery and OncologyLondon Sarcoma ServiceRoyal National Orthopaedic Hospital NHS Trust and University College London Hospitals Foundation TrustLondonUK; Department of OncologyUniversity College London Hospitals Foundation TrustLondonUK
| | - Paul O'Donnell
- Department(s) of HistopathologyRadiologySurgery and OncologyLondon Sarcoma ServiceRoyal National Orthopaedic Hospital NHS Trust and University College London Hospitals Foundation TrustLondonUK; Department of RadiologyRoyal National Orthopaedic Hospital NHS TrustStanmoreMiddlesexUK; Department of RadiologyInstitute of Orthopaedics and Musculoskeletal Science, UCLStanmoreUK
| | - Robin Pollock
- Department(s) of HistopathologyRadiologySurgery and OncologyLondon Sarcoma ServiceRoyal National Orthopaedic Hospital NHS Trust and University College London Hospitals Foundation TrustLondonUK; Department of SurgeryThe Bone Tumour Unit, Royal National Orthopaedic Hospital NHS TrustStanmoreMiddlesexUK
| | - Roberto Tirabosco
- Department of HistopathologyRoyal National Orthopaedic Hospital NHS TrustStanmoreMiddlesexUK; Department(s) of HistopathologyRadiologySurgery and OncologyLondon Sarcoma ServiceRoyal National Orthopaedic Hospital NHS Trust and University College London Hospitals Foundation TrustLondonUK
| | - M Fernanda Amary
- Department of HistopathologyRoyal National Orthopaedic Hospital NHS TrustStanmoreMiddlesexUK; Department(s) of HistopathologyRadiologySurgery and OncologyLondon Sarcoma ServiceRoyal National Orthopaedic Hospital NHS Trust and University College London Hospitals Foundation TrustLondonUK; Research Department of PathologyUCL Cancer InstituteHuntley StreetLondonUK
| | - Adrienne M Flanagan
- Department of HistopathologyRoyal National Orthopaedic Hospital NHS TrustStanmoreMiddlesexUK; Department(s) of HistopathologyRadiologySurgery and OncologyLondon Sarcoma ServiceRoyal National Orthopaedic Hospital NHS Trust and University College London Hospitals Foundation TrustLondonUK; Research Department of PathologyUCL Cancer InstituteHuntley StreetLondonUK
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Fluorescence In Situ Hybridization for MDM2 Amplification as a Routine Ancillary Diagnostic Tool for Suspected Well-Differentiated and Dedifferentiated Liposarcomas: Experience at a Tertiary Center. Sarcoma 2015; 2015:812089. [PMID: 25810689 PMCID: PMC4355609 DOI: 10.1155/2015/812089] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 01/05/2015] [Accepted: 01/19/2015] [Indexed: 02/01/2023] Open
Abstract
Background. The assessment of MDM2 gene amplification by fluorescence in situ hybridization (FISH) has become a routine ancillary tool for diagnosing atypical lipomatous tumor (ALT)/well-differentiated liposarcoma and dedifferentiated liposarcoma (WDL/DDL) in specialist sarcoma units. We describe our experience of its utility at our tertiary institute. Methods. All routine histology samples in which MDM2 amplification was assessed with FISH over a 2-year period were included, and FISH results were correlated with clinical and histologic findings. Results. 365 samples from 347 patients had FISH for MDM2 gene amplification. 170 were positive (i.e., showed MDM2 gene amplification), 192 were negative, and 3 were technically unsatisfactory. There were 122 histologically benign cases showing a histology:FISH concordance rate of 92.6%, 142 WDL/DDL (concordance 96.5%), and 34 cases histologically equivocal for WDL (concordance 50%). Of 64 spindle cell/pleomorphic neoplasms (in which DDL was a differential diagnosis), 21.9% showed MDM2 amplification. Of the cases with discrepant histology and FISH, all but 3 had diagnoses amended following FISH results. For discrepancies of benign histology but positive FISH, lesions were on average larger, more frequently in "classical" (intra-abdominal or inguinal) sites for WDL/DDL and more frequently core biopsies. Discrepancies of malignant histology but negative FISH were smaller, less frequently in "classical" sites but again more frequently core biopsies. Conclusions. FISH has a high correlation rate with histology for cases with firm histologic diagnoses of lipoma or WDL/DDL. It is a useful ancillary diagnostic tool in histologically equivocal cases, particularly in WDL lacking significant histologic atypia or DDL without corresponding WDL component, especially in larger tumors, those from intra-abdominal or inguinal sites or core biopsies. There is a significant group of well-differentiated adipocytic neoplasms which are difficult to diagnose on morphology alone, in which FISH for MDM2 amplification is diagnostically contributory.
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Malignant solitary fibrous tumor with high-grade nuclear atypia: An alternate entity for the undetermined tumor group. Pathol Res Pract 2015; 211:117-24. [DOI: 10.1016/j.prp.2014.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 11/19/2014] [Accepted: 12/01/2014] [Indexed: 11/19/2022]
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Lokka S, Scheel AH, Dango S, Schmitz K, Hesterberg R, Rüschoff J, Schildhaus HU. Challenging dedifferentiated liposarcoma identified by MDM2-amplification, a report of two cases. BMC Clin Pathol 2014; 14:36. [PMID: 25126005 PMCID: PMC4132276 DOI: 10.1186/1472-6890-14-36] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 07/16/2014] [Indexed: 11/20/2022] Open
Abstract
Background Liposarcoma is the most frequent soft tissue sarcoma. Well differentiated liposarcoma may progress into dedifferentiated liposarcoma with pleomorphic histology. A minority additionally features myogenic, osteo- or chondrosarcomatous heterologous differentiation. Genomic amplification of the Mouse double minute 2 homolog (MDM2) locus is characteristic for well differentiated and dedifferentiated liposarcomas. Detection of MDM2 amplification may supplement histopathology and aid to distinguish liposarcoma from other soft tissue neoplasia. Case presentation Here we present two cases of dedifferentiated liposarcoma with challenging presentation. Case 1 features a myogenic component. As the tumour infiltrated the abdominal muscles and showed immunohistochemical expression of myogenic proteins, rhabdomyosarcoma had to be ruled out. Case 2 has an osteosarcomatous component resembling extraosseous osteosarcoma. The MDM2 status was determined in both cases and helped making the correct diagnosis. Overexpression of MDM2 and co-overexpression of Cyclin-dependent kinase 4 is demonstrated by immunohistochemistry. The underlying MDM2 amplification is shown by fluorescence in situ hybridisation. Since low grade osteosarcoma may also harbour MDM2 amplification it is emphasised that the amplification has to be present in the lipomatous parts of the tumour to distinguish liposarcoma from extraosseous osteosarcoma. Conclusions The two cases exemplify challenges in the diagnoses of dedifferentiated liposarcoma. Liposarcoma often has pleomorphic histology and additionally may feature heterologous components that mimic other soft tissue neoplasms. Amplification of MDM2 is characteristic for well differentiated and dedifferentiated liposarcomas. Determination of the MDM2 status by in situ hybridisation may assist histopathology and help to rule out differential diagnoses.
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Affiliation(s)
- Suvi Lokka
- Institute of Pathology Nordhessen, Germaniastr. 7, 34119 Kassel, Germany
| | - Andreas H Scheel
- Institute of Pathology Nordhessen, Germaniastr. 7, 34119 Kassel, Germany.,Department of Pathology, University Medical Centre Göttingen, Robert-Koch-Str. 38, 37077 Göttingen, Germany
| | - Sebastian Dango
- Rotes Kreuz Krankenhaus, Department of Surgery, Hansteinstrasse 29, 34121 Kassel, Germany.,Department of General, Visceral, and Paediatric Surgery, University Medical Centre Göttingen, Robert-Koch-Str. 38, 37077 Göttingen, Germany
| | - Katja Schmitz
- Department of Pathology, University Medical Centre Göttingen, Robert-Koch-Str. 38, 37077 Göttingen, Germany
| | - Rudolf Hesterberg
- Rotes Kreuz Krankenhaus, Department of Surgery, Hansteinstrasse 29, 34121 Kassel, Germany
| | - Josef Rüschoff
- Institute of Pathology Nordhessen, Germaniastr. 7, 34119 Kassel, Germany
| | - Hans-Ulrich Schildhaus
- Department of Pathology, University Medical Centre Göttingen, Robert-Koch-Str. 38, 37077 Göttingen, Germany
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Kazlouskaya V, Blochin E, Lal K, Parker PM, Elston DM. Dermpath quiz. Indian Dermatol Online J 2013; 4:353-4. [PMID: 24350025 PMCID: PMC3853910 DOI: 10.4103/2229-5178.120684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Viktoryia Kazlouskaya
- Ackerman Academy of Dermatopathology, New York College of Osteopathic Medicine, New York, USA
| | - Elen Blochin
- Ackerman Academy of Dermatopathology, New York College of Osteopathic Medicine, New York, USA
| | - Karan Lal
- New York College of Osteopathic Medicine, New York, USA
| | - Paul M Parker
- Parker Center for Plastic Surgery, Paramus, New Jersey, USA
| | - Dirk M Elston
- Ackerman Academy of Dermatopathology, New York College of Osteopathic Medicine, New York, USA
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Fisher SB, Baxter KJ, Staley CA, Fisher KE, Monson DK, Murray DR, Oskouei SV, Weiss SW, Kooby DA, Maithel SK, Delman KA. The General Surgeon's quandary: atypical lipomatous tumor vs lipoma, who needs a surgical oncologist? J Am Coll Surg 2013; 217:881-8. [PMID: 24074812 DOI: 10.1016/j.jamcollsurg.2013.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 06/01/2013] [Accepted: 06/03/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Differentiating large lipomas from atypical lipomatous tumors (ALT) is challenging, and preoperative management guidelines are not well defined. The diagnostic ambiguity leads many surgeons to refer all patients with large lipomatous masses to an oncologic specialist, perhaps unnecessarily. STUDY DESIGN In this retrospective cohort study of patients with nonretroperitoneal lipomatous tumors, preoperative characteristics discernible without invasive diagnostic procedures were evaluated for diagnostic predictive value. RESULTS We identified 319 patients (256 with lipomas, 63 with ALTs) treated between 1994 and 2012. Patients with ALTs were older (60.5 vs 53.5 years, p < 0.0001), had larger tumors (16.0 vs 8.3 cm, p < 0.0001), had tumors more often located on an extremity (88.9% vs 60.5% torso, p < 0.0001), and more frequently had a history of previous operations at the same site, exclusive of excision leading to diagnosis and referral (20.6% vs 5.9%, p = 0.001). Local recurrence was observed in 2 patients with lipomas (0.8%) vs 14 with ALTs (22.6%, p < 0.0001). No patients with ALTs developed distant metastases or disease-specific mortality, with a median follow-up of 27.4 months (range 0 to 164.6 months). On multivariate analysis, age ≥ 55 years, tumor size ≥ 10 cm, extremity location, and history of previous resections were predictors for diagnosis of ALT (p < 0.05). CONCLUSIONS Characteristics of lipomatous masses associated with a diagnosis of ALT include patient age ≥ 55 years, tumor size ≥ 10 cm, previous resection, and extremity location (vs torso). These easily identifiable traits may guide surgical management or referral to a specialist.
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Affiliation(s)
- Sarah B Fisher
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
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Kashima TG, Gamage NM, Ye H, Amary MF, Flanagan AM, Ostlere SJ, Athanasou NA. Locally aggressive fibrous dysplasia. Virchows Arch 2013; 463:79-84. [PMID: 23760783 DOI: 10.1007/s00428-013-1437-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 05/22/2013] [Accepted: 05/28/2013] [Indexed: 10/26/2022]
Abstract
Although fibrous dysplasia (FD) is a benign fibro-osseous lesion, locally aggressive behaviour has rarely been described but is poorly characterised. In this study, we document clinical, radiological and pathological (including molecular genetics) findings in three cases of locally aggressive FD, two of which involved the ribs. Lesions in these cases, one of which was a recurrent lesion, were followed up for 2-7 years. All of the lesions showed typical histological features of FD but were characterised by extension through the bone cortex into the extra-osseous soft tissue. The lesions did not exhibit overexpression/amplification of CDK4 and MDM2; in two of the cases, a GNAS mutation was identified. Our findings confirm that FD can rarely exhibit locally aggressive behaviour with extension beyond the bone compartment into the surrounding soft tissue; these lesions can be distinguished from low-grade intramedullary osteosarcoma by lack of amplification/overexpression of CDK4 and MDM2 and the presence of a GNAS mutation.
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Affiliation(s)
- T G Kashima
- Department of Histopathology, NDORMS, University of Oxford, Oxford, UK
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