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Machado ER, van de Vlekkert D, Sheppard HS, Perry S, Downing SM, Laxton J, Ashmun R, Finkelstein DB, Neale GA, Hu H, Harwood FC, Koo SC, Grosveld GC, d'Azzo A. Haploinsufficiency of the lysosomal sialidase NEU1 results in a model of pleomorphic rhabdomyosarcoma in mice. Commun Biol 2022; 5:992. [PMID: 36127469 PMCID: PMC9489700 DOI: 10.1038/s42003-022-03968-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 09/08/2022] [Indexed: 11/08/2022] Open
Abstract
Rhabdomyosarcoma, the most common pediatric sarcoma, has no effective treatment for the pleomorphic subtype. Still, what triggers transformation into this aggressive phenotype remains poorly understood. Here we used Ptch1+/-/ETV7TG/+/- mice with enhanced incidence of rhabdomyosarcoma to generate a model of pleomorphic rhabdomyosarcoma driven by haploinsufficiency of the lysosomal sialidase neuraminidase 1. These tumors share mostly features of embryonal and some of alveolar rhabdomyosarcoma. Mechanistically, we show that the transforming pathway is increased lysosomal exocytosis downstream of reduced neuraminidase 1, exemplified by the redistribution of the lysosomal associated membrane protein 1 at the plasma membrane of tumor and stromal cells. Here we exploit this unique feature for single cell analysis and define heterogeneous populations of exocytic, only partially differentiated cells that force tumors to pleomorphism and promote a fibrotic microenvironment. These data together with the identification of an adipogenic signature shared by human rhabdomyosarcoma, and likely fueling the tumor's metabolism, make this model of pleomorphic rhabdomyosarcoma ideal for diagnostic and therapeutic studies.
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Affiliation(s)
- Eda R Machado
- Department of Genetics, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | | | - Heather S Sheppard
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Scott Perry
- Flow Cytometry Core Facility, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Susanna M Downing
- Department of Cell & Molecular Biology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Jonathan Laxton
- Flow Cytometry Core Facility, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Richard Ashmun
- Flow Cytometry Core Facility, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - David B Finkelstein
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Geoffrey A Neale
- Hartwell Center for Bioinformatics and Biotechnology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Huimin Hu
- Department of Genetics, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Frank C Harwood
- Department of Genetics, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Selene C Koo
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Gerard C Grosveld
- Department of Genetics, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA.
| | - Alessandra d'Azzo
- Department of Genetics, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA.
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2
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Tachibana M, Tsukamoto K, Takahashi M, Tsutsumi Y. Undifferentiated Pleomorphic Sarcoma With Hyaline Globules (Thanatosomes). Cureus 2021; 13:e15789. [PMID: 34168936 PMCID: PMC8215858 DOI: 10.7759/cureus.15789] [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] [Accepted: 06/21/2021] [Indexed: 11/30/2022] Open
Abstract
Hyaline globules (HGs) or thanatosomes belong to a well-defined microscopic phenomenon common to any cell type, representing eosinophilic and round-shaped intracytoplasmic inclusions as a result of altered cellular metabolism. We experienced a case of undifferentiated pleomorphic sarcoma (UPS) of the left thigh, immunoreactive diffusely for CD99 and p16INK4a and focally for alpha-smooth muscle actin. HGs were multifocally clustered in the cytoplasm of the tumor cells. An ultrastructural study using a formalin-fixed, paraffin-embedded block was performed to visualize HGs in the UPS cells. Light microscopically, multifocally clustered HGs were PAS-positive with diastase-resistance and fuchsinophilic in Masson's trichrome staining. HGs were immunoreactive for cleaved caspase-3, but negative for ubiquitin. Ultrastructurally, apoptotic tumor cells contained clusters of small-sized electron-dense globules. Granular material was often deposited in the globule matrix. The formation of the HGs is supposedly related to an apoptotic process of the tumor cells. Though a nonspecific and minor microscopic finding, HGs in soft tissue sarcomas may represent a useful histologic marker of enhanced cell turnover and/or ischemic injury. This is the third report describing HGs in UPS.
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Affiliation(s)
- Mitsuhiro Tachibana
- Department of Diagnostic Pathology, Shimada City General Medical Center, Shimada, JPN
| | - Kei Tsukamoto
- Department of Diagnostic Radiology, Shimada City General Medical Center, Shimada, JPN
| | - Mitsuru Takahashi
- Department of Orthopaedic Surgery, Shizuoka Cancer Center Hospital and Research Institute, Suntou, JPN
| | - Yutaka Tsutsumi
- Diagnostic Pathology Clinic, Pathos Tsutsumi, Inazawa, JPN
- Department of Diagnostic Pathology, Shimada City General Medical Center, Shimada, JPN
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3
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An Algorithmic Immunohistochemical Approach to Define Tumor Type and Assign Site of Origin. Adv Anat Pathol 2020; 27:114-163. [PMID: 32205473 DOI: 10.1097/pap.0000000000000256] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Immunohistochemistry represents an indispensable complement to an epidemiology and morphology-driven approach to tumor diagnosis and site of origin assignment. This review reflects the state of my current practice, based on 15-years' experience in Pathology and a deep-dive into the literature, always striving to be better equipped to answer the age old questions, "What is it, and where is it from?" The tables and figures in this manuscript are the ones I "pull up on the computer" when I am teaching at the microscope and turn to myself when I am (frequently) stuck. This field is so exciting because I firmly believe that, through the application of next-generation immunohistochemistry, we can provide better answers than ever before. Specific topics covered in this review include (1) broad tumor classification and associated screening markers; (2) the role of cancer epidemiology in determining pretest probability; (3) broad-spectrum epithelial markers; (4) noncanonical expression of broad tumor class screening markers; (5) a morphologic pattern-based approach to poorly to undifferentiated malignant neoplasms; (6) a morphologic and immunohistochemical approach to define 4 main carcinoma types; (7) CK7/CK20 coordinate expression; (8) added value of semiquantitative immunohistochemical stain assessment; algorithmic immunohistochemical approaches to (9) "garden variety" adenocarcinomas presenting in the liver, (10) large polygonal cell adenocarcinomas, (11) the distinction of primary surface ovarian epithelial tumors with mucinous features from metastasis, (12) tumors presenting at alternative anatomic sites, (13) squamous cell carcinoma versus urothelial carcinoma, and neuroendocrine neoplasms, including (14) the distinction of pheochromocytoma/paraganglioma from well-differentiated neuroendocrine tumor, site of origin assignment in (15) well-differentiated neuroendocrine tumor and (16) poorly differentiated neuroendocrine carcinoma, and (17) the distinction of well-differentiated neuroendocrine tumor G3 from poorly differentiated neuroendocrine carcinoma; it concludes with (18) a discussion of diagnostic considerations in the broad-spectrum keratin/CD45/S-100-"triple-negative" neoplasm.
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5
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Carvalho SD, Pissaloux D, Crombé A, Coindre JM, Le Loarer F. Pleomorphic Sarcomas: The State of the Art. Surg Pathol Clin 2019; 12:63-105. [PMID: 30709449 DOI: 10.1016/j.path.2018.10.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This article focuses on pleomorphic sarcomas, which are malignant mesenchymal tumors with complex genetic background at the root of their morphologic pleomorphism. They are poorly differentiated tumors that may retain different lines of differentiation, sometimes correlating with clinicopathological or prognostic features. Accurate diagnosis in this group of tumors relies on adequate sampling due to their heterogeneity and assessment with both microscopy and large panels of immunohistochemistry. Molecular analyses have a limited role in their diagnosis as opposed to translocation-related sarcomas but may provide theranostic and important prognostic information in the future.
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Affiliation(s)
- Sofia Daniela Carvalho
- Department of Pathology, Hospital de Braga, Sete Fontes-Sao Victor, 4710-243 Braga, Portugal; Department of Pathology, Institut Bergonié, 276 cours de l'Argonne, 33000, Bordeaux, France
| | - Daniel Pissaloux
- Department of Pathology, Centre Leon Berard, Promenade Lea Bullukian, 69376 Lyon, France
| | - Amandine Crombé
- Department of Radiology, Institut Bergonié, 276 cours de l'Argonne, 33000, Bordeaux, France
| | - Jean-Michel Coindre
- Department of Pathology, Institut Bergonié, 276 cours de l'Argonne, 33000, Bordeaux, France; University of Bordeaux, Talence, France
| | - François Le Loarer
- Department of Pathology, Hospital de Braga, Sete Fontes-Sao Victor, 4710-243 Braga, Portugal; University of Bordeaux, Talence, France.
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6
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Martinez-Ciarpaglini C, Monteagudo C. In regard to "A tale of two clones: Caldesmon staining in the differentiation of cutaneous spindle-cell neoplasms". J Cutan Pathol 2018; 45:869-870. [PMID: 30054907 DOI: 10.1111/cup.13329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/11/2018] [Accepted: 07/20/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - Carlos Monteagudo
- Department of Pathology, Hospital Clinico Universitario, University of Valencia, Valencia, Spain
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7
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Croce S, Ducoulombier A, Ribeiro A, Lesluyes T, Noel JC, Amant F, Guillou L, Stoeckle E, Devouassoux-Shisheboran M, Penel N, Floquet A, Arnould L, Guyon F, Mishellany F, Chakiba C, Cuppens T, Zikan M, Leroux A, Frouin E, Farre I, Genestie C, Valo I, MacGrogan G, Chibon F. Genome profiling is an efficient tool to avoid the STUMP classification of uterine smooth muscle lesions: a comprehensive array-genomic hybridization analysis of 77 tumors. Mod Pathol 2018; 31:816-828. [PMID: 29327710 DOI: 10.1038/modpathol.2017.185] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 11/10/2017] [Accepted: 11/12/2017] [Indexed: 12/15/2022]
Abstract
The diagnosis of a uterine smooth muscle lesion is, in the majority of cases, straightforward. However, in a small number of cases, the morphological criteria used in such lesions cannot differentiate with certainty a benign from a malignant lesion and a diagnosis of smooth muscle tumor with uncertain malignant potential (STUMP) is made. Uterine leiomyosarcomas are often easy to diagnose but it is difficult or even impossible to identify a prognostic factor at the moment of the diagnosis with the exception of the stage. We hypothesize, for uterine smooth muscle lesions, that there is a gradient of genomic complexity that correlates to outcome. We first tested this hypothesis on STUMP lesions in a previous study and demonstrated that this 'gray category' could be split according to genomic index into two groups. A benign group, with a low to moderate alteration rate without recurrence and a malignant group, with a highly rearranged profile akin to uterine leiomyosarcomas. Here, we analyzed a large series of 77 uterine smooth muscle lesions (from 76 patients) morphologically classified as 19 leiomyomas, 14 STUMP and 44 leiomyosarcomas with clinicopathological and genomic correlations. We confirmed that genomic index with a cut-off=10 is a predictor of recurrence (P<0.0001) and with a cut-off=35 is a marker for poor overall survival (P=0.035). For the tumors confined to the uterus, stage as a prognostic factor was not useful in survival prediction. At stage I, among the tumors reclassified as molecular leiomyosarcomas (ie, genomic index ≥10), the poor prognostic markers were: 5p gain (overall survival P=0.0008), genomic index at cut-off=35 (overall survival P=0.0193), 13p loss including RB1 (overall survival P=0.0096) and 17p gain including MYOCD gain (overall survival P=0.0425). Based on these findings (and the feasibility of genomic profiling by array-comparative genomic hybridization), genomic index, 5p and 17p gains prognostic value could be evaluated in future prospective chemotherapy trials.
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Affiliation(s)
- Sabrina Croce
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France.,Institut National de la Santé et de la Recherche Medicale (INSERM) U1218, Bordeaux, France
| | - Agnès Ducoulombier
- Oncology Department, Centre Oscar Lambret, Comprehensive Cancer Centre, Lille, France.,Oncology Department, Centre Antoine Lacassagne, Comprehensive Cancer Centre, Nice, France
| | - Agnès Ribeiro
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France
| | - Tom Lesluyes
- Institut National de la Santé et de la Recherche Medicale (INSERM) U1218, Bordeaux, France.,University of Bordeaux, Bordeaux, France
| | - Jean-Christophe Noel
- Department of Pathology, Clinic of Gynecopathology and Senology, Erasme University Hospital, Brussels, Belgium
| | - Frédéric Amant
- KU Leuven - University of Leuven, Department of Oncology, Gynaecologic Oncology; University Hospitals Leuven, Department of Obstetrics and Gynaecology, Leuven, Belgium.,Centre for Gynecologic Oncology Amsterdam (CGOA), Antoni Van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Louis Guillou
- Argot-Lab, Lausanne, Switzerland.,Institut Universitaire de Pathologie, Lausanne, Switzerland
| | - Eberhard Stoeckle
- Department of Surgery, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France
| | | | - Nicolas Penel
- Oncology Department, Centre Oscar Lambret, Comprehensive Cancer Centre, Lille, France
| | - Anne Floquet
- Department of Medical Oncology, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France
| | - Laurent Arnould
- Department of Pathology, Centre JF Leclerc, Comprehensive Cancer Centre, Dijon, France
| | - Frédéric Guyon
- Department of Surgery, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France
| | - Florence Mishellany
- Department of Pathology, Centre Jean Perrin, Comprehensive Cancer Centre, Clermont-Ferrand, France
| | - Camille Chakiba
- Department of Medical Oncology, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France
| | - Tine Cuppens
- KU Leuven - University of Leuven, Department of Oncology, Gynaecologic Oncology; University Hospitals Leuven, Department of Obstetrics and Gynaecology, Leuven, Belgium
| | - Michal Zikan
- Gynaecological Oncology Center, Department of Obstetrics and Gynaecology, Charles University in Prague - First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Agnès Leroux
- Department of Pathology, Centre Alexis Vautrin, Comprehensive Cancer Centre, Vandoeuvre-les Nancy, France
| | - Eric Frouin
- Department of Pathology, University Hospital, Poitiers, France
| | - Isabelle Farre
- Department of Pathology, Centre Oscar Lambret, Comprehensive Cancer Centre, Lille, France
| | - Catherine Genestie
- Department of Pathology, Institut Gustave Roussy, Comprehensive Cancer Centre, Villejuif, France
| | - Isabelle Valo
- Department of Pathology, ICO Site Paul Papin, Comprehensive Cancer Centre, Angers, France
| | - Gaëtan MacGrogan
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France
| | - Frédéric Chibon
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France.,Institut National de la Santé et de la Recherche Medicale (INSERM) U1218, Bordeaux, France
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8
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h-caldesmon immunoreactivity in atypical fibroxanthoma: implications for the differential diagnosis. Pathology 2018; 50:358-361. [PMID: 29490873 DOI: 10.1016/j.pathol.2017.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/04/2017] [Accepted: 09/12/2017] [Indexed: 12/15/2022]
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9
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Barbiero FJ, Huttner AJ, Judson BL, Baehring JM. Leiomyosarcoma of the infratemporal fossa with perineurial spread along the right mandibular nerve: a case report. CNS Oncol 2017; 6:281-285. [PMID: 28990793 DOI: 10.2217/cns-2017-0004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Leiomyosarcomas are malignant tumors displaying strong smooth muscle differentiation. They can often develop within the GI tract and myometrium, but are particularly rare in the head and neck. Perineurial spread of head and neck cancer is observed in patients with neoplasms of the skin (squamous cell carcinoma, melanoma) or skin appendages (adenoid cystic carcinoma). We report the case of a woman who presented with diplopia and headaches. MRI showed an infratemporal mass lesion and faint enhancement tracking along the mandibular nerve into the wall of the right cavernous sinus. A nerve biopsy revealed leiomyosarcoma. We review the medical literature to provide further insight into the diagnosis and management of this tumor and its peculiar pattern of spread. A similar case was unidentifiable in the literature.
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Affiliation(s)
- Frank J Barbiero
- Department of Neurology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Anita J Huttner
- Department of Pathology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Benjamin L Judson
- Department of Surgery, Otolaryngology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Joachim M Baehring
- Department of Neurology, Yale School of Medicine, New Haven, CT 06510, USA.,Department of Neurosurgery, Yale School of Medicine, New Haven, CT 06520, USA
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10
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Davidson B, Hellesylt E, Holth A, Danielsen HE, Skeie-Jensen T, Katz B. Neuron navigator-2 and cyclin D2 are new candidate prognostic markers in uterine sarcoma. Virchows Arch 2017. [DOI: 10.1007/s00428-017-2172-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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11
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Guo X, Jo VY, Mills AM, Zhu SX, Lee CH, Espinosa I, Nucci MR, Varma S, Forgó E, Hastie T, Anderson S, Ganjoo K, Beck AH, West RB, Fletcher CD, van de Rijn M. Clinically Relevant Molecular Subtypes in Leiomyosarcoma. Clin Cancer Res 2015; 21:3501-11. [PMID: 25896974 DOI: 10.1158/1078-0432.ccr-14-3141] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 04/11/2015] [Indexed: 01/23/2023]
Abstract
PURPOSE Leiomyosarcoma is a malignant neoplasm with smooth muscle differentiation. Little is known about its molecular heterogeneity and no targeted therapy currently exists for leiomyosarcoma. Recognition of different molecular subtypes is necessary to evaluate novel therapeutic options. In a previous study on 51 leiomyosarcomas, we identified three molecular subtypes in leiomyosarcoma. The current study was performed to determine whether the existence of these subtypes could be confirmed in independent cohorts. EXPERIMENTAL DESIGN Ninety-nine cases of leiomyosarcoma were expression profiled with 3'end RNA-Sequencing (3SEQ). Consensus clustering was conducted to determine the optimal number of subtypes. RESULTS We identified 3 leiomyosarcoma molecular subtypes and confirmed this finding by analyzing publically available data on 82 leiomyosarcoma from The Cancer Genome Atlas (TCGA). We identified two new formalin-fixed, paraffin-embedded tissue-compatible diagnostic immunohistochemical markers; LMOD1 for subtype I leiomyosarcoma and ARL4C for subtype II leiomyosarcoma. A leiomyosarcoma tissue microarray with known clinical outcome was used to show that subtype I leiomyosarcoma is associated with good outcome in extrauterine leiomyosarcoma while subtype II leiomyosarcoma is associated with poor prognosis in both uterine and extrauterine leiomyosarcoma. The leiomyosarcoma subtypes showed significant differences in expression levels for genes for which novel targeted therapies are being developed, suggesting that leiomyosarcoma subtypes may respond differentially to these targeted therapies. CONCLUSIONS We confirm the existence of 3 molecular subtypes in leiomyosarcoma using two independent datasets and show that the different molecular subtypes are associated with distinct clinical outcomes. The findings offer an opportunity for treating leiomyosarcoma in a subtype-specific targeted approach.
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Affiliation(s)
- Xiangqian Guo
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Vickie Y Jo
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Anne M Mills
- Department of Pathology, University of Virginia, Charlottesville, Virginia
| | - Shirley X Zhu
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Cheng-Han Lee
- Division of Anatomical Pathology, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Inigo Espinosa
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Marisa R Nucci
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sushama Varma
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Erna Forgó
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Trevor Hastie
- Department of Statistics, Stanford University, Stanford, California
| | - Sharon Anderson
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Kristen Ganjoo
- Stanford Comprehensive Cancer Center, Stanford University, Stanford, California
| | - Andrew H Beck
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Robert B West
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Christopher D Fletcher
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Matt van de Rijn
- Department of Pathology, Stanford University School of Medicine, Stanford, California.
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12
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Demicco EG, Boland GM, Brewer Savannah KJ, Lusby K, Young ED, Ingram D, Watson KL, Bailey M, Guo X, Hornick JL, van de Rijn M, Wang WL, Torres KE, Lev D, Lazar AJ. Progressive loss of myogenic differentiation in leiomyosarcoma has prognostic value. Histopathology 2015; 66:627-38. [PMID: 24889065 DOI: 10.1111/his.12466] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 05/24/2014] [Indexed: 01/15/2023]
Abstract
AIMS Well-differentiated leiomyosarcomas show morphologically recognizable smooth muscle differentiation, whereas poorly differentiated tumours may form a spectrum with a subset of undifferentiated pleomorphic sarcomas. The expression of certain muscle markers has been reported to have prognostic impact. We investigated the correlation between the morphological spectrum and the muscle marker expression profile of leiomyosarcoma, and the impact of these factors on patient outcomes. METHODS AND RESULTS Tissue microarrays including 202 non-uterine and 181 uterine leiomyosarcomas with a spectrum of tumour morphologies were evaluated for expression of immunohistochemical markers of muscle differentiation. Poorly differentiated tumours frequently lost one or more conventional smooth muscle markers [smooth muscle actin, desmin, h-caldesmon, and smooth muscle myosin (P < 0.0001)], as well as the more recently described markers SLMAP, MYLK, and ACTG2 (P < 0.0001). In primary tumours, both desmin and CFL2 expression predicted improved overall survival in multivariate analyses (P = 0.0111 and P = 0.043, respectively). Patients with muscle marker-enriched tumours (expressing all four conventional markers or any three of ACTG2, CFL2, CASQ2, MYLK, and SLMAP) had improved overall survival (P < 0.05) in univariate analyses. CONCLUSIONS Morphologically and immunohistochemically, poorly differentiated leiomyosarcomas can masquerade as undifferentiated pleomorphic sarcomas with progressive loss of muscle markers. The expression of muscle markers has prognostic significance in primary leiomyosarcomas independently of tumour morphology.
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Affiliation(s)
- Elizabeth G Demicco
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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