The Rise and Fall of Malignant Fibrous Histiocytoma

Myxofibrosarcoma in adolescents and young adults: a clinicopathologic study of 17 cases

Myxofibrosarcoma is a locally aggressive sarcoma that characteristically arises in the extremities of older patients. Cases arising at a younger age are rare, leading to diagnostic challenges. Our aim was to study the clinicopathologic features of myxofibrosarcoma in patients aged ≤40 years. Cases of myxofibrosarcoma and myxoid malignant fibrous histiocytoma arising in patients aged ≤40 years with clinical follow-up were collected from multiple institutions. Hematoxylin and eosin slides were evaluated for mitoses, necrosis, and epithelioid areas. Seventeen cases were identified (13 females, 4 males; 16-39 years; median 32 years), tumors ranged from 2.2 to 34 cm (median 4.1 cm). Anatomic sites included proximal extremity (9), distal extremity (4), trunk (1), and head/neck (3). Ten were superficial, and 6 were deep-seated. Three cases were predominantly epithelioid. In untreated resection specimens, 6 were FNCLCC grade 1, 4 grade 2, and 2 grade 3. Follow-up (6-204 months, median 36 months) revealed that 2 patients experienced local recurrences, 1 distant metastasis, and 2 patients both. The 5-year overall survival (OS) and event-free survival (EFS) were 84% and 55.9%, respectively. Tumor depth and necrosis were correlated with inferior OS (P = .025, P = .005), while tumor depth was also associated with worse EFS (P = <.001). We conclude that myxofibrosarcomas arising in adolescents and young adults show similar behavior compared to their older adult counterparts. Tumor depth and necrosis are poor prognostic factors in myxofibrosarcoma in this age group. Awareness that myxofibrosarcoma can rarely present in this population is important for accurate diagnosis.

Undifferentiated Pleomorphic Sarcoma of a Chronic Burn Scar of the Knee With Lymph Node Metastasis

Malignant transformation of chronic burn scars are usually toward cutaneous lineages, including squamous cell carcinoma, basal cell carcinoma, and malignant melanoma. Sarcomas are less common. Undifferentiated pleomorphic sarcoma(UPS) is a subtype of soft tissue sarcoma with storiform-pleomorphic cells of uncertain origin, and has sparingly been reported to arise from burn scars. The majority are localized lesions probably due to the spatial distance of mesenchymal cells from the epithelium. The authors describe a rare case of UPS of the chronic burn scar of his knee with ipsilateral femoral and external iliac lymph node metastasis.

The genomics of undifferentiated sarcoma of soft tissue: Progress, challenges and opportunities

Undifferentiated sarcoma of soft tissue (USTS) are aggressive sarcomas that remain a diagnosis of exclusion and show extreme genomic complexity. Many advances in diagnostic criteria have resulted in several revisions in the definition of this rare cancer type. Recent sequencing efforts have illuminated the nature of the genome complexity and have revealed extensive copy number heterogeneity and multiple evolutionary patterns of development. This review places these recent advances into their historical and translational context and covers the changes in nomenclature, molecular classification, and the promise of personalised medicine.

The Outcome of Patients With Localized Undifferentiated Pleomorphic Sarcoma of the Lower Extremity Treated at Stanford University

BACKGROUND

As a diagnosis of exclusion, Undifferentiated Pleomorphic Sarcoma (UPS) has unclear clinical characteristics. The objective of this retrospective cohort study is to investigate which clinical and prognostic factors of primary lower-extremity UPS will determine failure.

METHODS

We retrospectively reviewed 55 primary lower-extremity UPS cases treated at Stanford between 1998 and 2015. Overall Survival (OS) and Disease-Free Survival (DFS) curves were calculated. Univariate Fisher's Exact Tests were used to examine relationships between disease recurrence, treatment, patient factors, tumor characteristics, and surgical margins.

RESULTS

5-year DFS and OS rates were 60% (95% CI, 45%-72%) and 68% (95% CI, 53%-79%), respectively. The 5-year DFS rate for patients with positive margins was 33.3% (95% CI, 5%-68%) compared with 63% (95% CI, 47%-76%) for patients with negative margins. (Log-rank, P=0.03). The OS rate for those with disease recurrence was 42% % (95% CI, 16%-67%) compared with 76% (95% CI, 59%-87%) for patients who did not have disease recurrence (log-rank, P=0.021). Local failure occurred more frequently with omission of radiation therapy (Fisher's exact test, P=0.009).

CONCLUSIONS

Positive surgical margins are an important prognostic factor for predicting relapse in UPS. Relapse of any kind led to worse OS. Radiation therapy improved local control of disease but had no statistically significant effect on DFS, highlighting the need for improved diagnostics to identify those at highest risk for hematogenous metastasis and for selection of patients for adjuvant systemic treatment.

Genomic signatures predict poor outcome in undifferentiated pleomorphic sarcomas and leiomyosarcomas

Undifferentiated high-grade pleomorphic sarcomas (UPSs) display aggressive clinical behavior and frequently develop local recurrence and distant metastasis. Because these sarcomas often share similar morphological patterns with other tumors, particularly leiomyosarcomas (LMSs), classification by exclusion is frequently used. In this study, array-based comparative genomic hybridization (array CGH) was used to analyze 20 UPS and 17 LMS samples from untreated patients. The LMS samples presented a lower frequency of genomic alterations compared with the UPS samples. The most frequently altered UPS regions involved gains at 20q13.33 and 7q22.1 and losses at 3p26.3. Gains at 8q24.3 and 19q13.12 and losses at 9p21.3 were frequently detected in the LMS samples. Of these regions, gains at 1q21.3, 11q12.2-q12.3, 16p11.2, and 19q13.12 were significantly associated with reduced overall survival times in LMS patients. A multivariate analysis revealed that gains at 1q21.3 were an independent prognostic marker of shorter survival times in LMS patients (HR = 13.76; P = 0.019). Although the copy number profiles of the UPS and LMS samples could not be distinguished using unsupervised hierarchical clustering analysis, one of the three clusters presented cases associated with poor prognostic outcome (P = 0.022). A relative copy number analysis for the ARNT, SLC27A3, and PBXIP1 genes was performed using quantitative real-time PCR in 11 LMS and 16 UPS samples. Gains at 1q21-q22 were observed in both tumor types, particularly in the UPS samples. These findings provide strong evidence for the existence of a genomic signature to predict poor outcome in a subset of UPS and LMS patients.

MASL1: a neglected ROCO protein

The human ROCO proteins are a family of four proteins characterized by a conserved supradomain: a Ras-like GTPase domain. This domain consists of ROC (Ras of complex proteins) occurring in tandem with a COR (C-terminal of ROC) domain. Together, these proteins are linked to various pathologies including cancer and PD (Parkinson's disease). Despite an increasing research focus on these proteins, their functions in general, and their specific roles in disease, are still unknown. In the case of MASL1 (malignant fibrous histiocytoma amplified sequences with leucine-rich tandem repeats 1), a predicted oncoprotein in MFHs (malignant fibrous histiocytomas), there is a particular lack of information available in the literature. The aim of the present review is therefore to summarize the existing information on MASL1 and also to compile data that could be linked to MASL1 and thus help our understanding of this neglected ROCO protein.

Myxofibrosarcoma arising in the maxillary sinus: a case report with a review of the ultrastructural findings and differential diagnoses

This is a case report of a patient presenting with a destructive lesion with histologic features of a low grade malignancy in a predominantly myxoid matrix. Various low grade myxoid malignancies were considered in the differential diagnosis of which an overview is presented. A literature review of the ultrastructural findings and possible histogenesis is discussed along with the diagnostic criteria and recent change in the terminology regarding the malignancies previously diagnosed as myxoid malignant fibrous histiocytomas. A final diagnosis of a myxofibrosarcoma was only possible after assessing the immuno-histochemical profile, results of histochemical stains and ultrastructural features of this lesion.

The enigma of myxofibrosarcoma of the extremity

BACKGROUND

The reported high rate of local recurrence (LR) in myxofibrosarcoma raises the question of whether this sarcoma histology should be considered radioresistant. In this study, the authors compared rates and patterns of LR of high-grade (HG) myxofibrosarcoma with rates and patterns of HG leiomyosarcoma, which was chosen because of the similarity in incidence and general treatment approach.

METHODS

Two hundred two patients with primary, nonmetastatic extremity myxofibrosarcoma (n = 114) and leiomyosarcoma (n = 88) underwent limb-sparing surgery and were followed prospectively. All 202 patients had HG tumors, and 138 patients (68%) received adjuvant radiation therapy.

RESULTS

The groups were comparable in terms of age, sex, and receipt of chemotherapy. Compared with leiomyosarcoma, myxofibrosarcoma presented more frequently with tumors >5 cm (P < .001), deep location (P = .036), and upper extremity site (P = .015). In addition, rates of positive/close margins (P < .001) and the receipt of radiation therapy (P < .001) were significantly higher in the myxofibrosarcoma group. The 5-year overall LR rate was not significantly different according to histology (14.6% for myxofibrosarcoma, 13.2% for leiomyosarcoma; P = .594). The only predictor of LR for the whole cohort of patients was positive/close margins (P = .01). Of 17 myxofibrosarcoma LRs, 8 (47%) occurred out of field, versus 1 of 12 (8%) leiomyosarcoma LRs (P = .04). Leiomyosarcoma more commonly recurred distantly (54.1% vs 24.3% at 5 years; P = .014).

CONCLUSIONS

Despite more adverse clinical features, myxofibrosarcoma recurred distantly less often than leiomyosarcoma, whereas the LR rates were comparable between the 2 groups, suggesting that adjuvant radiation therapy is effective in myxofibrosarcoma. Myxofibrosarcoma LRs more commonly occurred out of field. Reduction in radiation field margins may not be advisable in patients with myxofibrosarcoma.

Transformation potential of bone marrow stromal cells into undifferentiated high-grade pleomorphic sarcoma

PURPOSE

Bone marrow adherent cells contain conventional bone marrow stromal cells and mesenchymal stem cells and these cells constitute the hematopoietic microenvironment. Mesenchymal stem cells have the capacity to give rise to multiple mesenchymal lineage cells and even ectodermal lineage cells. In the present study, we investigated what types of tumor cells are inducible from BM adherent cells by chemical carcinogens.

METHODS

Bone marrow cells from neonatal C3H/HeN mice were collected within 24 h after birth and then cultured. Four days later, bone marrow adherent cells were obtained and the cells were treated with 3-methylcholanthrene.

RESULTS

By this treatment, some transformed clones consisting of large spindle cells were obtained. The transformed cells were highly positive for CD44 and were positive for Sca-1, CD49d and CD106, whereas the cells were negative for hematolymphoid markers. The cell clones had the ability to support hematopoiesis in vitro. These results indicate that the transformed cell lines have the characteristics of BM stromal cells/mesenchymal stem cells. Moreover, during culture of the transformed cells, spontaneous bone nodule formation was observed. When the transformed cells were inoculated into immunodeficient mice subcutaneously, the neoplasms grew in the subcutaneous tissue of the mice. Microscopically and ultrastructurally, the neoplasms showed the typical morphology of undifferentiated high-grade pleomorphic sarcoma (UHGPS). Bone-related genes have been found to be expressed in both transformed cells and UHGPSs.

CONCLUSION

The present study suggests that UHGPSs are derived from BM stromal cells, probably mesenchymal stem cells.

Primary hepatic malignant fibrous histiocytoma: clinicopathologic characteristics and prognostic value of ezrin expression

Primary hepatic malignant fibrous histiocytoma (MFH) is a rare entity with ill-defined clinicopathologic characteristics. We present the largest series to date (7 cases) of primary hepatic MFH, a systematic review of 27 cases published in the English literature, and an analysis of prognostic factors including ezrin expression. The 2 men and 5 women in our series were 34 to 80 years old (average 61 y) and presented with abdominal pain (6/7), systemic symptoms of low-grade fever, malaise, anorexia and weight loss (4/7), and spiking fever (1/7). One case was an incidental finding. Computed tomography and ultrasound revealed a well-demarcated solitary heterogeneous low-density mass ranging from 5.5 to 20 cm (average 12 cm) in largest dimension (5/7), or multiple small nodules up to 2 cm in diameter (1/7) or a 10 cm multiloculated cystic lesion owing to extensive necrosis (1/7). Histologically, a storiform-pleomorphic pattern with variable degrees of necrosis predominated (6/7). A myxoid pattern was seen in only 1 case and this case lacked necrosis. Lymphoplasmacytic infiltration was seen in 3/7 of the cases. Tumors were grade I (1/7), grade II (2/7), grade III (4/7), stage pT1 (4/7), pT2 (1/7), pT4 (1/7), and pT4, cM1 (1/7) at diagnosis. Three patients with tumor cell ezrin immunoreactivity score >or=1 died of tumor within 1 year. Two patients with tumor cell ezrin immunoreactivity score <1 survived >4 years after surgery. Combined analysis of our series and previously reported cases suggest that primary hepatic MFH possess certain characteristic clinicopathologic features that may help in making the diagnosis and in differentiating it from other more common neoplasms in the liver. The prognosis of hepatic MFH depends primarily on tumor size and stage at the time of diagnosis. Ezrin expression in tumor cells can provide additional prognostic information and may be a potential target for new adjuvant therapies.