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Ortiz Requena D, Velez-Torres JM, Diaz-Perez JA, Gomez-Fernandez C, Montgomery EA, Rosenberg AE. Mesenchymal neoplasms of the tongue: A clinicopathologic study of 93 cases. Hum Pathol 2024; 150:42-50. [PMID: 38876200 DOI: 10.1016/j.humpath.2024.06.005] [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: 01/23/2024] [Revised: 06/06/2024] [Accepted: 06/11/2024] [Indexed: 06/16/2024]
Abstract
Neoplasms of the tongue are relatively common, and the vast majority are epithelial in phenotype. Although uncommon, a diverse and distinctive array of mesenchymal neoplasms arises in this anatomic site. To increase our understanding of these lesions, we reviewed our experience of MNs of the tongue and described their clinicopathologic features. The pathology archives from 2005 to 2021 and the consultation files of one of the authors were queried for all MNs of the tongue. We reviewed the histologic slides and ancillary studies and obtained clinical data from the available medical records. Ninety-three cases were identified, and they form the study cohort - to our knowledge, this is the largest series of mesenchymal neoplasms of the tongue. Forty-eight patients were female, and forty-five were male, with a mean age of 51 years (range: 1-94 years). The tumors included 43 (46.2%) hemangiomas, 14 (15%) granular cell tumors, 8 (9%) lipomas, 4 (4.3%) schwannomas, 4 (4.3%) solitary fibrous tumors - all with low risk of progression based on risk stratification criteria, 2 (2.2%) lymphangiomas, 3 (3.2%) Kaposi sarcomas, 2 (2.2%) chondromas, 2 (2.2%) myofibromas, 1 (1.1%) solitary circumscribed neuroma, 1 (1.1%) perineurioma, 1 (1.1%) neurofibroma, 1 (1.1%) ectomesenchymal chondromyxoid tumor, 1 (1.1%) atypical glomus tumor with a NOTCH2 rearrangement and TLL2 mutation, 1 (1.1%) spindle cell rhabdomyosarcoma, 1 (1.1%) pleomorphic fibroblastic sarcoma, 1 (1.1%) malignant rhabdoid tumor, 1 (1.1%) leiomyosarcoma, 1 (1.1%) angiosarcoma, and 1 (1.1%) alveolar soft part sarcoma. Most of the patients underwent surgical excision, and 1 patient (with hemangioma) underwent embolization. On follow-up, the patient with spindle cell rhabdomyosarcoma developed postoperative numbness at the surgical site and was disease-free through 17 months of follow-up. The patient with leiomyosarcoma declined adjuvant radiation and developed metastasis to the lung at 22 months. The patient with alveolar soft part sarcoma had metastases to the lung at the time of diagnosis and received adjuvant chemotherapy. The remaining patients had no local or distant recurrence. MNs of the tongue are usually benign and characterized by either endothelial, adipocytic, or schwannian differentiation. The mainstay of treatment is surgical excision with the extent of excision determined by tumor type. Adjuvant therapy is reserved for high-grade sarcomas.
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Affiliation(s)
- Domenika Ortiz Requena
- University of Miami Miller School of Medicine, Department of Pathology and Laboratory Medicine, Miami, FL, USA
| | - Jaylou M Velez-Torres
- University of Miami Miller School of Medicine, Department of Pathology and Laboratory Medicine, Miami, FL, USA
| | - Julio A Diaz-Perez
- Departments of Pathology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Carmen Gomez-Fernandez
- University of Miami Miller School of Medicine, Department of Pathology and Laboratory Medicine, Miami, FL, USA
| | - Elizabeth A Montgomery
- University of Miami Miller School of Medicine, Department of Pathology and Laboratory Medicine, Miami, FL, USA
| | - Andrew E Rosenberg
- University of Miami Miller School of Medicine, Department of Pathology and Laboratory Medicine, Miami, FL, USA.
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Dehner CA, Rudzinski ER, Davis JL. Rhabdomyosarcoma: Updates on classification and the necessity of molecular testing beyond immunohistochemistry. Hum Pathol 2024; 147:72-81. [PMID: 38135061 DOI: 10.1016/j.humpath.2023.12.004] [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: 11/16/2023] [Revised: 12/06/2023] [Accepted: 12/19/2023] [Indexed: 12/24/2023]
Abstract
Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children and adolescents under the age of 20. The current World Health Organization (WHO) classification for soft tissue and bone tumors recognizes 4 distinct subtypes of RMS based on clinicopathological and molecular genetic features: embryonal, alveolar, spindle cell/sclerosing and pleomorphic subtypes. However, with the increased use of molecular techniques, the classification of rhabdomyosarcoma has been evolving rapidly. New subtypes such as osseus RMS harboring TFCP2/NCOA2 fusions or RMS arising in inflammatory rhabdomyoblastic tumor have been emerging within the last decade, adding to the complexity of diagnosing skeletal muscle tumors. This review article provides an overview of classically recognized distinctive subtypes as well as new, evolving subtypes and discusses important morphologic, immunophenotypic and molecular genetic features of each subtype including recommendations for a diagnostic approach of malignant skeletal muscle neoplasms.
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Affiliation(s)
- Carina A Dehner
- Department of Pathology & Laboratory Medicine, Indiana University, Indianapolis, IN, USA
| | - Erin R Rudzinski
- Department of Laboratories, Seattle Children's Hospital and Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, WA, USA
| | - Jessica L Davis
- Department of Pathology & Laboratory Medicine, Indiana University, Indianapolis, IN, USA.
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3
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Jain E, Munjal G, Sharma S, Brar Z, Bhardwaj N, Dewan A, Jain D, Jha S, Lobo A, Malik V, Arora S, Varshney J, Beg A, Sampat NY, Parwani AV, Balzer B, Varma M, Yadav BS, Sharma SK, Singh HP, Gogoi K, Kumar D, Bhandari V, Fulara LM, Kumar A, Singh H, Bhattacharya M, Dixit M, Mohanty SK. Multifaceted Spindle Cell/Sclerosing Rhabdomyosarcoma With Role of Immunohistochemistry in Avoiding Misdiagnosis: A Multi-Institutional Study of 45 Distinct Tumors. Int J Surg Pathol 2024; 32:496-506. [PMID: 37489265 DOI: 10.1177/10668969231188422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Background. Spindle cell/sclerosing rhabdomyosarcoma is a rare neoplasm and has an aggressive clinical course. Because of its rarity, we performed a multi-institutional collaboration to comprehend the overarching clinical, histopathological, and immunohistochemical characteristics of a cohort of spindle cell/sclerosing rhabdomyosarcoma. Materials and Methods. Forty-five patients with spindle cell/sclerosing rhabdomyosarcoma were identified. Demographics, clinical, histopathological, and immunohistochemistry data were reviewed and recorded. Results. The patients' age ranged from 1 to 85 years with a male to female ratio of 1.2:1. There were 15 children/adolescents and 30 adults. Eighteen (40%) tumors were located in the head and neck region. Twenty-four (53%) tumors displayed a bimorphic cellular arrangement with hypercellular areas having short, long, and sweeping fascicular and herringbone pattern, and hypocellular areas with stromal sclerosis and associated hyalinized and/or chondromyxoid matrix. Histomorphological differentials considered were leiomyosarcoma, malignant peripheral nerve sheath tumor, fibrosarcoma, nodular fasciitis, liposarcoma, synovial sarcoma, sarcomatoid carcinoma, solitary fibrous tumor, dermatofibrosarcoma protuberans, and schwannoma. Six tumors exhibited marked stromal sclerosis. The myogenic nature was confirmed by immunohistochemistry. Positivity for at least one skeletal muscle-associated marker (MyoD1 and/or myogenin) was observed. Conclusion. Spindle cell/sclerosing rhabdomyosarcoma diagnosis can be challenging as a number of malignant spindle cell neoplasm mimic this entity. Thus a correct diagnosis requires immunohistochemical work up with a broad panel of antibodies. In view of rarity of this neoplasm, further studies on a large cohort of patients with clinical follow-up data are needed for a better understanding of this tumor.
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Affiliation(s)
- Ekta Jain
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | - Gauri Munjal
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | - Shivani Sharma
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | - Zoya Brar
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | - Nitin Bhardwaj
- Indian Council of Medical Research and National Institute of Malaria Research, New Delhi, India
| | - Aditi Dewan
- BLK-MAX Superspeciality Hospital, New Delhi, India
| | - Deepika Jain
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | - Shilpy Jha
- Advanced Medical and Research Institute, Bhubaneshwar, India
| | - Anandi Lobo
- Kapoor Pathology and Urology Centre, Raipur, India
| | - Vipra Malik
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | - Samriti Arora
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | - Juhi Varshney
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | - Arshi Beg
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | - Nakul Y Sampat
- Advanced Medical and Research Institute, Bhubaneshwar, India
| | - Anil V Parwani
- Wexner Medical Center, Department of Pathology, The Ohio State University, Columbus, OH, USA
| | | | - Monica Varma
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | - Brijpal S Yadav
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | | | - Hena Paul Singh
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | - Kamakhya Gogoi
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | - Devendra Kumar
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | | | - Lalit M Fulara
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | - Arvind Kumar
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | - Harish Singh
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | | | - Mallika Dixit
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | - Sambit K Mohanty
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
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Zhou B, Zhan C, Tian Y, Gao Z, Yan S. Primary hepatic malignant triton tumor mimicking hepatocellular carcinoma by demonstrating arterial-phase hypervascularity and subsequent washout on dynamic contrast-enhanced imaging: a case report and literature review. Front Med (Lausanne) 2024; 11:1361690. [PMID: 38504916 PMCID: PMC10949526 DOI: 10.3389/fmed.2024.1361690] [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: 12/26/2023] [Accepted: 02/19/2024] [Indexed: 03/21/2024] Open
Abstract
Background Malignant Triton tumor (MTT) is a relatively rare subtype of malignant peripheral nerve sheath tumor (MPNST) characterized by rhabdomyosarcoma differentiation. There are no distinct features of MTT, and it is easy to misdiagnose preoperatively. Case presentation Here, we describe a rare case of primary hepatic MTT in a 56-year-old male who presented with nonspecific abdominal pain for 1 day. Magnetic resonance imaging and abdominal computed tomography revealed an extremely large mass located in the right liver with intratumoral hemorrhage, arterial-phase hypervascularity and subsequent washout on dynamic contrast-enhanced imaging and the possibility of intrahepatic metastasis. Tumor marker levels revealed only an elevated level of alpha-fetoprotein (AFP: 5304.0 ng/mL). Then, he received transcatheter arterial chemoembolization combined with lenvatinib and pembrolizumab, and he was diagnosed with hepatocellular carcinoma. After 3 months of neoadjuvant therapy, we resected the hepatic cancer and adherent diaphragmatic pleura. MTT was confirmed by postoperative pathology and immunohistochemistry. Conclusion Despite the preoperative diagnosis of hepatocellular carcinoma with a rising serum AFP level, typical CT and MRI findings, histopathology assessment showing MPNST with rhabdomyosarcoma differentiation confirms the diagnosis of primary hepatic MTT.
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Affiliation(s)
- Bo Zhou
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Canyang Zhan
- Department of Neonatology, Children’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yang Tian
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhenzhen Gao
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Sheng Yan
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Luo H, Weng X, Zhong Z, Shan X, Lin W, Li S, Gu C. Spindle cell embryonal rhabdomyosarcoma of the prostate in an adult patient: a case report and review of the literature. J Int Med Res 2024; 52:3000605241234755. [PMID: 38501994 PMCID: PMC10953018 DOI: 10.1177/03000605241234755] [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: 10/26/2023] [Accepted: 02/07/2024] [Indexed: 03/20/2024] Open
Abstract
Rhabdomyosarcoma of the prostate is a rare mesenchymal tumor that originates from undifferentiated mesenchymal cells. Spindle cell rhabdomyosarcoma is a variant of embryonal rhabdomyosarcoma. The vast majority of these two pathological types occur in children, with only a few adult cases reported to date, and both are associated with poor clinical outcomes. We herein report a case involving a man in his early 40s with spindle cell embryonal rhabdomyosarcoma of the prostate. His chief complaint was difficult urination. The diagnosis was confirmed by puncture biopsy of the prostate, and pelvic lymph node metastasis was already present at the time of diagnosis. The patient underwent three courses of chemotherapy. However, his response to the treatment was very poor, and he died of the disease 4 months after diagnosis.
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Affiliation(s)
- Hanwen Luo
- Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Xiangtao Weng
- Department of Urology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Zibin Zhong
- Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Xiongwei Shan
- Department of Urology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Wenli Lin
- Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Siyi Li
- Department of Urology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Chiming Gu
- Department of Urology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
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6
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Ghazanfar NA, Anwar MS, Shah AA, Saeed H, Kashif M. Adult Para Testicular Spindle Cell Rhabdomyosarcoma: A Case Report From Pakistan. Cureus 2023; 15:e50082. [PMID: 38186500 PMCID: PMC10770514 DOI: 10.7759/cureus.50082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
Para testicular or intra-scrotal Rhabdomyosarcomas (RMS) are rare. The spindle cell variant of rhabdomyosarcoma is the least common variant among embryonal subtypes. They are mostly seen in childhood but rarely reported in adults. We present a case of a 56-year-old man who presented with a three-year history of painless left inguinoscrotal swelling, which he initially ignored and misinterpreted as an Inguinal hernia but later sought medical help upon a progressive increase in the size of the swelling. Clinically and radiologically, there was sparing of the left testis and spermatic cord with normal testicular tumor markers and no evidence of lymphadenopathy or metastasis. Surgical exploration was performed with complete excision of the mass, followed by histopathology and immunocytochemistry, confirming the diagnosis of spindle cell rhabdomyosarcoma. Prompt recognition, early diagnosis, and appropriate surgical treatment are the hallmarks of management. Regular and strict follow-up is needed due to the rarity of diagnosis.
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Grigorean VT, Serescu R, Anica A, Coman VE, Bedereag ŞI, Sfetea RC, Liţescu M, Pleşea IE, Florea CG, Burleanu C, Erchid A, Coman IS. Spindle Cell Rhabdomyosarcoma of the Inguinal Region Mimicking a Complicated Hernia in the Adult-An Unexpected Finding. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1515. [PMID: 37763635 PMCID: PMC10535666 DOI: 10.3390/medicina59091515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 09/29/2023]
Abstract
Rhabdomyosarcoma is a rare tumor that is diagnosed mostly in children and adolescents, rarely in adults, representing 2-5% of all soft tissue sarcomas. It has four subtypes that are recognized: embryonal (50%), alveolar (20%), pleomorphic (20%), and spindle cell/sclerosing (10%). The diagnosis of rhabdomyosarcoma is based on the histological detection of rhabdomyoblasts and the expression of muscle-related biomarkers. Spindle cell/sclerosing rhabdomyosarcoma consists morphologically of fusiform cells with vesicular chromatin arranged in a storiform pattern or long fascicles, with occasional rhabdomyoblasts. Also, dense, collagenous, sclerotic stroma may be seen more commonly in adults. We present a rare case of an adult who presented to the hospital with a tumor in the left inguinal area, was first diagnosed with a left strangulated inguinal hernia and was operated on as an emergency, although the diagnosis was ultimately a spindle cell rhabdomyosarcoma of the inguinal region.
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Affiliation(s)
- Valentin Titus Grigorean
- Discipline of General Surgery, “Bagdasar-Arseni” Clinical Emergency Hospital, 10th Clinical Department—General Surgery, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania; (V.T.G.); (V.E.C.); (I.S.C.)
- General Surgery Department, “Bagdasar-Arseni” Clinical Emergency Hospital, 12 Berceni Road, 041915 Bucharest, Romania; (C.G.F.); (C.B.); (A.E.)
| | - Radu Serescu
- Amethyst Medical Center, 42 Odăii Street, 075100 Otopeni, Romania; (R.S.); (A.A.)
| | - Andrei Anica
- Amethyst Medical Center, 42 Odăii Street, 075100 Otopeni, Romania; (R.S.); (A.A.)
- Ph.D. School, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
| | - Violeta Elena Coman
- Discipline of General Surgery, “Bagdasar-Arseni” Clinical Emergency Hospital, 10th Clinical Department—General Surgery, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania; (V.T.G.); (V.E.C.); (I.S.C.)
- General Surgery Department, “Bagdasar-Arseni” Clinical Emergency Hospital, 12 Berceni Road, 041915 Bucharest, Romania; (C.G.F.); (C.B.); (A.E.)
| | - Ştefan Iulian Bedereag
- Pathology Department, “Bagdasar-Arseni” Clinical Emergency Hospital, 12 Berceni Road, 041915 Bucharest, Romania; (Ş.I.B.); (I.E.P.)
| | - Roxana Corina Sfetea
- Discipline of Modern Languages, 3rd Preclinical Department—Complementary Sciences, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania;
| | - Mircea Liţescu
- Discipline of Surgery and General Anesthesia,“Sf. Ioan” Clinical Emergency Hospital, 2nd Department, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, “Sf. Ioan” Clinical Emergency Hospital, 13 Vitan-Bârzeşti Road, 042122 Bucharest, Romania
| | - Iancu Emil Pleşea
- Pathology Department, “Bagdasar-Arseni” Clinical Emergency Hospital, 12 Berceni Road, 041915 Bucharest, Romania; (Ş.I.B.); (I.E.P.)
| | - Costin George Florea
- General Surgery Department, “Bagdasar-Arseni” Clinical Emergency Hospital, 12 Berceni Road, 041915 Bucharest, Romania; (C.G.F.); (C.B.); (A.E.)
- Ph.D. School, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
| | - Cosmin Burleanu
- General Surgery Department, “Bagdasar-Arseni” Clinical Emergency Hospital, 12 Berceni Road, 041915 Bucharest, Romania; (C.G.F.); (C.B.); (A.E.)
- Ph.D. School, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
| | - Anwar Erchid
- General Surgery Department, “Bagdasar-Arseni” Clinical Emergency Hospital, 12 Berceni Road, 041915 Bucharest, Romania; (C.G.F.); (C.B.); (A.E.)
- Ph.D. School, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
| | - Ionuţ Simion Coman
- Discipline of General Surgery, “Bagdasar-Arseni” Clinical Emergency Hospital, 10th Clinical Department—General Surgery, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania; (V.T.G.); (V.E.C.); (I.S.C.)
- General Surgery Department, “Bagdasar-Arseni” Clinical Emergency Hospital, 12 Berceni Road, 041915 Bucharest, Romania; (C.G.F.); (C.B.); (A.E.)
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Dehner CA, Geiersbach K, Rowsey R, Murugan P, Broski SM, Meis JM, Rosenberg AE, Folpe AL. Rhabdomyosarcoma Arising in Inflammatory Rhabdomyoblastic Tumor: A Genetically Distinctive Subtype of Rhabdomyosarcoma. Mod Pathol 2023; 36:100131. [PMID: 36966552 DOI: 10.1016/j.modpat.2023.100131] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 01/30/2023] [Accepted: 02/05/2023] [Indexed: 03/03/2023]
Abstract
"Inflammatory rhabdomyoblastic tumor" (IRMT) is a recently coined name for a distinctive soft tissue neoplasm characterized by slow growth, a dense histiocytic infiltrate, scattered, bizarre-appearing tumor cells with morphologic and immunohistochemical evidence of skeletal muscle differentiation, a near-haploid karyotype with retained biparental disomy of chromosomes 5 and 22, and usually indolent behavior. There are 2 reports of rhabdomyosarcoma (RMS) arising in IRMT. We studied the clinicopathologic and cytogenomic features of 6 cases of IRMT with progression to RMS. Tumors occurred in the extremities of 5 men and 1 woman (median patient age, 50 years; median tumor size, 6.5 cm). Clinical follow-up (6 patients: median, 11 months; range 4-163 months) documented local recurrence and distant metastases in 1 and 5 of 6 patients, respectively. Therapy included complete surgical resection (4 patients) and adjuvant/neoadjuvant chemo/radiotherapy (6 patients). One patient died of disease, 4 were alive with metastatic disease, and one was without evidence of disease. All primary tumors contained conventional IRMT. Progression to RMS appeared as follows: (1) overgrowth of monomorphic rhabdomyoblasts with diminished histiocytes, (2) monomorphic spindle cell morphology with variably pleomorphic rhabdomyoblasts and low mitotic activity, or (3) morphologically undifferentiated spindle cell and epithelioid sarcoma. All but one were diffusely desmin-positive, with more limited MyoD1/myogenin expression. All RMS arising in IRMT, either primary or metastatic, demonstrated widespread loss of heterozygosity with retained heterozygosity of chromosomes 5 and 20, and all but one displayed additional gains and losses involving loci containing oncogenes/ tumor suppressor genes, most often CDKN2A and CDKN2B. RMS arising in IRMT have unique clinicopathologic and cytogenomic features, warranting classification as a distinct, potentially aggressive RMS subtype. It should be distinguished from other RMSs, particularly fusion-driven spindle cell RMS and pleomorphic RMS.
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Affiliation(s)
- Carina A Dehner
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Katherine Geiersbach
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Ross Rowsey
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Paari Murugan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | | | - Jeanne M Meis
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Andrew E Rosenberg
- Department of Pathology, Miller School of Medicine, University of Miami, Miami Florida
| | - Andrew L Folpe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
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Shi J, Gao R, Zhang J, Xu R, Jia Q, Ma Y, Lu H, Zhao K, Gao F, He W. Invasive spindle-cell rhabdomyosarcoma with osteolysis in a dog: case report and literature review. J Vet Diagn Invest 2023; 35:168-172. [PMID: 36600502 PMCID: PMC9999388 DOI: 10.1177/10406387221147319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Rhabdomyosarcoma (RMS), a malignant mesenchymal neoplasm derived from skeletal muscle, is relatively rare in both human and veterinary medicine. Here we report an unusual case of invasive spindle-cell RMS (SCRMS) with bone infiltration and pathologic fracture in a 3.5-y-old intact female Bulldog. Radiographically, a large, predominantly osteolytic mass in the tibia and fibula of the left hindlimb had features typical of a malignant primary bone tumor. Clinically, osteosarcoma was suspected, and the leg was amputated. Histologically, the mass was composed of loosely interwoven spindle-cell fascicles; tumor cells were fusiform with cigar-shaped nuclei and abundant eosinophilic cytoplasm. The neoplastic cells were strongly immunopositive for vimentin, muscle-specific actin, desmin, myogenin, and myoD1. Invasive SCRMS with osteolysis was diagnosed based on the histologic examination and immunohistochemical (IHC) stains. The dog was alive without any evidence of local recurrence or distant metastasis 18 mo post-surgery. RMS should be included in the differential diagnosis when osteolysis occurs; IHC staining confirmation is of great value for definitive diagnosis and treatment planning.
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Affiliation(s)
| | | | - Jing Zhang
- Laboratory of Veterinary Pathology, College of Veterinary Medicine, Key Laboratory of Zoonosis Research, Ministry of Education, Jilin University, Changchun, China
| | - Rongyi Xu
- Laboratory of Veterinary Pathology, College of Veterinary Medicine, Key Laboratory of Zoonosis Research, Ministry of Education, Jilin University, Changchun, China
| | - Qianhan Jia
- Laboratory of Veterinary Pathology, College of Veterinary Medicine, Key Laboratory of Zoonosis Research, Ministry of Education, Jilin University, Changchun, China
| | - Ying Ma
- Laboratory of Veterinary Pathology, College of Veterinary Medicine, Key Laboratory of Zoonosis Research, Ministry of Education, Jilin University, Changchun, China
| | - Huijun Lu
- Laboratory of Veterinary Pathology, College of Veterinary Medicine, Key Laboratory of Zoonosis Research, Ministry of Education, Jilin University, Changchun, China
| | - Kui Zhao
- Laboratory of Veterinary Pathology, College of Veterinary Medicine, Key Laboratory of Zoonosis Research, Ministry of Education, Jilin University, Changchun, China
| | - Feng Gao
- Laboratory of Veterinary Pathology, College of Veterinary Medicine, Key Laboratory of Zoonosis Research, Ministry of Education, Jilin University, Changchun, China
| | - Wenqi He
- Laboratory of Veterinary Pathology, College of Veterinary Medicine, Key Laboratory of Zoonosis Research, Ministry of Education, Jilin University, Changchun, China
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10
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Udager AM. Top 10 Significant Spindled Head and Neck Lesions to Scrutinze. Head Neck Pathol 2023; 17:132-142. [PMID: 36928738 PMCID: PMC10063744 DOI: 10.1007/s12105-023-01535-z] [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: 12/07/2022] [Accepted: 01/16/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Spindled lesions are a challenging area in head and neck pathology. This is particularly true in the sinonasal tract, where several uncommon entities with both unique and overlapping morphologic, immunophenotypic, and/or molecular features can occur. METHODS Review. RESULTS The clinicopathologic characteristics of biphenotypic sinonasal sarcoma and nine important differential diagnostic considerations with one or more overlapping feature are summarized to establish a practical framework for approaching spindled lesions of the sinonasal tract. CONCLUSION Morphologic evaluation is central to the work up of sinonasal spindle cell lesions-in particular, cellular morphology, tumor architecture and growth pattern, and the presence of admixed epithelial elements - however, focused immunohistochemical analysis of neural, myogenic, rhabdomyoblastic, epithelial, and/or melanocytic marker expression and/or ancillary tests for tumor-specific molecular alterations may be necessary for definitive diagnosis.
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Affiliation(s)
- Aaron M Udager
- Department of Pathology, University of Michigan Medical School, 3308 Rogel Cancer Center, 1500 E. Medical Center Drive, Ann Arbor, MI, 48103, USA.
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11
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Proia AD. Spindle Cell/Sclerosing Rhabdomyosarcoma of the Orbit. Ophthalmic Plast Reconstr Surg 2023; 39:e17-e20. [PMID: 35829629 DOI: 10.1097/iop.0000000000002252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A 3-year-old boy developed proptosis over 3 weeks. CT and MRI disclosed a 3.2 × 1.9 cm soft-tissue mass of the right extraconal and intraconal orbit with sphenoid bone erosion. After debulking through an upper eyelid crease incision, the tumor was diagnosed as a spindle cell/sclerosing rhabdomyosarcoma. DNA sequencing was negative for an L122R mutation in MyoD1 . Spindle cell/sclerosing rhabdomyosarcoma is an uncommon variant of this neoplasm, and only 2 patients with orbital tumors have been reported in 2 case series. Spindle cell/sclerosing rhabdomyosarcomas confined to the orbit are considered to have an excellent prognosis when treated with chemotherapy and radiation therapy. Diagnosis and treatment planning rely on histology, immunohistochemistry, and molecular analysis.
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Affiliation(s)
- Alan D Proia
- Departments of Pathology and Ophthalmology, Duke University School of Medicine, Durham, North Carolina, U.S.A
- Department of Pathology, Campbell University Jerry M. Wallace School of Osteopathic Medicine, Lillington, North Carolina, U.S.A
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12
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Ramesh K, Jangda A, Annam S, Mangrio MA, Sajeev K, Kumar A, Qayyum M, Jamali M, Yahya A, Mehbub H. Retroperitoneal Spindle Cell Rhabdomyosarcoma With Compression Features in a 48-Year-Old Male: A Case Report. Cureus 2022; 14:e29622. [PMID: 36321007 PMCID: PMC9604774 DOI: 10.7759/cureus.29622] [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: 09/26/2022] [Indexed: 12/04/2022] Open
Abstract
Spindle cell rhabdomyosarcoma (SC-RMS) is an unprecedented version of embryonal rhabdomyosarcomas (RMSs) that emerges from the mesenchyme with the capacity to differentiate into skeletal muscle cells. Retroperitoneal RMS is extremely rare in the adult population. We present the case of a primary spindle cell retroperitoneal RMS with compression features. Investigation-based diagnosis of RMS is difficult due to the lack of specificity of clinical findings. Radiology does not help in making an accurate diagnosis. Surgical removal of the tumor followed by chemotherapy and radiotherapy is the best possible treatment for RMS in adults. SC-RMS has a poor long-term prognosis. To our knowledge, such cases of retroperitoneal SC-RMS compressing the abdominal viscera and resulting in hydroureteronephrosis have never been reported before.
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13
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Donato UM, Donato S, Galligan A. A Four-Year-Old Female With a Rare P53 Gene Mutation Diagnosed With Li-Fraumeni Syndrome and Concomitant Metastatic Rhabdomyosarcoma: A Case Report. Cureus 2022; 14:e27009. [PMID: 35989815 PMCID: PMC9386298 DOI: 10.7759/cureus.27009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 11/05/2022] Open
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14
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Jakkampudi A, Kaliyath S, Hegde P, Mathias M, Shetty V. Spindle cell rhabdomyosarcoma in the adult: A rare case report. J Oral Maxillofac Pathol 2022; 26:S103-S106. [PMID: 35450245 PMCID: PMC9017831 DOI: 10.4103/jomfp.jomfp_251_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 12/21/2021] [Indexed: 11/28/2022] Open
Abstract
Spindle cell/sclerosing rhabdomyosarcoma (RMS) is an uncommon type of RMS and has been classified as a separate entity by the WHO in 2013. It affects both children and adults with a greater incidence in males. These tumors can pose a diagnostic challenge and can be difficult to differentiate from other spindle cell malignant tumors in the head and neck. Here, we report a case of spindle cell/sclerosing RMS in a young woman presenting with a swelling on the left side of the face of 3 months duration. A careful correlation with the radiographic images, histopathological findings and immunohistochemistry helped to arrive at a diagnosis.
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Affiliation(s)
- Ashlesha Jakkampudi
- Department of Pathology, K. S. Hegde Medical Academy, Nitte University, Mangalore, Karnataka, India
| | - Sajitha Kaliyath
- Department of Pathology, K. S. Hegde Medical Academy, Nitte University, Mangalore, Karnataka, India
| | - Padmaraj Hegde
- Department of Oral and Maxillofacial Surgery, A B Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Michelle Mathias
- Department of Pathology, K. S. Hegde Medical Academy, Nitte University, Mangalore, Karnataka, India
| | - Vikram Shetty
- Department of Oral and Maxillofacial Surgery, A B Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
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15
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Dermawan JK, Zhang L, Singer S, Chi P, Antonescu CR. Low-grade endometrial stromal sarcoma-like tumors in male with JAZF1 gene fusions. Genes Chromosomes Cancer 2022; 61:63-70. [PMID: 34651371 PMCID: PMC8811592 DOI: 10.1002/gcc.23003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 10/05/2021] [Indexed: 02/03/2023] Open
Abstract
Low-grade endometrial stromal sarcoma (ESS) is a hormone-responsive low-grade sarcoma typically occurring in the uterine corpus in women. Their genetic hallmarks are recurrent gene fusions involving JAZF1, partnering with either SUZ12 gene or less commonly with PHF1. Low-grade ESS-like sarcoma, or endometrioid stromal sarcoma, is exceptionally rare in males and has been reported to date only in two cases, one in the paratesticular area and the other of prostatic stromal origin. We report herein two new cases of low-grade ESS-like sarcoma in male patients, one presenting as a periprostatic/peri-rectal mass with a JAZF1-GLI3 fusion, while the other as a paratesticular mass with a JAZF1-PHF1 fusion. As the GLI3 fusion appeared novel, we searched the transcriptional signature of 35 low-grade ESS from our archives and found a similar JAZF1-GLI3 fusion in a low-grade ESS arising from the uterine corpus, supporting a common pathogenesis. Histopathologically, both cases demonstrate cellular, monotonous proliferation of ovoid to fusiform cells with a background of arteriolar vascular network. Immunohistochemically, the neoplastic cells express ER, PR, and CD10, similar to ESS. One case also expresses diffuse and strong AR. On follow-up, the patient with the periprostatic mass recurred 2 years after initial surgery with peritoneal "sarcomatosis." We describe the salient diagnostic morphologic, immunohistochemical, and molecular features and discuss the differential diagnosis and possible pathogenesis of this unusual entity.
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Affiliation(s)
| | - Lei Zhang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Samuel Singer
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ping Chi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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16
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Agaram NP. Evolving classification of rhabdomyosarcoma. Histopathology 2022; 80:98-108. [PMID: 34958505 PMCID: PMC9425116 DOI: 10.1111/his.14449] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/11/2021] [Accepted: 07/12/2021] [Indexed: 01/03/2023]
Abstract
Rhabdomyosarcomas comprise the single largest category of soft tissue sarcomas in children and adolescents in the United States, occurring in 4.5 million people aged below 20 years. Based on the clinicopathological features and genetic abnormalities identified, rhabdomyosarcomas are classified into embryonal, alveolar, spindle cell/sclerosing and pleomorphic subtypes. Each subtype shows distinctive morphology and has characteristic genetic abnormalities. This review discusses the evolution of the classification of rhabdomyosarcoma to the present day, together with a discussion of key histomorphological and genetic features of each subtype and the diagnostic approach to these tumours.
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Affiliation(s)
- Narasimhan P Agaram
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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17
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Genetic Characterization, Current Model Systems and Prognostic Stratification in PAX Fusion-Negative vs. PAX Fusion-Positive Rhabdomyosarcoma. Genes (Basel) 2021; 12:genes12101500. [PMID: 34680895 PMCID: PMC8535289 DOI: 10.3390/genes12101500] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/19/2021] [Accepted: 09/24/2021] [Indexed: 12/17/2022] Open
Abstract
Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children and adolescents and accounts for approximately 2% of soft tissue sarcomas in adults. It is subcategorized into distinct subtypes based on histological features and fusion status (PAX-FOXO1/VGLL2/NCOA2). Despite advances in our understanding of the pathobiological and molecular landscape of RMS, the prognosis of these tumors has not significantly improved in recent years. Developing a better understanding of genetic abnormalities and risk stratification beyond the fusion status are crucial to developing better therapeutic strategies. Herein, we aim to highlight the genetic pathways/abnormalities involved, specifically in fusion-negative RMS, assess the currently available model systems to study RMS pathogenesis, and discuss available prognostic factors as well as their importance for risk stratification to achieve optimal therapeutic management.
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18
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Ahmed AA, Habeebu S, Farooqi MS, Gamis AS, Gonzalez E, Flatt T, Sherman A, Surrey L, Arnold MA, Conces M, Koo S, Dioufa N, Barr FG, Tsokos MG. MYOD1 as a prognostic indicator in rhabdomyosarcoma. Pediatr Blood Cancer 2021; 68:e29085. [PMID: 33913590 PMCID: PMC9907363 DOI: 10.1002/pbc.29085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/22/2021] [Accepted: 04/09/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND/OBJECTIVES Rhabdomyosarcoma (RMS) is characterized by the expression of the myogenic regulatory protein MYOD1. Histologic types include alveolar, embryonal (ERMS), and spindle cell sclerosing RMS (SRMS). SRMS harbors MYOD1 mutations in a subset of adult cases in association with poor prognosis. DESIGN/METHODS To study the level of MYOD1 protein expression and its clinical significance, we have analyzed variable numbers of pediatric (<18 years of age) and adult (age range ≥18 to 35 years) ERMS and SRMS cases for presence or absence of MYOD1 immunoreactivity in correlation with clinical outcome and MYOD1 L122R mutations. RESULTS Lack of MYOD1 immunoreactivity, identified in 23.8% of nonalveolar RMS (non-ARMS) cases, was more prevalent in SRMS (44%) than ERMS (17.2%) and was significantly associated with low overall survival and unfavorable tumor sites (p < .05). Lack of MYOD1 immunoreactivity was not associated with MYOD1 L122R mutations, which were identified in 3/37 (8%) cases including only two of 31 (6.5%) pediatric cases, one of 11 or 9% pediatric SRMS, and one case of infant ERMS. CONCLUSION These studies highlight the prognostic role of MYOD1 in non-ARMS. Lack of MYOD1 immunoreactivity is associated with poor prognosis in ERMS and SRMS. MYOD1 gene mutations are generally infrequent in pediatric RMS. Although mutations are predominant in SRMS, they may exceptionally occur in infantile ERMS.
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Affiliation(s)
- Atif A. Ahmed
- Department of Pathology, Children’s Mercy Hospital/University of Missouri, Kansas City, Missouri, USA
| | - Sultan Habeebu
- Department of Pathology, Children’s Mercy Hospital/University of Missouri, Kansas City, Missouri, USA
| | - Midhat S. Farooqi
- Department of Pathology, Children’s Mercy Hospital/University of Missouri, Kansas City, Missouri, USA
| | - Alan S. Gamis
- Department of Pediatric Hematology Oncology, Children’s Mercy Hospital/University of Missouri, Kansas City, Missouri, USA
| | - Elizabeth Gonzalez
- Department of Pediatric Hematology Oncology, Children’s Mercy Hospital/University of Missouri, Kansas City, Missouri, USA
| | - Terrie Flatt
- Department of Pediatric Hematology Oncology, Children’s Mercy Hospital/University of Missouri, Kansas City, Missouri, USA
| | - Ashley Sherman
- Department of Health Services and Outcomes Research, Children’s Mercy Hospital/University of Missouri, Kansas City, Missouri, USA
| | - Lea Surrey
- Department of Pathology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael A. Arnold
- Department of Pathology and Laboratory Medicine, Nationwide Children’s Hospital, Columbus, Ohio, USA,Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Miriam Conces
- Department of Pathology and Laboratory Medicine, Nationwide Children’s Hospital, Columbus, Ohio, USA,Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Selene Koo
- Department of Pathology and Laboratory Medicine, Nationwide Children’s Hospital, Columbus, Ohio, USA,Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Nikolina Dioufa
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Frederic G. Barr
- Laboratory of Pathology, National Cancer Institute, Bethesda, Maryland, USA
| | - Maria G. Tsokos
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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19
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Tongue Spindle Cell Rhabdomyosarcoma: A Rare Case Report and Literature Review. J Maxillofac Oral Surg 2021; 20:464-469. [PMID: 34408375 DOI: 10.1007/s12663-020-01447-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022] Open
Abstract
Rhabdomyosarcoma (RMS) is a malignant soft tissue neoplasm with its origin in the skeletal muscle and is extremely rare in adults. By the World Health Organization (WHO), a new variant of RMS has been classified, i.e. the spindle cell (Sc) and sclerosing (S) RMS. While the Sc-RMS shows intersecting fascicles of nonpleomorphic spindle cells, the S-RMS is characterized by a marked hyalinization in a pseudovascular growth pattern associated with round-to-spindled tumour cells. According to the analysed data, the Sc/S-RMS variant has a worse outcome than other variants. The new classification of the Sc/S-RMS variant is valuable to the clinical practice. There are not many oral Sc/S-RMS cases reported. The aim of this paper is to demonstrate that an early diagnosis, an adequate treatment and a multidisciplinary approach have a positive effect on the prognosis of the patient. In this study, we analyse a new case of Sc-RMS variant in a young adult with an early diagnosis and a favourable outcome as a result of an appropriated multidisciplinary treatment: early surgery, radiotherapy and chemotherapy treatment.
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20
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Montoya-Cerrillo DM, Diaz-Perez JA, Velez-Torres JM, Montgomery EA, Rosenberg AE. Novel fusion genes in spindle cell rhabdomyosarcoma: The spectrum broadens. Genes Chromosomes Cancer 2021; 60:687-694. [PMID: 34184341 DOI: 10.1002/gcc.22978] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/21/2021] [Accepted: 06/21/2021] [Indexed: 11/12/2022] Open
Abstract
Rhabdomyosarcoma (RMS) encompasses a heterogeneous group of tumors with striated muscle differentiation. RMSs are classified as alveolar, embryonal, spindle cell/sclerosing, and pleomorphic types and molecular analysis of these tumors has identified aberrations that are useful in their further subclassification. Spindle cell rhabdomyosarcoma (SpRMS) is uncommon and has been described with VGLL2 fusions, EWSR1/FUS-TFCP2 rearrangements, and myoD1 mutations-the mutations are associated with significantly different prognoses. In addition, the NCOA2-MEIS1 fusion gene was recently described in two primary intraosseous RMS that contained spindle cell components. Herein, we report three cases of SpRMS harboring different novel fusion genes, one possessing EP300-VGLL3, a second with NCOA2-MEIS1 and CAV1-MET, and the third case had HMGA2-NEGR1 and multiple amplified genes.
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Affiliation(s)
- Diego M Montoya-Cerrillo
- Department of Pathology and Laboratory Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Julio A Diaz-Perez
- Department of Pathology and Laboratory Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Jaylou M Velez-Torres
- Department of Pathology and Laboratory Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Elizabeth A Montgomery
- Department of Pathology and Laboratory Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Andrew E Rosenberg
- Department of Pathology and Laboratory Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USA
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21
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Establishment and Characterization of a Cell Line (S-RMS1) Derived from an Infantile Spindle Cell Rhabdomyosarcoma with SRF-NCOA2 Fusion Transcript. Int J Mol Sci 2021; 22:ijms22115484. [PMID: 34067464 PMCID: PMC8196948 DOI: 10.3390/ijms22115484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Spindle cell rhabdomyosarcoma (S-RMS) is a rare tumor that was previously considered as an uncommon variant of embryonal RMS (ERMS) and recently reclassified as a distinct RMS subtype with NCOA2, NCOA1, and VGLL2 fusion genes. In this study, we established a cell line (S-RMS1) derived from a four-month-old boy with infantile spindle cell RMS harboring SRF-NCOA2 gene fusion. Methods: Morphological and molecular characteristics of S-RMS1 were analyzed and compared with two RMS cell lines, RH30 and RD18. Whole genome sequencing of S-RMS1 and clinical exome sequencing of genomic DNA were performed. Results: S-RMS1 showed cells small in size, with a fibroblast-like morphology and positivity for MyoD-1, myogenin, desmin, and smooth muscle actin. The population doubling time was 3.7 days. Whole genome sequencing demonstrated that S-RMS1 retained the same genetic profile of the tumor at diagnosis. A Western blot analysis showed downregulation of AKT-p and YAP-p while RT-qPCR showed upregulation of endoglin and GATA6 as well as downregulation of TGFßR1 and Mef2C transcripts. Conclusion: This is the first report of the establishment of a cell line from an infantile spindle cell RMS with SRF-NCOA2 gene fusion. S-RMS1 should represent a useful tool for the molecular characterization of this rare and almost unknown tumor.
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22
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Cai Z, Duncan D, Li R, Thomas J, Zhu H. BCOR-CCNB3 Sarcoma with Prominent Rhabdoid Cells Mimicking Rhabdomyoblasts: Expanding the Morphologic spectrum of BCOR-CCNB3 Sarcoma. Int J Surg Pathol 2021; 29:915-919. [PMID: 33909519 DOI: 10.1177/10668969211013891] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BCOR-CCNB3 sarcoma (BCS) is a rare recently defined undifferentiated sarcoma that predominantly affects children and young adults. The diagnosis of this tumor is difficult due to the highly variable morphology and nonspecific immunophenotype. Emerging data suggest that patients with BCS show response to Ewing sarcoma-based treatment regimen, thus correct diagnosis is of clinical relevance. In this study, we report a case of BCS arising from the big toe of a 15-year-old male patient. The tumor had a prominent population of rhabdoid cells with bright eosinophilic cytoplasm mimicking rhabdomyosarcoma. The tumor cells were focally positive for desmin and myogenin, and negative for CD99. Next-generation sequencing showed the presence of BCOR-CCNB3 gene fusion. BCS with prominent rhabdoid cells has not been described before. This study further expands the morphologic spectrum of BCS.
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Affiliation(s)
- Zhenjian Cai
- 12340University of Texas Health Science Center, McGovern Medical Center, Houston, TX, USA
| | - Darryl Duncan
- 12340University of Texas Health Science Center, McGovern Medical Center, Houston, TX, USA
| | - Rongying Li
- 12340University of Texas Health Science Center, McGovern Medical Center, Houston, TX, USA
| | - Jaiyeola Thomas
- 12340University of Texas Health Science Center, McGovern Medical Center, Houston, TX, USA
| | - Hui Zhu
- 12340University of Texas Health Science Center, McGovern Medical Center, Houston, TX, USA
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23
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Chen S, Rudzinski ER, Arnold MA. Challenges in the Diagnosis of Pediatric Spindle Cell/Sclerosing Rhabdomyosarcoma. Surg Pathol Clin 2020; 13:729-738. [PMID: 33183730 DOI: 10.1016/j.path.2020.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Rhabdomyosarcoma (RMS) is the most common pediatric soft tissue sarcoma, representing approximately 40% of all pediatric soft tissue sarcomas. The spindle cell/sclerosing subtype of RMS (SSRMS) accounts for roughly 5% to 10% of all cases of adult and pediatric RMS. Historically, SSRMS were described as paratesticular tumors with an excellent outcome. However, more recent studies have identified unique molecular subgroups of SSRMS, including those with MYOD1 mutations or VGLL2/NCOA2 fusions, which have widely disparate outcomes. The goal of this article is to better describe the biological heterogeneity of SSRMS, which may allow the pathologist to provide important prognostic information.
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Affiliation(s)
- Sonja Chen
- Warren Alpert Medical School of Brown University, Lifespan Academic Medical Center, Rhode Island Hospital, 593 Eddy Street APC12-115, Providence, RI 02903, USA.
| | - Erin R Rudzinski
- Seattle Children's Hospital and University of Washington Medical Center, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA
| | - Michael A Arnold
- Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, Aurora, 13123 East 16th Avenue, Aurora, CO 80045, USA
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24
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Olivas AD, Antic T. Rhabdomyosarcoma of the Adult Prostate: A Case Report With Complete Molecular Profile. Int J Surg Pathol 2019; 28:92-98. [DOI: 10.1177/1066896919867763] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Primary rhabdomyosarcoma of the adult prostate is rare and associated with an aggressive clinical course. Given the limited number of cases reported about the prostate, little is known about the impact of molecular mutations on tumor biology and prognosis in adults. In this article, we present a case of primary embryonal rhabdomyosarcoma of the adult prostate with a complete molecular mutational profile of the tumor.
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25
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Luk PP, Junaid M, Mahar A, Clark JR, Gupta R. Mammary-type myofibroblastoma in the head and neck region. Pathology 2019; 51:544-547. [PMID: 31221433 DOI: 10.1016/j.pathol.2019.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/21/2019] [Accepted: 01/28/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Peter P Luk
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Montasir Junaid
- The Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - Annabelle Mahar
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Jonathan R Clark
- The Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, NSW, Australia; Central Clinical School, The University of Sydney, NSW, Australia
| | - Ruta Gupta
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Central Clinical School, The University of Sydney, NSW, Australia.
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26
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Tsai JW, ChangChien YC, Lee JC, Kao YC, Li WS, Liang CW, Liao IC, Chang YM, Wang JC, Tsao CF, Yu SC, Huang HY. The expanding morphological and genetic spectrum of MYOD1-mutant spindle cell/sclerosing rhabdomyosarcomas: a clinicopathological and molecular comparison of mutated and non-mutated cases. Histopathology 2019; 74:933-943. [PMID: 30604891 DOI: 10.1111/his.13819] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 01/02/2019] [Indexed: 01/06/2023]
Abstract
AIMS Spindle cell/sclerosing rhabdomyosarcomas (SC/SRMS) feature spindled and/or rounded rhabdomyosarcomatous cells within variably hyalinised stroma. Only 30-67% of SC/SRMSs harbour neomorphic MYOD1 p.L122R mutations, indicating heterogeneity in this RMS type. We compared MYOD1-mutant and non-mutant cases to characterise the histological and genetic spectrum of mutated SC/SRMS. METHODS AND RESULTS Seventeen RMSs with spindled, sclerosing or hybrid histology were sequenced to identify MYOD1 and PIK3CA mutations and reappraised to assess histological features and myogenic immunophenotypes. Twelve SC/SRMSs harboured MYOD1 mutations, including homozygous p.L122R (n = 8), heterozygous p.L122R (n = 3) and heterozygous p.E118K (n = 1). MYOD1-mutant tumours affected nine females and three males aged 8-64 years (median = 22.5), had a median size of 4.2 cm (range = 2-22) and involved the head and neck (n = 7), extremities (n = 4) and mediastinum (n = 1). Fascicular/spindle histology was predominant in four cases, including one with heterologous lipoblasts in focally myxoid stroma. Four sclerosing cases mainly comprised rounded cells, including one with multinucleated tumour cells. Four cases were histologically hybrid. The only PIK3CA (p.H1047R) mutation was detected in a predominantly spindled MYOD1-p.L122R-mutated case, but not in its laser-microdissected lipoblast-containing area. All MYOD1-mutant cases exhibited diffuse MYOD1 expression but patchy myogenin reactivity. At final follow-up (median = 13.5 months), recurrences (n = 4), metastases (n = 2) or both (n = 1) occurred in seven MYOD1-mutant cases; one had died of disease. Five non-mutated cases were reclassified as spindle embryonal (n = 3), dense embryonal (n = 1) and unclassifiable (n = 1) RMSs. CONCLUSION MYOD1-mutant RMSs are uncommonly mutated with PIK3CA and behave aggressively with an expanded morphological and genetic spectrum, including lipoblastic differentiation, multinucleated cells and the alternative p.E118K mutation.
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Affiliation(s)
- Jen-Wei Tsai
- Department of Pathology, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan.,Bone and Soft Tissue Study Group, Taiwan Society of Pathology, Taipei, Taiwan
| | - Yi-Che ChangChien
- Department of Pathology, University of Debrecen Clinical Center, Debrecen, Hungary
| | - Jen-Chieh Lee
- Department and Graduate Institute of Pathology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.,Bone and Soft Tissue Study Group, Taiwan Society of Pathology, Taipei, Taiwan
| | - Yu-Chien Kao
- Department of Pathology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Bone and Soft Tissue Study Group, Taiwan Society of Pathology, Taipei, Taiwan
| | - Wan-Shan Li
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Bone and Soft Tissue Study Group, Taiwan Society of Pathology, Taipei, Taiwan
| | - Cher-Wei Liang
- Department of Pathology, Fu Jen Catholic University Hospital and Fu Jen Catholic University College of Medicine, New Taipei City, Taiwan.,Bone and Soft Tissue Study Group, Taiwan Society of Pathology, Taipei, Taiwan
| | - I-Chuang Liao
- Department of Pathology, National Cheng Kung University Hospital, Tainan, Taiwan.,Bone and Soft Tissue Study Group, Taiwan Society of Pathology, Taipei, Taiwan
| | - Yi-Ming Chang
- Department of Pathology, Tri-service General Hospital and Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.,Bone and Soft Tissue Study Group, Taiwan Society of Pathology, Taipei, Taiwan
| | - Jui-Chu Wang
- Department of Anatomical Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Feng Tsao
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shih-Chen Yu
- Department of Anatomical Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsuan-Ying Huang
- Department of Anatomical Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Bone and Soft Tissue Study Group, Taiwan Society of Pathology, Taipei, Taiwan
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Low-grade Endometrioid Stromal Sarcoma of the Paratestis: A Novel Report With Molecular Confirmation of JAZF1/SUZ12 Translocation. Am J Surg Pathol 2019; 42:695-700. [PMID: 29394168 DOI: 10.1097/pas.0000000000001030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Tumors with Müllerian-like serous or mucinous phenotypes originating in the testis and its adnexa are rare neoplasms that have been increasingly recognized in recent years. Cystadenomas with or without ovarian-type stroma, borderline tumors, and adenocarcinomas are the main documented types. Although a handful cases of putative endometrioid adenocarcinomas have been reported, to our knowledge no case of endometrial stromal-type neoplasm has ever been reported in the literature. A 59-year-old man presented with a 2 cm left intrascrotal mass that was found on sonographic examination to arise from the epididymal tail with prominent vascularization. He was otherwise healthy without significant clinical history, endocrinopathy, or external hormone therapy. His testicular tumor markers (beta-HCG, AFP) were normal. Histologic examination of the resection showed a multinodular tumor closely associated with the epididymis and composed of monotonous rounded to ovoid cells with scanty cytoplasm and prominent spiral-like arterioles and capillaries. Mitotic activity was high. No other tumor component was seen. Immunohistochemistry revealed strong and diffuse expression of vimentin, CD10, estrogen receptor, and progesterone receptor. Molecular examination (performed on paraffin-embedded tumor tissue using a 517 gene fusion next-generation sequencing assay) showed a JAZF1/SUZ12 translocation, which was then confirmed by fluorescence in situ hybridization (FISH). These findings are consistent with a low-grade endometrioid stromal sarcoma originating in the paratestis. This report represents a novel addition to the growing spectrum of Müllerian-analog testicular adnexal neoplasms.
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Abstract
Myogenic sarcomas include soft tissue sarcomas that show skeletal muscle differentiation (rhabdomyosarcoma) and those with smooth muscle differentiation (leiomyosarcoma). Rhabdomyosarcomas are more common in the pediatric age group and leiomyosarcomas occur more often in the adult population. Based on the clinico-pathologic features and genetic abnormalities identified, the rhabdomyosarcomas are classified into embryonal, alveolar, spindle cell/sclerosing, and pleomorphic subtypes. Each subtype shows distinctive morphology and has characteristic genetic abnormalities. In this update on myogenic sarcomas, each entity is discussed with special emphasis on recent updates in genetic findings and the diagnostic approach to these tumors.
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Affiliation(s)
- Narasimhan P Agaram
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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29
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Suurmeijer AJH, Kao YC, Antonescu CR. New advances in the molecular classification of pediatric mesenchymal tumors. Genes Chromosomes Cancer 2018; 58:100-110. [PMID: 30187985 DOI: 10.1002/gcc.22681] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 02/06/2023] Open
Abstract
Pediatric soft tissue tumors are relatively rare and show significant overlap in morphology and immunoprofile, often posing diagnostic and management challenges. Thus, their classification remains often subjective or lumped under "unclassified categories," as a number of lesions lack objective and reproducible criteria in diagnosis. Although in a subset of cases immunohistochemistry has been proved useful to identify a specific line of differentiation, most tumors lack a readily defined histogenesis, being characterized by a rather non-specific immunoprofile. Furthermore, tumors with an ambiguous diagnosis are difficult to grade and their risk of malignancy or clinical management remains uncertain. Advances in molecular genetics, including the more wide application of next generation sequencing in routine clinical practice, have improved diagnosis and refined classification based on objective molecular markers. Importantly, some soft tissue tumors in children are characterized by recurrent gene fusions involving either growth factors (eg, PDGFB) or protein kinases (eg, ALK, ROS, NTRK, BRAF), which have paved the way for new targeted treatments that block the respective upregulated downstream pathways. However, the majority of gene fusions or mutations detected in soft tissue tumors result in an abnormal function of transcription factors or chromatin remodeling. The present review focuses on the latest genetic discoveries in the spectrum of both benign and malignant pediatric soft tissue neoplasia. These genetic abnormalities promise to provide relevant insight for their proper classification, prognosis, and treatment. The entities discussed herein are grouped either based on their shared genetic mechanism or based on their presumed line of differentiation.
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Affiliation(s)
- Albert J H Suurmeijer
- Department of Pathology, University Medical Center Groningen, Groningen, The Netherlands
| | - Yu-Chien Kao
- Department of Pathology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Cristina R Antonescu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
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30
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Gui H, Lhospital E, Staddon AP, Nagda SN, Zager EL, Zhang PJL, Brooks JS. Combined Sclerosing and Spindle Cell Rhabdomyosarcoma in Previous Craniotomy Site: A Case Report and a Review of the Literature. Int J Surg Pathol 2018; 27:328-335. [PMID: 30270691 DOI: 10.1177/1066896918802030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Sclerosing rhabdomyosarcoma (RMS) is a rare subtype of RMS with unique prominent stromal hyalinization and a pseudovascular architecture. It overlaps morphologically with spindle cell RMS and poses both diagnostic and therapeutic challenges because of its rarity and aggressive clinical course. In this article, we report a case of sclerosing RMS arising from a prior craniotomy site, which demonstrated both sclerosing and spindle cell components. A literature review of RMS with sclerosing morphology identified 122 cases. Our review documents the following: sclerosing RMS occurs in both childhood and adult populations, has a predilection for the head and neck areas, and has a worse prognosis in adults. Sclerosing RMS harbors a high frequency of MYOD1 mutations, conferring a poor clinical outcome. Sclerosing RMS and spindle RMS likely represent a morphologic spectrum of one entity.
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Affiliation(s)
- Hongxing Gui
- 1 Department of Pathology and Laboratory Medicine, Pennsylvania Hospital of the University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Elliott Lhospital
- 1 Department of Pathology and Laboratory Medicine, Pennsylvania Hospital of the University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Arthur P Staddon
- 2 Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Suneel N Nagda
- 3 Department of Radiation Oncology, Perelman Center for Advanced Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Eric L Zager
- 4 Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul J L Zhang
- 5 Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, PA, USA
| | - John S Brooks
- 1 Department of Pathology and Laboratory Medicine, Pennsylvania Hospital of the University of Pennsylvania Health System, Philadelphia, PA, USA.,6 Professor of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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31
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Sclerosing rhabdomyosarcoma of the oral floor mimicking a salivary gland tumor: A case report with immunohistochemical and genetic analyses. HUMAN PATHOLOGY: CASE REPORTS 2018. [DOI: 10.1016/j.ehpc.2018.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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32
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Rekhi B, Gupta C, Chinnaswamy G, Qureshi S, Vora T, Khanna N, Laskar S. Clinicopathologic features of 300 rhabdomyosarcomas with emphasis upon differential expression of skeletal muscle specific markers in the various subtypes: A single institutional experience. Ann Diagn Pathol 2018; 36:50-60. [PMID: 30098515 DOI: 10.1016/j.anndiagpath.2018.07.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/07/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
Abstract
The present study was aimed at evaluating clinicopathologic and immunohistochemical (IHC) features of 300 rhabdomyosarcomas (RMSs), including differential IHC expression and prognostic value of myogenin and MyoD1 across various subtypes of RMSs. IHC expression of myogenin and MyoD1 was graded on the basis of percentage of tumor cells displaying positive intranuclear immunostaining i.e. grade 1 (1-25%); grade 2 (26-50%); grade 3 (51-76%) and grade 4 (76-100%).Clinical follow-up was available in 238 (79.3%) patients. Various clinicopathologic parameters were correlated with 3-year disease free survival (DFS) and overall survival (OS). There were 140 cases (46.7%) of alveolar RMS (ARMS), 90 of embryonal RMS (ERMS) (30%), 61 (20.3%) of spindle cell/sclerosing RMS and 9 cases (3%) of pleomorphic RMS. Most cases, barring pleomorphic RMSs, occurred in the first two decades (228 cases) (76%), frequently in males, in the head and neck region (126) (42%). By immunohistochemistry, desmin was positive in 292/299 (97.6%) tumors; myogenin in 238/267 (89.1%) and MyoD1 in 192/266 (72.2%) tumors. High myogenin expression (in ≥51% positive tumor cells) was significantly associated with ARMSs (95/121, 78.5%), as compared to other subtypes (48/117, 41%) (p value < 0.001). High MyoD1 expression (≥51% tumor cells) was seen in more cases of pure sclerosing, combined with spindle cell/sclerosing RMSs (10/10, 100%), as compared to the other subtypes (91/141, 67.4%) (p = 0.032). There was no significant difference between high myogenin expression and clinical outcomes. Patients without metastasis and harbouring tumors, measuring ≤5 cm showed a significant increase in OS, with p values = 0.01 and <0.001, respectively. ARMS was the most frequent subtype. There was a significant association between high myogenin expression and ARMSs and high MyoD1 expression and spindle cell/sclerosing RMSs. High myogenin expression did not correlate with clinical outcomes. Patients with smaller sized tumors and without metastasis had significantly better clinical outcomes.
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Affiliation(s)
- Bharat Rekhi
- Department of Surgical Pathology, Tata Memorial Hospital, Maharashtra, Mumbai, India.
| | - Chhavi Gupta
- Department of Surgical Pathology, Tata Memorial Hospital, Maharashtra, Mumbai, India
| | - Girish Chinnaswamy
- Department of Medical Oncology, Tata Memorial Hospital, Maharashtra, Mumbai, India
| | - Sajid Qureshi
- Department of Surgical Oncology, Tata Memorial Hospital, Maharashtra, Mumbai, India
| | - Tushar Vora
- Department of Medical Oncology, Tata Memorial Hospital, Maharashtra, Mumbai, India
| | - Nehal Khanna
- Department of Radiation Oncology, Tata Memorial Hospital, Maharashtra, Mumbai, India
| | - Siddhartha Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Maharashtra, Mumbai, India
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33
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Dashti NK, Wehrs RN, Thomas BC, Nair A, Davila J, Buckner JC, Martinez AP, Sukov WR, Halling KC, Howe BM, Folpe AL. Spindle cell rhabdomyosarcoma of bone with FUS-TFCP2 fusion: confirmation of a very recently described rhabdomyosarcoma subtype. Histopathology 2018; 73:514-520. [PMID: 29758589 DOI: 10.1111/his.13649] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/08/2018] [Indexed: 12/22/2022]
Abstract
AIMS Rhabdomyosarcomas of bone are extremely rare, with fewer than 10 reported cases. A very rare subtype of spindle cell/sclerosing rhabdomyosarcoma harbouring a FUS-TFCP2 fusion and involving both soft tissue and bone locations has been reported very recently. We report only the fourth case of this unusual, clinically aggressive rhabdomyosarcoma. MATERIAL AND RESULTS A previously well 72-year-old male presented with a destructive lesion of the mandible. Morphological and immunohistochemical study of a needle biopsy and the subsequent resection showed a spindle cell rhabdomyosarcoma. RNA-seq, RT-PCR and FISH confirmed the presence of the FUS-TFCP2 fusion. CONCLUSIONS Spindle cell rhabdomyosarcomas carrying the FUS-TFCP2 fusion are very rare rhabdomyosarcoma variants with osseous predilection. The classification and differential diagnosis of this unusual molecular variant of spindle cell/sclerosing rhabdomyosarcoma are discussed.
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Affiliation(s)
- Nooshi K Dashti
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Rebecca N Wehrs
- Division of Laboratory Genetics and Genomics, Mayo Clinic, Rochester, MN, USA
| | - Brittany C Thomas
- Division of Laboratory Genetics and Genomics, Mayo Clinic, Rochester, MN, USA
| | - Asha Nair
- Division of Laboratory Genetics and Genomics, Mayo Clinic, Rochester, MN, USA
| | - Jaime Davila
- Division of Laboratory Genetics and Genomics, Mayo Clinic, Rochester, MN, USA
| | - Jan C Buckner
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Anthony P Martinez
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - William R Sukov
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Kevin C Halling
- Division of Laboratory Genetics and Genomics, Mayo Clinic, Rochester, MN, USA
| | | | - Andrew L Folpe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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34
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Sequea DA, Reese ME. Lumbar Intraspinal Spindle Cell Rhabdomyosarcoma as a Rare Cause of Spinal Stenosis: A Case Report. PM R 2018; 10:966-968. [DOI: 10.1016/j.pmrj.2018.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 01/31/2018] [Accepted: 02/02/2018] [Indexed: 10/18/2022]
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35
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Levy AD, Manning MA, Miettinen MM. Soft-Tissue Sarcomas of the Abdomen and Pelvis: Radiologic-Pathologic Features, Part 2-Uncommon Sarcomas. Radiographics 2017; 37:797-812. [PMID: 28493803 DOI: 10.1148/rg.2017160201] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Soft-tissue sarcomas occurring in the abdomen and pelvis are an uncommon but important group of malignancies. Recent changes to the World Health Organization classification of soft-tissue tumors include the movement of gastrointestinal stromal tumors (GISTs) into the soft-tissue tumor classification. GIST is the most common intraperitoneal sarcoma. Liposarcoma is the most common retroperitoneal sarcoma, and leiomyosarcoma is the second most common. GIST, liposarcoma, and leiomyosarcoma account for the majority of sarcomas encountered in the abdomen and pelvis and are discussed in part 1 of this article. Undifferentiated pleomorphic sarcoma (previously called malignant fibrous histiocytoma), dermatofibrosarcoma protuberans, solitary fibrous tumor, malignant peripheral nerve sheath tumor, rhabdomyosarcoma, extraskeletal chondro-osseous sarcomas, vascular sarcomas, and sarcomas of uncertain differentiation uncommonly arise in the abdomen and pelvis and the abdominal wall. Although these lesions are rare sarcomas and their imaging features overlap, familiarity with the locations where they occur and their imaging features is important so they can be diagnosed accurately. The anatomic location and clinical history are important factors in the differential diagnosis of these lesions because metastasis, more-common sarcomas, borderline fibroblastic proliferations (such as desmoid tumors), and endometriosis have imaging findings that overlap with those of these uncommon sarcomas. In this article, the clinical, pathologic, and imaging findings of uncommon soft-tissue sarcomas of the abdomen and pelvis and the abdominal wall are reviewed, with an emphasis on their differential diagnosis.
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Affiliation(s)
- Angela D Levy
- From the Department of Radiology, Medstar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007 (A.D.L., M.A.M.); the American Institute for Radiologic Pathology, Silver Spring, Md (M.A.M.); and the Center of Cancer Research, National Cancer Institute, Bethesda, Md (M.M.M.)
| | - Maria A Manning
- From the Department of Radiology, Medstar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007 (A.D.L., M.A.M.); the American Institute for Radiologic Pathology, Silver Spring, Md (M.A.M.); and the Center of Cancer Research, National Cancer Institute, Bethesda, Md (M.M.M.)
| | - Markku M Miettinen
- From the Department of Radiology, Medstar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007 (A.D.L., M.A.M.); the American Institute for Radiologic Pathology, Silver Spring, Md (M.A.M.); and the Center of Cancer Research, National Cancer Institute, Bethesda, Md (M.M.M.)
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36
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Peters SM, Kunkle T, Perrino MA, Philipone EM, Yoon AJ. Mandibular embryonal rhabdomyosarcoma with cartilaginous metaplasia: report of a case and review of literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:e288-e293. [PMID: 29029988 DOI: 10.1016/j.oooo.2017.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 08/11/2017] [Accepted: 08/23/2017] [Indexed: 10/18/2022]
Abstract
Rhabdomyosarcoma (RMS) is a malignant tumor of skeletal muscle origin and frequently involves the head and neck region. It represents the second most common pediatric soft tissue sarcoma and accounts for 3% of all childhood cancers. Here, we report a case of embryonal RMS presenting as a right-sided facial swelling in a 7-year-old boy. Histologically, the tumor consisted of classic embryonal rhabdosarcomatous areas with metaplastic cartilage, in both initial biopsy and final resection specimens. Cartilaginous metaplasia arising in the background of RMS is a rare finding, thus raising a diagnostic challenge. To the best of our knowledge, this represents the first case of RMS with cartilaginous metaplasia in the oral cavity.
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Affiliation(s)
- Scott M Peters
- Division of Oral and Maxillofacial Pathology, Columbia University Medical Center, New York, NY, USA
| | - Tim Kunkle
- Division of Oral and Maxillofacial Surgery, Columbia University Medical Center, New York, NY, USA
| | - Michael A Perrino
- Division of Oral and Maxillofacial Surgery, Columbia University Medical Center, New York, NY, USA
| | - Elizabeth M Philipone
- Division of Oral and Maxillofacial Pathology, Columbia University Medical Center, New York, NY, USA
| | - Angela J Yoon
- Division of Oral and Maxillofacial Pathology, Columbia University Medical Center, New York, NY, USA.
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Xiao X, Hu R, Deng FM, Shen SS, Yang XJ, Wu CL. Practical Applications of Immunohistochemistry in the Diagnosis of Genitourinary Tumors. Arch Pathol Lab Med 2017; 141:1181-1194. [DOI: 10.5858/arpa.2016-0530-ra] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Context.—Pathologic diagnosis of tumors in the genitourinary system can be challenging based on morphology alone, particularly when diagnostic material is limited, such as in core biopsies. Immunohistochemical stain can be a useful tool to aid in the diagnosis.Objective.—To provide an update on practical applications and interpretation of immunohistochemical stains in the diagnosis of tumors in prostate, kidney, bladder, and testis. We particularly focus on difficult differential diagnoses, providing our insights in frequently encountered challenging situations. Commonly used immunohistochemical panels are discussed.Data Sources.—Review of literature and our own experience.Conclusion.—Immunohistochemical stain is a valuable tool in the diagnosis of genitourinary tumors when appropriately used.
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38
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Rotz SJ, Nagarajan R, Sorger JI, Pressey JG. Challenges in the Treatment of Sarcomas of Adolescents and Young Adults. J Adolesc Young Adult Oncol 2017; 6:406-413. [DOI: 10.1089/jayao.2017.0007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Seth J. Rotz
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Rajaram Nagarajan
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joel I. Sorger
- Division of Orthopedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joseph G. Pressey
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Rhabdomyosarcoma, Spindle Cell/Sclerosing Variant: A Clinical and Histopathological Examination of this Rare Variant with Three New Cases from the Oral Cavity. Head Neck Pathol 2017; 11:494-500. [PMID: 28466407 PMCID: PMC5677073 DOI: 10.1007/s12105-017-0818-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
Abstract
Spindle cell/sclerosing rhabdomyosarcoma (S-ScRMS) was recently recognized in 2013 by the World Health Organization (WHO) as a stand-alone entity (Parham et al., WHO classification of tumours of soft tissue and bone, IARC Press, Lyon, 2013). Historically, the spindle cell and sclerosing variants were subcategorized under embryonal type rhabdomyosarcoma. Current data supports that certain S-ScRMS cases have a more aggressive clinical course with reduction of long-term survival, and those found in the head and neck region often exhibit extensive local recurrence. Furthermore, due to variable histopathologic appearances and immunohistochemical findings, misdiagnosis is common. We aim to report the variability in histopathologic patterns, immunohistochemical findings, radiographic features, and clinical data on three new cases of S-ScRMS presenting in the oral cavity of young adult males (ages 22, 24, and 39 years). The English-language literature on S-ScRMS is briefly reviewed as well.
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40
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Thompson LD. Small round blue cell tumors of the sinonasal tract: a differential diagnosis approach. Mod Pathol 2017; 30:S1-S26. [PMID: 28060373 DOI: 10.1038/modpathol.2016.119] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 05/08/2016] [Accepted: 05/15/2016] [Indexed: 01/02/2023]
Abstract
One of the most challenging diagnostic categories within tumors of the sinonasal tract is the small round blue cell tumors. Biopsies are usually small and limited, resulting in considerable diagnostic difficulty for practicing surgical pathologists. These tumors share several overlapping histologic and immunophenotypic findings while also showing considerable variation within and between cases. Specific tumor site of origin, imaging findings, and clinical findings must be combined with the histology and pertinent ancillary studies if the correct diagnosis is to be reached. Discrimination between neoplasms is critical as there are significant differences in therapy and overall outcome. It is important to have a well developed differential diagnosis for this category of tumors, where each of the diagnoses is considered, evaluated, and either confirmed or excluded from further consideration. In an undifferentiated tumor, showing a small round blue cell morphology, using the mnemonic 'MR SLEEP' helps to highlight tumors to consider: melanoma, mesenchymal chondrosarcoma, rhabdomyosarcoma, sinonasal undifferentiated carcinoma, squamous cell carcinoma (including NUT carcinoma), small cell osteosarcoma, lymphoma, esthesioneuroblastoma (olfactory neuroblastoma), Ewing sarcoma/primitive neuroectodermal tumor, pituitary adenoma, and plasmacytoma. A panel of pertinent immunohistochemistry studies, histochemistries and/or molecular tests should aid in reaching a diagnosis, especially when taking the pattern and intensity of reactions into consideration.
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Affiliation(s)
- Lester Dr Thompson
- Department of Pathology, Woodland Hills Medical Center, Southern California Permanente Medical Group, Woodland Hills, CA, USA
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Rekhi B, Upadhyay P, Ramteke MP, Dutt A. MYOD1 (L122R) mutations are associated with spindle cell and sclerosing rhabdomyosarcomas with aggressive clinical outcomes. Mod Pathol 2016; 29:1532-1540. [PMID: 27562493 PMCID: PMC5133269 DOI: 10.1038/modpathol.2016.144] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 07/05/2016] [Accepted: 07/05/2016] [Indexed: 02/08/2023]
Abstract
Recurrent mutations in the myogenic transcription factor MYOD1 and PIK3CA were initially described in a subset of embryonal rhabdomyosarcomas. Recently, two independent studies demonstrated presence of MYODI (L122R) mutations as the basis to re-classify a spindle cell rhabdomyosarcoma, along with a sclerosing rhabdomyosarcoma, distinct from an embryonal rhabdomyosarcoma. We analyzed a much larger cohort of 49 primary rhabdomyosarcoma tumor samples of various subtypes, collected over a period of 9 years, for the presence of MYOD1 (L122R), PIK3CA (H1047), and PIK3CA (E542/E545) mutations, along with immunohistochemical analysis of desmin, myogenin, and MYOD1. Although activating PIK3CA mutations were absent across the sample set analyzed, we report 20% MYOD1 (L122R) mutation in rhabdomyosarcomas, found exclusively in 10 of 21 spindle cell and sclerosing rhabdomyosarcomas, occurring mostly in the head and neck region along with extremity sites (64%), than the paratesticular and intra-abdominal sites. Furthermore, while all 10 MYOD1 mutant spindle cell and sclerosing rhabdomyosarcoma samples showed diffuse and strong MYOD1 immunoexpression, 7 of 31 samples of rhabdomyosarcoma with wild-type MYOD1 were negative for MYOD1 expression. Clinically, a striking correlation was found between MYOD1 mutation and the clinical outcomes available for 15 of 21 cases: 5 of 7 patients with spindle cell and sclerosing rhabdomyosarcomas, harboring MYOD1 mutation, were alive-with-disease and 2 of 8 patients with spindle cell and sclerosing rhabdomyosarcomas, with mutant MYOD1, were free-of-disease. Taken together, we present the first report of MYOD1 (L122R) mutation in the largest cohort of 49 rhabdomyosarcomas reported so far, that are associated with a relatively aggressive clinical course. Moreover, consistent with the earlier two studies, this study further reinforces a relationship between spindle cell and the sclerosing rhabdomyosarcoma-now recognized as a single subtype, distinct from an embryonal rhabdomyosarcoma.
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Affiliation(s)
- Bharat Rekhi
- Department of Surgical Pathology, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | - Pawan Upadhyay
- Integrated Genomics Laboratory, Advanced Centre for Treatment, Research and Education In Cancer, Tata Memorial Centre, Navi Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Training School Complex Anushakti Nagar, Mumbai, India
| | - Manoj P Ramteke
- Integrated Genomics Laboratory, Advanced Centre for Treatment, Research and Education In Cancer, Tata Memorial Centre, Navi Mumbai, Maharashtra, India
| | - Amit Dutt
- Integrated Genomics Laboratory, Advanced Centre for Treatment, Research and Education In Cancer, Tata Memorial Centre, Navi Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Training School Complex Anushakti Nagar, Mumbai, India
- Wellcome Trust/ DBT India Alliance Intermediate Fellow, Tata Memorial Centre, ACTREC, Navi Mumbai, Maharashtra 410 210, India. E-mail:
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42
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Mahana S, Tomar R, Agarwal A, Sharma D, Khurana N, Gupta R. Spindle-cell rhabdomyosarcoma of the thumb: Rare site, rare tumor in a child. Diagn Cytopathol 2016; 44:1094-1097. [PMID: 27502215 DOI: 10.1002/dc.23552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 07/14/2016] [Accepted: 07/26/2016] [Indexed: 11/12/2022]
Abstract
Spindle-cell rhabdomyosarcoma (RMS) is a relatively recently recognized favorable variant of embryonal RMS occurring mainly in the paratesticular and head and neck regions. Cytological reports of spindle-cell RMS have been sparse in the literature and the awareness of its cytological features is not very wide among cytopathologists. A 2-year-old girl was brought to clinical attention for a progressively enlarging swelling of right thumb. Imaging studies showed it to be a soft-tissue tumor in the subcutaneous region. Fine-needle aspiration yielded moderately cellular smears composed of small, round cells and few spindle cells with tapered cytoplasm. A cytological impression of RMS was rendered, which was later confirmed as spindle-cell RMS on excision biopsy. Spindle-cell RMS, a favorable prognostic variant of embryonal RMS, should be considered in the cytologic diagnosis of soft-tissue tumors with round cell and spindle cell morphology. This is especially true for tumors occurring in hitherto unreported sites. Diagn. Cytopathol. 2016;44:1094-1097. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Sonam Mahana
- Department of Pathology, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Reena Tomar
- Department of Pathology, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Anil Agarwal
- Department of Orthopaedics, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Divya Sharma
- Department of Pathology, Chacha Nehru Bal Chikitsalaya, New Delhi, India.,Maulana Azad Medical College, New Delhi, India
| | - Nita Khurana
- Department of Pathology, Chacha Nehru Bal Chikitsalaya, New Delhi, India.,Maulana Azad Medical College, New Delhi, India
| | - Ruchika Gupta
- Department of Pathology, Chacha Nehru Bal Chikitsalaya, New Delhi, India
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43
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Refinements in Sarcoma Classification in the Current 2013 World Health Organization Classification of Tumours of Soft Tissue and Bone. Surg Oncol Clin N Am 2016; 25:621-43. [PMID: 27591490 DOI: 10.1016/j.soc.2016.05.001] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The fourth edition of the World Health Organization (WHO) Classification of Tumours of Soft Tissue and Bone was published in February 2013. The 2013 WHO volume provides an updated classification scheme and reproducible diagnostic criteria, which are based on recent clinicopathologic studies and genetic and molecular data that facilitated refined definition of established tumor types, recognition of novel entities, and the development of novel diagnostic markers. This article reviews updates and changes in the classification of bone and soft tissue tumors from the 2002 volume.
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44
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Clinical and molecular heterogeneity of head and neck spindle cell and sclerosing rhabdomyosarcoma. Oral Oncol 2016; 58:e6-e11. [PMID: 27261172 DOI: 10.1016/j.oraloncology.2016.05.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 05/06/2016] [Accepted: 05/11/2016] [Indexed: 10/21/2022]
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45
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A Molecular Study of Pediatric Spindle and Sclerosing Rhabdomyosarcoma: Identification of Novel and Recurrent VGLL2-related Fusions in Infantile Cases. Am J Surg Pathol 2016; 40:224-35. [PMID: 26501226 DOI: 10.1097/pas.0000000000000538] [Citation(s) in RCA: 168] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Sclerosing rhabdomyosarcoma (ScRMS) and spindle cell rhabdomyosarcoma (SRMS) have been recently reclassified as a stand-alone pathologic entity, separate from embryonal RMS. Genetically, a subset of the congenital cases display NCOA2 gene rearrangements, whereas tumors occurring in older children or adults harbor MYOD1 gene mutations with or without coexisting PIK3CA mutations. Despite these recent advances, a significant number of tumors lack known genetic alterations. In this study we sought to investigate a large group of pediatric SRMS/ScRMS, spanning a diverse clinical and pathologic spectrum, by using a combined fluorescence in situ hybridization, targeted DNA, and whole-transcriptome sequencing methodology for a more definitive molecular classification. A total of 26 SRMS and ScRMS cases were selected from the 2 participating institutions for the molecular analysis. Ten of the 11 congenital/infantile SRMS showed recurrent fusion genes: with novel VGLL2 rearrangements seen in 7 (63%), including VGLL2-CITED2 fusion in 4 and VGLL2-NCOA2 in 2 cases. Three (27%) cases harbored the previously described NCOA2 gene fusions, including TEAD1-NCOA2 in 2 and SRF-NCOA2 in 1. All fusion-positive congenital/infantile SRMS patients with available long-term follow-up were alive and well, none developing distant metastases. Among the remaining 15 SRMS patients older than 1 year, 10 (67%) showed MYOD1 L122R mutations, most of them following a fatal outcome despite an aggressive multimodality treatment. All 4 cases harboring coexisting MYOD1/PIK3CA mutations shared sclerosing morphology. All 5 fusion/mutation-negative SRMS cases presented as intra-abdominal or paratesticular lesions.
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Novel PAX3-NCOA1 Fusions in Biphenotypic Sinonasal Sarcoma With Focal Rhabdomyoblastic Differentiation. Am J Surg Pathol 2016; 40:51-9. [PMID: 26371783 DOI: 10.1097/pas.0000000000000492] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Sarcomas arising in the sinonasal region are uncommon and encompass a wide variety of tumor types, including the newly described biphenotypic sinonasal sarcoma (BSNS), which is characterized by a monomorphic spindle cell proliferation with dual neural and myogenic phenotypes. Most BSNSs harbor a pathognomonic PAX3-MAML3 fusion driven by t(2;4)(q35;q31.1), whereas the alternative fusion partner gene remains unidentified in a subset of PAX3-rearranged cases. As NCOA1 on 2p23 is a known partner in PAX3-related fusions in other tumor types (ie, alveolar rhabdomyosarcoma), we investigated its status by fluorescence in situ hybridization (FISH) and reverse transcription polymerase chain reaction assays in 2 BSNS cases showing only PAX3 gene rearrangements. Novel PAX3-NCOA1 fusions were identified in these 2 index cases showing an inv(2)(q35p23) by FISH and confirmed by reverse transcription polymerase chain reaction. Five additional BSNS cases with typical morphology were studied by FISH, revealing a PAX3-MAML3 fusion in 4 cases and only PAX3 rearrangement in the remaining case without abnormalities in MAML3 or NCOA1 gene. Except for 1 case with surface ulceration, all other tumors lacked increased mitotic activity or necrosis, and all cases immunohistochemically coexpressed S100 protein and actin, but lacked SOX10 reactivity. Interestingly, the 2 PAX3-NCOA1-positive cases showed desmin reactivity and displayed a small component of rhabdomyoblastic cells, which were not seen in the more common PAX3-MAML3 fusion cases. In conclusion, we report a novel PAX3-NCOA1 fusion in BSNS, which appears to be associated with focal rhabdomyoblastic differentiation and should be distinguished from PAX3-NCOA1-positive alveolar rhabdomyosarcoma or malignant Triton tumor. SOX10 immunohistochemistry is a useful marker in distinguishing BSNS from peripheral nerve sheath tumors.
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Boehme KA, Zaborski JJ, Riester R, Schweiss SK, Hopp U, Traub F, Kluba T, Handgretinger R, Schleicher SB. Targeting hedgehog signalling by arsenic trioxide reduces cell growth and induces apoptosis in rhabdomyosarcoma. Int J Oncol 2015; 48:801-12. [PMID: 26676886 DOI: 10.3892/ijo.2015.3293] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 11/12/2015] [Indexed: 11/06/2022] Open
Abstract
Rhabdomyosarcomas (RMS) are soft tissue tumours treated with a combination of surgery and chemotherapy. However, mortality rates remain high in case of recurrences and metastatic disease due to drug resistance and failure to undergo apoptosis. Therefore, innovative approaches targeting specific signalling pathways are urgently needed. We analysed the impact of different hedgehog (Hh) pathway inhibitors on growth and survival of six RMS cell lines using MTS assay, colony formation assay, 3D spheroid cultures, flow cytometry and western blotting. Especially the glioma-associated oncogene family (GLI) inhibitor arsenic trioxide (ATO) effectively reduced viability as well as clonal growth and induced cell death in RMS cell lines of embryonal, alveolar and sclerosing, spindle cell subtype, whereas normal skeletal muscle cells were hardly compromised by ATO. Combination of ATO with itraconazole potentiated the reduction of colony formation and spheroid size. These results show that ATO is a promising substance for treatment of relapsed and refractory RMS by directly targeting GLI transcription factors. The combination with itraconazole or other chemotherapeutic drugs has the opportunity to enforce the treatment efficiency of resistant and recurrent RMS.
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Affiliation(s)
- Karen A Boehme
- Laboratory of Cell Biology, Department of Orthopaedic Surgery, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Julian J Zaborski
- Laboratory of Cell Biology, Department of Orthopaedic Surgery, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Rosa Riester
- Laboratory of Cell Biology, Department of Orthopaedic Surgery, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Sabrina K Schweiss
- Laboratory of Cell Biology, Department of Orthopaedic Surgery, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Ulrike Hopp
- Laboratory of Cell Biology, Department of Orthopaedic Surgery, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Frank Traub
- Department of Orthopaedic Surgery, Eberhard Karls University, Tuebingen, Germany
| | - Torsten Kluba
- Department of Orthopaedic Surgery, Eberhard Karls University, Tuebingen, Germany
| | - Rupert Handgretinger
- Department of Haematology and Oncology, Children's Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Sabine B Schleicher
- Department of Haematology and Oncology, Children's Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
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Alaggio R, Coffin CM. The Evolution of Pediatric Soft Tissue Sarcoma Classification in the Last 50 Years. Pediatr Dev Pathol 2015; 18:481-94. [PMID: 26701753 DOI: 10.2350/15-07-1666-misc.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This review discusses the history of the classification of soft tissue sarcomas in children and adolescents, the current transition toward integration of morphology and molecular genetics as new entities emerge, and future perspectives.
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Affiliation(s)
- Rita Alaggio
- 1 Department of Medicine-DIMED, Pathology Unit, University of Padova, Via Gabelli, 61 35124, Padova, Italy
| | - Cheryl M Coffin
- 2 Department of Pathology, Vanderbilt Medical Center, 1161 21st Avenue South, Nashville, TN 37232, USA
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Dey B, Bharti JN, Dange P, Desai PA, Khurana N, Chander J. Paratesticular Spindle Cell Rhabdomyosarcoma. Rare Tumors 2015; 7:5823. [PMID: 26500726 PMCID: PMC4600988 DOI: 10.4081/rt.2015.5823] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 03/08/2015] [Accepted: 03/16/2015] [Indexed: 11/23/2022] Open
Abstract
Spindle cell rhabdomyosarcoma is a rare variant of embryonal rhabdomyosarcoma that affects young males and most commonly involves the paratesticular region. We report a case of paratesticular spindle cell rhabdomyosarcoma in a 14-year-old boy, who presented with a painless scrotal mass. Left inguinal orchidectomy was performed. Histopathological and immunohistochemical examination of the mass revealed spindle cell rhabdomyosarcoma of the paratesticular region.
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Affiliation(s)
- Biswajit Dey
- Department of Pathology, Maulana Azad Medical College and Lok Nayak Hospital , New Delhi, India
| | - Jyotsna Naresh Bharti
- Department of Pathology, Maulana Azad Medical College and Lok Nayak Hospital , New Delhi, India
| | - Prasad Dange
- Department of Pathology, Maulana Azad Medical College and Lok Nayak Hospital , New Delhi, India
| | - Parth Anil Desai
- Department of Pathology, Maulana Azad Medical College and Lok Nayak Hospital , New Delhi, India
| | - Nita Khurana
- Department of Pathology, Maulana Azad Medical College and Lok Nayak Hospital , New Delhi, India
| | - Jagdish Chander
- Department of Pathology, Maulana Azad Medical College and Lok Nayak Hospital , New Delhi, India
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50
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Myoepithelial Carcinoma of the Nasopharynx: Report of a Rare Case and a Review of the Literature. Head Neck Pathol 2015; 9:474-80. [PMID: 26115759 PMCID: PMC4651929 DOI: 10.1007/s12105-015-0638-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 06/20/2015] [Indexed: 12/26/2022]
Abstract
Salivary gland carcinomas are very rare in the nasopharynx, with the most frequent histologic types being adenoid cystic carcinoma, mucoepidermoid carcinoma and adenocarcinoma, not otherwise specified. Myoepithelial carcinoma (MECA) is a rare tumor of the salivary glands, and there are only three previously reported cases of nasopharyngeal MECA. The case presented is the fourth reported case of MECA in the nasopharynx. Due to the morphologic heterogeneity of MECA, immunohistochemistry is indispensable in ascertaining the diagnosis. MECA is a locally aggressive tumor, but the long-term prognosis of this tumor in the nasopharynx remains uncertain. In our case the tumor was unresectable and the patient was given chemo-radiotherapy. Despite this, residual tumor was seen on nasoscopy 5 months after initial diagnosis and was documented on a re-biopsy which displayed the same histomorphologic features as the original tumor.
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