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Tan-Garcia A, Tay TKY, Shi R, Yeo SJ, Sittampalam K. A hyalinised tenosynovial giant cell tumour with absence of giant cells posing a diagnostic challenge. Pathology 2023; 55:726-728. [PMID: 37080827 DOI: 10.1016/j.pathol.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/26/2022] [Accepted: 01/14/2023] [Indexed: 04/22/2023]
Affiliation(s)
- Alfonso Tan-Garcia
- Division of Pathology, Department of Anatomical Pathology, Singapore General Hospital, Singapore
| | - Timothy Kwang Yong Tay
- Division of Pathology, Department of Anatomical Pathology, Singapore General Hospital, Singapore
| | - Ruoyu Shi
- Division of Pathology, Department of Anatomical Pathology, Singapore General Hospital, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Kesavan Sittampalam
- Division of Pathology, Department of Anatomical Pathology, Singapore General Hospital, Singapore.
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Huang WP, Gao G, Yang Q, Chen Z, Qiu YK, Gao JB, Kang L. Malignant giant cell tumors of the tendon sheath of the right hip: A case report. World J Clin Cases 2022; 10:10763-10771. [PMID: 36312472 PMCID: PMC9602230 DOI: 10.12998/wjcc.v10.i29.10763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/09/2022] [Accepted: 08/30/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Malignant giant cell tumor of the tendon sheath (MGCTTS) is an extremely rare malignant tumor originating from synovial and tendon sheath tissue with highly aggressive biological behavior and a high rate of local recurrence and distant metastasis which should be considered a highly malignant sarcoma and managed aggressively. How to systemically treat MGCTTS remains a challenge. In this case, a patient with MGCTTS suffered a recurrence after 2 surgical resections received adjuvant chemotherapy and radiation therapy, but the treatment outcome remained poor. More clinical trials and better understanding of the biology and molecular aspects of this subtype of sarcoma are needed while novel medicines should be developed to efficiently target particular pathways.
CASE SUMMARY A 52-year-old man presented with persistent dull pain in the right groin accompanied by limited right hip motion starting 6 mo ago. Two months before his attending to hospital, the patient's pain worsened, presenting as severe pain when standing or walking, limping, and inability to straighten or move the right lower extremity. Surgical excision was performed and MGCTTS was confirmed by pathology examination. Two recurrences occurred after surgical resection, moreover, the treatment outcome remained poor after adjuvant chemotherapy and radiation therapy. The patient died only 10 mo after the initial diagnosis.
CONCLUSION MGCTTS is characterized by a joint mass with pain and limited motion. It typically grows along the tendons and infiltrated into the surrounding muscle and bone tissue, with a stubborn tendency to relapse, as well as pulmonary metastasis. Radically surgical resection provides a choice of treatment whereas post-operation care should be taken to preserve the function of the joint. Chemotherapy and radiotherapy can be used as alternative treatments when radical resection cannot be performed.
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Affiliation(s)
- Wen-Peng Huang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing 100034, China
| | - Ge Gao
- Department of Medical Imaging, Peking University First Hospital, Beijing 100034, China
| | - Qi Yang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing 100034, China
| | - Zhao Chen
- Department of Nuclear Medicine, Peking University First Hospital, Beijing 100034, China
| | - Yong-Kang Qiu
- Department of Nuclear Medicine, Peking University First Hospital, Beijing 100034, China
| | - Jian-Bo Gao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Lei Kang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing 100034, China
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Tap WD, Singh AS, Anthony SP, Sterba M, Zhang C, Healey JH, Chmielowski B, Cohn AL, Shapiro GI, Keedy VL, Wainberg ZA, Puzanov I, Cote GM, Wagner AJ, Braiteh F, Sherman E, Hsu HH, Peterfy C, Gelhorn HL, Ye X, Severson P, West BL, Lin PS, Tong-Starksen S. Results from Phase I Extension Study Assessing Pexidartinib Treatment in Six Cohorts with Solid Tumors including TGCT, and Abnormal CSF1 Transcripts in TGCT. Clin Cancer Res 2022; 28:298-307. [PMID: 34716196 PMCID: PMC9401544 DOI: 10.1158/1078-0432.ccr-21-2007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/16/2021] [Accepted: 10/27/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE To assess the response to pexidartinib treatment in six cohorts of adult patients with advanced, incurable solid tumors associated with colony-stimulating factor 1 receptor (CSF1R) and/or KIT proto-oncogene receptor tyrosine kinase activity. PATIENTS AND METHODS From this two-part phase I, multicenter study, pexidartinib, a small-molecule tyrosine kinase inhibitor that targets CSF1R, KIT, and FMS-like tyrosine kinase 3 (FLT3), was evaluated in six adult patient cohorts (part 2, extension) with advanced solid tumors associated with dysregulated CSF1R. Adverse events, pharmacokinetics, and tumor responses were assessed for all patients; patients with tenosynovial giant cell tumor (TGCT) were also evaluated for tumor volume score (TVS) and patient-reported outcomes (PRO). CSF1 transcripts and gene expression were explored in TGCT biopsies. RESULTS Ninety-one patients were treated: TGCT patients (n = 39) had a median treatment duration of 511 days, while other solid tumor patients (n = 52) had a median treatment duration of 56 days. TGCT patients had response rates of 62% (RECIST 1.1) and 56% (TVS) for the full analysis set. PRO assessments for pain showed improvement in patient symptoms, and 76% (19/25) of TGCT tissue biopsy specimens showed evidence of abnormal CSF1 transcripts. Pexidartinib treatment of TGCT resulted in tumor regression and symptomatic benefit in most patients. Pexidartinib toxicity was manageable over the entire study. CONCLUSIONS These results offer insight into outcome patterns in cancers whose biology suggests use of a CSF1R inhibitor. Pexidartinib results in tumor regression in TGCT patients, providing prolonged control with an acceptable safety profile.
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Affiliation(s)
- William D. Tap
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York.,Corresponding Author: William D. Tap, Sarcoma Medical Oncology Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065. Phone: 646-888-4163; Fax: 646-888-4252; E-mail:
| | | | | | - Mike Sterba
- Plexxikon Inc., South San Francisco, California
| | - Chao Zhang
- Plexxikon Inc., South San Francisco, California
| | - John H. Healey
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | | | | | - Geoffrey I. Shapiro
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Vicki L. Keedy
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Igor Puzanov
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | | | - Andrew J. Wagner
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Fadi Braiteh
- Comprehensive Cancer Centers of Nevada, Las Vegas, Nevada
| | - Eric Sherman
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | | | | | | | - Xin Ye
- Daiichi Sankyo Pharma Development, Basking Ridge, New Jersey
| | | | | | - Paul S. Lin
- Plexxikon Inc., South San Francisco, California
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Coleman M, Cook MR, Pool RR, Wavreille VA, Brown M, Selmic LE. Invasive Tendon Sheath Fibrosarcoma Causing Radial Osteolysis in a Golden Retriever. J Am Anim Hosp Assoc 2021; 57:285-289. [PMID: 34606584 DOI: 10.5326/jaaha-ms-7085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 11/11/2022]
Abstract
This case report details a previously undescribed malignancy of the tendon sheath in a golden retriever. This dog originally presented with lameness of the left forelimb, at which point radiographs revealed a monostotic, lytic lesion of the distal radius with overlying soft-tissue swelling. A fine-needle aspirate was performed, and cytology was compatible with a sarcoma, with the primary differential being an osteosarcoma. After amputation, the leg was submitted for histopathology, which revealed inconsistencies with a typical osteosarcoma lesion, including lack of osteoid deposition. Second opinion histopathology showed a fibrosarcoma that appeared to have originated in the tendon sheath of an extensor tendon and then secondarily invaded the radius. At the time of publication, ∼17 mo after amputation, the dog continues to do well without any evidence of recurrent or metastatic disease.
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Wang W, Long MM, Wei CJ, Cui XW, Ren JY, Gu YH, Li QF, Dai SD, Gu B, Wang ZC. Clinical comparison of tenosynovial giant cell tumors, synovial chondromatosis, and synovial sarcoma: analysis and report of 53 cases. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1059. [PMID: 34422971 PMCID: PMC8339857 DOI: 10.21037/atm-21-542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/18/2021] [Indexed: 12/12/2022]
Abstract
Background Tenosynovial giant cell tumors (TGCTs), synovial chondromatosis (SC), and synovial sarcoma (SS) exhibit similarities in clinical features and histochemical characteristics, and differential diagnosis remains challenging in clinical practice. Methods Data were collected from the pathology database of Shanghai Ninth People's Hospital regarding patients who underwent surgery from 2010 to 2019 with histologically confirmed TGCTs, SC, and SS. Demographic and clinicopathological data of these patients were reviewed. Immunohistochemistry staining of 14 different markers was performed. Correlation analyses of the prognoses were evaluated. Results A total of 26 patients with TGCTs (8 diffuse TGCTs and 18 localized TGCTs), 16 with SC, and 11 with SS were identified. Pain was the main symptom of patients with both TGCTs and SC, while a palpable mass was the most common symptom for patients with SS. In addition to clinical features, we identified vital risk factors for disease recurrence. The mean follow-up periods were 51, 39, and 14 months for TGCTs, SC, and SS, respectively. Younger patients with diffuse TGCTs or patients with a higher neutrophil/lymphocyte ratio (NLR) displayed a significantly higher frequency of recurrence. We also plotted receiver operating characteristic (ROC) curve analysis for age and NLR. The area under the ROC curve (AUC) was calculated and demonstrated the ability to distinguish recurrent from nonrecurrent cases. In addition, higher CD163 expression was linked to recurrent diffuse TGCT cases. Conclusions These data indicated possible characteristics of different aspects of TGCTs, SC, and SS. Further clarification and understanding of these factors will help with differential clinical diagnosis and recurrent risk assessment.
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Affiliation(s)
- Wei Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Man-Mei Long
- Department of Pathology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Cheng-Jiang Wei
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xi-Wei Cui
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie-Yi Ren
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Hui Gu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing-Feng Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shun-Dong Dai
- Department of Pathology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bin Gu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhi-Chao Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Lewis JH, Gelderblom H, van de Sande M, Stacchiotti S, Healey JH, Tap WD, Wagner AJ, Pousa AL, Druta M, Lin C, Baba HA, Choi Y, Wang Q, Shuster DE, Bauer S. Pexidartinib Long-Term Hepatic Safety Profile in Patients with Tenosynovial Giant Cell Tumors. Oncologist 2020; 26:e863-e873. [PMID: 33289960 PMCID: PMC8100574 DOI: 10.1002/onco.13629] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/25/2020] [Indexed: 02/06/2023] Open
Abstract
Background Pexidartinib is approved in the U.S. for tenosynovial giant cell tumors (TGCTs). Herein, we assessed the hepatic safety profile of pexidartinib across patients with TGCTs receiving pexidartinib. Materials, and Methods Hepatic adverse reactions (ARs) were assessed by type and magnitude of liver test abnormalities, classified as (a) isolated aminotransferase elevations (alanine [ALT] or aspartate [AST], without significant alkaline phosphatase [ALP] or bilirubin elevations), or (b) mixed or cholestatic hepatotoxicity (increase in ALP with or without ALT/AST and bilirubin elevations, based on adjudication). Median follow‐up from initial pexidartinib treatment was 39 months (range, 32–82) in 140 patients with TGCTs across clinical studies NCT01004861, NCT02371369, NCT02734433, and NCT03291288. Results In total, 95% of patients with TGCTs (133/140) treated with pexidartinib (median duration of exposure, 19 months [range, 1–76]), experienced a hepatic AR. A total of 128 patients (91%) had reversible, low‐grade dose‐dependent isolated AST/ALT elevations without significant ALP elevations. Five patients (4%) experienced serious mixed or cholestatic injury. No case met Hy's law criteria. Onset of hepatic ARs was predominantly in the first 2 months. All five serious hepatic AR cases recovered 1–7 months following pexidartinib discontinuation. Five patients from the non‐TGCT population (N = 658) experienced serious hepatic ARs, two irreversible cases. Conclusion This pooled analysis provides information to help form the basis for the treating physician's risk assessment for patients with TCGTs, a locally aggressive but typically nonmetastatic tumor. In particular, long‐term treatment with pexidartinib has a predictable effect on hepatic aminotransferases and unpredictable risk of serious cholestatic or mixed liver injury. Implications for Practice This is the first long‐term pooled analysis to report on the long‐term hepatic safety of pexidartinib in patients with tenosynovial giant cell tumors associated with severe morbidity or functional limitations and not amenable to improvement with surgery. These findings extend beyond what has been previously published, describing the observed instances of hepatic toxicity following pexidartinib treatment across the clinical development program. This information is highly relevant for medical oncologists and orthopedic oncologists and provides guidance for its proper use for appropriate patients within the Pexidartinib Risk Evaluation and Mitigation Safety program. Pexidartinib is approved in the U.S. for treatment of tenosynovial giant cell tumors (TGCT). This article assesses the hepatic safety profile of pexidartinib in TGCT cases and describes risk mitigation procedures designed to identify any instances of serious liver injury as early as possible to better inform prescribers and patients about this drug.
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Affiliation(s)
- James H. Lewis
- Georgetown University HospitalWashingtonDistrict of ColumbiaUSA
| | | | | | | | - John H. Healey
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical CollegeNew YorkNew YorkUSA
| | - William D. Tap
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical CollegeNew YorkNew YorkUSA
| | | | | | | | | | - Hideo A. Baba
- University Hospital Essen, University of Duisburg‐EssenGermany
| | | | - Qiang Wang
- Daiichi Sankyo, IncBasking RidgeNew JerseyUSA
| | | | - Sebastian Bauer
- University Hospital Essen, University of Duisburg‐EssenGermany
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