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Liu J, Liu P, Gong F, Tian Y, Zhao X. Case Report: A PD-L1-Positive Patient With Pleomorphic Rhabdomyosarcoma Achieving an Impressive Response to Immunotherapy. Front Immunol 2022; 13:815598. [PMID: 35371041 PMCID: PMC8968025 DOI: 10.3389/fimmu.2022.815598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/18/2022] [Indexed: 12/31/2022] Open
Abstract
There is currently a lack of effective systemic treatment for patients with advanced pleomorphic rhabdomyosarcoma (PRMS). Although programmed death protein 1 (PD-1) inhibitors have shown efficacy in various solid tumors, their effects on PRMS have not been well established. Here, we present a case of a 12-year-old Chinese male adolescent with metastatic PRMS who benefited from the PD-1 inhibitor nivolumab. The patient initially underwent primary tumor resection but failed to respond to subsequent first-line chemotherapy and second-line pazopanib treatment. Pathological examination showed positive PD-L1 expression and tumor-infiltrating lymphocytes in the tumor tissue, and the patient was administered nivolumab as a posterior-line treatment. After attaining a clinically partial response (PR), surgical resection was performed, which was followed by adjuvant nivolumab. At the time of the submission of this manuscript, the patient achieved recurrence-free survival (RFS) lasting 45 months and counting. This is the first clinical evidence that a patient with refractory PRMS was controlled by anti-PD-1 antibody, with an RFS lasting more than 3 years. This case suggests that PD-L1 expression and T-cell infiltration could be used as potential biomarkers for PRMS immunotherapy.
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Affiliation(s)
- Jiayong Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Bone and Soft Tissue Tumor, Peking University Cancer Hospital & Institute, Beijing, China
| | - Peijie Liu
- Department of Oncology, The First Affiliated Hospital of Henan University, Kaifeng, China
| | - Fuyu Gong
- The Medical Department, 3D Medicines Inc., Shanghai, China
| | - Youhui Tian
- The Medical Department, 3D Medicines Inc., Shanghai, China
| | - Xiaochen Zhao
- The Medical Department, 3D Medicines Inc., Shanghai, China
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2
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Enechukwu N, Ifeanyi EO, Ogun GO, Ogunbiyi AO. Cutaneous metastases of embryonal rhabdomyosarcoma in a black African child: the role of dermoscopy in reducing time to and cost of diagnosis. Ecancermedicalscience 2021; 15:1304. [PMID: 34824627 PMCID: PMC8580718 DOI: 10.3332/ecancer.2021.1304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Indexed: 11/06/2022] Open
Abstract
Cutaneous metastases are an uncommon feature of solid organ malignancies. The cost of multiple investigations and prolonged processing time of biopsies may lead to diagnostic delays especially in resource limited practice settings. Dermoscopy can provide useful clues and has been found to be useful in the diagnosis of cutaneous metastases. Dermoscopic findings of skin lesions may limit unnecessary investigations and shorten time to diagnosis. There are limited data on dermoscopic features of embryonal rhabdomyosarcoma in the literature. We report dermoscopic features of cutaneous metastasis of embryonal rhabdomyosarcoma seen in a black African child.
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Affiliation(s)
- Nkechi Enechukwu
- Dermatology Unit, Department of Medicine, Nnamdi Azikiwe University/Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi 435101, Nigeria
| | - Ezejiofor Ogochukwu Ifeanyi
- Dermatology Unit, Department of Medicine, Nnamdi Azikiwe University/Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi 435101, Nigeria
| | - Gabriel Olabiyi Ogun
- Department of Pathology, College of Medicine, University of Ibadan, Ibadan 200212, Nigeria
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3
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Villarreal-Martinez A, Regalado-Ceballos A, Ocampo-Candiani J, Vazquez-Martinez O, Herz-Ruelas M, Gomez-Flores M, Muñoz-Garza FZ, Chavez-Alvarez S. Primary cutaneous alveolar rhabdomyosarcoma: Report of a case and literature review. Int J Dermatol 2021; 61:e187-e193. [PMID: 34812497 DOI: 10.1111/ijd.15980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/14/2021] [Accepted: 10/28/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Alejandra Villarreal-Martinez
- Dermatology Department, Hospital Universitario "Dr Jose Eleuterio Gonzalez", Universidad Autónoma de Nuevo León, Nuevo León, México
| | - Airam Regalado-Ceballos
- Dermatology Department, Hospital Universitario "Dr Jose Eleuterio Gonzalez", Universidad Autónoma de Nuevo León, Nuevo León, México
| | - Jorge Ocampo-Candiani
- Dermatology Department, Hospital Universitario "Dr Jose Eleuterio Gonzalez", Universidad Autónoma de Nuevo León, Nuevo León, México
| | - Osvaldo Vazquez-Martinez
- Dermatology Department, Hospital Universitario "Dr Jose Eleuterio Gonzalez", Universidad Autónoma de Nuevo León, Nuevo León, México
| | - Maira Herz-Ruelas
- Dermatology Department, Hospital Universitario "Dr Jose Eleuterio Gonzalez", Universidad Autónoma de Nuevo León, Nuevo León, México
| | - Minerva Gomez-Flores
- Dermatology Department, Hospital Universitario "Dr Jose Eleuterio Gonzalez", Universidad Autónoma de Nuevo León, Nuevo León, México
| | - Fania Z Muñoz-Garza
- Dermatology Department, Hospital Universitario "Dr Jose Eleuterio Gonzalez", Universidad Autónoma de Nuevo León, Nuevo León, México
| | - Sonia Chavez-Alvarez
- Dermatology Department, Hospital Universitario "Dr Jose Eleuterio Gonzalez", Universidad Autónoma de Nuevo León, Nuevo León, México
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4
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Undifferentiated Sarcoma as Intermediate Step in the Progression of Malignant Melanoma to Rhabdomyosarcoma: Histologic, Immunohistochemical, and Molecular Studies of a New Case of Malignant Melanoma With Rhabdomyosarcomatous Differentiation. Am J Dermatopathol 2019; 41:221-229. [DOI: 10.1097/dad.0000000000001236] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Sabater-Marco V, Ballester-Sánchez R, Navarro-Cerveró L, Fuster-Diana C, García-García JA, Botella-Estrada R. Primary cutaneous embryonal rhabdomyosarcoma with desmoplastic growth pattern and anaplastic lymphoma kinase overexpression. Report of a case with special emphasis on the differential diagnosis. Clin Exp Dermatol 2019; 44:822-824. [PMID: 30597602 DOI: 10.1111/ced.13877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2018] [Indexed: 11/27/2022]
Affiliation(s)
- V Sabater-Marco
- Department of Pathology, University General Hospital, Avenida Tres Cruces 2, 46014, Valencia, Spain
| | | | - L Navarro-Cerveró
- Department of Pathology, Laboratory of Molecular Pathology, University General Hospital, Valencia, Spain
| | - C Fuster-Diana
- Department of Surgery, University General Hospital, Avenida Tres Cruces 2, 46014, Valencia, Spain
| | - J A García-García
- Department of Pathology, University General Hospital, Avenida Tres Cruces 2, 46014, Valencia, Spain
| | - R Botella-Estrada
- Department of Dermatology, University Hospital La Fe, Valencia, Spain
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6
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Wollina U, Riedel I, Abushika MR, Lotti T, Tchernev G. Giant Pendulous Carcinosarcoma - Squamous Cell Carcinoma-Type - of the Leg - A Case Report and Review of the Literature. Open Access Maced J Med Sci 2018; 6:112-114. [PMID: 29484002 PMCID: PMC5816276 DOI: 10.3889/oamjms.2018.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 11/05/2022] Open
Abstract
Cutaneous carcinosarcoma (CCS) is a rare non-melanoma skin cancer with a biphasic growth pattern. A tumour is composed of epithelial and mesenchymal cells that show clonality. In most cases, CCS develops in the head-and-neck region on the chronic sun-exposed skin of males. Here, we describe an 80-year-old female patient who developed a giant, pendulous CCS on the leg. A tumour was surgically removed. We found no evidence of metastatic spread.
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Affiliation(s)
- Uwe Wollina
- Städtisches Klinikum Dresden - Department of Dermatology and Allergology, Dresden, Sachsen, Germany
| | - Ina Riedel
- Städtisches Klinikum Dresden - Institute of Pathology "Georg Schmorl" Dresden, Sachsen, Germany
| | - Mohammad R Abushika
- Städtisches Klinikum Dresden - Department of Dermatology and Allergology, Dresden, Sachsen, Germany
| | - Torello Lotti
- University G. Marconi of Rome - Dermatology and Venereology, Rome, Italy
| | - Georgi Tchernev
- Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of Interior, Sofia, Bulgaria.,Onkoderma, Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
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No YA, Kwon HJ, Park KY, Hong SA, Seo SJ, Hong CK. Unilateral, erythematous, swollen, sclerosing patch with nodular progression on the right side of the face. Clin Exp Dermatol 2016; 41:945-947. [PMID: 27766675 DOI: 10.1111/ced.12919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Y A No
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - H J Kwon
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - K Y Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - S A Hong
- Department of Pathology, Chung-Ang University College of Medicine, Seoul, Korea
| | - S J Seo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - C K Hong
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
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Watanabe M, Ansai SI, Iwakiri I, Fukumoto T, Murakami M. Case of pleomorphic rhabdomyosarcoma arising on subcutaneous tissue in an adult patient: Review of the published works of 13 cases arising on cutaneous or subcutaneous tissue. J Dermatol 2016; 44:59-63. [PMID: 27569112 DOI: 10.1111/1346-8138.13549] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 07/10/2016] [Indexed: 12/26/2022]
Abstract
Rhabdomyosarcoma (RMS) is a malignant mesenchymal tumor usually occurring in children, young adults, and predominantly arising in the head and neck or deep soft tissue of the extremities. Pleomorphic RMS (PRMS) arising on subcutaneous tissue in an adult patient's trunk is extremely rare. We present a case of primary PRMS occurring on the back of a 50-year-old man. The tumor was diagnosed by histological and immunohistochemical findings of the resected specimen. One month after the surgery, axillary lymph node metastases were found. Subsequently, the patient received three cycles of combined chemotherapy. The rest of those axillary lymph nodes were reduced in size and there was no local recurrence 6 months postoperatively. PRMS is a very rare but aggressive tumor. Thus, it is important to confirm the diagnosis and provide adequate treatments.
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Affiliation(s)
- Mai Watanabe
- Division of Plastic and Reconstructive Surgery, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Japan
| | - Shin-Ichi Ansai
- Division of Dermatology, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Japan
| | - Itaru Iwakiri
- Division of Plastic and Reconstructive Surgery, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Japan
| | | | - Masahiro Murakami
- Division of Plastic and Reconstructive Surgery, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Japan
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Elomrani F, Touri S, Ouziane I, Berrada N, Boutayeb S, Mrabti H, Elkhannoussi B, Errihani H. Orbital rhabdomyosarcoma with skin metastasis: a case report. BMC Res Notes 2014; 7:670. [PMID: 25253623 PMCID: PMC4181003 DOI: 10.1186/1756-0500-7-670] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 09/23/2014] [Indexed: 11/26/2022] Open
Abstract
Background Rhabdomyosarcoma is a soft tissue neoplasm that usually arises in the headand neck region and genitourinary tract. Skin metastasis of rhabdomyosarcoma is extremely rare; of thirteen cases reported in the literature, most were children younger than 10 years and only three cases have been reported in adults. Case presentation A 20-year-old Moroccan man was admitted with a right orbital tumor. The tumor was excised and histopathology examination confirmed a diagnosis of rhabdomyosarcoma. The patient was treated with chemotherapy, but local recurrence occurred one year later. The patient underwent right orbital exenteration followed by chemotherapy and radiotherapy. After 6 months, the patient developed a cutaneous mass in the right lumbar region, which was resected. Immunohistochemical examination of the tumor showed this to be a cutaneous metastasis of rhabdomyosarcoma. The patient was treated by chemotherapy and there appeared to be no recurrence after 9 months of follow up. Conclusions Skin metastasis from rhabdomyosarcoma is extremely rare, particularly in adults. The purpose of presenting this case report is to raise awareness among clinicians— skin biopsy and immunohistochemistry are needed to distinguish this neoplasm from other cutaneous tumors so that appropriate treatment can be initiated.
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Affiliation(s)
- Fadwa Elomrani
- Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco.
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Abstract
Rhabdomyosarcoma (RMS) is a malignant soft tissue tumor with skeletal muscle differentiation that can rarely present as a primary cutaneous tumor. There are 3 main subtypes of RMS: embryonal, alveolar, and pleomorphic. Primary cutaneous pleomorphic RMS is extremely rare, there being only 9 reported cases in the literature, 2 of which are radiation induced. We present a case of primary pleomorphic RMS occurring on the sun-damaged skin of the face of an 89-year-old woman. The tumor was diagnosed by histology, immunohistochemistry, and electron microscopy. The patient was treated by surgery and adjuvant radiotherapy. The tumor recurred rapidly after surgical excision. She died 2 months after the diagnosis from complications of treatment, local symptoms of tumor, and concurrent illnesses. Primary cutaneous pleomorphic RMS is a rare tumor of adults and pursues an aggressive clinical course.
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11
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Feasel PC, Marburger TB, Billings SD. Primary cutaneous epithelioid rhabdomyosarcoma: a rare, recently described entity with review of the literature. J Cutan Pathol 2014; 41:588-91. [DOI: 10.1111/cup.12340] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 03/12/2014] [Accepted: 03/12/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Patrick C. Feasel
- Department of Anatomic Pathology; Cleveland Clinic; Cleveland OH USA,
| | - Trent B. Marburger
- Department of Anatomic Pathology; Cleveland Clinic; Cleveland OH USA,
- Department of Dermatology; Cleveland Clinic; Cleveland OH USA
| | - Steven D. Billings
- Department of Anatomic Pathology; Cleveland Clinic; Cleveland OH USA,
- Department of Dermatology; Cleveland Clinic; Cleveland OH USA
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12
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Sabater-Marco V, Zapater Latorre E, Martorell Cebollada M. Postradiation cutaneous pleomorphic rhabdomyosarcoma with extracellular collagen deposits reminiscent of so-called amianthoid fibers. J Cutan Pathol 2014; 41:316-21. [PMID: 24341853 DOI: 10.1111/cup.12282] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 10/21/2013] [Accepted: 11/17/2013] [Indexed: 12/24/2022]
Abstract
Rhabdomyosarcoma is a malignant mesenchymal neoplasm that rarely presents as primary skin tumor. So-called amianthoid fibers are hyalinized collagen mats that have been described in myofibroblastic tumors but not in rhabdomyosarcoma. A 65-year-old male developed a submandibular nodule 9 years after an oral squamous cell carcinoma, which had been treated with chemotherapy and radiotherapy. Histological examination of the nodule revealed a pleomorphic rhabdomyosarcoma with extracellular collagen deposits reminiscent of so-called amianthoid fibers. By immunohistochemistry, the tumor cells were positive for vimentin, desmin, smooth muscle actin (SMA), muscle-specific actin (MSA), CD10, CD56, CD99, β-catenin and D2-40. However, only 15-20% of the tumor cells were positive for myoglobin, MyoD1 and myf-4/myogenin. We describe first so-called amianthoid fibers harboring blood capillaries in a rhabdomyosarcoma, suggesting that they are rigid collagen structures that lead to tumor vascularization. The low expression for myogenic regulatory proteins and strong expression for other markers may be misleading and do not contribute to the diagnosis of rhabdomyosarcoma.
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Marburger TB, Gardner JM, Prieto VG, Billings SD. Primary cutaneous rhabdomyosarcoma: a clinicopathologic review of 11 cases. J Cutan Pathol 2012; 39:987-95. [PMID: 22994900 DOI: 10.1111/cup.12007] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 07/27/2012] [Accepted: 07/30/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Rhabdomyosarcoma is a malignant mesenchymal tumor with skeletal muscle differentiation. Primary cutaneous rhabdomyosarcoma is rare. We report a series of 11 cases of primary cutaneous rhabdomyosarcoma. METHODS Cases diagnosed as rhabdomyosarcoma arising in the dermis/subcutis with no identified primary tumor elsewhere were retrospectively reviewed. Follow-up was obtained. RESULTS The tumors occurred in five children and six adults. The adult subset consisted of pleomorphic, epithelioid and not otherwise specified (NOS) subtypes while the pediatric subset showed alveolar and embryonal subtypes. All cases showed immunohistochemical staining consistent with the diagnosis of rhabdomyosarcoma. Three adult cases showed immunoreactivity for cytokeratins (one pleomorphic, one epithelioid and one NOS. CONCLUSIONS Primary cutaneous rhabdomyosarcoma shows a bimodal age distribution and male predominance, correlating with rhabdomyosarcoma in deep soft tissue. Follow-up, available on all patients, showed aggressive behavior in both children and adults. Primary cutaneous rhabdomyosarcoma should be considered in the differential diagnosis of tumors with abundant eosinophilic cytoplasm and those with "small round blue cell" morphology. Desmin, myogenin and MYOD1 are a trio of markers with high sensitivity and specificity for primary cutaneous rhabdomyosarcoma. Cytokeratin immunoreactivity in primary cutaneous rhabdomyosarcoma represents a potential diagnostic pitfall in the differential diagnosis with sarcomatoid carcinoma.
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Affiliation(s)
- Trent B Marburger
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA
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