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Zhou J, Yu DH, Chen XR, Wang JY, Cai SQ. Pseudomyogenic hemangioendothelioma in the external genitalia. J Dtsch Dermatol Ges 2024; 22:700-703. [PMID: 38581344 DOI: 10.1111/ddg.15353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 12/21/2023] [Indexed: 04/08/2024]
Affiliation(s)
- Jiong Zhou
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dian-He Yu
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xin-Rong Chen
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Dermatology, Zhuji People's Hospital of Zhejiang Province, Zhuji, China
| | - Jian-You Wang
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Sui-Qing Cai
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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2
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Folpe AL. Vascular tumors of intermediate malignancy: An update. Hum Pathol 2024; 147:114-128. [PMID: 38360216 DOI: 10.1016/j.humpath.2024.01.014] [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: 01/22/2024] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/17/2024]
Abstract
The term "hemangioendothelioma" is used for endothelial neoplasms of intermediate malignancy and describes a group of rare neoplasms having biologic behavior falling in between that of the benign hemangiomas and fully malignant angiosarcomas. The hemangioendotheliomas fall into several specific, clinicopathologically and genetically distinct entities, specifically epithelioid hemangioendothelioma, kaposiform hemangioendothelioma, papillary intralymphatic angioendothelioma and retiform hemangioendothelioma (hobnailed hemangioendothelioma), pseudomyogenic hemangioendothelioma, composite hemangioendothelioma, and YAP1::TFE3-fused hemangioendothelioma. The clinical, morphologic, immunohistochemical, and genetic features, and the differential diagnosis of each of these rare entities are discussed in this review.
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Affiliation(s)
- Andrew L Folpe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55902, United States.
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3
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Zhou J, Yu DH, Chen XR, Wang JY, Cai SQ. Pseudomyogenes Hämangioendotheliom der äußeren Genitalien. J Dtsch Dermatol Ges 2024; 22:700-703. [PMID: 38730526 DOI: 10.1111/ddg.15353_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 12/21/2023] [Indexed: 05/13/2024]
Affiliation(s)
- Jiong Zhou
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dian-He Yu
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xin-Rong Chen
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Dermatology, Zhuji People's Hospital of Zhejiang Province, Zhuji, China
| | - Jian-You Wang
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Sui-Qing Cai
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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4
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Tortorelli I, Bellan E, Chiusole B, Murtas F, Ruggieri P, Pala E, Cerchiaro M, Buzzaccarini MS, Scarzello G, Krengli M, Bisinella G, Battisti S, Di Maggio A, Zagonel V, Tos APD, Sbaraglia M, Brunello A. Primary vascular tumors of bone: A comprehensive literature review on classification, diagnosis and treatment. Crit Rev Oncol Hematol 2024; 195:104268. [PMID: 38237880 DOI: 10.1016/j.critrevonc.2024.104268] [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] [Received: 08/22/2023] [Revised: 12/23/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024] Open
Abstract
Primary vascular tumors of bone are a heterogeneous group of neoplasms, ranging from benign hemangiomas to frankly malignant epithelioid hemangioendotheliomas and angiosarcomas. Over the years, their classification has been a matter of discussion, due to morphologic similarities and uncertainty regarding biologic behavior. Over the past decade, with the development of next-generation sequencing, there has been a significant improvement in the molecular characterization of these lesions. The integration of their morphologic, immunohistochemical and molecular features has led to a better stratification, with important prognostic and therapeutic implications. Nevertheless, primary vascular bone tumors still represent a challenge for medical oncologists. Given their rarity and heterogeneity, in the last few years, there has been no significant progress in medical treatment options, so further research is needed. Here we present a review of the current knowledge regarding primary vascular tumors of the bone, correlating clinicopathologic features with tumor behavior and therapeutic approaches.
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Affiliation(s)
- Ilaria Tortorelli
- Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV - IRCCS, Via Gattamelata 64, 35128 Padua, Italy; Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Via Nicolò Giustiniani 2, 35128 Padua, Italy
| | - Elena Bellan
- Department of Pathology, Azienda Ospedale Università Padova, Via Gabelli 61, 35121 Padua, Italy
| | - Benedetta Chiusole
- Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV - IRCCS, Via Gattamelata 64, 35128 Padua, Italy
| | - Fabio Murtas
- Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV - IRCCS, Via Gattamelata 64, 35128 Padua, Italy; Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Via Nicolò Giustiniani 2, 35128 Padua, Italy
| | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padua, Via Nicolò Giustiniani 1, 35128 Padua, Italy
| | - Elisa Pala
- Department of Orthopedics and Orthopedic Oncology, University of Padua, Via Nicolò Giustiniani 1, 35128 Padua, Italy
| | - Mariachiara Cerchiaro
- Department of Orthopedics and Orthopedic Oncology, University of Padua, Via Nicolò Giustiniani 1, 35128 Padua, Italy
| | | | - Giovanni Scarzello
- Radiotherapy Unit, Istituto Oncologico Veneto IOV - IRCCS, Via Nicolò Giustiniani 2, 35128 Padua, Italy
| | - Marco Krengli
- Radiotherapy Unit, Istituto Oncologico Veneto IOV - IRCCS, Via Nicolò Giustiniani 2, 35128 Padua, Italy
| | - Gianluca Bisinella
- Division of Orthopedics and Trauma, AULSS 6 Euganea, Ospedali Riuniti Padova Sud, Via Albere 30, Monselice, Padua, Italy
| | - Sara Battisti
- Division of Orthopedics and Trauma, AULSS 6 Euganea, Ospedali Riuniti Padova Sud, Via Albere 30, Monselice, Padua, Italy
| | - Antonio Di Maggio
- Oncologic Radiology Unit, Department of Radiology and Medical Physics, Istituto Oncologico Veneto IOV - IRCCS, Via Gattamelata 64, 35128 Padua, Italy
| | - Vittorina Zagonel
- Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV - IRCCS, Via Gattamelata 64, 35128 Padua, Italy
| | - Angelo Paolo Dei Tos
- Department of Pathology, Azienda Ospedale Università Padova, Via Gabelli 61, 35121 Padua, Italy; Department of Medicine, University of Padua School of Medicine, Via 8 Febbraio 2, 35122 Padua, Italy
| | - Marta Sbaraglia
- Department of Pathology, Azienda Ospedale Università Padova, Via Gabelli 61, 35121 Padua, Italy; Department of Medicine, University of Padua School of Medicine, Via 8 Febbraio 2, 35122 Padua, Italy
| | - Antonella Brunello
- Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV - IRCCS, Via Gattamelata 64, 35128 Padua, Italy.
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Warmke LM, Collier CD, Davis JL. NR1D1::MAML1 epithelioid and spindle cell sarcoma mimicking pseudomyogenic hemangioendothelioma in core biopsy: A case report and review of the literature. Genes Chromosomes Cancer 2023; 62:655-662. [PMID: 37326138 DOI: 10.1002/gcc.23186] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023] Open
Abstract
Epithelioid and spindle cell sarcomas with NR1D1::MAML1/2 gene fusions are rare and emerging entities. Only six cases of NR1D1-rearranged mesenchymal tumors have previously been reported in the literature; they are often characterized by an epithelioid morphology, at least focal pseudogland formation, prominent cytoplasmic vacuoles, and focal to diffuse immunohistochemical expression of keratin. We herein report the first case of an NR1D1::MAML1 epithelioid and spindle cell sarcoma with dual immunohistochemical expression of ERG and FOSB, mimicking a pseudomyogenic hemangioendothelioma (PHE) on core biopsy. The sarcoma arose in the left forearm of a 64-year-old man. Initial biopsy showed a mesenchymal neoplasm composed of epithelioid and spindle cells dispersed in myxoid stroma with scattered stromal neutrophils. The morphologic features, combined with the dual immunohistochemical expression of ERG and FOSB, initially mimicked PHE, representing an important potential diagnostic pitfall. The patient subsequently underwent a radical resection, which showed a much more diffuse epithelioid appearance with nested architecture and pseudogland formation. Next-generation sequencing was performed on the resection specimen, which revealed an NR1D1::MAML1 gene fusion, confirming the final diagnosis. Given the fully malignant potential of this tumor, knowledge and recognition of this rare entity are essential to ensure proper management, prevent misdiagnosis, and further characterize the clinical course of this emerging entity. Comprehensive molecular testing can help to identify these rare tumors and exclude the possibility of epithelioid mimics, including PHE.
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Affiliation(s)
- Laura M Warmke
- Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Christopher D Collier
- Department of Orthopedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jessica L Davis
- Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Spontaneously regressive multifocal bone pseudomyogenic hemangioendothelioma in a 17-year-old boy: a case report. Skeletal Radiol 2023; 52:119-127. [PMID: 35780259 DOI: 10.1007/s00256-022-04109-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 02/02/2023]
Abstract
Pseudomyogenic hemangioendothelioma (PMH) is a rare vascular tumor that occurs in young mostly male patients. Seventy percent of PMH cases are multifocal and 25% involve bones. PMH is an indolent tumor with mild local aggressiveness and an unclear pathology. Only two cases of spontaneous regressive bone PMH have been reported. Here, we report the case of a 17-year-old boy with a multifocal bone PMH diagnosed from a chronic pain in his left knee. The PMH affected the right scapula, both humeri, the right olecranon, the second metacarpal bone, the second and fourth right ribs, the thoracic and lumbar spine, the pelvic ring, the left and right femoral neck, and the left patella. Every lesion presented with a lobulated, lytic pattern, sometimes with a peripheral sclerotic rim. MRI showed a tissue lesion with a low intensity on T1-weighted sequences and high intensity on T2-weighted sequences. Enhancement of T1 gadolinium fat-saturated sequences was bright. After discussion, a national specialized board decided to actively monitor the patient and start general chemotherapy in the case of progression. The disease was stable at 3 and 6 months and showed signs of regression at 1 year, which was further confirmed at 2 years. CT scan and MRI highlighted a progressive filling of the tumor with cancellous bone and a regression of the tissue contingent. This case report highlights to a new therapeutic approach for indolent PMH that does not prevent further treatment in the case of progression.
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Sassi F, Sahraoui G, Charfi L, Jaidane O, Mrad K, Doghri R. Pseudomyogenic hemangioendothelioma: A misleading vascular tumor. Int J Surg Case Rep 2022; 99:107639. [PMID: 36108375 PMCID: PMC9568735 DOI: 10.1016/j.ijscr.2022.107639] [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] [Received: 08/30/2022] [Accepted: 09/08/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Pseudomyogenic hemangioendothelioma (PHE) is a rare vascular soft tissue tumor of intermediate malignancy. The aim of this study was to present a rare case of PHE in the back and to review its clinicopathological features, therapeutic modalities, evolutionary aspects and prognosis. Case presentation We report the case of a 21-year-old man who consulted for a multinodular mass at the scapula level, that increased in size within 2 months. An excisional surgery was performed. Macroscopic examination showed ulcerated centimetric nodules with a crusty surface. Microscopic examination showed a multinodular proliferation arranged in clusters, made of spindle cells or epithelioid cells with variable atypia. Immunohistochemical study showed the expression ofAE1-AE3, ERG and INI-1. There was no staining for EMA, CD34, and CD-31. The diagnosis of PHE was retained. Discussion PHE affects young adult males and usually develops in the extremities. Clinically, more than half of the patients present with local recurrence. Distant metastases have also been reported. Microscopically, PHE resembles a myoid tumor or epithelioid sarcoma because of the abundant eosinophilic cytoplasm and cell shape. Tumor cells express cytokeratin and inconsistently CD34 and CD31. Hence the need to complete the study of ERG and INI1 expression in all soft tissue epithelioid tumors. The translocation t(7;19)(q22; q13) as well as the expression of FOSB in immunohistochemistry allow to differentiate with epithelioid sarcoma. Surgery is the treatment option. Conclusion PHE is a confusing entity with several mesenchymal neoplasms that must be carefully differentiated. Data regarding age, sex, location, course, and recurrence are important for proper diagnosis. Pseudomyogenic hemangioendothelioma is a rare vascular tumor. It can be misdiagnosed with several mesenchymal neoplasms, importantly an epithelioid sarcoma which prognosis is poor. Local recurrence and late metastasis can occur, so a strict follow-up is mandatory. Wide excision is the treatment option.
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Brance ML, Cóccaro NM, Roitman P, Castiglioni A, Agostinis F, Spense M, Scheitlin B, Rene N, Brun LR. Pseudomyogenic hemangioendothelioma with bone and soft tissue involvement with favorable response to pamidronate: a case report and systematic review of the literature. Arch Osteoporos 2022; 17:28. [PMID: 35106633 DOI: 10.1007/s11657-022-01062-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 01/07/2022] [Indexed: 02/03/2023]
Abstract
Pseudomyogenic hemangioendothelioma (PMH) can be a challenge for diagnosis and might be confused with other tumors, such as epithelioid sarcoma. Here we present a case and a systematic review of the literature to identify and discuss PMH treatment in primary bone involvement. A 25-year-old woman was referred for bone pain (10/10) in the left lower limb. Magnetic resonance imaging (MRI) showed multiple bone lesions (left femur, tibia, patella, ankle, and foot) with well-defined borders without signs of local aggressiveness. Positron Emission Tomography-Computed Tomography (PET-CT) showed multiple metabolic musculoskeletal lesions in the left lower limb. A CT scan-guided biopsy was performed. Histological and immunohistochemical findings confirmed the diagnosis of PMH. After treatment with intravenous pamidronate (90 mg/monthly), the patient had clinical improvement, mild pain 2/10 without the use of non-steroidal anti-inflammatory drugs or opiates. Follow-up was assessed by MRI and PET-CT. PET-CT showed metabolic resolution of most of the bone and muscular lesions and a significant improvement of the femoral lesion. MRI showed that the lesions in the left femur, tibia, and foot had a marked decrease in size without intravenous post-contrast enhancement and smaller lesions had disappeared. After a 3-year follow-up, PET-CT showed no metabolically active images. Literature review identified 31 records including 58 clinical cases of PMH with primary bone involvement and treatment description for qualitative analysis. Most lesions (69%) were treated by local excision or curettage. In addition, amputations were performed in a significant percentage of cases (20.7%). In the last years, mTOR inhibitors (n = 7) and anti-resorptive treatments (n = 4) were considered as alternative treatment options, especially in multifocal lesions.
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Affiliation(s)
- María Lorena Brance
- Bone Biology Laboratory, School of Medicine, Rosario National University, Santa Fe, Argentina. .,Reumatología Y Enfermedades Óseas Rosario, Santa Fe, Argentina. .,National Council of Scientific and Technical Research (CONICET), Buenos Aires, Argentina.
| | | | - Pablo Roitman
- Pathology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Mariel Spense
- Orthopaedic Oncology, Sanatorio Británico, Rosario, Argentina
| | | | - Nicholas Rene
- Department of Radiation Oncology, Centro de Radioterapia, Rosario, Argentina
| | - Lucas R Brun
- Bone Biology Laboratory, School of Medicine, Rosario National University, Santa Fe, Argentina.,National Council of Scientific and Technical Research (CONICET), Buenos Aires, Argentina
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Durga G, Pasricha S, Sharma A, Pruthi M, Jajodia A, Gupta G, Kamboj M, Gupta M, Mehta A. Multifocal primary pseudomyogenic hemangioendothelioma of bone managed with denosumab: A rare case with diagnostic and therapeutic challenge. J Cancer Res Ther 2022; 18:817-819. [DOI: 10.4103/jcrt.jcrt_1138_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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10
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Abstract
Vascular tumors of bone can be diagnostically challenging because of their rarity and histologic overlap with diverse mimics. Vascular tumors of bone can be categorized as benign (hemangioma), intermediate-locally aggressive (epithelioid hemangioma), intermediate-rarely metastasizing (pseudomyogenic hemangioendothelioma), and malignant (epithelioid hemangioendothelioma and angiosarcoma). Recurrent genetic alterations have been described, such as FOSB rearrangements in pseudomyogenic hemangioendothelioma and a subset of epithelioid hemangiomas; CAMTA1 or TFE3 rearrangements in epithelioid hemangioendothelioma. This review discusses the clinical, histologic, and molecular features of vascular tumors of bone, along with diagnostic pitfalls and strategies for avoidance.
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Affiliation(s)
- Yin P Hung
- Department of Pathology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Hatfield BS, Smith SC, Boikos SA, Sayeed S. The cytologic features of primary pseudomyogenic hemangioendothelioma of bone. Diagn Cytopathol 2021; 49:1261-1264. [PMID: 34636475 DOI: 10.1002/dc.24887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/30/2021] [Accepted: 10/04/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Bryce S Hatfield
- Department of Pathology, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Steven C Smith
- Department of Pathology, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Sosipatros A Boikos
- Department of Hematology/Oncology, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Sadia Sayeed
- Department of Pathology, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
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12
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Ren J, Wang X, Zhou Y, Yue X, Chen S, Ding X, Zeng S, Jiang X, Liu X, Guo Q. A novel SERPINE1-FOSB fusion gene in pseudomyogenic hemangioendothelioma results in activation of intact FOSB and the PI3K-AKT-mTOR signaling pathway and responsiveness to sirolimus. J Dermatol 2021; 48:1900-1906. [PMID: 34580903 DOI: 10.1111/1346-8138.16158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/20/2021] [Accepted: 09/02/2021] [Indexed: 11/28/2022]
Abstract
Pseudomyogenic hemangioendothelioma (PHE) is an extremely rare disease that affects mainly the young and more men than women. PHE are multicentric, locally aggressive, have low metastatic potential, and affect multiple tissue planes. Genetic aberrations are frequently detected in PHE and may play important roles in the occurrence, development, and treatment of this disease. In this study, we report a case of PHE with a novel SERPINE1-FOSB fusion gene. The fusion introduced a strong promoter near the coding region of FOSB, resulting in overexpression of intact FOSB. Immunohistochemical analysis showed overexpression of pAKT and mTOR in tumor cells, suggesting activation of the PI3K-AKT-mTOR signaling pathway. The patient responded well to targeted therapy with sirolimus, an mTOR inhibitor. Our study correlated dysregulation of a specific signaling pathway and the effectiveness of a targeted therapy to a specific genetic aberration. This information may be useful for future investigations of targeted therapeutics and provide a potential predictive biomarker for therapeutic effectiveness in PHE cases.
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Affiliation(s)
- Jun Ren
- Department of Dermatology, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
| | - Xiaohui Wang
- Department of Dermatology, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
| | - Yulin Zhou
- United Diagnostic and Research Center for Clinical Genetics, Women and Children's Hospital, School of Medicine & School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Xin Yue
- Department of Radiology, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
| | - Shouhui Chen
- Department of Pathology, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
| | - Xin Ding
- Department of Pathology, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
| | - Shengqiang Zeng
- The Graduate School of Fujian Medical University, Fuzhou, Fujian, China
| | - Xiaoyong Jiang
- Department of Dermatology, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
| | - Xiaokun Liu
- Department of Dermatology, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
| | - Qiwei Guo
- United Diagnostic and Research Center for Clinical Genetics, Women and Children's Hospital, School of Medicine & School of Public Health, Xiamen University, Xiamen, Fujian, China
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Xu Z, Zaid HH, Yang M. Pseudomyogenic Hemangioendothelioma of the Talocalcaneal Coalition: A Case Report. J Foot Ankle Surg 2021; 60:1073-1078. [PMID: 34127373 DOI: 10.1053/j.jfas.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/05/2020] [Accepted: 04/04/2021] [Indexed: 02/03/2023]
Abstract
Pseudomyogenic hemangioendothelioma is a rare soft tissue tumor most often found in the lower extremities and predominantly occurring in males. The talocalcaneal coalition is an anatomic anomaly that develops between the talus and calcaneus bones, can cause hindfoot pain and subtalar joint stiffness, and has a prevalence of less than 1%. We present what is to our knowledge the first case report of a 17-year-old male with pseudomyogenic hemangioendothelioma occurring within a talocalcaneal coalition. The patient was treated with local excision of the tumor and the coalition. His American Orthopaedic Foot & Ankle Society ankle/hindfoot score went from 70 preoperatively to 92 at 1 year postoperatively, and he has had no evidence of recurrence at 1 and 3 years postoperatively. These tumors have suggestive but not diagnostic computed tomography, magnetic resonance imaging, and histopathological findings, and they are associated with a uniquely characteristic immunophenotype, including immunochemical reactivity to CD31, FLi-1, INI-1, ERG, and FOSB. Primary treatment of pseudomyogenic hemangioendothelioma most often involves local excision (but can require amputation) and may include adjuvant radiotherapy and/or chemotherapy. It has a relatively favorable prognosis, with a moderate risk of local recurrence and a low risk of metastases. Because metastases have been reported many years after treatment, long-term follow-up is necessary.
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Affiliation(s)
- Zhijie Xu
- Department of Orthopedics, the First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Hamood Hg Zaid
- Department of Orthopedics, the First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Maowei Yang
- Department of Orthopedics, the First Hospital of China Medical University, Shenyang, Liaoning Province, China.
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Diab ARF, Daradkeh SS, Hassouneh AM, Alabbadi AM. Pseudomyogenic Hemangioendothelioma Involving the Esophagus. J Chest Surg 2021; 54:524-527. [PMID: 33767026 PMCID: PMC8646068 DOI: 10.5090/jcs.20.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/20/2021] [Accepted: 02/09/2021] [Indexed: 11/18/2022] Open
Abstract
Herein, we describe the case of a 20-year-old woman who presented with dysphagia of 2 months’ duration associated with vomiting, moderate abdominal pain, decreased oral intake, and significant weight loss. During the past 3 years, the patient experienced intermittent mild abdominal pain with infrequent vomiting. Endoscopy at Jordan University Hospital showed a mass in the esophagus, and endoscopic biopsies were performed. The preliminary histopathological report excluded malignancy. Two days after endoscopy, the patient presented to the emergency department complaining of severely worsening pain and total dysphagia. The pain persisted despite intravenous paracetamol administration, which was concerning for esophageal perforation; therefore, an urgent surgical intervention was performed. The mass was removed surgically, along with a para-esophageal lymph node. The final histopathological results of the endoscopic and resected specimens supported the diagnosis of pseudomyogenic hemangioendothelioma (PMHE). This is the first case reporting esophageal involvement of PMHE.
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Murshed KA, Torres‐Mora J, ElSayed AM, Ammar A, Al‐Bozom I. Pseudomyogenic hemangioendothelioma of bone with rare WWTR1-FOSB fusion gene: Case report and literature review. Clin Case Rep 2021; 9:1494-1499. [PMID: 33768875 PMCID: PMC7981765 DOI: 10.1002/ccr3.3808] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/11/2020] [Accepted: 01/04/2021] [Indexed: 01/23/2023] Open
Abstract
Pseudomyogenic hemangioendothelioma rarely arises in bone. WWTR1-FOSB fusion gene is rarely reported in PMHE of bone. Currently, fusion genes can be used as diagnostic markers in PMHE; however, their prognostic and therapeutic significance is unclear.
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Affiliation(s)
- Khaled A. Murshed
- Department of Laboratory Medicine & PathologyHamad Medical CorporationDohaQatar
| | | | | | - Adham Ammar
- Department of Laboratory Medicine & PathologyHamad Medical CorporationDohaQatar
| | - Issam Al‐Bozom
- Department of Laboratory Medicine & PathologyHamad Medical CorporationDohaQatar
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16
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Rare Primary Malignant Bone Sarcomas. Cancers (Basel) 2020; 12:cancers12113092. [PMID: 33114111 PMCID: PMC7690832 DOI: 10.3390/cancers12113092] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/15/2020] [Accepted: 10/19/2020] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Primary malignant bone tumors are infrequent cancers. More than 90% of these neoplasms are classified as osteosarcomas, Ewing sarcomas or chondrosarcomas, and their clinical presentation, diagnosis, and treatment principles are well-established. The entities described in this article, are ultra-rare varieties of bone sarcomas, and there clinical and histological characteristics are not well known. Therefore, they are very difficult to be diagnosed and there is a lot of uncertainty on their treatment. Because of their rarity, it is also extremely difficult to perform clinical research on these cancers. This article creates more awareness of these very rare bone tumors. It explains how to recognize and diagnose each entity and it summarizes the medical scientific literature that is available on these cancers. Increasing awareness and clinical research for these cancers are key elements to improve the prognosis for patients with these diseases in the long term. Abstract Rare primary malignant bone sarcomas (RPMBS), other than osteosarcoma, chondrosarcoma, chordoma, and Ewing sarcoma, account for about 5–10% of primary bone tumors and represent a major diagnostic challenge. These tumors include spindle cell and round cell sarcoma entities, hemangiopericytoma-like and vascular tumors. Additionally, several histotypes, traditionally described in the soft tissues, such as myxofibrosarcoma, synovial sarcoma, and malignant peripheral nerve sheath tumor of bone, have been reported in patients with primary bone tumors. While wide surgical resection is the mainstay of local treatment, systemic therapy of these rare entities is controversial. Patients with undifferentiated spindle cell or pleomorphic high-grade tumors of bone, are usually treated with osteosarcoma-like chemotherapy, while patients with round cell and undifferentiated round cell tumors (URCTs), may respond to sarcoma treatment regimens for Ewing sarcoma patients. Studies on analogies and differences among these ultra-rare tumors have seldom been reported. This review describes relevance, clinical aspects, diagnostic procedures, staging, treatment recommendations, and current research in this composite tumor group.
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Primary Vascular Tumors of Bone: A Monoinstitutional Morphologic and Molecular Analysis of 427 Cases With Emphasis on Epithelioid Variants. Am J Surg Pathol 2020; 44:1192-1203. [PMID: 32271190 DOI: 10.1097/pas.0000000000001487] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Recent molecular discoveries have refined vascular bone tumor classification. To investigate the clinical relevance of these refinements, we reviewed all cases of primary vascular bone tumors treated at our Institute. On the basis of morphology, cases were assessed immunohistochemically and molecularly. A total of 427 cases of primary vascular tumor of bone with available follow-up and histologic material were retrieved and reclassified according to the most recent diagnostic criteria as follows: 289 hemangiomas, 38 epithelioid hemangiomas, 21 epithelioid hemangioendotheliomas, 2 retiform hemangioendotheliomas, 1 intraosseous papillary intralymphatic angioendothelioma, 24 pseudomyogenic hemangioendotheliomas, and 52 angiosarcomas (of these, 45 were epithelioid angiosarcomas and 7 spindle cell secondary angiosarcoma). Both epithelioid and classic hemangiomas behave as benign tumors with excellent prognosis. The distinction between cellular and conventional type of epithelioid hemangioma was not associated with a different clinical course. Conversely, epithelioid hemangioendothelioma exhibited a more aggressive clinical behavior than hemangioma, with higher rates of multifocality and distant spread. Immunohistochemical positivity for CAMTA1 or TFE3 did not have a prognostic implication. In epithelioid hemangioendothelioma, the presence of morphologic malignant features was associated with reduced disease-free (P=0.064) and overall survival (P=0.055). Pseudomyogenic hemangioendothelioma featured local aggressiveness in 5/24 patients exhibiting a clinical behavior closer to epithelioid hemangioma than epithelioid hemangioendothelioma. Last, 32/45 patients with epithelioid angiosarcoma died of disease with a median survival time of 10 months from diagnosis. In conclusion, the integration of morphologic, immunohistochemical, and molecular features allows a better stratification of primary vascular tumors of bone with significant prognostic and therapeutic implications.
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18
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Rekhi B, Ramadwar M. Cytomorphological features of an unusual case of a multifocal pseudomyogenic (epithelioid sarcoma-like) hemangioendothelioma in a young adult male. Diagn Cytopathol 2020; 49:E106-E112. [PMID: 32886445 DOI: 10.1002/dc.24606] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 12/15/2022]
Abstract
Pseudomyogenic (epithelioid sarcoma-like) hemangioendothelioma (PMHE) is a relatively newly described vascular neoplasm, characterized by distinct clinicopathological and molecular features, with no report on its cytomorphological features on smears, till date. A 17-year-old male presented with multiple nodules on his left upper limb. Radiologic imaging disclosed multiple lesions involving the soft tissues, skin, and bones of his left upper limb. Biopsy of one of the lesions on his left ring finger revealed a cellular tumor comprising plump spindle and epithelioid cells, containing moderate to abundant, eosinophilic cytoplasm; mild nuclear atypia, vesicular nuclear chromatin, discernible nucleoli, infrequent mitotic figures, and interspersed neutrophils. Immunohistochemically, tumor cells were positive for AE1/AE3, CD31, and FLI-1, while negative for CD34 and desmin. INI1/SMARCB1 was retained. MIB1/Ki67 highlighted nearly 3% tumor cells (low). Diagnosis of a PMHE was offered. A simultaneous fine needle aspiration cytology smears of the lesions in his left forearm and ipsilateral axillary region revealed spindle and some polygonal shaped cells, arranged in tight and loose clusters, as well as scattered singly, containing abundant cytoplasm with tapering cell membranes, at places; vesicular nuclear chromatin and characteristic intercellular fibrillary stromal material. The present case constitutes the first report on cytomorphological features of a PMHE, diagnosed on cytology, including its differential diagnoses, immunohistochemical features with molecular updates.
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Affiliation(s)
- Bharat Rekhi
- Department of Surgical Pathology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Mukta Ramadwar
- Department of Surgical Pathology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute (HBNI) University, Mumbai, India
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19
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Rekhi B, Rane S, Puri A. Two Cases of Intraosseous Pseudomyogenic (Epithelioid Sarcoma-Like) Hemangioendothelioma With Unusual Features, Expanding the Clinicopathological Spectrum. Int J Surg Pathol 2020; 29:454-461. [PMID: 32851904 DOI: 10.1177/1066896920951841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Pseudomyogenic (epithelioid sarcoma-like) hemangioendothelioma (PMHE) is a distinct vascular neoplasm mostly observed in the lower extremities of young adults with characteristic histopathological features. In this article, we present 2 unusual cases of PMHE. Case 1: A 28-year-old male presented with pain and stiffness in his left shoulder. Radiologic examination revealed an expansile, lytic, heterogeneously enhancing, destructive lesion in his left scapula, along with multiple avid marrow lesions in his other bones. Biopsy revealed a cellular tumor composed of plump spindly and epithelioid cells arranged in fascicles and focally, in clusters, admixed with neutrophils and histiocytes, with interspersed many osteoclast-like giant cells and reactive bone. Case 2: A 63-year-old male presented pain and swelling in his right middle finger, with no other lesion elsewhere in his body. Radiologic imaging disclosed a 1.5-cm-sized lobulated, expansile, lytic, destructive lesion in the distal end of the third metacarpal bone of his right hand. Biopsy examination revealed a cellular spindle cell tumor, composed of plump spindly cells, arranged in fascicles, including "tadpole-like" or "strap-like" cells and interspersed inflammatory cells. Immunohistochemically, tumor cells in both cases were positive for AE1/AE3, CD31, and Fli1, while negative for desmin and CD34. INI11 was retained. The presented cases of PMHE, occurring at unusual locations, in an older individual in the second case, along with variable histopathological features, noted in the first case, seem to expand the clinicopathological spectrum of these uncommon neoplasms. Differential diagnoses and review of similar cases are presented.
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Affiliation(s)
- Bharat Rekhi
- 29436Tata Memorial Centre, Homi Bhabha National Institute University, Mumbai, India
| | - Swapnil Rane
- 29436Tata Memorial Centre, Homi Bhabha National Institute University, Mumbai, India
| | - Ajay Puri
- 29436Tata Memorial Centre, Homi Bhabha National Institute University, Mumbai, India
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20
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Bridge JA, Sumegi J, Royce T, Baker M, Linos K. A novel CLTC-FOSB gene fusion in pseudomyogenic hemangioendothelioma of bone. Genes Chromosomes Cancer 2020; 60:38-42. [PMID: 32749039 DOI: 10.1002/gcc.22891] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 01/20/2023] Open
Abstract
Pseudomyogenic hemangioendothelioma, an uncommon mesenchymal neoplasm composed of plump spindled and/or epithelioid endothelial cells, may present multicentrically and tends to locally recur but rarely metastasizes. Morphologic resemblance to epithelioid sarcoma and other spindle cell neoplasms may result in diagnostic confusion. Molecular characterization of pseudomyogenic hemangioendothelioma has revealed these neoplasms often harbor a rearrangement of the FOSB gene with SERPINE1 or ACTB as recurrent fusion gene partners. Herein, a case of a fibular pseudomyogenic hemangioendothelioma with minimal extension into the adjacent soft tissue arising in a 17 year-old male is presented. The neoplasm exhibited sheets of epithelioid cells with abundant eosinophilic cytoplasm and variably eccentric nuclei. RNA sequencing revealed a novel CLTC-FOSB fusion transcript that was subsequently confirmed by direct sequencing of reverse transcription-polymerase chain reaction products demonstrating an in-frame fusion between exon 17 of the clathrin heavy chain (CLTC) gene and exon 2 of the FOSB (FosB proto-oncogene, AP-1 transcription factor subunit) gene. CLTC-FOSB fusion has not been described in a neoplasm before.
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Affiliation(s)
- Julia A Bridge
- Division of Molecular Pathology, The Translational Genomics Research Institute and Ashion Laboratory, Phoenix, Arizona, USA.,Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Janos Sumegi
- Division of Molecular Pathology, The Translational Genomics Research Institute and Ashion Laboratory, Phoenix, Arizona, USA
| | - Thomas Royce
- Division of Molecular Pathology, The Translational Genomics Research Institute and Ashion Laboratory, Phoenix, Arizona, USA
| | - Michael Baker
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Konstantinos Linos
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine, Lebanon, New Hampshire, USA
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21
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Wei J, Liao Z, Zhao G, Nahar N, Zhang C, Lu J, Yang Y, Yang J. Clinicopathological features of pseudomyogenic hemangioendothelioma and precision therapy based on whole exome sequencing. Cancer Commun (Lond) 2020; 40:197-201. [PMID: 32227592 PMCID: PMC7170657 DOI: 10.1002/cac2.12020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 03/05/2020] [Accepted: 03/11/2020] [Indexed: 12/18/2022] Open
Affiliation(s)
- Junqiang Wei
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, P. R. China.,National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, P. R. China.,Department of Orthopedics, Affiliated Hospital of Chengde Medical College, Chengde, Hebei, 067000, P. R. China
| | - Zhichao Liao
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, P. R. China.,National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, P. R. China
| | - Gang Zhao
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, P. R. China.,Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, P. R. China
| | - Nazmun Nahar
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, P. R. China.,National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, P. R. China.,International Medical School, Tianjin Medical University, Tianjin, 300061, P. R. China
| | - Chao Zhang
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, P. R. China.,National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, P. R. China
| | - Jia Lu
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, P. R. China.,National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, P. R. China
| | - Yun Yang
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, P. R. China.,National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, P. R. China
| | - Jilong Yang
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, P. R. China.,National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, P. R. China
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22
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Abstract
Hemangioendotheliomas are a heterogeneous group of vascular neoplasm that may affect the liver, bone, and soft tissues. Among its variants, pseudomyogenic hemangioendothelioma is rarely encountered. Pseudomyogenic hemangioendothelioma is usually characterized by multiple soft tissue lesions, with occasional bone lesions. Fewer than 20 cases with exclusive involvement of bone structures have been reported. We describe a case of pseudomyogenic hemangioendothelioma involving multiple bony structures but without soft tissue involvement in a 7-year-old girl, imaged with F-FDG PET/CT at diagnosis and during treatment with mammalian target of rapamycin inhibitors.
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23
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Xia RH, Zhu L, Wang LZ, Tian Z, Zhang CY, Hu YH, Gu T, Li J. Primary pseudomyogenic hemangioendothelioma of right maxilla: a case with immunohistochemistry and FOSB rearrangement study. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:e96-e105. [PMID: 32035861 DOI: 10.1016/j.oooo.2019.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/23/2019] [Accepted: 12/26/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Primary pseudomyogenic hemangioendothelioma (PMH) of bone is an extremely rare vascular neoplasm. We present here a case of primary PMH occurring in the maxilla. STUDY DESIGN A 34-year-old man was referred to our hospital for treatment because of possible recurrence after surgery and chemotherapy of a right maxillary malignant tumor. Morphologic features, immunophenotypes, and FOSB gene rearrangement status of the surgically sectioned sample were assessed by hematoxylin-eosin staining, immunohistochemistry, and fluorescence in situ hybridization, respectively. RESULTS Morphologically, the tumor cells were arranged in a loose fascicular and sheet-like manner, with a large number of reactive woven bones forming. The most striking feature was the presence of epithelioid cells with abundant brightly eosinophilic cytoplasm, which resembled the rhabdomyoblast in appearance. The tumor was diffusely positive for AE1/AE3, CD31, erythroblast transformation-specific transcription factor, and Friend leukemia integration 1; negative for CD34, CAM5.2, epithelial membrane antigen, and desmin; and had retained expression of integrase interactor 1. The tumor harbored FOSB rearrangement. No distant metastasis was found during the follow-up period (18 months). CONCLUSIONS To the best of our knowledge, this case represents the first report of PMH arising in the maxilla. The distinct morphologic features, immunophenotypes, and FOSB rearrangement could help achieve precise diagnosis and prevent misdiagnosis of mimics with overlapping features.
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Affiliation(s)
- Rong-Hui Xia
- Department of Oral Pathology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Ling Zhu
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Department of Radiology, Shanghai, China
| | - Li-Zhen Wang
- Department of Oral Pathology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Zhen Tian
- Department of Oral Pathology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Chun-Ye Zhang
- Department of Oral Pathology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yu-Hua Hu
- Department of Oral Pathology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Ting Gu
- Department of Oral Pathology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Jiang Li
- Department of Oral Pathology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China.
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24
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Sun Y, Zhao M, Lao IW, Yu L, Wang J. The clinicopathological spectrum of pseudomyogenic hemangioendothelioma: report of an additional series with review of the literature. Virchows Arch 2020; 477:231-240. [PMID: 31980959 DOI: 10.1007/s00428-020-02753-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/02/2020] [Accepted: 01/10/2020] [Indexed: 12/22/2022]
Abstract
We present here our experience with 24 cases of pseudomyogenic hemangioendothelioma (PMHE) to further delineate its clinicopathological spectrum. There were 18 males and 6 females with a median age of 28 years (range 10~64 years). Most patients presented with erythematous nodules or papules, with or without pain. The majority (63%) occurred in the lower extremities, whereas a minority involved the trunk (25%), upper extremities (8%), and head and neck (4%). Six cases (25%) had a primary bone origin. With physical and radiological examinations, 16 cases (67%) manifested as multifocal disease, involving multiple tissue planes or different bones within the anatomic region. Six cases (25%) involved skin, soft tissue, and bone simultaneously. Histologically, all cases showed features consistent with a PMHE characterized by loose fascicles or sheets of plump spindled to epithelioid cells harboring brightly eosinophilic cytoplasm and vesicular nuclei. In addition, five cases (21%) contained a prominent myxoid matrix, and one case displayed perineural and intravascular invasion. The follow-up information available in 18 patients revealed local recurrence in 4 patients (22%) and persistent disease in 8 patients (44%), respectively. One patient developed bilateral pulmonary metastases which showed significant remission after systemic chemotherapy. None of the patients died of the disease. As the clinical appearance of PMHE can be deceptive, a radiological examination is essential in identifying an insidious multifocal disease. Although PMHE has a predilection for the distal extremities of young males, this rare tumor type could also occur in unusual sites and affect middle-aged adults of both genders. The striking myoid appearance in association with myxoid stromal change may represent a potential diagnostic pitfall. Biologically, PMHE has an indolent clinical behavior, albeit metastatic disease may occur in rare instance.
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Affiliation(s)
- Yuefang Sun
- Department of Pathology, Shanghai Tenth People's Hospital, Tenth People's Hospital of Tongji University, 301 Yanchang Middle Road, Shanghai, 200072, China
| | - Ming Zhao
- Department of Pathology, Zhejiang Provincial People's Hospital, Hangzhou, 310014, China
| | - I Weng Lao
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology Shanghai Medical College, Fudan University, 270 Dong An St, Shanghai, 200032, China
| | - Lin Yu
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology Shanghai Medical College, Fudan University, 270 Dong An St, Shanghai, 200032, China
| | - Jian Wang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
- Department of Oncology Shanghai Medical College, Fudan University, 270 Dong An St, Shanghai, 200032, China.
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25
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Keil F, Dietmaier W, Hoffstetter P, Hillmann A, Evert M. ZFP36-FOSB fusion in a haemorrhagic epithelioid and spindle cell haemangioma of bone: is there a family of FOSB-rearranged vascular neoplasms of the bone? Histopathology 2020; 76:490-493. [PMID: 31553804 DOI: 10.1111/his.14002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Felix Keil
- Institute for Pathology, University of Regensburg, Regensburg, Germany
| | | | | | - Axel Hillmann
- Department of Sarcomas and Musculoskeletal Tumors, Barmherzige Brüder Hospital, Regensburg, Germany
| | - Matthias Evert
- Institute for Pathology, University of Regensburg, Regensburg, Germany
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26
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Expanding the Spectrum of Genetic Alterations in Pseudomyogenic Hemangioendothelioma With Recurrent Novel ACTB-FOSB Gene Fusions. Am J Surg Pathol 2019; 42:1653-1661. [PMID: 30256258 DOI: 10.1097/pas.0000000000001147] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Pseudomyogenic hemangioendothelioma (PHE) is an uncommon, rarely metastasizing vascular neoplasm with predilection to affect young adults. The tumors often present as multiple nodules involving various tissue planes, including superficial and deep soft tissues as well as bone. Recurrent SERPINE1-FOSB gene fusions have been reported as the hallmark genetic abnormality in PHE, however, in our experience, a number of cases with typical histology lack this genetic abnormality. In this study, we identify a novel ACTB-FOSB gene fusion, which is as prevalent as the initial translocation reported. We selected 15 consecutive cases of PHE with typical morphologic features which had material for molecular testing. The cohort included 10 males and 5 females, ranging in age from 17 to 58 years (median age: 33 y; mean age: 35.3 y). Eight (53%) cases were located in the lower extremities (foot, calf, tibia, thigh), 5 (33%) were located in the trunk, abdomen or pelvis (abdominal wall-2, shoulder, back, ischium) and 2 (13%) were located in the upper extremity (humerus and hand). Ten (67%) cases had multifocal presentation and 5 (33%) presented as solitary lesions. Three (20%) cases were located only in the superficial dermis and subcutaneous tissues, 4 (27%) involved the superficial and deep soft tissue and 8 (53%) cases involved only the deep soft tissue and bone. Using fluorescence in situ hybridization and ARCHER fusionplex analysis we identified a novel ACTB-FOSB gene fusion in 7 cases, while the remaining 8 had the previously described SERPINE1-FOSB fusion. The clinicopathologic features and behavior of PHE associated with the ACTB-FOSB gene fusion were similar to those harboring the SERPINE1-FOSB; except that tumors with the ACTB variant were more often associated with solitary presentation. In conclusion, our results expand the spectrum of genetic alterations in PHE with a novel gene fusion identified in half of the cases. We speculate that some of the novel targeted therapies that have shown promise in SERPINE1-FOSB-positive PHE might also be beneficial in this molecular subset.
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27
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Otani S, Nakayama R, Sekita T, Hirozane T, Asano N, Nishimoto K, Sasaki A, Okita H, Morioka H, Nakamura M, Matsumoto M. Pseudomyogenic hemangioendothelioma of bone treated with denosumab: a case report. BMC Cancer 2019; 19:872. [PMID: 31481040 PMCID: PMC6724307 DOI: 10.1186/s12885-019-6072-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 08/22/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Pseudomyogenic hemangioendothelioma (PMHE) is a rare endothelial neoplasm that involves the bones in only 14% of all cases. The optimal treatment strategy has not been established. We herein report a case of primary PMHE in which denosumab treatment showed activity in both imaging studies and the clinical outcome. CASE PRESENTATION A 20-year-old woman presented with worsening pain in her left ankle. Imaging studies showed multifocal fluorodeoxyglucose (FDG)-avid [maximum standardized uptake value (SUVmax), 15.95] osteolytic lesions in the bones of her left lower extremity. While waiting for the definitive pathologic diagnosis of PMHE, denosumab, a human immunoglobulin G2 monoclonal antibody against RANKL, was initiated to treat progressive bone absorption after curettage of one of the lesions. Denosumab induced osteosclerosis around the lesions and pain relief and was discontinued 4 years after its initiation. Although all of the multifocal lesions remained, they all became less FDG-avid (SUVmax, 2.6), and the patient developed no signs of new lesions or distant metastasis. CONCLUSION Denosumab plays a certain role in prevention of bone destruction by PMHE through suppression of osteoclast-like giant cells and would be an excellent treatment for bone absorption by PMHE of bone.
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Affiliation(s)
- Shinya Otani
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582, Japan
| | - Robert Nakayama
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582, Japan.
| | - Tetsuya Sekita
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582, Japan
| | - Toru Hirozane
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582, Japan
| | - Naofumi Asano
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582, Japan
| | - Kazumasa Nishimoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582, Japan
| | - Aya Sasaki
- Department of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Hajime Okita
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Hideo Morioka
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582, Japan
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28
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Abstract
The fourth edition of the WHO Classification of Soft Tissue and Bone Tumours, published in 2013, extends the approach to describe genetics and pathology of these tumours in the context of epidemiological, clinical and imaging data, which was adopted in the third edition. Added are a few new entities, reclassifications and renamings. The most important point, also of clinical relevance and with consequences for treatment, is the introduction of a stratification of bone tumours based on their biological behaviour into three groups (benign, intermediate, malignant) in analogy to soft tissue tumours.
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Affiliation(s)
- G Jundt
- Knochentumor-Referenzzentrum und DÖSAK-Referenzregister am Institut für Pathologie, Universitätsspital Basel, Schönbeinstraße 40, 4031, Basel, Schweiz.
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Dianat S, Yousaf H, Murugan P, Marette S. Pseudomyogenic hemangioendothelioma-A case report and review of the literature. Radiol Case Rep 2019; 14:1228-1232. [PMID: 31440320 PMCID: PMC6699196 DOI: 10.1016/j.radcr.2019.06.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 06/29/2019] [Indexed: 12/19/2022] Open
Abstract
Pseudomyogenic hemangioendothelioma (PMH) of bone is a very rare tumor and frequently presents at multiple locations. PMH is difficult to diagnose by imaging and histopathologic features. Various and partially discordant imaging findings have been reported in case reports and small case series. We report a case of a 63-year-old man with PMH isolated to the sacrum, presenting with chronic intermittent buttock pain that was incidentally identified on imaging for acute pancreatitis. We believe that learning about PMH of bone will help to include this disease in the differential diagnosis of lytic lesions of the sacrum. Becoming aware of the various and sometimes discordant imaging findings of this rare entity is important and helpful for radiologists, pathologists, and orthopedic surgeons.
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Affiliation(s)
- Saeed Dianat
- Department of Radiology, University of Minnesota, 20 Delaware St SE, Minneapolis, MN 55455, USA
| | - Hira Yousaf
- Department of Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Paari Murugan
- Department of Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Shelly Marette
- Department of Radiology, University of Minnesota, 20 Delaware St SE, Minneapolis, MN 55455, USA
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Kosemehmetoglu K, Rekhi B, Wakely PE, Pant V, Dervisoglu S, Aydingoz U. Pseudomyogenic (epithelioid sarcoma-like) hemangioendothelioma of bone: Clinicopathologic features of 5 cases. Ann Diagn Pathol 2019; 41:116-123. [DOI: 10.1016/j.anndiagpath.2019.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
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Wang W, Hong J, Meng J, Wu H, Shi M, Yan S, Huang Y. Survival Analysis of Patients with Osseous Malignant Vascular Tumors: Results of the Surveillance, Epidemiology, and End Results (SEER) Database from 1973 to 2015. Med Sci Monit 2019; 25:5525-5535. [PMID: 31344019 PMCID: PMC6676986 DOI: 10.12659/msm.914950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Osseous malignant vascular tumors (OMVTs) are rare lesions. Moreover, the prognostic determinants of OMVTs have not been reported. This study aimed to present epidemiological data and analyze the prognostic factors of survival in OMVT patients. Material/Methods OMVT patients who were diagnosed between 1973 and 2015 were screened using the Surveillance, Epidemiology, and End Results (SEER) program database, with special attention paid to osseous hemangiosarcoma (OAS) and osseous hemangioendothelioma (OHE). We assessed the prognostic values of cancer-specific survival (CSS) and overall survival (OS) rates with a Cox proportional hazards regression model and univariate and multivariate analyses. OS and CSS curves were obtained using the Kaplan-Meier method. Results A total of 202 cases were selected from the SEER database. The specific histopathological diagnoses were osseous hemangiosarcoma (n=127) and osseous hemangioendothelioma (n=75). Among OMVT patients, histology was an important factor in determining survival. Using multivariate analysis, old age, distant tumor stage, surgery, and low tumor grade were predictors of OS for OAS patients. Old age, surgery, and low tumor grade were predictors of CSS. Using multivariate analysis, old age and surgery were predictors of OS and CSS for OHE patients. Conclusions This study is the largest population-based study to show the demographic characteristics and analyze the prognosis of OMVT patients. Independent predictors of OS for patients with AS included old age, distant tumor stage, low tumor grade, and surgery. Old age, surgery, and low tumor grade were also predictors of CSS for patients with OAS. Independent predictors of CSS and OS for patients with OHE included old age and surgery.
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Affiliation(s)
- Wei Wang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
| | - Jianqiao Hong
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
| | - Jiahong Meng
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
| | - Haobo Wu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
| | - Mingmin Shi
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
| | - Shigui Yan
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
| | - Yiting Huang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
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32
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Effective Use of Sirolimus and Zoledronic Acid for Multiosteotic Pseudomyogenic Hemangioendothelioma of the Bone in a Child: Case Report and Review of Literature. J Pediatr Hematol Oncol 2019; 41:382-387. [PMID: 31094908 DOI: 10.1097/mph.0000000000001459] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pseudomyogenic hemangioendothelioma (PMH) is a rare neoplasm with vascular and sarcomatous elements, unpredictable course, and uncommon metastatic or fatal potential. Although systemic chemotherapy has been reported with variable success, generally accepted treatment is aggressive surgery with wide margins. Evidence-based treatment options are lacking, and lack of clear prognostic features poses a risk of undertreatment or overtreatment with associated morbidity and mortality. We report the use of initial systemic therapy with oral sirolimus (SIR) and IV zoledronic acid (ZA) to induce a sustained clinical response and avoidance of amputation in a 6-year-old boy. At 37 months after diagnosis, our patient remains in sustained clinical remission as documented by x-ray, MRI, and PET-CT with return of normal mobility/activity and resolution of swelling and pain. Literature review identified 20 cases of pediatric and young adult patients with PMH, of which 7 received some form of systemic therapy. To the best of our knowledge, our patient represents the youngest reported case of PMH and the first successful and limb-sparing utilization of systemic chemotherapy as primary treatment for PMH.
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33
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Sun YF, Wang J. Primary pseudomyogenic hemangioendothelioma of the vulva: a rare location for a rare entity. Diagn Pathol 2019; 14:66. [PMID: 31238962 PMCID: PMC6593540 DOI: 10.1186/s13000-019-0846-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 06/17/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Pseudomyogenic hemangioendothelioma (PMHE) is a recently described vascular neoplasm which typically occurs in the lower extremities of young to middle-aged adults. CASE PRESENTATION We present here a unique case of PMHE arising primarily in the vulva of a 51-year-old woman who presented with a painful vulvar nodule. Clinically, it was thought as Bartholin gland cyst, vulvar hematoma or papilloma. On surgery, two nodules were found with one located in the superficial dermis and the other in the deep subcutis. Histologically, these two nodules showed similar features, composed of fascicles or sheets of plump spindled to epithelioid cells with eosinophilic cytoplasm. Given the morphological resemblance to a myogenic tumor, the lesion was initially diagnosed as a rhabdomyosarcoma by the referring pathologist. However, a comprehensive reevaluation of the submitted slides made us reconsider a PMHE, which was subsequently confirmed by immunohistochemical study. CONCLUSION This case demonstrates that PMHE can also develop in the female external genitalia albeit extremely rare. This disease should be included in the differential diagnostic list of vulvar tumors with spindled to epithelioid morphology and cytokeratin-positive immunophenotypes.
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Affiliation(s)
- Yue-Fang Sun
- Department of Pathology, Shanghai Tenth People's Hospital, Tenth People's Hospital of Tongji University, 301 Yanchang Middle Road, Shanghai, 200072, China.
| | - Jian Wang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
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Caballero GA, Roitman PD. Pseudomyogenic Hemangioendothelioma (Epithelioid Sarcoma-Like Hemangioendothelioma). Arch Pathol Lab Med 2019; 144:529-533. [DOI: 10.5858/arpa.2018-0395-rs] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Pseudomyogenic hemangioendothelioma (PMH) is a rare vascular tumor that presents more frequently in young adults and has a male predominance. It is usually located in the superficial or deep soft tissues of the extremities, but concurrent bone involvement can be present. In approximately two-thirds of patients this disease is multifocal, often involving multiple tissue planes. It is a relapsing lesion with low metastatic potential. Given its clinical and morphologic characteristics (multifocality, epithelioid morphology, absence of clearly evident vascular differentiation on hematoxylin-eosin slides), PMH can be easily misinterpreted as other lesions, often with radically different treatment and prognosis. For this reason, we think it is important to recognize this entity, which has some unique features. Here, we will briefly describe the clinical and pathologic features of PMH, detailing its more relevant differential diagnoses.
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Affiliation(s)
- Gustavo A. Caballero
- From the Pathology Department, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Pablo D. Roitman
- From the Pathology Department, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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35
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Boriani S, Cecchinato R, Righi A, Bandiera S, Dei Tos AP, Ghermandi R, Gasbarrini A. Primary vascular bone tumors in the spine: a challenge for pathologists and spine oncology surgeons. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1502-1511. [DOI: 10.1007/s00586-019-05930-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 01/08/2019] [Accepted: 02/21/2019] [Indexed: 12/13/2022]
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36
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Pseudomyogenic hemangioendothelioma in the spine. CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
First described in 2003 as epithelioid-sarcoma-like hemangioendothelioma and later in 2011 as pseudomyogenic hemangioendothelioma, this rare vascular tumor is of intermediate malignant potential. It was officially included for the first time in the most recent World Health Organization's Classification of Tumours of Soft Tissue and Bone. It typically affects young adults with a predilection for the distal lower extremity. This tumor lacks morphologic features of vascular differentiation but shows unequivocal evidence of such differentiation with the use of relevant immunohistochemical stains such as FLI1, ERG, and CD31. Pseudomyogenic hemangioendothelioma can be diagnostically challenging and might be confused with other tumors, such as epithelioid sarcoma. In this review we discuss the clinical, morphologic, and immunohistochemical features of this tumor with particular emphasis on the differential diagnosis. Salient molecular and prognostic features are also reviewed.
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Affiliation(s)
- Ayah Al-Qaderi
- From the Department of Pathology, Microbiology and Forensic Medicine, School of Medicine-University of Jordan, Jordan University Hospital, Amman, Jordan
| | - Ahmad T Mansour
- From the Department of Pathology, Microbiology and Forensic Medicine, School of Medicine-University of Jordan, Jordan University Hospital, Amman, Jordan
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van IJzendoorn DGP, Bovée JVMG. Vascular Tumors of Bone: The Evolvement of a Classification Based on Molecular Developments. Surg Pathol Clin 2018; 10:621-635. [PMID: 28797505 DOI: 10.1016/j.path.2017.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The classification of vascular tumors of bone has been under debate over time. Vascular tumors in bone are rare, display highly overlapping morphology, and, therefore, are considered difficult by pathologists. Compared with their soft tissue counterparts, they are more often multifocal and sometimes behave more aggressively. Over the past decade, with the advent of next-generation sequencing, recurrent molecular alterations have been found in some of the entities. The integration of morphology and molecular changes has led to a better characterization of these separate entities.
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Affiliation(s)
- David G P van IJzendoorn
- Department of Pathology, Leiden University Medical Center, Postzone L1-Q, Postbus 9600, Leiden 2300 RC, The Netherlands
| | - Judith V M G Bovée
- Department of Pathology, Leiden University Medical Center, Postzone L1-Q, Postbus 9600, Leiden 2300 RC, The Netherlands.
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Pseudomyogenic hemangioendothelioma of skin, bone and soft tissue—a clinicopathological, immunohistochemical, and fluorescence in situ hybridization study. Hum Pathol 2018; 71:126-134. [DOI: 10.1016/j.humpath.2017.10.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/16/2017] [Accepted: 10/18/2017] [Indexed: 11/19/2022]
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40
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Mentzel T, Brenn T. Malignant mesenchymal neoplasms of the dermis and subcutis mimicking benign lesions: a case-based review. Virchows Arch 2017; 471:565-574. [PMID: 28699109 DOI: 10.1007/s00428-017-2187-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/20/2017] [Accepted: 06/28/2017] [Indexed: 01/11/2023]
Abstract
In this short review, malignant mesenchymal neoplasms of the dermis and subcutis mimicking benign lesions and their differential diagnoses are discussed. These include plaque-like dermatofibrosarcoma protuberans, superficial low-grade fibromyxoid sarcoma, low-grade superficial malignant peripheral nerve sheath tumour, epithelioid sarcoma, pseudomyogenic haemangioendothelioma, Kaposi sarcoma mimicking cavernous haemangioma and benign lymphangioendothelioma, and rare forms of angiosarcoma mimicking a benign vascular lesion.
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Affiliation(s)
- Thomas Mentzel
- Dermatopathologie Bodensee, Siemensstrasse 6/1, 88048, Friedrichshafen, Germany.
| | - Thomas Brenn
- Department of Pathology, NHS Lothian University Hospitals Trust and University of Edinburgh, Edinburgh, UK
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41
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Abstract
Primary bone sarcomas represent extremely rare entities. The use of now abolished labels, such as malignant fibrous histiocytoma and hemangiopericytoma, has significantly hampered the chance of identifying specific entities. It is now accepted that a broad variety of mesenchymal malignancies most often arising on the soft tissue may actually present as primary bone lesions. A more accurate morphologic partition is justified based on availability of distinct therapeutic options. An integrated diagnostic approach represents the only way to achieve a correct classification. In consideration of the significant complexity, primary bone sarcomas should ideally be handled in the context of expert centers.
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Abstract
An otherwise healthy 33-year-old man presents with new pain involving the right leg. Radiographs of the femur showed scattered lucent lesions. An MRI of the knee demonstrated nonspecific cortical-based lesions. Biopsy confirmed pseudomyogenic hemangioendothelioma. MDP bone scan and F-FDG PET/CT were obtained to evaluate for extent of disease demonstrating disease limited to the bone of the right leg. Interestingly, the FDG and MDP uptake and CT appearance of the disease were not entirely concordant, with some lesions being lytic on CT and associated with FDG and MDP uptake, other lesions being CT silent and either MDP or FDG avid.
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44
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Sugita S, Hirano H, Kikuchi N, Kubo T, Asanuma H, Aoyama T, Emori M, Hasegawa T. Diagnostic utility of FOSB immunohistochemistry in pseudomyogenic hemangioendothelioma and its histological mimics. Diagn Pathol 2016; 11:75. [PMID: 27515856 PMCID: PMC4982139 DOI: 10.1186/s13000-016-0530-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 08/08/2016] [Indexed: 01/11/2023] Open
Abstract
Background Pseudomyogenic hemangioendothelioma (PHE) is an unusual vascular tumor of intermediate malignancy that rarely metastasizes and tends to arise in the lower limbs of young adults and children. Histologically, PHE shows fascicular proliferation of eosinophilic spindle cells and/or epithelioid cells showing “pseudomyogenic” morphology. Immunohistochemically, PHE is usually positive for vimentin, cytokeratin, CD31 and ERG. Method We examined FOSB immunohistochemistry (IHC) in 27 cases consisting of 4 PHE and its histologic mimics including 6 epithelioid hemangioendotheliomas (EHE), 8 angiosarcomas (AS), 4 Kaposi sarcomas (KS) and 5 epithelioid sarcomas (ES). In addition, we performed IHC of CAMTA1 which has recently been established as a useful marker of EHE. We elucidated the diagnostic utility of FOSB IHC in the differential diagnosis of PHE and its histological mimics and also examined the usefulness of FOSB and CAMTA1 IHC combination in the differential diagnosis of the tumors. Results IHC revealed diffuse and strong FOSB expression in all PHE cases, while the other tumor types demonstrated limited, weak or no FOSB expression. All EHE cases exhibited diffuse and moderate to strong expression of CAMTA1. All tumor types except for EHE showed limited, weak or no CAMTA1 reactivity. Conclusions Diffuse and strong FOSB expression was specific for PHE in the current series and FOSB IHC is an effective tool for differentiating between PHE and its histological mimics. Moreover, the combination of FOSB and CAMTA1 IHC is useful for distinguishing PHE from EHE.
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Affiliation(s)
- Shintaro Sugita
- Department of Surgical Pathology, Sapporo Medical University, School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Hiroshi Hirano
- Department of Surgical Pathology, Sapporo Medical University, School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Noriaki Kikuchi
- Department of Surgical Pathology, Sapporo Medical University, School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Terufumi Kubo
- Department of Surgical Pathology, Sapporo Medical University, School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Hiroko Asanuma
- Department of Surgical Pathology, Sapporo Medical University, School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Tomoyuki Aoyama
- Department of Surgical Pathology, Sapporo Medical University, School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Makoto Emori
- Department of Orthopedic Surgery, Sapporo Medical University, School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Tadashi Hasegawa
- Department of Surgical Pathology, Sapporo Medical University, School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
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