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Kervarrec T, Battistella M, Macagno N. [Cutaneous adnexal tumours: Development and synthesis of diagnostic fusion genes]. Ann Pathol 2024:S0242-6498(24)00118-4. [PMID: 38839526 DOI: 10.1016/j.annpat.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 04/24/2024] [Accepted: 05/02/2024] [Indexed: 06/07/2024]
Abstract
Cutaneous adnexal tumours are a heterogeneous group of epithelial lesions that includes tumours with follicular, sudoral and/or sebaceous differentiation, or even several combined lines of differentiation. Over the last few years, molecular analysis of these lesions has allowed to identify specific molecular events responsible for tumour development in an increasing number of tumour types. Like other rare neoplasms, such as soft tissue tumours, adnexal tumours display fusion genes resulting from chromosomal translocations that may be specific for the diagnosis if molecular data are properly integrated in the clinical and morphological setting. Molecular testing of adnexal tumours is valuable as it allows to strengthen the robustness of the diagnosis for a group of tumours displaying a wide morphological spectrum. It has allowed to refine the diagnostic criteria and to develop increasingly specific diagnostic immunostainings. Finally, molecular testing has been responsible for the identification of new entities or morphological subtypes of previously known entities. The aim of this review is to provide an update on cutaneous adnexal tumours associated with fusion genes and to evaluate the impact of molecular data on the diagnosis of these lesions.
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Affiliation(s)
- Thibault Kervarrec
- Department of Pathology, université de Tours, hôpital Trousseau, CHRU de Tours, 37044 Tours, France; « Biologie des infections à polyomavirus » team, UMR Inra ISP 1282, université de Tours, Tours, France; CARADERM Network, Lille, France.
| | - Maxime Battistella
- CARADERM Network, Lille, France; Department of Pathology, hôpital Saint-Louis, université Paris 7, AP-HP, Paris, France
| | - Nicolas Macagno
- CARADERM Network, Lille, France; Department of Pathology, Timone University Hospital, Marseille, France
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2
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Mansour B, Donati M, Pancsa T, Grossman P, Šteiner P, Vaněček T, Comová K, Michal M, Michal M. Molecular analysis of apocrine mixed tumors and cutaneous myoepitheliomas: a comparative study confirming a continuous spectrum of one entity with near-ubiquitous PLAG1 and rare mutually exclusive HMGA2 gene rearrangements. Virchows Arch 2024:10.1007/s00428-024-03811-x. [PMID: 38736009 DOI: 10.1007/s00428-024-03811-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/08/2024] [Accepted: 04/19/2024] [Indexed: 05/14/2024]
Abstract
Myoepithelial neoplasms of the skin and soft tissue still represent a confusing and somewhat controversial field in pathology as it appears that this category includes several different entities. However, recent studies have suggested that both apocrine mixed tumors (AMT) and cutaneous myoepitheliomas (CM) harbor identical chromosomal rearrangements involving the PLAG1 gene and hence may represent a morphological spectrum. The aim of the present study was to share our institutional experience with these tumors and specifically focus on studying their immunohistochemical and molecular features to further assess their relatedness. Eleven cases of AMT and 7 cases of CM were collected and analyzed using immunohistochemistry (IHC), PLAG1 FISH, and Archer FusionPlex assay. There were 14 male and 4 female patients with ages ranging from 26 to 85 years (median 55.8 years, mean 58.5 years). AMTs were mainly located in the head and neck (n = 10), while CMs were mainly located in the acral sites (n = 5). PLAG1 IHC was diffusely strongly positive in 14/17 (82%) cases, whereas a single case of AMT diffusely expressed HMGA2. Both tumor groups showed PLAG1 gene fusions which were detected in 6/13 analyzable samples (AMT, n = 4 and CM, n = 2), and included TRPS1::PLAG1 (n = 3), NDRG1::PLAG1 (n = 1), CTNNB1::PLAG1 (n = 1) and a novel PXDNL::PLAG1 fusion (n = 1). The remaining 5 cases were negative, 5 were not analyzable and the single case positive for HMGA2 by IHC revealed a potential HMGA2 gene rearrangement. The cases were further studied by FISH, with 12/17 cases showing PLAG1 gene rearrangement (AMT, n = 8 and CM, n = 4). Altogether, 14/18 cases showed PLAG1 gene rearrangement by at least one of the methods. PLAG1 immunohistochemistry had a 92% specificity and sensitivity. Our study provided additional data to suggest that AMT and CM share overlapping morphological and immunohistochemical features as well as molecular background characterized by PLAG1 gene fusions and thus represent a morphological spectrum. In addition, we identified a novel PXDNL::PLAG1 fusion and suggested that rare cases may harbor HMGA2 gene alterations which seem to be mutually exclusive with PLAG1 gene fusions. The relatedness of these tumors to salivary gland myoepithelial neoplasms and distinctness from eccrine mixed tumors and other skin and soft tissue myoepithelial neoplasms with EWSR1/FUS fusions is discussed.
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Affiliation(s)
- Boulos Mansour
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.
| | - Michele Donati
- Department of Pathology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128, Roma, Italy
| | - Tamás Pancsa
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
- Bioptical Laboratory, Ltd., Pilsen, Czech Republic
| | - Petr Grossman
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
- Bioptical Laboratory, Ltd., Pilsen, Czech Republic
| | - Petr Šteiner
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
- Bioptical Laboratory, Ltd., Pilsen, Czech Republic
| | - Tomáš Vaněček
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
- Bioptical Laboratory, Ltd., Pilsen, Czech Republic
| | - Kateřina Comová
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
- Bioptical Laboratory, Ltd., Pilsen, Czech Republic
| | - Michal Michal
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
- Bioptical Laboratory, Ltd., Pilsen, Czech Republic
| | - Michael Michal
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
- Bioptical Laboratory, Ltd., Pilsen, Czech Republic
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Macagno N, Kervarrec T, Thanguturi S, Sohier P, Pissaloux D, Mescam L, Jullie ML, Frouin E, Osio A, Faisant M, Le Loarer F, Cribier B, Calonje E, Luna EVE, Massi D, Goto K, Nishida H, Paindavoine S, Houlier A, Tantot J, Benzerdjeb N, Tirode F, De la Fouchardière A, Battistella M. SOX10-Internal Tandem Duplications and PLAG1 or HMGA2 Fusions Segregate Eccrine-Type and Apocrine-Type Cutaneous Mixed Tumors. Mod Pathol 2024; 37:100430. [PMID: 38266920 DOI: 10.1016/j.modpat.2024.100430] [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: 05/31/2023] [Revised: 12/26/2023] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
Cutaneous mixed tumors exhibit a wide morphologic diversity and are currently classified into apocrine and eccrine types based on their morphologic differentiation. Some cases of apocrine-type cutaneous mixed tumors (ACMT), namely, hyaline cell-rich apocrine cutaneous mixed tumors (HCR-ACMT) show a prominent or exclusive plasmacytoid myoepithelial component. Although recurrent fusions of PLAG1 have been observed in ACMT, the oncogenic driver of eccrine-type cutaneous mixed tumors (ECMT) is still unknown. The aim of the study was to provide a comprehensive morphologic, immunohistochemical, and molecular characterization of these tumors. Forty-one cases were included in this study: 28 cases of ACMT/HCR-ACMT and 13 cases of ECMT. After morphologic and immunohistochemical characterization, all specimens were analyzed by RNA sequencing. By immunohistochemistry, all cases showed expression of SOX10, but only ACMT/HCR-ACMT showed expression of PLAG1 and HMGA2. RNA sequencing confirmed the presence of recurrent fusion of PLAG1 or HMGA2 in all cases of ACMT/HCR-ACMT, with a perfect correlation with PLAG1/HMGA2 immunohistochemical status, and revealed internal tandem duplications of SOX10 (SOX10-ITD) in all cases of ECMT. Although TRPS1::PLAG1 was the most frequent fusion, HMGA2::WIF1 and HMGA2::NFIB were detected in ACMT cases. Clustering analysis based on gene expression profiling of 110 tumors, including numerous histotypes, showed that ECMT formed a distinct group compared with all other tumors. ACMT, HCR-ACMT, and salivary gland pleomorphic adenoma clustered together, whereas myoepithelioma with fusions of EWSR1, FUS, PBX1, PBX3, POU5F1, and KLF17 formed another cluster. Follow-up showed no evidence of disease in 23 cases across all 3 tumor types. In conclusion, our study demonstrated for the first time SOX10-ITD in ECMT and HMGA2 fusions in ACMT and further refined the prevalence of PLAG1 fusions in ACMT. Clustering analyses revealed the transcriptomic distance between these different tumors, especially in the heterogenous group of myoepitheliomas.
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Affiliation(s)
- Nicolas Macagno
- CARADERM, French Network of Rare Skin Cancers, Lille, France; Department of Pathology, APHM, Timone, Marseille, France; Aix Marseille University, INSERM, MMG, Marseille, France.
| | - Thibault Kervarrec
- CARADERM, French Network of Rare Skin Cancers, Lille, France; Department of Pathology, Université de Tours, Centre Hospitalier Universitaire de Tours, Tours, France; "Biologie des infections à polyomavirus" team, UMR INRA ISP 1282, Université de Tours, Tours, France
| | | | - Pierre Sohier
- Department of Pathology, Hôpital Cochin, AP-HP. Centre-Université Paris Cité, Paris, France
| | - Daniel Pissaloux
- Department of Biopathology, Centre Léon Bérard, Lyon, France; Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Equipe Labellisée Ligue contre le Cancer, Lyon, France
| | - Lenaïg Mescam
- Department of Biopathology, Paoli-Calmettes Institute, Marseille, France
| | - Marie-Laure Jullie
- Department of Pathology, University Hospital of Bordeaux, Bordeaux, France
| | - Eric Frouin
- Department of Pathology, University Hospital of Poitiers, University of Poitiers, LITEC, Poitiers, France
| | - Amelie Osio
- National Center of Dermatopathology, Paris-la Roquette, Ivry, France; Department of Pathology, HCL Lyon-Sud Hospital, Lyon, France
| | | | - François Le Loarer
- Department of Biopathology, Bergonié Institute, Bordeaux, France; Bordeaux Institute of Oncology, BRIC U1312, INSERM, Université de Bordeaux, Institut Bergonié, Bordeaux, France
| | - Bernard Cribier
- Department of Dermatology, University of Strasbourg, Strasbourg, France
| | - Eduardo Calonje
- Department of Dermatopathology, St John's institute of Dermatology, Guy's and St Thomas' NHS trust, London, United Kingdom
| | - Evelyn Vanesa Erazo Luna
- Department of Dermatopathology, St John's institute of Dermatology, Guy's and St Thomas' NHS trust, London, United Kingdom
| | - Daniela Massi
- Section of Pathology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Keisuke Goto
- Department of Diagnostic Pathology, Faculty of Medicine, Oita, Japan
| | - Haruto Nishida
- Department of Diagnostic Pathology, Faculty of Medicine, Oita, Japan
| | | | - Aurelie Houlier
- Department of Biopathology, Centre Léon Bérard, Lyon, France
| | - Juliet Tantot
- Department of Pathology, HCL Lyon-Sud Hospital, Lyon, France
| | | | - Franck Tirode
- Department of Biopathology, Centre Léon Bérard, Lyon, France; Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Equipe Labellisée Ligue contre le Cancer, Lyon, France
| | - Arnaud De la Fouchardière
- Department of Biopathology, Centre Léon Bérard, Lyon, France; Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Equipe Labellisée Ligue contre le Cancer, Lyon, France
| | - Maxime Battistella
- CARADERM, French Network of Rare Skin Cancers, Lille, France; Department of Pathology, AP-HP Hospital Saint-Louis, INSERM U976, Université Paris Cité, Paris, France
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Kervarrec T, Tallet A, Macagno N, de la Fouchardière A, Pissaloux D, Tirode F, Bravo IG, Nicolas A, Baulande S, Sohier P, Balme B, Osio A, Jullie ML, Moulonguet I, Bonsang B, Tournier E, Herfs M, Frouin E, Zidan A, Calonje E, Berthon P, Touzé A, Seris A, Mortier L, Jouary T, Cribier B, Battistella M. Sweat Gland Tumors Arising on Acral Sites: A Molecular Survey. Am J Surg Pathol 2023; 47:1096-1107. [PMID: 37505808 DOI: 10.1097/pas.0000000000002098] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Recurrent oncogenic drivers have been identified in a variety of sweat gland tumors. Recently, integration of human papillomavirus type 42 (HPV42) has been reported in digital papillary adenocarcinoma (DPA). The main objectives of the present study were (i) to provide an overview of the prevalence of previously identified oncogenic drivers in acral sweat gland tumors and (ii) to genetically characterize tumors in which no recurrent genetic alteration has been identified yet. Cases of acral sweat gland tumors were identified from the database of the French network CARADERM. After histologic review, the presence of previously identified genetic alterations was investigated in the entire cohort (n=79) using a combination of immunohistochemistry and targeted DNA and RNA sequencing. Tumor entities with no recurrent genetic alterations were submitted to whole-transcriptome sequencing. CRTC1::MAML2 fusion was identified in cases of hidradenoma and hidradenocarcinoma (n=9/12 and n=9/12). A p.V600E mutation of BRAF was observed in all cases of tubular adenoma (n=4). YAP1:MAML2 and YAP1::NUTM1 fusions were observed in poroid tumors (n=15/25). ETV6::NTRK3 and TRPS1::PLAG1 fusion transcripts were identified in secretory carcinoma (n=1/1) and cutaneous mixed tumors (n=3/4), respectively. The HPV42 genome was detected in most cases of DPA (n=10/11) and in 1 adnexal adenocarcinoma not otherwise specified. Finally, whole-transcriptome analysis revealed BRD3::NUTM1 or NSD3::NUTM1 fusions in 2 cases of NUT adnexal carcinoma and NCOA4::RET and CCDC6::RET fusion transcripts in 2 cystadenoma/hidrocystoma-like tumors. Our study confirms distinctive cytogenetic abnormalities in a wide number of acral adnexal neoplasms and supports the use of molecular analysis as a valuable aid in the diagnosis of these rare and often difficult to diagnose group of neoplasms.
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Affiliation(s)
- Thibault Kervarrec
- CARADERM, French Network of Rare Cutaneous Cancer
- Department of Pathology, University Hospital Center of Tours
- "Biologie des infections polyomavirus" Team, UMR INRA ISP1282, University of Tours
| | - Anne Tallet
- Platform of Solid Tumor Molecular Genetics, University Hospital Center of Tours, Tours
| | - Nicolas Macagno
- CARADERM, French Network of Rare Cutaneous Cancer
- Department of Pathology, APHM, Timone University Hospital
- Aix Marseille University, INSERM, MMG, UMR1251, Marmara Institute, Marseille
| | - Arnaud de la Fouchardière
- CARADERM, French Network of Rare Cutaneous Cancer
- Department of Biopathology, Center Léon Bérard
- University of Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Equipe Labellisée Ligue contre le Cancer
| | - Daniel Pissaloux
- Department of Biopathology, Center Léon Bérard
- University of Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Equipe Labellisée Ligue contre le Cancer
| | - Franck Tirode
- University of Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Equipe Labellisée Ligue contre le Cancer
| | - Ignacio G Bravo
- French National Center for Scientific Research (CNRS), Laboratory MIVEGEC (CNRS IRD Univ Montpellier), Montpellier
| | - Alain Nicolas
- Institut Curie, PSL Research University, CNRS UMR3244
| | | | - Pierre Sohier
- CARADERM, French Network of Rare Cutaneous Cancer
- Faculté de Médecine Paris Centre Santé, University of Paris
- Department of Pathology, Cochin Hospital, AP-HP, AP-HP Centre-Université de Paris
| | - Brigitte Balme
- CARADERM, French Network of Rare Cutaneous Cancer
- Department of Pathology, University Hospital Center of Lyon-Sud, Hospices Civils de Lyon, Lyon
| | - Amélie Osio
- CARADERM, French Network of Rare Cutaneous Cancer
- National Center of Dermatopathology, Paris-la Roquette, Ivry
| | - Marie-Laure Jullie
- CARADERM, French Network of Rare Cutaneous Cancer
- Department of Pathology, University Hospital Center of Bordeaux, Pessac
| | | | - Benjamin Bonsang
- CARADERM, French Network of Rare Cutaneous Cancer
- Department of Pathology, Hôpital Ambroise Pare, AP-HP
| | - Emilie Tournier
- CARADERM, French Network of Rare Cutaneous Cancer
- Department of Pathology, CHU Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole
- Université Toulouse III Paul Sabatier, Toulouse
| | - Michael Herfs
- Laboratory of Experimental Pathology, GIGA-Cancer, University of Liège, Liège, Belgium
| | - Eric Frouin
- Department of Pathology, University Hospital Center of Poitiers, LITEC, UR 15560, University of Poitiers, Poitiers
| | - Anoud Zidan
- Dermatopathology Laboratory, St John's Institute of Dermatology, St Thomas' Hospital, London, UK
| | - Eduardo Calonje
- Dermatopathology Laboratory, St John's Institute of Dermatology, St Thomas' Hospital, London, UK
| | - Patricia Berthon
- "Biologie des infections polyomavirus" Team, UMR INRA ISP1282, University of Tours
| | - Antoine Touzé
- "Biologie des infections polyomavirus" Team, UMR INRA ISP1282, University of Tours
| | - Alice Seris
- CARADERM, French Network of Rare Cutaneous Cancer
- Department of Dermatology, Hospital Center of Pau, Pau
| | - Laurent Mortier
- CARADERM, French Network of Rare Cutaneous Cancer
- Department of Dermatology, University Hospital Center of Lille, Lille
| | - Thomas Jouary
- CARADERM, French Network of Rare Cutaneous Cancer
- Department of Dermatology, Hospital Center of Pau, Pau
| | - Bernard Cribier
- CARADERM, French Network of Rare Cutaneous Cancer
- Clinique Dermatologique, Hôpitaux Universitaires & Université de Strasbourg, Hôpital Civil, Strasbourg, France
| | - Maxime Battistella
- CARADERM, French Network of Rare Cutaneous Cancer
- Department of Pathology, Hopital Saint Louis, AP-HP Universite ́ Paris 7, Paris
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Kervarrec T, Sohier P, Pissaloux D, de la Fouchardiere A, Cribier B, Battistella M, Macagno N. Genetics of adnexal tumors: An update. Ann Dermatol Venereol 2023; 150:202-207. [PMID: 37270318 DOI: 10.1016/j.annder.2023.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 03/07/2023] [Indexed: 06/05/2023]
Abstract
Cutaneous adnexal tumors form a vast heterogeneous group that include frequent entities that are mostly benign, as well as rare tumors that are occasionally malignant. In contrast to cutaneous tumors arising from the interfollicular epidermis that develop as a result of accumulation of UV-induced DNA damage (basal cell carcinoma, squamous cell carcinoma), the oncogenesis of adnexal tumors is related to a broad spectrum of genetic mechanisms (e.g., point mutation, fusion genes, viral integration, etc.). In this setting, specific and recurrent genetic alterations have been progressively reported, and these allow better classification of these entities. For certain of them, immunohistochemical tools are now available, enabling precise integrated histological and molecular diagnosis since certain entities are linked to well-defined alterations. In this context, we aim in this review to summarize the main molecular tools currently available for the classification of adnexal tumors.
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Affiliation(s)
- T Kervarrec
- CARADERM Network, Lille, France; Department of Pathology, University Hospital Center of Tours, Tours, France.
| | - P Sohier
- CARADERM Network, Lille, France; Department of Pathology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, AP-HP Centre - University of Paris Cité, Paris, France; Faculty of Medicine, University of Paris Cité, Paris, France
| | - D Pissaloux
- Department of Pathology, Centre Léon Bérard, Lyon, France
| | | | - B Cribier
- CARADERM Network, Lille, France; Dermatology Clinic, University Hospital of Strasbourg, Hôpital Civil, Strasbourg, France
| | - M Battistella
- CARADERM Network, Lille, France; Department of Pathology, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, AP-HP Centre - Paris 7, Paris, France
| | - N Macagno
- CARADERM Network, Lille, France; Department of Pathology, AP-HM, University Hospital of la Timone, Marseille, France; University of Aix-Marseille, INSERM U1251, MMG, Marseille, France
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Ariasi C, Romanò C, Ghini I, Licata G, Rubelli L, Artelli GL, Calzavara-Pinton P, Arisi M. Cutaneous Syncytial Myoepithelioma with Positive CD34 Immunohistochemical Staining: An Unusual Tumor and a Challenging Diagnosis. Dermatopathology (Basel) 2023; 10:259-265. [PMID: 37754276 PMCID: PMC10529716 DOI: 10.3390/dermatopathology10030034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023] Open
Abstract
Cutaneous syncytial myoepithelioma (CSM) is a rare type of cutaneous neoplasm that typically presents as a solitary and well-circumscribed nodule on the skin. It predominantly occurs on the upper and lower extremities of adult patients. Immunohistochemically, CSM is characterized by the co-expression of smooth muscle and epithelial markers. Fluorescence in situ hybridization (FISH) targeting the EWSR1 gene rearrangement is an important diagnostic tool for CSM. In our case report, we found the focal positivity for CD34, which has never been previously observed; this was mostly confined to a central area of the neoplasm.
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Affiliation(s)
- Cesare Ariasi
- Department of Dermatology, University of Brescia, 25123 Brescia, Italy
| | - Carola Romanò
- Department of Dermatology, University of Brescia, 25123 Brescia, Italy
| | - Iacopo Ghini
- Department of Pathology, University of Brescia, 25123 Brescia, Italy
| | - Gaetano Licata
- Dermatology Unit, San Antonio Abate Hospital, 91016 Trapani, Italy
| | - Luca Rubelli
- Department of Dermatology, University of Brescia, 25123 Brescia, Italy
| | | | | | - Mariachiara Arisi
- Department of Dermatology, University of Brescia, 25123 Brescia, Italy
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