1
|
Palsgrove DN, Foss RD, Yu W, Garcia J, Rooper LM, Rekhtman N, Antonescu C, Gagan J, Agaimy A, Bishop JA. Adamantinoma-like Ewing Sarcoma (ALES) May Harbor FUS Rearrangements : A Potential Diagnostic Pitfall. Am J Surg Pathol 2023; 47:1243-1251. [PMID: 37494548 DOI: 10.1097/pas.0000000000002100] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Adamantinoma-like Ewing sarcoma (ALES) is a rare malignancy currently considered a variant of Ewing sarcoma with most known cases harboring EWSR1 rearrangements. Herein we present a series of 6 cases of EWSR1 -negative ALES. The tumors arose in the sinonasal tract (n=3), major salivary glands (submandibular gland=1; parotid=1), and anterior mediastinum (n=1) in patients ranging from 25 to 79 years of age. Most tumors were basaloid in appearance, growing in large nests separated by interlobular fibrosis without overt squamous pearls. However, 1 case closely resembled a well-differentiated neuroendocrine tumor with uniformly round nuclei, eosinophilic cytoplasm, and trabecular architecture. All cases were diffusely positive for pan-cytokeratin, p40 or p63, and CD99. A subset of cases showed diffuse reactivity for synaptophysin, including 1 sinonasal tumor which also demonstrated sustentacular S100 protein expression. Molecular testing showed FUS rearrangements in all cases. Gene partners included known ETS family members FEV (n=2) and FLI1 (n=1). Our results expand the molecular diagnostic considerations for ALES to include FUS rearrangements. We also show that ALES may harbor FUS :: FLI1 fusion, which has not been previously reported in the Ewing family of tumors. Furthermore, ALES may show unusual histologic and immunophenotypic features that can overlap with olfactory carcinoma including S100-positive sustentacular cells. ALES should be considered in the diagnostic differential of small round cell tumors and tumors with neuroendocrine differentiation with immunohistochemical workup to include p40 and CD99/NKX2.2.
Collapse
Affiliation(s)
- Doreen N Palsgrove
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas
| | - Robert D Foss
- Head & Neck Pathology, Joint Pathology Center, Silver Spring
| | - Wengdong Yu
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Lisa M Rooper
- Department of Pathology, Johns Hopkins Hospital, Baltimore, MD
| | - Natasha Rekhtman
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Cristina Antonescu
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Jeffrey Gagan
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas
| | - Abbas Agaimy
- Institute of Pathology, University Hospital, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Justin A Bishop
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas
| |
Collapse
|
2
|
Lanic MD, Guérin R, Wassef M, Durdilly P, Rainville V, Sater V, Jardin F, Ruminy P, Costes-Martineau V, Laé M. Detection of salivary gland and sinonasal fusions by a next-generation sequencing based, ligation-dependent, multiplex RT-PCR assay. Histopathology 2023; 83:685-699. [PMID: 37350081 DOI: 10.1111/his.14971] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 06/24/2023]
Abstract
AIMS The discovery of tumour type-specific gene fusion oncogenes in benign and malignant salivary gland and sinonasal (SGSN) tumours has significantly increased our knowledge about their molecular pathology and classification. METHODS AND RESULTS We developed a new targeted multiplexed next-generation sequencing (NGS)-based method that utilizes ligation dependent reverse-transcriptase polymerase chain reaction (LD-RT-PCR) to detect oncogenic fusion transcripts involving 116 genes, leading to 96 gene fusions known to be recurrently rearranged in these tumours. In all, 180 SGSN tumours (formalin-fixed, paraffin-embedded samples, 141 specimens and 39 core needle biopsies) from the REFCORpath (French network for rare head and neck cancers) with previously identified fusion genes by fluorescent in situ hybridisation (FISH), RT-PCR, or molecular immunohistochemistry were selected to test its specificity and sensitivity and validate its diagnostic use. Tested tumours encompassed 14 major tumours types, including secretory carcinoma, mucoepidermoid carcinoma, adenoid cystic carcinoma, salivary gland intraductal carcinoma, clear cell carcinoma, pleomorphic adenoma, adamantinoma-like Ewing Sarcoma, EWSR1::COLCA2 sinonasal sarcoma, DEK::AFF2 sinonasal carcinoma, and biphenotypic sinonasal sarcoma. In-frame fusion transcripts were detected in 97.8% of cases (176/180). Gene fusion assay results correlated with conventional techniques (immunohistochemistry [IHC], FISH, and RT-PCR) in 176/180 tumours (97.8%). CONCLUSION This targeted multiplexed NGS-based LD-RT-PCR method is a robust, highly sensitive method for the detection of recurrent gene fusions from routine clinical SGSN tumours. It can be easily customized to cover new fusions. These results are promising for implementing an integrated NGS system to rapidly detect genetic aberrations, facilitating accurate, genomics-based diagnoses, and accelerate time to precision therapies in SGSN tumours.
Collapse
Affiliation(s)
- Marie-Delphine Lanic
- INSERM U1245, Cancer Center Henri Becquerel, Institute of Research and Innovation in Biomedicine (IRIB), University of Normandy, UNIROUEN, Rouen, France
| | - René Guérin
- Department of Pathology, Centre Henri Becquerel, Rouen, France
| | - Michel Wassef
- Department of Pathology, Hôpital Lariboisière, Paris, France
| | | | - Vinciane Rainville
- INSERM U1245, Cancer Center Henri Becquerel, Institute of Research and Innovation in Biomedicine (IRIB), University of Normandy, UNIROUEN, Rouen, France
| | - Vincent Sater
- Department of Pathology, Centre Henri Becquerel, Rouen, France
| | - Fabrice Jardin
- INSERM U1245, Cancer Center Henri Becquerel, Institute of Research and Innovation in Biomedicine (IRIB), University of Normandy, UNIROUEN, Rouen, France
| | - Philippe Ruminy
- INSERM U1245, Cancer Center Henri Becquerel, Institute of Research and Innovation in Biomedicine (IRIB), University of Normandy, UNIROUEN, Rouen, France
| | | | - Marick Laé
- INSERM U1245, Cancer Center Henri Becquerel, Institute of Research and Innovation in Biomedicine (IRIB), University of Normandy, UNIROUEN, Rouen, France
- Department of Pathology, Centre Henri Becquerel, Rouen, France
| |
Collapse
|
3
|
Fritchie KJ, Ameline B, Andrei V, Griffith C, Shah AA, Dermawan JK, Trucco M, Budd T, Thangaiah JJ, Molligan J, Whaley RD, Magliocca K, Azzato E, van Zante A, Jo V, Xu B, Bishop JA, Rooper L, Baumhoer D. DNA Methylation Profiling Distinguishes Adamantinoma-Like Ewing Sarcoma From Conventional Ewing Sarcoma. Mod Pathol 2023; 36:100301. [PMID: 37567448 PMCID: PMC11195538 DOI: 10.1016/j.modpat.2023.100301] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/01/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023]
Abstract
Adamantinoma-like Ewing sarcoma (ALES) has traditionally been considered a variant of Ewing sarcoma because it generally harbors EWSR1::FLI1 fusions despite showing diffuse positivity for keratins and p40. However, it has become increasingly recognized that different tumors can have identical translocations, including shared fusions between carcinomas and sarcomas, raising questions as to whether ALES might represent a separate entity. Using methylation profiling, we further explored the relationship between Ewing sarcoma and ALES. The archives of multiple institutions were searched for candidate cases of ALES. DNA methylation profiling was performed and results were compared to corresponding data from conventional Ewing sarcoma. Twelve cases of ALES (5 previously reported) were identified in 10 men and 2 women (aged 20-72 years; median age, 41.5 years). Cases included tumors arising in the parotid gland (3), sinonasal cavity (2), submandibular gland (2), thyroid gland (1), neck (1), gingiva (1), hypopharynx (1), and mandible (1). Histologic review consistently showed sheets and nests of basaloid cells within a fibromyxoid or hyalinized stroma. All tumors were positive for at least 1 keratin and CD99 expression, whereas all 10 cases tested were positive for p63 or p40; S100 protein expression was noted in 2 cases. Cases harbored either EWSR1::FLI1 fusions (n = 6), FUS::FLI1 fusions (n = 1), and/or EWSR1 rearrangements (n = 6). Methylation profiling was successful in 11/12 cases evaluated. Unsupervised clustering and dimensionality reduction (Uniform Manifold Approximation and Projection) of DNA methylation data revealed a distinct methylation cluster for all 11 cases, including the tumor with the FUS::FLI1 fusion, which clearly segregated them from the conventional Ewing sarcoma. Follow-up (n = 11, 1-154 months) revealed that 4 patients experienced recurrence and 6 developed metastatic disease. ALES demonstrates a distinct methylation signature from conventional Ewing sarcoma. This finding adds to the distinctive immunoprofile of ALES, suggesting that these 2 tumors should be considered distinct entities rather than histologic extremes of the same disease.
Collapse
Affiliation(s)
- Karen J Fritchie
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio.
| | - Baptiste Ameline
- Bone Tumor Reference Center at the Institute for Medical Genetics and Pathology, University Hospital and University of Basel, Basel, Switzerland
| | - Vanghelita Andrei
- Bone Tumor Reference Center at the Institute for Medical Genetics and Pathology, University Hospital and University of Basel, Basel, Switzerland
| | | | - Akeesha A Shah
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio
| | | | - Matteo Trucco
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplant, Cleveland Clinic, Cleveland, Ohio
| | - Thomas Budd
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Judith J Thangaiah
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Jeremy Molligan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Rumeal D Whaley
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Kelly Magliocca
- Department of Pathology & Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Elizabeth Azzato
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Annemieke van Zante
- Department of Pathology, University of California, San Francisco School of Medicine, San Francisco, California
| | - Vickie Jo
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Bin Xu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, Manhattan, New York
| | - Justin A Bishop
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lisa Rooper
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Daniel Baumhoer
- Bone Tumor Reference Center at the Institute for Medical Genetics and Pathology, University Hospital and University of Basel, Basel, Switzerland
| |
Collapse
|
4
|
Kakkar A, Bharati V, Pulimala S, Kumar R, Bhalla AS. Fine-needle aspiration cytology of adamantinoma-like Ewing sarcoma: An unusual parotid tumor. Diagn Cytopathol 2023; 51:E38-E44. [PMID: 36190155 DOI: 10.1002/dc.25061] [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: 06/04/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 12/13/2022]
Abstract
Adamantinoma-like Ewing sarcoma (ALES) is a histological subtype of Ewing sarcoma that demonstrates the morphological and immunohistochemical features of the latter, harbors the EWSR1::FLI1 gene fusion, and additionally demonstrates complex epithelial differentiation on morphology and immunohistochemistry. Accurate preoperative diagnosis has potential to inform management and improve patient outcome. Cytomorphology of ALES is not well documented, with available reports showing a spectrum of features. An aspirate from a 30-year-old male with a swelling in right parotid region, interpreted elsewhere as acinic cell carcinoma (ACC), was submitted to us for review. Smears showed dispersed cells and loosely cohesive clusters with scant cytoplasm and large nuclei with focal nuclear molding, prompting a diagnosis of malignant neoplasm, possibly neuroendocrine carcinoma. Cytoplasmic vacuoles and tigroid background were present focally, the former of which had possibly led to interpretation as ACC. No material was available for ancillary tests. Parotidectomy revealed features of ALES. The cytological features of ALES in the parotid overlap with several basaloid and round blue cell neoplasms that are more common at this site. ALES should be considered in all salivary gland aspirates with isomorphic small round or basaloid cells, with or without the presence of squamous differentiation. Rosettes, cytoplasmic vacuoles, and a tigroid background are subtle morphological clues to the diagnosis, which if suspected on cytomorphology, can be confirmed using ancillary techniques.
Collapse
Affiliation(s)
- Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Vandna Bharati
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Shijitha Pulimala
- Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
5
|
Xu B. Proceedings of the North American Society of Head and Neck Pathology, Los Angeles, CA, March 20, 2022. Emerging Bone and Soft Tissue Neoplasms in the Head and Neck Region. Head Neck Pathol 2022; 16:158-167. [PMID: 35307771 PMCID: PMC9019004 DOI: 10.1007/s12105-022-01418-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/18/2022] [Indexed: 12/20/2022]
Abstract
In the past decade, several emerging bone and soft tissue neoplasms of the head and neck region have been described in the literature, including GLI1-altered mesenchymal tumors, (intraosseous) rhabdomyosarcoma with TFCP2 fusion, and adamantinoma-like Ewing sarcoma. This review provides a summary of the clinical features, histologic characteristics, immunoprofile, key diagnostic features, and differential diagnoses of these emerging entities. Notably, all three entities show epithelioid morphology and cytokeratin immunopositivity, highlighting the need to consider these mesenchymal neoplasms in the differential diagnoses of cytokeratin-positive epithelioid tumors in the head and neck region. Appropriate workups including detection of the characteristic molecular alterations are essential for the correct diagnosis.
Collapse
Affiliation(s)
- Bin Xu
- Department of Pathology and Laboratory Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| |
Collapse
|
6
|
Bal M, Shah A, Rekhi B, Mittal N, Rane SU, Rabade K, Shetty O, Pantavaidya G, Nair D, Prabhash K, Aishwarya M, Govindarajan KK, Laskar S, Laskar SG, Patil A. Adamantinoma-Like Ewing Sarcoma of the Head and Neck: A Case-Series of a Rare and Challenging Diagnosis. Head Neck Pathol 2022; 16:679-694. [PMID: 35025056 PMCID: PMC9424385 DOI: 10.1007/s12105-022-01412-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/03/2022] [Indexed: 01/16/2023]
Abstract
Adamantinoma-like Ewing sarcoma (ALES) is a rare malignant tumor characterized by EWSR1::FLI1 related fusions and complex epithelial differentiation. ALES poses a tremendous diagnostic challenge owing to its resemblance to a wide variety of common head and neck malignancies. We aimed to study the clinicopathologic spectrum of ALES diagnosed at our institute. A retrospective review of the clinical and pathologic features of all EWSR1-rearranged ALES cases was performed after confirming the diagnosis. The cases lacking EWSR1 rearrangement were excluded. A total of 7 patients were analyzed. The median age was 27 years (range 7-42 years). There were 4 males and 3 female patients. Tumors were distributed as follows: maxilla (n = 2), parotid (n = 2), nasal cavity (n = 1), ethmoid/maxilla (n = 1), and thyroid (n = 1). Tumor size ranged from 2.2 to 5.5 cm. On microscopy, tumors displayed nested-lobular architecture, monomorphic cells, and interlobular fibrotic stroma. Other features included: palisading (n = 5), squamous differentiation (n = 2), keratinization (n = 1), colonisation of salivary ducts (n = 1) and thyroid follicles (n = 1), follicle-like cysts (n = 3), calcification (n = 2), necrosis (n = 3). Mitotic rate was 4-15/2 mm2. On immunohistochemistry, cytokeratins (100%), p40 (100%), strong/diffuse membranous CD99 (100%), NKX2.2 (100%), Fli-1 (71%), and synaptophysin (71%) was positive. Patients received chemotherapy (n = 7) and radiotherapy (n = 4). Two patients developed recurrence at 6 and 10 months; 3 developed metastases at 0, 6, and 25 months. ALES is a rare and aggressive malignancy that mimics diverse neoplasms common in the head and neck region. Awareness of the morphologic and immunohistochemistry spectrum of this tumor is essential to avoid diagnostic errors.
Collapse
Affiliation(s)
- Munita Bal
- grid.450257.10000 0004 1775 9822Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra India
| | - Aekta Shah
- grid.450257.10000 0004 1775 9822Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra India
| | - Bharat Rekhi
- grid.450257.10000 0004 1775 9822Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra India
| | - Neha Mittal
- grid.450257.10000 0004 1775 9822Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra India
| | - Swapnil Ulhas Rane
- grid.450257.10000 0004 1775 9822Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra India
| | - Katha Rabade
- grid.450257.10000 0004 1775 9822Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra India
| | - Omshree Shetty
- grid.450257.10000 0004 1775 9822Division of Molecular Pathology and Translational Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra India
| | - Gouri Pantavaidya
- grid.450257.10000 0004 1775 9822Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra India
| | - Deepa Nair
- grid.450257.10000 0004 1775 9822Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra India
| | - Kumar Prabhash
- grid.450257.10000 0004 1775 9822Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra India
| | - M. Aishwarya
- grid.414953.e0000000417678301Department of Pediatric Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pudducherry, India
| | - Krishan Kumar Govindarajan
- grid.414953.e0000000417678301Department of Pediatric Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pudducherry, India
| | - Siddhartha Laskar
- grid.450257.10000 0004 1775 9822Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra India
| | - Sarbani Ghosh Laskar
- grid.450257.10000 0004 1775 9822Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra India
| | - Asawari Patil
- grid.450257.10000 0004 1775 9822Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra India
| |
Collapse
|
7
|
Abstract
Undifferentiated small round cell sarcomas represent a heterogeneous group of mesenchymal neoplasms. While imprecise, this term nevertheless provides a useful framework for conceptualizing these tumors. This article highlights current trends in their classification based on morphology, immunohistochemistry, and advanced molecular techniques. As next-generation sequencing becomes commonplace in diagnostic laboratories pathologists can expect to differentiate these tumors with increasing confidence, and actively contribute to related discoveries. Ultimately, when synthesized with rigorous clinical outcome data and other investigative techniques, a more robust landscape for the molecular diagnosis and classification of undifferentiated small round cell sarcomas is expected to emerge in the future.
Collapse
|
8
|
Carter T, Crook M, Murch A, Beesley AH, de Klerk N, Charles A, Kees UR. Incidence of NUT carcinoma in Western Australia from 1989 to 2014: a review of pediatric and adolescent cases from Perth Children's Hospital. BMC Cancer 2021; 21:740. [PMID: 34176480 PMCID: PMC8237419 DOI: 10.1186/s12885-021-08432-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 06/02/2021] [Indexed: 11/26/2022] Open
Abstract
Background NUT carcinoma (NC), previously known as NUT midline carcinoma, is a rare and very aggressive cancer that occurs in both children and adults. NC is largely chemoresistant, with an overall survival of less than 7 months. Because the carcinoma is not restricted to a particular organ, diagnosis is often a challenge. In the absence of a clearly determined incidence for NC, we sought to study the diagnosis of patients in a well-defined population. Methods We systematically reviewed records of all patients that presented to the Oncology Department of the Princess Margaret Hospital for Children from 1989 to 2014. This institution in the geographically isolated state of Western Australia has a catchment population of around 2 million. We then identified all high grade undifferentiated sarcomas or carcinomas in the 0–16 year age group. Results Over 26 years, we found 14 patients of 16 years or younger with undifferentiated malignant tumors. Of these, five tumors were positive by immunohistochemistry for the NUT/NUTM1 (Nuclear Protein in Testis) protein and/or the translocation t(15;19). Three patients presented with thoracic tumors, one with a para-spinal tumor, and one had an upper airway nasopharyngeal carcinoma. In all five cases, there was an initial response to therapy and then progression. This 26-year survey was conducted in a geographically isolated state with a well-defined population, and we determined an estimated incidence of NC of around 0.41 per million child years (0–16 yrs. of age) at risk. From three patients it was feasible to derive cell lines for further genetic analyses and drug screening. Conclusions For the first time, the incidence of NC could be determined in a well-defined geographic area. The calculated rate of NC incidence is consistent with a history of under-recognition for this malignancy. These findings indicate that improved diagnostic detection of NC would enable better management and counselling of patients. Our findings emphasize the heterogeneity of NC, and they highlight the need to develop personalised therapy options, and to consider a diagnosis of NC in undifferentiated malignant tumors.
Collapse
Affiliation(s)
- Tina Carter
- Perth Children's Hospital, Perth, 6009, Australia.,PathWest, Nedlands, 6009, Perth, Western Australia.,Telethon Kids Institute, University of Western Australia, Perth, 6009, Australia
| | - Maxine Crook
- Perth Children's Hospital, Perth, 6009, Australia.,PathWest, Nedlands, 6009, Perth, Western Australia
| | | | - Alex H Beesley
- Telethon Kids Institute, University of Western Australia, Perth, 6009, Australia
| | - Nick de Klerk
- Telethon Kids Institute, University of Western Australia, Perth, 6009, Australia
| | - Adrian Charles
- Perth Children's Hospital, Perth, 6009, Australia.,PathWest, Nedlands, 6009, Perth, Western Australia.,Department of Pathology, Sidra Medical and Research Center, PO Box 26999, Doha, Qatar
| | - Ursula R Kees
- Telethon Kids Institute, University of Western Australia, Perth, 6009, Australia.
| |
Collapse
|
9
|
Marais YA, Saini AK, Ferreira N, Reddy K, Zühlke A, Rossouw N, Zaharie SD, Schubert PT. Adamantinoma-like Variant of Ewing Sarcoma in the Metatarsal Bone After Chemotherapy: Report of a Case Successfully Treated with Pedicled Osteocutaneous Fibular Transfer. Int J Surg Pathol 2021; 29:798-803. [PMID: 33703949 DOI: 10.1177/10668969211001449] [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] [Indexed: 11/17/2022]
Abstract
Adamantinoma-like Ewing sarcoma is a rare variant of Ewing sarcoma with histologic and immunohistochemical evidence of squamous differentiation. This variant most commonly occurs in the head and neck region with a few cases reported in the long bones of the limbs. It may be associated with poorer clinical outcome and could pose a diagnostic challenge, particularly if it occurs in older patients or as a metastatic lesion. We present a case of Ewing sarcoma in the metatarsal of an 11-year-old boy that manifested adamantinoma-like morphology after neoadjuvant chemotherapy. Chemotherapy has been reported to induce neuronal maturation and rhabdoid morphology in cases of Ewing sarcoma, but no reports of treatment-induced squamous differentiation with P40/P63 expression have been demonstrated. This is also the first documented case treated with a pedicled osteocutaneous fibular transfer in a metatarsal malignancy, which is usually treated by either ray or below-knee amputation.
Collapse
Affiliation(s)
- Yolandi A Marais
- National Health Laboratory Service, 121470Stellenbosch University, Cape Town, South Africa
| | - Aaron K Saini
- 26697Division of Orthopaedic Surgery, Stellenbosch University, Cape Town, South Africa
| | - Nando Ferreira
- 26697Division of Orthopaedic Surgery, Stellenbosch University, Cape Town, South Africa
| | - Kershinee Reddy
- Paediatric Oncology Unit, 26697Stellenbosch University, Cape Town, South Africa
| | - Alexander Zühlke
- Division of Plastic and Reconstructive Surgery, 26697Stellenbosch University, Cape Town, South Africa
| | - Nelmarie Rossouw
- Division of Radiodiagnosis, 26697Stellenbosch University, Cape Town, South Africa
| | - Stefan D Zaharie
- National Health Laboratory Service, 121470Stellenbosch University, Cape Town, South Africa
| | - Pawel T Schubert
- National Health Laboratory Service, 121470Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
10
|
Rooper LM, Bishop JA. Soft Tissue Special Issue: Adamantinoma-Like Ewing Sarcoma of the Head and Neck: A Practical Review of a Challenging Emerging Entity. Head Neck Pathol 2020; 14:59-69. [PMID: 31950471 PMCID: PMC7021882 DOI: 10.1007/s12105-019-01098-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/12/2019] [Indexed: 02/07/2023]
Abstract
Adamantinoma-like Ewing sarcoma (ALES) is a rare variant of Ewing sarcoma that is defined by complex epithelial differentiation, including expression of cytokeratin and p40 and frequent keratin pearl formation. In recent years, ALES has been increasingly recognized in the head and neck, where it can mimic a wide range of small round blue cell tumors and basaloid carcinomas. However, there has been persistent controversy regarding whether ALES is best classified and managed as a sarcoma or carcinoma. This review summarizes the characteristic clinical, pathologic, immunophenotypic, and molecular features of ALES with an emphasis on differential diagnosis and tumor classification.
Collapse
Affiliation(s)
- Lisa M Rooper
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Justin A Bishop
- Department of Pathology, University of Texas Southwestern Medical Center, 6201 Harry Hines Blvd, Dallas, TX, 75390-9073, USA.
| |
Collapse
|
11
|
Thompson LD, Lewis JS, Skálová A, Bishop JA. Don't stop the champions of research now: a brief history of head and neck pathology developments. Hum Pathol 2020; 95:1-23. [DOI: 10.1016/j.humpath.2019.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 12/12/2022]
|
12
|
Rooper LM, Jo VY, Antonescu CR, Nose V, Westra WH, Seethala RR, Bishop JA. Adamantinoma-like Ewing Sarcoma of the Salivary Glands: A Newly Recognized Mimicker of Basaloid Salivary Carcinomas. Am J Surg Pathol 2019; 43:187-194. [PMID: 30285997 DOI: 10.1097/pas.0000000000001171] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Adamantinoma-like Ewing sarcoma (ALES) is a rare tumor that demonstrates the EWSR1-FLI1 translocation characteristic of Ewing sarcoma despite overt epithelial differentiation including diffuse expression of cytokeratins and p40. Most cases of ALES described to date have occurred in the head and neck where they can mimic a wide range of small round blue cell tumors. Because distinguishing ALES from basaloid salivary gland carcinomas can be particularly difficult, we analyzed a series of 10 ALESs that occurred in the salivary glands with the aim of identifying features that allow for better recognition of this entity. The salivary ALESs included 8 parotid gland and 2 submandibular gland tumors in patients ranging from 32 to 77 years (mean: 52 y). Nine were initially misclassified as various epithelial neoplasms. Although these tumors displayed the basaloid cytology, rosette formation, infiltrative growth, and nuclear monotony characteristic of ALES, peripheral palisading and overt keratinization were relatively rare in this site. Salivary ALESs not only displayed positivity for AE1/AE3, p40, and CD99, but also demonstrated a higher proportion of synaptophysin reactivity than has been reported for nonsalivary ALESs. These morphologic and immunohistochemical findings make ALES susceptible to misclassification as various other tumors including basal cell adenocarcinoma, adenoid cystic carcinoma, squamous cell carcinoma, NUT carcinoma, large cell neuroendocrine carcinoma and myoepithelial carcinoma. Nevertheless, monotonous cytology despite highly infiltrative growth and concomitant positivity for p40 and synaptophysin can provide important clues for consideration of ALES, and identification of the defining EWSR1-FLI1 translocations can confirm the diagnosis.
Collapse
Affiliation(s)
- Lisa M Rooper
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD
| | - Vickie Y Jo
- Department of Pathology, Brigham and Women's Hospital
| | | | - Vania Nose
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - William H Westra
- Department of Pathology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Raja R Seethala
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Justin A Bishop
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD.,Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| |
Collapse
|
13
|
Adamantinoma-Like Ewing's Family Tumor of the Sino Nasal Region: A Case Report and a Brief Review of Literature. Case Rep Pathol 2019; 2019:5158182. [PMID: 31249713 PMCID: PMC6530217 DOI: 10.1155/2019/5158182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/23/2019] [Accepted: 04/14/2019] [Indexed: 12/20/2022] Open
Abstract
Ewing's sarcoma family of tumors (EFTs) are malignant mesenchymal tumors with a predilection for bone and soft tissue. They are characterized by their monomorphic small blue round cell morphology. However rare morphologic variants of EFTs can also show overt epithelial differentiation in the form of squamoid differentiation along with strong cytokeratin expression. This particular subset of EFTs are known as adamantinoma-like EFTs which can be difficult to differentiate from epithelial head and neck malignancies. Here we report a case of sinonasal adamantinoma-like EFT in an 18-year-old male patient. The lesion differed from a typical EFT by means of overt squamoid differentiation which showed a basaloid appearance with peripheral palisading. The immunohistochemistry was positive for pan-cytokeratin, p40, p63, ERG, FLI1, and CK5/6. It was negative for actin, desmin, and WT-1. Initial diagnosis of a basaloid squamous cell carcinoma was made. Further molecular studies were also done due to the complex presentation of the tumor. EWSR testing with break-apart analysis confirmed EWSR1 and FLI1 rearrangements. Further confirmation was done with RT-PCR. The case was found to be positive for EWS-FLI-1 translocation. The revised immunohistochemistry panel showed CD99, ERG, FLI1, and synaptophysin positivity. The lesion was reclassified as an adamantinoma-like ES. Our case reinforces the fact that a subset of EFTs can show histomorphologic and immunohistochemical features of aberrant epithelial differentiation. These cases are difficult to differentiate from usual epithelial malignancies which occur in this region. This diagnostic pitfall can be avoided by the inclusion of CD99 and/or FLI1 in the immunohistochemical assessment of any round cell malignancy at any anatomic location. A strong and diffuse CD99 positivity should prompt molecular testing for the presence of EWSR1 gene rearrangements.
Collapse
|
14
|
Morlote D, Harada S, Lindeman B, Stevens TM. Adamantinoma-Like Ewing Sarcoma of the Thyroid: A Case Report and Review of the Literature. Head Neck Pathol 2019; 13:618-623. [PMID: 30734898 PMCID: PMC6854136 DOI: 10.1007/s12105-019-01021-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/03/2019] [Indexed: 02/06/2023]
Abstract
Currently considered a variant of Ewing sarcoma, adamantinoma-like Ewing sarcoma is a rare malignancy that shows classic Ewing sarcoma-associated gene fusions but also epithelial differentiation. Here we present the 6th reported case of adamantinoma-like Ewing sarcoma involving the thyroid gland. Sections of the thyroid tumor from a 20-year old woman showed sheets, lobules and trabeculae of primitive, uniform, small round blue cells that diffusely expressed pankeratin, p40 and CD99. Fluorescent in situ hybridization revealed an EWSR1 gene rearrangement and an EWSR1-FLI1 fusion was detected by RT-PCR. Neck lymph nodes were not involved, and the patient was treated with a Ewing sarcoma chemotherapy protocol and radiation and is disease free 7 months after surgery. The unusual histology and immunohistochemical profile of adamantinoma-like Ewing sarcoma makes diagnosis and classification very challenging. We also present a literature review of adamantinoma-like Ewing sarcoma involving the thyroid.
Collapse
Affiliation(s)
- Diana Morlote
- Department of Pathology, University of Alabama at Birmingham, 3548 North Pavilion, 1802 6th Ave. S, Birmingham, AL 35249 USA
| | - Shuko Harada
- Department of Pathology, University of Alabama at Birmingham, 3548 North Pavilion, 1802 6th Ave. S, Birmingham, AL 35249 USA
| | - Brenessa Lindeman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL USA
| | - Todd M. Stevens
- Department of Pathology, University of Alabama at Birmingham, 3548 North Pavilion, 1802 6th Ave. S, Birmingham, AL 35249 USA
| |
Collapse
|
15
|
Lilo MT, Bishop JA, Olson MT, Ali SZ. Adamantinoma-like Ewing sarcoma of the parotid gland: Cytopathologic findings and differential diagnosis. Diagn Cytopathol 2017; 46:263-266. [PMID: 29034595 DOI: 10.1002/dc.23829] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 09/20/2017] [Accepted: 09/27/2017] [Indexed: 12/19/2022]
Abstract
Adamantinoma-like Ewing sarcoma (AES) is a rare variant of Ewing sarcoma family of tumors (EFTs), primarily affecting bone and soft tissue. AES has mixed features of Ewing sarcoma (ES)/primitive neuroectodermal tumor (PNET) and adamantinoma with a complex immunoprofile and EWSR1 gene rearrangements. Herein, we report a 72-year-old male who presented with left parotid mass, right neck mass and thyroid nodules. Fine needle aspiration of the left parotid mass displayed nests of monotonous epithelioid cells with basaloid features in a background of small round blue cells and lymphocytes. AES can involve head and neck region and is characterized by groups of primitive small round blue cells admixed with groups of epithelioid cells with amphophilic cytoplasm and focal squamous differentiation. The proportion of these components can be variable, creating diagnostic challenges, particularly in unusual anatomic sites such as the parotid gland. However, when additional material is available, CD99 and/or FLI1 immunostains need to be included for diagnostic confirmation.
Collapse
Affiliation(s)
- Mohammed T Lilo
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21224
| | - Justin A Bishop
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21224
| | - Matthew T Olson
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21224
| | - Syed Z Ali
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21224.,Department of Radiology, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21224
| |
Collapse
|
16
|
Alexiev BA, Tumer Y, Bishop JA. Sinonasal adamantinoma-like Ewing sarcoma: A case report. Pathol Res Pract 2016; 213:422-426. [PMID: 28262274 DOI: 10.1016/j.prp.2016.11.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 11/15/2016] [Accepted: 11/28/2016] [Indexed: 12/22/2022]
Abstract
We describe the case of a sinonasal adamantinoma-like Ewing sarcoma in a 41-year-old male. Histologically, the tumor exhibited distinctive areas of nested growth pattern with prominent stromal fibrosis and metaplastic bone formation. The tumor cells were small and uniform with minimal amount of pale eosinophilic to clear cytoplasm and round or oval nuclei with finely dispersed chromatin and small nucleoli. Approximately 20% of the tumor parenchyma comprised of small clusters of basaloid cells within an osteofibrous background resembling adamantinoma. The tumor showed strong expression of keratins, p63, CD99 and Fli-1, and EWSR1 rearrangement. The diagnosis of sinonasal Ewing family tumors is particularly problematic owing to the large number of potential mimics. For any poorly differentiated or undifferentiated head and neck tumor, cellular monotony and CD99 immunoreactivity should prompt consideration for molecular studies that include analysis of both EWSR1 and FLI1, even in the presence of strong cytokeratin expression or focal keratinization.
Collapse
Affiliation(s)
- Borislav A Alexiev
- Department of Pathology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, 251 East Huron St, Feinberg 7-342A, Chicago, IL 60611, United States.
| | - Yanki Tumer
- Department of Radiology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, 676 N. St Clair, Suite 800, Chicago, IL, 60611, United States
| | - Justin A Bishop
- Department of Pathology, The Johns Hopkins University School of Medicine, 401 N. Broadway, Weinberg 2249, Baltimore, MD 21231, United States
| |
Collapse
|
17
|
Bishop JA, French CA, Ali SZ. Cytopathologic features of NUT midline carcinoma: A series of 26 specimens from 13 patients. Cancer Cytopathol 2016; 124:901-908. [PMID: 27400194 DOI: 10.1002/cncy.21761] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/15/2016] [Accepted: 06/15/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND NUT midline carcinoma (NMC) is an increasingly recognized neoplasm defined by rearrangements of the nuclear protein in testis (NUT) gene (also known as NUTM1). NMC is important to diagnose for prognostic and diagnostic reasons, but to date, only a small case series and rare case reports of the cytopathologic features of NMC have been published. METHODS All NMC specimens (confirmed by molecular testing and/or NUT immunoreactivity) with cytopathologic material available were identified at 2 academic centers. All smears were reviewed, and the cytologic characteristics were described. RESULTS Twenty-six cytopathologic specimens of NMC were identified from 13 patients: 8 men and 5 women ranging in age from 16 to 68 years (mean, 35 years). The NMCs arose in the mediastinum (n = 4), sinonasal tract (n = 4), neck (n = 2), lung (n = 1), lung and mediastinum (n = 1), and kidney (n = 1). Cytologic specimens included serous cavity effusions (n = 13), fine-needle aspirates (n = 9), bronchial brushings (n = 2), bronchial lavage (n = 1), and bronchial washings (n = 1). Ancillary studies were performed on cell blocks for only 6 samples from 4 patients: immunohistochemistry (n = 6) and flow cytometry (n = 1). All 13 NMCs had corresponding surgical pathology material. The NUT rearrangement status was known in 10 cases, and in 3 cases, the diagnosis was established by immunoreactivity for NUT. On cytologic smears, the NMCs were mostly hypercellular with monotonous, small to midsize, primitive-appearing cells largely distributed singly in a discohesive pattern. The tumor cells had round to oval nuclei that appeared mostly naked and devoid of cytoplasm. The nuclei varied in chromatin density from mostly pale, open chromatin to a hyperchromatic, neuroendocrine-type appearance, often with focal cell-to-cell molding, and most examples had a distinct, small nucleolus. CONCLUSIONS NMC is a recently recognized tumor that should be considered in the differential diagnosis of small round cell tumors, especially but not exclusively in the mediastinum and the head and neck. The cytologic features of NMC overlap considerably with those of other neoplasms, and a definitive diagnosis depends on a demonstration of NUT translocation by either immunohistochemical or molecular means. Cancer Cytopathol 2016;124:901-908. © 2016 American Cancer Society.
Collapse
Affiliation(s)
- Justin A Bishop
- Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Syed Z Ali
- Department of Pathology and Radiology, Johns Hopkins Hospital, Baltimore, Maryland
| |
Collapse
|
18
|
Metastatic squamous cell carcinoma in the neck presenting with Horner syndrome - a cause of the condition not previously described. Br J Oral Maxillofac Surg 2016; 54:689-91. [DOI: 10.1016/j.bjoms.2015.10.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 10/25/2015] [Indexed: 11/23/2022]
|
19
|
Abstract
Surgical pathology of the sinonasal region (i.e., nasal cavity and the paranasal sinuses) is notoriously difficult, due in part to the remarkable diversity of neoplasms that may be encountered in this area. In addition, a number of neoplasms have been only recently described in the sinonasal tract, further compounding the difficulty for pathologists who are not yet familiar with them. This manuscript will review the clinicopathologic features of some of the recently described sinonasal tumor types: NUT midline carcinoma, HPV-related carcinoma with adenoid cystic-like features, SMARCB1 (INI-1) deficient sinonasal carcinoma, biphenotypic sinonasal sarcoma, and adamantinoma-like Ewing family tumor.
Collapse
Affiliation(s)
- Justin A Bishop
- Departments of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland; Otolaryngology-Head and Neck Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
| |
Collapse
|
20
|
Adamantinoma-like Ewing family tumors of the head and neck: a pitfall in the differential diagnosis of basaloid and myoepithelial carcinomas. Am J Surg Pathol 2015; 39:1267-74. [PMID: 26034869 DOI: 10.1097/pas.0000000000000460] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Ewing sarcoma family tumors (EFTs) of the head and neck are rare and may be difficult to diagnose, as they display significant histologic overlap with other more common undifferentiated small blue round cell malignancies. Occasionally, EFTs may exhibit overt epithelial differentiation in the form of diffuse cytokeratin immunoexpression or squamous pearls, resembling the so-called adamantinoma-like EFTs and being challenging to distinguish from bona fide carcinomas. Furthermore, the presence of EWSR1 gene rearrangement correlated with strong keratin expression may suggest a myoepithelial carcinoma. Herein, we analyze a series of 7 adamantinoma-like EFTs of the head and neck, most of them being initially misdiagnosed as carcinomas because of their anatomic location and strong cytokeratin immunoexpression, and subsequently reclassified as EFT by molecular techniques. The tumors arose in the sinonasal tract (n=2), parotid gland (n=2), thyroid gland (n=2), and orbit (n=1), in patients ranging in age from 7 to 56 years (mean, 31 y). Microscopically, they departed from the typical EFT morphology by growing as nests with peripheral nuclear palisading and prominent interlobular fibrosis, imparting a distinctly basaloid appearance. Moreover, 2 cases exhibited overt keratinization in the form of squamous pearls, and 1 sinonasal tumor demonstrated areas of intraepithelial growth. All cases were positive for CD99, pancytokeratin, and p40. A subset of cases showed synaptophysin, S100 protein, and/or p16 reactivity, further confounding the diagnosis. Fluorescence in situ hybridization assays showed EWSR1 and FLI1 rearrangements in all cases. Our results reinforce that a subset of head and neck EFTs may show strong cytokeratin expression or focal keratinization, and are therefore histologically indistinguishable from more common true epithelial neoplasms. Thus, CD99 should be included in the immunopanel of a round cell malignancy regardless of strong cytokeratin expression or anatomic location, and a strong and diffuse CD99 positivity should prompt molecular testing for the presence of EWSR1 gene rearrangements.
Collapse
|
21
|
Lezcano C, Clarke MR, Zhang L, Antonescu CR, Seethala RR. Adamantinoma-like Ewing sarcoma mimicking basal cell adenocarcinoma of the parotid gland: a case report and review of the literature. Head Neck Pathol 2015; 9:280-5. [PMID: 25081914 PMCID: PMC4424212 DOI: 10.1007/s12105-014-0558-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 07/23/2014] [Indexed: 12/27/2022]
Abstract
Adamantinoma-like Ewing sarcoma (AES) is a rare variant of the Ewing family of tumors that resembles classic adamantinoma of bone. AES shows epithelial differentiation and a more complex immunohistochemical expression profile with keratin and basal marker immunoreactivity and can resemble a variety of carcinomas. We report an unusual case of an AES of the parotid gland that mimicked a basal cell adenocarcinoma. Like basal cell adenocarcinoma, this AES showed a nested basaloid proliferation with peripheral palisading in tumor nests with 'basaloid' epithelial differentiation as highlighted by cytokeratin AE1/3 and p40 positivity. However, unlike most basal cell adenocarcinomas, this tumor demonstrated high grade morphology, showed no true ductal or myoepithelial component, and also showed a tendency towards neuroectodermal phenotype with focal rosette formation, CD99 and weak synaptophysin immunoreactivity. EWSR1 and FLI1 fluorescence in situ hybridization confirmed the presence of a translocation supporting the diagnosis of AES. This is the first case of AES presenting as a primary parotid mass highlighting the potential to be mistaken for primary salivary gland carcinomas, which in addition to basal cell adenocarcinoma include other basaloid tumors such as adenoid cystic carcinoma.
Collapse
Affiliation(s)
- Cecilia Lezcano
- Department of Pathology, University of Pittsburgh Medical Center, 200 Lothrop St, Scaife Hall A615, Pittsburgh, PA, 15213, USA,
| | | | | | | | | |
Collapse
|
22
|
Xie LS, Wang H, Xiang JJ, Xu RJ. Massive osseous and cartilaginous metaplasia of soft tissue Ewing sarcoma in adult: report of two cases. Histopathology 2015; 67:417-20. [PMID: 25585827 DOI: 10.1111/his.12650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Le-si Xie
- Department of Pathology, Hangzhou First People's Hospital, Hangzhou, Zhejiang, China
| | - Hao Wang
- Prenatal diagnosis Center, Hangzhou Women's Hospital, Hangzhou, Zhejiang, China
| | - Jing-jing Xiang
- Department of Pathology, Hangzhou First People's Hospital, Hangzhou, Zhejiang, China
| | - Ru-jun Xu
- Department of Pathology, Hangzhou First People's Hospital, Hangzhou, Zhejiang, China
| |
Collapse
|
23
|
Tumeurs de la famille Ewing/PNET : vers un nouveau paradigme ? Ann Pathol 2015; 35:86-97. [DOI: 10.1016/j.annpat.2014.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 11/13/2014] [Indexed: 01/28/2023]
|
24
|
Antonescu C. Round cell sarcomas beyond Ewing: emerging entities. Histopathology 2013; 64:26-37. [PMID: 24215322 DOI: 10.1111/his.12281] [Citation(s) in RCA: 134] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 09/06/2013] [Indexed: 12/17/2022]
Abstract
Primitive small blue round cell tumours (SBRCT) of childhood and young adults have been problematic to diagnose and classify. Diagnosis is also complicated in cases with atypical morphology, aberrant immunoprofiles and unusual clinical presentations. Even with the increased use of ancillary techniques in archival material, such as immunohistochemistry and molecular/genetic methods, a proportion of these tumours cannot be subclassified into specific histological types. A subset of tumours resembling microscopically the Ewing sarcoma family of tumours (EFT), being composed of primitive small round cells and occurring in paediatric or young adult age groups, remain unclassified, being negative for EWSR1, SS18(SYT), DDIT3(CHOP) and FOXO1(FKHR) gene rearrangements by FISH/RT-PCR. A small number of cases sharing the undifferentiated EFT appearance have been characterized recently carrying BCOR-CCNB3 or CIC-DUX4 fusions. However, based on the somewhat limited number of cases, it remains unclear if these newly defined genetic entities belong to any of the pre-existing clinicopathological disorders or represent altogether novel conditions. This review presents the latest molecular findings related to these SBRCTs, beyond the common EWSR1-ETS fusions. Specific attention has been paid to morphological features not associated typically with classic EFT, and the value of ancillary tests that can be applied when dealing with EWSR1-negative SBRCTs is discussed.
Collapse
Affiliation(s)
- Cristina Antonescu
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
25
|
Barroca H, Bom-Sucesso M. Fine needle biopsy with cytology in paediatrics: the importance of a multidisciplinary approach and the role of ancillary techniques. Cytopathology 2013; 25:6-20. [DOI: 10.1111/cyt.12110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2013] [Indexed: 01/25/2023]
Affiliation(s)
- H. Barroca
- Serviço de Anatomia Patológica; Serviço de Pediatria; Centro Hospitalar de S. João; Porto Portugal
| | - M. Bom-Sucesso
- Unidade de Hematologia-Oncologia Pediátrica; Serviço de Pediatria; Centro Hospitalar de S. João; Porto Portugal
| |
Collapse
|
26
|
Barroca H, Souto Moura C, Lopes JM, Lisboa S, Teixeira MR, Damasceno M, Bastos P, Sobrinho-Simões M. PNET with neuroendocrine differentiation of the lung: Report of an unusual entity. Int J Surg Pathol 2013; 22:427-33. [PMID: 24141023 DOI: 10.1177/1066896913502227] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ewing's sarcoma/primitive neuroectodermal tumor (PNET) has been the subject of recent reports describing morphologic variants (adamantinoma-like, large cell, spindle cell, sclerosing, clear cell, and vascular-like) of the most classic form, as well as cases displaying unusual morphologic differentiation and atypical immunohistochemical features. We report a case of an uncommon lung tumor in a 20-year-old female, morphologically and molecularly consistent with an Ewing's sarcoma/PNET tumor with foci of squamous differentiation, and peculiar expression of vimentin, high-molecular-weight keratins, p63, synaptophysin, and chromogranin. This case raises a challenging differential diagnostic problem with therapeutic implications: Should the patient be treated following the protocols for Ewing's sarcoma/PNET tumors or as for lung carcinoma with neuroendocrine features? The patient we report here was treated with neoadjuvant chemotherapy for Ewing's sarcoma/PNET according to Euro Ewing 99 study protocol followed by surgery and has no evidence of disease 15 months after the initial diagnosis. This highlights the importance of achieving the correct diagnosis of these atypical tumors using all clinical, morphological, and ancillary methods available to allow for their correct and timely treatment.
Collapse
Affiliation(s)
- Helena Barroca
- Centro Hospitalar S João, Porto, Portugal Departamento de Patologia e Oncologia Médica da Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Conceição Souto Moura
- Centro Hospitalar S João, Porto, Portugal Departamento de Patologia e Oncologia Médica da Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - José Manuel Lopes
- Centro Hospitalar S João, Porto, Portugal Departamento de Patologia e Oncologia Médica da Faculdade de Medicina da Universidade do Porto, Porto, Portugal Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal
| | - Susana Lisboa
- Instituto Português de Oncologia do Porto e Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - Manuel R Teixeira
- Instituto Português de Oncologia do Porto e Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - Margarida Damasceno
- Centro Hospitalar S João, Porto, Portugal Departamento de Patologia e Oncologia Médica da Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | | | - Manuel Sobrinho-Simões
- Centro Hospitalar S João, Porto, Portugal Departamento de Patologia e Oncologia Médica da Faculdade de Medicina da Universidade do Porto, Porto, Portugal Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal
| |
Collapse
|
27
|
Eloy C, Oliveira M, Vieira J, Teixeira MR, Cruz J, Sobrinho-Simões M. Carcinoma of the thyroid with ewing family tumor elements and favorable prognosis: report of a second case. Int J Surg Pathol 2013; 22:260-5. [PMID: 23637256 DOI: 10.1177/1066896913486696] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The rare reports of primary, nonneuroendocrine small cell carcinomas of the thyroid have not provided enough evidence to support the recognition of these tumors as an entity or to understand their etiopathogenesis. We report the second case of a primary, nonneuroendocrine small cell carcinoma of the thyroid displaying diffuse expression of cytokeratins, CD99, and p63, in the absence of vimentin expression, in a 24-year-old male who is alive without any signs of disease 13 years after total thyroidectomy and radioactive iodine. The tumor disclosed the EWSR1-FLI1 rearrangement, and we propose to designate it as a carcinoma of the thyroid with Ewing family tumor elements.
Collapse
|
28
|
Adamantinoma-like Ewing Family Tumor of Soft Tissue Associated With the Vagus Nerve. Am J Surg Pathol 2013; 37:772-9. [DOI: 10.1097/pas.0b013e31828e5168] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
29
|
Ewing sarcoma family of tumours: unusual histological variants and immunophenotypic characteristics. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.mpdhp.2012.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
30
|
Calretinin staining facilitates differentiation of olfactory neuroblastoma from other small round blue cell tumors in the sinonasal tract. Am J Surg Pathol 2012; 35:1786-93. [PMID: 22020045 DOI: 10.1097/pas.0b013e3182363b78] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Olfactory neuroblastoma (ONB) is an uncommon malignant tumor of the sinonasal tract and has a wide histologic differential diagnosis that includes other small round blue cell tumors (SRBCTs). Even with the use of immunohistochemistry (IHC), the correct diagnosis may be difficult, especially in small biopsies. The purpose of this study is to determine the usefulness of calretinin and p63 as an aid to distinguish ONB from other sinonasal SRBCTs. METHODS IHC staining for calretinin and p63 was performed on 21 specimens diagnosed as ONB and on 42 other sinonasal SRBCTs. Specimens were retrieved from the files of the QEII HSC, Halifax and UHN, Toronto. RESULTS All but 1 ONB (20 of 21) showed calretinin staining, with 15 of 21 showing staining in >75% of the tumor area and 18 of 21 showing moderate-to-strong staining intensity. Only pituitary adenomas (3 of 3) and a single case of small cell carcinoma, neuroendocrine type (1 of 2), showed a similar staining pattern. None of the ONBs showed staining for p63. P63 was positive in all cases of nonkeratinizing squamous cell carcinoma (2 of 2) and in single cases of mantle cell lymphoma (1 of 1) and poorly differentiated neuroendocrine carcinoma (1 of 1); however, it inconsistently stained diffuse large B-cell lymphoma (4 of 5), extranodal NK/T-cell lymphoma, nasal type (1 of 4), sinonasal undifferentiated carcinoma (1 of 6), and Ewing sarcoma/primitive neuroectodermal tumor (2 of 6). CONCLUSIONS Calretinin appears to be a useful marker to distinguish ONBs from other SRBCTs of the sinonasal tract, particularly when staining is moderate/strong and extensive. The calretinin-positive, p63-negative phenotype is fairly specific for ONB. The addition of these 2 IHC stains may aid in the diagnosis of sinonasal SRBCTs that are poorly differentiated, have inconclusive conventional IHC, or are found in small biopsies.
Collapse
|
31
|
Affiliation(s)
- Shih Feng Huang
- Department of Surgery, Division of General Surgery, Cardinal Tien Hospital, College of Medicine, Fu Jen Catholic University, Taipei, Taiwan
| | | | | | | | | | | |
Collapse
|
32
|
Abstract
OBJECTIVE To present a case of extraskeletal Ewing's sarcoma originating in the masseter muscle, and to review the diagnosis and management of these rare tumours. METHODS Case report and literature review. RESULTS We report a patient with Ewing's sarcoma of the masseter muscle with mandibular invasion. She was treated with induction chemotherapy, salvage surgery and free flap reconstruction. CONCLUSION This case highlights the management of these rare tumours. Aggressive multi-modal treatment, including multi-agent chemotherapy, surgical resection and irradiation, appears to offer the best prognosis. Contemporary reconstructive techniques can restore function and form in cases with challenging defects.
Collapse
|
33
|
Abstract
Nut midline carcinomas are uncommon carcinomas characterized by chromosomal rearrangements that involve the gene encoding the nuclear protein of the testis (NUT). This article reviews the clinicopathologic features of these malignancies. Ancillary testing is discussed as well as the pathologic differential diagnosis.
Collapse
Affiliation(s)
- Edward B. Stelow
- Dept of Pathology, UVA Health System, University of Virginia, Jefferson Park Ave., Box 800214, Charlottesville, VA 22908 USA
| |
Collapse
|
34
|
CD99-positive large cell neuroendocrine carcinoma with rearranged EWSR1 gene in an infant: a case of prognostically favorable tumor. Virchows Arch 2010; 457:389-95. [DOI: 10.1007/s00428-010-0944-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 06/14/2010] [Accepted: 06/17/2010] [Indexed: 10/19/2022]
|
35
|
|
36
|
Carcinomas of the upper aerodigestive tract with rearrangement of the nuclear protein of the testis (NUT) gene (NUT midline carcinomas). Adv Anat Pathol 2009; 16:92-6. [PMID: 19550370 DOI: 10.1097/pap.0b013e31819923e4] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This manuscript reviews carcinomas of the upper aerodigestive tract associated with genetic rearrangements of the nuclear protein of the testis (NUT) gene, also known as NUT midline carcinomas. The literature is reviewed regarding all reported cases of NUT midline carcinomas and the clinicopathologic features are discussed. Our current understanding of the molecular pathogenesis of the disease is also discussed, along with the differential diagnosis for undifferentiated or poorly differentiated malignancy of the upper aerodigestive tract.
Collapse
|
37
|
Song JH, You WS, Chung IY, Seo SW. The Changes in Extraocular Muscles in Horner's Syndrome of Rats. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2009. [DOI: 10.3341/jkos.2009.50.10.1576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ji Hye Song
- Department of Ophthalmology, School of Medicine, Gyeongsang National University, Jinju, Korea
| | - Woong Sun You
- Department of Ophthalmology, School of Medicine, Gyeongsang National University, Jinju, Korea
| | - In Young Chung
- Department of Ophthalmology, School of Medicine, Gyeongsang National University, Jinju, Korea
| | - Seong Wook Seo
- Department of Ophthalmology, School of Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea
| |
Collapse
|