1
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Dashti NK, Schukow CP, Kilpatrick SE. Back to the future! Selected bone and soft tissue neoplasms with shared genetic alterations but differing morphological and immunohistochemical phenotypes. Hum Pathol 2024; 147:129-138. [PMID: 38521373 DOI: 10.1016/j.humpath.2024.03.005] [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: 03/07/2024] [Accepted: 03/13/2024] [Indexed: 03/25/2024]
Abstract
Bone and soft tissue tumors (BST) are a highly heterogeneous group largely classified by their line of differentiation, based on their resemblance to their normal counterpart in adult tissue. Yet, rendering a specific diagnosis can be challenging, primarily due to their rarity and overlapping histopathologic features or clinical presentations. Over the past few decades, seemingly histogenetic-specific gene fusions/translocations and amplifications have been discovered, aiding in a more nuanced classification, leading to well-established objective diagnostic criteria and the development of specific surrogate ancillary tests targeting these genetic aberrations (e.g., immunohistochemistry). Ironically, the same research also has revealed that some specific tumor subtypes may be the result of differing and often multiple gene fusions/translocations, but, more interestingly, identical gene fusions may be present in more than one phenotypically and biologically distinct neoplasm, sometimes with entirely different clinical behavior. Prime examples include, EWSR1::ATF1 and, less commonly, EWSR1::CREB1 gene fusions present in both clear cell sarcoma, a malignant high-grade tumor with melanocytic differentiation, and angiomatoid fibrous histiocytoma, a mesenchymal neoplasm of intermediate malignancy with a generally indolent course. Similarly, MDM2 amplification, once deemed to be pathognomonic for atypical lipomatous tumor/well differentiated and dedifferentiated liposarcoma, has been documented in a range of additional distinct tumors, including low grade osteosarcomas (e.g. low grade central and surface parosteal) and high-grade intimal sarcomas, amongst others. Such findings reinforce the importance of careful attention to morphological and clinicoradiological features and correlation with molecular testing before rendering a specific diagnosis. Future classification systems in BST neoplasms cannot be solely based on molecular events and ideally will balance morphologic features with molecular analysis. Herein, we provide a narrative literature review of the more common BST neoplasms with shared genetic events but differing demographics, morphology, immunophenotype, and clinical behavior, re-emphasizing the importance of the hematoxylin and eosin slide and the "eye" of the practicing pathologist.
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Affiliation(s)
- Nooshin K Dashti
- Department of Pathology and Laboratory Medicine Dartmouth Health, Lebanon, 03766, NH, USA; Geisel School of Medicine at Dartmouth, Lebanon, 03766, NH, USA
| | - Casey P Schukow
- Corewell Health's Beaumont Hospital, Department of Pathology, Royal Oak, MI, 48073, USA
| | - Scott E Kilpatrick
- Department of Pathology & Laboratory Medicine, Cleveland Clinic, L25, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
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2
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Prasad AS, Shanbhogue KP, Ramani NS, Balasubramanya R, Surabhi VR. Non-gastrointestinal stromal tumor, mesenchymal neoplasms of the gastrointestinal tract: a review of tumor genetics, pathology, and cross-sectional imaging findings. Abdom Radiol (NY) 2024; 49:1716-1733. [PMID: 38691132 DOI: 10.1007/s00261-024-04329-1] [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: 02/16/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 05/03/2024]
Abstract
There is a diverse group of non-gastrointestinal stromal tumor (GIST), mesenchymal neoplasms of the gastrointestinal (GI) tract that demonstrate characteristic pathology and histogenesis as well as variable imaging findings and biological behavior. Recent advancements in tumor genetics have unveiled specific abnormalities associated with certain tumors, influencing their molecular pathogenesis, biology, response to treatment, and prognosis. Notably, giant fibrovascular polyps of the esophagus, identified through MDM2 gene amplifications, are now classified as liposarcomas. Some tumors exhibit distinctive patterns of disease distribution. Glomus tumors and plexiform fibromyxomas exhibit a pronounced affinity for the gastric antrum. In contrast, smooth muscle tumors within the GI tract are predominantly found in the esophagus and colorectum, surpassing the incidence of GISTs in these locations. Surgical resection suffices for symptomatic benign tumors; multimodality treatment may be necessary for frank sarcomas. This article aims to elucidate the cross-sectional imaging findings associated with a wide spectrum of these tumors, providing insights that align with their histopathological features.
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Affiliation(s)
| | | | - Nisha S Ramani
- Department of Pathology, Michael E. DeBakey VA Medical Center, Houston, USA
| | | | - Venkateswar R Surabhi
- Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1473, Houston, TX, 77030, USA.
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3
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Shalaby A, Telugu RB, Deshpande PA, Qureshi A, Al Adawi H, Al Harthi S, Al Hinai K, Al Miskry H, Nadaf A, Niaz Z, Al Riyami M, Itkin B, Al Haddabi IH. Malignant Gastrointestinal Neuroectodermal Tumor of Small Intestine Showing DOG1 Expression: A Case Report and Review of Literature. Int J Surg Pathol 2024; 32:374-379. [PMID: 37248556 DOI: 10.1177/10668969231176020] [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] [Indexed: 05/31/2023]
Abstract
Malignant gastrointestinal neuroectodermal tumor (GNET), also referred to as clear cell sarcoma-like tumor of the GI tract is a rare mesenchymal tumor of the gastrointestinal tract. It has to be distinguished from various mimickers including gastrointestinal stromal tumor (GIST) due to its aggressive course and different natural history and therapeutic approach. Here we report a case of GNET arising in the small intestine with aberrant DOG1 expression posing a diagnostic challenge. In this context, the combination of clinical, histomorphological, immunohistochemical, and molecular features helped to establish a proper diagnosis.
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Affiliation(s)
- Asem Shalaby
- Department of Pathology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
- Department of Pathology, College of Medicine, Mansoura University, Mansoura, Egypt
| | - Ramesh Babu Telugu
- Department of Pathology, Clinical Laboratory Services, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman
| | - Prashant Ajit Deshpande
- Department of Molecular Pathology, Clinical Laboratory Services, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman
| | - Asim Qureshi
- Department of Pathology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Humaid Al Adawi
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Sara Al Harthi
- Department of Pathology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Khulood Al Hinai
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hilal Al Miskry
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Asmanaz Nadaf
- Department of Pathology, Clinical Laboratory Services, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman
| | - Zahida Niaz
- Department of Pathology, Clinical Laboratory Services, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman
| | - Marwa Al Riyami
- Department of Pathology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Boris Itkin
- Department of Medical Oncology, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman
| | - Ibrahim Hassan Al Haddabi
- Department of Pathology, Clinical Laboratory Services, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman
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4
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Jia Y, Yan Y, Hebbard P, Garvin G, Lu MV. Malignant Gastrointestinal Neuroectodermal Tumor (GNET) Mimicking Small Bowel Lymphoma: A Case Report. Cureus 2024; 16:e59105. [PMID: 38803719 PMCID: PMC11128377 DOI: 10.7759/cureus.59105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
A malignant gastrointestinal neuroectodermal tumor (GNET) is a rare entity, characterized as a malignant mesenchymal neoplasm occurring exclusively near the gastrointestinal tract, prone to frequent local recurrence and metastasis. Here, we report a case of a 49-year-old male presented with abdominal pain and weight loss. The patient had a remote history of thymic B-cell lymphoma. An abdominal computed tomography (CT) scan revealed a focal wall thickening of the terminal ileum with mesenteric lymphadenopathy, suggestive of lymphoma. A core needle biopsy of the mesenteric node was inconclusive. A right hemicolectomy was subsequently performed. Histologically, abundant multinucleated osteoclast-like giant cells are present. The tumor cells show diffuse strong positivity for S100 and SOX10. EWSR1-ATF1 gene fusion was identified by fluorescence in situ hybridization (FISH), consistent with a diagnosis of GNET. This case emphasizes a diagnostic challenge of a rare malignancy.
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Affiliation(s)
- Yong Jia
- Department of Pathology, University of Manitoba, Winnipeg, CAN
| | - Yi Yan
- Department of Radiology, University of Manitoba, Winnipeg, CAN
- Department of Medical Imaging, St. Joseph's Health Care, London, CAN
| | - Pamela Hebbard
- Department of Surgical Oncology, University of Manitoba, Winnipeg, CAN
| | - Gregory Garvin
- Department of Medical Imaging, St. Joseph's Health Care, London, CAN
| | - Miao Vivian Lu
- Department of Pathology, University of Manitoba, Winnipeg, CAN
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Warmke LM, Perret R, Ledoux P, Michot A, Italiano A, Zou YS, Matoso A, Argani P, Ulbright TM, Baumhoer D, Ameline B, Gross JM. EWSR1::WT1 Fusions in Neoplasms Other Than Conventional Desmoplastic Small Round Cell Tumor: Three Tumors Occurring Outside the Female Genital Tract. Mod Pathol 2024; 37:100418. [PMID: 38158126 DOI: 10.1016/j.modpat.2023.100418] [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: 07/21/2023] [Revised: 11/07/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
Desmoplastic small round cell tumor (DSRCT) is a high-grade, primitive round cell sarcoma classically associated with prominent desmoplastic stroma, coexpression of keratin and desmin, and a characteristic EWSR1::WT1 gene fusion. DSRCT typically arises in the abdominopelvic cavity of young males with diffuse peritoneal spread and poor overall survival. Although originally considered to be pathognomonic for DSRCT, EWSR1::WT1 gene fusions have recently been detected in rare tumors lacking the characteristic morphologic and immunohistochemical features of DSRCT. Here, we report 3 additional cases of neoplasms other than conventional DSCRCT with EWSR1::WT1 gene fusions that occurred outside the female genital tract. Two occurred in the abdominopelvic cavities of a 27-year-old man and a 12-year-old girl, whereas the third arose in the axillary soft tissue of an 85-year-old man. All cases lacked prominent desmoplastic stroma and were instead solid and cystic with peripheral fibrous pseudocapsules and occasional intervening fibrous septa. Necrosis was either absent (1/3) or rare (2/3), and mitotic activity was low (<1 to 3 per 10 hpf). In immunohistochemical studies, there was expression of smooth muscle actin (3/3) and desmin (3/3), rare to focal reactivity for EMA (2/3), and variable expression of CK AE1/AE3 (1/3). Myogenin and MyoD1 were negative, and C-terminus-specific WT1 was positive in both cases tested (2/2). All 3 tumors followed a more indolent clinical course with 2 cases demonstrating no evidence of disease at 20 and 44 months after resection. The patient from case 3 died of other causes at 14 months with no evidence of recurrence. DNA methylation profiling showed that the 3 cases clustered with DSRCT; however, they demonstrated fewer copy number variations with 2 cases having a flat profile (0% copy number variation). Differential methylation analysis with hierarchical clustering further showed variation between the 3 cases and conventional DSRCT. Although further study is needed, our results, in addition to previous reports, suggest that EWSR1::WT1 gene fusions occur in rare and seemingly distinctive tumors other than conventional DSRCT with indolent behavior. Proper classification of these unusual soft tissue tumors with EWSR1::WT1 gene fusions requires direct correlation with tumor morphology and clinical behavior, which is essential to avoid overtreatment with aggressive chemotherapy.
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Affiliation(s)
- Laura M Warmke
- Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana.
| | - Raul Perret
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France; Bordeaux Institute of Oncology, BRIC, INSERM, Bordeaux University, Bergonié Institute, Bordeaux, France
| | - Pauline Ledoux
- Department of Diagnostic and Interventional Oncological Imaging, Institut Bergonié, Regional Comprehensive Cancer of Nouvelle-Aquitaine, Bordeaux, France
| | - Audrey Michot
- Plastic and Reconstructive Surgery Department, Bergonié Institute, Bordeaux, France
| | - Antoine Italiano
- Sarcoma Unit, Institut Bergonié, Bordeaux, Gironde, France; Faculty of Medicine, University of Bordeaux, Bordeaux, Gironde, France
| | - Ying S Zou
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Andres Matoso
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Pedram Argani
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Thomas M Ulbright
- Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Daniel Baumhoer
- Bone Tumor Reference Center at the Institute of Pathology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Baptiste Ameline
- Bone Tumor Reference Center at the Institute of Pathology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - John M Gross
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
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Miao X, Chen J, Yang L, Lu H. Primary pulmonary myxoid sarcoma with EWSR1::CREB1 fusion: a literature review. J Cancer Res Clin Oncol 2024; 150:108. [PMID: 38421462 PMCID: PMC10904531 DOI: 10.1007/s00432-024-05634-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/27/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE This review primarily aims to review the epidemiology, clinical characteristics, imaging, pathology, immunohistochemistry, diagnosis, differential diagnosis, treatment, and prognosis of Primary pulmonary myxoid sarcoma (PPMS) with EWS RNA binding protein 1::cAMP response element binding protein 1 (EWSR1::CREB1) fusion. It provides reference for the diagnosis and treatment of this disease. METHODS Retrospectively collected the literature about PPMS with EWSR1::CREB1 fusion, its clinical, radiology, histology, molecular characteristics and current treatment strategies were collated and analyzed. This review provides a detailed differential diagnosis of the disease. RESULTS PPMS is an exceptionally rare, low-grade malignant tumor of the lung. This tumor commonly infiltrates lung tissue and develops within bronchial passages. It is identified by a genetic rearrangement involving the EWSR1 gene and a distinct chromosomal translocation t(2; 22)(q33; q12). Variants include EWSR1::CREB1 fusion and EWS RNA binding protein 1::activating transcription factors (EWSR1::ATF1) fusion. PPMS with EWSR1::CREB1 fusion is more prevalent among middle-aged individuals and affects both sexes almost equally. Clinical symptoms are relatively non-specific, primarily including cough, hemoptysis, and weight loss. Most patients undergo surgery and experience a favorable prognosis. Further research is required to validate the effectiveness of alternative treatments for PPMS with EWSR1::CREB1 fusion. CONCLUSION EWSR1 rearrangement and EWSR1::CREB1 fusion are crucial genetic features of PPMS and serve as important diagnostic markers. Immunohistochemically, PPMS tests positive for EMA. In terms of treatment, surgery has been the primary approach in recent years. Therefore, the efficacy of other treatments still requires further investigation.
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Affiliation(s)
- Xinyu Miao
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, People's Republic of China
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology On Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China
| | - Jing Chen
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology On Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China
- Postgraduate Training Base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, 310022, People's Republic of China
| | - Lan Yang
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology On Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China
- Postgraduate Training Base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, 310022, People's Republic of China
| | - Hongyang Lu
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology On Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China.
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China.
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Pepper MA, Dulken BW, Wang Y, Zemek AJ, Martin BA, Charu V, Longacre TA. S100 Protein Expression in Primary and Metastatic Neuroendocrine Neoplasms: A Specific Marker of Pancreatic Origin. Am J Surg Pathol 2024; 48:157-162. [PMID: 37991258 PMCID: PMC10786441 DOI: 10.1097/pas.0000000000002154] [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] [Indexed: 11/23/2023]
Abstract
Neuroendocrine neoplasms can arise in a wide variety of anatomic sites including the gastrointestinal tract, pancreas, and lung, among others. Here, we report on the expression of S100 protein in a tissue microarray composed of 919 distinct primary and metastatic neuroendocrine neoplasms from 548 patients. S100 protein is a commonly used marker in many laboratories for the identification of neural and melanocytic neoplasms and occasionally used in the workup for neuroendocrine neoplasms when the diagnosis of paraganglioma is being considered. We show that strong S100 protein expression is highly specific to well-differentiated neuroendocrine tumors of pancreatic origin. This finding suggests potential diagnostic utility of this marker in cases of tumors of unknown origin, and emphasizes that S100 protein expression should not be an unexpected finding in neuroendocrine tumors of pancreatic origin.
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Affiliation(s)
- Michael A. Pepper
- Department of Pathology, Stanford University School of Medicine, Stanford
| | - Ben W. Dulken
- Department of Pathology, Stanford University School of Medicine, Stanford
| | - Yiwen Wang
- Department of Pathology, Stanford University School of Medicine, Stanford
| | - Allison J. Zemek
- Department of Pathology, Southern California Permanente Medical Group, Downey, CA
| | - Brock A. Martin
- Department of Pathology, Stanford University School of Medicine, Stanford
- Department of Pathology and Laboratory Medicine, University of Louisville School of Medicine, Louisville, KY
| | - Vivek Charu
- Department of Pathology, Stanford University School of Medicine, Stanford
| | - Teri A. Longacre
- Department of Pathology, Stanford University School of Medicine, Stanford
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Njima M, Lahbacha B, Ben Jabra S, Moussa A, Bellalah A, Ben Abdeljelil N, Ben Hammouda S, Njim L, Hadhri R, Zakhama A. Small Intestine Gastrointestinal Clear Cell Sarcoma: A Case Report and Review of the Literature. J Investig Med High Impact Case Rep 2024; 12:23247096231225869. [PMID: 38229428 PMCID: PMC10798064 DOI: 10.1177/23247096231225869] [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: 05/28/2023] [Revised: 11/29/2023] [Accepted: 12/23/2023] [Indexed: 01/18/2024] Open
Abstract
Gastrointestinal clear cell sarcoma (GICCS)/malignant gastrointestinal neuroectodermal tumor (GNET) is an extremely rare form of cancer with aggressive clinical behavior. It has distinct pathological, immunohistochemical, ultrastructural, and molecular features. Herein, we present the case of a 20-year-old woman with no notable medical history who presented to the outpatient department with complaints of abdominal pain and vomiting. Symptoms had been evolving for 3 months. The physical examination revealed slight abdominal tenderness and melena. Biological investigations revealed iron-deficiency anemia. The upper and lower endoscopies showed no abnormalities. Magnetic resonance enterography revealed small bowel wall thickening of 15 mm × 2 mm. Exploratory laparotomy revealed an ileal mass with mesenteric lymphadenopathy. A wide resection of the mass was then performed. The final pathological report confirmed the diagnosis of small bowel GICCS/GNET. After 11 months of follow-up, the patient presented with mesenteric lymph node metastases.
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Affiliation(s)
- Manel Njima
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine of Monastir, Tunisia
| | - Bahaeddine Lahbacha
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine of Monastir, Tunisia
| | - Sadok Ben Jabra
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine of Monastir, Tunisia
| | - Amani Moussa
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine of Monastir, Tunisia
| | - Ahlem Bellalah
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine of Monastir, Tunisia
| | - Nouha Ben Abdeljelil
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine of Monastir, Tunisia
| | - Seifeddine Ben Hammouda
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine of Monastir, Tunisia
| | - Leila Njim
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine of Monastir, Tunisia
| | - Rim Hadhri
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine of Monastir, Tunisia
| | - Abdelfattah Zakhama
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine of Monastir, Tunisia
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Ozenberger BB, Li L, Wilson ER, Lazar AJ, Barrott JJ, Jones KB. EWSR1::ATF1 Orchestrates the Clear Cell Sarcoma Transcriptome in Human Tumors and a Mouse Genetic Model. Cancers (Basel) 2023; 15:5750. [PMID: 38136296 PMCID: PMC10742207 DOI: 10.3390/cancers15245750] [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: 11/01/2023] [Revised: 12/03/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
Clear cell sarcoma (CCS) is a rare, aggressive malignancy that most frequently arises in the soft tissues of the extremities. It is defined and driven by expression of one member of a family of related translocation-generated fusion oncogenes, the most common of which is EWSR1::ATF1. The EWSR1::ATF1 fusion oncoprotein reprograms transcription. However, the binding distribution of EWSR1::ATF1 across the genome and its target genes remain unclear. Here, we interrogated the genomic distribution of V5-tagged EWSR1::ATF1 in tumors it had induced upon expression in mice that also recapitulated the transcriptome of human CCS. ChIP-sequencing of V5-EWSR1::ATF1 identified previously unreported motifs including the AP1 motif and motif comprised of TGA repeats that resemble GGAA-repeating microsatellites bound by EWSR1::FLI1 in Ewing sarcoma. ChIP-sequencing of H3K27ac identified super enhancers in the mouse model and human contexts of CCS, which showed a shared super enhancer structure that associates with activated genes.
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Affiliation(s)
- Benjamin B. Ozenberger
- Department of Oncological Sciences, University of Utah School of Medicine, Salt Lake City, UT 84132, USA; (B.B.O.); (L.L.); (E.R.W.)
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Li Li
- Department of Oncological Sciences, University of Utah School of Medicine, Salt Lake City, UT 84132, USA; (B.B.O.); (L.L.); (E.R.W.)
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Emily R. Wilson
- Department of Oncological Sciences, University of Utah School of Medicine, Salt Lake City, UT 84132, USA; (B.B.O.); (L.L.); (E.R.W.)
| | - Alexander J. Lazar
- Department of Pathology, Genomic Medicine and Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Jared J. Barrott
- Department of Biology, Brigham Young University, Provo, UT 84602, USA;
| | - Kevin B. Jones
- Department of Oncological Sciences, University of Utah School of Medicine, Salt Lake City, UT 84132, USA; (B.B.O.); (L.L.); (E.R.W.)
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
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10
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Seghrouchni N, Miry A, El Zouiti Z, Karich N, Abdenbitsen A, Bennani A. A Rare Case of Clear Cell Sarcoma of the Tongue: A Case Report. Cureus 2023; 15:e50739. [PMID: 38234940 PMCID: PMC10794058 DOI: 10.7759/cureus.50739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 01/19/2024] Open
Abstract
Clear cell sarcoma (CCS), previously known as soft tissue melanoma due to similarities with melanoma, is a rare and aggressive neoplasm. This tumor predominantly occurs in the lower limbs and rarely affects the tongue, as well as other head and neck locations. To our knowledge, only five cases have been reported in the English literature. CCS presents many similar morphological and immunohistochemical features to those of melanomas, sarcomatoid cell carcinoma, angiomatoid histiocytoma, and Ewing sarcoma, which makes the diagnosis difficult, especially in cases of uncommon locations. The treatment is based on oncological surgery and adjuvant radiation therapy as these tumors show low sensitivity to chemotherapy. This study aimed to report a case of an 88-year-old male patient who presented a large, rapidly growing nodular lesion on the right border of the mobile tongue diagnosed with CCS of the tongue.
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Affiliation(s)
- Noura Seghrouchni
- Laboratory of Pathology, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda, Oujda, MAR
| | - Achraf Miry
- Laboratory of Pathology, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda, Oujda, MAR
| | - Zainab El Zouiti
- Department of Maxillofacial Surgery, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda, Oujda, MAR
| | - Nassira Karich
- Laboratory of Pathology, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda, Oujda, MAR
| | - Adil Abdenbitsen
- Department of Maxillofacial Surgery, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda, Oujda, MAR
| | - Amal Bennani
- Laboratory of Pathology, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda, Oujda, MAR
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11
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Su D, Yang H, Zhao M, Zhou H, Wu J, Zhao Z, Zhong J, Xue Q, Hong Y, Sun J, Li X, Zhao T. Malignant gastrointestinal neuroectodermal tumor: a case report and literature review. Ann Med Surg (Lond) 2023; 85:6196-6201. [PMID: 38098564 PMCID: PMC10718339 DOI: 10.1097/ms9.0000000000001400] [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: 09/05/2023] [Accepted: 10/06/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction and importance A malignant gastrointestinal neuroectodermal tumor (GNET) is an extremely rare primary malignant mesenchymal tumor of the gastrointestinal tract characterized by EWSR1 gene rearrangement. An optimal systemic treatment strategy for advanced/recurrent GNET has not yet been identified. Case presentation A 24-year-old male patient was hospitalized with abdominal pain and underwent two operations for a tumor in his small intestine. Immunohistochemistry (IHC) showed strong expression of S-100 protein and SOX 10. Fluorescence in situ hybridization analysis and next-generation sequencing analysis indicated that there were EWSR gene rearrangements and the presence of EWSR-ATP1 gene fusions, respectively. The diagnosis of GNET in the small intestine was confirmed by pathology. The young patient received the fifth-line of apatinib mesylate and the sixth-line of apatinib combined with temozolomide. The two apatinib-containing regimens showed stable disease and progression-free survival of 4.7 months and 3.1 months with single-agent apatinib or apatinib combined with temozolomide, respectively. Clinical discussion To our best knowledge, this is the first report of malignant GNET treated with apatinib and temozolomide. Apatinib-containing regimens might has antineoplastic activity against GNET. The authors reviewed the relevant reports of previous GNET treatment, summarized the clinicopathological characteristics of GNET, and found that there are no reports of apatinib for backline treatment of GNET. Conclusion Containing apatinib may provide an additional treatment option for patients with chemotherapy-resistant GNET tumors.
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Affiliation(s)
- Dan Su
- Department of Clinical Medicine, Hangzhou Medical College
| | - Hujuan Yang
- Graduate School of Clinical Medicine, Bengbu Medical College, Bengbu, Anhui
| | | | - Hongying Zhou
- Department of Medical Oncology, Cancer Center, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College)
| | - Jin Wu
- Department of Medical Oncology, Chun’an First People’s Hospital
| | - Zhongkuo Zhao
- General Surgery Department, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang
| | | | - Qian Xue
- Department of Medical Oncology, Cancer Center, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College)
| | - Yupeng Hong
- Department of Medical Oncology, Cancer Center, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College)
| | - Jie Sun
- Department of Respiratory and Critical Care Medicine, Shidong Hospital, Yangpu District, Shanghai, People’s Republic of China
| | - Xiaoyi Li
- Graduate School of Clinical Medicine, Bengbu Medical College, Bengbu, Anhui
| | - Tongwei Zhao
- Department of Medical Oncology, Cancer Center, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College)
- Graduate School of Clinical Medicine, Bengbu Medical College, Bengbu, Anhui
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12
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Park SY, Seo JW. Clear Cell Sarcoma-Like Tumor of the Gastrointestinal Tract with Peritoneal Metastasis in a Young Adult: A Case Report with Literature Review. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:1169-1175. [PMID: 37869114 PMCID: PMC10585088 DOI: 10.3348/jksr.2022.0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/07/2023] [Accepted: 02/06/2023] [Indexed: 10/24/2023]
Abstract
Clear cell sarcoma-like tumor of the gastrointestinal tract (CCSLTGT) is a rare malignant mesenchymal tumor of the gastrointestinal (GI) tract with a high probability of local recurrence and distant metastasis in young adults. To the best of our knowledge, only seven case reports have described the imaging findings of a CCSLTGT originating from in the small intestine in English literatures so far. Therefore, we report the imaging findings of a CCSLTGT that occurred in the small intestine of a 22-year-old female and summarize the imaging findings of the previous reports.
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13
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Fischer GM, Papke DJ. Gene fusions in superficial mesenchymal neoplasms: Emerging entities and useful diagnostic adjuncts. Semin Diagn Pathol 2023:S0740-2570(23)00046-1. [PMID: 37156707 DOI: 10.1053/j.semdp.2023.04.014] [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: 03/09/2023] [Accepted: 04/24/2023] [Indexed: 05/10/2023]
Abstract
Cutaneous mesenchymal neoplasms are diagnostically challenging because of their overlapping morphology, and, often, the limited tissue in skin biopsy specimens. Molecular and cytogenetic techniques have identified characteristic gene fusions in many of these tumor types, findings that have expanded our understanding of disease pathogenesis and motivated development of useful ancillary diagnostic tools. Here, we provide an update of new findings in tumor types that can occur in the skin and superficial subcutis, including dermatofibrosarcoma protuberans, benign fibrous histiocytoma, epithelioid fibrous histiocytoma, angiomatoid fibrous histiocytoma, glomus tumor, myopericytoma/myofibroma, non-neural granular cell tumor, CIC-rearranged sarcoma, hybrid schwannoma/perineurioma, and clear cell sarcoma. We also discuss recently described and emerging tumor types that can occur in superficial locations and that harbor gene fusions, including nested glomoid neoplasm with GLI1 alterations, clear cell tumor with melanocytic differentiation and ACTIN::MITF translocation, melanocytic tumor with CRTC1::TRIM11 fusion, EWSR1::SMAD3-rearranged fibroblastic tumor, PLAG1-rearranged fibroblastic tumor, and superficial ALK-rearranged myxoid spindle cell neoplasm. When possible, we discuss how fusion events mediate the pathogenesis of these tumor types, and we also discuss the related diagnostic and therapeutic implications of these events.
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Affiliation(s)
- Grant M Fischer
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States of America
| | - David J Papke
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States of America.
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14
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Acosta AM, Bridge JA, Dal Cin PS, Sholl LM, Cornejo KM, Fletcher CDM, Ulbright TM. Inflammatory and Nested Testicular Sex Cord Tumor: A Novel Neoplasm With Aggressive Clinical Behavior and Frequent EWSR1::ATF1 Gene Fusions. Am J Surg Pathol 2023; 47:504-517. [PMID: 36791251 DOI: 10.1097/pas.0000000000002022] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
A subset of malignant testicular sex cord tumors (TSCTs), heretofore interpreted as Sertoli cell tumors, not otherwise specified, exhibits distinctive morphologic features that partially overlap with those of seminoma. In this study, we evaluated the clinicopathologic and molecular characteristics of 13 such tumors. The patients were 20 to 73 years old (median, 36 y), and all with available data presented with testicular masses (median size, 3 cm), with 2 having synchronous retroperitoneal metastases. All 11 patients with available follow-up developed metastases to retroperitoneal lymph nodes, nonretroperitoneal lymph nodes, bone, contralateral testis, and/or lung. Microscopically, the tumors showed solid nests and sheets of epithelioid cells with granular, eosinophilic to clear/vacuolated cytoplasm, admixed in most (12/13) cases with variable proportions of lymphocytes, plasma cells, eosinophils, and neutrophils. Additional features included intracytoplasmic hyaline inclusions and a prominent collagenous, sometimes hyalinized stroma. Mitotic activity was relatively low (median, 1 mitosis/10 HPF), but tumor necrosis was frequent (11/13). Local invasion of adjacent structures and lymphovascular invasion were noted in some tumors (4/9 cases with available data for each feature). All were α-inhibin-positive and lacked nuclear reactivity for β-catenin. In addition, all tested cases were positive for epithelial membrane antigen (9/9) and steroidogenic factor-1 (8/8), and 8/10 expressed CD30. Two "index" cases were initially analyzed using a DNA sequencing panel, which identified EWSR1::ATF1 fusions in both. Subsequently, EWSR1::ATF1 fusions were demonstrated in 8 of the remaining 11 cases using fluorescence in situ hybridization or DNA sequencing. One of the 3 cases that were negative for EWSR1::ATF1 harbored ATF1 amplification. This study, therefore, shows that a group of malignant TSCTs resembling seminoma is characterized by α-inhibin and steroidogenic factor-1 positivity, no expression of nuclear β-catenin, frequent CD30 positivity and recurrent EWSR1::ATF1 fusions. We have descriptively termed these neoplasms "inflammatory and nested TSCT." Importantly, inflammatory and nested TSCTs show significant differences in morphology, immunoprofile, molecular biology, and, likely, clinical behavior from Sertoli cell tumors, not otherwise specified and should be classified separately.
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Affiliation(s)
- Andres M Acosta
- Department of Pathology of Brigham and Women's Hospital, Harvard Medical School
| | - Julia A Bridge
- University of Nebraska Medical Center, University of Nebraska, Omaha, NE
- ProPath, Dallas, TX
| | - Paola S Dal Cin
- Department of Pathology of Brigham and Women's Hospital, Harvard Medical School
| | - Lynette M Sholl
- Department of Pathology of Brigham and Women's Hospital, Harvard Medical School
| | | | | | - Thomas M Ulbright
- Indiana University School of Medicine, Indiana University Health Partners, Indianapolis, IN
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15
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Ulici V, Hornick JL, Davis JL, Mehrotra S, Meis JM, Halling KC, Fletcher CD, Kao E, Folpe AL. "E-MGNET": Extra-Enteric Malignant Gastrointestinal Neuroectodermal Tumor- A Clinicopathological and Molecular Genetic Study of 11 Cases. Mod Pathol 2023; 36:100160. [PMID: 36934861 DOI: 10.1016/j.modpat.2023.100160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/28/2023] [Accepted: 03/12/2023] [Indexed: 03/19/2023]
Abstract
Malignant gastrointestinal neuroectodermal tumors (MGNET), also known as "gastrointestinal clear cell sarcoma-like tumor", are very rare, aggressive sarcomas characterized by enteric location, distinctive pathologic features, and EWSR1/FUS::ATF1/CREB1 fusions. Despite identical genetics, the clinicopathologic features of MGNET are otherwise quite different from clear cell sarcoma of soft parts (CCS). Only exceptional extra-enteric MGNET (E-MGNET) have been reported. We report a series of 11 E-MGNET, the largest to date. Cases diagnosed as MGNET and occurring in non-intestinal locations were retrieved. Clinical follow-up was obtained. The tumors occurred in 3 males and 8 females (14-70 years of age, median 33 years) and involved the soft tissues of the neck (3), shoulder (1), buttock (2), orbit (1), and tongue/parapharyngeal space (1), the urinary bladder (1) and the falciform ligament/liver (1). Tumors showed morphologic features of enteric MGNET (small, relatively uniform, round to ovoid cells with round, regular nuclei containing small nucleoli, growing in multinodular and vaguely lobular patterns, with solid, pseudoalveolar and pseudopapillary architecture). Immunohistochemical results were: S100 protein (11/11), SOX10 (11/11), synaptophysin (3/10), CD56 (7/9), CD117 (3/9), DOG1 (0/4), ALK (4/8), chromogranin A (0/10), HMB45 (0/11), Melan-A (0/11), tyrosinase (0/4), MiTF (0/11). NGS results were: EWSR1::ATF1 (7 cases), EWSR1::CREB1 (3 cases) and EWSR1::PBX1 (1 case). The EWSR1::PBX1-positive tumor was similar to other cases, including osteoclast-like giant cells, and negative for myoepithelial markers. Clinical follow-up (range: 10 to 70 months; median 34 months) showed 4 patients dead of disease (10.5, 12, 25 and 64 months after diagnosis), 1 patient alive with extensive metastases (43 months after diagnosis), 1 patient alive with persistent local disease (11 months after diagnosis), and 4 alive without disease (10, 47, 53 and 70 months after diagnosis). One case is too recent for follow-up. The clinicopathologic and molecular genetic features of rare E-MGNET are essentially identical to those occurring in intestinal locations. Otherwise-typical E-MGNET may harbor EWSR1::PBX1, a finding previously unreported in this tumor type. As in enteric locations, the behavior of E-MGNET is aggressive, with metastases and/or death from disease in at least 50% of patients. E-MGNET should be distinguished from CCS and other tumors with similar fusions. ALK expression appears to be a common feature of tumors harboring EWSR1/FUS::ATF1/CREB1 fusion but is unlikely to predict therapeutic response to ALK inhibition. Future advances in our understanding of these unusual tumors will hopefully lead to improved nomenclature.
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Affiliation(s)
- Veronica Ulici
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jessica L Davis
- Department of Pathology, University of Indiana, Indianapolis, IN
| | - Swati Mehrotra
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, IL
| | - Jeanne M Meis
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kevin C Halling
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | | | - Erica Kao
- Department of Pathology, Brooke Army Medical Center, San Antonio, TX
| | - Andrew L Folpe
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN.
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16
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Boșoteanu M, Cristian M, Așchie M, Baz RA, Zielonka AM, Cozaru GC, Boșoteanu LA. The Malignant Gastrointestinal Neuroectodermal Tumor (GNET): A Distinct Entity and the Challenging Differential Diagnosis with Mesenchymal, Lymphoid, and Melanic Tumors: A Case Report and Brief Review of the Literature. Diagnostics (Basel) 2023; 13:diagnostics13061131. [PMID: 36980439 PMCID: PMC10047330 DOI: 10.3390/diagnostics13061131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023] Open
Abstract
(1) Background: A malignant gastrointestinal neuroectodermal tumor (GNET) is an ultra-rare primary neoplasm with a distinctive histopathological, immunohistochemical, molecular, and ultramicroscopic profile, synonymous terminology with clear cell sarcoma-like tumor of the gastrointestinal tract. This case report aims to describe a case of GNET with challenging mesenchymal, lymphoid, and melanic tumor differential diagnosis. (2) Case presentation: We discuss the case of a 67-year-old male patient who presented with diffuse abdominal pain, intermittent lack of intestinal transit, and frequent episodes of nausea, followed by segmental resection of the jejunum and sigmoid colon. The patient had no relevant medical history. The surgical specimen underwent immunohistochemical staining and morphological evaluation. (3) Results: Histopathological analysis reveals a moderately homogeneous polyhedral-epithelioid and spindle cell neoplastic proliferation with a zonal discohesive pattern and extensive and focal fasciculated architecture. Twenty monoclonal antibodies were used for immunostaining, which allowed GNET to be diagnosed on the basis of the tumoral immune profile, characterized by positive reactivity of S100, SOX10, and CD 56. (4) Conclusions: The poor prognosis of GNET is highlighted in the present study, along with the vital importance of differential diagnosis issues with mesenchymal, lymphoid, and melanic tumors, which make the diagnosis difficult for both pathologists and clinicians.
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Affiliation(s)
- Mădălina Boșoteanu
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania
- Department of Clinical Pathology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
- Department of Pathology, “Ovidius” Clinical Hospital, 905900 Constanta, Romania
| | - Miruna Cristian
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania
- Department of Clinical Pathology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology—CEDMOG, “Ovidius” University of Constanta, 900591 Constanta, Romania
- Institute of Doctoral Studies, School of Medicine, “Ovidius” University of Constanta, 900573 Constanta, Romania
- Correspondence: (M.C.); (R.A.B.); Tel.: +40-735-868-090 (M.C.)
| | - Mariana Așchie
- Department of Clinical Pathology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology—CEDMOG, “Ovidius” University of Constanta, 900591 Constanta, Romania
- Academy of Medical Sciences, 030167 Bucharest, Romania
| | - Radu Andrei Baz
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania
- Department of Radiology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
- Correspondence: (M.C.); (R.A.B.); Tel.: +40-735-868-090 (M.C.)
| | | | - Georgeta Camelia Cozaru
- Department of Clinical Pathology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology—CEDMOG, “Ovidius” University of Constanta, 900591 Constanta, Romania
| | - Luana Andreea Boșoteanu
- Institute of Doctoral Studies, School of Medicine, “Ovidius” University of Constanta, 900573 Constanta, Romania
- Dermatology Department, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
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17
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Wetterwald L, Riggi N, Kyriazoglou A, Dei Tos G, Dei Tos A, Digklia A. Clear cell sarcoma: state-of-the art and perspectives. Expert Rev Anticancer Ther 2023; 23:235-242. [PMID: 36811446 DOI: 10.1080/14737140.2023.2183846] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
INTRODUCTION Clear cell sarcoma (CCS) is an ultrarare soft tissue sarcoma (STS) with a poor prognosis due to its propensity to metastasize and its low chemosensitivity. The standard treatment of localized CCS consists of wide surgical excision with or without additive radiotherapy. However, unresectable CCS is generally treated with conventional systemic therapies available for treatment of STS despite the weak scientific evidence to support its use. AREAS COVERED In this review, we discuss the clinicopathologic characteristics of CSS, as well as the current treatment landscape and future therapeutic approaches. EXPERT OPINION The current treatment strategy of advanced CCSs, based on STSs regimens, shows a lack of effective options. Combination therapiesin particular, the association of immunotherapy and TKIs, represent a promising approach. Translational studies are needed in order to decipher the regulatory mechanisms involved in the oncogenesis of this ultrarare sarcoma and identify potential molecular targets.
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Affiliation(s)
- Laureline Wetterwald
- Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Lausanne, Switzerland
| | - Nicolò Riggi
- Experimental Pathology, Institute of Pathology, Lausanne University Lausanne, Switzerland
| | | | - Giovanni Dei Tos
- Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Lausanne, Switzerland
| | - Angelo Dei Tos
- Department of Pathology, Azienda Ospedale-Università Padova Padua, Italy.,Department of Medicine, University of Padua School of Medicine Padua, Italy
| | - Antonia Digklia
- Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Lausanne, Switzerland.,Sarcoma Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Lausanne, Switzerland
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18
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Yang W, Cai Z, Nie P, Yuan T, Zhou H, Du Q, Qiu S, Zhang J, Yang L. Case report and literature review: Small bowel intussusception due to solitary metachronous metastasis from renal cell carcinoma. Front Oncol 2022; 12:1072485. [PMID: 36601471 PMCID: PMC9806257 DOI: 10.3389/fonc.2022.1072485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Solitary metachronous small bowel metastasis from renal cell carcinoma (RCC) is rare. In contrast to idiopathic intussusception frequently occurring in children, adult intussusception is fairly uncommon and usually indicates a malignancy. Case presentation We presented an 84-year-old man with small bowel intussusception and obstruction due to a solitary metachronous metastasis from RCC. Computed tomography with intravenous contrast revealed small bowel obstruction and a 4 × 4 cm intraluminal soft-tissue mass with moderate enhancement. During urgent exploratory laparotomy, a pedunculated tumor of the distal ileum was found to be the lead point of intussusception. Hence, reduction of the intestinal invagination and segmental resection of the ileum with functional end-to-end anastomosis were performed. Histological examination finally confirmed the diagnosis. The postoperative recovery was uneventful. The patient was discharged without any complications on postoperative day 6. Conclusion The case report highlights the rarity of solitary metachronous small bowel metastases from RCC and suggests that life-long follow-up of RCC patients is critical due to its unpredictable behavior and the possibility of a long period of dormancy. Complete surgical resection remains the mainstay treatment for such patients.
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Affiliation(s)
- Wenming Yang
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhaolun Cai
- Gastric Cancer Center, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Pan Nie
- Department of Gastrointestinal Surgery, The Third People’s Hospital of Chengdu, Chengdu, China
| | - Tao Yuan
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hang Zhou
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Du
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Siyuan Qiu
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jianhao Zhang
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Lie Yang
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Lie Yang,
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19
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Bravo-Taxa M, Huanca-Amesquita L. [Malignant gastrointestinal neuroectodermal tumor: A report of 2 cases and a review of the literature]. REVISTA ESPANOLA DE PATOLOGIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ANATOMIA PATOLOGICA Y DE LA SOCIEDAD ESPANOLA DE CITOLOGIA 2022; 55:267-273. [PMID: 36154735 DOI: 10.1016/j.patol.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/25/2020] [Accepted: 07/06/2020] [Indexed: 06/16/2023]
Abstract
Malignant gastrointestinal neuroectodermal tumour (GNET) is an extremely rare neoplasm first described by Zambrano in 2003 as clear cell sarcoma like tumor of the gastrointestinal tract. In contrast to clear cell sarcoma, it has giant osteoclast cells and shows diffuse and intense positivity for S-100 with no immunohistochemical or ultrastructural melanocyte differentiation. We present the first cases of GNET reported in South America, occurring in Peru. Two cases of GNET, one in a female and one in a male, both between 60 and 70 years of age, were referred to our hospital for reevaluation. One underwent further treatment in our centre, but with an unfavourable evolution. Pathologists should be aware of the diagnostic criteria for GNET in order to avoid misdiagnosis due to confusion with other non-epithelial gastrointestinal neoplasms.
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20
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Youssef B, Mohamed RM, Vahhabaghai P, Asberry D. An Incidental Malignant Gastrointestinal Neuroectodermal Tumor of the Stomach: A Rare Case Report and a Literature Review. Cureus 2022; 14:e28042. [PMID: 36120228 PMCID: PMC9473673 DOI: 10.7759/cureus.28042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 11/05/2022] Open
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21
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Dermawan JK, Vanoli F, Herviou L, Sung YS, Zhang L, Singer S, Tap WD, Benayed R, Bale TA, Benhamida JK, Dickson BC, Antonescu CR. Comprehensive genomic profiling of EWSR1/FUS::CREB translocation-associated tumors uncovers prognostically significant recurrent genetic alterations and methylation-transcriptional correlates. Mod Pathol 2022; 35:1055-1065. [PMID: 35347249 PMCID: PMC9329182 DOI: 10.1038/s41379-022-01023-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 12/22/2022]
Abstract
To elucidate the mechanisms underlying the divergent clinicopathologic spectrum of EWSR1/FUS::CREB translocation-associated tumors, we performed a comprehensive genomic analysis of fusion transcript variants, recurrent genetic alterations (mutations, copy number alterations), gene expression, and methylation profiles across a large cohort of tumor types. The distribution of the EWSR1/FUS fusion partners-ATF1, CREB1, and CREM-and exon involvement was significantly different across different tumor types. Our targeted sequencing showed that secondary genetic events are associated with tumor type rather than fusion type. Of the 39 cases that underwent targeted NGS testing, 18 (46%) had secondary OncoKB mutations or copy number alterations (29 secondary genetic events in total), of which 15 (52%) were recurrent. Secondary recurrent, but mutually exclusive, TERT promoter and CDKN2A mutations were identified only in clear cell sarcoma (CCS) and associated with worse overall survival. CDKN2A/B homozygous deletions were recurrent in angiomatoid fibrous histiocytoma (AFH) and restricted to metastatic cases. mRNA upregulation of MITF, CDH19, PARVB, and PFKP was found in CCS, compared to AFH, and correlated with a hypomethylated profile. In contrast, S100A4 and XAF1 were differentially upregulated and hypomethylated in AFH but not CCS. Unsupervised clustering of methylation profiles revealed that CREB family translocation-associated tumors form neighboring but tight, distinct clusters. A sarcoma methylation classifier was able to accurately match 100% of CCS cases to the correct methylation class; however, it was suboptimal when applied to other histologies. In conclusion, our comprehensive genomic profiling of EWSR1/FUS::CREB translocation-associated tumors uncovered mostly histotype, rather than fusion-type associated correlations in transcript variants, prognostically significant secondary genetic alterations, and gene expression and methylation patterns.
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Affiliation(s)
| | - Fabio Vanoli
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Laurie Herviou
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yun-Shao Sung
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lei Zhang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Samuel Singer
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William D. Tap
- Department of Medicine, Sarcoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ryma Benayed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tejus A. Bale
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jamal K. Benhamida
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brendan C. Dickson
- Department of Pathology and Laboratory Medicine, Sinai Health System, Toronto, Ontario, Canada
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22
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Miller CQ, Al-Hader A, Vance GH, Zhang C. Malignant gastrointestinal neuroectodermal tumour arising in the extrahepatic bile ducts; a rare neoplasm in an unusual anatomic location. BMJ Case Rep 2022; 15:e250094. [PMID: 35858740 PMCID: PMC9305702 DOI: 10.1136/bcr-2022-250094] [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] [Indexed: 11/04/2022] Open
Abstract
Malignant gastrointestinal neuroectodermal tumour (GNET) is a rare, aggressive neoplasm with fewer than 100 cases reported in the literature. Most cases arise in the tubular gastrointestinal tract. We reported a unique case of GNET arising in the extrahepatic bile ducts and reviewed the literature of GNETs. The patient is a female in her mid-30s who presented with painless jaundice and diarrhoea several months after cholecystectomy for biliary dyskinesia. Workup revealed a tumour arising from the peripheral 4B bile ducts involving the left hepatic duct and bifurcation. Histologic examination of the lesion showed a malignant spindled and epithelioid neoplasm which strongly expressed S100 and SOX-10. Neoplastic cells were negative for various cytokeratins and melanoma markers. FISH testing using EWSR1 break-apart probes showed rearrangement of the EWSR1 gene region. The immunohistochemical and molecular findings are consistent with a diagnosis of GNET arising in the extrahepatic bile ducts.
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Affiliation(s)
- C Quinn Miller
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ahmad Al-Hader
- Department of Medicine, Division of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Gail H Vance
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Chen Zhang
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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23
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Malignant Gastrointestinal Neuroectodermal Tumor: A New Kid on the Block? J Comput Assist Tomogr 2022; 46:676-681. [PMID: 35759779 DOI: 10.1097/rct.0000000000001350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Also referred to as "osteoclast-rich, clear cell sarcoma-like tumor of the gastrointestinal tract (CCSLGT)," malignant gastrointestinal neuroectodermal tumor is a newly described, rare, aggressive sarcoma that commonly arises in the small bowel, stomach, and colon. Histogenesis is likely from an autonomous nervous system-related primitive cell of neural crest origin. The hallmark genetic finding of EWS-CREB1 or EWS-ATF1 fusion transcripts clinches the diagnosis. Annular constrictive lesions tend to be smaller, show homogenous contrast enhancement on computed tomography, and may present with bowel obstruction. Larger, expansile masses tend to be exophytic and show heterogeneous contrast enhancement. Surgical resection is the mainstay of treatment. Frequent recurrences, metastases, and death from disease in 75% of patients portend a poor prognosis. Targeted chemotherapy based on specific tumor pathways is being developed.
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24
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Huang WP, Li LM, Gao JB. Postoperative multiple metastasis of clear cell sarcoma-like tumor of the gastrointestinal tract in adolescent: A case report. World J Clin Cases 2022; 10:6175-6183. [PMID: 35949819 PMCID: PMC9254186 DOI: 10.12998/wjcc.v10.i18.6175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/25/2021] [Accepted: 04/28/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Clear cell sarcoma-like tumor of the gastrointestinal tract (CCSLGT) is a rare malignant gastrointestinal mesenchymal soft tissue tumor. Its genetic feature is EWSR1 gene rearrangement. Histologically, it is often accompanied by a varying number of CD68-positive osteoclast-like giant cells. CCSLGT mostly occurs in the small intestinal wall of young people and children. In terms of clinical manifestations, there is no significant difference between it and other gastrointestinal tumors, and the diagnosis depends on immunohistochemistry and gene detection.
CASE SUMMARY A 16-year-old man developed dizziness and fatigue 2 mo ago, and 10 d ago showed progressive exacerbation of paroxysmal epigastric pain and stopped flatulence and defecation. Computed tomography showed a soft tissue mass in the distal ileum. After complete resection of the lesion, it was diagnosed by combined immunohistochemical and genetic examination as CCSLGT. After surgery, the patient gradually developed lymph node, liver, lung, bone, left thigh, pleura and adrenal metastasis. The survival time was 4 years and 8 mo.
CONCLUSION Whole abdominal computed tomography enhancement is recommended for patients with gastrointestinal symptoms. There is no effective treatment for CCSLGT with multiple metastases via the lymphatic system and bloodstream after surgical resection.
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Affiliation(s)
- Wen-Peng Huang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Li-Ming Li
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Jian-Bo Gao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
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25
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Vyas M, Hissong E, Gonzalez RS, Shia J, Jessurun J. Metastatic Neoplasms Involving the Stomach. Am J Clin Pathol 2022; 157:863-873. [PMID: 34875001 DOI: 10.1093/ajcp/aqab202] [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: 08/30/2021] [Accepted: 10/22/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Metastatic neoplasms involving the stomach are rare and diagnostically challenging if clinical history of malignancy is absent or unavailable. This study was designed to identify the tumors that most frequently metastasize to the stomach and the morphologic features that can provide clues to investigate the possibility of metastasis and predict the primary sites. METHODS All patients with metastatic neoplasms involving the stomach were included in the study. The H&E- and immunohistochemical-stained slides were reviewed, and all clinical, endoscopic, and radiologic information was recorded. RESULTS One hundred fifty patients, including 84 (56%) women and 66 (44%) men (mean age, 64 years), were identified. Gastric metastases were the initial presentation in 15% cases. Epithelial tumors (73.3%) comprised the largest group, followed by melanoma (20.6%), sarcomas (4%), germ cell tumors (1.3%), and hematolymphoid neoplasms (0.7%). Lobular breast carcinoma was the most common neoplasm overall in women, while in men, it was melanoma. Solid/diffuse growth pattern (75%) was more common compared with glandular morphology. The solid/diffuse category included lobular breast carcinoma (21.3%), melanoma (20.6%), and renal cell carcinoma (10.6%), while the glandular category was dominated by gynecologic serous carcinomas (7.3%) with papillary/micropapillary architecture. CONCLUSIONS Metastatic neoplasms should be considered in the differential diagnosis of gastric neoplasms, particularly those with a diffuse/solid growth pattern. Glandular neoplasms are difficult to differentiate from gastric primaries except for Müllerian neoplasms, which frequently show a papillary/micropapillary architecture.
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Affiliation(s)
- Monika Vyas
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School , Boston, MA , USA
- Department of Pathology, Memorial Sloan Kettering Cancer Center , New York, NY , USA
| | - Erika Hissong
- Department of Pathology, New York Presbyterian/Weill Cornell Medical Center , New York NY , USA
| | - Raul S Gonzalez
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School , Boston, MA , USA
| | - Jinru Shia
- Department of Pathology, Memorial Sloan Kettering Cancer Center , New York, NY , USA
| | - Jose Jessurun
- Department of Pathology, New York Presbyterian/Weill Cornell Medical Center , New York NY , USA
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26
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Sasaki M, Tanaka M, Asukai K, Koguchi H, Inoue Y, Moriyama M, Tsukahara T, Kawahara T, Hayashi E, Hattori Y, Hasegawa I, Kataoka H. Malignant gastrointestinal neuroectodermal tumor presenting with small intestinal obstruction: A case report. DEN OPEN 2022; 2:e119. [PMID: 35873522 PMCID: PMC9302053 DOI: 10.1002/deo2.119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/09/2022] [Accepted: 03/15/2022] [Indexed: 11/19/2022]
Abstract
Malignant gastrointestinal neuroectodermal tumors (GNETs) are rare malignant mesenchymal neoplasms. To our knowledge, only 99 cases have been reported worldwide. The tumor has an aggressive malignancy, with a rapid progression. The histological features of GNET overlap with those of clear cell sarcoma, which contain Ewing sarcoma breakpoint region 1 mutation. GNETs lack melanocyte‐specific markers, while clear cell sarcoma exhibits melanocytic differentiation. Various symptoms have been reported previously, and the most reported lesion is in the small bowel. The patient was a 69‐year‐old man who presented with abdominal pain and vomiting. Computed tomography revealed a nodule in the small bowel, which induced small intestinal obstruction. Enteroscopic images revealed a submucosal tumor. Surgery was performed, and the patient was diagnosed with GNET. Only two patients whose primary lesions were in the small intestine, including the patient in this report, have undergone enteroscopy before surgery. This is a rare case of GNET in which a patient underwent enteroscopy before surgical treatment.
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Affiliation(s)
- Makiko Sasaki
- Department of Gastroenterology Japan Community Health Care Organization Chukyo Hospital Aichi Japan
- Department of Gastroenterology and Metabolism Nagoya City University Graduate School of Medical Science Aichi Japan
| | - Mamoru Tanaka
- Department of Gastroenterology and Metabolism Nagoya City University Graduate School of Medical Science Aichi Japan
| | - Koki Asukai
- Department of Gastroenterology Japan Community Health Care Organization Chukyo Hospital Aichi Japan
| | - Hiroki Koguchi
- Department of Gastroenterology Japan Community Health Care Organization Chukyo Hospital Aichi Japan
| | - Yusuke Inoue
- Department of Gastroenterology Japan Community Health Care Organization Chukyo Hospital Aichi Japan
| | - Mizuki Moriyama
- Department of Surgery Japan Community Health Care Organization Chukyo Hospital Aichi Japan
- Department of Surgery Kasugai Municipal Hospital Aichi Japan
| | - Tetsuo Tsukahara
- Department of Surgery Japan Community Health Care Organization Chukyo Hospital Aichi Japan
- Department of Surgery Anjo Kosei Hospital Aichi Japan
| | - Takeo Kawahara
- Department of Surgery Japan Community Health Care Organization Chukyo Hospital Aichi Japan
| | - Eiji Hayashi
- Department of Surgery Japan Community Health Care Organization Chukyo Hospital Aichi Japan
| | - Yukinori Hattori
- Department of Pathology Japan Community Health Care Organization Chukyo Hospital Aichi Japan
| | - Izumi Hasegawa
- Department of Gastroenterology Japan Community Health Care Organization Chukyo Hospital Aichi Japan
| | - Hiromi Kataoka
- Department of Gastroenterology and Metabolism Nagoya City University Graduate School of Medical Science Aichi Japan
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27
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Rahi H, Olave MC, Fritchie KJ, Greipp PT, Halling KC, Kipp BR, Graham RP. Gene Fusions in Gastrointestinal Tract cancers. Genes Chromosomes Cancer 2022; 61:285-297. [PMID: 35239225 DOI: 10.1002/gcc.23035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 11/10/2022] Open
Abstract
Fusion genes have been identified a wide array of human neoplasms including hematologic and solid tumors, including gastrointestinal tract neoplasia. A fusion gene is the product of parts of two genes which are joined together following a deletion, translocation or chromosomal inversion. Together with single nucleotide variants, insertions, deletions, and amplification, fusion genes represent one of the key genomic mechanisms for tumor development. Detecting fusions in the clinic is accomplished by a variety of techniques including break-apart fluorescence in situ hybridization (FISH), reverse transcription-polymerase chain reaction (RT-PCR), and next-generation sequencing (NGS). Some recurrent gene fusions have been successfully targeted by small molecule or monoclonal antibody therapies (i.e. targeted therapies), while others are used for as biomarkers for diagnostic and prognostic purposes. The purpose of this review article is to discuss the clinical utility of detection of gene fusions in carcinomas and neoplasms arising primarily in the digestive system. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Hamed Rahi
- Division of Laboratory of Genetics and Genomics, Mayo Clinic, Rochester, MN, USA
| | - Maria C Olave
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
| | - Karen J Fritchie
- Division of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Patricia T Greipp
- Division of Laboratory of Genetics and Genomics, Mayo Clinic, Rochester, MN, USA
| | - Kevin C Halling
- Division of Laboratory of Genetics and Genomics, Mayo Clinic, Rochester, MN, USA.,Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
| | - Benjamin R Kipp
- Division of Laboratory of Genetics and Genomics, Mayo Clinic, Rochester, MN, USA.,Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
| | - Rondell P Graham
- Division of Laboratory of Genetics and Genomics, Mayo Clinic, Rochester, MN, USA.,Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
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28
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Kandler T, Cortez E, Clinton L, Hemmerich A, Ahmed O, Wong R, Forns T, MacNeill AJ, Hamilton TD, Khorasani M, Feng X. A Case Series of Metastatic Malignant Gastrointestinal Neuroectodermal Tumors and Comprehensive Genomic Profiling Analysis of 20 Cases. Curr Oncol 2022; 29:1279-1297. [PMID: 35200608 PMCID: PMC8870546 DOI: 10.3390/curroncol29020109] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/02/2022] [Accepted: 02/14/2022] [Indexed: 12/23/2022] Open
Abstract
Malignant gastrointestinal neuroectodermal tumor (GNET) is an ultra-rare soft tissue sarcoma, therefore often misdiagnosed and has no available standard treatment. Here, we report 3 cases of metastatic GNET with variable clinical courses. Our small case series as well as extensive literature review, further support that GNET is a spectrum of diseases with variable inherent biology and prognosis. Surgical management in the setting of recurrent/metastatic disease may be appropriate for GNET with indolent nature. Response to systemic treatments including chemotherapy and targeted treatments is variable, likely related to heterogenous biology as well. Furthermore, we retrospectively identified 20 additional GNET cases from Foundation Medicine’s genomic database and expanded on their clinicopathological and genomic features. Comprehensive genomic profiling (CGP) with DNA and RNA sequencing of this cohort, in the course of clinical care, demonstrated recurrent EWSR1 chromosomal rearrangements and a sparsity of additional recurrent or driver genomic alterations. All cases had low tumor mutational burden (TMB) and were microsatellite stable.
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Affiliation(s)
- Taylor Kandler
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada;
| | - Eliane Cortez
- Foundation Medicine, Inc., Cambridge, MA 02141, USA;
| | - Lani Clinton
- Foundation Medicine, Inc., Morrisville, NC 27560, USA; (L.C.); (A.H.)
| | - Amanda Hemmerich
- Foundation Medicine, Inc., Morrisville, NC 27560, USA; (L.C.); (A.H.)
| | - Osama Ahmed
- Department of Medical Oncology, Saskatoon Cancer Center, Saskatoon, SK S7N 4H4, Canada;
| | - Ralph Wong
- Department of Medical Oncology, Cancer Care Manitoba, Winnipeg, MB R3E 0V9, Canada;
| | - Taylor Forns
- Department of Pathology, Duke University, Durham, NC 27710, USA;
| | - Andrea J. MacNeill
- Department of Surgery, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (A.J.M.); (T.D.H.); (M.K.)
| | - Trevor D. Hamilton
- Department of Surgery, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (A.J.M.); (T.D.H.); (M.K.)
| | - Mohammadali Khorasani
- Department of Surgery, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (A.J.M.); (T.D.H.); (M.K.)
| | - Xiaolan Feng
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada;
- Department of Medical Oncology, Tom Baker Cancer Center, Calgary, AB T2N 4N2, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Correspondence:
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29
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Epithelioid Malignant Peripheral Nerve Sheath Tumor in the Liver: Report of a Rare Unusual Case with Rhabdoid Morphology and Review of the Literature. Case Rep Pathol 2022; 2022:8815771. [PMID: 35223119 PMCID: PMC8881152 DOI: 10.1155/2022/8815771] [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: 09/30/2020] [Accepted: 02/08/2022] [Indexed: 11/17/2022] Open
Abstract
Malignant peripheral nerve sheath tumor (MPNST) is a rare aggressive type of sarcoma. The epithelioid variant of MPNST has a distinctive morphology and immunophenotype, which can be a diagnostic challenge when it arises in an unusual location. Awareness of these morphologic entities is essential to make an accurate diagnosis. Here, we report a case of epithelioid MPNST involving the liver. The tumor displayed rhabdoid morphology and an unusual immunophenotype. The report also discusses histopathologic features, molecular alterations, and the differential diagnoses of this rare entity.
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30
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Agaimy A. [Mesenchymal tumors and tumor-like lesions of the gastrointestinal tract: an overview]. DER PATHOLOGE 2022; 43:31-44. [PMID: 34919183 DOI: 10.1007/s00292-021-01040-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 06/14/2023]
Abstract
Mesenchymal tumors and tumor-like lesions of the gastrointestinal (GI) tract are uncommon. They vary from reactive tumefactive lesions and benign neoplasms to highly aggressive sarcomas. Among them, GI stromal tumors (GISTs) are most common, followed, with less frequency, by smooth muscle and neurogenic tumors. The major challenge resides in correctly identifying GISTs and providing a comprehensive report (including risk assessment and genotyping) that represents the basis for an optimized surgical-oncological treatment and/or adjuvant therapy. On the other hand, the challenge of benign lesions is to find a good name (well understandable and reproducible diagnostic term) that helps avoid diagnostic ambiguity and prognostic uncertainty so that overprognostication and overtreatment can be prevented. Moreover, several recently described genetically defined benign and malignant entities need be correctly diagnosed due to their special "targeted" therapeutic options and to further characterize their clinicopathological and biological properties in the future. These recent entities include aggressive epithelioid inflammatory myofibroblastic sarcoma (ALK-RANBP2-driven), malignant gastrointestinal neuroectodermal tumor (EWSR1-ATF1/CREB-related), NTRK-rearranged neoplasms, and, most recently, colorectal NUTM1-rearranged sarcomas. This review highlights the major clinicopathological features of gastrointestinal mesenchymal lesions in light of recent developments.
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Affiliation(s)
- Abbas Agaimy
- Pathologisches Institut, Universitätsklinikum Erlangen, Krankenhausstraße 8-10, 91054, Erlangen, Deutschland.
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31
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Malignant gastrointestinal neuroectodermal tumor in head and neck: two challenging cases with diverse morphology and different considerations for differential diagnosis. Virchows Arch 2022; 481:131-136. [PMID: 35039897 DOI: 10.1007/s00428-022-03274-y] [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: 08/27/2021] [Revised: 12/02/2021] [Accepted: 01/09/2022] [Indexed: 10/19/2022]
Abstract
Malignant gastrointestinal neuroectodermal tumor (MGNET) is a sarcoma typically involving the gastrointestinal tract with neuroectodermal differentiation and EWSR1-ATF1/CREB1 fusions. Recently, rare MGNET cases were reported in extragastrointestinal sites. We identified 2 cases of MGNET arising in unprecedented laryngeal and intracranial locations, respectively. Both cases showed spindle and epithelioid tumor cells with amphophilic to clear cytoplasm and occasionally prominent nucleoli, arranged in solid, fascicular, and pseudoalveolar patterns. Case 1 exhibited moderate to marked nuclear atypia and focal intraepithelial component. In contrast, case 2 comprised predominantly low-grade epithelioid cells with extensive pseudopapillary structures. Both tumors showed an S100/SOX10-positive and HMB45/melan-A-negative immunoprofile as well as EWSR1-ATF1 fusion. A chief obstacle in diagnosing case 1 was the histologic and immunophenotypic resemblance to melanoma. The striking pseudopapillary architecture and the intracranial location of case 2 rendered differential diagnoses including meningioma and ependymoma. With the peculiar locations and morphology, these cases posed great diagnostic challenge.
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32
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Unusual lung tumors-from morphology to genetics. Mod Pathol 2022; 35:57-65. [PMID: 34518633 DOI: 10.1038/s41379-021-00914-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/24/2021] [Accepted: 08/24/2021] [Indexed: 11/08/2022]
Abstract
Most pathologists are well versed in the diagnosis of lung cancer, given the common nature of the disease. Occasionally more unusual neoplasms are encountered in lung biopsies and resections, which may be difficult to distinguish from "run of the mill" lung cancer cases based on overlapping morphologic and immunophenotypic features. The accurate diagnosis of these rare entities is quite challenging and requires careful morphological examination paired with judicious use of ancillary immunohistochemical and genetic studies. Herein, the clinicopathological and genetic features of five unusual lung tumors will be reviewed, including thoracic SMARCA4-deficient undifferentiated tumor, NUT carcinoma, sclerosing pneumocytoma, primary pulmonary myxoid sarcoma/angiomatoid fibrous histiocytoma, and bronchiolar adenoma/ ciliated muconodular papillary tumor. Since recognition of these entities by pathologists is of increasing importance to guide prognosis and therapy, emphasis will be placed on practical tips to reach these rare diagnoses with confidence.
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33
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Myoepithelial and oral intracranial myxoid mesenchymal tumor-like neoplasms as diagnostic considerations of the ever-expanding extracranial myxocollagenous tumors harboring FET-CREB fusions. Pathol Res Pract 2022; 229:153700. [DOI: 10.1016/j.prp.2021.153700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/08/2021] [Accepted: 11/18/2021] [Indexed: 11/18/2022]
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34
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Adhya A, Mishra P, Biswas D, Pattnaik S, Patra S, Muduly D, Balasubiramaniyan V. Malignant gastrointestinal neuroectodermal tumor: A case-based review of literature. J Cancer Res Ther 2022; 18:885-897. [DOI: 10.4103/jcrt.jcrt_829_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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35
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Sbaraglia M, Bellan E, Mentzel T, Dei Tos AP. The contribution of Juan Rosai to the pathology of soft tissue tumors. Pathologica 2021; 113:396-409. [PMID: 34837098 PMCID: PMC8720402 DOI: 10.32074/1591-951x-551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 11/30/2022] Open
Abstract
The conceptual evolution in the field of soft tissue tumor pathology has been mostly driven by a relatively small group of individuals that includes giants of the past and the present such as James Ewing, Raffaele Lattes, Arthur Purdy Stout, Franz Enzinger, Sharon Weiss, Lennart Angervall, Harry Evans, Marku Miettinen, and Christopher Fletcher. Juan Rosai, not only exerted an immense impact on surgical pathology in general, but in consideration of his unique talent in identifying novel clinicopathologic entities, has also contributed remarkably to current understanding of mesenchymal neoplasms. The creation of desmoplastic small round cell tumor certainly ranks among his most relevant efforts, although he actually put his mark on a broad variety of soft tissue lesions, including vascular neoplasms. It would be impossible to include in a single article all the entities that he created or contributed to refine; therefore, this review is limited to a selection of what we believe represent true milestones.
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Affiliation(s)
- Marta Sbaraglia
- Department of Pathology, Azienda Ospedale-Università Padova.,Department of Medicine, University of Padua School of Medicine
| | - Elena Bellan
- Department of Medicine, University of Padua School of Medicine
| | | | - Angelo P Dei Tos
- Department of Pathology, Azienda Ospedale-Università Padova.,Department of Medicine, University of Padua School of Medicine
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36
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Nachiappan M, Srikantaiah GD, Gadiyaram S. Clinical, pathological, and genetic profile of clear cell sarcoma-like tumour of jejunum: report of a rare aggressive tumour of small bowel. Clin J Gastroenterol 2021; 15:107-111. [PMID: 34792784 DOI: 10.1007/s12328-021-01554-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 11/06/2021] [Indexed: 11/30/2022]
Abstract
Clear cell sarcoma-like tumour of the gastrointestinal tract (CCSLGT) is a rare entity which has been recently described as late as 2003. Only around 70 cases have been reported in the English literature till date. CCSLGT is mostly seen in young adults in the late 20 s and early 30 s. CCSLGT are aggressive tumours. They are similar to the clear cell sarcoma of the soft tissue but lack melanocytic differentiation, retain neuroendocrine differentiation, and have osteoclastic giant cells. EWSR1-CREB1 fusion is characteristic of these tumours. Complete surgical excision is the best treatment option available. They have a high recurrence rate and poor prognosis. Currently, effective chemotherapy or a targeted agent is not available for the management of these tumours. Here, we describe a case of clear cell sarcoma-like tumour of jejunum encountered by us in a young man. The immunohistochemical and genetic profiling of these tumours are also discussed.
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Affiliation(s)
- Murugappan Nachiappan
- Dept of Surgical Gastroenterology and MIS, Sahasra Hospital, New no 30, 39th Cross, Jayanagar 8th Block, Bangalore, 560082, India
| | | | - Srikanth Gadiyaram
- Dept of Surgical Gastroenterology and MIS, Sahasra Hospital, New no 30, 39th Cross, Jayanagar 8th Block, Bangalore, 560082, India.
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37
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Liao S, Wang X, Li J, Yu X. Clinical presentation and imaging characteristics of clear cell sarcoma-like tumour of the gastrointestinal tract with liver metastasis: a case description. Quant Imaging Med Surg 2021; 11:4690-4694. [PMID: 34737937 DOI: 10.21037/qims-21-186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/02/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Shuting Liao
- Department of Radiology, Zhuhai Hospital Affiliated with Jinan University, Zhuhai People's Hospital, Zhuhai, China
| | - Xuedong Wang
- Department of Radiology, Zhuhai Hospital Affiliated with Jinan University, Zhuhai People's Hospital, Zhuhai, China
| | - Jiamin Li
- Department of Radiology, Zhuhai Hospital Affiliated with Jinan University, Zhuhai People's Hospital, Zhuhai, China
| | - Xiangrong Yu
- Department of Radiology, Zhuhai Hospital Affiliated with Jinan University, Zhuhai People's Hospital, Zhuhai, China
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38
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Li Z, Pu X, He L, Fu Y, Li L, Xu Y, Guan W, Fan X. Malignant Gastrointestinal Neuroectodermal Tumor in the Right Heart: A Report of an Extremely Rare Case Presenting With a Cardiac Mass. Front Cardiovasc Med 2021; 8:702215. [PMID: 34540914 PMCID: PMC8440875 DOI: 10.3389/fcvm.2021.702215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/26/2021] [Indexed: 01/14/2023] Open
Abstract
Malignant gastrointestinal neuroectodermal tumor (GNET) is an extremely rare soft tissue sarcoma and has been designated as a new entity recently. At present, GNET virtually exclusively occurs in the gastrointestinal tract. Here we report a case of extra-GNET that arose in the right heart. A 62-year-old male complained of chest distress and breathing difficulty while lying down at night for over 1 month at admission. The radiological findings revealed an occupying lesion involving the right atrium and the right ventricle without any abdominal abnormalities. The patient then underwent a surgical resection. Microscopically, neoplastic cells proliferated in the pattern of nests and sheets with fibrous separation. Focal areas with cellular dyscohesion imparted a vague pseudopapillary pattern. These tumor cells were small to medium in size with fine chromatin and predominantly pale eosinophilic cytoplasm. The nuclei were typically round to oval with somewhat irregular contours and contained small nucleoli. The mitotic figures were easily found. Immunohistochemically, the neoplastic cells were positive for S100 and SOX-10 but negative for HMB-45, A103, and CD99. EWSR1-AFTF1 rearrangement was detected by fluorescence in situ hybridization and further confirmed by whole-transcriptome sequence analysis. The patient had pulmonary metastasis 8 months later and soon died of the disease. The overall survival of the patient was 20 months. In summary, we reported an extremely rare case of cardiac GNET, indicating that the location of GNET should not be confined to the GI tract as initially defined. Due to the lack of a specific effective treatment and the occurrence of early metastasis, cardiac GNET conferred a poor prognosis. More clinical and experimental studies are warranted to better manage this disease in the future.
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Affiliation(s)
- Zhiwen Li
- Department of Pathology, The Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China.,Department of Pathology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaohong Pu
- Department of Pathology, The Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Lu He
- Department of Pathology, The Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Yao Fu
- Department of Pathology, The Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Lin Li
- Department of Pathology, The Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Yuemei Xu
- Department of Pathology, The Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Wenyan Guan
- Department of Pathology, The Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Xiangshan Fan
- Department of Pathology, The Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
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Chen C, Yin W, Wang X, Li P, Chen Y, Jin X, Yang P, Wu H. Synchronous Malignant Gastrointestinal Neuroectodermal Tumor and SMARCA4-Deficient Undifferentiated Carcinoma With Independent Origins in the Small Intestine: A Case Report. Front Oncol 2021; 11:665056. [PMID: 34513665 PMCID: PMC8429901 DOI: 10.3389/fonc.2021.665056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/05/2021] [Indexed: 01/14/2023] Open
Abstract
Background Malignant gastrointestinal neuroectodermal tumor (GNET) is a rare malignant mesenchymal neoplasm that commonly arises in the small bowel, stomach or colon. Meanwhile, SMARCA4-deficient undifferentiated carcinoma is a rarely reported entity with highly aggressive behavior that may involve the ovary, lung, gastrointestinal (GI) tract, endometrium and other organs. To our knowledge, we describe for the first time, an extremely rare case of synchronous GNET and SMARCA4-deficient undifferentiated carcinoma with independent origins in the small intestine. Case Presentation A 46-year-old woman presented with multiple small intestine masses and underwent surgical resection. Two distinct entities, GNET and SMARCA4-deficient undifferentiated carcinoma, were identified. GNET was composed of epithelioid and spindle cells with clear or eosinophilic cytoplasm arranged in sheets, nest, papillary, fascicular, palisade, rosette like or pseudoalveolar pattern. The neoplastic cells were positive for S-100 and SOX-10. Ewing sarcoma breakpoint region 1 gene (EWSR1) rearrangement was confirmed by fluorescence in situ hybridization (FISH), and EWSR1-CREB1 fusion was revealed by next-generation sequencing (NGS). SMARCA4-deficient undifferentiated carcinoma was composed mainly of poorly adhesive rhabdoid cells with eosinophilic cytoplasm arranged in a diffuse pattern. Multifocal necrosis, brisk mitotic figures as well as multinucleated tumor cells were observed. The neoplastic cells diffusely expressed pancytokeratin and vimentin, and was negative for SMARCA4(BRG1). Frame shift mutation of SMARCA4 was detected by NGS. Conclusions This is the first report that GNET and SMARCA4-deficient undifferentiated carcinoma occurred simultaneously in the small intestine, with the latter showing multiple involvement of the jejunum and ileum. The potential mechanism underlying co-existence of these two rare malignancies is unknown and need further investigations and concern.
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Affiliation(s)
- Cuimin Chen
- Department of Pathology, Shenzhen Hospital of Peking University, Shenzhen, China
| | - Weihua Yin
- Department of Pathology, Shenzhen Hospital of Peking University, Shenzhen, China
| | - Xingen Wang
- Department of Pathology, Shenzhen Hospital of Peking University, Shenzhen, China
| | - Ping Li
- Department of Pathology, Shenzhen Hospital of Peking University, Shenzhen, China
| | - Yaoli Chen
- Department of Pathology, Shenzhen Hospital of Peking University, Shenzhen, China
| | - Xianglan Jin
- Department of Pathology, Shenzhen Hospital of Peking University, Shenzhen, China
| | - Ping Yang
- Department of Pathology, Shenzhen Hospital of Peking University, Shenzhen, China
| | - Huanwen Wu
- Department of Pathology, Peking Union Medical College Hospital, Peking, China
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40
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Sivasubramaniam P, Tiegs-Heiden CA, Sturgis CD, Hagen CE, Hartley CP, Thangaiah JJ. Malignant gastrointestinal neuroectodermal tumor: Cytologic, histologic, immunohistochemical, and molecular pitfalls. Ann Diagn Pathol 2021; 55:151813. [PMID: 34509898 DOI: 10.1016/j.anndiagpath.2021.151813] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 12/28/2022]
Abstract
Malignant gastrointestinal neuroectodermal tumor (GNET) is a rare malignant primary gastrointestinal mesenchymal tumor which can be diagnosed via fine-needle aspiration (FNA) cytology. In the context of FNA, the diagnosis requires a cell block and the use of significant resources including immunohistochemical stains and molecular testing. The differential diagnosis of GNET includes clear cell sarcoma (CCS), gastrointestinal stromal tumor (GIST), gastric schwannoma, metastatic melanoma, malignant perivascular epithelioid cell tumor (PEComa) and granular cell tumor, among others. Here we describe a case which was initially diagnosed as malignant granular cell tumor by FNA which was later revised to GNET following the finding of an EWSR1-ATF1 fusion gene rearrangement.
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Affiliation(s)
| | | | - Charles D Sturgis
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Catherine E Hagen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Kasajima A, Konukiewitz B, Schlitter AM, Weichert W, Bräsen JH, Agaimy A, Klöppel G. Mesenchymal/non-epithelial mimickers of neuroendocrine neoplasms with a focus on fusion gene-associated and SWI/SNF-deficient tumors. Virchows Arch 2021; 479:1209-1219. [PMID: 34350470 PMCID: PMC8724147 DOI: 10.1007/s00428-021-03156-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 12/24/2022]
Abstract
Mimickers of neuroendocrine neoplasms (NEN) include a number of important pitfall tumors. Here, we describe our experience with mesenchymal mimics of NENs to illustrate their spectrum and draw the attention particularly to a group of mesenchymal/non-epithelial neoplasms (MN) that combine epithelioid histology with neuroendocrine (NE-) features and peculiar genetic abnormalities. In a consultation series of 4498 cases collected between 2009 and 2021, 2099 neoplasms expressing synaptophysin and/or chromograninA were reviewed and analyzed. A total of 364 (18%) were diagnosed as non-NENs, while the remaining tumors were NEN. The group of mesenchymal/non-epithelial neoplasms with NE-features (MN-NE) included 31/364 (8%) cases. These mostly malignant neoplasms showed an epithelioid morphology. While all but one tumor expressed synaptophysin, mostly patchy, only 10/29 (34%) co-expressed chromograninA. A total of 13/31 (42%) of the MN-NE showed EWSR1-related gene fusions (6 Ewing sarcomas, 5 clear cell sarcomas, and 1 desmoplastic small round cell tumor, 1 neoplasm with FUS-CREM gene fusion) and 7 (23%) were SWI/SNF (SMARCB1 or SMARCA4)-deficient neoplasms. The remaining MN-NE included synovial sarcoma, sclerosing epithelioid mesenchymal neoplasm, melanoma, alveolar soft part sarcoma, solitary fibrous tumor, and chordoma. A total of 27/31 MN-NE were from the last 8 years, and 6 of them were located in the pancreas. Eleven MN-NE were initially diagnosed as neuroendocrine carcinomas (NECs). MN-NE with epithelioid features play an increasing role as mimickers of NECs. They mostly belong to tumors with gene fusions involving the EWSR1 gene, or with SWI/SNF complex deficiency. Synaptophysin expression is mostly patchy and chromograninA expression is infrequent in MN-NE of this series and data extracted from literature.
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Affiliation(s)
- Atsuko Kasajima
- Department of Pathology, Technical University Munich, Trogerstr. 18, 81675, Munich, Germany.
- The German Cancer Consortium (DKTK), Heidelberg, Germany.
| | - Björn Konukiewitz
- Department of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Anna Melissa Schlitter
- Department of Pathology, Technical University Munich, Trogerstr. 18, 81675, Munich, Germany
- The German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Wilko Weichert
- Department of Pathology, Technical University Munich, Trogerstr. 18, 81675, Munich, Germany
- The German Cancer Consortium (DKTK), Heidelberg, Germany
| | | | - Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander-University, Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Günter Klöppel
- Department of Pathology, Technical University Munich, Trogerstr. 18, 81675, Munich, Germany
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Generation of human embryonic stem cell models to exploit the EWSR1-CREB fusion promiscuity as a common pathway of transformation in human tumors. Oncogene 2021; 40:5095-5104. [PMID: 34193943 PMCID: PMC8364490 DOI: 10.1038/s41388-021-01843-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 05/03/2021] [Accepted: 05/14/2021] [Indexed: 11/12/2022]
Abstract
Chromosomal translocations constitute driver mutations in solid tumors and leukemias. The mechanisms of how related or even identical gene fusions drive the pathogenesis of various tumor types remain elusive. One remarkable example is the presence of EWSR1 fusions with CREB1 and ATF1, members of the CREB family of transcription factors, in a variety of sarcomas, carcinomas and mesotheliomas. To address this, we have developed in vitro models of oncogenic fusions, in particular, EWSR1-CREB1 and EWSR1-ATF1, in human embryonic stem (hES) cells, which are capable of multipotent differentiation, using CRISPR-Cas9 technology and HDR together with conditional fusion gene expression that allows investigation into the early steps of cellular transformation. We show that expression of EWSR1-CREB1/ATF1 fusion in hES cells recapitulates the core gene signatures, respectively, of angiomatoid fibrous histiocytoma (AFH) and gastrointestinal clear cell sarcoma (GI-CCS), although both fusions lead to cell lethality. Conversely, expression of the fusions in hES cells differentiated to mesenchymal progenitors is compatible with prolonged viability while maintaining the core gene signatures. Moreover, in the context of a mesenchymal lineage, the proliferation of cells expressing the EWSR1-CREB1 fusion is further extended by deletion of the tumor suppressor TP53. We expect the generation of isogenic lines carrying oncogenic fusions in various cell lineages to expand our general understanding of how those single genetic events drive tumorigenesis while providing valuable resources for drug discovery.
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43
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Flucke U, van Noesel MM, Siozopoulou V, Creytens D, Tops BBJ, van Gorp JM, Hiemcke-Jiwa LS. EWSR1-The Most Common Rearranged Gene in Soft Tissue Lesions, Which Also Occurs in Different Bone Lesions: An Updated Review. Diagnostics (Basel) 2021; 11:diagnostics11061093. [PMID: 34203801 PMCID: PMC8232650 DOI: 10.3390/diagnostics11061093] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/07/2021] [Accepted: 06/10/2021] [Indexed: 01/09/2023] Open
Abstract
EWSR1 belongs to the FET family of RNA-binding proteins including also Fused in Sarcoma (FUS), and TATA-box binding protein Associated Factor 15 (TAF15). As consequence of the multifunctional role of EWSR1 leading to a high frequency of transcription of the chromosomal region where the gene is located, EWSR1 is exposed to aberrations such as rearrangements. Consecutive binding to other genes leads to chimeric proteins inducing oncogenesis. The other TET family members are homologous. With the advent of widely used modern molecular techniques during the last decades, it has become obvious that EWSR1 is involved in the development of diverse benign and malignant tumors with mesenchymal, neuroectodermal, and epithelial/myoepithelial features. As oncogenic transformation mediated by EWSR1-fusion proteins leads to such diverse tumor types, there must be a selection on the multipotent stem cell level. In this review, we will focus on the wide variety of soft tissue and bone entities, including benign and malignant lesions, harboring EWSR1 rearrangement. Fusion gene analysis is the diagnostic gold standard in most of these tumors. We present clinicopathologic, immunohistochemical, and molecular features and discuss differential diagnoses.
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Affiliation(s)
- Uta Flucke
- Department of Pathology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.M.v.N.); (B.B.J.T.); (L.S.H.-J.)
- Correspondence: ; Tel.: +31-24-36-14387; Fax: +31-24-36-68750
| | - Max M. van Noesel
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.M.v.N.); (B.B.J.T.); (L.S.H.-J.)
- Division Cancer & Imaging, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | | | - David Creytens
- Department of Pathology, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium;
| | - Bastiaan B. J. Tops
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.M.v.N.); (B.B.J.T.); (L.S.H.-J.)
| | - Joost M. van Gorp
- Department of Pathology, St Antonius Hospital, 3435 CM Nieuwegein, The Netherlands;
| | - Laura S. Hiemcke-Jiwa
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.M.v.N.); (B.B.J.T.); (L.S.H.-J.)
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44
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Sbaraglia M, Businello G, Bellan E, Fassan M, Dei Tos AP. Mesenchymal tumours of the gastrointestinal tract. Pathologica 2021; 113:230-251. [PMID: 34294940 PMCID: PMC8299319 DOI: 10.32074/1591-951x-309] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Mesenchymal tumours represent a heterogenous group of neoplasms encopassing benign, intermediate malignancy, and malignant entities. Sarcomas account for approximately 1% of human malignancies. In consideration of their rarity as well as of intrinsic complexity, diagnostic accuracy represents a major challenge. Traditionally, mesenchymal tumours are regarded as lesions the occurrence of which is mostly limited to somatic soft tissues. However, the occurrence of soft tissue tumours at visceral sites represent a well recognized event, and the GI-tract ranks among the most frequently involved visceral location. There exist entities such as gastrointestinal stromal tumours (GIST) and malignant gastointestinal neuroectodermal tumors that exhibit exquisite tropism for the GI-tract. This review will focus also on other relevant clinico-pathologic entities in which occurrence at visceral location is not at all negligible.
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Affiliation(s)
- Marta Sbaraglia
- Department of Pathology, Azienda Ospedale-Università Padova, Padua, Italy.,Department of Medicine, University of Padua School of Medicine, Padua, Italy
| | - Gianluca Businello
- Department of Medicine, University of Padua School of Medicine, Padua, Italy
| | - Elena Bellan
- Department of Medicine, University of Padua School of Medicine, Padua, Italy
| | - Matteo Fassan
- Department of Pathology, Azienda Ospedale-Università Padova, Padua, Italy.,Department of Medicine, University of Padua School of Medicine, Padua, Italy
| | - Angelo Paolo Dei Tos
- Department of Pathology, Azienda Ospedale-Università Padova, Padua, Italy.,Department of Medicine, University of Padua School of Medicine, Padua, Italy
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45
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Gonzalez RS, Raza A, Propst R, Adeyi O, Bateman J, Sopha SC, Shaw J, Auerbach A. Recent Advances in Digestive Tract Tumors: Updates From the 5th Edition of the World Health Organization "Blue Book". Arch Pathol Lab Med 2021; 145:607-626. [PMID: 32886739 DOI: 10.5858/arpa.2020-0047-ra] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The World Health Organization Classification of Tumours: Digestive System Tumors, 5th edition, was published in 2019 and shows several impactful changes as compared with the 4th edition published in 2010. Changes include a revised nomenclature of serrated lesions and revamping the classification of neuroendocrine neoplasms. Appendiceal goblet cell adenocarcinoma is heavily revised, and intrahepatic cholangiocarcinoma is split into 2 subtypes. New subtypes of colorectal carcinoma and hepatocellular carcinoma are described. Precursor lesions are emphasized with their own entries, and both dysplastic and invasive lesions are generally recommended to be graded using a 2-tier system. Hematolymphoid tumors, mesenchymal tumors, and genetic tumor syndromes each have their own sections in the 5th edition. New hematolymphoid lesions include monomorphic epitheliotropic intestinal T-cell lymphoma; duodenal-type follicular lymphoma; intestinal T-cell lymphoma, not otherwise specified; and indolent T-cell lymphoproliferative disorder of the gastrointestinal tract. This paper will provide an in-depth look at the changes in the 5th edition as compared with the 4th edition. OBJECTIVE.— To provide a comprehensive, in-depth update on the World Health Organization classification of digestive tumors, including changes to nomenclature, updated diagnostic criteria, and newly described entities. DATA SOURCES.— The 5th edition of the World Health Organization Classification of Tumours: Digestive System Tumours, as well as the 4th edition. CONCLUSIONS.— The World Health Organization has made many key changes in its newest update on tumors of the digestive system. Pathologists should be aware of these changes and incorporate them into their practice as able or necessary.
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Affiliation(s)
- Raul S Gonzalez
- The Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Gonzalez)
| | - Anwar Raza
- The Department of Pathology and Human Anatomy, Loma Linda University, Loma Linda, California (Raza, Propst)
| | - Robert Propst
- The Department of Pathology and Human Anatomy, Loma Linda University, Loma Linda, California (Raza, Propst)
| | - Oyedele Adeyi
- The Department of Pathology, University of Minnesota, Minneapolis (Adeyi, Bateman)
| | - Justin Bateman
- The Department of Pathology, University of Minnesota, Minneapolis (Adeyi, Bateman)
| | - Sabrina C Sopha
- The Department of Pathology, University of Maryland Baltimore Washington Medical Center, Glen Burnie (Sopha)
| | - Janet Shaw
- The Joint Pathology Center, Silver Spring, Maryland (Shaw, Auerbach)
| | - Aaron Auerbach
- The Joint Pathology Center, Silver Spring, Maryland (Shaw, Auerbach)
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Kumar N, Bhoriwal S, Yadav R, Deo SVS. Clear Cell Sarcoma of Sigmoid Colon: a Rare Malignancy with Common Clinical Manifestations. J Gastrointest Cancer 2021; 51:1070-1073. [PMID: 32385725 DOI: 10.1007/s12029-020-00413-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
MESH Headings
- Adult
- Anemia/etiology
- Anemia/therapy
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/genetics
- Biopsy
- Colectomy
- Colon, Sigmoid/diagnostic imaging
- Colon, Sigmoid/pathology
- Colon, Sigmoid/surgery
- Colonoscopy
- Cytogenetic Analysis
- Diagnosis, Differential
- Erythrocyte Transfusion
- Gastrointestinal Hemorrhage/etiology
- Gastrointestinal Hemorrhage/therapy
- Humans
- Ileostomy
- Immunohistochemistry
- Intestinal Mucosa/diagnostic imaging
- Intestinal Mucosa/pathology
- Intestinal Mucosa/surgery
- Male
- Rectum
- Sarcoma, Clear Cell/complications
- Sarcoma, Clear Cell/diagnosis
- Sarcoma, Clear Cell/genetics
- Sarcoma, Clear Cell/surgery
- Sigmoid Neoplasms/complications
- Sigmoid Neoplasms/diagnosis
- Sigmoid Neoplasms/genetics
- Sigmoid Neoplasms/surgery
- Tomography, X-Ray Computed
- Treatment Outcome
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Affiliation(s)
- Navin Kumar
- Department of Surgical Oncology, Dr. BRA-IRCH, All India Institute of Medical Sciences, New Delhi, India.
| | - Sandeep Bhoriwal
- Department of Surgical Oncology, Dr. BRA-IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Rajni Yadav
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - S V S Deo
- Department of Surgical Oncology, Dr. BRA-IRCH, All India Institute of Medical Sciences, New Delhi, India
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47
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Malignant Gastrointestinal Neuroectodermal Tumour-Case Report with Review of Literature. J Gastrointest Cancer 2021; 52:1125-1130. [PMID: 33523361 DOI: 10.1007/s12029-020-00575-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 12/22/2022]
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48
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Agnihotri M, Kothari K, Khadilkar A. Catechism (Quiz 8). INDIAN J PATHOL MICR 2021; 63:342-344. [PMID: 32317555 DOI: 10.4103/ijpm.ijpm_15_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] Open
Affiliation(s)
- Mona Agnihotri
- Department of Pathology, Seth G.S. Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Kanchan Kothari
- Department of Pathology, Seth G.S. Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Ameya Khadilkar
- Department of Pathology, Seth G.S. Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
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Zhu P, Zhang T, Bi K, Wu Y, Chen X, Zhang H, Huang D, Zhang L, Zeng Y, Yi X. Primary Clear Cell Sarcoma of the Ileum: A Case Report With Next-Generation Sequencing Analysis. Int J Surg Pathol 2021; 29:677-684. [PMID: 33412984 DOI: 10.1177/1066896920985311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As the concept of clear cell sarcoma-like tumor or malignant gastrointestinal neuroectodermal tumor (CCS-LT/MGNET) has been widely accepted, primary CCS of the gastrointestinal tract (CCS-GI) is becoming a rare entity. In this article, we describe a case of primary CCS-GI that occurred in the ileum of a 65-year-old male to further illustrate its rare occurrence. Similar to CCS of soft tissue (CCS-ST), the tumor was composed of spindled to epithelioid cells displaying fascicular, nested, or pseudopapillary arrangement. The tumor cells had large round to ovoid nuclei with vesicular chromatin and prominent nucleoli, containing eosinophilic to pale cytoplasm. In contrast to CCS-LT/MGNET, immunohistochemical study also showed variable positivity of HMB45, melan A, and MiTF besides the strong and diffuse staining of S100 protein and SOX10. Fluorescence in situ hybridization (FISH) using fusion probes identified EWSR1 and ATF1 genes rearrangement. Next-generation sequencing (NGS) analysis further revealed EWSR1 exons9/8-ATF1 exon4 and ATF1 exon3- EWSR1 exon11 fusion genes. CCS-GI and CCS-LT/MGNET possibly represent 2 related entities of the same spectrum, which differentiate along 2 different pathways.
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Affiliation(s)
- Peipei Zhu
- Department of Pathology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tingting Zhang
- Department of Pathology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ke Bi
- Department of Pathology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yunjin Wu
- Department of Pathology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xue Chen
- Department of Pathology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Haoyang Zhang
- Department of Pathology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dandan Huang
- Department of Pathology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Long Zhang
- Department of Pathology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yu Zeng
- Department of Pathology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xianghua Yi
- Department of Pathology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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50
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Rekhi B. Recent updates in the diagnosis of soft tissue tumors: Newly described tumor entities, newer immunohistochemical and genetic markers, concepts, including "inter-tumor relationships". INDIAN J PATHOL MICR 2021; 64:448-459. [PMID: 34341252 DOI: 10.4103/ijpm.ijpm_1361_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
During the last two decades, there have been significant strides in the diagnosis of soft tissue tumors, including identification of various tumor entities, newer immunohistochemical markers, and an increasing number of molecular signatures, defining certain tumors. Lately, there are certain emerging tumor entities, defined by their molecular features with an impact on treatment. At the same time, there is a certain degree of overlap in the expression of certain immunohistochemical antibody markers, as well as genetic markers, with certain gene rearrangements and chimeric fusions observed among completely different tumors. Moreover, a certain amount of clinicopathological, immunohistochemical, and molecular proximity has been unraveled among certain tumor types. Over the years, the World Health Organization (WHO) fascicles on tumors of soft tissue have succinctly brought out these aspects. The present review describes recent updates in the diagnosis of soft tissue tumors, including certain newly described tumor entities; emphasizing upon newer, specific immunohistochemical and molecular markers, along with concepts, regarding "intertumor relationships".
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Affiliation(s)
- Bharat Rekhi
- Department of Surgical Pathology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
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