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Dehner CA, Rudzinski ER, Davis JL. Rhabdomyosarcoma: Updates on classification and the necessity of molecular testing beyond immunohistochemistry. Hum Pathol 2024; 147:72-81. [PMID: 38135061 DOI: 10.1016/j.humpath.2023.12.004] [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: 11/16/2023] [Revised: 12/06/2023] [Accepted: 12/19/2023] [Indexed: 12/24/2023]
Abstract
Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children and adolescents under the age of 20. The current World Health Organization (WHO) classification for soft tissue and bone tumors recognizes 4 distinct subtypes of RMS based on clinicopathological and molecular genetic features: embryonal, alveolar, spindle cell/sclerosing and pleomorphic subtypes. However, with the increased use of molecular techniques, the classification of rhabdomyosarcoma has been evolving rapidly. New subtypes such as osseus RMS harboring TFCP2/NCOA2 fusions or RMS arising in inflammatory rhabdomyoblastic tumor have been emerging within the last decade, adding to the complexity of diagnosing skeletal muscle tumors. This review article provides an overview of classically recognized distinctive subtypes as well as new, evolving subtypes and discusses important morphologic, immunophenotypic and molecular genetic features of each subtype including recommendations for a diagnostic approach of malignant skeletal muscle neoplasms.
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Affiliation(s)
- Carina A Dehner
- Department of Pathology & Laboratory Medicine, Indiana University, Indianapolis, IN, USA
| | - Erin R Rudzinski
- Department of Laboratories, Seattle Children's Hospital and Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, WA, USA
| | - Jessica L Davis
- Department of Pathology & Laboratory Medicine, Indiana University, Indianapolis, IN, USA.
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2
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Hornick JL, Plaza JA, Mentzel T, Gru AA, Brenn T. PRAME Expression Is a Useful Tool in the Diagnosis of Primary and Metastatic Dedifferentiated and Undifferentiated Melanoma. Am J Surg Pathol 2023; 47:1390-1397. [PMID: 37727938 DOI: 10.1097/pas.0000000000002125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Although mostly recognized in the metastatic setting dedifferentiated and undifferentiated melanomas are increasingly recognized as cutaneous and, less commonly, mucosal primary tumors. Their diagnosis is challenging and dependent on sampling and recognition of a conventional melanoma precursor and/or detection of a mutation in a conventional melanoma driver gene. PRAME immunohistochemistry has recently become an important ancillary tool in the separation of melanoma from benign nevi, but no comprehensive studies exist regarding its value in the detection of dedifferentiated and undifferentiated melanomas and their separation from atypical fibroxanthoma and pleomorphic dermal sarcoma, the main differential diagnoses on sun-damaged skin. After retrieval from archival files, we performed PRAME immunohistochemistry on 11 primary and 10 metastatic dedifferentiated and undifferentiated melanomas, 11 atypical fibroxanthomas, and 10 pleomorphic dermal sarcomas. Nuclear staining was assigned extent (ranging from 0 to 4 and reflecting the percentage of PRAME-positive tumor nuclei) and intensity scores (graded as absent, weak, moderate, and strong, with assigned scores ranging from 0 to 3) with combined scores ranging from 0 to 7. Both primary and metastatic dedifferentiated and undifferentiated melanomas showed strong and diffuse nuclear PRAME staining with median combined scores of 7. Strong and diffuse staining was also seen in all conventional melanoma precursors except for desmoplastic melanoma. In contrast, PRAME staining in atypical fibroxanthoma and pleomorphic dermal sarcoma was patchy and weak with median combined scores of 2. Our data emphasize the diagnostic utility of PRAME staining as a first screening tool in the detection and workup of dedifferentiated and undifferentiated melanomas, both in the primary and metastatic settings. PRAME immunohistochemistry is particularly helpful as it is also positive in tumors without a recognizable conventional melanoma precursor and in those associated with desmoplastic melanomas, where PRAME is typically found to be negative.
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Affiliation(s)
- Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jose A Plaza
- Division of Dermatopathology, Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Thomas Mentzel
- MVZ Dermatopathologie Friedrichshafen/Bodensee PartG, Friedrichshafen, Germany
| | - Alejandro A Gru
- Department of Pathology, University of Virginia, Charlottesville, VA
| | - Thomas Brenn
- Department of Pathology and Laboratory Medicine
- Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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3
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Shafi S, Shah M, Jones D, Beane JD, Oghumu S, Iwenofu OH. Comprehensive molecular profile of primary cutaneous epithelioid rhabdomyosarcoma: A tumor genomically and molecularly related to malignant melanoma. Genes Chromosomes Cancer 2023; 62:678-684. [PMID: 37357966 DOI: 10.1002/gcc.23185] [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: 03/03/2023] [Revised: 05/22/2023] [Accepted: 05/30/2023] [Indexed: 06/27/2023] Open
Abstract
The histogenesis of the rare primary cutaneous epithelioid rhabdomyosarcoma (PCERMS) remains unclear, with the morphological and immunophenotypic appearance of a rhabdomyosarcoma but a genomic profile consistent with sarcomatoid undifferentiated malignant melanoma (SUMM). Here, we provide comprehensive clinical, histopathological, and genomic analysis of a putative PCERMS presenting in an elderly patient. Histopathologic examination revealed an ulcerative tumefactive lesion with diffuse replacement of the dermis by sheets of malignant epithelioid cells with a rhabdoid appearance. By immunohistochemistry, the tumor cells were strongly and diffusely positive for desmin and myogenin. Comprehensive genomic analysis with a 542 gene DNA-based sequencing panel revealed likely biallelic NF1 inactivation (mutation and deletion), TERT promoter mutation, and a high tumor mutation burden (>100 mutations/mB) with features of a UV-mutational signature, which are all genomic features that can be seen in undifferentiated malignant melanoma. This case provides evidence of a close relationship at a molecular level between PCERMS and SUMM. Molecular genomic characterization of a larger cohort of PCERMS is warranted for further elucidation.
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Affiliation(s)
- Saba Shafi
- Department of Pathology & Laboratory Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Manan Shah
- Department of Internal Medicine, Division of Hematology & Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Dan Jones
- Department of Pathology & Laboratory Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- The James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Joal D Beane
- The James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
- Divison of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Steve Oghumu
- Department of Pathology & Laboratory Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - O Hans Iwenofu
- Department of Pathology & Laboratory Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- The James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
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4
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Wiedemeyer K, Brenn T. Dedifferentiated and undifferentiated melanomas: a practical approach to a challenging diagnosis. Hum Pathol 2023; 140:22-31. [PMID: 37001740 DOI: 10.1016/j.humpath.2023.03.014] [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: 01/31/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
Dedifferentiation, defined as the loss of cellular features of terminal differentiation resulting in a more primitive, unspecialized phenotype, is a rare phenomenon in melanoma and more commonly observed in the metastatic setting than in primary melanomas. The diagnosis of dedifferentiated melanoma poses a significant challenge, and the tumors need to be carefully sampled and worked up to identify any residual morphologic, immunohistochemical, or molecular evidence of their melanocytic lineage. This article reviews our current knowledge of the clinical, histopathological, immunohistochemical, and molecular features of these rare tumors and provides a practical diagnostic approach and discussion of the relevant differential diagnoses and associated diagnostic pitfalls.
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Affiliation(s)
- Katharina Wiedemeyer
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2L 2K8, Canada
| | - Thomas Brenn
- Departments of Pathology and Laboratory Medicine and Medicine, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2L 2K8, Canada.
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5
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O'Neill P, Amanuel B, Mesbah Ardakani N. Cutaneous Malignant Melanoma With Rhabdomyosarcomatous Dedifferentiation: an Immunohistological and Molecular Case Study With Literature Review. Am J Dermatopathol 2023; 45:470-474. [PMID: 37130217 DOI: 10.1097/dad.0000000000002451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
ABSTRACT Cutaneous malignant melanoma can show a wide range of cytomorphological variability, in particular exhibiting a rhabdoid appearance is not uncommon in melanoma cells; however, the phenomenon of "dedifferentiation" with loss of melanocytic immunohistochemical properties and expression of skeletal muscle immunomarkers is exceedingly rare. Owing to the rarity of such melanomas, their clinicopathological features and molecular profile remain largely unknown. In this report, we describe the clinical, immunomorphological, and molecular features of melanomas with rhabdomyosarcomatous dedifferentiation by presenting a new case and exploring the literature for the previously reported cases.
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Affiliation(s)
- Paul O'Neill
- Department of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, WA, Australia
| | - Benhur Amanuel
- Department of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, WA, Australia
- School of Pathology and Laboratory Medicine, University of Western Australia, Perth, WA, Australia; and
| | - Nima Mesbah Ardakani
- Department of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, WA, Australia
- School of Medicine, University of Notre Dame, Fremantle, WA, Australia
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6
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Surkova VS, Volchenko NN, Nikitina EA, Troshenkov EA, Lavrova AM, Khakimova GG. Primary alveolar rhabdomyosarcoma of the breast skin: a case report and literature review. TUMORS OF FEMALE REPRODUCTIVE SYSTEM 2022. [DOI: 10.17650/1994-4098-2022-18-3-71-77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Alveolar rhabdomyosarcoma is one of the four subtypes of rhabdomyosarcoma identified by the World Health Organization. This type of malignant neoplasms more often affects deep soft tissues of extremities and occurs in young ages, regardless of gender. According to the medical literature, no more than 45 cases of the development of primary cutaneous rhabdomyosarcoma have been reported in the world. In this report, we describe a clinical case of a 40-year-old woman with primary localization of alveolar radbomyosarcoma in the skin of the mammary gland.
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Affiliation(s)
- V. S. Surkova
- P.A. Herzen Moscow Oncology Research Institute – a branch of the National Medical Radiology Research Center, Ministry of Health of Russia
| | - N. N. Volchenko
- P.A. Herzen Moscow Oncology Research Institute – a branch of the National Medical Radiology Research Center, Ministry of Health of Russia
| | - E. A. Nikitina
- P.A. Herzen Moscow Oncology Research Institute – a branch of the National Medical Radiology Research Center, Ministry of Health of Russia
| | - E. A. Troshenkov
- P.A. Herzen Moscow Oncology Research Institute – a branch of the National Medical Radiology Research Center, Ministry of Health of Russia
| | - A. M. Lavrova
- P.A. Herzen Moscow Oncology Research Institute – a branch of the National Medical Radiology Research Center, Ministry of Health of Russia
| | - G. G. Khakimova
- Tashkent branch of the Republican Specialized Research and Practical Medical Center of Oncology and Radiology; Department of Oncology and Pediatric Oncology, Tashkent Pediatric Medical Institute
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7
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Yim SH, Kim D, Hong D, Jung KE, Lee Y, Seo YJ, Park S. Primary cutaneous malignant melanoma with rhabdomyosarcomatous differentiation originating from a melanocytic nevus in a patient with myelodysplastic syndrome. J Cutan Pathol 2022; 49:875-880. [PMID: 35707850 DOI: 10.1111/cup.14272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 06/10/2022] [Accepted: 06/12/2022] [Indexed: 11/30/2022]
Abstract
Malignant melanoma (MM) may rarely exhibit divergent differentiation, in which melanocytic markers may be lost, leading to difficulty in diagnosis. A 64-year-old man recently diagnosed with myelodysplastic syndrome complained of development of a nodule in a melanocytic nevus on his scalp. On histopathologic examination, junctional nevus nests and diffuse cellular infiltrations with a sheet-like growth pattern of pleomorphic epithelioid cells were observed in the upper dermis. Junctional nevus cells were S-100 positive, and pleomorphic epithelioid cells extending from the junctional nests were weakly positive for S-100. Large polygonal cells with eccentric nuclei and intracytoplasmic hyaline inclusions were observed in the mid to deep dermis. These rhabdomyoblast-like polygonal cells diffusely expressed desmin and were focally positive for MyoD1. Some clusters of polygonal cells in the deep dermis expressed SOX10. Collectively, these clinical and histopathologic features suggested MM with rhabdomyosarcomatous differentiation. Desmin- and skeletal-muscle-specific markers should be applied to melanocytic tumors with atypical epithelioid cells resembling rhabdomyoblasts, especially if these cells are negative for melanocytic markers.
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Affiliation(s)
- Su-Hyuk Yim
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Doyeon Kim
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Dongkyun Hong
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Kyung Eun Jung
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Young Lee
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Young-Joon Seo
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Sanghyun Park
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Republic of Korea
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Gallagher KPD, van Heerden W, Said-Al-Naief N, Carlos R, Arboleda LPA, Rodrigues-Fernandes CI, Araújo ALD, Fonseca FP, Pontes HAR, Innocentini LMAR, Romañach MJ, Vargas PA, Lopes MA, Santos-Silva AR, Khurram SA. Molecular profile of head and neck rhabdomyosarcomas: A systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:354-366. [PMID: 35840496 DOI: 10.1016/j.oooo.2021.12.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/16/2021] [Accepted: 12/19/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This systematic review aimed to identify the molecular alterations of head and neck rhabdomyosarcomas (HNRMS) and their prognostic values. STUDY DESIGN An electronic search was performed using PubMed, Embase, Scopus, and Web of Science with a designed search strategy. Inclusion criteria comprised cases of primary HNRMS with an established histopathological diagnosis and molecular analysis. Forty-nine studies were included and were appraised for methodological quality using the Joanna Briggs Institute Critical Appraisal tools. Five studies were selected for meta-analysis. RESULTS HNRMS predominantly affects pediatric patients (44.4%), and the parameningeal region (57.7%) is the most common location. The alveolar variant (43.2%) predominates over the embryonal and spindle cell/sclerosing types, followed by the epithelioid and pleomorphic variants. PAX-FOXO1 fusion was observed in 103 cases of alveolar RMS (79.8%). MYOD1 mutation was found in 39 cases of sclerosing/spindle cell RMS (53.4%). FUS/EWSR1-TFCP2 gene fusions were identified in 21 cases of RMS with epithelioid and spindle cell morphologies (95.5%). The 5-year overall survival rate of patients was 61.3%, and MYOD1 mutation correlated with significantly higher mortality. CONCLUSION The genotypic profile of histologic variants of HNRMS is widely variable, and MYOD1 mutation could be a potential prognostic factor, but more studies are required to establish this.
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Affiliation(s)
- Karen Patricia Domínguez Gallagher
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil; Practicing Graduate Professor, School of Dentistry, National University of Asunción (UNA), Asunción, Paraguay
| | - Willie van Heerden
- Department of Oral Pathology and Oral Biology, School of Dentistry, University of Pretoria, South Africa
| | - Nasser Said-Al-Naief
- Professor, Oral and Maxillofacial Pathology, Oregon Health and Science University, School of Dentistry and School of Medicine, OR, USA
| | - Roman Carlos
- Department of Pathology, Integra Cancer Center, Guatemala City, Guatemala
| | - Lady Paola Aristizabal Arboleda
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Carla Isabelly Rodrigues-Fernandes
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Anna Luíza Damaceno Araújo
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Felipe Paiva Fonseca
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Hélder Antônio Rebelo Pontes
- Oral Pathology Department, João de Barros Barreto University Hospital, Federal University of Pará, Belém, Pará, Brazil
| | - Lara Maria Alencar Ramos Innocentini
- Dentistry and Stomatology Division, Ophthalmology, Otolaryngology and Head and Neck Surgery Department, University Hospital of the Ribeirão Preto Medical School, University of São Paulo, SP, Brazil
| | - Mário José Romañach
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Pablo Agustin Vargas
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Márcio Ajudarte Lopes
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil.
| | - Syed Ali Khurram
- Unit of Oral & Maxillofacial Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
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9
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Epithelioid Rhabdomyosarcoma at the High Parietal Area of the Head: A Case Report. Medicina (B Aires) 2022; 58:medicina58070951. [PMID: 35888670 PMCID: PMC9317532 DOI: 10.3390/medicina58070951] [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: 06/03/2022] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 11/17/2022] Open
Abstract
Epithelioid rhabdomyosarcoma is a rare condition, which may be clinically misinterpreted as melanoma due to its morphological appearance. Careful morphological and immunohistochemical analysis play an important role in its diagnosis. This case report describes the clinicopathological features of an epithelioid RMS diagnosed at the high parietal area of the head. A 71-year-old male patient presented a red-brown pigmented ulcerative nodule in the high parietal region of the head. Previous biopsy and computer tomography imaging revealed a malignant melanoma in stage I (pT2, sN0, Mx). After tumor operation, histological and immunohistochemical analysis of the tumor were conducted. Histological analysis showed an erosive lesion with a monomorphic cell population containing small cells with prominent nucleoli. A positivity was confirmed for CD10, Vimentin, and Desmin. MyoD1 was detected, as well as a fluctuating signal for p53. Molecular analysis revealed a negativity for Sox-10, and a weak positivity for CK8/18 by absence of p40. Based on the morphological and immunohistochemical findings, the tumor was diagnosed as epithelioid RMS.
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10
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Drabent P, Fraitag S. Malignant Superficial Mesenchymal Tumors in Children. Cancers (Basel) 2022; 14:cancers14092160. [PMID: 35565289 PMCID: PMC9104419 DOI: 10.3390/cancers14092160] [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: 03/19/2022] [Revised: 04/12/2022] [Accepted: 04/22/2022] [Indexed: 11/16/2022] Open
Abstract
Malignant superficial mesenchymal tumors are a very diverse group of neoplasms with few clinical and radiological discriminatory factors. Hence, some of these cancers are rarely suspected based on clinical and radiological grounds, others may be easily misdiagnosed, and the histological analysis of a biopsy or resection is central in the diagnostic process. In children, the age at presentation is a major element of the differential diagnosis. Some tumors have a very distinct epidemiology, while others may be seen at any age. More recently, the advances in molecular biology have greatly improved the diagnosis of mesenchymal tumors and new entities are still being described. In the present review, we provide an overview of the diversity of malignant superficial mesenchymal tumors in children, including new and/or rare entities. We discuss the important diagnostic features, be they clinical, histological, or molecular. Special attention was given to the genetic features of these tumors, particularly when they were helpful for the diagnosis or treatment.
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Affiliation(s)
- Philippe Drabent
- Department of Pathology, Necker-Enfants Malades Hospital, APHP, 75015 Paris, France;
- Faculté de Médecine, Université de Paris, 75005 Paris, France
| | - Sylvie Fraitag
- Department of Pathology, Necker-Enfants Malades Hospital, APHP, 75015 Paris, France;
- Faculté de Médecine, Université de Paris, 75005 Paris, France
- Correspondence:
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11
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Liu J, Liu P, Gong F, Tian Y, Zhao X. Case Report: A PD-L1-Positive Patient With Pleomorphic Rhabdomyosarcoma Achieving an Impressive Response to Immunotherapy. Front Immunol 2022; 13:815598. [PMID: 35371041 PMCID: PMC8968025 DOI: 10.3389/fimmu.2022.815598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/18/2022] [Indexed: 12/31/2022] Open
Abstract
There is currently a lack of effective systemic treatment for patients with advanced pleomorphic rhabdomyosarcoma (PRMS). Although programmed death protein 1 (PD-1) inhibitors have shown efficacy in various solid tumors, their effects on PRMS have not been well established. Here, we present a case of a 12-year-old Chinese male adolescent with metastatic PRMS who benefited from the PD-1 inhibitor nivolumab. The patient initially underwent primary tumor resection but failed to respond to subsequent first-line chemotherapy and second-line pazopanib treatment. Pathological examination showed positive PD-L1 expression and tumor-infiltrating lymphocytes in the tumor tissue, and the patient was administered nivolumab as a posterior-line treatment. After attaining a clinically partial response (PR), surgical resection was performed, which was followed by adjuvant nivolumab. At the time of the submission of this manuscript, the patient achieved recurrence-free survival (RFS) lasting 45 months and counting. This is the first clinical evidence that a patient with refractory PRMS was controlled by anti-PD-1 antibody, with an RFS lasting more than 3 years. This case suggests that PD-L1 expression and T-cell infiltration could be used as potential biomarkers for PRMS immunotherapy.
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Affiliation(s)
- Jiayong Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Bone and Soft Tissue Tumor, Peking University Cancer Hospital & Institute, Beijing, China
| | - Peijie Liu
- Department of Oncology, The First Affiliated Hospital of Henan University, Kaifeng, China
| | - Fuyu Gong
- The Medical Department, 3D Medicines Inc., Shanghai, China
| | - Youhui Tian
- The Medical Department, 3D Medicines Inc., Shanghai, China
| | - Xiaochen Zhao
- The Medical Department, 3D Medicines Inc., Shanghai, China
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12
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Primary Cutaneous Alveolar Rhabdomyosarcoma in an Elderly Adult: A Rare Potential Mimic of Merkel Cell Carcinoma. Am J Dermatopathol 2022; 44:218-222. [PMID: 34991098 DOI: 10.1097/dad.0000000000002124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Rhabdomyosarcoma (RMS) rarely arises as a primary skin tumor. It is also very rare in older adults, especially the alveolar type. We report an 80-year-old White woman who presented with a painful, erythematous, raised lesion (2 × 3.5 cm) above the left knee that was fixed within the skin, yet mobile about underlying soft tissue. A punch biopsy showed monotonous malignant round blue cells involving the dermis. Immunostains showed diffuse expression of CD56, focal chromogranin, focal dot-like pancytokeratin, CK7, and neurofilament, but negative for synaptophysin, CK20, SOX-10, MUM-1, CD43, TTF-1, and CD99. A CK20-negative variant of Merkel cell carcinoma was initially favored, but given the unusual immunophenotype and the presence of cellular dyscohesion, desmin and myogenin stains were performed, both of which were diffusely positive. Molecular testing revealed rearrangement of PAX3 and FOXO1 loci, confirming the diagnosis of alveolar RMS. PET/CT showed a probable 1.9-cm left inguinal lymph node metastasis; no internal or deep soft tissue primary tumor mass was identified, supporting a true primary cutaneous origin. Alveolar RMS may express keratins and neuroendocrine markers, making it easy to confuse with Merkel cell carcinoma on those exceptionally rare instances, when it arises in the skin of older adults.
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13
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Ketheeswaranathan V, Monteiro M, Ah-Weng A. Adult Cutaneous Rhabdomyosarcoma (RMS). ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2022. [DOI: 10.1016/j.adoms.2021.100208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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14
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Ferreira I, Arends MJ, Weyden L, Adams DJ, Brenn T. Primary de‐differentiated, trans‐differentiated and undifferentiated melanomas: overview of the clinicopathological, immunohistochemical and molecular spectrum. Histopathology 2021; 80:135-149. [DOI: 10.1111/his.14545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 12/20/2022]
Affiliation(s)
- Ingrid Ferreira
- Experimental Cancer Genetics Wellcome Sanger Institute Wellcome Genome Campus Cambridge UK
- Université Libre de Bruxelles Brussels Belgium
| | - Mark J Arends
- Division of Pathology Cancer Research UK Edinburgh Centre Edinburgh UK
| | - Louise Weyden
- Experimental Cancer Genetics Wellcome Sanger Institute Wellcome Genome Campus Cambridge UK
| | - David J Adams
- Experimental Cancer Genetics Wellcome Sanger Institute Wellcome Genome Campus Cambridge UK
| | - Thomas Brenn
- Division of Pathology Cancer Research UK Edinburgh Centre Edinburgh UK
- Department of Pathology and Laboratory Medicine and the Arnie Charbonneau Cancer Institute Cumming School of Medicine University of Calgary Calgary AB Canada
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Ferreira I, Droop A, Edwards O, Wong K, Harle V, Habeeb O, Gharpuray-Pandit D, Houghton J, Wiedemeyer K, Mentzel T, Billings SD, Ko JS, Füzesi L, Mulholland K, Prusac IK, Liegl-Atzwanger B, de Saint Aubain N, Caldwell H, Riva L, van der Weyden L, Arends MJ, Brenn T, Adams DJ. The clinicopathologic spectrum and genomic landscape of de-/trans-differentiated melanoma. Mod Pathol 2021; 34:2009-2019. [PMID: 34155350 DOI: 10.1038/s41379-021-00857-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/03/2021] [Accepted: 06/03/2021] [Indexed: 02/03/2023]
Abstract
Dedifferentiation and transdifferentiation are rare and only poorly understood phenomena in cutaneous melanoma. To study this disease more comprehensively we have retrieved 11 primary cutaneous melanomas from our pathology archives showing biphasic features characterized by a conventional melanoma and additional areas of de-/trans-differentiation as defined by a lack of immunohistochemical expression of all conventional melanocytic markers (S-100 protein, SOX10, Melan-A, and HMB-45). The clinical, histologic, and immunohistochemical findings were recorded and follow-up was obtained. The patients were mostly elderly (median: 81 years; range: 42-86 years) without significant gender predilection, and the sun-exposed skin of the head and neck area was most commonly affected. The tumors were deeply invasive with a mean depth of 7 mm (range: 4-80 mm). The dedifferentiated component showed atypical fibroxanthoma-like features in the majority of cases (7), while additional rhabdomyosarcomatous and epithelial transdifferentiation was noted histologically and/or immunohistochemically in two tumors each. The background conventional melanoma component was of desmoplastic (4), superficial spreading (3), nodular (2), lentigo maligna (1), or spindle cell (1) types. For the seven patients with available follow-up data (median follow-up period of 25 months; range: 8-36 months), two died from their disease, and three developed metastases. Next-generation sequencing of the cohort revealed somatic mutations of established melanoma drivers including mainly NF1 mutations (5) in the conventional component, which was also detected in the corresponding de-/trans-differentiated component. In summary, the diagnosis of primary cutaneous de-/trans-differentiated melanoma is challenging and depends on the morphologic identification of conventional melanoma. Molecular analysis is diagnostically helpful as the mutated gene profile is shared between the conventional and de-/trans-differentiated components. Importantly, de-/trans-differentiation does not appear to confer a more aggressive behavior.
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Affiliation(s)
- Ingrid Ferreira
- Experimental Cancer Genetics, Wellcome Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK
- Université Libre de Bruxelles, Brussels, Belgium
| | - Alastair Droop
- Experimental Cancer Genetics, Wellcome Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK
| | - Olivia Edwards
- Experimental Cancer Genetics, Wellcome Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK
| | - Kim Wong
- Experimental Cancer Genetics, Wellcome Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK
| | - Victoria Harle
- Experimental Cancer Genetics, Wellcome Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK
| | - Omar Habeeb
- Department of Anatomic Pathology, Middlemore Hospital, Auckland, NZ, New Zealand
| | | | - Joseph Houghton
- Department of Pathology, Royal Victoria Hospital, Belfast, Ireland
| | - Katharina Wiedemeyer
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Thomas Mentzel
- Dermatopathology Friedrichshafen, Friedrichshafen, Germany
| | | | - Jennifer S Ko
- Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Laszlo Füzesi
- Center for Pathology, Robert-Weixler-Straße 48a, Kempten, Germany
| | | | - Ivana Kuzmic Prusac
- Department of Pathology, University Hospital Split and Split University School of Medicine, Split, Croatia
| | - Bernadette Liegl-Atzwanger
- Diagnostic and Research Centre for Molecular Biomedicine, Diagnostic and Research Centre for Pathology, Translational Sarcoma Pathology, Comprehensive Cancer Centre Subunit Sarcoma, Medical University Graz, Graz, Austria
| | - Nicolas de Saint Aubain
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Helen Caldwell
- Division of Pathology, Cancer Research UK Edinburgh Centre, The University of Edinburgh, Institute of Genetics and Cancer, Edinburgh, UK
| | - Laura Riva
- Experimental Cancer Genetics, Wellcome Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK
| | - Louise van der Weyden
- Experimental Cancer Genetics, Wellcome Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK
| | - Mark J Arends
- Division of Pathology, Cancer Research UK Edinburgh Centre, The University of Edinburgh, Institute of Genetics and Cancer, Edinburgh, UK
| | - Thomas Brenn
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Division of Pathology, Cancer Research UK Edinburgh Centre, The University of Edinburgh, Institute of Genetics and Cancer, Edinburgh, UK.
- The Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - David J Adams
- Experimental Cancer Genetics, Wellcome Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK
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16
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Fu S, Zeng Y, Zhang J, Zhou Y, Fan S, Chen M, Zhang G. A red nodule on the tip of the nose in a Chinese girl. Indian J Dermatol Venereol Leprol 2021; 88:1-3. [PMID: 34245519 DOI: 10.4103/ijdvl.ijdvl_563_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/01/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Siqi Fu
- Department of Dermatology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yu Zeng
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jing Zhang
- Department of Dermatology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ying Zhou
- Department of Dermatology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Songqing Fan
- Department of Pathology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Mingliang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guiying Zhang
- Department of Dermatology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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17
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Local Recurrence Rates of Skin Tumors After Resection With Complete Circumferential Peripheral and Deep Margin Assessment-Identification of High-Risk Entities. Dermatol Surg 2021; 47:e31-e36. [PMID: 33565775 DOI: 10.1097/dss.0000000000002431] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The local recurrence rates of malignant skin tumors after micrographic controlled surgery using complete circumferential peripheral and deep margin assessment (CCPDMA) are reported to be low. However, in daily practice, tumor entities with a significantly higher recurrence rate are found. OBJECTIVE The aim of the investigation was to identify these high-risk tumors to develop approaches for risk stratification. PATIENTS AND METHODS We included different malignant tumors that were surgically treated and examined with CCPDMA using paraffin sections and H&E staining. Re-excisions were performed until the tumor was completely removed. RESULTS Ninety-nine thousand three hundred seventy-two tumors were included in the study; the follow-up period was 4 years (median). Eight tumor entities were identified as high-risk entities, showing a significantly higher local recurrence rate of over 20%: desmoplastic squamous cell carcinoma, desmoplastic melanoma, Merkel cell carcinoma, microcystic adnexal carcinoma, pleomorphic sarcoma, liposarcoma as well as angiosarcoma, and extramammary Paget's disease. CONCLUSION Complete circumferential peripheral and deep margin assessment allows complete control of the resection margins and enables skin-sparing resections with low recurrence rates for basal cell carcinomas, nondesmoplastic squamous cell carcinomas, lentiginous melanomas, and dermatofibrosarcoma protuberans. However, other tumors show significantly higher recurrence rates and therefore need to be classified as high-risk tumors.
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18
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Epithelioid Rhabdomyosarcoma: Report of a Cutaneous Case and Literature Review of a Recently Described Variant of Rhabdomyosarcoma. Am J Dermatopathol 2021; 42:275-279. [PMID: 31688007 DOI: 10.1097/dad.0000000000001560] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Rhabdomyosarcoma affects mainly pediatric patients and is currently classified into 4 categories: embryonal, alveolar, pleomorphic, and spindle cell/sclerosing. Epithelioid rhabdomyosarcoma is a recently described variant of rhabdomyosarcoma in which primary cutaneous presentation is infrequent. In this brief report, we describe a rare case of epithelioid rhabdomyosarcoma in an 81-year-old man, presenting as a skin lesion in the neck, which increased in size in 1 month. After imaging evaluation, a solid cervical mass was discovered. A biopsy was performed, and the diagnosis of epithelioid rhabdomyosarcoma was rendered. The patient died due to rapid progression of the tumor. To make an accurate diagnosis and ensure appropriate patient management, it is necessary to be aware of this variant and use proper immunohistochemical stains when facing an epithelioid malignancy, expanding the differential diagnosis of epithelioid neoplasms.
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Bajaj G, Tirumani H, Whisman MK, Srivastava S, Ram R, Jambhekar K, Gardner JM, Pandey T. Comprehensive Review of Abdominopelvic Mesenchymal Tumors With Radiologic Pathologic Correlation and Update on Current Treatment Guidelines-Part 2. Semin Ultrasound CT MR 2020; 41:239-259. [PMID: 32446434 DOI: 10.1053/j.sult.2020.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Soft-tissue sarcomas are a diverse group of rare mesenchymal malignancies accounting for only 1% of all solid adult malignancies. These have been categorized in 12 broad groups by the World Health Organization (WHO) with their recent update in 2013. Majority of them lack specific imaging features serving as imaging conundrums for a radiologist. These are often large masses at presentation as they are asymptomatic or cause vague clinical symptoms. These tumors are challenging for surgeons as well as they find it difficult to achieve complete resection because of complex intra-abdominal anatomy and their close relationship with critical structures. Often, a multidisciplinary approach is required to decide on the most appropriate management for these complex cases so as to provide optimal patient care. Knowledge of the WHO classification, pathologic features, and treatment options available helps the radiologist make a meaningful contribution in multidisciplinary discussions of such cases and overall patient care. Liposarcoma (well-differentiated and dedifferentiated liposarcomas), leiomyosarcoma, and gastrointestinal stromal tumor are the 3 most common primary intra-abdominal sarcomas. In part 1 of this article, general features of soft-tissue sarcomas and some of the common tumors from WHO category 1-4 found in abdomen and pelvis are discussed. Part 2 will focus on common tumors from remainder of the WHO categories.
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Affiliation(s)
- Gitanjali Bajaj
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR.
| | - Harika Tirumani
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Michella K Whisman
- Department of Pathology, University of Michigan, Ann Arbor, MI; MSK/MRI-Body Imaging, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Shweta Srivastava
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Roopa Ram
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Kedar Jambhekar
- MSK/MRI-Body Imaging, University of Arkansas for Medical Sciences, Little Rock, AR; Department of Radiology and Orthopedics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Jerad M Gardner
- Departments of Pathology and Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Tarun Pandey
- Department of Radiology and Orthopedics, University of Arkansas for Medical Sciences, Little Rock, AR; University of Arkansas for Medical Sciences, Little Rock, AR
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20
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de Aguiar MCF, de Noronha MS, Silveira RL, Araújo JAD, Werkema FS, Bell D, Caldeira PC. Epithelioid rhabdomyosarcoma: Report of the first case in the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:e308-e315. [PMID: 32173396 DOI: 10.1016/j.oooo.2020.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 01/03/2020] [Accepted: 01/11/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Epithelioid rhabdomyosarcoma (EpiRMS) is a novel morphologically distinct variant of rhabdomyosarcoma, with an unusually challenging microscopic diagnosis. The occurrence of rhabdomyosarcomas in the jaws is extremely rare. This study presents the first case of EpiRMS in the jaw (mandible) and a literature review of the previous 35 cases of EpiRMS. STUDY DESIGN Here, we report a case of EpiRMS affecting an 18-year-old male patient. Clinical, imaging, microscopic, and immunohistochemical features are discussed and previously reported cases of EpiRMS are reviewed. RESULTS An 18-year-old male patient presented with an exophytic sessile growth on the buccal gingiva, and orthopantomography revealed irregular bone loss. Microscopic analysis showed a large number of cells with epithelioid appearance. Immunohistochemistry staining was positive for desmin, myogenin, MyoD1, smooth muscle actin, h-caldesmon, INI-1, and AE1-AE3. The patient's disease was staged as T4aN1M0 and was treated with surgical excision combined with chemotherapy. CONCLUSIONS The occurrence of RMS in the mandible is rare, and this is the first case of EpiRMS in the jaw. EpiRMS is an unusual histologic subtype that mimics other sarcomas and epithelial malignancies, making diagnosis a challenge. A specific immunohistochemistry panel aids in the diagnosis. EpiRMS has an aggressive course and an unfavorable prognosis.
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Affiliation(s)
- Maria Cássia Ferreira de Aguiar
- Universidade Federal de Minas Gerais, School of Dentistry, Department of Oral Surgery and Pathology, Belo Horizonte, Minas Gerais, Brazil.
| | - Mariana Saturnino de Noronha
- Universidade Federal de Minas Gerais, School of Dentistry, Department of Oral Surgery and Pathology, Belo Horizonte, Minas Gerais, Brazil
| | - Roger Lanes Silveira
- Otorhinolaryngology and Head and Neck Surgery Service, Santa Casa, Belo Horizonte, Minas Gerais, Brazil
| | | | - Flavio Sirihal Werkema
- Otorhinolaryngology and Head and Neck Surgery Service, Santa Casa, Belo Horizonte, Minas Gerais, Brazil
| | - Diana Bell
- Department of Pathology, Division of Pathology/Lab Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Patrícia Carlos Caldeira
- Universidade Federal de Minas Gerais, School of Dentistry, Department of Oral Surgery and Pathology, Belo Horizonte, Minas Gerais, Brazil
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21
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Undifferentiated Sarcoma as Intermediate Step in the Progression of Malignant Melanoma to Rhabdomyosarcoma: Histologic, Immunohistochemical, and Molecular Studies of a New Case of Malignant Melanoma With Rhabdomyosarcomatous Differentiation. Am J Dermatopathol 2019; 41:221-229. [DOI: 10.1097/dad.0000000000001236] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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22
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Sabater-Marco V, Ballester-Sánchez R, Navarro-Cerveró L, Fuster-Diana C, García-García JA, Botella-Estrada R. Primary cutaneous embryonal rhabdomyosarcoma with desmoplastic growth pattern and anaplastic lymphoma kinase overexpression. Report of a case with special emphasis on the differential diagnosis. Clin Exp Dermatol 2019; 44:822-824. [PMID: 30597602 DOI: 10.1111/ced.13877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2018] [Indexed: 11/27/2022]
Affiliation(s)
- V Sabater-Marco
- Department of Pathology, University General Hospital, Avenida Tres Cruces 2, 46014, Valencia, Spain
| | | | - L Navarro-Cerveró
- Department of Pathology, Laboratory of Molecular Pathology, University General Hospital, Valencia, Spain
| | - C Fuster-Diana
- Department of Surgery, University General Hospital, Avenida Tres Cruces 2, 46014, Valencia, Spain
| | - J A García-García
- Department of Pathology, University General Hospital, Avenida Tres Cruces 2, 46014, Valencia, Spain
| | - R Botella-Estrada
- Department of Dermatology, University Hospital La Fe, Valencia, Spain
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23
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Erythematous Nodule on the Face of a Child: Answer. Am J Dermatopathol 2018; 40:699-700. [PMID: 30119103 DOI: 10.1097/dad.0000000000000857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Campbell K, Kumarapeli AR, Gokden N, Cox RM, Hutchins L, Gardner JM. Metastatic melanoma with dedifferentiation and extensive rhabdomyosarcomatous heterologous component. J Cutan Pathol 2018; 45:360-364. [PMID: 29405341 DOI: 10.1111/cup.13122] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/22/2018] [Accepted: 01/30/2018] [Indexed: 11/30/2022]
Abstract
Melanoma may undergo dedifferentiation and sarcomatous transformation with loss of melanocytic markers. Dedifferentiated melanoma rarely forms true rhabdomyoblasts with skeletal muscle immunophenotype (rhabdomyosarcomatous heterologous component). A 52-year-old woman was diagnosed with invasive melanoma (Breslow thickness 0.83 mm) of the upper back in 2012, treated by wide local excision only. In 2013, an axillary mass was excised to show metastatic melanoma with 2 morphologies: an epithelioid morphology expressing S100 and MART-1 and a spindled morphology with loss of melanocytic markers but strong expression of desmin. This metastasis was found to have BRAF V600E mutation. In 2015, a thoracic epidural mass biopsy showed atypical spindle cells with focal HMB-45 but essentially no S100 expression. Numerous rhabdomyoblasts, some with striations that were strongly positive for desmin and myogenin, were present. In 2016, a right nephrectomy was performed for metastasis to the kidney, and showed sheets of spindle cells and rhabdomyoblasts expressing desmin and myogenin but not S100. Only focal areas demonstrated expression of HMB-45 and SOX-10, supporting the melanocytic origin of the tumor. The numerous rhabdomyoblasts and the loss of S100 expression in the metastatic lesions in this case could have easily led to misdiagnosis if the clinical history was not known.
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Affiliation(s)
- Katelynn Campbell
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Asangi R Kumarapeli
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Neriman Gokden
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Roni M Cox
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Laura Hutchins
- Department of Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jerad M Gardner
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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25
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Abstract
This overview of mesenchymal tumors presenting in the skin and/or subcutis in children brings together the range of neoplasms and hamartomas which are seen in this age-group. It is not surprising from the perspective of the pediatric or general surgical pathologist that vascular anomalies, including true neoplasms and vascular malformations, are the common phenotypic category. Since there is considerable morphologic overlap among these lesions, clinicopathologic correlation may be more important than for many of the other mesenchymal tumors. The skin and subcutis are the most common sites of clinical presentation for the infantile myofibroma which is the most common of fibrous mesenchymal tumors in children. Several of the other mesenchymal tumors are more common adults-like dermatofibrosarcoma protuberans, but nonetheless have an important presence in children, even as a congenital neoplasm. A lipomatous tumor in a young child should be considered as a possible manifestation of an overgrowth syndrome.
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Affiliation(s)
- Louis P Dehner
- 1 Lauren V. Ackerman Laboratory of Surgical Pathology, St. Louis Children's Hospital, Washington University Medical Center, St. Louis, Missouri.,2 Dermatopathology Center and Division of Dermatology, Washington University Medical Center, St. Louis, Missouri
| | - Alejandro A Gru
- 3 Department of Pathology, University of Virginia, Charlottesville, Virginia.,4 Department of Dermatology, University of Virginia, Charlottesville, Virginia
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26
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Oliphant H, Taylor M, Rajak S. Primary cutaneous pleomorphic rhabdomyosarcoma in the periocular region. Clin Exp Ophthalmol 2017; 47:140-141. [PMID: 29282833 DOI: 10.1111/ceo.13141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 12/22/2017] [Indexed: 01/14/2023]
Affiliation(s)
- Huw Oliphant
- The Sussex Eye Hospital, Brighton and Sussex University Hospitals, Brighton, UK
| | - Mark Taylor
- Department of Pathology, Brighton and Sussex University Hospitals, Brighton, UK
| | - Saul Rajak
- The Sussex Eye Hospital, Brighton and Sussex University Hospitals, Brighton, UK
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27
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Helm M, Vasievich M, Warren C. Primary Cutaneous Rhabdomyosarcoma: an illustrative case of an uncommon neoplasm. Int J Dermatol 2017; 57:242-244. [PMID: 29247463 DOI: 10.1111/ijd.13868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 10/20/2017] [Accepted: 11/12/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Matthew Helm
- Penn State Hershey Medical Center, Hershey, PA, USA
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28
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No YA, Kwon HJ, Park KY, Hong SA, Seo SJ, Hong CK. Unilateral, erythematous, swollen, sclerosing patch with nodular progression on the right side of the face. Clin Exp Dermatol 2016; 41:945-947. [PMID: 27766675 DOI: 10.1111/ced.12919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Y A No
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - H J Kwon
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - K Y Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - S A Hong
- Department of Pathology, Chung-Ang University College of Medicine, Seoul, Korea
| | - S J Seo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - C K Hong
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
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29
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Watanabe M, Ansai SI, Iwakiri I, Fukumoto T, Murakami M. Case of pleomorphic rhabdomyosarcoma arising on subcutaneous tissue in an adult patient: Review of the published works of 13 cases arising on cutaneous or subcutaneous tissue. J Dermatol 2016; 44:59-63. [PMID: 27569112 DOI: 10.1111/1346-8138.13549] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 07/10/2016] [Indexed: 12/26/2022]
Abstract
Rhabdomyosarcoma (RMS) is a malignant mesenchymal tumor usually occurring in children, young adults, and predominantly arising in the head and neck or deep soft tissue of the extremities. Pleomorphic RMS (PRMS) arising on subcutaneous tissue in an adult patient's trunk is extremely rare. We present a case of primary PRMS occurring on the back of a 50-year-old man. The tumor was diagnosed by histological and immunohistochemical findings of the resected specimen. One month after the surgery, axillary lymph node metastases were found. Subsequently, the patient received three cycles of combined chemotherapy. The rest of those axillary lymph nodes were reduced in size and there was no local recurrence 6 months postoperatively. PRMS is a very rare but aggressive tumor. Thus, it is important to confirm the diagnosis and provide adequate treatments.
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Affiliation(s)
- Mai Watanabe
- Division of Plastic and Reconstructive Surgery, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Japan
| | - Shin-Ichi Ansai
- Division of Dermatology, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Japan
| | - Itaru Iwakiri
- Division of Plastic and Reconstructive Surgery, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Japan
| | | | - Masahiro Murakami
- Division of Plastic and Reconstructive Surgery, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Japan
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30
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Yu L, Lao IW, Wang J. Epithelioid rhabdomyosarcoma: a clinicopathological study of seven additional cases supporting a distinctive variant with aggressive biological behaviour. Pathology 2016; 47:667-72. [PMID: 26517641 DOI: 10.1097/pat.0000000000000321] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We present our experience with seven cases of epithelioid rhabdomyosarcoma (RMS) to further characterise its clinicopathological features. There were five males and two females with ages ranging from 19 to 84 years (mean 56 years). Four tumours occurred in the somatic soft tissue, two in organs and one in the bone. The mean tumour size was 10.7 cm (range 3.5-15 cm). Histologically, six tumours were characterised by sheet-like growth of uniform epithelioid cells with large vesicular nuclei, prominent nucleoli, high mitotic activity and moderate to abundant amphophilic-to-eosinophilic cytoplasm. One tumour was composed of dyscohesive cells with rhabdoid appearance embedded in a myxoid matrix. Features suggestive of rhabdomyoblastic differentiation were absent. However, immunohistochemical study revealed skeletal muscle differentiation in all cases. Of note, focal expression of epithelial markers with co-expression of neuroendocrine markers was noted in five and three cases, respectively. Of six patients with follow-up, one experienced local recurrence and three developed metastases. To date, three patients have died of disease within 14 months. This study further demonstrates that epithelioid RMS represents a distinct variant of RMS with an aggressive behaviour. It may be misdiagnosed as poorly differentiated neuroendocrine carcinoma due to co-expression of epithelial and neuroendocrine markers.
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Affiliation(s)
- Lin Yu
- 1Department of Pathology, Fudan University Shanghai Cancer Center, Fudan University 2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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31
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Kim JH, Oh S, Jun JY, Shim JH, Park JH, Lee DY. Cutaneous Metastasis of Rhabdomyosarcoma Originated from Maxillary Sinus in a Young Adult Female. Ann Dermatol 2016; 28:519-21. [PMID: 27489446 PMCID: PMC4969493 DOI: 10.5021/ad.2016.28.4.519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 08/06/2015] [Accepted: 08/17/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
- Jun-Hwan Kim
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seunghwan Oh
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Young Jun
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joon Ho Shim
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Hye Park
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Youn Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Boyd AS. A 17-Year-Old Boy with a Fungating and Ulcerative Plaque on the Chest. Pediatr Dermatol 2016; 33:225-6. [PMID: 27001323 DOI: 10.1111/pde.12757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Alan S Boyd
- Department of Medicine, Division of Dermatology and Pathology, Vanderbilt University Medical Center, Nashville, Tennessee
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33
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Van Dorpe J, Hoorens A, Van Roy N, Dedeurwaerdere F, Creytens D. The challenging differential diagnosis of skin tumours with a rhabdoid phenotype: not all tumours with rhabdoid phenotype belong to the group of SMARCB1-deficient tumours. Histopathology 2015. [PMID: 26216536 DOI: 10.1111/his.12790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jo Van Dorpe
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Anne Hoorens
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Nadine Van Roy
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | | | - David Creytens
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
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34
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Seok JY, Jeong J, Cheon YW, Cho HY, Ha SY, Chung DH. Alveolar rhabdomyosarcoma of the lip in an adult with clear cell features. J Pathol Transl Med 2015; 49:81-4. [PMID: 25812664 PMCID: PMC4357406 DOI: 10.4132/jptm.2014.06.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 05/30/2014] [Accepted: 06/03/2014] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jae Yeon Seok
- Department of Pathology, Gachon University Gil Medical Center, Incheon, Korea
| | - Juhyeon Jeong
- Department of Pathology, Gachon University Gil Medical Center, Incheon, Korea
| | - Young Woo Cheon
- Department of Plastic Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Hyun Yee Cho
- Department of Pathology, Gachon University Gil Medical Center, Incheon, Korea
| | - Seung Yeon Ha
- Department of Pathology, Gachon University Gil Medical Center, Incheon, Korea
| | - Dong Hae Chung
- Department of Pathology, Gachon University Gil Medical Center, Incheon, Korea
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35
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Abstract
Rhabdomyosarcoma (RMS) is a malignant soft tissue tumor with skeletal muscle differentiation that can rarely present as a primary cutaneous tumor. There are 3 main subtypes of RMS: embryonal, alveolar, and pleomorphic. Primary cutaneous pleomorphic RMS is extremely rare, there being only 9 reported cases in the literature, 2 of which are radiation induced. We present a case of primary pleomorphic RMS occurring on the sun-damaged skin of the face of an 89-year-old woman. The tumor was diagnosed by histology, immunohistochemistry, and electron microscopy. The patient was treated by surgery and adjuvant radiotherapy. The tumor recurred rapidly after surgical excision. She died 2 months after the diagnosis from complications of treatment, local symptoms of tumor, and concurrent illnesses. Primary cutaneous pleomorphic RMS is a rare tumor of adults and pursues an aggressive clinical course.
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36
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Sabater-Marco V, Zapater Latorre E, Martorell Cebollada M. Postradiation cutaneous pleomorphic rhabdomyosarcoma with extracellular collagen deposits reminiscent of so-called amianthoid fibers. J Cutan Pathol 2014; 41:316-21. [PMID: 24341853 DOI: 10.1111/cup.12282] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 10/21/2013] [Accepted: 11/17/2013] [Indexed: 12/24/2022]
Abstract
Rhabdomyosarcoma is a malignant mesenchymal neoplasm that rarely presents as primary skin tumor. So-called amianthoid fibers are hyalinized collagen mats that have been described in myofibroblastic tumors but not in rhabdomyosarcoma. A 65-year-old male developed a submandibular nodule 9 years after an oral squamous cell carcinoma, which had been treated with chemotherapy and radiotherapy. Histological examination of the nodule revealed a pleomorphic rhabdomyosarcoma with extracellular collagen deposits reminiscent of so-called amianthoid fibers. By immunohistochemistry, the tumor cells were positive for vimentin, desmin, smooth muscle actin (SMA), muscle-specific actin (MSA), CD10, CD56, CD99, β-catenin and D2-40. However, only 15-20% of the tumor cells were positive for myoglobin, MyoD1 and myf-4/myogenin. We describe first so-called amianthoid fibers harboring blood capillaries in a rhabdomyosarcoma, suggesting that they are rigid collagen structures that lead to tumor vascularization. The low expression for myogenic regulatory proteins and strong expression for other markers may be misleading and do not contribute to the diagnosis of rhabdomyosarcoma.
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37
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Caserto BG. A Comparative Review of Canine and Human Rhabdomyosarcoma With Emphasis on Classification and Pathogenesis. Vet Pathol 2013; 50:806-26. [DOI: 10.1177/0300985813476069] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Rhabdomyosarcomas are a diverse group of malignant mesenchymal neoplasms exhibiting variable levels of differentiation toward skeletal myocytes. Neoplastic cells may resemble relatively undifferentiated myoblasts, satellite cells, or more differentiated elongated spindle cells and multicellular myotubes. In veterinary medicine, classification into subtypes and variants is based on an outdated system derived from human pathology and is solely based on histologic characteristics. In contrast, classification of human rhabdomyosarcoma is based on histologic, immunohistochemical, and molecular diagnostic techniques, and subclassification has clinical and prognostic relevance. Relevance of tumor subtyping has not been established in veterinary medicine. Recent discoveries of components of the molecular pathogenesis and genomes of human rhabdomyosarcomas have led to new diagnostic techniques and revisions of the human classification system. The current classification system in veterinary medicine is reviewed in light of these changes. Diagnosis of rhabdomyosarcoma using histopathology, electron microscopy, and the clinical aspects of human and canine rhabdomyosarcomas is compared. The clinical features and biologic behavior of canine rhabdomyosarcomas are compared with canine soft tissue sarcomas.
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Affiliation(s)
- B. G. Caserto
- Cornell University College of Veterinary Medicine, Department of Biomedical Sciences, Ithaca, NY, USA
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38
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Tchernev G, Tronnier M, Ananiev J, Taneva T, Patterson JW, Gulubova M, Trafeli JP, Gegova A, Harrell M, Guarneri C, Wollina U, Cardoso JC, Kanazawa N, Zisova L, Forsea AM, Zouboulis CC. Atypical fibroxanthoma-a diagnosis of exclusion! Wien Med Wochenschr 2013; 163:380-6. [PMID: 23319144 DOI: 10.1007/s10354-012-0173-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 12/25/2012] [Indexed: 11/26/2022]
Abstract
Fibrohistiocytic tumors of the skin comprise a large range of lesions. One such tumor is the atypical fibroxanthoma (AFX), which is widely considered as a "pseudomalignant" tumor. It is derived from fibroblasts and expresses a variety of histiocytic markers. We present a case of AFX, localized in the right temporal region of the scalp, successfully treated with surgical excision. Immunohistochemical staining helps differentiate this tumor from others in the clinical differential diagnosis, including malignant melanoma, squamous cell carcinoma, and other nonmelanocytic spindle cell tumors such as leiomyosarcoma, rhabdomyosarcoma, angiosarcoma, liposarcoma, and dermatofibrosarcoma protuberans. Historically, AFX was believed to be a superficial variant of malignant fibrous histiocytoma (MFH). However, MFH is now considered a more generalized term for a sarcomatous neoplasm of the subcutaneous tissue. The histopathology of MFH shares features with some malignant mesenchymal neoplasms such as liposarcoma, leiomyosarcoma, rhabdomyosarcoma, and angiosarcoma, but can be differentiated using immunohistochemistry and/or electron microscopy. More recently, the examples of MFH that do not exhibit a more specific line of differentiation have been reclassified as undifferentiated pleomorphic sarcoma (UPS). Many authors currently cannot draw a distinction between AFX and UPS. The clinical and histopathological differences between AFX and UPS are often difficult to delineate. It is probable that they represent two poles of the same disease. Surgical excision in the patient we describe resulted in excellent aesthetic results with lack of recurrence in the 7-month postoperative period.
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Affiliation(s)
- Georgi Tchernev
- Polyclinic for Dermatology and Venereology, Medical Faculty, University Hospital Lozenetz, Sofia University, Bulgaria.
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