1
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Sadeghi S, Johnson EF, Sominidi Damodaran S, Mittal S, Mohandesi NA. Solitary ulcerated nodule on the scalp in an 11-year-old girl. Pediatr Dermatol 2024. [PMID: 39011668 DOI: 10.1111/pde.15613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/24/2024] [Indexed: 07/17/2024]
Affiliation(s)
- Sara Sadeghi
- Department of Medicine, South Brooklyn Health, Brooklyn, New York, USA
| | - Emma F Johnson
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Setu Mittal
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
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2
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Abdouh S, Boujguenna I, Soleh A, Abkari I, Rais H. Navigating diagnostic challenges-distinguishing malignant melanoma and clear cell sarcoma of soft tissues: a case report and review of the literature. J Med Case Rep 2024; 18:249. [PMID: 38755643 PMCID: PMC11100201 DOI: 10.1186/s13256-024-04542-y] [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: 01/11/2024] [Accepted: 04/03/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Within the spectrum of melanocytic-differentiated tumors, the challenge faced by pathologists is discerning accurate diagnoses, with clear cell sarcoma of soft tissues standing out as a rare and aggressive neoplasm originating from the neural crest. Accounting for 1% of all soft tissue sarcomas, clear cell sarcoma of soft tissues poses diagnostic complexities, often misidentified owing to its phenotypic resemblance to malignant melanoma. This chapter delves into the intricacies of clear cell sarcoma of soft tissues, its epidemiology, characteristic manifestations, and the imperative need for a comprehensive diagnostic approach involving immunohistochemical and molecular analyses. CASE PRESENTATION A compelling case unfolds as a 25-year-old male from Morocco, initially misdiagnosed with malignant melanoma, experiences tumor recurrence on the second toe. With no history of trauma or familial neoplasia, the patient's clinical journey is explored, emphasizing the importance of detailed clinical examinations and radiological assessments. The chapter elucidates the histopathological findings, immunohistochemical spectrum, and the correlation between clinical parameters and diagnostic inference, ultimately leading to metatarsal amputation. This clinical vignette highlights the multidimensional diagnostic process in soft tissue neoplasms, emphasizing the synergistic role of clinical, radiological, and histopathological insights. CONCLUSION The diagnostic challenges inherent in melanocytic-differentiated tumors, exemplified by the rarity of soft tissue clear cell sarcoma, underscore the essential role of an integrated diagnostic approach. This concluding chapter emphasizes the perpetual collaboration required across pathology, clinical medicine, and radiology for nuanced diagnostic precision and tailored therapeutic strategies. The rarity of these soft tissue malignancies necessitates ongoing interdisciplinary engagement, ensuring the optimization of prognosis and treatment modalities through a comprehensive understanding of the diagnostic intricacies presented by clear cell sarcoma of soft tissues.
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Affiliation(s)
- Soufiane Abdouh
- Pathology Department, Mohammed VI University Hospital Center, Marrakesh, Morocco.
| | - Imane Boujguenna
- Faculty of Medicine and Pharmacy, Ibn Zohr University, Guelmim, Morocco
| | - Abdelwahed Soleh
- Orthopedic Surgery Department, Mohammed VI University Hospital Center, Marrakesh, Morocco
| | - Imad Abkari
- Orthopedic Surgery Department, Mohammed VI University Hospital Center, Marrakesh, Morocco
| | - Hanane Rais
- Pathology Department, Mohammed VI University Hospital Center, Marrakesh, Morocco
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3
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Wu B, Yin L, Pan Z, Tao J, Wang Q. Clear cell sarcoma in the post-molar area: Report of an ultra-rare case and literature review of oral clear cell sarcoma. Oral Oncol 2023; 147:106604. [PMID: 37879148 DOI: 10.1016/j.oraloncology.2023.106604] [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: 10/08/2023] [Revised: 10/15/2023] [Accepted: 10/20/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Clear cell sarcoma of soft tissue is an exceptionally rare sarcoma. It is even rarer in the oral cavity. To our knowledge, this case is the first reported clear cell sarcoma involving the post-molar area. Pathologically, clear cell sarcoma has low mitotic activity, rare nuclear pleomorphism, and necrosis. Its biological behavior is often underestimated by morphology. It is a highly aggressive tumor. CASE REPORT A 39-year-old female presented with an asymptomatic mass in the post-molar area. It was mistaken for a benign or low-grade malignant tumor based on frozen incisional biopsy samples. The surgical resection sample was tested by NGS, which detected a rare EWSR1::CREB1 in clear cell sarcoma. The final diagnosis was made by combining morphological, immunohistochemical, and molecular test results. The patient did not receive any adjuvant therapy after surgery and no recurrence of the disease was detected at 8 months of follow-up. CONCLUSION The study highlights that mild histological manifestation in the oral cavity should be considered the possibility of CCS affecting young patients. Careful histological investigation, sufficient immunohistochemical staining, and molecular tests are essential to the diagnosis.
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Affiliation(s)
- Bin Wu
- Department of Thyroid Breast Surgery, Zhongshan Hospital, Dalian University, 6 Jiefang Street, Dalian, China
| | - Liying Yin
- Department of Pathology, The Second Hospital, Dalian Medical University, 467 Zhongshan Road, Dalian, China
| | - Ziang Pan
- Department of Pathology, The Second Hospital, Dalian Medical University, 467 Zhongshan Road, Dalian, China
| | - Juan Tao
- Department of Pathology, The Second Hospital, Dalian Medical University, 467 Zhongshan Road, Dalian, China.
| | - Qimin Wang
- Department of Pathology, The Second Hospital, Dalian Medical University, 467 Zhongshan Road, Dalian, China.
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4
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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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5
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Sun Y, Liu D, Chen X, Zhang J, Yang S. Epithelioid mesenchymal neoplasm with FUS::CREM gene fusion in the tongue: Report of a rare and challenging diagnosis. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 135:e108-e113. [PMID: 36697296 DOI: 10.1016/j.oooo.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/27/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
FET (encompassing both EWSR1 and FUS) fusions with genes from the CREB family (CREB1, ATF1, and CREM) are involved in a variety of neoplasms. Recently, FET::CREB fusions were recognized in a group of malignant epithelioid neoplasm with a striking predilection to mesothelial-lined cavities and frequent cytokeratin immunoexpression. Herein, we report a rare mesenchymal neoplasm with epithelioid morphology and nonspecific immunoprofile harboring a FUS::CREM fusion arising in the oral tongue of a 53-year-old man. Histology showed a well-circumscribed tumor composed of epithelioid cells with eosinopohilic or clear cytoplasm with sparse stroma, accompanied by peripheral lymphoplasmacytic infiltrates. Immunohistochemically, an extensive panel revealed only patchy expression of synaptophysin and weak-to-moderate nuclear expression of TFE3, and negativity for other markers including cytokeratins, epithelial membrane antigen, p63/p40, vimentin, S100, smooth muscle actin, CD34, desmin, SOX10, glial fibrillary acidic protein, melan-A, HMB45, and CD68. A FUS::CREM gene fusion was detected by next generation sequencing at an outside institution, and subsequent fluorescence in situ hybridization analysis confirmed the presence of FUS gene rearrangement. The identification and analysis of additional cases should help to clarify the nosologic status and the biologic potential of this tumor.
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Affiliation(s)
- Yanan Sun
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China; Department of Pathology, School & Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China
| | - Deyu Liu
- Department of Oral and Maxillofacial Surgery, Affiliated Haikou Hospital, Central South University, Haikou, Hainan, China
| | - Xinming Chen
- Department of Pathology, School & Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China
| | - Jiali Zhang
- Department of Pathology, School & Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China
| | - Shaodong Yang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China; Department of Pathology, School & Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China.
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6
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Skalova A, Leivo I, Hellquist H, Simpson RHW, Vander Poorten V, Willems SM, Mosaieby E, Slouka D, Ferlito A. Clear Cell Neoplasms of Salivary Glands: A Diagnostic Challenge. Adv Anat Pathol 2022; 29:217-226. [PMID: 35249992 DOI: 10.1097/pap.0000000000000339] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This review focuses on the heterogenous group of clear cell neoplasms of salivary glands and attempts to identify major differential diagnostic features. Within the head and neck region, clear cells are found most commonly in salivary gland tumors, but may also be seen in tumors of squamous or odontogenic epithelial origin, primary or metastatic carcinomas, benign or malignant melanocytic lesions, or benign or malignant mesenchymal tumors. Clear cells occur fairly commonly among a wide variety of salivary gland neoplasms, but mostly they constitute only a minor component of the tumor cell population. Clear cells represent a major diagnostic feature in two salivary gland neoplasms, epithelial-myoepithelial carcinoma and hyalinizing clear cell carcinoma. In addition, salivary gland neoplasms composed predominantly of clear cells could also include clear cell variants of other salivary neoplasms, such as mucoepidermoid carcinoma and myoepithelial carcinoma, but their tumor type-specific histologic features may only be available in limited nonclear cell areas of the tumor. Diagnosing predominantly clear cell salivary gland tumors is difficult because the immunoprofiles and morphologic features may overlap and the same tumor entity may also have a wide range of other histologic presentations. Many salivary gland tumors are characterized by tumor type-specific genomic alterations, particularly gene fusions of the ETV6 gene in secretory carcinoma, the MYB and MYBL1 genes in adenoid cystic carcinoma, the MAML2 gene in mucoepidermoid carcinoma, the EWSR1 gene in hyalinizing clear cell carcinoma, and others. Thus, along with conventional histopathologic examination and immunoprofiling, molecular and genetic tests may be important in the diagnosis of salivary gland clear cell tumors by demonstrating genetic alterations specific to them.
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Affiliation(s)
| | - Ilmo Leivo
- Institute of Biomedicine, Pathology, University of Turku and Department of Pathology, Turku University Hospital, Turku, Finland
| | - Henrik Hellquist
- Epigenetics and Human Disease Laboratory, Department of Biomedical Sciences and Medicine, Algarve Biomedical Center (ABC), University of Algarve, Faro, Portugal
| | - Roderick H W Simpson
- Department of Anatomical Pathology, University of Calgary, Calgary, Alberta, Canada
| | - Vincent Vander Poorten
- Department of Oncology, Section Head and Neck Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Stefan M Willems
- Department of Pathology and Medical Biology, University of Groningen, Groningen, The Netherlands
| | - Elaheh Mosaieby
- Departments of Pathology
- Molecular and Genetic Laboratory, Bioptic Laboratory Ltd, Plzen, Czech Republic
| | - David Slouka
- Otorhinolaryngology, Faculty of Medicine in Plzen, Charles University
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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7
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Compound Clear Cell Sarcoma: A Case Report With Ulceration and Pagetoid Scatter. Am J Dermatopathol 2022; 44:687-690. [DOI: 10.1097/dad.0000000000002238] [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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8
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Evangelou Z, Linos K. Nevus, melanoma or something else? Mesenchymal neoplasms with melanocytic differentiation. J Cutan Pathol 2022; 49:747-759. [PMID: 35338512 DOI: 10.1111/cup.14232] [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: 09/26/2021] [Revised: 03/13/2022] [Accepted: 03/20/2022] [Indexed: 11/30/2022]
Abstract
The overwhelming majority of cutaneous neoplasms with melanocytic differentiation are nevi, melanomas and more rarely melanocytomas. Nevertheless, there is also a group of mesenchymal neoplasms with genuine melanocytic differentiation which can create diagnostic difficulties with significant repercussions. These can rarely present as primary or metastatic cutaneous lesions. Theones that are relevant to a dermatopathologist include malignant melanotic nerve sheath tumor, perivascular epithelioid cell neoplasm and clear cell sarcoma. This work will provide a thorough review of clinical presentation, morphologic and immunohistochemical features as well as molecular pathogenesis of these tumors. We hope to familiarize the general dermatopathology readership with a group of neoplasms of mesenchymal lineage exhibiting melanocytic differentiation and ultimately avoid diagnostic misadventures. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Zoi Evangelou
- Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Konstantinos Linos
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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9
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Sidlik Muskatel R, Pillar N, Godefroy J, Lotem M, Goldstein G. Case report: Robust response of metastatic clear cell sarcoma treated with cabozantinib and immunotherapy. Front Pediatr 2022; 10:940927. [PMID: 36275056 PMCID: PMC9582433 DOI: 10.3389/fped.2022.940927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022] Open
Abstract
Clear Cell Sarcoma (CCS), also referred to as malignant melanoma of soft parts, is a rare and aggressive malignant tumor. It comprises 1% of all soft tissue sarcomas and is known to be radio- and chemotherapy resistant. CCS shares morphological and immunohistochemical features with malignant melanoma, including melanin biosynthesis and melanocytic markers. However, it is distinct for the presence of EWSR1-ATF1 translocation which activates MITF transcription factor. We report here of an aggressive case of CCS in a 9-year-old patient, which demonstrates the critical role of molecular analysis in the diagnosis and treatment of uncommon cancer variants in the era of personalized medicine. The EWSR1-ATF1 translocation induces pathological c-Met activation, and so, following unsuccessful CTLA4 and PD-1 blockade immunotherapy, the child received cabozantinib, a small molecule tyrosine kinase inhibitor, with the intent to block c-Met oncogenic effect. In parallel, active immunization, using hapten di-nitrophenyl modified autologous tumor cells was administered with monotherapy PD-1 inhibitor nivolumab. Under this "triplet" therapy, the patient attained an initial partial response and was progression-free for 2 years, in good performance status and resumed schooling. Based on our observation, cabozantinib can be used as an effective and potentially life-prolonging treatment in CCS. We suggest that priming the child's immune system using her autologous tumor and combating T cell exhaustion with PD-1 blockade may have synergized with the targeted therapy. Combining targeted and immunotherapy is a rapidly growing practice in solid tumors and provides a glimpse of hope in situations that previously lacked any treatment option.
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Affiliation(s)
- Rakefet Sidlik Muskatel
- The Dyna and Fala Weinstock Department of Pediatric Hematology Oncology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Nir Pillar
- Department of Pathology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Jeremy Godefroy
- Hadassah Hebrew University Medical Center, Nuclear Medicine Institute, Jerusalem, Israel
| | - Michal Lotem
- Center for Melanoma and Cancer Immunotherapy, Hadassah Hebrew University Medical Center, Sharett Institute of Oncology, Jerusalem, Israel
| | - Gal Goldstein
- The Dyna and Fala Weinstock Department of Pediatric Hematology Oncology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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10
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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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11
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Sezer E, Çeliker P, Yalçın Ö, Erdem ZB. Clear cell sarcoma of soft tissue with eccrine differentiation: A case report and review of the literature. J Cutan Pathol 2021; 48:1034-1037. [PMID: 33599302 DOI: 10.1111/cup.13989] [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: 11/20/2020] [Revised: 02/14/2021] [Accepted: 02/16/2021] [Indexed: 11/28/2022]
Abstract
Clear cell sarcoma of soft tissue (CCSST) is a deep soft tissue tumor presenting in the extremities of young adults. Histopathologically, nests and sheets of polygonal cells with clear to eosinophilic cytoplasm separated by fibrous septa as well as occasional "wreath-like" giant cells are visualized. However, CCSST has been noted to have atypical histopathological features, such as epidermotropism or myxoid differentiation, or occurrence at unusual sites. Here, we present a case of eccrine ductal differentiation in CCSST. The patient, a 21-year-old woman, presented with a lump of 10-year duration sized 3 × 5 cm on the plantar surface of the fourth and fifth interdigital spaces. There had been an increase in size as well as pain and redness over 6 years. Besides the characteristic findings, there were ductal structures in continuity with the upper dermis indicative of ductal differentiation. The tumor stained positively for S100, HMB45, and succinic dehydrogenase; ducts stained positively for epithelial membrane antigen (EMA) and carcinoembryonic antigen (CEA). CCSST was confirmed with cytogenetic analysis showing the translocation associated with EWSR1-ATF1 fusion gene. Therefore, ductal differentiation is a unique finding that should be considered when evaluating for CCSST.
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Affiliation(s)
- Engin Sezer
- Department of Dermatology, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Pelin Çeliker
- SUNY Downstate College of Medicine, New York, New York, USA
| | - Özben Yalçın
- Department of Pathology, Prof. Dr. Cemil Tascıoglu City Hospital, Istanbul, Turkey
| | - Zeynep Betül Erdem
- Department of Pathology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
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12
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Donati M, Nožička J, Kastnerova L, Hajkova V, Persichetti P, Michal M, Kazakov DV. Primary Cutaneous Desmoplastic Melanoma With Collagen Rosettes and Pseudoglandular Features. Am J Dermatopathol 2021; 43:221-224. [PMID: 33201013 DOI: 10.1097/dad.0000000000001809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Primary cutaneous desmoplastic melanoma (DM) is a group of rare melanocytic tumors arising on severely sun-damaged skin, histologically characterized by the proliferation of spindled melanocytes in a prominent desmoplastic stroma, with a range of morphological presentations. In this article, we report a unique case of primary cutaneous DM composed of a nodular proliferation of highly pleomorphic spindled and epithelioid cells, pseudoglandular structures, clear cell change, and unusual collagen rosettes. Immunohistochemical analysis showed a strong and diffuse positivity for S-100 protein, SOX-10, nestin, p75 (nerve growth factor receptor), WT1, and p53. Molecular analysis detected a mutation in the NF1 gene [c.4084C > T, p.(Arg1362Ter)], 2 different pathogenic mutations in TP53 [c.742C > T, p.(Arg248Trp), AF:12%, COSM1640831 and c.528C > G, p.(Cys176Trp), AF:12%, COSM11114], and a mutation in GNAS [c.601C > T, p.(Arg201Cys), AF: 9%, COSM123397]. To the best of our knowledge, this is the first case reporting collagen rosettes and pseudoglandular features in primary cutaneous DM.
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Affiliation(s)
- Michele Donati
- Department of Pathology, University Hospital Campus Bio-Medico, Rome, Italy
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - Jan Nožička
- Histological and Cytological Laboratory, Usti and Orlici, Czech Republic
| | - Liubov Kastnerova
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
- Bioptical Laboratory, Pilsen, Czech Republic ; and
| | - Veronika Hajkova
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
- Bioptical Laboratory, Pilsen, Czech Republic ; and
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico di Roma University, Rome, Italy
| | - Michal Michal
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
- Bioptical Laboratory, Pilsen, Czech Republic ; and
| | - Dmitry V Kazakov
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
- Bioptical Laboratory, Pilsen, Czech Republic ; and
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13
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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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14
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Tran V, Slavin J. Soft Tissue Tumour Pathology. Sarcoma 2021. [DOI: 10.1007/978-981-15-9414-4_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Sbaraglia M, Zanatta L, Toffolatti L, Spallanzani A, Bertolini F, Mattioli F, Lami F, Presutti L, Dei Tos AP. Clear cell sarcoma-like/malignant gastrointestinal neuroectodermal tumor of the tongue: a clinicopathologic and molecular case report. Virchows Arch 2020; 478:1203-1207. [PMID: 33005982 DOI: 10.1007/s00428-020-02933-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/07/2020] [Accepted: 09/15/2020] [Indexed: 12/18/2022]
Abstract
Malignant gastrointestinal neuroectodermal tumor (M-GNET) and clear cell sarcoma (CCS) of soft tissue represent closely related, extremely rare, malignant mesenchymal neoplasm of uncertain differentiation. Both entities are characterized genetically by the same molecular alterations represented by the presence of EWSR1-ATF1 and, more rarely, EWSR1-CREB1 fusion genes. The latter translocation seems to be more represented in M-GNET that, despite significant morphologic overlap with CCS, tends to lack overt features of melanocytic differentiation. Most M-GNET occur in the lower gastrointestinal tract, whereas occurrence in the upper tract has been reported only exceptionally. The differential diagnosis represents a major challenge, and accurate diagnosis impact significantly on therapeutic planning. We herein report the clinicopathologic features of a molecularly confirmed M-GNET that arose at the base of the tongue and review the pertinent literature.
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Affiliation(s)
- Marta Sbaraglia
- Department of Pathology, Azienda Ospedale Università Padova, Padua, Italy.
| | - Lucia Zanatta
- Department of Pathology, Azienda ULSS N. 2 Marca Trevigiana, Treviso, Italy
| | - Luisa Toffolatti
- Department of Pathology, Azienda ULSS N. 2 Marca Trevigiana, Treviso, Italy
| | - Andrea Spallanzani
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Federica Bertolini
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Francesco Mattioli
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Federico Lami
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Livio Presutti
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Angelo P 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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16
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Primary Intracranial Mesenchymal Tumor with EWSR1-CREM Gene Fusion: A Case Report and Literature Review. World Neurosurg 2020; 142:318-324. [PMID: 32668333 DOI: 10.1016/j.wneu.2020.07.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND The prevalence of gene translocation in some mesenchymal tumors can be used as highly specific molecular diagnostic markers in clinic and pathology. EWSR1 is a partner gene in a large, diverse range of mesenchymal tumors. CASE DESCRIPTION This paper describes the case of a 31-year-old man who was diagnosed with a primary intracranial mesenchymal tumor with EWSR1-CREM gene fusion and eventually returned to a normal live with no signs of tumor recurrence or metastasis after treatment, including surgery therapy, radiotherapy, and 6 cycles of vincristine-doxorubicin-cyclophosphamide chemotherapy, even though the classification and grade of the tumor are still controversial. CONCLUSIONS This case is a novel entity of intracranial mesenchymal neoplasm with EWSR1-CREM gene fusion which was confirmed by histopathology, molecular pathology, and next-generation sequencing (NGS). The literature review shows only 5 cases of intracranial tumor harboring EWSR1-CREM gene fusion with similar features. With the further application of molecular pathology and NGS in clinical practice, there will be more intracranial mesenchymal tumor cases with EWSR1-CREM gene fusion found in the future, which may lead to further understanding of the diagnosis and clinical features of this neoplasm.
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Alhatem A, Nudelman M, Schwartz RA, Hassoun P, Malliah RB, Lambert WC. Primary Cutaneous Clear Cell Sarcoma, Clinical Outcome With Sentinel Lymph Nodes Status. Am J Clin Pathol 2020; 153:799-810. [PMID: 32157275 DOI: 10.1093/ajcp/aqaa009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Primary cutaneous clear cell sarcoma (PCS) is a rare malignancy and difficult to differentiate from melanoma. We investigated factors influencing survival and recurrence. METHODS An institutional cancer registry and literature search were used for a retrospective study. Only clear cell sarcoma cases with a primary site of skin and subcutaneous tissue were included. Kaplan-Meier and Cox regression analyses were used to assess survival time and hazard ratios. RESULTS Three eligible cases were identified at our institution. In addition, the PubMed and Google Scholar reviews identified 1,878 items, with 23 patients with PCS. The median age was 25 years with 62% female. The tumors ranged in size from 0.4 to 4.5 cm. Cytogenetics showed t(12;22)(q13;q12) in all cases and a unique variant of t(2;22)(q32.3;q12) in one case. Surgery was the most common treatment, followed by chemotherapy/radiation. PCS recurred in 46% of patients with a median relapse-free survival time of 15 months. Only two known PCS-related mortalities were recorded, at 38 and 60 months following initial diagnosis. Smaller tumor size and negative sentinel lymph node biopsy (SLNB) status were significantly associated with a better disease-free survival. CONCLUSIONS Tumor size and SLNB status influence PCS survival and recurrence. More research is needed due to the rarity of this disease.
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Affiliation(s)
- Albert Alhatem
- Department of Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark
- Department of Pathology and Laboratory Medicine, Hackensack Meridian Health, Hackensack, NJ
| | | | - Robert A Schwartz
- Department of Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark
- Department of Dermatology, Rutgers New Jersey Medical School, Newark
| | - Patrice Hassoun
- Department of Pathology and Laboratory Medicine, Hackensack Meridian Health, Hackensack, NJ
| | - Rajit B Malliah
- Department of Pathology and Laboratory Medicine, Hackensack Meridian Health, Hackensack, NJ
| | - W Clark Lambert
- Department of Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark
- Department of Dermatology, Rutgers New Jersey Medical School, Newark
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19
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Silverman DA, Smith SW, Essig GF, Kang SY, Schoenfield L, Kim LR. Clear cell sarcoma of the nasal soft tissue envelope. OTOLARYNGOLOGY CASE REPORTS 2019. [DOI: 10.1016/j.xocr.2019.100127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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21
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Ko JS, Wang L, Billings SD, Pissaloux D, Tirode F, Berry R, De La Fouchardiere A. CRTC1‐TRIM11
fusion defined melanocytic tumors: A series of four cases. J Cutan Pathol 2019; 46:810-818. [DOI: 10.1111/cup.13533] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/29/2019] [Accepted: 06/20/2019] [Indexed: 12/16/2022]
Affiliation(s)
| | - Lin Wang
- Department of PathologyCleveland Clinic Cleveland Ohio
| | | | - Daniel Pissaloux
- Department of PathobiologyCentre Léon Bérard Lyon France
- Univ Lyon, Université Claude Bernard Lyon 1Research Cancer Center of Lyon Lyon France
| | - Franck Tirode
- Univ Lyon, Université Claude Bernard Lyon 1Research Cancer Center of Lyon Lyon France
| | - Ryan Berry
- Department of PathologyCleveland Clinic Cleveland Ohio
| | - Arnaud De La Fouchardiere
- Department of PathobiologyCentre Léon Bérard Lyon France
- Univ Lyon, Université Claude Bernard Lyon 1Research Cancer Center of Lyon Lyon France
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Abstract
Among the various genes that can be rearranged in soft tissue neoplasms associated with nonrandom chromosomal translocations, EWSR1 is the most frequent one to partner with other genes to generate recurrent fusion genes. This leads to a spectrum of clinically and pathologically diverse mesenchymal and nonmesenchymal neoplasms, variably manifesting as small round cell, spindle cell, clear cell or adipocytic tumors, or tumors with distinctive myxoid stroma. This review summarizes the growing list of mesenchymal neoplasms that are associated with EWSR1 gene rearrangements.
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Affiliation(s)
- Khin Thway
- Sarcoma Unit, Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK.
| | - Cyril Fisher
- Department of Musculoskeletal Pathology, Royal Orthopaedic Hospital NHS Foundation Trust, Robert Aitken Institute for Clinical Research, University of Birmingham, Birmingham B15 2TT, UK
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Obiorah IE, Ozdemirli M. Clear cell sarcoma in unusual sites mimicking metastatic melanoma. World J Clin Oncol 2019; 10:213-221. [PMID: 31205866 PMCID: PMC6556591 DOI: 10.5306/wjco.v10.i5.213] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/07/2019] [Accepted: 03/16/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Clear cell sarcoma is an aggressive rare malignant neoplasm with morphologic and immunohistochemical similarities to malignant melanoma. Both disease entities display melanin pigment and melanocytic markers, making differentiation between the two difficult. Although clear cell sarcoma cases in the literature have mainly involved deep soft tissues of the extremities, trunk or limb girdles, we report here two cases of primary clear cell sarcoma in unusual sites and describe their clinicopathologic findings.
CASE SUMMARY The first case involves a 37-year-old female, who presented with jaw pain and a submandibular mass. The second case involves a 33-year-old male, who presented with back pain and a thoracic spine tumor. Both cases showed tumors with diffuse infiltration of neoplastic cells that were positive for melanocytic markers, and in both cases this finding led to an initial diagnosis of metastatic melanoma. However, further analysis by fluorescence in situ hybridization (commonly known as FISH) showed a rearrangement of the EWS RNA binding protein 1 (EWSR1) gene on chromosome 22q12 in both patients, confirming the diagnosis of clear cell sarcoma.
CONCLUSION Distinction between clear cell sarcoma and malignant melanoma can be made by FISH, particularly in cases of unusual tumor sites.
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Affiliation(s)
- Ifeyinwa E Obiorah
- Department of Pathology, Medstar Georgetown University Hospital, Washington, DC 20007, United States
| | - Metin Ozdemirli
- Department of Pathology, Medstar Georgetown University Hospital, Washington, DC 20007, United States
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Cota C, Saggini A, Lora V, Kutzner H, Rütten A, Sangüeza O, Requena L, Cerroni L. Uncommon Histopathological Variants of Malignant Melanoma: Part 1. Am J Dermatopathol 2019; 41:243-263. [PMID: 30024414 DOI: 10.1097/dad.0000000000001218] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Despite new horizons opened by recent advances in molecular pathology, histological evaluation still remains the diagnostic gold standard regarding cutaneous melanocytic neoplasms. Several histological variants of melanoma have been described, and their knowledge is crucial for accurate diagnosis and classification of cases with unusual clinicopathological features. Uncommon histological variants of melanoma have been described based on a broad constellation of features, including architectural pattern, stromal alterations, cytological attributes, and other morphological properties. This review is aimed at providing an extensive discussion of unusual but distinctive histopathological variants of melanoma.
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Affiliation(s)
- Carlo Cota
- Research Unit Dermatopathology, Department of Dermatology, Medical University of Graz, Graz, Austria
- San Gallicano Dermatological Institute, Rome, Italy
| | - Andrea Saggini
- Research Unit Dermatopathology, Department of Dermatology, Medical University of Graz, Graz, Austria
- Anatomic Pathology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Viviana Lora
- San Gallicano Dermatological Institute, Rome, Italy
| | - Heinz Kutzner
- Dermatopathology Friedrichshafen, Friedrichshafen, Germany
| | - Arno Rütten
- Dermatopathology Friedrichshafen, Friedrichshafen, Germany
| | - Omar Sangüeza
- Department of Pathology, Wake Forest School of Medicine, Winston Salem, NC
| | - Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Lorenzo Cerroni
- Research Unit Dermatopathology, Department of Dermatology, Medical University of Graz, Graz, Austria
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25
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Chen G, Sun S, Du Z, Sun Y, Pan Z, Che X, Xie R. Intra-Extracranial Primary Clear Cell Sarcoma: The First Report and Review of the Literature. World Neurosurg 2019; 126:e1140-e1146. [PMID: 30880192 DOI: 10.1016/j.wneu.2019.02.216] [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: 12/27/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Clear cell sarcoma (CCS) is a rare malignant soft tissue tumor with poor prognosis owing to metastasis and insensitive response to chemotherapy and radiotherapy. METHODS We first searched PubMed and Embase using the terms "clear cell sarcoma," "malignant melanoma of soft tissue," "head," and "neck." In the 15 articles selected for literature review, only 27% (4/15) of patients were diagnosed with primary CCS of the head. Pathologically, those tumors arose from either the scalp or the superficial temporal fascia, but none invaded the skull and brain. Next, the search was performed in the same database using the terms "clear cell sarcoma," "malignant melanoma of soft tissue," and "bone," and only 24 articles were selected. RESULTS In the case reported here, a 36-year-old woman was found to have a palpable mass located at the left temporal-occipital region, and surgical finding confirmed the invasion into the skull and the brain. The diagnosis of primary CCS was made because of the detection of t(12;22)(q13;q12) in >50% of tumor cells by fluorescence in situ hybridization, and metastasis to the lymph nodes and lungs was discovered by postoperative positron emission tomography-computed tomography. CONCLUSIONS To the best of our knowledge, this is the first case of primary central nervous system CCS. Primary CCS may involve the skull and should be one of the differential diagnoses for intra-extracranial communicating tumors. Further research on biological characteristics and molecular targeted therapy of CCS are needed to improve its poor prognosis.
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Affiliation(s)
- Gong Chen
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Shifeng Sun
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Zunguo Du
- Department of Pathology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yirui Sun
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhiguang Pan
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoming Che
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Rong Xie
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.
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26
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Donzel M, Zidane-Marinnes M, Paindavoine S, Breheret R, de la Fouchardière A. Clear cell sarcoma of the soft palate mimicking unclassified melanoma. Pathology 2019; 51:331-334. [PMID: 30837084 DOI: 10.1016/j.pathol.2018.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 09/30/2018] [Accepted: 10/19/2018] [Indexed: 11/18/2022]
Affiliation(s)
- M Donzel
- Département of Biopathology, Centre Leon Bérard, Lyon, France
| | - M Zidane-Marinnes
- Département de Pathologie Cellulaire et Tissulaire, CHU Angers, Angers, France
| | - S Paindavoine
- Département of Biopathology, Centre Leon Bérard, Lyon, France
| | - R Breheret
- Service ORL-CCF, CHU Angers, Angers, France
| | - A de la Fouchardière
- Département of Biopathology, Centre Leon Bérard, Lyon, France; UMR Inserm 1052 CNRS 5286, Centre Léon Bérard, Lyon, France.
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27
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Breton S, Dubois M, Geay JF, Gillebert Q, Tordjman M, Guinebretière JM, Denoux Y. [Clear cell sarcoma or gastrointestinal neuroectodermal tumor (GNET) of the tongue? Case report and review of the literature of an extremely rare tumor localization]. Ann Pathol 2018; 39:167-171. [PMID: 30554833 DOI: 10.1016/j.annpat.2018.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 10/10/2018] [Accepted: 10/16/2018] [Indexed: 12/24/2022]
Abstract
Clear cells sarcomas (CCS) are exceptionally rare in the tongue, with, to our knowledge, only three previous reports in anglo-saxon literature. Through our case, we will discuss the differential diagnosis of clear cells tumors of the tongue and bring this tumour closer to the newly described entity of the gastrointestinal tract named "clear cells sarcoma-like gastrointestinal (SCCLGI)", recently renamed "gastrointestinal neuroectodermal tumour (GNET)". SCCLGI/GNET share morphological and molecular characteristics with SCC but had until then been observed only in the digestive tract. Our case could be a lingual localization of a SCCLGI/GNET. SCC and SCCLGI/GNET characteristic molecular profil involves EWSR1-ATF1 [t(12; 22) (q13; q12)] and EWSR1-CREB1 [t(2; 22) (q34; q12)] fusion genes, but it is not specific of these tumours.
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Affiliation(s)
- Sarah Breton
- Service d'anatomie pathologique, hôpital André-Mignot, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - Matthieu Dubois
- Service d'ORL, hôpital André-Mignot, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - Jean-François Geay
- Service d'hématologie-oncologie, centre hospitalier de Versailles, hôpital André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France
| | - Quentin Gillebert
- Service de médecine nucléaire, hôpital André-Mignot, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - Mickaël Tordjman
- Service de médecine nucléaire, hôpital André-Mignot, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - Jean-Marc Guinebretière
- Service de pathologie, institut Curie, hôpital René-Huguenin, 35, rue Dailly, 92210 Saint-Cloud, France
| | - Yves Denoux
- Service d'anatomie pathologique, hôpital André-Mignot, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France.
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28
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Linos K, Kozel JA, Hurley MY, Andea AA. Review of the medical literature and assessment of current utilization patterns regarding the use of two common fluorescence in situ hybridization assays in the diagnosis of dermatofibrosarcoma protuberans and clear cell sarcoma. J Cutan Pathol 2018; 45:905-913. [DOI: 10.1111/cup.13345] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 07/14/2018] [Accepted: 08/06/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Konstantinos Linos
- Department of Pathology and Laboratory Medicine; Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth Lebanon; Lebanon New Hampshire
| | | | - Maria Yadira Hurley
- Departments of Dermatology and Pathology; Saint Louis University School of Medicine; St. Louis Missouri
| | - Aleodor A. Andea
- Departments of Dermatology and Pathology; University of Michigan Medical Center; Ann Arbor Michigan
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Allanson BM, Weber MA, Jackett LA, Chan C, Lau L, Ziegler DS, Warby M, Mayoh C, Cowley MJ, Tucker KM, Long GV, Maher A, Anazodo A, Scolyer RA. Oral malignant gastrointestinal neuroectodermal tumour with junctional component mimicking mucosal melanoma. Pathology 2018; 50:648-653. [PMID: 30177220 DOI: 10.1016/j.pathol.2018.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 07/16/2018] [Accepted: 07/22/2018] [Indexed: 02/07/2023]
Abstract
Malignant gastrointestinal neuroectodermal tumour (GNET) is a recently characterised rare and aggressive tumour that typically arises in association with the small intestine of adults. We present a novel case of this entity and expand the spectrum of its reported morphological features. The patient was a 5-year-old female, the youngest reported patient affected by the condition, and presented with extra-abdominal disease. The histopathological features included the presence of a junctional component of the palatal tumour, which mimicked mucosal melanoma, a feature that has not been previously reported in GNET. Whole genome and RNA sequencing was performed that demonstrated the EWSR1-ATF1 translocation characteristic of GNET. Knowledge of this entity and its features, together with careful morphological assessment supplemented by judicious immunohistochemical and molecular studies should enable the correct diagnosis to be established.
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Affiliation(s)
- Benjamin M Allanson
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
| | - Martin A Weber
- Department of Anatomical Pathology, NSW Health Pathology East, Prince of Wales Hospital/Sydney Children's Hospital, Randwick, NSW, Australia; School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Louise A Jackett
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Charles Chan
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Department of Anatomical Pathology, NSW Health Pathology, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Loretta Lau
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia; Children's Cancer Institute, University of New South Wales, Sydney, NSW, Australia
| | - David S Ziegler
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia; Children's Cancer Institute, University of New South Wales, Sydney, NSW, Australia
| | - Meera Warby
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Chelsea Mayoh
- Children's Cancer Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mark J Cowley
- Children's Cancer Institute, University of New South Wales, Sydney, NSW, Australia; Kinghorn Centre for Clinical Genomics, Garvan Institute, Sydney, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Katherine M Tucker
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Georgina V Long
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Annabelle Maher
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Antoinette Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia; Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Richard A Scolyer
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
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31
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Obiorah IE, Brenholz P, Özdemirli M. Primary Clear Cell Sarcoma of the Dermis Mimicking Malignant Melanoma. Balkan Med J 2017; 35:203-207. [PMID: 29072181 PMCID: PMC5863262 DOI: 10.4274/balkanmedj.2017.0796] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background: Clear cell sarcoma is a rare malignant soft tissue neoplasm that typically involves tendons and aponeurosis. Clear cell sarcoma in the dermis is an extremely rare occurrence, and it is difficult to differentiate between this neoplasm and dermal malignant melanoma because they have similar morphologic and immunohistochemical features. Although rare, clear cell sarcoma of the skin typically occurs in the extremities. To our knowledge, there are no reported cases of primary clear cell sarcoma of the skin occurring in the neck. Here, we report an unusual case of clear cell sarcoma arising in the skin of the neck. Case Report: A 43-year-old female presented with a right neck lesion. Histologic sections of the lesion showed a nodular proliferation of spindle cells with pale cytoplasm with epithelioid features involving the entire dermis with no epidermal component. The tumour cells were positive for melanocytic markers, including S100 and Human Melanoma Black 45, which led to an initial diagnosis of malignant melanoma. Fluorescence in situ hybridization showed a rearrangement of the EWSR1 gene on chromosome 22q12, which led to a diagnosis of primary clear cell sarcoma in the skin. Conclusion: Because the treatments for clear cell sarcoma and conventional melanoma are different, fluorescence in situ hybridization for EWSR1 should be performed in any dermal lesions with melanocytic features that do not have an in situ component.
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Affiliation(s)
- Ifeyinwa E Obiorah
- Department of Pathology, Medstar Georgetown University Hospital, Washington, USA
| | - Pauline Brenholz
- Department of Medical Genetics, Integrated Oncology, New York, USA
| | - Metin Özdemirli
- Department of Pathology, Medstar Georgetown University Hospital, Washington, USA
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32
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Abstract
The mesenchymal tumors discussed herein represent a heterogeneous group of neoplasms with distinctive morphologic, immunophenotypic, and molecular genetic features. These uncommon tumors often arise in the dermis and subcutis and can pose a major diagnostic challenge to dermatopathologists because they closely mimic melanoma, carcinoma, fibrous histiocytoma, schwannoma, or granulomatous inflammation. This article reviews the clinical presentation, histopathology, differential diagnosis, and diagnostic pitfalls of epithelioid sarcoma, clear cell sarcoma, perivascular epithelioid cell tumor, ossifying fibromyxoid tumor, pleomorphic hyalinizing angiectatic tumor, and hemosiderotic fibrolipomatous tumor. Associated molecular genetic findings are also briefly reviewed with an emphasis on their diagnostic usefulness.
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Affiliation(s)
- Darya Buehler
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, L5/184 CSC, Madison, WI 53792, USA.
| | - Paul Weisman
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, B1779 WIMR, Madison, WI 53792, USA
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33
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Ogawa T, Maruyama H, Tanaka R, Fujisawa Y, Fujimoto M. Clear cell sarcoma of the scalp: A case report. J Dermatol 2017; 44:e276-e277. [PMID: 28791725 DOI: 10.1111/1346-8138.13979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Tatsuya Ogawa
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroshi Maruyama
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ryota Tanaka
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yasuhiro Fujisawa
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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