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Kosemehmetoglu K, Mosaieby E, Šteiner P, Vaněček T, Baranovska-Andrigo V, Michal M. Calcifying Spindle Cell Soft Tissue Tumor With SOX10::PLAG1 Fusion: A Case Report of a Morphologically Distinctive and Potentially Novel Soft Tissue Tumor. Genes Chromosomes Cancer 2024; 63:e23249. [PMID: 38884173 DOI: 10.1002/gcc.23249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/02/2024] [Accepted: 05/14/2024] [Indexed: 06/18/2024] Open
Abstract
The widespread use of advanced molecular techniques has led to the identification of several tumor types with PLAG1 gene fusions some of which also affect the skin and soft tissues. Herein, we present a 38-year-old female with a subcutaneous tumor affecting her forearm, which does not seem to fit into any currently recognized entity. It was a well-circumscribed tumor measuring 6 × 4,5 × 4 cm. It had a thick capsule composed of bland spindle cells forming palisades and Verocay body-like structures within a myxocollagenous background. Scattered calcifications were dispersed throughout the lesion. No cytological atypia, mitotic activity, or necrosis were present. Targeted NGS revealed a SOX10::PLAG1 fusion and fluorescent in situ hybridization confirmed the presence of PLAG1 gene rearrangement. The neoplastic cells showed a diffuse immunohistochemical expression of S100, SOX10, and PLAG1, as well as patchy desmin and CD34 positivity. The methylation profile of this tumor did not match any other entity covered by the DKFZ sarcoma classifier and apart from the gain of chromosome 12, the copy number profile was normal. The tumor was completely excised, and the patient has been free of disease for 4 years since the excision. While more cases are needed to confirm this tumor as a distinct entity, we propose a provisional name "SOX10::PLAG1-rearranged calcifying spindle cell tumor."
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Affiliation(s)
- Kemal Kosemehmetoglu
- Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Petr Šteiner
- Bioptica Laboratory, Ltd., Plzen, Czech Republic
| | | | - Vira Baranovska-Andrigo
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Plzen, Czech Republic
| | - Michael Michal
- Bioptica Laboratory, Ltd., Plzen, Czech Republic
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Plzen, Czech Republic
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Mansour B, Donati M, Pancsa T, Grossman P, Šteiner P, Vaněček T, Comová K, Michal M, Michal M. Molecular analysis of apocrine mixed tumors and cutaneous myoepitheliomas: a comparative study confirming a continuous spectrum of one entity with near-ubiquitous PLAG1 and rare mutually exclusive HMGA2 gene rearrangements. Virchows Arch 2024:10.1007/s00428-024-03811-x. [PMID: 38736009 DOI: 10.1007/s00428-024-03811-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/08/2024] [Accepted: 04/19/2024] [Indexed: 05/14/2024]
Abstract
Myoepithelial neoplasms of the skin and soft tissue still represent a confusing and somewhat controversial field in pathology as it appears that this category includes several different entities. However, recent studies have suggested that both apocrine mixed tumors (AMT) and cutaneous myoepitheliomas (CM) harbor identical chromosomal rearrangements involving the PLAG1 gene and hence may represent a morphological spectrum. The aim of the present study was to share our institutional experience with these tumors and specifically focus on studying their immunohistochemical and molecular features to further assess their relatedness. Eleven cases of AMT and 7 cases of CM were collected and analyzed using immunohistochemistry (IHC), PLAG1 FISH, and Archer FusionPlex assay. There were 14 male and 4 female patients with ages ranging from 26 to 85 years (median 55.8 years, mean 58.5 years). AMTs were mainly located in the head and neck (n = 10), while CMs were mainly located in the acral sites (n = 5). PLAG1 IHC was diffusely strongly positive in 14/17 (82%) cases, whereas a single case of AMT diffusely expressed HMGA2. Both tumor groups showed PLAG1 gene fusions which were detected in 6/13 analyzable samples (AMT, n = 4 and CM, n = 2), and included TRPS1::PLAG1 (n = 3), NDRG1::PLAG1 (n = 1), CTNNB1::PLAG1 (n = 1) and a novel PXDNL::PLAG1 fusion (n = 1). The remaining 5 cases were negative, 5 were not analyzable and the single case positive for HMGA2 by IHC revealed a potential HMGA2 gene rearrangement. The cases were further studied by FISH, with 12/17 cases showing PLAG1 gene rearrangement (AMT, n = 8 and CM, n = 4). Altogether, 14/18 cases showed PLAG1 gene rearrangement by at least one of the methods. PLAG1 immunohistochemistry had a 92% specificity and sensitivity. Our study provided additional data to suggest that AMT and CM share overlapping morphological and immunohistochemical features as well as molecular background characterized by PLAG1 gene fusions and thus represent a morphological spectrum. In addition, we identified a novel PXDNL::PLAG1 fusion and suggested that rare cases may harbor HMGA2 gene alterations which seem to be mutually exclusive with PLAG1 gene fusions. The relatedness of these tumors to salivary gland myoepithelial neoplasms and distinctness from eccrine mixed tumors and other skin and soft tissue myoepithelial neoplasms with EWSR1/FUS fusions is discussed.
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Affiliation(s)
- Boulos Mansour
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.
| | - Michele Donati
- Department of Pathology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128, Roma, Italy
| | - Tamás Pancsa
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
- Bioptical Laboratory, Ltd., Pilsen, Czech Republic
| | - Petr Grossman
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
- Bioptical Laboratory, Ltd., Pilsen, Czech Republic
| | - Petr Šteiner
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
- Bioptical Laboratory, Ltd., Pilsen, Czech Republic
| | - Tomáš Vaněček
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
- Bioptical Laboratory, Ltd., Pilsen, Czech Republic
| | - Kateřina Comová
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
- Bioptical Laboratory, Ltd., Pilsen, Czech Republic
| | - Michal Michal
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
- Bioptical Laboratory, Ltd., Pilsen, Czech Republic
| | - Michael Michal
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
- Bioptical Laboratory, Ltd., Pilsen, Czech Republic
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Ariasi C, Romanò C, Ghini I, Licata G, Rubelli L, Artelli GL, Calzavara-Pinton P, Arisi M. Cutaneous Syncytial Myoepithelioma with Positive CD34 Immunohistochemical Staining: An Unusual Tumor and a Challenging Diagnosis. Dermatopathology (Basel) 2023; 10:259-265. [PMID: 37754276 PMCID: PMC10529716 DOI: 10.3390/dermatopathology10030034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023] Open
Abstract
Cutaneous syncytial myoepithelioma (CSM) is a rare type of cutaneous neoplasm that typically presents as a solitary and well-circumscribed nodule on the skin. It predominantly occurs on the upper and lower extremities of adult patients. Immunohistochemically, CSM is characterized by the co-expression of smooth muscle and epithelial markers. Fluorescence in situ hybridization (FISH) targeting the EWSR1 gene rearrangement is an important diagnostic tool for CSM. In our case report, we found the focal positivity for CD34, which has never been previously observed; this was mostly confined to a central area of the neoplasm.
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Affiliation(s)
- Cesare Ariasi
- Department of Dermatology, University of Brescia, 25123 Brescia, Italy
| | - Carola Romanò
- Department of Dermatology, University of Brescia, 25123 Brescia, Italy
| | - Iacopo Ghini
- Department of Pathology, University of Brescia, 25123 Brescia, Italy
| | - Gaetano Licata
- Dermatology Unit, San Antonio Abate Hospital, 91016 Trapani, Italy
| | - Luca Rubelli
- Department of Dermatology, University of Brescia, 25123 Brescia, Italy
| | | | | | - Mariachiara Arisi
- Department of Dermatology, University of Brescia, 25123 Brescia, Italy
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Mahmood MN. Cutaneous Syncytial Myoepithelioma: A Unique Variant Worth Recognizing. Dermatopathology (Basel) 2023; 10:219-225. [PMID: 37489454 PMCID: PMC10366857 DOI: 10.3390/dermatopathology10030030] [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: 07/03/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/26/2023] Open
Abstract
Cutaneous syncytial myoepithelioma is a recently characterized variant of cutaneous myoepithelioma with a distinct histopathological and immunohistochemical profile. It is more common in men and predominately involves upper and lower extremities. Microscopically, it is a dermal tumor with a characteristic solid syncytial growth pattern displaying positivity with EMA and S100 immunohistochemical stains. Lately, EWSR1-PBX3 fusion has been documented in a vast majority. Although it follows a benign clinical course, its histopathological differential diagnosis includes clinically aggressive neoplasia. This contribution summarizes the derivation, clinical presentation, histopathological and immunohistochemical features, molecular genetics, pertinent differential diagnosis, and behavior of this unique cutaneous appendageal tumor.
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Affiliation(s)
- Muhammad N Mahmood
- Department of Laboratory Medicine and Pathology, University of Alberta Hospital, Edmonton, AB T6G 2B7, Canada
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Skylis RR, de Souza GB, de Almeida RC, Dedivitis RA. Pleomorphic adenoma in tonsil. J Surg Case Rep 2023; 2023:rjad261. [PMID: 37255959 PMCID: PMC10226808 DOI: 10.1093/jscr/rjad261] [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: 04/11/2023] [Accepted: 04/25/2023] [Indexed: 06/01/2023] Open
Abstract
Salivary tumors that involve the tonsil are rare, representing 0.5% of salivary neoplasms. Most tumors arise from the parotid glands. Rare studies have been reported in the literature regarding pleomorphic adenomas affecting the tonsil. Patients are usually asymptomatic and present with a slow-growing, mobile and painless mass. Radiological examinations are usually unable to differentiate benign from malignant tumors in most cases. There is low recurrence with complete excision of the tumor. The prognosis is excellent except in the rare cases of malignant transformation. This report describes the management of a case of pleomorphic adenoma affecting the palatine tonsils and the difficulty regarding the histopathological diagnosis.
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Affiliation(s)
- Robert Reis Skylis
- Correspondence address. Metropolitan University of Santos School of Medicine, Av Francisco Glicério, 6-8 - Santos 11045-002, Brazil. Tel: +551332211514; E-mail:
| | | | | | - Rogério Aparecido Dedivitis
- Metropolitan University of Santos School of Medicine, Santos SP, Brazil
- University of São Paulo School of Medicine, São Paulo, Brazil
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Koo M, Wi YC, Kim J, Lee SW. Subcutaneous Myoepithelioma in the Extremity: A Potential Pitfall in the Differential Diagnosis of Subcutaneous Tumors. Medicina (B Aires) 2023; 59:medicina59040667. [PMID: 37109625 PMCID: PMC10143696 DOI: 10.3390/medicina59040667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/03/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
We present a rare case of myoepithelioma in the subcutaneous layer of the shoulder with ultrasonography (US) and magnetic resonance imaging (MRI). US showed a lobulated hyperechoic mass, leading to an impression of lipoma. MRI showed the mass with low signal intensity on T1-weighted images (T1WI), high signal intensity on fat-suppressed T2-weighted images (T2WI), intermediate signal intensity on T2WI, and intense enhancement with adjacent fascial thickening. Imaging findings of soft tissue myoepithelioma have not been established. We report its US and MRI features mimicking features from a lipomatous tumor to infiltrative malignancy. Although soft tissue myoepithelioma has nonspecific image findings to confirm its diagnosis, some findings may help to make the differential diagnosis. Preoperative pathologic confirmation is recommended in a soft tissue neoplasm.
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Affiliation(s)
- Minsun Koo
- Department of Radiology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul 03312, Republic of Korea
| | - Young Chan Wi
- Department of Pathology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul 03312, Republic of Korea
| | - Jimin Kim
- Department of Radiology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul 03312, Republic of Korea
- Correspondence: (J.K.); (S.-W.L.)
| | - Sheen-Woo Lee
- Department of Radiology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul 03312, Republic of Korea
- Correspondence: (J.K.); (S.-W.L.)
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Cutaneous Myoepithelial Neoplasms on Acral Sites Show Distinctive and Reproducible Histopathologic and Immunohistochemical Features. Am J Surg Pathol 2022; 46:1241-1249. [PMID: 35354162 DOI: 10.1097/pas.0000000000001896] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cutaneous myoepithelial neoplasms are a heterogenous group of neoplasms with mixed tumors typically affecting the head and myoepitheliomas showing a predilection for the extremities. Their malignant counterparts, myoepithelial carcinoma, and malignant mixed tumor are exceptionally rare in the skin, and the morphologic criteria for malignancy are only poorly defined. The aim of the present study was to characterize the clinicopathologic features of myoepithelial neoplasms presenting on acral skin. The clinical and histopathologic features of 11 tumors were recorded, and follow-up was obtained. Immunohistochemistry was performed for S100, SOX10, glial fibrillary acidic protein, keratins, epithelial membrane antigen, p63, p40, smooth muscle actin, desmin, and PLAG1. The tumors mainly affected the feet of adults (range: 26 to 78 y; median: 47 y) with a predilection for the great toe and a male predominance of 1.8:1. Most tumors (91%) displayed a lobular architecture composed of solid and nested growth of epithelioid cells with plasmacytoid features in a myxoid or angiomatous stroma. Scattered cytologic atypia and rare duct differentiation were frequently noted. Three tumors with confluent cytologic atypia, infiltrative growth, and lymphovascular invasion were classified as malignant. By immunohistochemistry, the tumors were positive for S100, SOX10, keratins AE1/AE3, CK5/6 and CK7, and PLAG1. Local recurrence and bilateral pulmonary metastasis were observed in a patient presenting with a histopathologically benign-appearing tumor. Two patients with malignant tumors experienced local recurrences, and 1 developed metastasis to soft tissue, lung, and mediastinal lymph nodes. All patients are currently alive, all but 1 with no evidence of disease after a median follow-up interval of 96 months (range: 2 to 360 mo). In conclusion, acral myoepithelial neoplasms show distinctive and reproducible histopathologic and immunohistochemical features. They are best regarded as a distinctive subset of mixed tumors with features reminiscent of their salivary gland counterparts. While most tumors pursue a benign disease course, histopathologic features appear to be a poor indicator of prognosis.
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