1
|
Warmke LM, Yu W, Meis JM. Sclerosing Epithelioid Fibrosarcoma. Surg Pathol Clin 2024; 17:119-139. [PMID: 38278601 DOI: 10.1016/j.path.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
Sclerosing epithelioid fibrosarcoma (SEF) is a distinctive sarcoma that may arise in nearly any soft tissue site or bone. While there has been past controversy as to whether it is related to low-grade fibromyxoid sarcoma (LGFMS), it has been shown to behave far more aggressively than LGFMS. SEF has a propensity to metastasize to the lungs and bone and arise within the abdominal cavity. Histologically, it is characterized by uniform nuclei embedded in a densely collagenous stroma simulating osteoid. By immunohistochemistry, it is often strongly positive for MUC4. The majority (75%) have EWSR1 gene rearrangement, most commonly with CREB3L1 as a fusion partner, although a variety of FUS/EWSR1 and CREB3L1/CREB3L2/CREB3L3 fusions have been described in addition to others. SEF is currently recalcitrant to nearly all chemotherapy and radiation therapy.
Collapse
Affiliation(s)
- Laura M Warmke
- Department of Pathology and Laboratory Medicine, Indiana University, IU Health Pathology Laboratory, 350 W 11th Street, Room 4086, Indianapolis, IN 46202, USA
| | - Wendong Yu
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Pathology Unit #085, Houston, TX 77030, USA
| | - Jeanne M Meis
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Pathology Unit #085, Houston, TX 77030, USA.
| |
Collapse
|
2
|
Murshed KA, Al-Bozom I, Ammar A. Sclerosing epithelioid fibrosarcoma: in-depth review of a genetically heterogeneous tumor. APMIS 2021; 129:455-460. [PMID: 34048081 DOI: 10.1111/apm.13157] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/10/2021] [Indexed: 11/27/2022]
Abstract
First described in 1995 by Meis-Kindbloom et al. as a variant of fibrosarcoma simulating carcinoma, sclerosing epithelioid fibrosarcoma (SEF) is a malignant soft tissue sarcoma characterized by epithelioid cells in dense sclerotic stroma, frequent immunoreactivity for MUC4 and heterogeneous genetic profile with recurrent EWSR1 gene rearrangement. It typically affects middle-age adults with a predilection for the lower extremity. It is believed that SEF is closely related to low-grade fibromyxoid sarcoma (LGFMS), both tumors show overlapping features in morphology, immunophenotype, and molecular profile. In this review, we discuss the clinical, morphologic, and immunohistochemical features of SEF with particular emphasis on its molecular diversity and relation to LGFMS.
Collapse
Affiliation(s)
- Khaled A Murshed
- Department of Laboratory Medicine & Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Issam Al-Bozom
- Department of Laboratory Medicine & Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Adham Ammar
- Department of Laboratory Medicine & Pathology, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
3
|
Nagano N, Ishikawa N, Nagase M, Araki A, Iwahashi T, Maruyama R. A case of cellular variants of Sclerosing epithelioid fibrosarcoma resembling Plasmacytoma/Myeloma: Diagnostic difficulty in the fine needle aspiration. Int J Surg Case Rep 2020; 68:228-233. [PMID: 32193142 PMCID: PMC7078455 DOI: 10.1016/j.ijscr.2020.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 03/02/2020] [Accepted: 03/04/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Sclerosing epithelioid sarcoma (SEF) is a rare fibroblastic sarcoma. It is classically composed of cords of epithelioid cells embedded in a hyalinized stroma; however, cases of cellular variants also exist. A cellular variants of SEF can mimic Plasmacytoma/Myeloma (PM) and myoepithelioma. Hence, accurate diagnosis of SEF is important for cytologists and pathologists. PRESENTATION OF CASE We present the case of a 75-year-old female patient diagnosed with a cellular variant of SEF occurring in the erector spinal muscle. Immunostaining of MUC4 and fluorescence in situ hybridization of EWSR1 (break-apart signal) were used for diagnosis. CONCLUSION The cellular variants of SEF presented diagnostic difficulties in fine needle aspiration. Moreover, it could not be distinguished from PM.
Collapse
Affiliation(s)
- Nahoko Nagano
- Department of Surgical Pathology, Shimane University Hospital, Japan.
| | | | - Mamiko Nagase
- Department of Organ Pathology, Shimane University School of Medicine, Japan
| | - Asuka Araki
- Department of Organ Pathology, Shimane University School of Medicine, Japan
| | - Teruaki Iwahashi
- Department of Surgical Pathology, Shimane University Hospital, Japan
| | - Riruke Maruyama
- Department of Organ Pathology, Shimane University School of Medicine, Japan
| |
Collapse
|
4
|
Laliberte C, Leong IT, Holmes H, Monteiro EA, O'Sullivan B, Dickson BC. Sclerosing Epithelioid Fibrosarcoma of the Jaw: Late Recurrence from a Low Grade Fibromyxoid Sarcoma. Head Neck Pathol 2017; 12:619-622. [PMID: 29274042 PMCID: PMC6232198 DOI: 10.1007/s12105-017-0879-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 12/12/2017] [Indexed: 01/27/2023]
Abstract
Sclerosing epithelioid fibrosarcoma (SEF) is an uncommon variant of fibrosarcoma that is characterized by a distinct morphology. It most frequently presents in the deep soft tissues of the lower extremities, often in intimate association with fascia and periosteum, although reports of the head and neck involvement have been reported. A minority of cases show morphological, immunohistochemical and molecular overlap with low grade fibromyxoid sarcoma (LG-FMS). Herein, we describe a case of a bland spindle cell neoplasm presenting in the jaw that was initially incompletely excised. Over the course of 20 years the tumor subsequently recurred with a SEF morphology. Molecular testing performed on both specimens subsequently confirmed the presence of an EWSR1-CREB3L1 gene fusion. This report highlights the diagnostic difficulty with LG-FMS, particularly in unusual anatomic locations; reiterates the potential for the uncommon EWSR1-CREB3L1 fusion product in LG-FMS; and, reaffirms the potential for progression and/or overlap between LG-FMS to SEF over time.
Collapse
Affiliation(s)
- Catherine Laliberte
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, 600 University Ave, Suite 6.500.12.5, Toronto, ON, M5G 1X5, Canada
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
| | - Iona T Leong
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, 600 University Ave, Suite 6.500.12.5, Toronto, ON, M5G 1X5, Canada
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
| | - Howard Holmes
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, 600 University Ave, Suite 6.500.12.5, Toronto, ON, M5G 1X5, Canada
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
| | - Eric A Monteiro
- Department of Otolaryngology, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Hospital, Toronto, ON, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Brendan C Dickson
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, 600 University Ave, Suite 6.500.12.5, Toronto, ON, M5G 1X5, Canada.
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
5
|
Mertens F, Antonescu CR, Mitelman F. Gene fusions in soft tissue tumors: Recurrent and overlapping pathogenetic themes. Genes Chromosomes Cancer 2015; 55:291-310. [PMID: 26684580 DOI: 10.1002/gcc.22335] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 11/01/2015] [Accepted: 11/01/2015] [Indexed: 12/21/2022] Open
Abstract
Gene fusions have been described in approximately one-third of soft tissue tumors (STT); of the 142 different fusions that have been reported, more than half are recurrent in the same histologic subtype. These gene fusions constitute pivotal driver mutations, and detailed studies of their cellular effects have provided important knowledge about pathogenetic mechanisms in STT. Furthermore, most fusions are strongly associated with a particular histotype, serving as ideal molecular diagnostic markers. In recent years, it has also become apparent that some chimeric proteins, directly or indirectly, constitute excellent treatment targets, making the detection of gene fusions in STT ever more important. Indeed, pharmacological treatment of STT displaying fusions that activate protein kinases, such as ALK and ROS1, or growth factors, such as PDGFB, is already in clinical use. However, the vast majority (52/78) of recurrent gene fusions create structurally altered and/or deregulated transcription factors, and a small but growing subset develops through rearranged chromatin regulators. The present review provides an overview of the spectrum of currently recognized gene fusions in STT, and, on the basis of the protein class involved, the mechanisms by which they exert their oncogenic effect are discussed.
Collapse
Affiliation(s)
- Fredrik Mertens
- Department of Clinical Genetics, University and Regional Laboratories, Lund University, Lund, Sweden
| | | | - Felix Mitelman
- Department of Clinical Genetics, University and Regional Laboratories, Lund University, Lund, Sweden
| |
Collapse
|