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Su H, Yu C, Ma X, Song Q. Combined immunotherapy and targeted treatment for primary alveolar soft part sarcoma of the lung: case report and literature review. Invest New Drugs 2021; 39:1411-1418. [PMID: 33765213 DOI: 10.1007/s10637-021-01105-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/16/2021] [Indexed: 12/18/2022]
Abstract
Primary acinar soft part sarcoma of the lung (ASPS) is a rare malignancy with unique cellular structure and clinical and genetic characteristics. Most patients do not exhibit clear clinical symptoms, with only a few developing respiratory symptoms. The typical histological characteristics are acinoid or organ-like structures. Immunofluorescence in situ hybridization suggests a rearrangement of the transcription factor E3 gene. Patients respond poorly to chemotherapy and are, thus, primarily treated with surgery and targeted therapy. We report herein a unique case of primary alveolar soft part sarcoma of the lung. The patient was a 24-year-old man with metastases to multiple organs, such as the brain, lungs, pancreas, and liver. The craniocerebral lesions attained partial remission after whole-brain radiotherapy and targeted combined immunotherapy, and other distant metastases completely disappeared after targeted combined immunotherapy (anlotinib and camrelizumab), indicating significant treatment efficacy. Anlotinib is an oral multi-target tyrosine kinase inhibitor (TKI) that exerts its anti-tumor effects by acting on various kinases. Camrelizumab is a humanized immunoglobulin G4 monoclonal antibody that can target PD-1 to block the interaction between PD-L1 and programmed death ligand 2, ultimately causing an anti-tumor effect. This is the first report of successful use of anlotinib combined with camrelizumab in the treatment of advanced primary ASPS. The treatment benefit provides preliminary evidence that targeted therapy, combined with immunotherapy, may be a safe and effective approach to treat primary pulmonary ASPS patients, thus warranting further investigation.
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Affiliation(s)
- Hui Su
- Department of Oncology, Liaocheng People's Hospital, Liaocheng, 252000, Shandong Province, China.,Qingdao University, Qingdao, 266000, Shandong Province, China
| | - Chao Yu
- Department of Orthopedics, Liaocheng People's Hospital, Liaocheng, 252000, Shandong Province, China
| | - Xuezhen Ma
- Department of Oncology, Qingdao Central Hospital, The Second Affiliated Hospital of Medical College of Qingdao University, Qingdao, 266000, Shandong, China
| | - Qingcui Song
- Department of Oncology, Liaocheng People's Hospital, Liaocheng, 252000, Shandong Province, China.
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Zhao M, Rao Q, Wu C, Zhao Z, He X, Ru G. Alveolar soft part sarcoma of lung: report of a unique case with emphasis on diagnostic utility of molecular genetic analysis for TFE3 gene rearrangement and immunohistochemistry for TFE3 antigen expression. Diagn Pathol 2015; 10:160. [PMID: 26369552 PMCID: PMC4570486 DOI: 10.1186/s13000-015-0399-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 08/28/2015] [Indexed: 12/29/2022] Open
Abstract
Alveolar soft part sarcoma (ASPS) is a rare, malignant mesenchymal tumor of distinctive clinical, morphologic, ultrastructural, and cytogenetical characteristics. It typically arises in the extremities of adolescents and young adults, but has also been documented in a number of unusual sites, thus causing diagnostic confusions both clinically and morphologically. The molecular signature of ASPS is a specific der(17)t(X;17)(p11.2;q25) translocation, which results in the fusion of TFE3 transcription factor gene at Xp11.2 with ASPL at 17q25. Recent studies have shown that the ASPL-TFE3 fusion transcript can be identified by reverse-transcriptase polymerase chain reaction analysis and TFE3 gene rearragement can be detected using a dual-color, break apart fluorescence in situ hybridization assay in paraffin-embedded tissue, and the resultant fusion protein can be detected immunohistochemically with antibody directed to the carboxy terminal portion of TFE3. Herein, we report a unique case of ASPS presenting as an asymptomatic mass in the lung of a 48 year-old woman without evidence of a primary soft tissue tumor elsewhere at the time of initial diagnosis. To the best of our knowledge, this is the third report of such cases appearing in the English language literature to date. We emphasize the differential diagnoses engendered by ASPS including a series of tumors involving the lung that have nested and alveolar growth patterns, and both clear and eosinophilic cytoplasm, and demonstrate the utility of molecular genetic analysis for TFE3 rearrangement and immunohistochemistry for TFE3 antigen expression for arriving at accurate diagnosis.
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Affiliation(s)
- Ming Zhao
- Depatment of Pathology, Zhejiang Provincial People's Hospital, Hangzhou, 310014, China.
| | - Qiu Rao
- Department of Pathology, Nanjing Jinling Hospital, Nanjing, 210000, China.
| | - Cuiyun Wu
- Department of Radiology, Zhejiang Provincial People's Hospital, Hangzhou, 310014, China.
| | - Zhongsheng Zhao
- Depatment of Pathology, Zhejiang Provincial People's Hospital, Hangzhou, 310014, China.
| | - Xianglei He
- Depatment of Pathology, Zhejiang Provincial People's Hospital, Hangzhou, 310014, China.
| | - Guoqing Ru
- Depatment of Pathology, Zhejiang Provincial People's Hospital, Hangzhou, 310014, China.
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Emmez H, Kale A, Sevinç Ç, Börcek AÖ, Yilmaz G, Kaymaz M, Uluoğlu Ö, Paşaoğlu A. Primary Intracerebral Alveolar Soft Part Sarcoma in an 11-Year-Old Girl: Case Report and Review of the Literature. NMC Case Rep J 2014; 2:31-35. [PMID: 28663959 PMCID: PMC5364931 DOI: 10.2176/nmccrj.2014-0009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 05/16/2014] [Indexed: 01/21/2023] Open
Abstract
Alveolar soft part sarcoma (ASPS), a rarely observed tumor, is a soft tissue sarcoma with an unidentified cell origin. It constitutes 0.5–1.0% of all soft tissue sarcomas. It may appear in various parts of the body, but mostly observed in the trunk and the extremities. It has a high metastasis potential. To the best of our knowledge, only three cases of primary intracranial ASPS without a demonstrable lesion elsewhere is encountered. An 11-year-old girl was operated because of fronto-parietal mass lesion by craniotomy. Pathological examination revealed ASPS and no primary focus was detected. In spite of radiotherapy and chemotherapy as an adjuvant therapy, after 45 months she had a second operation for recurrence of the tumor. Since it is possible to observe metastases in late phases, up to 30 years, the patients must be followed up for a long period. Although radiotherapy and chemotherapy followed by surgery is the most accepted treatment strategy, the prognosis is still poor.
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Affiliation(s)
- Hakan Emmez
- Department of Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Aydemir Kale
- Department of Neurosurgery, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Çelik Sevinç
- Department of Pathology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Alp Özgün Börcek
- Department of Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Güldal Yilmaz
- Department of Pathology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Memduh Kaymaz
- Department of Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ömer Uluoğlu
- Department of Pathology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Aydın Paşaoğlu
- Department of Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
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Ju HU, Seo KW, Jegal Y, Ahn JJ, Lee YJ, Kim YM, Oak C, Ra SW. A case of alveolar soft part sarcoma of the pleura. J Korean Med Sci 2013; 28:331-5. [PMID: 23400231 PMCID: PMC3565149 DOI: 10.3346/jkms.2013.28.2.331] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Accepted: 11/20/2012] [Indexed: 11/30/2022] Open
Abstract
Alveolar soft part sarcoma (ASPS) is a rare malignant soft-tissue neoplasm of unknown histogenesis. The two main sites of occurrence are the lower extremities in adults and the head and neck in children. We report the first case of pleural ASPS occurring in a 58-yr-old man who presented with progressive dyspnea. A computed tomographic scan of the thorax revealed a large enhancing pleural mass with pleural effusion in the left hemithorax. Wide excision of the pleural mass was performed. Histologically, the tumor consisted of organoid nests of large polygonal cells, the cytoplasm of which had eosinophilic and D-PAS positive granules. Immunohistochemical staining showed that the tumor cell nuclei were positive for transcription factor 3 (TFE3). The pleural ASPS with multiple bone metastases recurred 1 yr after surgery and the patient died of acute pulmonary embolism 1.5 yr after diagnosis.
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Affiliation(s)
- Hyeong Uk Ju
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kwang Won Seo
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Yangjin Jegal
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jong-Joon Ahn
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Young Jik Lee
- Department of Thoracic and Cardiovascular Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Young Min Kim
- Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Chulho Oak
- Department of Internal Medicine, Kosin University Gospel Hospital, University of Kosin College of Medicine, Busan, Korea
| | - Seung Won Ra
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Cohen DB, Jones DM, Fergus AH, Qian J, Schwartz MS. Metastatic alveolar soft-part sarcoma of the intracranial skull base: case report. Skull Base 2011; 12:33-8. [PMID: 17167641 PMCID: PMC1654768 DOI: 10.1055/s-2002-21571] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
A patient with an intracranial skull base alveolar soft-part sarcoma, thought on preoperative imaging to be a meningioma, is presented. The mass was removed and identified by pathological evaluation to be an alveolar soft-part sarcoma. Postoperative investigation revealed widespread systemic disease. The histologic and clinical characteristics of this unusual tumor and the implications for prognosis and treatment are discussed.
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Abstract
Alveolar soft part sarcoma (ASPS) is a rare epithelial-like soft tissue sarcoma. The two main sites of its occurrence are the lower extremities in adults and the head and neck in children. Primary pulmonary involvement of this sarcoma, without evidence of soft tissue tumor elsewhere, is very exceptional. We present a case of primary ASPS of the lung in a 42-yr-old woman. A computed tomographic scan of the thorax demonstrated a well-circumscribed, solid tumor located in the right upper lobe. The mass was resected by right upper lobectomy. After 5 months, three metastatic lesions, involving lumbar vertebrae and occipital scalp, were found. Histologically, the tumor consisted of alveolar nests of large polygonal tumor cells, the cytoplasm of which frequently revealed periodic acid-Schiff-positive, diastase-resistant intracytoplasmic rod-like structures. On immunohistochemical staining, the tumor cells were positive only for vimentin and alpha-smooth muscle actin. Ultrastructural study using electron microscopy revealed characteristic electron-dense, rhomboid intracytoplasmic crystals.
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Affiliation(s)
- Yeong Dae Kim
- Department of Thoracic & Cardiovascular Surgery, College of Medicine, Pusan National University, Busan, Korea
| | - Chang Hun Lee
- Department of Pathology, College of Medicine, Pusan National University, Busan, Korea
- Medical Research Institute, College of Medicine, Pusan National University, Busan, Korea
| | - Min Ki Lee
- Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
- Medical Research Institute, College of Medicine, Pusan National University, Busan, Korea
| | - Yeon Joo Jeong
- Department of Diagnostic Radiology, College of Medicine, Pusan National University, Busan, Korea
| | - Jee Yeon Kim
- Department of Pathology, College of Medicine, Pusan National University, Busan, Korea
| | - Do Youn Park
- Department of Pathology, College of Medicine, Pusan National University, Busan, Korea
| | - Mee Young Sol
- Department of Pathology, College of Medicine, Pusan National University, Busan, Korea
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Laroia ST, Potti A, Rabbani M, Mehdi SA, Koch M. Unusual pulmonary lesions: case 3. Pulmonary vein leiomyosarcoma presenting as a left atrial mass. J Clin Oncol 2002; 20:2749-51. [PMID: 12039939 DOI: 10.1200/jco.2002.20.11.2749] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sandeep T Laroia
- University of North Dakota, Veterans' Affairs Medical Center, and MeritCare Medical Center, Fargo, ND, USA
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