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Miao X, Chen J, Yang L, Lu H. Primary pulmonary myxoid sarcoma with EWSR1::CREB1 fusion: a literature review. J Cancer Res Clin Oncol 2024; 150:108. [PMID: 38421462 PMCID: PMC10904531 DOI: 10.1007/s00432-024-05634-4] [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: 12/26/2023] [Accepted: 01/27/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE This review primarily aims to review the epidemiology, clinical characteristics, imaging, pathology, immunohistochemistry, diagnosis, differential diagnosis, treatment, and prognosis of Primary pulmonary myxoid sarcoma (PPMS) with EWS RNA binding protein 1::cAMP response element binding protein 1 (EWSR1::CREB1) fusion. It provides reference for the diagnosis and treatment of this disease. METHODS Retrospectively collected the literature about PPMS with EWSR1::CREB1 fusion, its clinical, radiology, histology, molecular characteristics and current treatment strategies were collated and analyzed. This review provides a detailed differential diagnosis of the disease. RESULTS PPMS is an exceptionally rare, low-grade malignant tumor of the lung. This tumor commonly infiltrates lung tissue and develops within bronchial passages. It is identified by a genetic rearrangement involving the EWSR1 gene and a distinct chromosomal translocation t(2; 22)(q33; q12). Variants include EWSR1::CREB1 fusion and EWS RNA binding protein 1::activating transcription factors (EWSR1::ATF1) fusion. PPMS with EWSR1::CREB1 fusion is more prevalent among middle-aged individuals and affects both sexes almost equally. Clinical symptoms are relatively non-specific, primarily including cough, hemoptysis, and weight loss. Most patients undergo surgery and experience a favorable prognosis. Further research is required to validate the effectiveness of alternative treatments for PPMS with EWSR1::CREB1 fusion. CONCLUSION EWSR1 rearrangement and EWSR1::CREB1 fusion are crucial genetic features of PPMS and serve as important diagnostic markers. Immunohistochemically, PPMS tests positive for EMA. In terms of treatment, surgery has been the primary approach in recent years. Therefore, the efficacy of other treatments still requires further investigation.
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Affiliation(s)
- Xinyu Miao
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, People's Republic of China
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology On Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China
| | - Jing Chen
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology On Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China
- Postgraduate Training Base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, 310022, People's Republic of China
| | - Lan Yang
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology On Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China
- Postgraduate Training Base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, 310022, People's Republic of China
| | - Hongyang Lu
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology On Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China.
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China.
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Dabas SK, Menon NN, Ranjan R, Gurung B, Tiwari S, Bassan BB, Shukla H, Pasricha S, Sinha A, Kapoor R, Verma VK, Verma D, Arora S, Sharma A, Mukharjee S, Singal R, Fernandes TB. Extraskeletal Myxoid Chondrosarcoma of Floor of Mouth-A Rare Case Report and Review of Literature. Indian J Otolaryngol Head Neck Surg 2024; 76:1290-1297. [PMID: 38440485 PMCID: PMC10908772 DOI: 10.1007/s12070-023-04271-6] [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: 09/06/2023] [Accepted: 10/05/2023] [Indexed: 03/06/2024] Open
Abstract
Introduction Chondrosarcomas are rare malignancies of the cartilage and myxoid chondrosarcoma is its variant which commonly occurs in soft tissue of extremities. Extraskeletal chondrosarcoma is a rare malignant neoplasm of bone or soft tissue origin and is characterized by the presence of spindle cells admixed with well differentiated cartilage or chondroid stroma. They are mostly radioresistant tumours and surgical resections with adequate margins is considered as the ideal treatment modality with adjuvant radiotherapy in high grade tumours and add on chemotherapy, in case of presence of poor prognostic factors. Case Report A 51-year-old diabetic, hypertensive female patient presented to our outpatient department with difficulty in chewing food for a duration of 6 months. On clinical examination, she had an ulceroproliferative growth involving right lower alveolus and floor of mouth. MRI face and neck with contrast showed a 4.1 × 2.9 × 4.5 cm lesion involving right lower alveolus extending to floor of mouth. Biopsy showed features of extraskeletal myxoid chondrosarcoma. She was planned for upfront surgery (Right composite resection with modified radical neck dissection with free fibula flap). Patient was stable post-surgery and was discharged in stable condition. Final histopathology report was high grade myxoid chondrosarcoma. The case was presented in tumour board and the patient was planned for adjuvant radiotherapy. She has been on regular follow up for the past 2 years and shows no signs of recurrence. Conclusion Extraskeletal myxoid chondrosarcoma of oral cavity is a rare entity and very few cases are reported. It is a malignant neoplasm which is diagnosed with the help of immunohistochemistry. Surgery is the ideal modality of treatment accompanied by adjuvant radiotherapy in cases of high-grade tumours.
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Affiliation(s)
- Surendra K Dabas
- Department of Surgical oncology, BLK- MAX Super specialty hospital, Pusa road, Rajendra Place, Delhi, 110005 India
| | - Nandini N Menon
- Department of Surgical oncology, BLK- MAX Super specialty hospital, Pusa road, Rajendra Place, Delhi, 110005 India
| | - Reetesh Ranjan
- Department of Surgical oncology, BLK- MAX Super specialty hospital, Pusa road, Rajendra Place, Delhi, 110005 India
| | - Bikas Gurung
- Department of Surgical oncology, BLK- MAX Super specialty hospital, Pusa road, Rajendra Place, Delhi, 110005 India
| | - Sukirti Tiwari
- Department of Surgical oncology, BLK- MAX Super specialty hospital, Pusa road, Rajendra Place, Delhi, 110005 India
| | - Bharat Bhushan Bassan
- Department of Surgical oncology, BLK- MAX Super specialty hospital, Pusa road, Rajendra Place, Delhi, 110005 India
| | - Himanshu Shukla
- Department of Surgical oncology, BLK- MAX Super specialty hospital, Pusa road, Rajendra Place, Delhi, 110005 India
| | - Sunil Pasricha
- Pathology Department, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, 110085 India
| | - Ajit Sinha
- Department of Surgical oncology, BLK- MAX Super specialty hospital, Pusa road, Rajendra Place, Delhi, 110005 India
| | - Rahul Kapoor
- Department of Surgical oncology, BLK- MAX Super specialty hospital, Pusa road, Rajendra Place, Delhi, 110005 India
| | - Vinay Kumar Verma
- Department of Surgical oncology, BLK- MAX Super specialty hospital, Pusa road, Rajendra Place, Delhi, 110005 India
| | - Devesh Verma
- Department of Surgical oncology, BLK- MAX Super specialty hospital, Pusa road, Rajendra Place, Delhi, 110005 India
| | - Saurabh Arora
- Department of nuclear medicine, BLK- MAX Super specialty hospital, Pusa road, Rajendra Place, Delhi, 110005 India
| | - Ashwani Sharma
- Department of Surgical oncology, BLK- MAX Super specialty hospital, Pusa road, Rajendra Place, Delhi, 110005 India
| | - Sourabh Mukharjee
- Department of Surgical oncology, BLK- MAX Super specialty hospital, Pusa road, Rajendra Place, Delhi, 110005 India
| | - Rishu Singal
- Department of Radiodiagnosis, BLK- MAX Super specialty hospital, Pusa road, Rajendra Place, Delhi, 110005 India
| | - Trishala Bhadauria Fernandes
- Department of Surgical oncology, BLK- MAX Super specialty hospital, Pusa road, Rajendra Place, Delhi, 110005 India
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Brodsky CN, Bucala MD, Abdulfatah EM, Siegel GW. Extraskeletal Myxoid Chondrosarcoma: Retrospective Case Series Examining Prognostic Factors, Treatment Approaches, and Oncologic Outcomes. Am J Clin Oncol 2023; 46:172-177. [PMID: 36825763 DOI: 10.1097/coc.0000000000000988] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
OBJECTIVES Extraskeletal myxoid chondrosarcoma (EMC) is an ultrarare soft tissue sarcoma, and a limited number of studies are published regarding its clinical course and efficacy of treatment. The goal of this retrospective case series is to explore patient characteristics, treatment approaches, and oncologic outcomes to help inform future EMC management. METHODS All patients with a diagnosis of EMC seen at the University of Michigan Sarcoma Center between 1998 and 2021 were identified. A chart review was performed to analyze demographics, tumor characteristics, treatments, and outcomes. RESULTS Forty-four patients with EMC were identified. The median follow-up was 49.8 months. The median age at diagnosis was 57 (range: 25 to 79), and 35 patients (80%) were male. Thirty-four patients (77%) had locoregional disease at diagnosis, and 26 patients (59%) ultimately developed metastatic disease. After locoregional curative-intent surgery, 15 patients had documented recurrence, of which 11 were metastatic (73%). Five-year overall survival was 79% for all patients, 86% for locoregional disease, and 58% for metastatic disease; for locoregional disease, 5-year disease-free and metastasis-free survival post-surgery were 43% and 53%, respectively; 1-year progression-free survival for metastatic disease from the start of first-line systemic therapy was 43%. Older age was the only factor statistically associated with improved prognosis, although perioperative radiotherapy, lower histologic grade, and negative margins also had directional associations with outcomes. CONCLUSIONS The data in this patient series are generally consistent with published literature on EMC and demonstrate a high recurrence rate, high propensity for metastasis, and high rate of progression of metastatic disease on systemic therapy.
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Sugino H, Iwata S, Satomi K, Mori T, Nobusawa S, Nagashima T, Matsushita Y, Yatabe Y, Ichimura K, Kawai A, Yoshida A. Keratin-positive fibrotic extraskeletal myxoid chondrosarcoma: a close mimic of myoepithelial tumour. Histopathology 2023; 82:937-945. [PMID: 36754860 DOI: 10.1111/his.14882] [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: 11/21/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/10/2023]
Abstract
AIMS Extraskeletal myxoid chondrosarcoma (EMC) is a rare form of adult sarcoma with distinct histology and NR4A3 gene fusion. Immunohistochemically, EMCs are variably positive for S100 protein and neuroendocrine markers. Unlike histologically similar soft-tissue myoepithelial tumours, keratin expression is rare. Prompted by two recent EMC cases with diffuse keratin expression, we investigated the expression of epithelial markers in a molecularly confirmed cohort of EMC and identified two additional similar cases. METHODS AND RESULTS Four keratin-positive EMCs occurred in one man and three women aged 46-59 years. All tumours displayed nonclassic histology with prominent stromal fibrosis, and keratin AE1/AE3 was expressed either diffusely (N = 2) or focally (N = 2). In one tumour, keratin expression was limited to the sclerotic area. All tumours coexpressed epithelial membrane antigen and two additionally expressed S100 protein or glial fibrillary acidic protein. All tumours harboured NR4A3 fusions, including TAF15::NR4A3 (N = 1) and EWSR1::NR4A3 (N = 3). Two cases were initially considered as most consistent with myoepithelial tumours based on widespread stromal fibrosis and keratin expression. DNA methylation analysis classified two tumours tested as EMCs. CONCLUSIONS We identified a small subset of EMCs characterised by keratin expression and prominent stromal fibrosis. This histological pattern must be recognised in the differential diagnosis of myoepithelial tumours because misclassification may lead to the erroneous prediction of tumour behaviour and may alter patient management. NR4A3 genetic analysis should be considered even in the face of keratin expression and prominent stromal fibrosis.
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Affiliation(s)
- Hirokazu Sugino
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Shintaro Iwata
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan.,Rare Cancer Center, National Cancer Center, Tokyo, Japan
| | - Kaishi Satomi
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan.,Department of Pathology, Kyorin University School of Medicine, Tokyo, Japan
| | - Taisuke Mori
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | | | - Toshiteru Nagashima
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Yuko Matsushita
- Department of Brain Disease Translational Research, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yasushi Yatabe
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Koichi Ichimura
- Department of Brain Disease Translational Research, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan.,Rare Cancer Center, National Cancer Center, Tokyo, Japan
| | - Akihiko Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan.,Rare Cancer Center, National Cancer Center, Tokyo, Japan
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Muacevic A, Adler JR, Ide Y, Kawai K, Futani H, Shibahara H. Extraskeletal Myxoid Chondrosarcoma of the Vulva: A Case Report. Cureus 2023; 15:e33601. [PMID: 36636521 PMCID: PMC9831112 DOI: 10.7759/cureus.33601] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 01/11/2023] Open
Abstract
Extraskeletal myxoid chondrosarcoma (EMC) of the vulva is extremely rare. We report our experience with a case of disease control by radiation therapy to a localized lesion of EMC. A 41-year-old woman presented to our clinic with a vulvar mass. Magnetic resonance imaging showed a 15 cm mass between the perineum and the medial thigh muscle. It was the "adductor magnus muscle." After the needle biopsy, a histopathological diagnosis of EMC was made. Tissue genomic analysis detected the EWSR1-NR4A3 fusion gene. A joint operation by the Department of Orthopedics, Gynecology, and Plastic Surgery was performed, which included a wide excision of the perineum, partial excision of the medial thigh muscle, and rectus abdominis valvuloplasty. Intraoperatively, pubic infiltration was detected. Postoperative pelvic radiotherapy was administered as adjuvant therapy. Recurrent common iliac lymph node metastases outside the irradiation field and multiple lung metastases were observed. Pazopanib was administered as adjuvant therapy. Pulmonary metastases were controlled, but the pelvic tumor had spread, so the patient underwent radiation therapy. After second-line chemotherapy with doxorubicin, left pleural effusion and mediastinal lymph node metastasis appeared, and third-line chemotherapy with eribulin mesylate was administered. The pleural effusion improved, but the patient developed cough again, and trabectedin was administered as the fourth chemotherapy. In this case, there was no local recurrence for three years after radiotherapy, suggesting the effectiveness of radiotherapy in local control.
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Lenz J, Klubíčková N, Ptáková N, Hájková V, Grossmann P, Šteiner P, Kinkor Z, Švajdler M, Michal M, Konečná P, Macháčová D, Hurník P, Tichý M, Tichý F, Kyllar M, Fiala L, Kavka M, Michal M. Extraskeletal myxoid chondrosarcoma: A study of 17 cases focusing on the diagnostic utility of INSM1 expression and presenting rare morphological variants associated with non-EWSR1::NR4A3 fusions. Hum Pathol 2022; 134:19-29. [PMID: 36563884 DOI: 10.1016/j.humpath.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/18/2022] [Accepted: 12/15/2022] [Indexed: 12/25/2022]
Abstract
Extraskeletal myxoid chondrosarcoma (EMC) is a rare sarcoma of uncertain lineage. Insulinoma-associated protein 1 (INSM1) has recently been described as a highly specific and sensitive immunohistochemical marker for EMC. The goal of this study was to evaluate the diagnostic significance of INSM1 immunohistochemistry in EMC. Furthermore, correlations between molecular and morphological findings were performed. Sixteen of 17 EMC cases were stained with the INSM1 antibody. Tumors with at least 5% INSM1-positive cells and any staining intensity were considered positive. Molecular testing was successfully performed in 12/17 cases. The immunohistochemical analysis detected 13 INSM1-positive (81%) and 3 INSM1-negative tumors (19%). The extent of the staining was classified as 1+ in 7 cases (44%), 2+ in 2 cases (13%), 3+ in 2 cases (13%) and 4+ in 2 cases (13%). Intensity of immunostaining was weak in 5 cases (31%), moderate in 2 cases (13%) and strong in 6 cases (38%). Molecular assays revealed 8 EWSR1::NR4A3 positive tumors (67%), 2 TAF15::NR4A3 positive tumors (17%), 1 TCF12::NR4A3 positive tumor (8%) and 1 NR4A3 positive tumor (8%) in which no other gene alteration was identified. Two of them, namely TCF12 positive and one TAF15 positive tumors, were highly cellular and partially associated with pseudopapillary architecture. Our study found that moderate/strong expression of INSM1 in more than 25% of tumor cells was present in only 31% of cases. Thus, the diagnostic utility of INSM1 is rather low. Two morphologically unique cases of non-EWSR1 rearranged EMC with an extremely rare pseudopapillary growth pattern are also reported.
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Affiliation(s)
- Jiří Lenz
- Department of Pathology, Znojmo Hospital, MUDr. Jana Janského 2675/11, 669 02 Znojmo, Czech Republic; Cytohisto S.r.o., Bří. Mrštíků 3065, 690 02 Břeclav, Czech Republic; Department of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, University of Veterinary Sciences Brno, Palackého Tř. 1946/1, 612 42 Brno, Czech Republic.
| | - Natálie Klubíčková
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 00 Plzeň, Czech Republic; Bioptical Laboratory, Ltd., Mikulášské Nám. 4, 326 00 Pilsen, Czech Republic.
| | - Nikola Ptáková
- Bioptical Laboratory, Ltd., Mikulášské Nám. 4, 326 00 Pilsen, Czech Republic.
| | - Veronika Hájková
- Bioptical Laboratory, Ltd., Mikulášské Nám. 4, 326 00 Pilsen, Czech Republic.
| | - Petr Grossmann
- Bioptical Laboratory, Ltd., Mikulášské Nám. 4, 326 00 Pilsen, Czech Republic.
| | - Petr Šteiner
- Bioptical Laboratory, Ltd., Mikulášské Nám. 4, 326 00 Pilsen, Czech Republic.
| | - Zdeněk Kinkor
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 00 Plzeň, Czech Republic; Bioptical Laboratory, Ltd., Mikulášské Nám. 4, 326 00 Pilsen, Czech Republic.
| | - Marián Švajdler
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 00 Plzeň, Czech Republic; Bioptical Laboratory, Ltd., Mikulášské Nám. 4, 326 00 Pilsen, Czech Republic.
| | - Michal Michal
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 00 Plzeň, Czech Republic; Bioptical Laboratory, Ltd., Mikulášské Nám. 4, 326 00 Pilsen, Czech Republic.
| | - Petra Konečná
- Department of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, University of Veterinary Sciences Brno, Palackého Tř. 1946/1, 612 42 Brno, Czech Republic.
| | - Dominika Macháčová
- Department of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, University of Veterinary Sciences Brno, Palackého Tř. 1946/1, 612 42 Brno, Czech Republic.
| | - Pavel Hurník
- Institute of Molecular and Clinical Pathology and Medical Genetics, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic.
| | - Michal Tichý
- Department of Pathology, Masaryk Memorial Cancer Institute, Žlutý Kopec 543/7, 602 00, Brno, Czech Republic.
| | - František Tichý
- Department of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, University of Veterinary Sciences Brno, Palackého Tř. 1946/1, 612 42 Brno, Czech Republic.
| | - Michal Kyllar
- Institute of Morphology, Department of Pathobiology, University of Veterinary Medicine, Veterinärplatz 1, 1210 Vienna, Austria.
| | - Luděk Fiala
- Cytohisto S.r.o., Bří. Mrštíků 3065, 690 02 Břeclav, Czech Republic; Charles University Prague, First Faculty of Medicine, Kateřinská 1660/32, 121 08 Prague, Czech Republic.
| | - Miroslav Kavka
- Department of Surgery, Znojmo Hospital, MUDr. Jana Janského 2675/11, 669 02 Znojmo, Czech Republic.
| | - Michael Michal
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 00 Plzeň, Czech Republic; Bioptical Laboratory, Ltd., Mikulášské Nám. 4, 326 00 Pilsen, Czech Republic.
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Elmajee M, Osman K, Dermanis A, Duffaydar H, Soon WC, czyz M. A literature Review: The genomic landscape of spinal chondrosarcoma and potential diagnostic, prognostic & therapeutic implications. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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He X, Wang Y, Zou C, Zheng C, Luo Y, Zhou Y, Tu C. Case Report: Gene Heterogeneity in the Recurrent and Metastatic Lesions of a Myxoid Chondrosarcoma Patient With Aggressive Transformation. Front Genet 2022; 13:791675. [PMID: 35910216 PMCID: PMC9330136 DOI: 10.3389/fgene.2022.791675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 06/23/2022] [Indexed: 11/29/2022] Open
Abstract
Extraskeletal myxoid chondrosarcoma (EMC) is a rare soft tissue sarcoma. In view of the indolent course throughout the prolonged natural history of EMC, it was considered as a low-grade soft-tissue sarcoma. However, recent studies have revealed a high recurrence and metastatic potential in EMC, and the invasiveness of EMC may progress during the protracted clinical course. The mechanism for this aggressive transformation remains unknown. Here, we present a rare case of EMC with aggressive behavior. This case was confirmed via pathology and NR4A3 fluorescent in situ hybridization. To verify the genetic characteristics of this rare case, a total gene sequencing analyses was performed in the recurrent and metastatic lesions. Intriguingly, different gene mutations were determined in the recurrent and metastatic lesions, which implied the genetic heterogeneity among the different lesions might be related to the aggressiveness of EMC. Furthermore, we discuss a few potential agents against the mutated genes in this case, which may provide novel insights regarding the targeted therapy of EMC.
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Affiliation(s)
- Xuanhong He
- Department of Orthopedics, Orthopedics Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Yitian Wang
- Department of Orthopedics, Orthopedics Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Chang Zou
- Department of Orthopedics, Orthopedics Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Chuanxi Zheng
- Department of Orthopedics, Orthopedics Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Luo
- Department of Orthopedics, Orthopedics Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Zhou
- Department of Orthopedics, Orthopedics Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Chongqi Tu
- Department of Orthopedics, Orthopedics Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Chongqi Tu,
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Reeves H, Smalle T. Complete surgical excision of a high‐grade extraskeletal mesenchymal chondrosarcoma, resulting in a longer survival than previously reported. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Hannah Reeves
- Translational Research and Animal Clinical Trial Study (TRACTS) Group U‐VET Animal Hospital, Melbourne, Veterinary School, Faculty of Veterinary and Agricultural Sciences University of Melbourne Werribee Melbourne VIC Australia
| | - Tesh Smalle
- Translational Research and Animal Clinical Trial Study (TRACTS) Group U‐VET Animal Hospital, Melbourne, Veterinary School, Faculty of Veterinary and Agricultural Sciences University of Melbourne Werribee Melbourne VIC Australia
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Artificial intelligence significantly improves the diagnostic accuracy of deep myxoid soft tissue lesions in histology. Sci Rep 2022; 12:6965. [PMID: 35484289 PMCID: PMC9051062 DOI: 10.1038/s41598-022-11009-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/18/2022] [Indexed: 12/04/2022] Open
Abstract
Deep myxoid soft tissue lesions have posed a diagnostic challenge for pathologists due to significant histological overlap and regional heterogeneity, especially when dealing with small biopsies which have profoundly low accuracy. However, accurate diagnosis is important owing to difference in biological behaviors and response to adjuvant therapy, that will guide the extent of surgery and the need for neo-adjuvant therapy. Herein, we trained two convolutional neural network models based on a total of 149,130 images representing diagnoses of extra skeletal myxoid chondrosarcoma, intramuscular myxoma, low-grade fibromyxoid sarcoma, myxofibrosarcoma and myxoid liposarcoma. Both AI models outperformed all the pathologists, with a significant improvement of accuracy up to 97% compared to average pathologists of 69.7% (p < 0.00001), corresponding to 90% reduction in error rate. The area under curve of the best AI model was on average 0.9976. It could assist pathologists in clinical practice for accurate diagnosis of deep soft tissue myxoid lesions, and guide clinicians for precise and optimal treatment for patients.
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Fice MP, Lee L, Kottamasu P, Almajnooni A, Cohn MR, Gusho CA, Gitelis S, Blank AT. Extraskeletal myxoid chondrosarcoma: A case series and review of the literature. Rare Tumors 2022; 14:20363613221079754. [PMID: 35251555 PMCID: PMC8891938 DOI: 10.1177/20363613221079754] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background Extraskeletal myxoid chondrosarcoma (EMC) is a rare malignant soft tissue sarcoma (STS) that accounts for less than 3% of all soft tissue tumors. The conventional treatment for primary EMC is wide local excision with or without radiation therapy. Materials and Methods This study was a retrospective review of all EMC cases treated within a single institution between 1992 and 2019. EMC was diagnosed using a combination of histologic morphology and immunostaining, with confirmatory fluorescent in situ hybridization. Overall survival (OS) and disease-specific survival (DSS) were defined using Kaplan–Meier analysis. Results Fifteen patients were evaluated, including 11 males and four females. The average age at presentation was 51.7 ± 20.4 years and the mean follow-up time was 61.5 months (range, 5–286 months). The average resected tumor size at largest dimension was 7.14 cm (range, 2.4–18.7). Twelve of fifteen (80%) patients underwent wide local excision, and nine of the twelve (75%) underwent local radiation therapy. The 1-, 5-, and 10-year OS was 80% (95% CI, 59.8–100), 72% (95% CI, 48.5–95.5), and 72% (95% CI, 48.5–95.5), respectively. The 1-, 5-, and 10-year DSS was 92.3% (95% CI, 77.8–100), 83.1% (95% CI, 61.5–100), and 83.1% (95% CI, 61.5–100), respectively. At last follow-up, 11 patients were alive and ten (90.9%) were disease free. Conclusions Extraskeletal myxoid chondrosarcoma is a very rare STS most often seen in males and in the extremities. Our cohort was too small to provide meaningful statistical analysis; however, we observed lower rates of local recurrence in patients treated with radiation.
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Affiliation(s)
- Michael P Fice
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center, Chicago, IL, USA
| | - Linus Lee
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center, Chicago, IL, USA
| | - Pavan Kottamasu
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center, Chicago, IL, USA
| | | | - Matthew R Cohn
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center, Chicago, IL, USA
| | - Charles A Gusho
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center, Chicago, IL, USA
| | - Steven Gitelis
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center, Chicago, IL, USA
| | - Alan T Blank
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center, Chicago, IL, USA
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12
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Dubal SB, Pathuthara S, Yadav S, Rekhi B. An uncommon diagnosis in pleural effusion cytology. Cytojournal 2021. [PMID: 33500692 PMCID: PMC8645513 DOI: 10.25259/cytojournal_61_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Sanjivani B. Dubal
- Department of Cytopathology and Surgical Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India,
| | - Saleem Pathuthara
- Department of Cytopathology and Surgical Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India,
| | - Subhash Yadav
- Department of Cytopathology and Surgical Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India,
| | - Bharat Rekhi
- Department of Cytopathology and Surgical Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India,
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Flucke U, van Noesel MM, Siozopoulou V, Creytens D, Tops BBJ, van Gorp JM, Hiemcke-Jiwa LS. EWSR1-The Most Common Rearranged Gene in Soft Tissue Lesions, Which Also Occurs in Different Bone Lesions: An Updated Review. Diagnostics (Basel) 2021; 11:diagnostics11061093. [PMID: 34203801 PMCID: PMC8232650 DOI: 10.3390/diagnostics11061093] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/07/2021] [Accepted: 06/10/2021] [Indexed: 01/09/2023] Open
Abstract
EWSR1 belongs to the FET family of RNA-binding proteins including also Fused in Sarcoma (FUS), and TATA-box binding protein Associated Factor 15 (TAF15). As consequence of the multifunctional role of EWSR1 leading to a high frequency of transcription of the chromosomal region where the gene is located, EWSR1 is exposed to aberrations such as rearrangements. Consecutive binding to other genes leads to chimeric proteins inducing oncogenesis. The other TET family members are homologous. With the advent of widely used modern molecular techniques during the last decades, it has become obvious that EWSR1 is involved in the development of diverse benign and malignant tumors with mesenchymal, neuroectodermal, and epithelial/myoepithelial features. As oncogenic transformation mediated by EWSR1-fusion proteins leads to such diverse tumor types, there must be a selection on the multipotent stem cell level. In this review, we will focus on the wide variety of soft tissue and bone entities, including benign and malignant lesions, harboring EWSR1 rearrangement. Fusion gene analysis is the diagnostic gold standard in most of these tumors. We present clinicopathologic, immunohistochemical, and molecular features and discuss differential diagnoses.
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Affiliation(s)
- Uta Flucke
- Department of Pathology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.M.v.N.); (B.B.J.T.); (L.S.H.-J.)
- Correspondence: ; Tel.: +31-24-36-14387; Fax: +31-24-36-68750
| | - Max M. van Noesel
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.M.v.N.); (B.B.J.T.); (L.S.H.-J.)
- Division Cancer & Imaging, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | | | - David Creytens
- Department of Pathology, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium;
| | - Bastiaan B. J. Tops
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.M.v.N.); (B.B.J.T.); (L.S.H.-J.)
| | - Joost M. van Gorp
- Department of Pathology, St Antonius Hospital, 3435 CM Nieuwegein, The Netherlands;
| | - Laura S. Hiemcke-Jiwa
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.M.v.N.); (B.B.J.T.); (L.S.H.-J.)
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14
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Almoiliqy M, Al-danakh A, Safi M, Alradhi M, AL-Azab M, Adlat S, Zhou W, Mohammed ASA, Al-maamari A. Surgery Treatment Improved the Overall Survival Rate in Locoregional Myxoid Leiomyosarcoma than Other Myxosarcomas in the United States. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:9999529. [PMID: 34007412 PMCID: PMC8110404 DOI: 10.1155/2021/9999529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/20/2021] [Indexed: 12/15/2022]
Abstract
Myxosarcomas are rare malignant tumors of soft connective tissues, classified into various subtypes, including myxoid liposarcoma, myxoid chondrosarcoma, and myxoid leiomyosarcoma. In this study, we proposed to study the demographic, tumor characteristics, and overall survival rate and compared the treatment modalities between these cancers. Patient data collected based on locoregional metastasis presentation of the abovementioned tumors with a cutoff study of survival duration up to 10 years were obtained from the SEER database during 1975-2016. Our results indicated that elderly patients and females were more in locoregional myxoid leiomyosarcoma than myxoid liposarcoma and myxoid chondrosarcoma with locoregional metastasis. The white race represented the most patients who suffered from these cancers than other races. The heart is the primary site for the abovementioned cancers, in addition to the female genitals to the myxoid leiomyosarcoma. Myxoid liposarcoma and myxoid chondrosarcoma patients with locoregional metastasis were suffering from grade II, while locoregional myxoid leiomyosarcoma patients with blank grading were due to missed data. Surgery was the most common treatment modality in this study compared with radiotherapy and chemotherapy. Kaplan-Meier analysis showed a significant difference in survival time between the three subtypes by using histology, and myxoid leiomyosarcoma showed prolonged survival than others. Elderly, female, white, unknown grade, surgery, no radiation, and no chemotherapy variables were independent factors associated with overall survival among these cancers. Multivariate analysis also showed significant differences in overall survival between the three tumors by histology, and myxoid leiomyosarcoma was with a better prognosis than others. Multivariate analysis of locoregional myxoid leiomyosarcoma showed the statistical significance of black race, grade, and radiotherapy, indicating them as independent prognostic factors of locoregional myxoid leiomyosarcoma. We conclude that surgery was the primary treatment modality against these cancers than radiotherapy and chemotherapy. And the locoregional myxoid leiomyosarcomas showed a better prognosis and higher survival rate than locoregional myxoid liposarcoma and locoregional myxoid chondrosarcoma.
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Affiliation(s)
- Marwan Almoiliqy
- Key Lab of Aromatic Plant Resources Exploitation and Utilization in Sichuan Higher Education, Yibin University, Yibin, 644000 Sichuan, China
- Department of Pharmacology, Pharmaceutical College, Dalian Medical University, Dalian 116044, China
| | - Abdullah Al-danakh
- Department of Urology, First Affiliated Hospital of Dalian Medical University, Dalian 116044, China
| | - Mohammed Safi
- Department of Oncology, First Affiliated Hospital of Dalian Medical University, Dalian 116044, China
| | - Mohammed Alradhi
- Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian 116044, China
| | - Mahmoud AL-Azab
- Department of Immunology, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - Salah Adlat
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510100, China
| | - Wanhai Zhou
- Key Lab of Aromatic Plant Resources Exploitation and Utilization in Sichuan Higher Education, Yibin University, Yibin, 644000 Sichuan, China
| | - Aiman Saleh A. Mohammed
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, Interdisciplinary Excellence Center, University of Szeged, Szeged 6720, Hungary
| | - Ahmed Al-maamari
- Department of Pharmacology, School of Basic Medical Sciences, Xi'an Jiaotong University, Health Science Center, Xi'an 710061, China
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15
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Lal DN, El-Zammar O, Naous R, Damron TA. Intra-articular Extraskeletal EWSR1-Negative NR4A3-Positive Myxoid Chondrosarcoma: A Case Report. JBJS Case Connect 2021; 10:e0614. [PMID: 32649120 DOI: 10.2106/jbjs.cc.19.00614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Extraskeletal myxoid chondrosarcomas (EMCs) are rare soft-tissue malignancies. Intra-articular occurrence is even more rare. To our knowledge, this case is one of only 2 reported intra-articular EMC cases of the knee free of local recurrence and/or amputation at follow-up. This case is also distinctive for being fluorescence in-situ hybridization-negative for the typical EMC-balanced translocation t(9;22) which fuses EWSR1 with NR4A3, harboring instead a variant translocation resulting in fusion of NR4A3 with a less common gene fusion partner. CONCLUSION This is a unique case of intra-articular EMC of the knee with a rare molecular fingerprint and an unusually positive outcome.
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Affiliation(s)
- Divakar N Lal
- 1Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York 2Department of Pathology, SUNY Upstate Medical University, Syracuse, New York
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16
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Wakely PE. Extraskeletal myxoid chondrosarcoma: combining cytopathology with molecular testing to achieve diagnostic accuracy. J Am Soc Cytopathol 2020; 10:293-299. [PMID: 32828707 DOI: 10.1016/j.jasc.2020.07.135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Advances in the genetics of soft tissue neoplasia have allowed for the diagnostic recognition of specific tumor types from small biopsy specimens, including those procured using the fine needle aspiration (FNA) biopsy technique. Extraskeletal myxoid chondrosarcoma (EMC) is a malignant mesenchymal neoplasm characterized by NR4A3 and, less specifically, by EWSR1 gene rearrangements. A series of EMC cytologic specimens was examined to demonstrate the diagnostic value of incorporating fluorescence in situ hybridization (FISH) testing in cytologic cases of suspected EMC. MATERIALS AND METHODS A search was made of our cytopathology and surgical pathology databases for cases diagnosed as EMC. FNA biopsy cytology, exfoliative cytology, imprint cytology, and FISH analysis were performed and examined using standard techniques. RESULTS A total of 16 cases of EMC were retrieved from 15 patients (male/female ratio, 2.8:1; mean age, 62 years). Of the 15 patients, 10 were new patients with primary tumors, 2 had locally recurrent tumors, and 4 had metastases. The sites included the extremities in 10 cases, the trunk in 4, serous effusion in 1, and a mediastinal lymph node in 1 case. The specific cytologic diagnoses were EMC (14 cases; 88%), suspicious for EMC (n = 1), and malignant cells (n = 1). All cases for which FISH testing was successfully used were specifically recognized as EMC. Aspirates and imprint smears consisted of uniformly rounded cells set in an opaque myxoid/chondromyxoid stroma (less abundant and more diaphanous in the effusion sample), sometimes arranged in short anastomosing cords. FNA of 1 case of an EMC cellular variant mimicked a malignant small rounded cell tumor. CONCLUSION EMC can be added to the growing list of soft tissue neoplasms that are specifically recognizable using cytopathology, coupled with judicious application of ancillary molecular testing.
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Affiliation(s)
- Paul E Wakely
- Department of Pathology, James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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EWSR1-NFATC2 Translocation-associated Sarcoma Clinicopathologic Findings in a Rare Aggressive Primary Bone or Soft Tissue Tumor. Am J Surg Pathol 2020; 43:1112-1122. [PMID: 30994538 DOI: 10.1097/pas.0000000000001260] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In recent years, a novel small round cell sarcoma harboring EWSR1-NFATC2 translocation with immunomorphologic overlap with Ewing sarcoma (ES), myoepithelial tumors, and extraskeletal myxoid chondrosarcoma has emerged. There has not been a case series devoted to describing its detailed clinicopathologic and immunohistochemical characteristics. Six sarcomas harboring EWSR1-NFATC2 fusion transcripts by reverse transcription polymerase chain reaction and amplification of the fusion gene by fluorescence in situ hybridization were identified. The patients were 5 adult men and 1 adult woman. Three were primary bone tumors of the radius and 3 were primary soft tissue tumors. Most tumors showed monomorphic round to epithelioid cells in anastomosing cords and abundant myxohyaline to collagenous extracellular matrix. Two tumors had large areas of a solid, matrix-poor histomorphology. All tumors stained for CD99 and NKX2.2; while EMA, dot-like cytokeratin, and focal WT-1 and SMA were present in some tumors. All but 1 tumor showed poor histologic and radiologic responses to neoadjuvant ES-specific chemotherapy. Local or distant recurrences happened in 4 cases. EWSR1-NFATC2 sarcoma is a novel translocation-associated sarcoma. It presents as either a primary bone or soft tissue tumor, usually exhibits distinctive histopathologic features, and has predilection for long bones of adult men. It consistently shows recurrent fusion gene amplification readily detectable by EWSR1 breakapart fluorescence in situ hybridization, which serves as a diagnostic surrogate. It has potential for local and distant recurrence and histologic progression, and is resistant to Ewing sarcoma-specific chemotherapy.
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18
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Chen Z, Yang Y, Chen R, Ng CS, Shi H. Primary pulmonary myxoid sarcoma with EWSR1-CREB1 fusion: a case report and review of the literature. Diagn Pathol 2020; 15:15. [PMID: 32039736 PMCID: PMC7008573 DOI: 10.1186/s13000-020-00930-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 02/05/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary pulmonary myxoid sarcoma (PPMS) is an extremely rare lung sarcoma that is characterized in most cases by recurrent balanced chromosomal translocation t(2;22)(q33;q12) leading to the oncogenic fusion gene EWSR1-CREB1. CASE PRESENTATION We report a case of PPMS with molecular confirmation using fluorescence in situ hybridization (FISH) and DNA sequencing in a 45-year-old female patient. Computer tomography (CT) scanning revealed a peripheral circumscribed solid mass of 2.1 × 2 cm in the right lung superior lobe. Histologically, the tumor cells ranged from stellate, polygonal to chondrocyte-like or physaliferous-like, forming reticular network of delicate lace-like cellular strands and cords in abundant myxoid stroma. The tumor cell immunophenotype was positive for vimentin, EMA and negative for CK-pan, TTF-1, CAM5.2, S-100, calponin, SMA, desmin, ALK, CD31 and CD34. Molecular analysis demonstrated EWSR1-CREB1 gene fusion in this tumor. During 38 months of follow-up, the patient was alive with no clinical or radiological evidence of recurrence or metastasis. CONCLUSION PPMS is a rare low-grade sarcoma with distinct histological and genetic features. We add another case to the literature of this rare tumor and report for the first time occurrence of chondrocyte-like and physaliferous-like tumor cells in this tumor, thus enriching its morphologic and cytologic spectrum.
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Affiliation(s)
- Zhenwei Chen
- Department of Pathology, Jinhua Municipal Central Hospital, 351 Mingyue Road, Jinhua, 321000 Zhejiang Province People’s Republic of China
| | - Yihui Yang
- Department of Pathology, Jinhua Municipal Central Hospital, 351 Mingyue Road, Jinhua, 321000 Zhejiang Province People’s Republic of China
| | - Rongming Chen
- Department of Pathology, the People’s Hospital of Changfeng County, Changfeng County, Anhui Province People’s Republic of China
| | - Chi Sing Ng
- Department of Pathology, St. Teresa’s Hospital, Kowloon, Hong Kong
| | - Hongqi Shi
- Department of Pathology, Jinhua Municipal Central Hospital, 351 Mingyue Road, Jinhua, 321000 Zhejiang Province People’s Republic of China
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Xu Y, Gao H, Gao JL. Myoepithelioma-like tumor of the vulvar region: a case report in China and review of the literature. Diagn Pathol 2020; 15:3. [PMID: 31915021 PMCID: PMC6950797 DOI: 10.1186/s13000-019-0923-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 12/27/2019] [Indexed: 01/30/2023] Open
Abstract
Background Myoepithelioma-like tumor of the vulvar region (MELTVR) is a recently described mesenchymal neoplasm which typically arising in vulvar regions of adult women. Case presentation Here we report a case of a 65-year-old woman who presented with a 6-year history of subcutaneous mass in the vulvar region. The mass had recently increased in size continuously. Histologically, the tumor cells had an epithelioid to spindled shape. Epithelioid tumor cells proliferated singly or in a loosely cohesive manner with myxoid areas, while spindled tumor cells grew in diffuse sheets or storiform arrangements mainly in nonmyxoid areas. Immunohistochemically, the tumor cells were positive for vimentin, epithelial membrane antigen, calponin, and were partially mild to moderate positive for estrogen receptor, but completely negative for S100 protein, glial fibrillary acidic protein, CD34, desmin, SMA and cytokeratin. INI1/SMARCB1 expression was deficient. EWSR1 and FUS genes were intact tested by fluorescence in situ hybridization analysis. Based on these findings, we diagnose this case as MELTVR. The patient remained relapse-free after the lesion was widely excised during 8 months follow-up. Conclusions This disease should be included in the differential diagnostic list of vulvar tumors with epithelioid to spindled morphology. Recognition of its histopathological features and immunohistochemical reactivity will help to understand the tumor better.
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Affiliation(s)
- Yan Xu
- Department of Pathology, East Hospital, Tongji University, 1800 Yuntai Road, Pudong New District, Shanghai, 200120, China.,Central Laboratory, East Hospital, Tongji University, Shanghai, China
| | - Hui Gao
- Department of Pathology, East Hospital, Tongji University, 1800 Yuntai Road, Pudong New District, Shanghai, 200120, China.,Central Laboratory, East Hospital, Tongji University, Shanghai, China
| | - Jin-Li Gao
- Department of Pathology, East Hospital, Tongji University, 1800 Yuntai Road, Pudong New District, Shanghai, 200120, China. .,Central Laboratory, East Hospital, Tongji University, Shanghai, China.
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Alexiev BA, Obeidin F, Jennings LJ. Ewing sarcoma with myxoid stroma: Case report of an unusual histological variant. Pathol Res Pract 2019; 215:152665. [PMID: 31585812 DOI: 10.1016/j.prp.2019.152665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/20/2019] [Accepted: 09/21/2019] [Indexed: 11/18/2022]
Abstract
We describe the case of a Ewing sarcoma with prominent myxoid stroma of the temporal bone in a 26-year-old female. Histologically, the tumor exhibited a fascicular growth pattern of round to spindled cells with a minimal amount of pale eosinophilic to clear cytoplasm and oval or spindled nuclei with finely dispersed chromatin and small nucleoli. Myxoid changes were prominent (>50%), with reticular or pseudoacinar growth of the loosely cohesive cells. The tumor showed strong expression of CD99, FLI1, and CD56 and was positive for the EWSR1-FLI1 fusion transcript. The diagnosis of Ewing sarcoma with myxoid stroma (myxoid variant) is particularly problematic owing to the large number of potential mimics. The tumor extends the morphologic spectrum of Ewing sarcoma beyond the previously described histological variants, and broadens the differential diagnosis. For any round/spindle cell sarcoma, prominent myxoid stroma and CD99 immunoreactivity should prompt consideration for molecular studies that include analysis of both EWSR1 and FLI1.
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Affiliation(s)
- Borislav A Alexiev
- Department of Pathology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, 251 East Huron St, Feinberg 7-342A, Chicago, IL 60611, United States.
| | - Farres Obeidin
- Department of Pathology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, 251 East Huron St, Feinberg 7-342A, Chicago, IL 60611, United States
| | - Lawrence J Jennings
- Department of Pathology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, 251 East Huron St, Feinberg 7-342A, Chicago, IL 60611, United States
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Abstract
RATIONALE Extraskeletal myxoid chondrosarcoma is a slow-growing soft tissue tumor of adults with a propensity for local recurrence and eventual metastasis. Only 17 pediatric and adolescent cases have been reported. PATIENT CONCERNS Here we present an 11-year-old boy with a 3-year history of a slowly growing painless left leg mass. Magnetic resonance imaging of the lesion revealed a subfascial well-circumscribed lesion with intramuscular extension in the medial gastrocnemius muscle of the left leg. DIAGNOSES He underwent wide local excision of the mass and the histomorphological and immunohistochemical findings were consistent with extraskeletal myxoid chondrosarcoma. INTERVENTIONS Possible radiotherapy was the further management plan. OUTCOMES He was in good condition with no evidence of recurrence at 6 months postsurgery. LESSONS Although pediatric cases of extraskeletal myxoid chondrosarcoma were reported to be aggressive, the tumor in this case demonstrated indolent behavior. Furthermore, the tumor in this case showed primitive round cell foci which adds to a previous study that especially reported this morphology in pediatric cases.
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Affiliation(s)
- Ali Al Khader
- Faculty of Medicine, Al-Balqa Applied University, Full-time lecturer of pathology
| | - Esra Nsour
- Department of pathology, Al Hussein Salt Hospital, Ministry of Health, Al-Salt
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Lam SW, van IJzendoorn DG, Cleton-Jansen AM, Szuhai K, Bovée JV. Molecular Pathology of Bone Tumors. J Mol Diagn 2019; 21:171-182. [DOI: 10.1016/j.jmoldx.2018.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/04/2018] [Accepted: 11/16/2018] [Indexed: 12/23/2022] Open
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Omori T, Fujiwara T, Kunisada T, Takeda K, Hasei J, Yoshida A, Yanai H, Ozaki T. A rare manifestation of extraskeletal myxoid chondrosarcoma with a huge expanding hematoma. J Orthop Sci 2019; 24:377-381. [PMID: 28187993 DOI: 10.1016/j.jos.2016.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 11/12/2016] [Accepted: 12/06/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Toshinori Omori
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Tomohiro Fujiwara
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan; Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan.
| | - Toshiyuki Kunisada
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan; Department of Medical Materials for Musculoskeletal Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Ken Takeda
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan; Department of Intelligent Orthopaedic System Development, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Joe Hasei
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Aki Yoshida
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroyuki Yanai
- Department of Diagnostic Pathology, Okayama University Hospital, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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Romañach MJ, Carlos R, Nuyens M, de Andrade BAB, de Almeida OP. Extraskeletal myxoid chondrosarcoma of the masticator space in a pediatric patient. J Clin Exp Dent 2017. [PMID: 28638563 PMCID: PMC5474342 DOI: 10.4317/jced.53888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Extraskeletal myxoid chondrosarcoma (EMC) is a malignant soft-tissue neoplasm rarely described in the head and neck region of children and adolescents. We describe a case of EMC affecting the masticator space and a literature review. A 13-year-old boy who presented a large painless, diffuse mass causing progressive midfacial asymmetry of 6 months duration. Histopathological evaluation revealed a multinodular lesion, containing scattered round vacuolated tumor cells dispersed in an abundant myxoid stroma, separated by fibrous septae. Immunohistochemical analysis revealed positivity for vimentin, neuron-specific enolase, and chromogranin. The Ki-67 labelling index was 42%. The patient was treated surgically with tumor resection followed by adjuvant local radiotherapy. The patient died 1 year after initial diagnosis due to locoregional tumor dissemination. EMC should be considered in the differential diagnosis of myxoid neoplasms in the head and neck region.
Key words:Extraskeletal myxoid chondrosarcoma, masticator space, parapharyngeal space, immunohistochemistry, children.
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Affiliation(s)
- Mário-José Romañach
- DDS, PhD, Oral Pathology, Department of Oral Diagnosis and Pathology, Federal University of Rio de Janeiro School of Dentistry, Brazil
| | - Román Carlos
- DDS, Division of Pathology, Centro Clínico de Cabeza y Cuello/ Hospital Herrera Llerandi, Guatemala
| | - Michel Nuyens
- MD, Division of Otorhinolaryngology - Head and Neck Surgery, Centro Clínico de Cabeza y Cuello/ Hospital Herrera Llerandi, Guatemala
| | | | - Oslei-Paes de Almeida
- DDS, PhD, Oral Pathology Section, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Brazil
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Kawabata A, Husnik R, Donne VL, Grasperge B, Boudreaux BL, Bauer R. Pathology in Practice. J Am Vet Med Assoc 2017; 250:1113-1116. [PMID: 28467750 DOI: 10.2460/javma.250.10.1113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Prieto-Granada CN, Ganim RB, Zhang L, Antonescu C, Mueller J. Primary Pulmonary Myxoid Sarcoma: A Newly Described Entity-Report of a Case and Review of the Literature. Int J Surg Pathol 2017; 25:518-525. [PMID: 28449608 DOI: 10.1177/1066896917706413] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Primary pulmonary myxoid sarcoma (PPMS) is a recently described, exceedingly rare low-grade lung sarcoma that tends to present in young females as an endobronchial mass and shows evidence of an EWSR1- CREB1 fusion. Herein, we present a case of PPMS with fluorescence in situ hybridization (FISH) analysis for EWSR1 and CREB1 rearrangements. An 80-year-old woman presented with an endobronchial, multinodular tumor exhibiting spindle, ovoid and epithelioid cells arranged in reticular/lattice-like and alveolar-like patterns in a myxoid background. The tumor showed focal epithelial membrane antigen immunoreactivity as well as an Alcian blue-positive stroma that was sensitive to digestion with hyaluronidase. EWSR1 and CREB1 rearrangements were detected by break-apart FISH probes. The patient showed persistence of disease 36 months after diagnosis and was discharged to hospice care. We contribute with a report of an additional case of this very unusual entity and perform a brief review of the literature published so far on the subject.
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Affiliation(s)
| | - Rose B Ganim
- 2 Baystate Medical Center-University of Massachusetts Medical School Regional Campus, Springfield, MA, USA
| | - Lei Zhang
- 3 Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - James Mueller
- 2 Baystate Medical Center-University of Massachusetts Medical School Regional Campus, Springfield, MA, USA
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Extraskeletal Myxoid Chondrosarcoma of the Foot Clinically Mimicking Plantar Fibromatosis. Am J Dermatopathol 2017; 39:e38-e40. [PMID: 27655120 DOI: 10.1097/dad.0000000000000735] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Extraskeletal myxoid chondrosarcoma (EMC) is a rare soft tissue sarcoma usually presenting in proximal extremities of middle-aged men. The authors discuss a unique case of EMC, localized in the plantar foot of a 76-year-old woman, clinically suspected as plantar fibromatosis. It is important to avoid misdiagnosis of EMC because of their propensity for late recurrence and their metastatic potential.
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Finos L, Righi A, Frisoni T, Gambarotti M, Ghinelli C, Benini S, Vanel D, Picci P. Primary extraskeletal myxoid chondrosarcoma of bone: Report of three cases and review of the literature. Pathol Res Pract 2017; 213:461-466. [PMID: 28249774 DOI: 10.1016/j.prp.2017.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 02/08/2017] [Accepted: 02/08/2017] [Indexed: 11/28/2022]
Abstract
Extraskeletal myxoid chondrosarcoma is a rare neoplasm of soft tissue. The usual location is in deep parts of the proximal extremities and limb girdles in middle-aged adults. The bone location as primary location is extremely rare and few cases are reported. We present three cases arising in bone with molecular confirmation using both RT-PCR and FISH analysis. Patients include two men and one woman with an age of 62, 69 and 73 years old. The mean size of the lesion was 13cm (range 8-18cm). Tumors arose in the iliac bone in two cases and in the proximal humerus in the other case. At time of diagnosis the three cases show bone cortex and soft tissue involvement. On imaging, lesions have a lobular pattern, are purely lytic, but take up contrast medium after injection. Two patients are alive with disease (local recurrence and lung metastasis) after five years and five years and six months, respectively and one patient died of disease two years after the diagnosis. The primary extraskeletal myxoid chondrosarcoma of bone seems to have a more aggressive behavior than the soft tissue counterpart. The molecular confirmation of diagnosis using RT-PCR is necessary to do the differential diagnosis with other entities, in particular with myoepithelioma that shows similar morphological features and EWSR1 and FUS genes rearrangement.
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Affiliation(s)
- L Finos
- Department of Pathology, Rizzoli Institute, Bologna, Italy
| | - A Righi
- Department of Pathology, Rizzoli Institute, Bologna, Italy.
| | - T Frisoni
- Department of Orthopaedic Oncology, Rizzoli Institute, Bologna, Italy
| | - M Gambarotti
- Department of Pathology, Rizzoli Institute, Bologna, Italy
| | - C Ghinelli
- Laboratory of Experimental Oncology, Rizzoli Institute, Italy
| | - S Benini
- Department of Pathology, Rizzoli Institute, Bologna, Italy
| | - D Vanel
- Department of Pathology, Rizzoli Institute, Bologna, Italy
| | - P Picci
- Department of Pathology, Rizzoli Institute, Bologna, Italy; Laboratory of Experimental Oncology, Rizzoli Institute, Italy
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Abstract
Extraskeletal myxoid chondrosarcomas (EMC) are a rare entity of soft tissue tumors that have slow growth with metastatic potential. We discuss here a case of EMC presenting with right upper extremity pain and hemoptysis. Computed tomography scans chest showed diffuse metastatic numerous lung nodules bilaterally. Biopsy confirmed the diagnosis of the tumor. Chemotherapy was a bigger challenge for our patient due to sparse research and data in the literature about the disease.
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Affiliation(s)
| | - Neha Khanna
- Department of Cardiovascular Imaging, Mount Sinai Hospital, New York, USA
| | - Adam Jacobi
- Department of Radiology, Mount Sinai Hospital, New York, USA
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Kobayashi H, Kikuta K, Sekita T, Susa M, Nishimoto K, Sasaki A, Kameyama K, Sugita S, Hasegawa T, Nakamura M, Matsumoto M, Morioka H. Diagnosis of extraskeletal myxoid chondrosarcoma in the thigh using EWSR1-NR4A3 gene fusion: a case report. J Med Case Rep 2016; 10:321. [PMID: 27832806 PMCID: PMC5105269 DOI: 10.1186/s13256-016-1113-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 10/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extraskeletal myxoid chondrosarcoma is a rare soft tissue sarcoma that has unusual ultrastructural and molecular features. However, unlike other soft tissue sarcomas, it does not have specific clinical symptoms or radiological features, which can make its diagnosis difficult. Nevertheless, extraskeletal myxoid chondrosarcoma has a rare gene fusion (EWSR1-NR4A3) that is useful for making a differential diagnosis. CASE PRESENTATION A 43-year-old Japanese man presented with a soft tissue mass in his right thigh. A physical examination and radiography revealed a large soft tissue mass. During magnetic resonance imaging, the mass exhibited isointensity on T1-weighted images and high intensity on T2-weighted images, as well as gadolinium enhancement at the side edge of the partition structure. Thus, we considered a possible diagnosis of a malignant myxoid soft tissue tumor, such as myxoid liposarcoma, myxofibrosarcoma, or metastatic carcinomas, including myoepithelial tumor and neuroendocrine tumor, and performed an incisional biopsy to make a definitive diagnosis. The pathological findings revealed a lobulated tumor with a myxoid structure and atypical spindle-shaped cells that created eosinophilic cord-like forms. Immunohistochemistry revealed that the tumor was positive for S-100 and negative for synaptophysin, chromogranin A, and pan keratin (AE1/AE3). The percentage of Ki-67 was 10 % in the hot spot area. Based on these clinicopathological findings, we initially considered the possibility of a myxoid liposarcoma, although we did not observe any lipoblasts. Therefore, we considered the possibility of an extraskeletal myxoid chondrosarcoma. As this tumor is very rare, we searched for the EWSR1-NR4A3 gene fusion using fluorescence in situ hybridization, which confirmed the diagnosis of extraskeletal myxoid chondrosarcoma. Positron emission tomography-computed tomography did not identify any obvious metastases, and we performed radical resection of our patient's vastus medialis and femur with a 3 cm margin. After the resection, we treated his resected femur using liquid nitrogen, and reconstructed his femur using autogenous fibula and plate fixation. No local recurrence or metastasis was observed at the 1-year follow-up. CONCLUSION Genetic testing is useful for diagnosing extraskeletal myxoid chondrosarcoma based on the presence of the EWSR1-NR4A3 gene fusion.
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Affiliation(s)
- Hiroki Kobayashi
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, 160-8582, Tokyo, Japan
| | - Kazutaka Kikuta
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, 160-8582, Tokyo, Japan.
| | - Tetsuya Sekita
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, 160-8582, Tokyo, Japan
| | - Michiro Susa
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, 160-8582, Tokyo, Japan
| | - Kazumasa Nishimoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, 160-8582, Tokyo, Japan
| | - Aya Sasaki
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Kaori Kameyama
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Shintaro Sugita
- Department of Surgical Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tadashi Hasegawa
- Department of Surgical Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, 160-8582, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, 160-8582, Tokyo, Japan
| | - Hideo Morioka
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, 160-8582, Tokyo, Japan
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Morioka H, Takahashi S, Araki N, Sugiura H, Ueda T, Takahashi M, Yonemoto T, Hiraga H, Hiruma T, Kunisada T, Matsumine A, Susa M, Nakayama R, Nishimoto K, Kikuta K, Horiuchi K, Kawai A. Results of sub-analysis of a phase 2 study on trabectedin treatment for extraskeletal myxoid chondrosarcoma and mesenchymal chondrosarcoma. BMC Cancer 2016; 16:479. [PMID: 27418251 PMCID: PMC4946242 DOI: 10.1186/s12885-016-2511-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 06/20/2016] [Indexed: 01/27/2023] Open
Abstract
Background Trabectedin is reported to be particularly effective against translocation-related sarcoma. Recently, a randomized phase 2 study in patients with translocation-related sarcomas unresponsive or intolerable to standard chemotherapy was conducted, which showed clinical benefit of trabectedin compared with best supportive care (BSC). Extraskeletal myxoid chondrosarcoma (EMCS) and Mesenchymal chondrosarcoma (MCS) are very rare malignant soft tissue sarcomas, and are associated with translocations resulting in fusion genes. In addition, the previous in vivo data showed that trabectedin affect tumor necrosis and reduction in vascularization in a xenograft model of a human high-grade chondrosarcoma. The aim of the present analysis was to clarify the efficacy of trabectedin for EMCS and MCS subjects in the randomized phase 2 study. Methods Five subjects with EMCS and MCS received trabectedin treatment in the randomized phase 2 study. Three MCS subjects were allocated to the BSC group. Objective response and progression-free survival (PFS) were assessed according to the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 by central radiology imaging review. Results The median follow-up time of the randomized phase 2 study was 22.7 months, and one subject with MCS was still receiving trabectedin treatment at the final data cutoff. The median PFS was 12.5 months (95 % CI: 7.4–not reached) in the trabectedin group, while 1.0 months (95 % CI: 0.3–1.0 months) in MCS subjects of the BSC group. The six-month progression-free rate was 100 % in the trabectedin group. One subject with MCS showed partial response, and the others in the trabectedin group showed stable disease. Overall survival of EMCS and MCS subjects was 26.4 months (range, 10.4–26.4 months) in the trabectedin group. At the final data cutoff, two of five subjects were still alive. Conclusions This sub-analysis shows that trabectedin is effective for patients with EMCS and MCS compared with BSC. The efficacy results were better than previously reported data of TRS. These facts suggest that trabectedin become an important choice of treatment for patients with advanced EMCS or MCS who failed or were intolerable to standard chemotherapy. Trial registration The randomized phase 2 study is registered with the Japan Pharmaceutical Information Center, number JapicCTI-121850 (May 31, 2012).
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Affiliation(s)
- Hideo Morioka
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Shunji Takahashi
- Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Nobuhito Araki
- Department of Orthopaedic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Hideshi Sugiura
- Department of Orthopaedic Surgery, Aichi Cancer Center Hospital, Aichi, Japan
| | - Takafumi Ueda
- Department of Orthopaedic Surgery, Osaka National Hospital, Osaka, Japan
| | - Mitsuru Takahashi
- Division of Orthopaedic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Tsukasa Yonemoto
- Division of Orthopaedic Surgery, Chiba Cancer Center, Chiba, Japan
| | - Hiroaki Hiraga
- Department of Orthopaedic Surgery, Hokkaido Cancer Center, Hokkaido, Japan
| | - Toru Hiruma
- Department of Musculoskeletal Tumor Surgery, Kanagawa Cancer Center, Kanagawa, Japan
| | - Toshiyuki Kunisada
- Department of Medical Materials for Musculoskeletal Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Akihiko Matsumine
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Michiro Susa
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Robert Nakayama
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazumasa Nishimoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazutaka Kikuta
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Keisuke Horiuchi
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology, Rare Cancer Center, National Cancer Center Hospital, Tokyo, Japan
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Henderson-Jackson EB, Bui MM. Molecular Pathology of Soft-Tissue Neoplasms and Its Role in Clinical Practice. Cancer Control 2016; 22:186-92. [PMID: 26068763 DOI: 10.1177/107327481502200209] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Soft-tissue neoplasms embody a histologically diverse group of mesenchymal tumors. Oftentimes the histopathological diagnosis of soft-tissue tumors is challenging due to overlapping pathological features. METHODS We reviewed the current and most importantly known recurrent or tumor-specific genetic abnormalities involving soft-tissue tumors, focusing on how they are useful in working up differential diagnoses and the relevance of potentially targeted therapies. RESULTS Molecular diagnostic tools have shown great advantage as an aid in the differentiation between different soft-tissue tumor entities, providing a potential avenue in the identification of novel therapeutic targets. Gastrointestinal stromal tumor is a well-known example of a soft-tissue tumor with a successful, molecularly driven treatment with response rates of more than 80% in stable disease and partial remission. Classifying soft-tissue neoplasms by their molecular genetic pathology has been considered as molecular testing becomes more integrated into various diagnostic and prognostic algorithms. CONCLUSIONS Molecular pathology provides a unique opportunity for pathologists to play a crucial role in the multidisciplinary care of patients with sarcoma. These opportunities include but are not limited to the appropriate triage of tissue for molecular testing and the integration of molecular testing results, with histological and immunohistochemical findings providing actionable information for the diagnosis, prognosis, and choice of therapeutic modality.
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Farhane FZ, Alami Z, Bouhafa T, Elmazghi A, Hassouni K. Paravertebral extraskeletal myxoid chondrosarcoma: a case report and review of the literature. Pan Afr Med J 2015; 21:213. [PMID: 26448808 PMCID: PMC4587080 DOI: 10.11604/pamj.2015.21.213.6639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 04/10/2015] [Indexed: 11/26/2022] Open
Abstract
The extraskeletal myxoid chondrosarcoma (CME) is a rare malignant soft tissue tumour described as a distinct clinical, histological, immunohistochemical, genetical and evolutive entity. It represents only 2.5% of soft tissue sarcomas. Its individualization is important because it has a long and indolent clinical course, and tumour-related death often occurs after a long survival period. The diagnostic key is morphological supported by immunohistochemistry and genetics t (9; 22) that allow differentiating it from other tumours with myxoid stroma and from chordoma. This report describes a patient with paravertebral extraskeletal myxoid chondrosrcoma with a high locoregional extension.
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Affiliation(s)
| | - Zineb Alami
- Department of Radiotherapy, Hassan II University Hospital, Fez, Morocco
| | - Touria Bouhafa
- Department of Radiotherapy, Hassan II University Hospital, Fez, Morocco
| | | | - Khalid Hassouni
- Department of Radiotherapy, Hassan II University Hospital, Fez, Morocco
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Luzar B, Tanaka M, Schneider J, Calonje E. Cutaneous microcystic/reticular schwannoma: a poorly recognized entity. J Cutan Pathol 2015; 43:93-100. [PMID: 26350054 DOI: 10.1111/cup.12624] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/19/2015] [Accepted: 08/02/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Microcystic/ reticular schwannoma is exceptionally rare yet distinctive morphological variant of schwannoma with predilection for visceral sites lacking association with neurofibromatosis. AIMS To further delineate clinicopathological features of cutaneous microcystic/reticular schwannoma and to discuss its differential diagnosis. RESULTS We analyzed three cutaneous microcystic/reticular schwannomas, occurring in two males and one female (mean age: 37.6 years). The tumors presented as a non-painful slightly raised papule (mean: 0.7 cm) on upper arm (n = 2) and back (n = 1). No recurrences were observed despite marginal excision (mean follow up: 42 months). Histopathologically, a multilobular proliferation was present in the dermis composed of bland tumor cells forming distinctive microcystic, reticular, lace-like or pseudoglandular structures, containing abundant myxoid/mucinous material. By immunohistochemistry, tumor cells lining microcystic structures corresponded to Schwann cells (diffuse S100 positive, variable GFAP positivity). A discontinuous EMA-positive perineurium was present at the periphery of some of the lobules. CONCLUSION Cutaneous microcystic/reticular schwannoma expands the spectrum of benign peripheral nerve sheath tumors with reticular morphology encountered in the skin. Other tumors in this group include reticular perineurioma and hybrid tumors with reticular morphology, e.g. reticular perineurioma/schwannoma and reticular perineurioma/neurofibroma.
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Affiliation(s)
- Boštjan Luzar
- Institute of Pathology, Medical Faculty University of Ljubljana, Ljubljana, Slovenia
| | - Maiko Tanaka
- Department of Dermatology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Johann Schneider
- Division of Anatomical Pathology at University of Stellenbosch, Cape Town, South Africa
| | - Eduardo Calonje
- Department of Dermatopathology, St John's Institute of Dermatology, St Thomas' Hospital, London, UK
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35
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Villert A, Kolomiets L, Vasilyev N, Perelmuter V, Savenkova O. Extraskeletal myxoid chondrosarcoma of the vulva: A case report. Oncol Lett 2015; 10:2095-2099. [PMID: 26622802 PMCID: PMC4579798 DOI: 10.3892/ol.2015.3586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 01/07/2015] [Indexed: 01/11/2023] Open
Abstract
Extraskeletal myxoid chondrosarcoma (ESMC) of the vulva is an extremely rare tumor and currently, there is little available information on its biological behavior and treatment strategy. The present study reports a case of recurrent ESMC of the vulva in a 32-year-old female. The patient presented with an increasingly painful mass of the right vulva, at the site of an exision which had been performed 7-months previously. The tumor mass was histopathologically diagnosed as primary ESMC of the vulva and subsequently, vulvectomy was performed. Cytological examination showed negative surgical margins. Intraoperative radiation therapy at a single dose of 10 Gy was administered to the bed of the removed tumor. The patient refused chemotherapy and five months after surgery, a new lesion was identified in the inguinal region. Bilateral inguinal-femoral lymph node dissection was performed and external beam radiation therapy at a dose of 40 Gy was administered to the inguinal region. Follow-up examination seven months after surgery revealed no evidence of disease progression and at present, the patient remains alive. This study highlights the importance of analyzing each clinical case of ESMC as this may lead to the development of guidelines for the optimal treatment of this rare tumor.
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Affiliation(s)
- Alisa Villert
- Department of Oncogynecology, Cancer Research Institute, Siberian Branch of the Russian Academy of Medical Sciences, Tomsk, Russia
| | - Larisa Kolomiets
- Department of Oncogynecology, Cancer Research Institute, Siberian Branch of the Russian Academy of Medical Sciences, Tomsk, Russia
| | - Nikolay Vasilyev
- Department of Clinical Pathology and Cytology, Cancer Research Institute, Siberian Branch of the Russian Academy of Medical Sciences, Tomsk, Russia
| | - Vladimir Perelmuter
- Department of Clinical Pathology and Cytology, Cancer Research Institute, Siberian Branch of the Russian Academy of Medical Sciences, Tomsk, Russia
| | - Olga Savenkova
- Department of Clinical Pathology and Cytology, Cancer Research Institute, Siberian Branch of the Russian Academy of Medical Sciences, Tomsk, Russia
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Lubana SS, Bashir T, Tuli SS, Kemeny MM, Heimann DM. Breast Metastasis of Extraskeletal Myxoid Chondrosarcoma: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:406-14. [PMID: 26125202 PMCID: PMC4492482 DOI: 10.12659/ajcr.894804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Female, 58 Final Diagnosis: Extraskeletal myxoid chondrosarcoma with widespread metastases Symptoms: — Medication: — Clinical Procedure: Left below knee amputation Specialty: Oncology
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Affiliation(s)
- Sandeep Singh Lubana
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, NY, USA
| | - Tayyaba Bashir
- Department of Medical Hematology-Oncology, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, NY, USA
| | - Sandeep S Tuli
- Department of Radiology, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, NY, USA
| | - Margaret M Kemeny
- Department of Surgical Oncology, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, NY, USA
| | - David M Heimann
- Department of Surgical Oncology, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, NY, USA
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Rao P, Colen RR, Bruner JM, Meis JM. Extraskeletal myxoid chondrosarcoma presenting as an intradural spinal mass: report of a rare clinical presentation with an emphasis on differential diagnostic considerations. Rare Tumors 2014; 6:5586. [PMID: 25568751 PMCID: PMC4274445 DOI: 10.4081/rt.2014.5586] [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: 08/06/2015] [Accepted: 10/13/2014] [Indexed: 01/30/2023] Open
Abstract
Extraskeletal myxoid chondrosarcoma is a rare soft tissue neoplasm that occurs predominantly in the soft tissues of the lower extremities. Herein we present a case of a 29 year old male who presented with bilateral femoral numbness believed to be the result of prior injury to his back. A magnetic resonance imaging revealed a mass in the T4-T5 epidural space compressing the spinal cord. Laminectomy was performed and the lesion removed piecemeal. The pathology specimen consisted of multiple fragments of dura involved by a myxoid neoplasm with a nodular growth pattern. The tumor cells were arranged in anastomosing cords and strands. Individual tumor cells were small, of uniform size and shape, with small hyperchromatic nuclei and scant eosinophilic cytoplasm. Immunohistochemical stains were performed which showed the tumor cells were diffusely positive for vimentin and focally positive for EMA, S-100 protein and cytokeratin, whereas they were negative for CD34 and CD99. Fluorescence in situ hybridization (FISH) studies showed a clonal population of cells with re-arrangement of the EWSR1 locus, confirming the histologic impression of extraskeletal myxoid chondrosarcoma. This is the first report of a case of an extraskeletal myxoid chondrosarcoma arising from the dura, confirmed to have rearrangement of the EWSR1 gene by FISH. There have only been two other cases of dural based extraskeletal myxoid chondrosarcoma reported prior to our case. We also briefly review the published literature and discuss differential diagnostic considerations for this rare tumor.
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Affiliation(s)
- Priya Rao
- Departments of Pathology and Houston, TX, USA
| | - Rivka R Colen
- Departments of Radiology, University of Texas MD Anderson Cancer Center , Houston, TX, USA
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Oike N, Ogose A, Kawashima H, Umezu H, Inagawa S. Extraskeletal myxoid chondrosarcoma arising in the femoral vein: a case report. Skeletal Radiol 2014; 43:1465-9. [PMID: 24818862 DOI: 10.1007/s00256-014-1897-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 03/27/2014] [Accepted: 04/11/2014] [Indexed: 02/02/2023]
Abstract
Soft tissue tumors arising in deep veins of the extremities are uncommon, although a few cases of synovial sarcoma or leiomyosarcoma arising in the femoral vein have been documented. However, to the best of our knowledge, an extraskeletal myxoid chondrosarcoma (EMC) arising in the femoral vein has not been reported in the English literature. We report a case of EMC arising in the femoral vein of a 70-year-old man who presented with right leg edema and was diagnosed with a deep venous thrombosis (DVT) by computed tomography (CT). Magnetic resonance imaging (MRI) revealed a mass in the right proximal thigh that was diagnosed as myxomatous sarcoma by aspiration cytology, and anticoagulant therapy was initiated. The mass was surgically resected en bloc, including the femoral vein and surrounding soft tissue, and the femoral artery was preserved. The femoral vein was not reconstructed. The histologic diagnosis was an extraskeletal myxoid chondrosarcoma. The patient received postoperative local radiation treatment, with a total dose of 60 Gy, and is currently doing well with no evidence of local recurrence or metastasis at 8 months after surgery. In summary, this case report shows that EMC can arise in the femoral vein, and that reconstruction of the femoral vein is not always necessary during surgery for soft tissue tumors.
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Affiliation(s)
- Naoki Oike
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, 757-1 Asahimachi-dori, Niigata, 951-8510, Japan,
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Extraskeletal Myxoid Chondrosarcoma of the Vulva With PLAG1 Gene Activation. Appl Immunohistochem Mol Morphol 2014; 22:537-42. [DOI: 10.1097/pai.0b013e31829852e7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Flucke U, Vogels RJC, de Saint Aubain Somerhausen N, Creytens DH, Riedl RG, van Gorp JM, Milne AN, Huysentruyt CJ, Verdijk MAJ, van Asseldonk MM, Suurmeijer AJH, Bras J, Palmedo G, Groenen PJTA, Mentzel T. Epithelioid Hemangioendothelioma: clinicopathologic, immunhistochemical, and molecular genetic analysis of 39 cases. Diagn Pathol 2014; 9:131. [PMID: 24986479 PMCID: PMC4100035 DOI: 10.1186/1746-1596-9-131] [Citation(s) in RCA: 157] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 06/22/2014] [Indexed: 02/07/2023] Open
Abstract
Abstract Virtual Slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/4010279141259481
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Affiliation(s)
- Uta Flucke
- Department of Pathology, Radboud University Medical Center, P,O, Box 9101, 6500 HB Nijmegen, The Netherlands.
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Benini S, Cocchi S, Gamberi G, Magagnoli G, Vogel D, Ghinelli C, Righi A, Picci P, Alberghini M, Gambarotti M. Diagnostic Utility of Molecular Investigation in Extraskeletal Myxoid Chondrosarcoma. J Mol Diagn 2014; 16:314-23. [DOI: 10.1016/j.jmoldx.2013.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 11/14/2013] [Accepted: 12/17/2013] [Indexed: 01/30/2023] Open
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Zhang GW, Wang AJ, Zhang GH, Zhao SN, Qu JL. Extraskeletal myxoid chondrosarcoma: A report of two cases. Oncol Lett 2014; 7:1289-1291. [PMID: 24944710 PMCID: PMC3961448 DOI: 10.3892/ol.2014.1884] [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: 06/28/2013] [Accepted: 01/07/2014] [Indexed: 11/05/2022] Open
Abstract
Extraskeletal myxoid chondrosarcoma (EMC) is a relatively rare but well-defined neoplasm. This report describes two patients, one with EMC of the buttock and one with EMC of the knee. The two cases presented with large lobed masses and long T1 and T2 signaling identified by magnetic resonance imaging (MRI). An enhanced MRI scan demonstrated enhancement of the tumors. The tumors were composed of strands or cords of oval and spindle cells embedded in abundant myxoid stroma. Pathology results confirmed EMC.
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Affiliation(s)
- Guo-Wei Zhang
- CT/MR Room, Yantaishan Hospital, Yantai, Shandong 264001, P.R. China
| | - Ai-Jie Wang
- CT/MR Room, Yantaishan Hospital, Yantai, Shandong 264001, P.R. China
| | - Guang-Hui Zhang
- CT/MR Room, Yantaishan Hospital, Yantai, Shandong 264001, P.R. China
| | - Shan-Na Zhao
- CT/MR Room, Yantaishan Hospital, Yantai, Shandong 264001, P.R. China
| | - Jian-Li Qu
- CT/MR Room, Yantaishan Hospital, Yantai, Shandong 264001, P.R. China
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Rapidis AD. Sarcomas of the head and neck in adult patients: current concepts and future perspectives. Expert Rev Anticancer Ther 2014; 8:1271-97. [DOI: 10.1586/14737140.8.8.1271] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Abstract
Chondrosarcoma is a cartilage forming neoplasm, which is the second most common primary malignancy of bone. Clinicians who treat chondrosarcoma patients must determine the grade of the tumor, and must ascertain the likelihood of metastasis. Acral lesions are unlikely to metastasize, regardless of grade, whereas axial, or more proximal lesions are much more likely to metastasize than tumors found in the distal extremities with equivalent histology. Chondrosarcoma is resistant to both chemotherapy and radiation, making wide local excision the only treatment. Local recurrence is frequently seen after intralesional excision, thus wide local excision is sometimes employed despite significant morbidity, even in low-grade lesions. Chondrosarcoma is difficult to treat. The surgeon must balance the risk of significant morbidity with the ability to minimize the chance of local recurrence and maximize the likelihood of long-term survival.
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Affiliation(s)
- Lee R Leddy
- Medical University of South Carolina, Charleston, SC, USA,
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Matsukuma S, Hisaoka M, Obara K, Kono T, Takeo H, Sato K, Hata Y. Primary pulmonary myxoid sarcoma withEWSR1-CREB1fusion, resembling extraskeletal myxoid chondrosarcoma: Case report with a review of Literature. Pathol Int 2012; 62:817-22. [PMID: 23252871 DOI: 10.1111/pin.12014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 11/08/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Susumu Matsukuma
- Department of Pathology; Japan Self Defense Forces Central Hospital; Tokyo; Japan
| | - Masanori Hisaoka
- Department of Pathology and Oncology; School of Medicine; University of Occupational and Environmental Health; Kitakyushu; Japan
| | - Kiyohaya Obara
- Division of Thoracic Surgery; Japan Self Defense Forces Central Hospital; Tokyo; Japan
| | - Takako Kono
- Department of Pathology; Japan Self Defense Forces Central Hospital; Tokyo; Japan
| | - Hiroaki Takeo
- Department of Pathology; Japan Self Defense Forces Central Hospital; Tokyo; Japan
| | - Kimiya Sato
- Department of Pathology; Japan Self Defense Forces Central Hospital; Tokyo; Japan
| | - Yoshinobu Hata
- Department of Chest Surgery; Toho University Omori Medical Center; Tokyo; Japan
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Extraskeletal myxoid chondrosarcoma with small bowel metastasis causing bowel obstruction. Case Rep Oncol Med 2012; 2012:621025. [PMID: 23213584 PMCID: PMC3506900 DOI: 10.1155/2012/621025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 10/21/2012] [Indexed: 11/17/2022] Open
Abstract
A 28-year-old female with history of chest wall extraskeletal myxoid chondrosarcoma (EMC) presented to the emergency department complaining of two weeks of lightheadedness and fatigue. Laboratories showed hemoglobin of 7.6 g/dL and a positive hemoccult test. Upper and lower endoscopies were unremarkable, and the patient was discharged after blood transfusion. The next day she returned to the ED with left-sided weakness and perioral numbness. Brain CT scan revealed a 6 cm right frontal mass with midline shift and edema that required urgent craniotomy with resection of a hemorrhagic tumor. The patient continued dropping her hemoglobin, and CT scans showed a rounded 3 cm small bowel mass in the mid ileum. Repeat upper endoscopy revealed a 2 × 2 cm ulcerated mass in the fourth portion of the duodenum. The patient was taken to the operating room and was found to have two lesions; one in the distal duodenum and a second one in the mid ileum causing small bowel intussusception. Pathology was consistent with metastatic EMC grade 2/3, involving the bowel and mesenteric fat. Extraskeletal myxoid chondrosarcoma (EMC) is a rare soft-tissue sarcoma with unique features that distinguishes, it from other sarcomas. It has been often described as a low-grade sarcoma although there are certain characteristics like high mitotic activity and the presence of focal regions of Ki67 staining above 25% that correlate with aggressive behavior of the tumor. This is the first case of EMC metastatic to the small bowel to be reported to the medical community.
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Ogura K, Fujiwara T, Beppu Y, Chuman H, Yoshida A, Kawano H, Kawai A. Extraskeletal myxoid chondrosarcoma: a review of 23 patients treated at a single referral center with long-term follow-up. Arch Orthop Trauma Surg 2012; 132:1379-86. [PMID: 22678528 DOI: 10.1007/s00402-012-1557-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Extraskeletal myxoid chondrosarcoma (EMC) is a rare soft tissue sarcoma. Although it has been regarded as a low-grade sarcoma unassociated with tumor-related death, a recent study has suggested an insidious nature with a high propensity for relapse during a long disease course. The aim of this study was to clarify the long-term clinical features of EMC treated at a single referral center using state-of-the-art techniques. METHODS A retrospective review of 23 consecutive patients (10 males, 13 females; mean age 58 years) treated between 1979 and 2008 (mean follow-up; 109 months) was performed. RESULTS Surgery for the primary tumor was performed in 22 patients, and 7 cases recurred locally due to inadequate resection. Eleven patients had metastatic disease, either at diagnosis (3) or developing later (8). The 5/10-year overall survival rates were 91/84 %, and the 5/10-year local recurrence-free and metastasis-free survival rates for patients with localized disease were 89/62 and 89/61 %, respectively. Larger tumor size (>10 cm) and metastases at diagnosis were significant negative prognostic factors. Four patients received ifosfamide-based chemotherapy with no objective response. There was no local recurrence in three patients who underwent R1 resection followed by adjuvant radiotherapy. Clinical palliation and retarded progression of the metastatic disease were achieved in three patients who underwent radiotherapy. CONCLUSIONS EMC is indolent but has a high propensity for relapse over 5 years of follow-up. Definitive initial surgery and careful monitoring for a prolonged period are important. Radiotherapy seems beneficial in an adjuvant setting and as palliative therapy for metastatic disease.
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Affiliation(s)
- Koichi Ogura
- Division of Musculoskeletal Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
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Shivapathasundram G, Sammons V, Darwish B. Spinal intradural myxoid chondrosarcoma. J Neurosurg Spine 2012; 17:280-4. [DOI: 10.3171/2012.6.spine111089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors present a rare case of intradural extramedullary spinal chondrosarcoma. This 38-year-old man presented with urinary retention and lower-limb weakness. Magnetic resonance imaging demonstrated a thoracic intradural extramedullary spinal tumor, which was resected. Histopathology revealed a meningeal myxoid chondrosarcoma. Despite adjuvant radiotherapy, the patient had multiple recurrences and metastases and died 18 months following his first surgery. The management of the rare entity of spinal canal chondrosarcoma is discussed.
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