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Mc Connell L, Gazdova J, Beck K, Srivastava S, Harewood L, Stewart JP, Hübschmann D, Stenzinger A, Glimm H, Heilig CE, Fröhling S, Gonzalez D. Detection of Structural Variants in Circulating Cell-Free DNA from Sarcoma Patients Using Next Generation Sequencing. Cancers (Basel) 2020; 12:E3627. [PMID: 33287361 PMCID: PMC7761870 DOI: 10.3390/cancers12123627] [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: 10/06/2020] [Revised: 11/16/2020] [Accepted: 11/30/2020] [Indexed: 12/21/2022] Open
Abstract
Circulating tumour DNA (ctDNA) analysis using next generation sequencing (NGS) is being implemented in clinical practice for treatment stratification and disease monitoring. However, using ctDNA to detect structural variants, a common occurrence in sarcoma, can be challenging. Here, we use a sarcoma-specific targeted NGS panel to identify translocations and copy number variants in a cohort of 12 tissue specimens and matched circulating cell-free DNA (cfDNA) from soft tissue sarcoma patients, including alveolar rhabdomyosarcoma (n = 2), Ewing's Sarcoma (n = 2), synovial sarcoma (n = 2), extraskeletal myxoid chondrosarcoma (n = 1), clear cell sarcoma (n = 1), undifferentiated round cell sarcoma (n = 1), myxoid liposarcoma (n = 1), alveolar soft part cell sarcoma (n = 1) and dedifferentiated liposarcoma (n = 1). Structural variants were detected in 11/12 (91.6%) and 6/12 (50%) of tissue and plasma samples, respectively. Structural variants were detected in cfDNA at variant allele frequencies >0.2% with an average sequencing depth of 1026×. The results from this cohort show clinical potential for using NGS in ctDNA to aid in the diagnosis and clinical monitoring of sarcomas and warrant additional studies in larger cohorts.
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Affiliation(s)
- Lauren Mc Connell
- Patrick G Johnston Centre for Cancer Research, Queen’s University, Belfast BT9 7AE, UK; (L.M.C.); (J.G.); (S.S.); (L.H.); (J.S.)
| | - Jana Gazdova
- Patrick G Johnston Centre for Cancer Research, Queen’s University, Belfast BT9 7AE, UK; (L.M.C.); (J.G.); (S.S.); (L.H.); (J.S.)
| | - Katja Beck
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany; (K.B.); (C.E.H.); (S.F.)
- German Cancer Research Center, 69120 Heidelberg, Germany;
| | - Shambhavi Srivastava
- Patrick G Johnston Centre for Cancer Research, Queen’s University, Belfast BT9 7AE, UK; (L.M.C.); (J.G.); (S.S.); (L.H.); (J.S.)
| | - Louise Harewood
- Patrick G Johnston Centre for Cancer Research, Queen’s University, Belfast BT9 7AE, UK; (L.M.C.); (J.G.); (S.S.); (L.H.); (J.S.)
| | - JP Stewart
- Patrick G Johnston Centre for Cancer Research, Queen’s University, Belfast BT9 7AE, UK; (L.M.C.); (J.G.); (S.S.); (L.H.); (J.S.)
| | - Daniel Hübschmann
- Computational Oncology, Molecular Diagnostics Program, National Center for Tumor Diseases (NCT) Heidelberg and DKFZ, 69120 Heidelberg, Germany;
- Heidelberg Institute for Stem Cell Technology and Experimental Medicine (HI-STEM), 69120 Heidelberg, Germany
| | - Albrecht Stenzinger
- German Cancer Research Center, 69120 Heidelberg, Germany;
- Institute of Pathology, University Hospital Heidelberg Im Neuenheimer Feld 224, 69120 Heidelberg, Germany
| | - Hanno Glimm
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Dresden and German Cancer Research Center (DKFZ), 01307 Dresden, Germany;
- Center for Personalized Oncology, National Center for Tumour Diseases (NCT) Dresden and University Hospital Carl Gustav Carus Dresden at TU Dresden, 01307 Dresden, Germany
- Translational Functional Cancer Genomics, National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), 01307 Dresden, Germany
| | - Christoph E. Heilig
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany; (K.B.); (C.E.H.); (S.F.)
- German Cancer Research Center, 69120 Heidelberg, Germany;
| | - Stefan Fröhling
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany; (K.B.); (C.E.H.); (S.F.)
- German Cancer Research Center, 69120 Heidelberg, Germany;
| | - David Gonzalez
- Patrick G Johnston Centre for Cancer Research, Queen’s University, Belfast BT9 7AE, UK; (L.M.C.); (J.G.); (S.S.); (L.H.); (J.S.)
- Belfast Health & Social Care Trust, Belfast BT9 7AB, UK
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McConnell L, Houghton O, Stewart P, Gazdova J, Srivastava S, Kim C, Catherwood M, Strobl A, Flanagan AM, Oniscu A, Kroeze LI, Groenen P, Taniere P, Salto-Tellez M, Gonzalez D. A novel next generation sequencing approach to improve sarcoma diagnosis. Mod Pathol 2020; 33:1350-1359. [PMID: 32047232 DOI: 10.1038/s41379-020-0488-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 02/08/2023]
Abstract
Sarcoma is a rare disease affecting both bone and connective tissue and with over 100 pathologic entities, differential diagnosis can be difficult. Complementing immune-histological diagnosis with current ancillary diagnostic techniques, including FISH and RT-PCR, can lead to inconclusive results in a significant number of cases. We describe here the design and validation of a novel sequencing tool to improve sarcoma diagnosis. A NGS DNA capture panel containing probes for 87 fusion genes and 7 genes with frequent copy number changes was designed and optimized. A cohort of 113 DNA samples extracted from soft-tissue and bone sarcoma FFPE material with clinical FISH and/or RT-PCR results positive for either a translocation or gene amplification was used for validation of the NGS method. Sarcoma-specific translocations or gene amplifications were confirmed in 110 out of 113 cases using FISH and/or RT-PCR as gold-standard. MDM2/CDK4 amplification and a total of 25 distinct fusion genes were identified in this cohort of patients using the NGS approach. Overall, the sensitivity of the NGS panel is 97% with a specificity of 100 and 0% failure rate. Targeted NGS appears to be a feasible and cost-effective approach to improve sarcoma subtype diagnosis with the ability to screen for a wide range of genetic aberrations in one test.
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Affiliation(s)
| | - Oisín Houghton
- Belfast Health & Social Care Trust, Belfast, BT9 7AB, UK
| | - Peter Stewart
- CCRCB, Queen's University Belfast, Belfast, BT9 7AE, UK
| | - Jana Gazdova
- CCRCB, Queen's University Belfast, Belfast, BT9 7AE, UK
| | | | - Chang Kim
- CCRCB, Queen's University Belfast, Belfast, BT9 7AE, UK
| | | | - Anna Strobl
- Royal National Orthopedic Hospital Stanmore, Middlesex, HA7 4LP, UK
- UCL Cancer Institute, London, WC1E 6BT, UK
| | - Adrienne M Flanagan
- Royal National Orthopedic Hospital Stanmore, Middlesex, HA7 4LP, UK
- UCL Cancer Institute, London, WC1E 6BT, UK
| | - Anca Oniscu
- Pathology Department at the Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - Leonie I Kroeze
- Department of Pathology, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands
| | - Patricia Groenen
- Department of Pathology, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands
| | - Philippe Taniere
- Pathology Department at Queen's Elizabeth Hospital Birmingham, Birmingham, B15 2TH, UK
| | - Manuel Salto-Tellez
- CCRCB, Queen's University Belfast, Belfast, BT9 7AE, UK
- Belfast Health & Social Care Trust, Belfast, BT9 7AB, UK
| | - David Gonzalez
- CCRCB, Queen's University Belfast, Belfast, BT9 7AE, UK.
- Belfast Health & Social Care Trust, Belfast, BT9 7AB, UK.
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Agrawal T, Monaco SE. Musculoskeletal small biopsies from small patients: current status in 2 academic hospitals. J Am Soc Cytopathol 2020; 9:442-449. [PMID: 32654990 DOI: 10.1016/j.jasc.2020.05.011] [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: 04/10/2020] [Revised: 05/19/2020] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Pediatric bone and soft tissue (BST) lesions typically undergo biopsy prior to treatment, which commonly involves core needle biopsy (CNB) and/or fine-needle aspiration biopsy (FNAB). This study looks at the utility of small biopsies in the current diagnosis of pediatric BST lesions from 2 institutions. MATERIALS AND METHODS A retrospective search of BST small biopsies obtained during a 2-year time period (2018-2019) at 2 academic institutions was performed to look at clinicopathologic features, biopsy diagnoses, and correlation with follow-up. RESULTS A total of 96 pediatric patients (average age 11.2 years, range: 10 months-19 years) with BST lesions underwent a small biopsy, which represents 5% of the total BST lesions biopsied. The results show that the majority of lesions were benign (65%), and diagnosed by CNB alone (73%); a combination of FNAB and CNB (16%), and FNAB alone (11%), were less frequent. The CNB was effective in making a definitive diagnosis in 93% of cases and overall small biopsy was effective in 91% of the cases. Cases with definitive diagnoses on small biopsy were more likely to have concurrent CNB or characteristic ancillary studies performed. CONCLUSIONS Although pediatric BST lesions constitute only 5% of all BST lesions biopsied, minimally invasive small biopsies with cytologic evaluation for triage and appropriate ancillary study utilization can help render specific diagnoses that help to determine the appropriate treatment for young patients with BST lesions. The current diagnostic approach frequently involves CNB with intraprocedural evaluation or concurrent FNAB, with fewer biopsied by FNAB alone.
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Affiliation(s)
- Tanupriya Agrawal
- Department of Pathology, University of Rochester Medical Center (URMC), Rochester, New York
| | - Sara E Monaco
- Department of Pathology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania.
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Apellaniz‐Ruiz M, Cullinan N, Grant R, Marrano P, Priest JR, Thorner PS, Goudie C, Foulkes WD. DICER1 screening in 15 paediatric paratesticular sarcomas unveils an unusual DICER1-associated sarcoma. JOURNAL OF PATHOLOGY CLINICAL RESEARCH 2020; 6:185-194. [PMID: 32222066 PMCID: PMC7339209 DOI: 10.1002/cjp2.164] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/04/2020] [Accepted: 03/06/2020] [Indexed: 12/14/2022]
Abstract
Individuals with DICER1 syndrome, a genetic disorder caused by pathogenic germline variants in DICER1, are at increased risk of developing a wide array of predominantly childhood onset conditions, including genitourinary sarcomas. However, data on DICER1 involvement in paratesticular sarcomas have not been published. Herein, we analyse a series of 15 paediatric paratesticular sarcomas and describe in detail the case of a male infant with a paratesticular myxoid tumour, considered to be a low‐grade sarcoma, who also manifested a cystic nephroma, a classic DICER1 syndrome phenotype. He harboured a pathogenic germline DICER1 variant and different somatic hot‐spot mutations in each tumour. The paratesticular tumour showed strong and diffuse expression for WT1 and CD10, an unusual immunophenotype in paediatric sarcomas, but typical of tumours of Müllerian origin. The tumour was postulated to arise from the appendix testis, a Müllerian remnant located in the paratestis. Such an origin would be analogous to other DICER1‐associated non‐epithelial gynaecological tumours, thought to arise from Müllerian derivatives. These findings point towards a key role of DICER1 in Müllerian‐derived structures. Supporting this hypothesis is the fact that the other paratesticular sarcomas from the series were either negative or focally positive for WT1 and for CD10, and none had any DICER1 mutations. In summary, we present the first case of a paratesticular sarcoma associated with DICER1 syndrome, emphasising that paratesticular tumours with an unusual histological appearance may suggest an underlying DICER1 mutation, especially in the presence of a personal or family history of DICER1‐associated disease. In this context, DICER1 mutation testing could lead to changes in clinical care including implementation of cancer care surveillance strategies.
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Affiliation(s)
- Maria Apellaniz‐Ruiz
- Department of Human GeneticsMcGill UniversityMontréalCanada
- Lady Davis Institute, Segal Cancer CentreJewish General Hospital, McGill UniversityMontréalCanada
| | - Noelle Cullinan
- Division of Hematology‐Oncology, The Hospital for Sick Children, and Department of PediatricsUniversity of TorontoTorontoCanada
| | - Ronald Grant
- Division of Hematology‐Oncology, The Hospital for Sick Children, and Department of PediatricsUniversity of TorontoTorontoCanada
| | - Paula Marrano
- Division of PathologyThe Hospital for Sick ChildrenTorontoCanada
| | | | - Paul S Thorner
- Division of PathologyThe Hospital for Sick ChildrenTorontoCanada
- Department of Laboratory Medicine and PathobiologyUniversity of TorontoTorontoCanada
| | - Catherine Goudie
- Division of Hematology‐Oncology, Montréal Children's Hospital, Department of PediatricsMcGill UniversityMontréalCanada
| | - William D Foulkes
- Department of Human GeneticsMcGill UniversityMontréalCanada
- Lady Davis Institute, Segal Cancer CentreJewish General Hospital, McGill UniversityMontréalCanada
- Program in Cancer Genetics, Department of Oncology and Human GeneticsMcGill UniversityMontréalCanada
- Department of Medical GeneticsResearch Institute of the McGill University Health CentreMontréalCanada
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Kennedy K, Thomas R, Durrant J, Jiang T, Motsinger-Reif A, Breen M. Genome-wide DNA copy number analysis and targeted transcriptional analysis of canine histiocytic malignancies identifies diagnostic signatures and highlights disruption of spindle assembly complex. Chromosome Res 2019; 27:179-202. [PMID: 31011867 DOI: 10.1007/s10577-019-09606-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/18/2019] [Accepted: 02/19/2019] [Indexed: 12/16/2022]
Abstract
Canine histiocytic malignancies (HM) are rare across the general dog population, but overrepresented in certain breeds, such as Bernese mountain dog and flat-coated retriever. Accurate diagnosis relies on immunohistochemical staining to rule out histologically similar cancers with different prognoses and treatment strategies (e.g., lymphoma and hemangiosarcoma). HM are generally treatment refractory with overall survival of less than 6 months. A lack of understanding regarding the mechanisms of disease development and progression hinders development of novel therapeutics. While the study of human tumors can benefit veterinary medicine, the rarity of the suggested orthologous disease (dendritic cell sarcoma) precludes this. This study aims to improve the understanding of underlying disease mechanisms using genome-wide DNA copy number and gene expression analysis of spontaneous HM across several dog breeds. Extensive DNA copy number disruption was evident, with losses of segments of chromosomes 16 and 31 detected in 93% and 72% of tumors, respectively. Droplet digital PCR (ddPCR) evaluation of these regions in numerous cancer specimens effectively discriminated HM from other common round cell tumors, including lymphoma and hemangiosarcoma, resulting in a novel, rapid diagnostic aid for veterinary medicine. Transcriptional analysis demonstrated disruption of the spindle assembly complex, which is linked to genomic instability and reduced therapeutic impact in humans. A key signature detected was up-regulation of Matrix Metalloproteinase 9 (MMP9), supported by an immunohistochemistry-based assessment of MMP9 protein levels. Since MMP9 has been linked with rapid metastasis and tumor aggression in humans, the data in this study offer a possible mechanism of aggression in HM.
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Affiliation(s)
- Katherine Kennedy
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC, 27607, USA.,Sentinel Biomedical Incorporated, Centennial Biomedical Campus, Raleigh, NC, 27607, USA
| | - Rachael Thomas
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC, 27607, USA.,Comparative Medicine Institute, North Carolina State University, Raleigh, NC, 27607, USA
| | - Jessica Durrant
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, 27607, USA
| | - Tao Jiang
- Bioinformatics Research Center, North Carolina State University, Raleigh, NC, 27695, USA.,Department of Statistics, North Carolina State University, Raleigh, NC, 27695, USA
| | - Alison Motsinger-Reif
- Bioinformatics Research Center, North Carolina State University, Raleigh, NC, 27695, USA.,Department of Statistics, North Carolina State University, Raleigh, NC, 27695, USA
| | - Matthew Breen
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC, 27607, USA. .,Comparative Medicine Institute, North Carolina State University, Raleigh, NC, 27607, USA. .,Cancer Genetics Program, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, 27599, USA. .,Duke Cancer Institute, Duke University, Durham, NC, 27710, USA.
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Dutta SK, Dasgupta S, Bhattacharyya NK, Jain P, Bose D, Biswas PK. Comparative Study of Imprint Cytology and Histopathology of Soft Tissue Tumors. Indian J Med Paediatr Oncol 2018; 38:461-465. [PMID: 29333013 PMCID: PMC5759065 DOI: 10.4103/ijmpo.ijmpo_132_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: The components of soft tissue are fibroblasts, collagen, vascular structures, fatty tissue, skeletal muscles, smooth muscles, and neural tissue. The real incidence of soft tissue tumors (STTs) is difficult to estimate because most of them are benign (Benign: Malignant-100:1). Aims: The aim of the present study was undertaken to note the patterns of presentation of patients with STTs and to evaluate the findings of imprint cytology (IC) and histopathological examination (HPE) of STTs. Materials and Methods: The present study was undertaken for 1 year. A total of 41 patients with clinically and radiologically diagnosed STTs were included in the study. Following surgery, imprint smear was taken for each tumor, before delivering the tissue to 10% formalin. HPE was subsequently performed. Results: The age of the patients ranged from 4 months to 80 years with a mean of 35.6 ± 17.5 years. The ratio of males to females was 1.05:1. HPE revealed that 21 (51.2%) tumors were benign and 20 (48.8%) malignant. Imprint smears revealed 16 (39%) tumors to be benign and 20 (48.8%) malignant. IC was inconclusive in 5 (12.2%) cases. The sensitivity of IC was found to be 89.5% and specificity 82.35%. The positive predictive value of IC was 85%. The accuracy of IC for diagnosis of both benign and malignant tumors was found to be 75%. Conclusion: IC of STTs is a rapid and simple method of intraoperative diagnosis, and it can serve as a viable alternative to frozen section biopsy, particularly in rural settings.
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Affiliation(s)
- Sujit Kumar Dutta
- Department of Pathology, Medical College, Kolkata, West Bengal, India
| | - Senjuti Dasgupta
- Department of Pathology, Medical College, Kolkata, West Bengal, India
| | | | - Parul Jain
- Department of Pathology, Medical College, Kolkata, West Bengal, India
| | - Debdas Bose
- Department of Pathology, Medical College, Kolkata, West Bengal, India
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Smolle MA, Andreou D, Tunn PU, Szkandera J, Liegl-Atzwanger B, Leithner A. Diagnosis and treatment of soft-tissue sarcomas of the extremities and trunk. EFORT Open Rev 2017; 2:421-431. [PMID: 29209518 PMCID: PMC5702952 DOI: 10.1302/2058-5241.2.170005] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The relatively low incidence and often atypical clinical presentation of soft-tissue sarcomas (STS) impedes early and adequate diagnosis. Patients may report on recently enlarged soft-tissue swellings, infrequently complain of painful lesions, or even have no symptoms at all. A thorough diagnostic work-up is essential in order to distinguish between benign soft-tissue tumours and STSs. Patient history, clinical features and radiological findings all help in assessing the underlying pathology. ‘Worrying’ features such as recent increase in size, deep location relative to the fascia, a tumour exceeding 4 cm in size, and invasive growth patterns seen on imaging should prompt verification by biopsy. Even though acquisition of biopsy material may be incomplete, one should bear in mind some essential rules. Regardless of the biopsy technique applied, the most direct route to the lump in question should be identified, contamination of adjacent structures should be avoided and a sufficient amount of tissue acquired. Treatment of STS is best planned by a multidisciplinary team, involving experts from various medical specialities. The benchmark therapy consists of en bloc resection of the tumour, covered by a safety margin of healthy tissue. Depending on tumour histology, grade, local extent and anatomical stage, radiotherapy, chemotherapy and isolated hyperthermic limb perfusion may be employed. Due to the complexity of treatment, any soft-tissue swelling suspected of malignancy is best referred directly to a sarcoma centre, where therapeutic management is carefully planned by an experienced multidisciplinary team.
Cite this article: EFORT Open Rev 2017;2:421-431. DOI: 10.1302/2058-5241.2.170005
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Affiliation(s)
| | | | - Per-Ulf Tunn
- Sarcoma Center Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch, Germany
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9
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Iwasaki H, Ishiguro M, Nishio J, Aoki M, Yokoyama R, Yokoyama K, Taguchi K, Nabeshima K. Extensive lipoma-like changes of myxoid liposarcoma: morphologic, immunohistochemical, and molecular cytogenetic analyses. Virchows Arch 2015; 466:453-64. [PMID: 25650275 PMCID: PMC4392166 DOI: 10.1007/s00428-015-1721-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 01/02/2015] [Accepted: 01/19/2015] [Indexed: 10/27/2022]
Abstract
Myxoid liposarcomas (MLSs) with extensive lipoma-like changes (MLSLC) are rare, and it is often difficult to distinguish them from well-differentiated liposarcoma (LS)/dedifferentiated LS (WDLS/DDLS) with myxoid changes. For the characterization of these neoplasms, we studied 8 MLSLCs, 11 ordinary MLSs, 4 WDLSs, and 6 DDLSs. Cytogenetically, MLSLC and ordinary MLS were characterized by t(12;16)(q13;p11) and FUS-DDIT3 fusion gene, whereas WDLS/DDLS lacked the fusion gene but possessed giant marker/ring chromosomes. Both lipoma-like and myxoid components of the same MLSLC exhibited the identical FUS-DDIT3, as confirmed by fluorescence in situ hybridization (FISH) and reverse transcription polymerase chain reaction (RT-PCR). Immunohistochemically, MDM2 and CDK4 were positive in WDLS/DDLS but negative in MLSLC and ordinary MLS. PPARγ, C/EBPα, adipophilin, and perilipin were found in each type of LS. Adipophilin was expressed chiefly in tiny fat droplets of immature lipoblasts, whereas perilipin showed a strong positive staining in large fat vacuoles of signet ring and multivacuolated lipoblasts. The Ki-67 labeling index was lower in the lipoma-like component of MLSLC when compared with the myxoid component of the same tumors as well as ordinary MLS (p < 0.001). When compared with ordinary MLS, MLSLC may be less aggressive in clinical behavior (rare recurrences or metastases) after a wide surgical excision. In conclusion, the distinction between MLSLC and WDLS/DDLS is important, because of the differences of molecular cytogenetic features as well as clinical behaviors between these distinct sarcomas presenting similar morphologic features. In addition, the combined immunohistochemical detection of adipophilin and perilipin may provide a useful ancillary tool for identification of lipoblastic cells in soft tissue sarcomas.
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Affiliation(s)
- Hiroshi Iwasaki
- Department of Pathology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan,
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10
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Yang Z, Sweedler JV. Application of capillary electrophoresis for the early diagnosis of cancer. Anal Bioanal Chem 2014; 406:4013-31. [DOI: 10.1007/s00216-014-7722-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 02/18/2014] [Accepted: 02/21/2014] [Indexed: 02/07/2023]
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Morgan SS, Nagle RB, Cranmer LD. Serum protein acidic and rich in cysteine (SPARC) as a prognostic marker in soft tissue sarcomas. Clin Sarcoma Res 2014; 4:2. [PMID: 24484617 PMCID: PMC3917620 DOI: 10.1186/2045-3329-4-2] [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: 12/17/2013] [Accepted: 01/29/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Serum protein acidic and rich in cysteine (SPARC) is a matricellular secreted glycoprotein that performs several cellular functions and has been implicated in tumorigenesis in a variety of tumor types. The chemotherapeutic agent nanoparticle albumin-encapsulated (NAB)-paclitaxel has been postulated to exploit SPARC expression to target neoplastic cells. SPARC's role, and potentially the role of NAB-paclitaxel, in the highly heterogeneous class of soft-tissue sarcomas (STS) has not been investigated. Our objective was to explore the pattern of SPARC expression and its prognostic significance in STS. METHODS 27 tissue specimens representing various STS histologies were stained for SPARC expression by immunohistochemistry (IHC). Staining intensity was scored blindly. Survival was determined from patients' medical records and analyzed using Kaplan-Meier and log-rank with respect to SPARC expression level. RESULTS Elevated SPARC expression was observed in 15/27 (56%) specimens. Overall patient survival segregated strongly based on levels of SPARC expression. Patients who expressed low-to-moderate levels of SPARC exhibited median survival of 22.1 months, while the median survival of patients with moderate-to-high expression levels was 4.4 months (log rank; p = 0.0016). CONCLUSIONS SPARC expression is elevated in a significant proportion of STS specimens analyzed in this study, but it does not appear to correlate with specific STS histologies. Given our limited sample size, we cannot draw definitive conclusions regarding association of SPARC with STS subtype. Overall survival segregates strongly by degree of SPARC expression, with elevated expression being adverse. If validated in a larger study, our results suggest that trials in STS with agents potentially targeting SPARC, such as NAB-paclitaxel, should be stratified by SPARC expression level.
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Affiliation(s)
- Sherif S Morgan
- The University of Arizona Cancer Center, 1515 N. Campbell Avenue, Tucson, AZ, USA
| | - Raymond B Nagle
- The University of Arizona Cancer Center, 1515 N. Campbell Avenue, Tucson, AZ, USA
- Department of Pathology, University of Arizona, Tucson, AZ, USA
| | - Lee D Cranmer
- The University of Arizona Cancer Center, 1515 N. Campbell Avenue, Tucson, AZ, USA
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Radons J. The role of inflammation in sarcoma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 816:259-313. [PMID: 24818727 DOI: 10.1007/978-3-0348-0837-8_11] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Sarcomas encompass a heterogenous group of tumors with diverse pathologically and clinically overlapping features. It is a rarely curable disease, and their management requires a multidisciplinary team approach. Chronic inflammation has emerged as one of the hallmarks of tumors including sarcomas. Classical inflammation-associated sarcomas comprise the inflammatory malignant fibrous histiocytoma and Kaposi sarcoma. The identification of specific chromosomal translocations and important intracellular signaling pathways such as Ras/Raf/MAPK, insulin-like growth factor, PI3K/AKT/mTOR, sonic hedgehog and Notch together with the increasing knowledge of angiogenesis has led to development of targeted therapies that aim to interrupt these pathways. Innovative agents like oncolytic viruses opened the way to design new therapeutic options with encouraging findings. Preclinical evidence also highlights the therapeutic potential of anti-inflammatory nutraceuticals as they can inhibit multiple pathways while being less toxic. This chapter gives an overview of actual therapeutic standards, newest evidence-based studies and exciting options for targeted therapies in sarcomas.
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Affiliation(s)
- Jürgen Radons
- Department of Radiotherapy and Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany,
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Yu D, Zhang Y, Mao Z, Gao C. Study of the selective uptake progress of aptamer-modified PLGA particles by liver cells. Macromol Biosci 2013; 13:1413-21. [PMID: 23868860 DOI: 10.1002/mabi.201300165] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 06/09/2013] [Indexed: 11/09/2022]
Abstract
It is of paramount importance to study the cellular uptake processes of particles with defined surface property, especially the uptake pathways and intracellular transportation. In this study, aptamer AS1411 molecules, which are known to specifically bind the over-expressed nucleolin on cancer cell membrane, were conjugated onto bovine serum albumin-decorated poly(D,L-lactide-co-glycolide; PLGA, Φ400 nm) particles with a density of 1-1.7 molecule/10 nm(2). The aptamer-modified PLGA particles were preferably ingested by liver cancer cells with higher amount and faster rate. The clathrin-mediated endocytosis and macropinocytosis pathways played a more important role in uptake of the aptamer modified particles.
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Affiliation(s)
- Dahai Yu
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, China
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14
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Intracranial malignant triton tumor in a patient with neurofibromatosis type 1: case report and review of the literature. Brain Tumor Pathol 2013; 31:149-54. [DOI: 10.1007/s10014-013-0147-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 03/29/2013] [Indexed: 10/26/2022]
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15
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Nishio J, Aoki M, Nabeshima K, Iwasaki H, Naito M. Characterization of giant marker and ring chromosomes in a pleomorphic leiomyosarcoma of soft tissue by spectral karyotyping. Oncol Rep 2012; 28:533-8. [PMID: 22641359 DOI: 10.3892/or.2012.1835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 04/13/2012] [Indexed: 11/05/2022] Open
Abstract
Pleomorphic leiomyosarcoma of soft tissue is relatively rare and its cytogenetic and molecular genetic data are scarce. We present a case of pleomorphic leiomyosarcoma arising in the left thigh of a 60-year-old man. Fluorine-18-deoxyglucose positron emission tomography imaging showed a homogenously high uptake within the mass in the proximal left thigh (maximum standardized uptake value, 20.9). Following a core needle biopsy, wide resection of the tumor was performed. Histologically, the tumor was composed of a mixture of spindle cells, polygonal cells and bizarre giant cells forming interlacing bundles and a storiform pattern. Immunohistochemically, the tumor cells were positive for vimentin, smooth muscle actin and desmin. The MIB-1 labeling index was 19.7% in the highest spot. Cytogenetic analysis exhibited a complex karyotype with several numerical and structural alterations, including giant marker and ring chromosomes. Spectral karyotyping demonstrated that giant marker and ring chromosomes were composed of material from the X chromosome. Metaphase-based comparative genomic hybridization analysis showed high-level amplifications of 1q21-q25 and 12q13-q21 and gains of 1p31-p32, 10p11-p13, 17p11 and 19p13. The patient received postoperative adjuvant radiotherapy and doxorubicin-based chemotherapy. No local recurrence or distant metastasis was detected during a follow-up period of 19 months. The clinicopathological, cytogenetic and molecular genetic features of pleomorphic soft tissue leiomyosarcoma are discussed.
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Affiliation(s)
- Jun Nishio
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
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16
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Drury R, Verghese ET, Hughes TA. The roles of microRNAs in sarcomas. J Pathol 2012; 227:385-91. [DOI: 10.1002/path.4037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 03/23/2012] [Accepted: 03/29/2012] [Indexed: 01/02/2023]
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17
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Xie L, Tong W, Yu D, Xu J, Li J, Gao C. Bovine serum albumin nanoparticles modified with multilayers and aptamers for pH-responsive and targeted anti-cancer drug delivery. ACTA ACUST UNITED AC 2012. [DOI: 10.1039/c2jm16831f] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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18
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Tong W, Song X, Gao C. Layer-by-layer assembly of microcapsules and their biomedical applications. Chem Soc Rev 2012; 41:6103-24. [DOI: 10.1039/c2cs35088b] [Citation(s) in RCA: 357] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Morgan SS, Cranmer LD. Systematic therapy for unresectable or metastatic soft-tissue sarcomas: past, present, and future. Curr Oncol Rep 2011; 13:331-49. [PMID: 21633784 DOI: 10.1007/s11912-011-0182-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Unresectable or metastatic disease occurs in 40% to 60% of soft-tissue sarcoma (STS) patients and portends a poor prognosis. For decades, doxorubicin has formed the backbone of systemic treatment, with response rates of approximately 26%. Patients progressing following first-line therapy were left with few proven options. No other cytotoxic chemotherapy agent or combination has demonstrated superiority to doxorubicin. Advances in targeted therapy of STS have been hindered by STS heterogeneity and poorly understood disease biology. Despite challenges, progress has been made in specific STS subtypes. Here, we highlight the challenges, progress, and lessons learned from STS trials published in the last 20 to 25 years.
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Affiliation(s)
- Sherif S Morgan
- Melanoma/Sarcoma Research Program, Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
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20
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Nishio J, Isayama T, Yoshimura I, Ohjimi H, Iwasaki H, Naito M. Myxoid liposarcoma of the ankle: a case report. J Foot Ankle Surg 2011; 51:76-9. [PMID: 22018762 DOI: 10.1053/j.jfas.2011.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Indexed: 02/03/2023]
Abstract
Myxoid liposarcoma occurs predominantly in the deep soft tissues of the extremities, and tends to metastasize to a wide range of soft tissue or bone locations. We report a case of myxoid liposarcoma arising in the ankle of a 19-year-old man. A diagnosis of myxoid liposarcoma was made by open biopsy, and a wide resection requiring plastic surgical reconstruction was performed. Cytogenetic analysis of the resected tumor exhibited a reciprocal translocation t(12;16)(q13;p11) as the sole anomaly, which is found in more than 90% of myxoid liposarcoma cases. The patient had no evidence of local recurrence or metastasis within 7 years of follow-up. Although myxoid liposarcoma is rare in the ankle, it should be considered in the differential diagnosis of a painless soft tissue mass in this region.
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Affiliation(s)
- Jun Nishio
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Jonan-ku, Fukuoka, Japan.
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21
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Nishio J, Iwasaki H, Nabeshima K, Naito M. Cytogenetics and molecular genetics of myxoid soft-tissue sarcomas. GENETICS RESEARCH INTERNATIONAL 2011; 2011:497148. [PMID: 22567356 PMCID: PMC3335514 DOI: 10.4061/2011/497148] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 06/06/2011] [Indexed: 01/29/2023]
Abstract
Myxoid soft-tissue sarcomas represent a heterogeneous group of mesenchymal tumors characterized by a predominantly myxoid matrix, including myxoid liposarcoma (MLS), low-grade fibromyxoid sarcoma (LGFMS), extraskeletal myxoid chondrosarcoma (EMC), myxofibrosarcoma, myxoinflammatory fibroblastic sarcoma (MIFS), and myxoid dermatofibrosarcoma protuberans (DFSP). Cytogenetic and molecular genetic analyses have shown that many of these sarcomas are characterized by recurrent chromosomal translocations resulting in highly specific fusion genes (e.g., FUS-DDIT3 in MLS, FUS-CREB3L2 in LGFMS, EWSR1-NR4A3 in EMC, and COL1A1-PDGFB in myxoid DFSP). Moreover, recent molecular analysis has demonstrated a translocation t(1; 10)(p22; q24) resulting in transcriptional upregulation of FGF8 and NPM3 in MIFS. Most recently, the presence of TGFBR3 and MGEA5 rearrangements has been identified in a subset of MIFS. These genetic alterations can be utilized as an adjunct in diagnostically challenging cases. In contrast, most myxofibrosarcomas have complex karyotypes lacking specific genetic alterations. This paper focuses on the cytogenetic and molecular genetic findings of myxoid soft-tissue sarcomas as well as their clinicopathological characteristics.
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Affiliation(s)
- Jun Nishio
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
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22
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Contributions of cytogenetics and molecular cytogenetics to the diagnosis of adipocytic tumors. J Biomed Biotechnol 2011; 2011:524067. [PMID: 21274402 PMCID: PMC3025394 DOI: 10.1155/2011/524067] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2010] [Accepted: 12/15/2010] [Indexed: 12/14/2022] Open
Abstract
Over the last 20 years, a number of tumor-specific chromosomal translocations and associated fusion genes have been identified for mesenchymal neoplasms including adipocytic tumors. The addition of molecular cytogenetic techniques, especially fluorescence in situ hybridization (FISH), has further enhanced the sensitivity and accuracy of detecting nonrandom chromosomal translocations and/or other rearrangements in adipocytic tumors. Indeed, most resent molecular cytogenetic analysis has demonstrated a translocation t(11;16)(q13;p13) that produces a C11orf95-MKL2 fusion gene in chondroid lipoma. Additionally, it is well recognized that supernumerary ring and/or giant rod chromosomes are characteristic for atypical lipomatous tumor/well-differentiated liposarcoma and dedifferentiated liposarcoma, and amplification of 12q13–15 involving the MDM2, CDK4, and CPM genes is shown by FISH in these tumors. Moreover, myxoid/round cell liposarcoma is characterized by a translocation t(12;16)(q13;p11) that fuses the DDIT3 and FUS genes. This paper provides an overview of the role of conventional cytogenetics and molecular cytogenetics in the diagnosis of adipocytic tumors.
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Dennis MM, McSporran KD, Bacon NJ, Schulman FY, Foster RA, Powers BE. Prognostic Factors for Cutaneous and Subcutaneous Soft Tissue Sarcomas in Dogs. Vet Pathol 2010; 48:73-84. [DOI: 10.1177/0300985810388820] [Citation(s) in RCA: 165] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- M. M. Dennis
- Faculty of Veterinary Science, University of Sydney, Sydney, New South Wales, Australia
| | | | - N. J. Bacon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - F. Y. Schulman
- Department of Veterinary Pathology, Armed Forces Institute of Pathology, Washington, DC, and Marshfield Labs, Veterinary Services, Marshfield, Wisconsin
| | - R. A. Foster
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - B. E. Powers
- Veterinary Diagnostic Laboratory, Colorado State University, Fort Collins, Colorado
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Establishment of a new human pleomorphic malignant fibrous histiocytoma cell line, FU-MFH-2: molecular cytogenetic characterization by multicolor fluorescence in situ hybridization and comparative genomic hybridization. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2010; 29:153. [PMID: 21092322 PMCID: PMC3001428 DOI: 10.1186/1756-9966-29-153] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 11/24/2010] [Indexed: 11/10/2022]
Abstract
Background Pleomorphic malignant fibrous histiocytoma (MFH) is one of the most frequent malignant soft tissue tumors in adults. Despite the considerable amount of research on MFH cell lines, their characterization at a molecular cytogenetic level has not been extensively analyzed. Methods and results We established a new permanent human cell line, FU-MFH-2, from a metastatic pleomorphic MFH of a 72-year-old Japanese man, and applied multicolor fluorescence in situ hybridization (M-FISH), Urovysion™ FISH, and comparative genomic hybridization (CGH) for the characterization of chromosomal aberrations. FU-MFH-2 cells were spindle or polygonal in shape with oval nuclei, and were successfully maintained in vitro for over 80 passages. The histological features of heterotransplanted tumors in severe combined immunodeficiency mice were essentially the same as those of the original tumor. Cytogenetic and M-FISH analyses displayed a hypotriploid karyotype with numerous structural aberrations. Urovysion™ FISH revealed a homozygous deletion of the p16INK4A locus on chromosome band 9p21. CGH analysis showed a high-level amplification of 9q31-q34, gains of 1p12-p34.3, 2p21, 2q11.2-q21, 3p, 4p, 6q22-qter, 8p11.2, 8q11.2-q21.1, 9q21-qter, 11q13, 12q24, 15q21-qter, 16p13, 17, 20, and X, and losses of 1q43-qter, 4q32-qter, 5q14-q23, 7q32-qter, 8p21-pter, 8q23, 9p21-pter, 10p11.2-p13, and 10q11.2-q22. Conclusion The FU-MFH-2 cell line will be a particularly useful model for studying molecular pathogenesis of human pleomorphic MFH.
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Sugimura H, Mori H, Nagura K, Kiyose SI, Tao H, Hong T, Isozaki M, Igarashi H, Shinmura K, Hasegawa A, Kitayama Y, Tanioka F. Fluorescence in situ hybridization analysis with a tissue microarray: 'FISH and chips' analysis of pathology archives. Pathol Int 2010; 60:543-50. [PMID: 20618731 DOI: 10.1111/j.1440-1827.2010.02561.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Practicing pathologists expect major somatic genetic changes in cancers, because the morphological deviations in the cancers they diagnose are so great that the somatic genetic changes to direct these phenotypes of tumors are supposed to be correspondingly tremendous. Several lines of evidence, especially lines generated by high-throughput genomic sequencing and genome-wide analyses of cancer DNAs are verifying their preoccupations. This article reviews a comprehensive morphological approach to pathology archives that consists of fluorescence in situ hybridization with bacterial artificial chromosome (BAC) probes and screening with tissue microarrays to detect structural changes in chromosomes (copy number alterations and rearrangements) in specimens of human solid tumors. The potential of this approach in the attempt to provide individually tailored medical practice, especially in terms of cancer therapy, is discussed.
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Affiliation(s)
- Haruhiko Sugimura
- Department of Pathology, Hamamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ward, Hamamatsu 431-3192, Japan.
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26
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Abstract
Bone and soft tissue sarcomas are an infrequent and heterogeneous group of mesenchymal tumors including more than a hundred different entities attending to histologic patterns. Research into the molecular aspects of sarcomas has increased greatly in the last few years. This enormous amount of knowledge has allowed, for instance, to refine the classification of sarcomas, improve the diagnosis, and increase the number of therapeutical targets available, most of them under preclinical evaluation. However, other important key issues, such as sarcomagenesis and the cell of origin of sarcomas, remain unresolved. From a molecular point of view, these neoplasias are grouped into 2 main types: (a) sarcomas showing relatively simple karyotypes and translocations, which originate gene fusions (eg, EWS-FLI1 in Ewing sarcoma) or point mutations (eg, c-kit in the gastrointestinal tumors) and (b) sarcomas showing unspecific gene alterations, very complex karyotypes, and no translocations. The discovery of the early mechanisms involved in the genesis of sarcomas, the more relevant signaling pathways, and the development of genetically engineered mouse models could also provide a new individualized therapeutic strategy against these tumors. This review describes the clinical application of some of the molecular alterations found in sarcomas, some advances in the field of sarcomagenesis, and the development of animal models.
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