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Tortorelli I, Bellan E, Chiusole B, Murtas F, Ruggieri P, Pala E, Cerchiaro M, Buzzaccarini MS, Scarzello G, Krengli M, Bisinella G, Battisti S, Di Maggio A, Zagonel V, Tos APD, Sbaraglia M, Brunello A. Primary vascular tumors of bone: A comprehensive literature review on classification, diagnosis and treatment. Crit Rev Oncol Hematol 2024; 195:104268. [PMID: 38237880 DOI: 10.1016/j.critrevonc.2024.104268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/23/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024] Open
Abstract
Primary vascular tumors of bone are a heterogeneous group of neoplasms, ranging from benign hemangiomas to frankly malignant epithelioid hemangioendotheliomas and angiosarcomas. Over the years, their classification has been a matter of discussion, due to morphologic similarities and uncertainty regarding biologic behavior. Over the past decade, with the development of next-generation sequencing, there has been a significant improvement in the molecular characterization of these lesions. The integration of their morphologic, immunohistochemical and molecular features has led to a better stratification, with important prognostic and therapeutic implications. Nevertheless, primary vascular bone tumors still represent a challenge for medical oncologists. Given their rarity and heterogeneity, in the last few years, there has been no significant progress in medical treatment options, so further research is needed. Here we present a review of the current knowledge regarding primary vascular tumors of the bone, correlating clinicopathologic features with tumor behavior and therapeutic approaches.
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Affiliation(s)
- Ilaria Tortorelli
- Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV - IRCCS, Via Gattamelata 64, 35128 Padua, Italy; Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Via Nicolò Giustiniani 2, 35128 Padua, Italy
| | - Elena Bellan
- Department of Pathology, Azienda Ospedale Università Padova, Via Gabelli 61, 35121 Padua, Italy
| | - Benedetta Chiusole
- Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV - IRCCS, Via Gattamelata 64, 35128 Padua, Italy
| | - Fabio Murtas
- Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV - IRCCS, Via Gattamelata 64, 35128 Padua, Italy; Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Via Nicolò Giustiniani 2, 35128 Padua, Italy
| | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padua, Via Nicolò Giustiniani 1, 35128 Padua, Italy
| | - Elisa Pala
- Department of Orthopedics and Orthopedic Oncology, University of Padua, Via Nicolò Giustiniani 1, 35128 Padua, Italy
| | - Mariachiara Cerchiaro
- Department of Orthopedics and Orthopedic Oncology, University of Padua, Via Nicolò Giustiniani 1, 35128 Padua, Italy
| | | | - Giovanni Scarzello
- Radiotherapy Unit, Istituto Oncologico Veneto IOV - IRCCS, Via Nicolò Giustiniani 2, 35128 Padua, Italy
| | - Marco Krengli
- Radiotherapy Unit, Istituto Oncologico Veneto IOV - IRCCS, Via Nicolò Giustiniani 2, 35128 Padua, Italy
| | - Gianluca Bisinella
- Division of Orthopedics and Trauma, AULSS 6 Euganea, Ospedali Riuniti Padova Sud, Via Albere 30, Monselice, Padua, Italy
| | - Sara Battisti
- Division of Orthopedics and Trauma, AULSS 6 Euganea, Ospedali Riuniti Padova Sud, Via Albere 30, Monselice, Padua, Italy
| | - Antonio Di Maggio
- Oncologic Radiology Unit, Department of Radiology and Medical Physics, Istituto Oncologico Veneto IOV - IRCCS, Via Gattamelata 64, 35128 Padua, Italy
| | - Vittorina Zagonel
- Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV - IRCCS, Via Gattamelata 64, 35128 Padua, Italy
| | - Angelo Paolo Dei Tos
- Department of Pathology, Azienda Ospedale Università Padova, Via Gabelli 61, 35121 Padua, Italy; Department of Medicine, University of Padua School of Medicine, Via 8 Febbraio 2, 35122 Padua, Italy
| | - Marta Sbaraglia
- Department of Pathology, Azienda Ospedale Università Padova, Via Gabelli 61, 35121 Padua, Italy; Department of Medicine, University of Padua School of Medicine, Via 8 Febbraio 2, 35122 Padua, Italy
| | - Antonella Brunello
- Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV - IRCCS, Via Gattamelata 64, 35128 Padua, Italy.
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Abdelmogod A, Papadopoulos L, Riordan S, Wong M, Weltman M, Lim R, McEvoy C, Fellowes A, Fox S, Bedő J, Penington J, Pham K, Hofmann O, Vissers JHA, Grimmond S, Ratnayake G, Christie M, Mitchell C, Murray WK, McClymont K, Luk P, Papenfuss AT, Kee D, Scott CL, Goldstein D, Barker HE. A Matched Molecular and Clinical Analysis of the Epithelioid Haemangioendothelioma Cohort in the Stafford Fox Rare Cancer Program and Contextual Literature Review. Cancers (Basel) 2023; 15:4378. [PMID: 37686662 PMCID: PMC10487006 DOI: 10.3390/cancers15174378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Epithelioid haemangioendothelioma (EHE) is an ultra-rare malignant vascular tumour with a prevalence of 1 per 1,000,000. It is typically molecularly characterised by a WWTR1::CAMTA1 gene fusion in approximately 90% of cases, or a YAP1::TFE3 gene fusion in approximately 10% of cases. EHE cases are typically refractory to therapies, and no anticancer agents are reimbursed for EHE in Australia. METHODS We report a cohort of nine EHE cases with comprehensive histologic and molecular profiling from the Walter and Eliza Hall Institute of Medical Research Stafford Fox Rare Cancer Program (WEHI-SFRCP) collated via nation-wide referral to the Australian Rare Cancer (ARC) Portal. The diagnoses of EHE were confirmed by histopathological and immunohistochemical (IHC) examination. Molecular profiling was performed using the TruSight Oncology 500 assay, the TruSight RNA fusion panel, whole genome sequencing (WGS), or whole exome sequencing (WES). RESULTS Molecular analysis of RNA, DNA or both was possible in seven of nine cases. The WWTR1::CAMTA1 fusion was identified in five cases. The YAP1::TFE3 fusion was identified in one case, demonstrating unique morphology compared to cases with the more common WWTR1::CAMTA1 fusion. All tumours expressed typical endothelial markers CD31, ERG, and CD34 and were negative for pan-cytokeratin. Cases with a WWTR1::CAMTA1 fusion displayed high expression of CAMTA1 and the single case with a YAP1::TFE3 fusion displayed high expression of TFE3. Survival was highly variable and unrelated to molecular profile. CONCLUSIONS This cohort of EHE cases provides molecular and histopathological characterisation and matching clinical information that emphasises the molecular patterns and variable clinical outcomes and adds to our knowledge of this ultra-rare cancer. Such information from multiple studies will advance our understanding, potentially improving treatment options.
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Affiliation(s)
- Arwa Abdelmogod
- Limestone Coast Local Health Network, Flinders University, Bedford Park, SA 5042, Australia;
| | - Lia Papadopoulos
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; (L.P.); (R.L.); (J.B.); (J.P.); (A.T.P.); (D.K.); (C.L.S.)
- The Australian Rare Cancer Portal, BioGrid, Parkville, VIC 3051, Australia;
- Eastern Health Clinical School, Monash University, Box Hill, VIC 3128, Australia
| | - Stephen Riordan
- Prince of Wales Clinical School, University of NSW, Randwick, NSW 2031, Australia;
- Gastrointestinal and Liver Unit, Prince of Wales Hospital, Randwick, NSW 2031, Australia
| | - Melvin Wong
- Radiology Department, Prince of Wales Hospital, Randwick, NSW 2031, Australia;
| | - Martin Weltman
- Department of Gastroenterology, Nepean Hospital, Kingswood, NSW 2747, Australia;
| | - Ratana Lim
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; (L.P.); (R.L.); (J.B.); (J.P.); (A.T.P.); (D.K.); (C.L.S.)
| | - Christopher McEvoy
- Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; (C.M.); (A.F.)
| | - Andrew Fellowes
- Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; (C.M.); (A.F.)
| | - Stephen Fox
- Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; (C.M.); (A.F.)
| | - Justin Bedő
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; (L.P.); (R.L.); (J.B.); (J.P.); (A.T.P.); (D.K.); (C.L.S.)
| | - Jocelyn Penington
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; (L.P.); (R.L.); (J.B.); (J.P.); (A.T.P.); (D.K.); (C.L.S.)
| | - Kym Pham
- Centre for Cancer Research and Department of Clinical Pathology, University of Melbourne, Melbourne, VIC 3010, Australia; (K.P.); (O.H.); (J.H.A.V.); (S.G.)
| | - Oliver Hofmann
- Centre for Cancer Research and Department of Clinical Pathology, University of Melbourne, Melbourne, VIC 3010, Australia; (K.P.); (O.H.); (J.H.A.V.); (S.G.)
| | - Joseph H. A. Vissers
- Centre for Cancer Research and Department of Clinical Pathology, University of Melbourne, Melbourne, VIC 3010, Australia; (K.P.); (O.H.); (J.H.A.V.); (S.G.)
| | - Sean Grimmond
- Centre for Cancer Research and Department of Clinical Pathology, University of Melbourne, Melbourne, VIC 3010, Australia; (K.P.); (O.H.); (J.H.A.V.); (S.G.)
| | | | | | - Catherine Mitchell
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; (C.M.); (W.K.M.)
| | - William K. Murray
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; (C.M.); (W.K.M.)
| | - Kelly McClymont
- Sullivan Nicolaides Pathology, Brisbane, QLD 4000, Australia;
| | - Peter Luk
- Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia;
| | - Anthony T. Papenfuss
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; (L.P.); (R.L.); (J.B.); (J.P.); (A.T.P.); (D.K.); (C.L.S.)
- Department of Gastroenterology, Nepean Hospital, Kingswood, NSW 2747, Australia;
- Sir Peter MacCallum Cancer Centre, Department of Oncology, University of Melbourne, Parkville, VIC 3000, Australia
| | - Damien Kee
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; (L.P.); (R.L.); (J.B.); (J.P.); (A.T.P.); (D.K.); (C.L.S.)
- The Australian Rare Cancer Portal, BioGrid, Parkville, VIC 3051, Australia;
- Sir Peter MacCallum Cancer Centre, Department of Oncology, University of Melbourne, Parkville, VIC 3000, Australia
- Austin Health, Heidelberg, VIC 3084, Australia
| | - Clare L. Scott
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; (L.P.); (R.L.); (J.B.); (J.P.); (A.T.P.); (D.K.); (C.L.S.)
- The Australian Rare Cancer Portal, BioGrid, Parkville, VIC 3051, Australia;
- The Royal Womens’ Hospital, Parkville, VIC 3052, Australia;
- Sir Peter MacCallum Cancer Centre, Department of Oncology, University of Melbourne, Parkville, VIC 3000, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, VIC 3010, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC 3010, Australia
| | - David Goldstein
- The Australian Rare Cancer Portal, BioGrid, Parkville, VIC 3051, Australia;
- Eastern Health Clinical School, Monash University, Box Hill, VIC 3128, Australia
- Nelune Center, Prince of Wales Hospital, Randwick, NSW 2031, Australia
| | - Holly E. Barker
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; (L.P.); (R.L.); (J.B.); (J.P.); (A.T.P.); (D.K.); (C.L.S.)
- Department of Medical Biology, University of Melbourne, Melbourne, VIC 3010, Australia
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Cine HS, Uysal E, Senturk S, Ay G, Caner B. Anteroposterior Combined Surgery of a Rare Massive Epithelioid Hemangioendothelioma at the Cervicothoracic Junction. Cureus 2023; 15:e43032. [PMID: 37551289 PMCID: PMC10404447 DOI: 10.7759/cureus.43032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2023] [Indexed: 08/09/2023] Open
Abstract
Epithelioid hemangioendothelioma is a rare mesenchymal tumor of vascular endothelial origin. Non-soft tissue epithelioid hemangioendothelioma can also be seen in different organs. Although chemotherapy has been used in some patients, complete surgical removal of the tumor tissue has proven to be the most durable solution. A 15-year-old female patient was admitted to our institution with right arm and neck pain. The patient complained of numbness and weakness in the right hand. Computerized tomography indicated an expansile lesion exhibiting osteolytic features located predominantly on the right side of the corpus, pedicle, lamina, and lateral processes of the C7-T1 vertebra. The patient underwent a surgical procedure involving the application of a bilateral C4-5-6 lateral mass screw, left C7-T1 pedicle screw, and bilateral T2-3 pedicle screw and fusion. The complete residual neoplasm was surgically removed during the procedure. Due to the rarity of epithelioid hemangioendothelioma, the existing literature on this topic is confined to case reports, supplemented by a small number of retrospective descriptive case series that aimed to improve our understanding of the clinical, pathological, and molecular features of the condition, as well as to guide potential treatment strategies.
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Affiliation(s)
- Hidayet Safak Cine
- Neurosurgery, Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, TUR
| | - Ece Uysal
- Neurological Surgery, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, TUR
| | | | - Gülnihal Ay
- Pathology, Istanbul Medeniyet University, Göztepe Research and Training Hospital, Istanbul, TUR
| | - Basak Caner
- Neurosurgery, Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, TUR
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Paulson KG, Ravi V, Rubin BP, Park M, Loggers ET, Cranmer LD, Wagner MJ. Incidence, demographics, and survival of malignant hemangioendothelioma in the United States. Cancer Med 2023; 12:15101-15106. [PMID: 37260142 PMCID: PMC10417180 DOI: 10.1002/cam4.6181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/15/2023] [Accepted: 05/20/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Malignant hemangioendothelioma is an endothelial cancer with heterogeneous clinical behavior that can range from indolent to aggressive, of which the majority are epithelioid (EHE). Its incidence and demographics have not been previously well defined in a large cohort. METHODS This retrospective analysis used the US Cancer Statistics National Program of Cancer Registries - Surveillance Epidemiology End Results (SEER) combined database to identify patients in the US newly diagnosed with hemangioendothelioma between the years of 2001 and 2017 (n = 1986). Survival analyses were performed on a subset of patients within the SEER-18 database with survival information available (n = 417). Outcomes included incidence, demographics of patients newly diagnosed with hemangioendothelioma, extent of disease at presentation, and overall survival. RESULTS The incidence of hemangioendothelioma in the US is 0.4 cases per million person-years. Although cases rose to 122 newly diagnosed in the year 2017 (90 EHE, 32 other hemangioendothelioma), incidence rates were stable. Skin and connective tissues were the most common presenting sites (33.4%), followed by liver (24.5%), lung (17.6%), and bone (12.5%). Median age at diagnosis was 55 years; 27.2% of patients were pediatric, adolescent, or young adult (<40 years). At presentation, 36.4% of patients had localized disease; 21.6% presented with regional and 41.7% with distant metastases. Observed survival at 3 years was 79.7%, 70.7%, and 46.0% for patients presenting with local, regional, and distant disease and most deaths occurred within the first 2 years. CONCLUSIONS Malignant hemangioendothelioma is ultra-rare but meaningfully impacts affected patients. These data may provide benchmarks for comparison of new approaches to hemangioendothelioma therapy and highlight poor survival outcomes.
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Affiliation(s)
- Kelly G. Paulson
- Medical OncologyProvidence‐Swedish Cancer InstituteSeattleWashingtonUSA
| | - Vinod Ravi
- Sarcoma Medical OncologyMD Anderson Cancer CenterHoustonTexasUSA
| | - Brian P. Rubin
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland ClinicClevelandOhioUSA
| | - Min Park
- Medical OncologyProvidence‐Swedish Cancer InstituteSeattleWashingtonUSA
| | - Elizabeth T. Loggers
- Clinical Research DivisionFred Hutchinson Cancer CenterSeattleWashingtonUSA
- Division of Medical OncologyUniversity of WashingtonSeattleWashingtonUSA
| | - Lee D. Cranmer
- Clinical Research DivisionFred Hutchinson Cancer CenterSeattleWashingtonUSA
- Division of Medical OncologyUniversity of WashingtonSeattleWashingtonUSA
| | - Michael J. Wagner
- Clinical Research DivisionFred Hutchinson Cancer CenterSeattleWashingtonUSA
- Division of Medical OncologyUniversity of WashingtonSeattleWashingtonUSA
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Tomassen T, Versleijen-Jonkers YMH, Hillebrandt-Roeffen MHS, Van Cleef PHJ, van Dalen T, Weidema ME, Desar IME, Flucke U, van Gorp JM. Prognostic Factors in Epithelioid Hemangioendothelioma: Analysis of a Nationwide Molecularly/Immunohistochemically Confirmed Cohort of 57 Cases. Cancers (Basel) 2023; 15:3304. [PMID: 37444414 DOI: 10.3390/cancers15133304] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Epithelioid hemangioendothelioma (EHE) is an extremely rare vascular sarcoma with variable aggressive clinical behavior. In this retrospective study, we aimed to investigate prognostic factors based on clinicopathologic findings in a molecularly/immunohistochemically confirmed nationwide multicenter cohort of 57 EHE cases. Patients had unifocal disease (n = 29), multifocal disease (n = 5), lymph node metastasis (n = 8) and/or distant metastasis (n = 15) at the time of diagnosis. The overall survival rate was 71.4% at 1 year and 50.7% at 5 years. Survival did not correlate with sex, age or histopathological parameters. No survival differences were observed between multifocal and metastatic disease, suggesting that multifocality represents early metastases and treatment options are limited in comparison to unifocal disease. In unifocal tumors, survival could be predicted using the risk stratification model of Shibayama et al., dividing the cases into low- (n = 4), intermediate- (n = 15) and high- (n = 3) risk groups. No clinical or histopathological parameters were associated with progressive unifocal disease course. Lymph node metastases at the time of diagnosis occurred in 14.0% of the cases and were mainly associated with tumor localization in the head and neck area, proposing lymph node dissection. In conclusion, our results demonstrate the aggressive behavior of EHE, emphasize the prognostic value of a previously described risk stratification model and may provide new insights regarding tumor focality, therapeutic strategies and prognosis.
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Affiliation(s)
- Tess Tomassen
- Department of Pathology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Yvonne M H Versleijen-Jonkers
- Department of Medical Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Melissa H S Hillebrandt-Roeffen
- Department of Medical Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Patricia H J Van Cleef
- Department of Pathology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Thijs van Dalen
- Department of Surgery, Utrecht University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Marije E Weidema
- Department of Medical Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Ingrid M E Desar
- Department of Medical Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Uta Flucke
- Department of Pathology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands
| | - Joost M van Gorp
- Department of Pathology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
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