1
|
Spunt SL, Xue W, Gao Z, Dixon AH, Million L, Polites SF, Vasudevan SA, Kao SC, McCarville MB, Parham DM, Barkauskas DA, Cai Z, Cost C, Mascarenhas L, Weiss AR. Embryonal sarcoma of the liver in pediatric and young adult patients: A report from Children's Oncology Group study ARST0332. Cancer 2024; 130:2683-2693. [PMID: 38567652 PMCID: PMC11260243 DOI: 10.1002/cncr.35305] [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: 11/20/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Embryonal sarcoma of the liver (ESL) is a rare mesenchymal tumor most common in childhood; the optimal treatment approach is uncertain. The clinical features and outcomes of patients with ESL enrolled in a Children's Oncology Group (COG) clinical trial that evaluated a risk-based strategy for treating soft tissue sarcomas in patients aged <30 years were evaluated. METHODS This subset analysis included patients with ESL enrolled in COG study ARST0332. Central review of records, pathology, and imaging confirmed the diagnosis, presenting features, and surgery extent and complications. All patients received dose-intensive ifosfamide/doxorubicin chemotherapy, with cycle timing dependent on surgery and radiotherapy. Tumor resection occurred before study entry or after four cycles of chemotherapy; radiotherapy for residual tumor was optional. RESULTS Thirty-nine eligible/evaluable patients with ESL were analyzed. All tumors were >10 cm in diameter; four were metastatic. Tumor resection was performed upfront in 23 and delayed in 16. Positive surgical margins (n = 6) and intraoperative tumor rupture (n = 6) occurred only in upfront resections. Eight patients received radiotherapy. Estimated 5-year event-free and overall survival were 79% (95% confidence interval [CI], 65%-93%) and 95% (95% CI, 87%-100%), respectively. Positive margins increased the local recurrence risk. One of 13 patients with documented hemorrhagic ascites and/or tumor rupture developed extrahepatic intra-abdominal tumor recurrence. CONCLUSIONS The treatment strategy used in ARST0332 achieved favorable outcomes for patients with ESL despite a substantial proportion having high-risk disease features. Deferring tumor resection until after neoadjuvant chemotherapy may decrease the risk of intraoperative tumor rupture and improve the likelihood of adequate surgical margins.
Collapse
Affiliation(s)
- Sheri L. Spunt
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Wei Xue
- Department of Biostatistics, University of Florida College of Public Health and Health Professions and College of Medicine, Gainesville, FL
| | - Zhengya Gao
- Department of Biostatistics, University of Florida College of Public Health and Health Professions and College of Medicine, Gainesville, FL
| | - Andrea Hayes Dixon
- Department of Surgery, Howard University College of Medicine, Washington, DC
| | - Lynn Million
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA
| | | | - Sanjeev A. Vasudevan
- Department of Surgery, Division of Pediatric Surgery, Texas Children’s Hospital, Baylor College of Medicine
| | - Simon C. Kao
- Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA
| | - M. Beth McCarville
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN
| | - David M. Parham
- Department of Pathology and Laboratory Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Donald A. Barkauskas
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Zhongjie Cai
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Carrye Cost
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Leo Mascarenhas
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA and Cancer and Blood Disease Institute, Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Aaron R. Weiss
- Department of Pediatrics, Maine Medical Center, Portland, ME
| |
Collapse
|
2
|
Liu J, Chang X, Xiao G, Zhong J, Huang B, Zhang J, Gao B, Peng G, Nie X. Case report: Undifferentiated sarcoma with multiple tumors involved in Lynch syndrome: Unexpected favorable outcome to sintilimab combined with chemotherapy. Front Oncol 2022; 12:1014859. [DOI: 10.3389/fonc.2022.1014859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022] Open
Abstract
BackgroundPatients with Lynch syndrome are at an increased risk of developing simultaneous or metachronous tumors, while sarcomas have been occasionally reported. Sarcomas are generally not considered part of the common Lynch syndrome tumor spectrum. However, more and more studies and case reports suggested that sarcoma could be a rare clinical manifestation of Lynch syndrome, leading to new treatment strategies for sarcoma.Case summaryWe report the case of a 74-year-old male patient with Lynch syndrome who had rectal mucinous adenocarcinoma and prostate adenocarcinoma and then developed undifferentiated sarcoma of the left neck two years later. Mismatch repair deficiency (dMMR) was confirmed by immunohistochemical staining for the mismatch repair proteins MSH2, MSH6, MLH1 and PMS2. The result of polymerase chain reaction (PCR) microsatellite instability (MSI) testing of sarcoma showed high-level microsatellite instability (MSI-H). Additionally, a pathogenic germline mutation in MSH2 (c.2459-12A>G) was detected by next-generation sequencing (NGS). Taking into account HE morphology, immunohistochemical phenotype, MSI status, NGS result, medical history and germline MSH2 gene mutation, the pathological diagnosis of left neck biopsy tissue was Lynch syndrome related undifferentiated sarcoma with epithelioid morphology. The patient has been receiving immunotherapy (sintilimab) combined with chemotherapy (tegafur, gimeracil and oteracil potassium capsules) and currently has stable disease. We also reviewed the literature to understand the association between sarcoma and Lynch syndrome.ConclusionSarcoma may now be considered a rare clinical manifestation of Lynch syndrome. Attention and awareness about the association between Lynch syndrome and sarcoma need to be increased. Therefore, timely detection of MMR proteins and validation at the gene level for suspicious patients are the keys to avoiding missed or delayed diagnosis and to identifying patients suited for immunotherapy, which may also help to provide appropriate genetic counseling and follow-up management for patients.
Collapse
|
3
|
Mori A, Fukase K, Masuda K, Sakata N, Mizuma M, Ohtsuka H, Morikawa T, Nakagawa K, Hayashi H, Motoi F, Naitoh T, Murakami K, Unno M. A case of adult undifferentiated embryonal sarcoma of the liver successfully treated with right trisectionectomy: a case report. Surg Case Rep 2017; 3:19. [PMID: 28144858 PMCID: PMC5285294 DOI: 10.1186/s40792-017-0295-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/24/2017] [Indexed: 12/14/2022] Open
Abstract
Background Undifferentiated embryonal sarcoma of the liver (UESL) is a rare malignant mesenchymal tumor that usually occurs in children and is rarely diagnosed in adults. Case presentation Here, we describe the case of a 65-year-old woman who presented with a huge cystic lesion in the liver. Laboratory studies performed on admission showed modest inflammation, poor nutrition, and elevated levels of total bilirubin, alkaline phosphatase, and γ-glutamyl transferase. Computed tomography showed a well-defined, heterogeneous tumor with multiple cysts involving the right lobe and the medial segment of the liver, with a maximum diameter of 16 cm. Positron emission tomography/computed tomographic scans showed the uptake of 2-(fluorine-18)-fluoro-2-deoxy-d-glucose in a part of the cyst. The patient was diagnosed with mucinous cystadenocarcinoma or sarcoma of the liver and underwent right trisectionectomy. Histopathological studies revealed that the tumor was composed of pleomorphic and polynuclear dyskaryotic cells with eosinophilic globules in the cytoplasm. Mesenchymal hamartoma-like tissue was observed in the peripheral part of the tumor. Immunohistochemical analyses showed the tumor stained with vimentin, α-smooth muscle actin, desmin, α1-antitrypsin, and α1-antichymotripsin. Therefore, a histological diagnosis of UESL was made. Eighteen months following treatment, two recurrent tumors in the remnant liver were detected and resection of the recurrent tumors was performed. Conclusions A UESL should be considered in the differential diagnosis of large cystic hepatic lesions. Although the prognosis of UESL is extremely unfavorable, aggressive surgical resection should be the most important factor for ensuring long-term survival.
Collapse
Affiliation(s)
- Akiko Mori
- Department of Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Koji Fukase
- Department of Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Kunihiro Masuda
- Department of Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Naoaki Sakata
- Department of Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Masamichi Mizuma
- Department of Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Hideo Ohtsuka
- Department of Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Takanori Morikawa
- Department of Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Kei Nakagawa
- Department of Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Hiroki Hayashi
- Department of Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Fuyuhiko Motoi
- Department of Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Takeshi Naitoh
- Department of Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Keigo Murakami
- Department of Pathology, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
| |
Collapse
|
4
|
Techavichit P, Masand PM, Himes RW, Abbas R, Goss JA, Vasudevan SA, Finegold MJ, Heczey A. Undifferentiated Embryonal Sarcoma of the Liver (UESL): A Single-Center Experience and Review of the Literature. J Pediatr Hematol Oncol 2016; 38:261-8. [PMID: 26925712 DOI: 10.1097/mph.0000000000000529] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Undifferentiated embryonal sarcoma of the liver (UESL) is a rare and aggressive pediatric malignancy. The purpose of this study was to review the clinical, radiologic, and pathologic features and outcome of children with UESL at our institution, in the United Network of Organ Sharing database and to review the existing literature to define the state of the art for children with UESL. Six children were diagnosed with UESL at the Texas Children's Cancer Center between 1993 and 2014, 12 children underwent liver transplantation registered in the United Network of Organ Sharing database, and 198 children with UESL were described in 23 case series during 1978 to 2014. Patients were treated with multimodal treatment approaches including primary surgical resection, neoadjuvant and/or adjuvant chemotherapy, and liver transplantation resulting in overall survival reported between 20% and 100% with significant improvement over the recent years. We show that complete tumor removal remains the key element of treatment and our single-institutional experience and data in the published literature suggest that combination chemotherapy with ifosfamide and doxorubicin to facilitate complete surgical resection is an effective approach to cure children with UESL.
Collapse
Affiliation(s)
- Piti Techavichit
- *Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand Departments of †Radiology ‡Pediatrics, Section Gastroenterology §Surgery ∥Pathology ¶Pediatrics, Section Hematology and Oncology, Baylor College of Medicine, Houston, TX
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Srinivasa S, Lee WG, Aldameh A, Koea JB. Spontaneous hepatic haemorrhage: a review of pathogenesis, aetiology and treatment. HPB (Oxford) 2015; 17:872-80. [PMID: 26252245 PMCID: PMC4571754 DOI: 10.1111/hpb.12474] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 06/11/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND A spontaneous hepatic haemorrhage (SHH) is a rare condition that presents acutely to both hepatobiliary and general surgeons. Management of the condition is challenging because of the emergent presentation requiring immediate intervention, the presence of underlying chronic liver disease and the multiple potential underlying aetiological conditions. METHODS A literature search on a spontaneous hepatic haemorrhage was instituted on Medline (1966-2014), Cochrane Register of Controlled Trials, EMBASE (1947-2014), PubMed, Web of Science and Google Scholar. The specific topics of interest were causes - including rare causes, pathophysiological mechanisms and management options. A narrative review was planned from the outset. RESULTS After 1546 abstracts were reviewed, 74 studies were chosen for inclusion. Hepatocellular carcinoma (HCC) is the commonest cause of a spontaneous haemorrhage with 10% of HCC presenting with bleeding. Other causes are benign hepatic lesions (hemangioma, adenoma, focal nodular hyperplasia, nodular regenerative hyperplasia, biliary cystadenoma and angiomyelolipoma), malignant hepatic tumours (angiosarcoma, haemangioendothelioma, hepatoblastoma and rhabdoid sarcoma), peliosis hepatis, amyloid, systemic lupus erythematosis, polyarteritis nodosa, HELLP syndrome and acute fatty liver of pregnancy. Treatment practice emphasizes arterial embolization to obtain haemostasis with a hepatectomy reserved for tumour-bearing patients after staging and assessment of liver function. CONCLUSION A spontaneous hepatic haemorrhage is an acute presentation of a spectrum of conditions that requires early diagnosis and multidisciplinary management.
Collapse
Affiliation(s)
- Sanket Srinivasa
- The Department of Surgery, North Shore HospitalTakapuna, Auckland, New Zealand
| | - Wai G Lee
- The Department of Surgery, North Shore HospitalTakapuna, Auckland, New Zealand
| | - Ali Aldameh
- The Department of Surgery, North Shore HospitalTakapuna, Auckland, New Zealand
| | - Jonathan B Koea
- The Department of Surgery, North Shore HospitalTakapuna, Auckland, New Zealand
| |
Collapse
|
6
|
Abstract
PURPOSE Embryonal sarcoma accounts for 6 % of liver tumors. This study reviews its features and the results of treatment in a referral center. METHODS We retrospectively reviewed liver tumors treated between 1995 and 2011. PRETEXT staging and biopsy were used to tailor chemotherapy according to SIOP protocols. Radical surgery was performed when possible. Complications and cumulative survival were the outcome endpoints. RESULTS Six out of 156 primary liver tumors (four males and two females) were sarcomas. The mean age at diagnosis was 81 ± 8.5 months. The most frequent finding was abdominal mass. Alfa-fetoprotein was normal. Imaging depicted heterogeneous tumors with septa, necrosis, and hemorrhagic areas. The diagnosis was ascertained by biopsy. Three tumors were located in the right lobe (PRETEXT II): two were bilobar (PRETEXT III) and one was in the left lobe (PRETEXT I). Two children had metastases at diagnosis and high-risk chemotherapy (vincristine, carboplatin, epirubicin) was administered with poor response. They died without operation 4 and 10 months later. Four patients with local disease underwent typical liver resections after chemotherapy (iphosphamide, vincristine, actinomycin D, and doxorrubicin). Overall actuarial survival at 70 months was 66.6 %. CONCLUSIONS Extended and metastatic embryonal sarcoma do poorly whereas localized tumors amenable to complete surgical removal after chemotherapy can cure.
Collapse
|
7
|
Rare case of adult undifferentiated (embryonal) sarcoma of the liver treated with liver transplantation: excellent long-term survival. Case Reports Hepatol 2012; 2012:519741. [PMID: 25374706 PMCID: PMC4208439 DOI: 10.1155/2012/519741] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Accepted: 08/22/2012] [Indexed: 12/14/2022] Open
Abstract
We present the case of a 54-year-old gentleman who presented with abdominal distension and a CT scan of his abdomen revealed a large (25 cm) left hepatic lobe tumor. He received chemotherapy for over 1.5 years. The CT scans at the completion of this therapy revealed that the tumor had actually slightly grown in size. He underwent orthotopic liver transplantation without any major complications. The explant histopathology revealed an undifferentiated embryonal cell sarcoma (UECS) composed of relatively bland spindled cells arranged in short fascicles. It is now 10 years and 3 months since his last transplant and the patient remains well with no tumor recurrence.
Collapse
|
8
|
Shattaf A, Jamil A, Khanani MF, El-Hayek M, Baroudi M, Trad O, Ishaqi MK. Undifferentiated sarcoma of the liver: a rare pediatric tumor. Ann Saudi Med 2012; 32:203-5. [PMID: 22366834 PMCID: PMC6086650 DOI: 10.5144/0256-4947.2012.203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Undifferentiated embryonal sarcoma of the liver (UESL) is an uncommon hepatic tumor of mesenchymal origin recognized as a unique clinicopathologic entity since 1978. UESL has historically been considered an aggressive neoplasm with an unfavorable prognosis. Survival has improved using recent multimodal approaches, designed for patients with soft tissue sarcomas at other sites. Several small series have reported survival of up to 70% of children. We report a case of a 12-year-old boy from the United Arab Emirates who relapsed after complete surgical resection and was then successfully treated with re-resection followed by chemotherapy and radiotherapy. With a follow-up of 5 years, he is well and asymptomatic, and is leading a healthy life. This case emphasizes the fact that these poorly prognostic tumors may benefit from post-surgery chemotherapy. This case illustrates the improved survival of UESL patients following the multimodality therapy with a relatively long follow-up. This is the first case of UESL reported in this region of the world.
Collapse
Affiliation(s)
- Aysha Shattaf
- Division of Pediatric Hematology and Oncology, Tawam Hospital, Al-Ain, United Arab Emirates
| | | | | | | | | | | | | |
Collapse
|
9
|
Wei ZG, Tang LF, Chen ZM, Tang HF, Li MJ. Childhood undifferentiated embryonal liver sarcoma: clinical features and immunohistochemistry analysis. J Pediatr Surg 2008; 43:1912-9. [PMID: 18926232 DOI: 10.1016/j.jpedsurg.2008.06.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2008] [Revised: 06/14/2008] [Accepted: 06/17/2008] [Indexed: 12/18/2022]
Abstract
PURPOSE The aim of the study was to report on 3 cases of childhood undifferentiated embryonal liver sarcoma (UELS) and to highlight the clinical features, laboratory findings, diagnosis, and management of this rare disease. METHODS The patients' age, sex, clinical features, laboratory findings, pathologic results, and therapy were reviewed. Immunohistochemistry analysis was performed on the resected mass sections. RESULTS In this study, 2 cases were female (aged 8 and 12 years) and 1 was male (aged 9 years). The causes of hospitalization were mainly abdominal pain, mass, or fever. An elevated erythrocyte sedimentation rate was noted in 2 available cases, and alpha fetoprotein (AFP) was within the normal range. Imaging findings indicated a well-defined heterogeneous large mass in the right lobe. Histopathologic evaluation of the mass confirmed the diagnosis of UELS. Immunohistochemical staining showed that vimentin and CD68 antigen were positive in all samples, whereas desmin was positive in one sample. Surgery with chemotherapy was performed in 2 cases. CONCLUSION The diagnosis of UELS depends mainly on the pathologic findings. Undifferentiated embryonal liver sarcoma should be included in the differential diagnosis of mass in the liver, especially with well-defined heterogeneous imaging findings and normal AFP. Diagnosis and management should be made early as UELS is a potentially treatable tumor.
Collapse
Affiliation(s)
- Zhong Gu Wei
- Department of Pathology, The Children's Hospital of Zhejiang University School of Medicine, 57 Zhugan Xiang, Hangzhou 310003, China
| | | | | | | | | |
Collapse
|
10
|
Jiménez Fuertes M, López Andújar R, de Juan Burgueño M, Moya Herráiz A, Sanjuán Rodríguez F, Montalvá Orón E, Pareja Ibars E, Mir Pallardó J. [Hepatic undifferentiated (embryonal) sarcoma in an adult: a case report and literature review]. GASTROENTEROLOGIA Y HEPATOLOGIA 2008; 31:12-7. [PMID: 18218274 DOI: 10.1157/13114564] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Undifferentiated (embryonal) sarcoma of the liver (USL) is a rare malignant hepatic tumor in adults. We report the case of a 40-year-old man with USL who was successfully treated with surgical resection and chemotherapy using ifosfamide and adriamycin. To our knowledge, only 70 cases of USL in adults have been reported worldwide in the 40 years since this clinicopathological entity was defined. Although the prognosis of the disease remains generally poor, long term survival has been achieved in patients with a combination of surgery and chemotherapy.
Collapse
Affiliation(s)
- Montiel Jiménez Fuertes
- Unidad de Cirugía y Trasplante Hepatobiliopancreático, Hospital Universitario La Fe, Valencia, España.
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Kiani B, Ferrell LD, Qualman S, Frankel WL. Immunohistochemical analysis of embryonal sarcoma of the liver. Appl Immunohistochem Mol Morphol 2007; 14:193-7. [PMID: 16785789 DOI: 10.1097/01.pai.0000173052.37673.95] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Embryonal sarcoma of the liver is a rare, aggressive malignant tumor that typically occurs in children and teenagers. Microscopic features include spindle, oval, or stellate cells with poorly defined cell borders, nuclear pleomorphism and multinucleation, and variable immunoreactivity to cytokeratin, vimentin, and alpha-1-antitrypsin. Intracellular and extracellular PAS-positive, diastase-resistant hyaline globules are commonly present. The authors evaluated a panel of IHC stains to better define the pattern of immunoreactivity in this tumor. Embryonal sarcomas of the liver were identified from archival files and were immunostained with antibodies: cytokeratin AE1/3, hepatocyte, SMMS, myogenin, calponin, h-caldesmon, desmin, S100, vimentin, CD34, C-kit (CD117), CD10, ALK-1, PE10, Bcl2, p53, and Ki-67. Six cases were identified. Patient age ranged from 6 to 24 years. Tumors ranged from 10 to 20 cm and contained spindled and epithelioid areas with PAS-positive, diastase-resistant globules and atypical cells with focal multinucleation. All cases showed immunoreactivity with vimentin and five showed immunoreactivity with Bcl2. Focal immunoreactivity was seen with cytokeratin AE1/3 in three cases, CD10 in four, calponin in two, desmin in one, and p53 in four. All tumors were negative with hepatocyte, myogenin, CD34, SMMS, h-caldesmon, PE10, ALK-1, and S100. No cytoplasmic staining was seen with C-kit. The proliferation index ranged from 30% to 95%. The diagnosis of embryonal sarcoma is based on typical morphologic features in a large liver tumor occurring in a young patient. The most useful IHC stains help to exclude tumors such as hepatoblastoma, hepatocellular carcinoma, embryonal rhabdomyosarcoma, and other sarcomas.
Collapse
Affiliation(s)
- Bahram Kiani
- Department of Pathology, Ohio State University Medical Center, Columbus, OH, USA
| | | | | | | |
Collapse
|
12
|
Chat L, Mahi M, Chellaoui M, Khattab M, Benamour-Ammar H. [Embryonal rhabdomyosarcoma of the liver: an unusual site of origin]. JOURNAL DE RADIOLOGIE 2007; 88:72-4. [PMID: 17299371 DOI: 10.1016/s0221-0363(07)89793-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
|
13
|
Bisogno G, Pilz T, Perilongo G, Ferrari A, Harms D, Ninfo V, Treuner J, Carli M. Undifferentiated sarcoma of the liver in childhood: a curable disease. Cancer 2002; 94:252-7. [PMID: 11815984 DOI: 10.1002/cncr.10191] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Undifferentiated (embryonal) sarcoma of the liver (UESL) is a rare childhood hepatic tumor, and it is generally considered an aggressive neoplasm with an unfavorable prognosis. METHODS The Soft Tissue Sarcoma Italian and German Cooperative Groups enrolled 17 children with UESL in studies conducted between 1979 and 1995. They were treated using the same multimodal approach as for patients with sarcomas including conservative surgery at diagnosis, multiagent chemotherapy, and second-look operation in cases of residual disease. Radiotherapy was occasionally used (2 of 17 patients). RESULTS Twelve patients are alive with follow-up ranging from 2.4 to 20 years. Eight underwent complete tumor resection either at diagnosis or after preoperative chemotherapy, and all are currently alive. After initial chemotherapy tumor reduction was evident in six of nine evaluable cases. Overall three patients died of disease and one of a surgical complication. One child died in second complete remission for a non-disease-related cause. CONCLUSIONS The current prognosis of UESL no longer should be regarded as poor. Modern multimodal treatment and supportive therapy have improved survival.
Collapse
Affiliation(s)
- Gianni Bisogno
- Pediatric Oncology-Hematology Division, University of Padova, Padova, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Abstract
Primary angiosarcoma of the liver accounts for up to 2% of all primary liver tumors and is the second most common primary malignant neoplasm of the liver. Approximately 10 to 20 new cases are diagnosed every year in the United States and the prevalence varies from 0.14 to 0.25 per million. In an autopsy series from Chicago, one hepatic angiosarcoma was noted for every 30 cases of hepatocellular carcinoma.
Collapse
Affiliation(s)
- H Mani
- Department of Pathology, Indian Navy Health Service, Asvini, Colaba, Mumbai, India
| | | |
Collapse
|
15
|
Pollono DG, Drut R. Undifferentiated (embryonal) sarcoma of the liver: fine-needle aspiration cytology and preoperative chemotherapy as an approach to diagnosis and initial treatment. A case report. Diagn Cytopathol 1998; 19:102-6. [PMID: 9702485 DOI: 10.1002/(sici)1097-0339(199808)19:2<102::aid-dc6>3.0.co;2-g] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The present report describes the case of a 9-year-old girl with an undifferentiated (embryonal) sarcoma of the liver diagnosed by fine-needle aspiration cytology (FNAC). The smears revealed pleomorphic cells, some with cytoplasmic vacuoles and eosinophilic inclusions, as well as spindle cells and myxoid tissue, cytologic features which appear to be distinctive from any other malignant tumor of the liver. Preoperative chemotherapy was then given using a protocol for high-grade soft-tissue sarcomas (MMT95 953 branch B, SIOP). This scheme induced very good response allowing complete surgery 8 months after diagnosis. The patient is alive and well 11 months after surgery. The combined FNAC-preoperative chemotherapy approach may prove useful for this highly malignant tumor.
Collapse
Affiliation(s)
- D G Pollono
- Unidad de Oncología, Hospital de Niños Superiora Sor María Ludovica, La Plata, Argentina
| | | |
Collapse
|
16
|
Joshi SW, Merchant NH, Jambhekar NA. Primary multilocular cystic undifferentiated (embryonal) sarcoma of the liver in childhood resembling hydatid cyst of the liver. Br J Radiol 1997; 70:314-6. [PMID: 9166061 DOI: 10.1259/bjr.70.831.9166061] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Undifferentiated (embryonal) sarcoma (UES) is a very rare primary malignant tumour of the liver; typically presenting in later childhood. This tumour usually appears on CT and ultrasound as a predominantly solid mass with or without cystic areas. We report a case of primary UES which had a multilocular cystic appearance resembling a hydatid cyst on imaging.
Collapse
Affiliation(s)
- S W Joshi
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel Mumbai India
| | | | | |
Collapse
|
17
|
Sola-Pérez J, Pérez-Guillermo M, Giménez-Bascuñana A, Garre-Sánchez C. Cytopathology of undifferentiated (embryonal) sarcoma of the liver. Diagn Cytopathol 1995; 13:44-51. [PMID: 7587875 DOI: 10.1002/dc.2840130110] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We have studied one undifferentiated (embryonal) sarcoma of the liver (USL) by fine-needle aspiration cytology (FNAC) and have correlated the cytologic findings with those seen in the histologic sections. The main cytologic and immunocytochemical features were: cellular aspirates, mesenchymal clusters, disparity in individual cell size (small round cells, and multinucleated giant cells, sometimes bizarre), absence of biliary pigment, AFP-negative and vimentin-negative tumor cells, AFP-negative and PAS-positive hyaline globules, and apoptotic cells. Only immunostaining for alpha-1-antitrypsin, alpha-1-antichymotrypsin, and carcinoembryonic antigen were positive in tumor cells in histologic sections. The differential diagnosis should be carried out with rhabdomyosarcomas, hepatoblastomas, malignant fibrous histiocytomas, and poorly differentiated hepatocarcinomas. We think that the cytologic features observed in this case, evaluated both in the appropriate clinical context and in the light of the laboratory findings, may permit the correct diagnosis of this infrequent liver tumor. Nevertheless, more cases need to be studied to assess the reliability of our findings.
Collapse
Affiliation(s)
- J Sola-Pérez
- Department of Pathology, Arrixaca University Hospital, El Palmar, Murcia, Spain
| | | | | | | |
Collapse
|
18
|
Moon WK, Kim WS, Choi BI, Kim IO, Yeon KM, Han MC. Undifferentiated embryonal sarcoma of the liver treated with chemotherapy: CT imaging in four patients. ABDOMINAL IMAGING 1995; 20:133-7. [PMID: 7787716 DOI: 10.1007/bf00201521] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND The purpose of this study was to describe the computed tomography (CT) findings of undifferentiated embryonal sarcoma after chemotherapy and to correlate the CT imaging findings with pathologic findings. METHODS Ten CT images obtained before and after chemotherapy in four patients with hepatic undifferentiated embryonal sarcoma were retrospectively reviewed and correlated with pathologic findings. RESULTS After chemotherapy, tumor volume decreased by 50-90% and initially nonresectable tumor or gross residual tumor was successfully excised in three patients. In all patients, enhancing peripheral solid portions and septations changed to low-attenuation areas, and in three patients increased or de novo calcifications were found at the periphery of the tumor. Resected pathologic specimen after chemotherapy showed well-encapsulated masses with central necrosis, fibrosis, and dystrophic calcifications. CONCLUSIONS These CT findings will be useful in monitoring the treatment response of hepatic undifferentiated embryonal sarcoma during chemotherapy.
Collapse
Affiliation(s)
- W K Moon
- Department of Radiology, Seoul National University College of Medicine, Republic of Korea
| | | | | | | | | | | |
Collapse
|
19
|
Babin-Boilletot A, Flamant F, Terrier-Lacombe MJ, Marsden HB, van Unnik A, Deméocq F, Zucker JM, Voûte PA, Otten J, Behar C. Primitive malignant nonepithelial hepatic tumors in children. MEDICAL AND PEDIATRIC ONCOLOGY 1993; 21:634-9. [PMID: 8412995 DOI: 10.1002/mpo.2950210905] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Primary intrahepatic malignant nonepithelial tumors are very rare in children and account for 2% of all malignant mesenchymatous tumors under the age of 15 years. Clinical presentation, radiologic features, and histologic types are not unequivocal. The predominant role of surgery takes place either initially in small localized tumors or later, after initial reductive chemotherapy. In all cases, complete resection is the necessary but not sufficient condition for cure. Additional radiotherapy seems ineffective. High-dose chemotherapy and/or liver transplantation can be proposed for resistant cases. The disease-free survival rate is 37% at 2 years for the whole series.
Collapse
Affiliation(s)
- A Babin-Boilletot
- Service d'Onco-Hematologie, Centre Hospitalier Régional, Strasbourg, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Tozzi MC, Tarani L, Di Nardo R, Bruni L, Cappelli C, Funaro G, Cozzi F, Vignetti P. The hepatic malignant mesenchymoma: a case report. Eur J Pediatr 1992; 151:488-91. [PMID: 1396908 DOI: 10.1007/bf01957750] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We report a case of hepatic mesenchymoma in an 8-year-old girl who presented with abdominal pain and ultrasonographic diagnosis of hepatic echinococcosis. Due to the good general condition of the patient and the diagnostic confirmation of liver hydatid disease by the CT scan, antiparasitic therapy with albendazole was started. After 1 month of therapy the girl's general condition worsened as did the ultrasonographic picture. On laparatomy a large cystic mass was observed within the right hepatic lobe and was removed. Pathological examination of the mass excluded an echinococcal cyst and demonstrated a malignant hepatic mesenchymoma.
Collapse
Affiliation(s)
- M C Tozzi
- Fifth Paediatric Department, University of Rome, Italy
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Walker NI, Horn MJ, Strong RW, Lynch SV, Cohen J, Ong TH, Harris OD. Undifferentiated (embryonal) sarcoma of the liver. Pathologic findings and long-term survival after complete surgical resection. Cancer 1992; 69:52-9. [PMID: 1727675 DOI: 10.1002/1097-0142(19920101)69:1<52::aid-cncr2820690111>3.0.co;2-l] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Undifferentiated (embryonal) sarcoma of liver is a rare tumor with a reputed poor prognosis. Four patients with this tumor are reported, of whom three were alive without recurrence 1.5, 2.5, and 12 years after initial complete surgical resection, and two of whom received no adjuvant therapy. The fourth patient, in whom complete surgical resection of tumor was not achieved, died with recurrent tumor at 13 months. The latter tumor differed histologically and consisted mainly of closely packed smaller undifferentiated cells with a higher mitotic and apoptotic rate. Eosinophilic globules, characteristic of embryonal sarcoma, were found in some cases to contain condensed nuclear chromatin, evidence of origin from tumor cells dying by apoptosis. One tumor mainly contained large cysts lined by biliary-type epithelium; this suggested an origin from a multipotent precursor cell able to differentiate along both stromal and epithelial lines.
Collapse
Affiliation(s)
- N I Walker
- Department of Pathology, Princess Alexandra Hospital, Brisbane, Australia
| | | | | | | | | | | | | |
Collapse
|
22
|
Kadomatsu K, Nakagawara A, Zaizen Y, Nagoshi M, Tsuneyoshi M, Fukushige T, Haigou A, Suita S. Undifferentiated (embryonal) sarcoma of the liver: report of three cases. Surg Today 1992; 22:451-5. [PMID: 1421867 DOI: 10.1007/bf00308797] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Undifferentiated (embryonal) sarcoma is a rare malignant tumor of the liver. It typically presents in late childhood and its prognosis is poor. We experienced three cases of such a tumor during the period of 1976-1989; two of these patients are still alive without disease. Each case was independently treated with a combination of surgery and pre- and/or postoperative chemotherapy, which was found to be effective. In one surviving patient, cyclophosphamide and vincristine were found to be effective, while in the other a combination of cisplatin, Adriamycin (ADM), vincristine and cyclophosphamide was observed to induce a rapid reduction in the size of the recurrent tumor. Thus, an adequate combination of surgery and chemotherapy may improve the prognosis of this tumor.
Collapse
Affiliation(s)
- K Kadomatsu
- Department of Pediatric Surgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 19-1990. A 12-year-old boy with a long travel history and a hepatic mass. N Engl J Med 1990; 322:1378-85. [PMID: 2325736 DOI: 10.1056/nejm199005103221908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
24
|
Pritchard J, Malone M. "Liver mass in a 4 year old child:....." by Applebaum et al. MEDICAL AND PEDIATRIC ONCOLOGY 1990; 18:87. [PMID: 1688463 DOI: 10.1002/mpo.2950180119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
25
|
Leuschner I, Schmidt D, Harms D. Undifferentiated sarcoma of the liver in childhood: morphology, flow cytometry, and literature review. Hum Pathol 1990; 21:68-76. [PMID: 2403976 DOI: 10.1016/0046-8177(90)90077-i] [Citation(s) in RCA: 85] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Nine cases of undifferentiated sarcoma of the liver in childhood were investigated by conventional light microscopy, immunohistochemistry, and DNA flow cytometry. Different histologic patterns were discernible. In some cases, areas resembling poorly differentiated rhabdomyosarcoma were present. This histologic diversity was supported by the immunohistologic detection of desmin and cytokeratins in five cases. When evaluated by flow cytometry, four of five cases investigated were diploid; only one was aneuploid, and this patient had the most aggressive course. Follow-up investigations of our patients and those described in the literature revealed that the prognosis of this type of tumor is not as bad as is generally assumed. Of the patients reported in the literature with detailed follow-up information, 37.5% survived without evidence of disease for an average of 37.5 months, death occurred in 47.5% after an average of 11.9 months, and 15.0% were alive with disease.
Collapse
Affiliation(s)
- I Leuschner
- Institut für Pathologie, Universität Kiel, FRG
| | | | | |
Collapse
|
26
|
Chou P, Mangkornkanok M, Gonzalez-Crussi F. Undifferentiated (embryonal) sarcoma of the liver: ultrastructure, immunohistochemistry, and DNA ploidy analysis of two cases. PEDIATRIC PATHOLOGY 1990; 10:549-62. [PMID: 2371180 DOI: 10.3109/15513819009067143] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We describe the histopathologic, immunohistochemical, electronmicroscopic features, and DNA flow cytometric analysis of 2 cases of undifferentiated (embryonal) sarcoma of the liver. The tumor cells were found to be uniformly nonreactive to antibodies that identify cells belonging to the macrophagic-monocytic system. Focal expression of cytokeratin was an unexpected finding. We conclude that the observations are compatible with origin of this sarcoma from primitive mesenchyme. Uncertainty still exists about histogenesis, but the morphologic features of this neoplasm are quite characteristic. Both tumors demonstrate aneuploid stem lines with high S phase. Whether these findings are prognostically significant remains to be seen.
Collapse
Affiliation(s)
- P Chou
- Department of Pathology, Northwestern University, Chicago, Illinois 60614
| | | | | |
Collapse
|
27
|
Miettinen M, Kahlos T. Undifferentiated (embryonal) sarcoma of the liver. Epithelial features as shown by immunohistochemical analysis and electron microscopic examination. Cancer 1989; 64:2096-103. [PMID: 2680050 DOI: 10.1002/1097-0142(19891115)64:10<2096::aid-cncr2820641021>3.0.co;2-e] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The cell differentiation properties of two undifferentiated (embryonal) sarcomas of the liver (USL), one in a 9-year-old boy and one in a 23-year-old man, were studied by immunohistochemistry and electron microscopic examination. Both tumors showed a part pleomorphic pattern and a part myxoid spindle cell sarcomatous pattern. An electron microscopic examination showed some tonofilament-like bundles of intermediate filaments and cell junctions in one case, suggesting the presence of epithelial differentiation in that tumor. An immunohistochemical analysis showed a large number of cytokeratin-positive neoplastic cells in both cases as studied with two different monoclonal antibodies, and most cells were positive for vimentin. No cells showed desmin, glial fibrillary acidic protein, or epithelial membrane antigen (EMA). Due to the presence of cytokeratin immunoreactivity, the possibility was considered that these tumors would represent anaplastic sarcomatoid variants of hepatocellular carcinoma. The tumor cells showed cytoplasmic alpha-1-antitrypsin (AAT) positivity, and were negative for alpha-fetoprotein. Because the immunoreactivity of AAT is widespread in different types of tumors, it is not possible to conclude that the AAT positivity would indicate the hepatoma nature of USL; however, this remains a possibility, especially when considering that in vitro transformed hepatocytes have been shown to be capable of forming sarcomatous tumors.
Collapse
Affiliation(s)
- M Miettinen
- Department of Pathology, University of Helsinki, Finland
| | | |
Collapse
|
28
|
Steiner M, Bostrum B, Leonard AS, Dehner LP. Undifferentiated (embryonal) sarcoma of the liver. A clinicopathologic study of a survivor treated with combined technique therapy. Cancer 1989; 64:1318-22. [PMID: 2766226 DOI: 10.1002/1097-0142(19890915)64:6<1318::aid-cncr2820640625>3.0.co;2-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Undifferentiated (embryonal) sarcoma is one of the less common primary malignant tumors of the liver that typically, although not exclusively, presents in later childhood. It has come to be recognized as an aggressive neoplasm with the potential for local recurrence and distant metastasis, despite a seemingly successful total surgical resection. This report documents our experience with an 8-year-old boy who had an 80% hepatectomy for an undifferentiated (embryonal) sarcoma, followed by cisplatin (90 mg/m2), doxorubicin (20 mg/m2/d), and radiation therapy (1950 cGy) to the tumor bed. Residual microscopic tumor was very likely present in the region of the inferior vena cava, but exploratory laparotomies for the purpose of "second-look" biopsies were performed with negative results after the completion of each course of chemotherapy. The patient is off of treatment and disease-free 30 months after the diagnosis. Because the survival at this time has been so poor for this highly malignant tumor, we suggest that the combination of therapeutic techniques and second-look laparotomy(s) to identify any subclinical tumor may be a reasonable approach. Ultrastructural and immunohistochemical studies by us and other investigators indicate that the neoplastic cells are primitive mesenchymal cells by electron microscopic study and have immunoreactivity limited to vimentin, alpha-1-antitrypsin, and alpha-1-antichymotrypsin.
Collapse
Affiliation(s)
- M Steiner
- Department of Pediatrics, University of Minnesota Medical School, Hospital and Clinic, Minneapolis
| | | | | | | |
Collapse
|
29
|
Cancer in Childhood — Solid Tumours. Surg Oncol 1989. [DOI: 10.1007/978-3-642-72646-0_71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|