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Potterveld SK, Wang N, Sangoi AR. Upper Urothelial Tract Extraosseous Bone Formation: An Unexpected Finding and Differential Diagnostic Considerations. Int J Surg Pathol 2024; 32:1222-1225. [PMID: 38298018 DOI: 10.1177/10668969231221755] [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] [Indexed: 02/02/2024]
Abstract
Extraosseous bone formation of the upper urothelial tract is an unusual phenomenon with limited documentation in the uropathology literature, reported in only 2 clinical series of patients undergoing percutaneous nephrolithotomy for the management of renal stones. While speculations regarding the pathogenesis of this occurrence have been published, heterotopic ossification is still poorly understood. We report the finding of extraosseous bone formation in the renal pelvis of a 30-year-old male patient with a history of kidney stones. Histologic sections of the ureter and renal pelvis showed submucosal nodules of woven bone. Ancillary fluorescence in-situ hybridization studies were negative for MDM2 amplification and USP6 rearrangement.
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Affiliation(s)
| | - Nancy Wang
- Department of Urology, Palo Alto Medical Foundation, Mountain View, CA, USA
| | - Ankur R Sangoi
- Department of Pathology, Stanford Medical Center, Stanford, CA, USA
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2
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Vuong M, Mejbel HA, Mackinnon AC, Roden D, Suster DI. Nodular Fasciitis of the Buccal Mucosa with a Novel USP6 Gene Rearrangement: A Case Report and Review of the Literature. Head Neck Pathol 2024; 18:79. [PMID: 39167308 PMCID: PMC11339223 DOI: 10.1007/s12105-024-01687-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Accepted: 08/07/2024] [Indexed: 08/23/2024]
Abstract
Nodular fasciitis is a rare but benign fibroblastic proliferation that typically presents as a solitary lesion with rapid growth and variable mitotic activity. The lesions usually occur on the extremities and occasionally in the head/neck region. Involvement of the buccal mucosa is extremely rare with only few reports in the literature; in this case report, we describe a 41 year old female who presented with a 6-month history of a stable intraoral lump at the junction of the upper and lower lip. Fine needle aspiration revealed an atypical spindle cell population with plump cells. The surgical excision demonstrated a well circumscribed tan-white firm nodule. Histologic examination revealed a spindle cell proliferation that grew in short, intersecting fascicles with focal storiform architecture. The lesion had a pushing border that was not overtly infiltrative and the stroma contained focal myxoid changes giving a "tissue culture" appearance to the cells. Immunohistochemical testing showed the tumor cells were vimentin (+), SMA (+), weakly Calponin (+), and desmin (-), cytokeratin (-), AE1/AE3 (-), S100 (-), ALK (-), STAT6 (-), and beta-catenin (-). Fluorescence in-situ hybridization (FISH) revealed a USP6 gene rearrangement with an atypical probe pattern. Next generation sequencing identified a novel SPTAN1::USP6 fusion gene confirming the diagnosis of buccal nodular fasciitis. Identification of the characteristic histologic features and USP6 gene rearrangements helped support the diagnosis. A review of the literature identified 25 cases of nodular fasciitis involving the buccal mucosa. The occurrence of this tumor in an unusual location may pose difficulties for diagnosis.
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Affiliation(s)
- Mallissa Vuong
- Department of Pathology, Rutgers New Jersey Medical School, 150 Bergen Street, Newark, NJ, 07103, USA
| | | | | | - Dylan Roden
- Department of Otolaryngology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - David I Suster
- Department of Pathology, Rutgers New Jersey Medical School, 150 Bergen Street, Newark, NJ, 07103, USA.
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3
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Arcovito G, Crucitta S, Del Re M, Caporalini C, Palomba A, Nozzoli F, Franchi A. Recurrent USP6 rearrangement in a subset of atypical myofibroblastic tumours of the soft tissues: low-grade myofibroblastic sarcoma or atypical/malignant nodular fasciitis? Histopathology 2024; 85:244-253. [PMID: 38651320 DOI: 10.1111/his.15196] [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: 02/11/2024] [Revised: 03/24/2024] [Accepted: 04/06/2024] [Indexed: 04/25/2024]
Abstract
AIMS Low-grade myofibroblastic sarcoma (LGMS) is a rarely metastasizing myofibroblastic tumour mostly affecting extremities and the head and neck of adults. Histologically, it shows long infiltrative fascicles of spindle cells with moderate nuclear atypia. By immunohistochemistry, it stains positive for smooth muscle actin (SMA) and sometimes for desmin. To date, no recurrent genetic abnormalities have been described. Ubiquitin-specific peptidase 6 (USP6) gene rearrangement is typically found in some benign bone and soft-tissue tumours including nodular fasciitis (NF), among others. Nevertheless, rare cases of USP6-rearranged tumours resembling NF with atypical features have been reported. METHODS AND RESULTS One index case of LGMS of the deltoid in a 56-year-old man presented the THBS2::USP6 translocation by RNA sequencing (Archer FusionPlex Sarcoma v2 panel). Further screening of 11 cases of LGMS using fluorescent in situ hybridization (FISH) analysis with a USP6 break-apart probe identified two additional cases. These cases were investigated with RNA-sequencing, and a RRBP1::USP6 translocation was detected in one. The other case was not assessable because of low-quality RNA. Noteworthy, rearranged LGMSs presented distinctive features including variable multinodular/plexiform architecture, prominent vasculature with occasional wall thickening, scattered osteoclast-like multinucleated giant cells, and peripheral lymphoid aggregates. CONCLUSION Our findings support the notion that among soft-tissue neoplasms with fibroblastic/myofibroblastic phenotype, USP6 rearrangement is not limited to benign tumours, and warrants further investigation of genetic changes in myofibroblastic sarcomas.
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Affiliation(s)
- Giorgia Arcovito
- Section of Pathology, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Stefania Crucitta
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marzia Del Re
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Annarita Palomba
- Unit of Histopathology and Molecular Diagnostic, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Filippo Nozzoli
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Alessandro Franchi
- Section of Pathology, Department of Translational Research, University of Pisa, Pisa, Italy
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4
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Werenski JO, Hung YP, Chang CY, Nielsen GP, Lozano-Calderón SA. Myositis ossificans mimicking bone surface osteosarcoma: case report with literature review. APMIS 2024; 132:535-543. [PMID: 38741286 DOI: 10.1111/apm.13422] [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: 08/16/2023] [Accepted: 04/26/2024] [Indexed: 05/16/2024]
Abstract
Myositis ossificans, a benign tumor composed of spindle cells and osteoblasts, can clinically and radiologically mimic osteosarcoma. While recognition and accurate diagnosis of myositis ossificans can be a challenge, this is critical as it may allow a conservative surgical approach to maximize functional outcomes. Herein, we present a patient with surface myositis ossificans confirmed genetically by the presence of COL1A1::USP6 gene fusion, along with a literature review. Due to the enhanced visualization of the bone matrix, computed tomography (CT) imaging may be a superior imaging modality to magnetic resonance (MR) imaging. Staged biopsies with samples obtained from the periphery and center of the lesions may allow pathologists to discern the zonal distribution histologically. Furthermore, immunohistochemistry fluorescence in situ hybridization and molecular testing can aid in the distinction of myositis ossificans from mimics. Because of their resemblance to other bone tumors, these cases of myositis ossificans highlight the importance of a multidisciplinary approach integrating clinical, radiologic, and pathologic analysis and involving serial imaging, sampling, and judicious use of ancillary immunohistochemical and molecular testing.
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Affiliation(s)
- Joseph O Werenski
- Orthopaedic Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yin P Hung
- Division of Bone and Soft Tissue Pathology, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Connie Y Chang
- Division of Musculoskeletal Imaging & Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - G Petur Nielsen
- Division of Bone and Soft Tissue Pathology, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Santiago A Lozano-Calderón
- Orthopaedic Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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5
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Makise N, Lin J, Kageyama H, Kinoshita H, Kamoda H, Hagiwara Y, Oikawa M, Sugiyama T, Kawana H, Araki A, Yonemoto T, Kawazu M, Itami M. Nanopore DNA Sequencing Detected Chromothripsis-Induced PAFAH1B1::USP6 Rearrangement in Periosteal Solid Aneurysmal Bone Cyst Initially Diagnosed as Osteosarcoma. Genes Chromosomes Cancer 2024; 63:e23254. [PMID: 38979775 DOI: 10.1002/gcc.23254] [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: 05/03/2024] [Revised: 06/16/2024] [Accepted: 06/18/2024] [Indexed: 07/10/2024] Open
Abstract
An aneurysmal bone cyst (ABC) is a benign bone neoplasm that typically occurs during the first and second decades of life. ABC usually presents as a rapidly growing intramedullary expansile mass with multiple blood-filled cysts in the metaphysis of the long tubular bones. Here, we report a case of a periosteal solid ABC that was initially diagnosed as a high-grade surface osteosarcoma. A 10-year-old male was referred to our hospital for swelling and tenderness of the left upper arm. Radiography revealed periosteal mass without fluid-fluid levels. On performing open biopsy, the tumor showed hypercellular proliferation of uniform spindle to epithelioid cells with brisk mitotic activity (up to 12/2 mm2) and lace-like osteoid formation, which was diagnosed as a high-grade surface osteosarcoma. After one course of chemotherapy using adriamycin and cisplatin, peripheral sclerosis was conspicuous, which led to pathological review and revision of diagnosis as "possibly osteoblastoma." The patient was disease-free for 4 years after marginal resection and curettage. Retrospective nanopore DNA sequencing unexpectedly detected a PAFAH1B1::USP6 rearrangement. The fusion gene was further validated using reverse transcription-polymerase chain reaction and the diagnosis was revised to ABC. Chromothripsis involving chromosome 17 has also been identified. Methylation analysis classified the present tumor as an ABC or non-ossifying fibroma using t-distributed stochastic neighbor embedding and unsupervised hierarchical clustering. This case report highlights the utility of nanopore DNA sequencing for soft tissue and bone tumor diagnosis.
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Affiliation(s)
- Naohiro Makise
- Division of Surgical Pathology, Chiba Cancer Center, Chiba, Japan
| | - Jason Lin
- Division of Cell Therapy, Chiba Cancer Center, Chiba, Japan
| | - Hajime Kageyama
- Division of Surgical Pathology, Chiba Cancer Center, Chiba, Japan
| | | | - Hiroto Kamoda
- Department of Orthopedic Surgery, Chiba Cancer Center, Chiba, Japan
| | - Yoko Hagiwara
- Department of Orthopedic Surgery, Chiba Cancer Center, Chiba, Japan
| | - Mariko Oikawa
- Division of Surgical Pathology, Chiba Cancer Center, Chiba, Japan
| | | | - Hidetada Kawana
- Division of Surgical Pathology, Chiba Cancer Center, Chiba, Japan
| | - Akinobu Araki
- Division of Surgical Pathology, Chiba Cancer Center, Chiba, Japan
| | - Tsukasa Yonemoto
- Department of Orthopedic Surgery, Chiba Cancer Center, Chiba, Japan
| | | | - Makiko Itami
- Division of Surgical Pathology, Chiba Cancer Center, Chiba, Japan
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6
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Mejbel HA, Morris J, Bahrami A. Aggressive fibromatosis-like tumour with ANGPTL2::USP6 fusion. Histopathology 2024; 84:1243-1245. [PMID: 38379048 DOI: 10.1111/his.15158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/17/2024] [Accepted: 02/03/2024] [Indexed: 02/22/2024]
Affiliation(s)
- Haider A Mejbel
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jonathan Morris
- Department of Orthopedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Armita Bahrami
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
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7
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Singh R, Madasswery S, Colman M, Kent PM. Denosumab and sclerotherapy for recurrent spinal aneurysmal bone cyst in a child. BMJ Case Rep 2024; 17:e257450. [PMID: 38589235 PMCID: PMC11015305 DOI: 10.1136/bcr-2023-257450] [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] [Indexed: 04/10/2024] Open
Abstract
Aneurysmal bone cyst (ABC) is a non-malignant, locally destructive, blood-filled lesion in the bone that tends to grow aggressively. A young girl presented with a rapid recurrence after aggressive surgery of a large symptomatic sacral-spinal ABC. After a multidisciplinary tumour board, she was successfully treated with sclerotherapy and monthly intravenous denosumab. The patient has maintained asymptomatic for over 36 months now and has returned to full activity and strength. She never required surgery and has had radiologic resolution of the lesions. Treatment of recurrent ABC requires a multidisciplinary team approach. We believe this to be the first report to use this combined therapy to provide an alternative to morbid surgery for children with ABCs.
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Affiliation(s)
- Raj Singh
- College of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Matt Colman
- Rush University Rush Medical College, Chicago, Illinois, USA
| | - Paul McKeegan Kent
- Medical Director, FibroFighters Foundation LLC, Temecula, California, USA
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8
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Yeung MCF, Yau RCH, Ho KWY, Lam AYL, Shek TWH. USP6-translocated fibroblastic tumour with lipofibromatosis-like morphology. Pathology 2024; 56:428-431. [PMID: 37867009 DOI: 10.1016/j.pathol.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/27/2023] [Accepted: 07/14/2023] [Indexed: 10/24/2023]
Affiliation(s)
- Maximus C F Yeung
- Department of Pathology, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
| | - Raymond C H Yau
- Department of Orthopedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Kenneth W Y Ho
- Department of Orthopedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Albert Y L Lam
- Department of Orthopedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Tony W H Shek
- Department of Pathology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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9
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Balko J, Golas W, Kaspar L, Krskova L, Strnadova M, Kotis J, Zamecnik J. Novel and unusual USP6 fusion partners in aneurysmal bone cyst and their role in pathogenesis and histopathological evaluation of this disease. J Clin Pathol 2024:jcp-2023-209306. [PMID: 38429095 DOI: 10.1136/jcp-2023-209306] [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: 11/23/2023] [Accepted: 02/19/2024] [Indexed: 03/03/2024]
Abstract
AIMS The purpose of this study is to report novel and unusual USP6 fusion partners in aneurysmal bone cysts (ABCs). These findings may be useful in routine diagnostics as well as in studying the biology of USP6-related disorders. METHODS A cohort of seven patients diagnosed with ABC examined between 2014 and 2023 at Motol University Hospital in Prague was included into this retrospective non-randomised study. All cases were analysed using histopathological evaluation, immunohistochemistry and Anchored multiplex RNA methods. Demographic characteristics and clinical data were also analysed. RESULTS We identified two novel (ZFX and IP6K2), three unusual (MEF2A, EIF1 and COL1A2) and two common (CDH11) fusion partners with USP6 gene among all seven cases of ABC. CONCLUSIONS Cases in our study were diagnosed as ABCs due to characteristic clinical and morphological presentation. However, not all cases are as self-evident, and molecular testing is necessary. The identification of these gene alterations can be useful in distinction between true ABC and ABC-like changes among many benign and malignant bone tumours.
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Affiliation(s)
- Jan Balko
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - William Golas
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Ludvik Kaspar
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Lenka Krskova
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Martina Strnadova
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Johana Kotis
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Josef Zamecnik
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
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10
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El Bejjaj I, Mercier A, Mcleer A, Valmary-Degano S. [Fibro-osseous pseudotumor of the digits: One of USP6-related fibroblastic/myofibroblastic tumors]. Ann Pathol 2024:S0242-6498(23)00232-8. [PMID: 38341311 DOI: 10.1016/j.annpat.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/12/2023] [Accepted: 12/14/2023] [Indexed: 02/12/2024]
Abstract
Fibro-osseous pseudotumor of the digits is a benign tumour closely related to myositis ossificans. It is a rare lesion seldom reported in the literature. We report the case of a 33-year-old woman with lancinating pain in the first phalanx of the second finger of the right hand, associated with inflammation. The histopathological examination of the surgical excision biopsy of the lesion revealed a spindle-shaped proliferation within a sclerosing, hyaline, and osteoid stroma. In our observation, immunohistochemistry and molecular biology are the main elements that helped to establish the diagnosis and eliminate the various differential diagnoses, despite a non-specific histopathological aspect.
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Affiliation(s)
- Iatimad El Bejjaj
- Service d'anatomie et cytologie pathologique, CHU de Grenoble Alpes, 38000 Grenoble, France
| | - Anaïs Mercier
- Service d'anatomie et cytologie pathologique, CHU de Grenoble Alpes, 38000 Grenoble, France
| | - Anne Mcleer
- Service d'anatomie et cytologie pathologique, CHU de Grenoble Alpes, 38000 Grenoble, France; Université de Grenoble Alpes, Inserm U1209, CNRS UMR5309, institut pour l'avancée des biosciences, département de pathology, CHU Grenoble Alpes, 38000, Grenoble, France
| | - Séverine Valmary-Degano
- Service d'anatomie et cytologie pathologique, CHU de Grenoble Alpes, 38000 Grenoble, France; Université de Grenoble Alpes, Inserm U1209, CNRS UMR5309, institut pour l'avancée des biosciences, département de pathology, CHU Grenoble Alpes, 38000, Grenoble, France.
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11
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Mejbel HA, Siegal GP, Wei S. Palmer Nodular Fasciitis Harboring a Novel SREBF1::USP6 Fusion Gene. Int J Surg Pathol 2024:10668969241229330. [PMID: 38304953 DOI: 10.1177/10668969241229330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
The diagnosis of low-grade fibroblastic/myofibroblastic tumors of acral sites can be challenging. These tumors encompass a diverse group of neoplasms with a spectrum of biologic potential ranges from benign to overtly malignant. They often demonstrate significant clinical, radiologic, and immunophenotypic overlap, in which the molecular phenotype may play an important diagnostic role to arrive at the final diagnosis. Herein, we report a case of soft tissue mass lesion presented on the palm of an adult patient for four months. Histologically, the tumor consisted of primarily low-grade spindle cells expressing smooth muscle actin. Molecular testing revealed a novel SREBF1::USP6 fusion gene, confirming the final diagnosis of nodular fasciitis and ultimately expanding its molecular profile. This case highlights the diagnostic value of single, cost-effective, targeted molecular panel to arrive at an accurate diagnosis and provide helpful therapeutic information.
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Affiliation(s)
- Haider A Mejbel
- Departments of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Gene P Siegal
- Departments of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shi Wei
- Departments of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Pathology & Laboratory Medicine, University of Kansas School of Medicine, Kansas City, KS, USA
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12
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Alsharif MT, Alzahrani A, Zaki H, Bukhari AF, Jazzar A. Oral Nodular Fasciitis: A Case Report in an Uncommon Location and Review of the Literature. Cureus 2024; 16:e54803. [PMID: 38405650 PMCID: PMC10891457 DOI: 10.7759/cureus.54803] [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: 02/22/2024] [Indexed: 02/27/2024] Open
Abstract
Nodular fasciitis (NF) is a benign, self-limiting condition that is often misdiagnosed due to its resemblance to other lesions. Although NF is common, its occurrence in the oral cavity is rare and particularly challenging for both clinicians and pathologists. To date, no case has been reported in the retromolar area of the oral cavity. A 49-year-old male patient presented with a painless, rapidly growing, firm nodule in the right retromolar area. Histopathological examination revealed spindle cell proliferation with characteristics of NF and immunohistochemical analysis confirmed the diagnosis. The lesion was treated by conservative surgical excision, without recurrence at a one-year follow-up. In the current case, 54 cases of oral nodular fasciitis (ONF) have been documented. The majority of ONF-affected individuals are in their 40s, with a 1:1 male-to-female ratio. The buccal mucosa was the most commonly involved site followed by the tongue and labial mucosa. Histopathologically, the most prominent features were the proliferation of uniform spindle-shaped cells within a myxomatous and/or fibrotic background. A positive smooth muscle actin (SMA) stain was a consistent finding. Complete local excision remains the preferred treatment method, and no recurrences have been reported. This report underscores the importance of considering NF in the differential diagnosis of oral spindle cell lesions and emphasizes the need for a comprehensive evaluation to guide appropriate management.
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Affiliation(s)
- Maha T Alsharif
- Department of Oral Diagnostic Sciences, Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
| | - Asma Alzahrani
- Department of Oral Diagnostic Sciences, Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
| | - Hattan Zaki
- Department of Oral and Maxillofacial Diagnostic Sciences, Taibah University, Madinah, SAU
| | - Alaa F Bukhari
- Department of Oral Diagnostic Sciences, Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
| | - Ahoud Jazzar
- Department of Oral Diagnostic Sciences, Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
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13
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Rekhi B, Qian X, Domanski HA, Klijanienko J, Field A. Pitfalls in soft tissue cytopathology. Cytopathology 2024; 35:30-47. [PMID: 37548096 DOI: 10.1111/cyt.13282] [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: 06/09/2023] [Revised: 06/28/2023] [Accepted: 07/16/2023] [Indexed: 08/08/2023]
Abstract
Fine needle aspiration biopsy (FNAB) is a diagnostic modality for the evaluation of suspicious soft tissue masses. Despite its reasonable sensitivity, specificity and positive predictive value in differentiating benign from malignant neoplasms, the exact subtyping of the primary soft tissue tumours can be challenging. Certain tumours constitute "pitfalls" and add to the diagnostic challenge. This review provides a detailed account of the diagnostic challenges in soft tissue cytopathology, including pitfalls and, more importantly, the ways to overcome these challenges by integrating clinical details, key cytomorphological features and judicious application of ancillary techniques.
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Affiliation(s)
- Bharat Rekhi
- Department of Pathology, Bone and Soft Tissues, Disease Management Group (DMG) Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Xiaohua Qian
- Department of Pathology, Cytopathology Service and Bone and Soft Tissue Service, Stanford University School of Medicine, Stanford, California, USA
| | | | | | - Andrew Field
- Department of Anatomical Pathology, St. Vincent's Hospital, University of New South Wales Sydney and Notre Dame University Sydney Clinical Medical Schools, Sydney, New South Wales, Australia
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14
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Grover C, Gupta P, Gupta C, Nambiyar K, Goel S. Fibro-Osseus Pseudotumor of the Digit: A Case Report and Review of Literature. Skin Appendage Disord 2023; 9:470-476. [PMID: 38107840 PMCID: PMC10721281 DOI: 10.1159/000532113] [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: 02/15/2023] [Accepted: 07/10/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Bony subungual growths arising on the digital tip are uncommon. Among these, subungual exostosis is a common cause. Case Presentation We describe a 35-year-old-male patient with a rare occurrence of a fibro-osseus pseudotumor of the digit. It presents with reactive intramembranous ossification, with no continuity with the distal phalanx, helping differentiate it from a subungual exostosis. The patient presented with an asymptomatic subungual growth, lifting up the nail plate distally causing onycholysis. The characteristic clinical, radiological, and histopathological features of the case are described, which helped confirm the diagnosis. Conclusion Cases with fibro-osseus pseudotumor of the digit reported in literature are reviewed comprehensively. The factors helping differentiate this from the other bony tumors affecting the distal phalanx, including subungual exostosis, myositis ossificans, and osteosarcoma are also highlighted.
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Affiliation(s)
- Chander Grover
- Department of Dermatology and STD, Guru Teg Bahadur Hospital, University College of Medical Sciences, University of Delhi, Delhi, India
| | - Pratibha Gupta
- Department of Dermatology and STD, Guru Teg Bahadur Hospital, University College of Medical Sciences, University of Delhi, Delhi, India
| | - Chhavi Gupta
- Department of Radiodiagnosis, Guru Teg Bahadur Hospital, University College of Medical Sciences, University of Delhi, Delhi, India
| | - Kaniyappan Nambiyar
- Department of Pathology, Guru Teg Bahadur Hospital, University College of Medical Sciences, University of Delhi, Delhi, India
| | - Shitij Goel
- Department of Dermatology, School of Medical Sciences and Research, Sharda University, Greater Noida, India
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15
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Zhang Q, Guo C, Liu L, Li Y. miR-148b-3p suppresses the proliferation and migration of Schwann cells by targeting USP6 following sciatic nerve injury. Neurol Res 2023; 45:1035-1043. [PMID: 37702221 DOI: 10.1080/01616412.2023.2257413] [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: 07/25/2022] [Accepted: 06/05/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Peripheral nerve injury is a common disorder associated with damaged axons and distal myelin sheath degeneration, and Schwann cells play a paramount role in peripheral nerve regeneration. This study aims to explore the role of microRNA miR-148b-3p on Schwann cells after peripheral nerve injury. METHODS Sciatic nerve transection was conducted in rat as the model of peripheral nerve injury. The expression level of miR-148b-3p and Ubiquitin Specific Peptidase 6 (USP6) was detected by qRT-PCR and Western blot at diverse time points after nerve transection. Cell migration and proliferation were determined in primary Schwann cells isolated from rat. The functional interaction of miR-148b-3p and USP6 mRNA was validated by dual-luciferase reporter assay. RESULTS In the animal model of sciatic nerve injury, miR-148b-3p expression level in the proximal nerve stump showed downregulation after nerve transection procedure, while USP6 expression level was elevated. The overexpression of miR-148b-3p inhibited the proliferation and migration of primary Schwann cells, while suppressing miR-148b-3p showed the opposite effect. USP6 mRNA was identified as a target of miR-148b-3p, which was found to mediate the effect of miR-148b-3p. USP6 silencing suppressed the migration and proliferation in primary Schwann cells. CONCLUSION Our data demonstrated the functional role of miR-148b-3p/USP6 axis in regulating the migration and proliferation of Schwann cells following peripheral nerve injury. miR-148b-3p showed downregulation and its target USP6 was upregulated after nerve transection procedure. Targeting miR-148b-3p/USP6 axis may provide a novel opportunity for peripheral nerve repair.
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Affiliation(s)
- Qin Zhang
- Department of Rehabilitation, The First People's Hospital of Jingmen, Jingmen, Hubei, China
| | - Chengkun Guo
- Department of Rehabilitation, The First People's Hospital of Jingmen, Jingmen, Hubei, China
| | - Lijuan Liu
- Department of Rehabilitation, The First People's Hospital of Jingmen, Jingmen, Hubei, China
| | - Yang Li
- Department of Rehabilitation, The First People's Hospital of Jingmen, Jingmen, Hubei, China
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16
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Mejbel HA, Siegal GP, Wei S. Periosteal Fasciitis With Unusual Radiologic Features Harboring a Novel STAG1::USP6 Fusion Gene. Int J Surg Pathol 2023; 31:1387-1392. [PMID: 36694417 DOI: 10.1177/10668969221150369] [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] [Indexed: 01/26/2023]
Abstract
Periosteal fasciitis is a subtype of nodular fasciitis originating from the periosteum. The diagnosis can be challenging and requires radiologic-pathologic correlation. Advances in molecular analysis confirmed that nodular fasciitis and its related lesions harbor a USP6 gene rearrangement with one of the several potential partners. Herein, we report a case of periosteal fasciitis with metaplastic bone formation detected incidentally during a radiologic survey for breast carcinoma. Radiologic examination revealed a 2.4 cm, heterogeneous, avidly enhancing lesion of the right femoral distal metaphysis concerning for low-grade periosteal chondrosarcoma. Histological examination of a core needle biopsy revealed a tumor composed of bland spindle cells with myofibroblastic and osteoblastic phenotypes admixed with immature bone and cartilaginous elements. Molecular analysis revealed a novel STAG1::USP6 fusion that helped arrive at the right diagnosis and further expands the molecular profile of USP6-associated neoplasms.
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Affiliation(s)
- Haider A Mejbel
- Departments of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gene P Siegal
- Departments of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
- Departments of Genetics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shi Wei
- Departments of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Pathology & Laboratory Medicine, University of Kansas School of Medicine, Kansas City, KS, USA
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17
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Li S, Song Y, Wang K, Liu G, Dong X, Yang F, Chen G, Cao C, Zhang H, Wang M, Li Y, Zeng T, Liu C, Li B. USP32 deubiquitinase: cellular functions, regulatory mechanisms, and potential as a cancer therapy target. Cell Death Discov 2023; 9:338. [PMID: 37679322 PMCID: PMC10485055 DOI: 10.1038/s41420-023-01629-1] [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: 06/09/2023] [Revised: 08/18/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023] Open
Abstract
An essential protein regulatory system in cells is the ubiquitin-proteasome pathway. The substrate is modified by the ubiquitin ligase system (E1-E2-E3) in this pathway, which is a dynamic protein bidirectional modification regulation system. Deubiquitinating enzymes (DUBs) are tasked with specifically hydrolyzing ubiquitin molecules from ubiquitin-linked proteins or precursor proteins and inversely regulating protein degradation, which in turn affects protein function. The ubiquitin-specific peptidase 32 (USP32) protein level is associated with cell cycle progression, proliferation, migration, invasion, and other cellular biological processes. It is an important member of the ubiquitin-specific protease family. It is thought that USP32, a unique enzyme that controls the ubiquitin process, is closely linked to the onset and progression of many cancers, including small cell lung cancer, gastric cancer, breast cancer, epithelial ovarian cancer, glioblastoma, gastrointestinal stromal tumor, acute myeloid leukemia, and pancreatic adenocarcinoma. In this review, we focus on the multiple mechanisms of USP32 in various tumor types and show that USP32 controls the stability of many distinct proteins. Therefore, USP32 is a key and promising therapeutic target for tumor therapy, which could provide important new insights and avenues for antitumor drug development. The therapeutic importance of USP32 in cancer treatment remains to be further proven. In conclusion, there are many options for the future direction of USP32 research.
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Grants
- Bing Li, Department of Genetics and Cell Biology, School of Basic Medicine, Qingdao University, Qingdao, China Chunyan Liu, Department of Genetics and Cell Biology, School of Basic Medicine, Qingdao University, Qingdao, China
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Affiliation(s)
- Shuang Li
- Department of Genetics and Cell Biology, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Yang Song
- Department of Genetics and Cell Biology, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Kexin Wang
- Department of Genetics and Cell Biology, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Guoxiang Liu
- Department of Genetics and Cell Biology, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Xiaolei Dong
- Department of Genetics and Cell Biology, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Fanghao Yang
- Department of Genetics and Cell Biology, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Guang Chen
- Department of Genetics and Cell Biology, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Can Cao
- Department of Genetics and Cell Biology, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Huhu Zhang
- Department of Genetics and Cell Biology, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Mengjun Wang
- Department of Genetics and Cell Biology, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Ya Li
- Department of Genetics and Cell Biology, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Teng Zeng
- Department of Genetics and Cell Biology, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Chunyan Liu
- Department of Genetics and Cell Biology, School of Basic Medicine, Qingdao University, Qingdao, China.
| | - Bing Li
- Department of Genetics and Cell Biology, School of Basic Medicine, Qingdao University, Qingdao, China.
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, China.
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18
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Abstract
Ubiquitin-specific protease 6 (USP6) rearrangements have been identified in aneurysmal bone cyst, nodular fasciitis, myositis ossificans, fibro-osseous pseudotumour of digits and cellular fibroma of tendon sheath. These entities show clinical as well as histological overlap, suggesting they are all clonal neoplastic belonging to the same biological spectrum and referred to as 'USP6-associated neoplasms'. They all show a characteristic gene fusion formed by juxtaposition of the USP6 coding sequences to the promoter regions of several partner genes, leading to USP6 transcriptional upregulation.
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Affiliation(s)
- Fleur Cordier
- Pathology, Ghent University Hospital, Ghent, Belgium
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19
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Dhillon P, Jebastin Thangaiah J, Anderson TL, Tiegs-Heiden CA. Fasciitis ossificans: imaging features, histology, and differential diagnosis. Clin Radiol 2023:S0009-9260(23)00217-9. [PMID: 37331849 DOI: 10.1016/j.crad.2023.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/06/2023] [Accepted: 05/11/2023] [Indexed: 06/20/2023]
Abstract
AIM To describe the imaging features of fasciitis ossificans and its histopathological features. MATERIALS AND METHODS Using a word search of existing pathology reports at the Mayo Clinic, six cases of fasciitis ossificans were identified. The clinical history, histology, and available imaging of the affected area were reviewed. RESULTS Imaging consisted of radiographs, mammograms, ultrasound images, bone scintigraphs, computed tomography (CT), and magnetic resonance imaging (MRI) images. All cases demonstrated a soft-tissue mass. The characteristic MRI appearance was a T2 hyperintense enhancing mass with surrounding soft-tissue oedema. Peripheral calcifications were seen on radiographs, CT, and/or ultrasound. Histological sections showed distinct zonation, with nodular fasciitis-like zones of myofibroblastic proliferation, which merged with osteoblasts that rim the ill-defined trabeculae of woven bone and became continuous with the mature lamellar bone surrounded by a thin layer of compressed fibrous tissue. CONCLUSION Imaging features of fasciitis ossificans are that of an enhancing soft-tissue mass located within a fascial plane with prominent surrounding oedema and mature peripheral calcification. Imaging and histology are that of myositis ossificans but occurring within the fascia. It is important that radiologists are aware of the diagnosis of fasciitis ossificans and appreciate its similarity to myositis ossificans. This is particularly important in anatomical locations with fascias but no muscle. Given the radiographic and histological overlap between these entities, nomenclature that encompasses both could be considered in the future.
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Affiliation(s)
- P Dhillon
- Department of Radiology, Mayo Clinic, 200 1(st) Street S.W., Rochester, MN 55905, USA
| | - J Jebastin Thangaiah
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 1(st) Street S.W., Rochester, MN 55905, USA
| | - T L Anderson
- Department of Radiology, Mayo Clinic, 200 1(st) Street S.W., Rochester, MN 55905, USA
| | - C A Tiegs-Heiden
- Department of Radiology, Mayo Clinic, 200 1(st) Street S.W., Rochester, MN 55905, USA.
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20
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Azam R, Mrkonjic M, Gupta A, Gladdy R, Covelli AM. Mesenchymal Tumors of the Breast: Fibroblastic/Myofibroblastic Lesions and Other Lesions. Curr Oncol 2023; 30:4437-4482. [PMID: 37232796 DOI: 10.3390/curroncol30050338] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/05/2023] [Accepted: 04/08/2023] [Indexed: 05/27/2023] Open
Abstract
Mesenchymal breast tumors are a rare and diverse group of tumors that present some of the most challenging cases for multidisciplinary breast cancer teams. As a result of overlapping morphologies and a lack of large-scale studies on these tumors, practices are often heterogeneous and slow to evolve. Herein, we present a non-systematic review that focuses on progress, or lack thereof, in the field of mesenchymal breast tumors. We focus on tumors originating from fibroblastic/myofibroblastic cells and tumors originating from less common cellular origins (smooth muscle, neural tissue, adipose tissue, vascular tissue, etc.).
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Affiliation(s)
- Riordan Azam
- Postgraduate Medical Education, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Miralem Mrkonjic
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G 1X5, Canada
- Mount Sinai Hospital and Princess Margaret Cancer Center, University of Toronto, Toronto, ON M5G 2C4, Canada
| | - Abha Gupta
- Department of Medical Oncology, University of Toronto, Toronto, ON M5G 1X8, Canada
- The Hospital for Sick Children and Princess Margaret Cancer Center, University of Toronto, Toronto, ON M5G 1X5, Canada
| | - Rebecca Gladdy
- Mount Sinai Hospital and Princess Margaret Cancer Center, University of Toronto, Toronto, ON M5G 2C4, Canada
- Division of Surgical Oncology, Department of Surgery, University of Toronto, Toronto, ON M5G 1X5, Canada
| | - Andrea M Covelli
- Mount Sinai Hospital and Princess Margaret Cancer Center, University of Toronto, Toronto, ON M5G 2C4, Canada
- Division of Surgical Oncology, Department of Surgery, University of Toronto, Toronto, ON M5G 1X5, Canada
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21
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Preobrazhenskaya EV, Suleymanova AM, Bizin IV, Zagrebin FA, Romanko AA, Saitova ES, Mulkidzhan RS, Imyanitov EN. Spectrum of kinase gene rearrangements in a large series of paediatric inflammatory myofibroblastic tumours. Histopathology 2023. [PMID: 37071060 DOI: 10.1111/his.14912] [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: 12/30/2022] [Revised: 02/24/2023] [Accepted: 03/20/2023] [Indexed: 04/19/2023]
Abstract
INTRODUCTION Inflammatory myofibroblastic tumours (IMTs), being an exceptionally rare category of paediatric neoplasms, often contain druggable gene rearrangements involving tyrosine kinases. METHODS AND RESULTS This study presents a large consecutive series of IMTs which were analysed for the presence of translocations by the PCR test for 5'/3'-end ALK, ROS1, RET, NTRK1, NTRK2 and NTRK3 unbalanced expression, variant-specific PCR for 47 common gene fusions and NGS TruSight RNA fusion panel. Kinase gene rearrangements were detected in 71 of 82 (87%) IMTs (ALK: n = 47; ROS1: n = 20; NTRK3: n = 3; PDGFRb: n = 1). The test for unbalanced expression had 100% reliability in identifying tumours with ALK fusions, but failed to reveal ROS1 rearrangements in eight of 20 (40%) ROS1-driven IMTs; however, ROS1 alterations were detectable by variant-specific PCR in 19 of 20 (95%) cases. ALK rearrangements were particularly common in patients below 1 year of age (10 of 11 (91%) versus 37 of 71 (52%), P = 0.039). ROS1 fusions occurred more often in lung IMTs than in tumours of other organs (14 of 35 (40%) versus six of 47 (13%), P = 0.007). Among 11 IMTs with no kinase gene rearrangement identified, one tumour demonstrated ALK activation via gene amplification and overexpression, and another neoplasm carried COL1A1::USP6 translocation. CONCLUSIONS PCR-based pipeline provides a highly efficient and non-expensive alternative for molecular testing of IMTs. IMTs with no detectable rearrangements need further studies.
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Affiliation(s)
- Elena V Preobrazhenskaya
- Department of Tumor Growth Biology, N.N. Petrov Institute of Oncology, Saint-Petersburg, Russia
- Department of Medical Genetics, St.-Petersburg Pediatric Medical University, Saint-Petersburg, Russia
| | - Amina M Suleymanova
- Institute of Pediatric Oncology, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia
| | - Ilya V Bizin
- Department of Tumor Growth Biology, N.N. Petrov Institute of Oncology, Saint-Petersburg, Russia
| | - Fyodor A Zagrebin
- Department of Tumor Growth Biology, N.N. Petrov Institute of Oncology, Saint-Petersburg, Russia
| | - Alexandr A Romanko
- Department of Medical Genetics, St.-Petersburg Pediatric Medical University, Saint-Petersburg, Russia
| | - Evgeniya S Saitova
- Department of Tumor Growth Biology, N.N. Petrov Institute of Oncology, Saint-Petersburg, Russia
| | - Rimma S Mulkidzhan
- Department of Tumor Growth Biology, N.N. Petrov Institute of Oncology, Saint-Petersburg, Russia
| | - Evgeny N Imyanitov
- Department of Tumor Growth Biology, N.N. Petrov Institute of Oncology, Saint-Petersburg, Russia
- Department of Medical Genetics, St.-Petersburg Pediatric Medical University, Saint-Petersburg, Russia
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22
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Shen J, Lin X, Dai F, Chen G, Lin H, Fang B, Liu H. Ubiquitin-specific peptidases: Players in bone metabolism. Cell Prolif 2023:e13444. [PMID: 36883930 PMCID: PMC10392067 DOI: 10.1111/cpr.13444] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/22/2023] [Accepted: 02/28/2023] [Indexed: 03/09/2023] Open
Abstract
Osteoporosis is an ageing-related disease, that has become a major public health problem and its pathogenesis has not yet been fully elucidated. Substantial evidence suggests a strong link between overall age-related disease progression and epigenetic modifications throughout the life cycle. As an important epigenetic modification, ubiquitination is extensively involved in various physiological processes, and its role in bone metabolism has attracted increasing attention. Ubiquitination can be reversed by deubiquitinases, which counteract protein ubiquitination degradation. As the largest and most structurally diverse cysteinase family of deubiquitinating enzymes, ubiquitin-specific proteases (USPs), comprising the largest and most structurally diverse cysteine kinase family of deubiquitinating enzymes, have been found to be important players in maintaining the balance between bone formation and resorption. The aim of this review is to explore recent findings highlighting the regulatory functions of USPs in bone metabolism and provide insight into the molecular mechanisms governing their actions during bone loss. An in-deep understanding of USPs-mediated regulation of bone formation and bone resorption will provide a scientific rationale for the discovery and development of novel USP-targeted therapeutic strategies for osteoporosis.
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Affiliation(s)
- Jianlin Shen
- Department of Orthopaedics, Affiliated Hospital of Putian University, Putian, China
| | - Xiaoning Lin
- Department of Orthopaedics, Affiliated Hospital of Putian University, Putian, China
| | - Feifei Dai
- School of Medicine, Putian Universtiy, Putian, China
| | - Guoli Chen
- Department of Orthopaedics, Affiliated Hospital of Putian University, Putian, China
| | - Haibin Lin
- Department of Orthopaedics, Affiliated Hospital of Putian University, Putian, China
| | - Bangjiang Fang
- Department of Emergency, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Institute of Emergency and Critical Care Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Huan Liu
- Department of Orthopaedics, Affiliated Hospital of Putian University, Putian, China
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23
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Gruenewald LD, Koch V, Gruber-Rouh T, Thalhammer A, Frank J, Marzi I, Booz C, Yel I, Mahmoudi S, Bernatz S, Laudenberger I, Lingwal N, Vogl TJ, Eichler K. MR angiography facilitates the differentiation of aneurysmal from unicameral bone cysts. Br J Radiol 2023; 96:20220849. [PMID: 36745072 PMCID: PMC10078881 DOI: 10.1259/bjr.20220849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES The objective of this work was to evaluate the incremental value of MR angiography over plain radiographs and MRI for the differentiation of aneurysmal bone cysts (ABCs) from unicameral bone cysts (UBCs). METHODS Thirty-six juvenile patients with histologically secured primary ABCs or UBCs were included in this retrospective study. Two radiologists assessed all obtained images in a blinded fashion using a catalog of previously suggested imaging findings. A second readout with supplementary MR angiography images was performed after 8 weeks to prevent observer recall bias. Diagnostic accuracy parameters were calculated for individual imaging findings, and overall diagnostic accuracy and diagnostic confidence were assessed for all readouts. Receiver operating characteristic (ROC) curve comparison was used to determine the incremental value of MR angiography. RESULTS Of 16 imaging features, only abnormal vascularization in MR angiography provided sufficient diagnostic accuracy for the identification of ABCs. Other imaging features such as fluid-fluid levels and internal septations were insufficient for the differentiation of UBCs from ABCs. Availability of MR angiography images significantly increased diagnostic accuracy (94.4 vs 75.0% and 83.3 vs 69.4%, respectively, p < 0.05) and diagnostic confidence (4.5 vs 3.7, p < 0.05) of reading radiologists. CONCLUSION The presence of arterial feeders in MR angiography can accurately discriminate primary ABCs from UBCs and increases the diagnostic accuracy and diagnostic confidence of reporting radiologists. ADVANCES IN KNOWLEDGE Radiographic differentiation of cystic bone lesions such as ABCs and UBCs remains challenging. We demonstrate that MR angiography provides incremental value and suggest inclusion in standard examination protocols.
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Affiliation(s)
- Leon David Gruenewald
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Vitali Koch
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Tatjana Gruber-Rouh
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Axel Thalhammer
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Johannes Frank
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Ibrahim Yel
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Scherwin Mahmoudi
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Simon Bernatz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Isabella Laudenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Neelam Lingwal
- Department of Biostatistics and Mathematical Modeling, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Katrin Eichler
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
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24
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Sun L, Zhao Z, Zhu Y. USP6-associated neoplasm as a tentative subset of postoperative spindle cell nodule. Histopathology 2023; 82:587-595. [PMID: 36404122 DOI: 10.1111/his.14841] [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: 08/12/2022] [Revised: 10/29/2022] [Accepted: 11/14/2022] [Indexed: 11/22/2022]
Abstract
AIM Postoperative spindle cell nodule (PSCN) is a pseudosarcomatous proliferative lesion of unclear molecular genetic origins. METHODS AND RESULTS We examined seven patients with PSCN, using routine haematoxylin-eosin (H&E) slide preparations and a series of immunostains. The latter targeted keratin, vimentin, α-smooth muscle actin (SMA), anaplastic lymphoma kinase (ALK [D5F3]), and other proteins. Ubiquitin-specific peptidase 6 (USP6) and anaplastic lymphoma kinase (ALK) gene rearrangements were also analysed by fluorescence in situ hybridization (FISH). There were histories of prior surgical intervention (n = 6) or trauma (n = 1) in all seven patients. All lesions were highly cellular and mitotically active spindle cell proliferations, with no cytologic atypia, nuclear pleomorphism, or aberrant mitoses. Immunohistochemical (IHC) staining disclosed focal, weak keratin positivity in two lesions, whereas vimentin (diffuse, strongly positive) and SMA (tram-track pattern) were present in each instance, and ALK (D5F3) was entirely negative. FISH analysis confirmed USP6 gene rearrangements in all seven cases, showing no ALK gene rearrangements. RNA sequencing results showed an MYH9::USP6 gene fusion in only one lesion (No. 6). CONCLUSION A subset of PSCN is marked by USP6 gene rearrangements, a genetic feature of nodular fasciitis (NF). Given its similarity to NF, a designation as USP6-associated neoplasm (UAN) seems reasonable, signifying a transient clonal neoplastic lesion.
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Affiliation(s)
- Lili Sun
- Department of Pathology, Cancer Hospital of Dalian University of Technology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Zehua Zhao
- Department of Pathology, Cancer Hospital of Dalian University of Technology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Yanmei Zhu
- Department of Pathology, Cancer Hospital of Dalian University of Technology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
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25
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Broski SM, Wenger DE. Multimodality imaging features of USP6-associated neoplasms. Skeletal Radiol 2023; 52:297-313. [PMID: 35962835 DOI: 10.1007/s00256-022-04146-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/16/2022] [Accepted: 06/27/2022] [Indexed: 02/02/2023]
Abstract
Since the discovery of USP6 gene rearrangements in aneurysmal bone cysts nearly 20 years ago, we have come to recognize that there is a family of USP6-driven mesenchymal neoplasms with overlapping clinical, morphologic, and imaging features. This family of neoplasms now includes myositis ossificans, aneurysmal bone cyst, nodular fasciitis, fibroma of tendon sheath, fibro-osseous pseudotumor of digits, and their associated variants. While generally benign and in many cases self-limiting, these lesions may undergo rapid growth, and be confused with malignant bone and soft tissue lesions, both clinically and on imaging. The purpose of this article is to review the imaging characteristics of the spectrum of USP6-driven neoplasms, highlight key features that allow distinction from malignant bone or soft tissue lesions, and discuss the role of imaging and molecular analysis in diagnosis.
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Affiliation(s)
- Stephen M Broski
- Department of Radiology, Mayo Clinic, Charlton Building North, 1st Floor, 200 First Street SW , Rochester, MN, 55905, USA.
| | - Doris E Wenger
- Department of Radiology, Mayo Clinic, Charlton Building North, 1st Floor, 200 First Street SW , Rochester, MN, 55905, USA
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26
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Khodeneva N, Sugimoto MA, Davan-Wetton CSA, Montero-Melendez T. Melanocortin therapies to resolve fibroblast-mediated diseases. Front Immunol 2023; 13:1084394. [PMID: 36793548 PMCID: PMC9922712 DOI: 10.3389/fimmu.2022.1084394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 11/28/2022] [Indexed: 02/01/2023] Open
Abstract
Stromal cells have emerged as central drivers in multiple and diverse diseases, and consequently, as potential new cellular targets for the development of novel therapeutic strategies. In this review we revise the main roles of fibroblasts, not only as structural cells but also as players and regulators of immune responses. Important aspects like fibroblast heterogeneity, functional specialization and cellular plasticity are also discussed as well as the implications that these aspects may have in disease and in the design of novel therapeutics. An extensive revision of the actions of fibroblasts on different conditions uncovers the existence of numerous diseases in which this cell type plays a pathogenic role, either due to an exacerbation of their 'structural' side, or a dysregulation of their 'immune side'. In both cases, opportunities for the development of innovative therapeutic approaches exist. In this regard, here we revise the existing evidence pointing at the melanocortin pathway as a potential new strategy for the treatment and management of diseases mediated by aberrantly activated fibroblasts, including scleroderma or rheumatoid arthritis. This evidence derives from studies involving models of in vitro primary fibroblasts, in vivo models of disease as well as ongoing human clinical trials. Melanocortin drugs, which are pro-resolving mediators, have shown ability to reduce collagen deposition, activation of myofibroblasts, reduction of pro-inflammatory mediators and reduced scar formation. Here we also discuss existing challenges, both in approaching fibroblasts as therapeutic targets, and in the development of novel melanocortin drug candidates, that may help advance the field and deliver new medicines for the management of diseases with high medical needs.
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Zhang Y, Qiu Y, Zhang X, He X, Chen C, Chen M, Zhang H. USP6-associated soft tissue tumors with bone metaplasia: Clinicopathologic and genetic analysis and the identification of novel USP6 fusion partners. Front Oncol 2023; 12:1065071. [PMID: 36727055 PMCID: PMC9885078 DOI: 10.3389/fonc.2022.1065071] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/30/2022] [Indexed: 01/17/2023] Open
Abstract
Introduction Among those tumors with consistent USP6 rearrangement, some arise from soft tissue and show bone metaplasia, including myositis ossificans (MO), fibro-osseous pseudotumor of digits (FOPD), soft tissue aneurysmal bone cyst (ST-ABC) and fasciitis ossificans (FO). These lesions are easily confused with malignancies because they show a rapid growth rate and brisk mitoses. Here, we aim to clarify the clinicopathologic and genetic characteristics of this entity and analyze the correlations among the different subtypes in one of the largest cohorts. Materials and Methods The clinicopathologic features of 73 cases of MO, FOPD, ST-ABC and FO diagnosed at West China Hospital, Sichuan University from January 2010 to December 2021 were retrospectively analyzed. Forty-three undecalcified samples were analyzed by systematic genetic studies, including fluorescence in situ hybridization (FISH), reverse transcription polymerase chain reaction (RT-PCR), Sanger sequencing and next-generation-based sequencing were performed. Results This series included 40 males and 33 females aged 2 to 80 years old (median: 31 years). FOPD occurred in extremal soft tissue, while lower extremities (38/58, 65.5%) were the most commonly involved lesions in the other three subgroups. Histologically, proliferative myofibroblasts/fibroblasts with varying degrees of osteoid tissue were present. Fluorescence in situ hybridization (FISH) results indicated that 22 cases (22/27, 81.5%) were positive for USP6 rearrangement, and 5 cases were negative. Among those cases with positive FISH results, 18 underwent reverse transcription-polymerase chain reaction (RT-PCR) detection that successfully detected common USP6 fusion types. Thirteen cases showed COL1A1::USP6 fusion, one showed MYH9::USP6 fusion, and 4 were negative for common fusion types. Next-generation-based sequencing technology was performed on two lesions with negative RT-PCR results and novel fusion partners SNHG3 and UBE2G1 were discovered. Conclusions Our findings revealed that COL1A1 is the most common fusion partner in this entity, unlike primary aneurysmal bone cysts and nodular fasciitis. Notably, we believed that FO may demonstrate more similar clinicopathologic and genetic manifestations with MO/FOPD and ST-ABC instead of nodular fasciitis for involving lower limbs most frequently and showing recurrent COL1A1::USP6 fusion. Additionally, this study also found two novel USP6 fusion partners, which further expanded our knowledge of this neoplastic spectrum.
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Imada H, Torigoe T, Yazawa Y, Kanno S, Ichikawa J, Yamaguchi T, Kawasaki T. Case Report: Extraskeletal osteosarcoma with preceding myositis ossificans. Front Oncol 2023; 13:1024768. [PMID: 36910624 PMCID: PMC9999043 DOI: 10.3389/fonc.2023.1024768] [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: 08/24/2022] [Accepted: 02/13/2023] [Indexed: 02/26/2023] Open
Abstract
Extraskeletal osteosarcoma (EO) is a soft tissue sarcoma characterized by the production of bone matrix by neoplastic cells. Benign osteoid in EO, leading to a diagnostic dilemma, is rarely encountered. Herein, for the first time, we present a case with cytogenetically confirmed EO combined with or preceding myositis ossificans (MO). A 21-year-old man had a mildly painful swelling in his left knee. Imaging studies demonstrated a 39-mm mass with peripheral mineralization and cystic change on the posterolateral side of the left fibular head. He was clinically suspected of having either MO or a malignancy, such that wide resection was performed. Macroscopically, the mass was grayish to brown. In the cut section, multiple cystic lesions in addition to solid components were noted. Histopathologically, the solid components demonstrated diffuse proliferation of pleomorphic tumor cells with osteoclast-like giant cells. The malignant tumor cells formed osteoid. In the periphery, the mass was benign, showing mature bone tissue and focally non-malignant woven bone with fibroblasts, compatible with zonation. Fluorescence in situ hybridization (FISH) demonstrated split signals of the USP6 gene. These findings suggested EO with preceding MO. Although the pathogenesis remains to be elucidated, the observed USP6 rearrangement might contribute to both the diagnosis of EO with preceding MO and an understanding of the underlying histopathology.
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Affiliation(s)
- Hiroki Imada
- Department of Pathology, Saitama Medical University Saitama Medical Center, Kawagoe, Japan
| | - Tomoaki Torigoe
- Department of Orthopaedic Oncology and Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Yasuo Yazawa
- Department of Orthopaedic Oncology and Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Satoshi Kanno
- Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Jiro Ichikawa
- Department of Orthopedic Surgery, Graduate School of Medical Science, University of Yamanashi, Chuo, Japan
| | - Takehiko Yamaguchi
- Department of Pathology, Dokkyo Medical University Nikko Medical Center, Nikko, Japan
| | - Tomonori Kawasaki
- Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Japan
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Rottmann D, Abdulfatah E, Pantanowitz L. Molecular testing of soft tissue tumors. Diagn Cytopathol 2023; 51:12-25. [PMID: 35808975 PMCID: PMC10084007 DOI: 10.1002/dc.25013] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/27/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The diagnosis of soft tissue tumors is challenging, especially when the evaluable material procured is limited. As a result, diagnostic ancillary testing is frequently needed. Moreover, there is a trend in soft tissue pathology toward increasing use of molecular results for tumor classification and prognostication. Hence, diagnosing newer tumor entities such as CIC-rearranged sarcoma explicitly requires molecular testing. Molecular testing can be accomplished by in situ hybridization, polymerase chain reaction, as well as next generation sequencing, and more recently such testing can even be accomplished leveraging an immunohistochemical proxy. CONCLUSION This review evaluates the role of different molecular tests in characterizing soft tissue tumors belonging to various cytomorphologic categories that have been sampled by small biopsy and cytologic techniques.
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Affiliation(s)
- Douglas Rottmann
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Eman Abdulfatah
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Liron Pantanowitz
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Jabbari S, Salari B, He M, Dehner LP. Infantile Fibrosarcoma and Other Spindle Cell Neoplasms of Infancy. A Review of Morphologically Overlapping yet Molecularly Distinctive Entities. Fetal Pediatr Pathol 2022; 41:996-1014. [PMID: 35044292 DOI: 10.1080/15513815.2021.2024631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Regardless of age at presentation, many soft tissue neoplasms have overlapping histopathologic and immunophenotypic features to serve as a diagnostic challenge. CASE REPORT We reported a case of a spindle cell neoplasm in an infant, which was initially considered a vascular anomaly clinically and an eventual biopsy revealed marked inflammation with a spindle cell component that was resolved as an infantile fibrosarcoma with an ETV6 break-apart. CONCLUSION The context of this case lead to a further consideration of various other spindle cell neoplasms arising predominantly in the soft tissues during the infancy period as defined by the first two years of age. Though sharing similar morphologic features, these tumors can be categorized into several molecular genetic groups, which have provided both diagnostic and pathogenetic insights as well as treatment options in some cases.
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Affiliation(s)
- Shiva Jabbari
- Lauren V. Ackerman Laboratory of Surgical Pathology, Washington University Medical Center, St. Louis, MO, USA
| | - Behzad Salari
- Lauren V. Ackerman Laboratory of Surgical Pathology, Washington University Medical Center, St. Louis, MO, USA
| | - Mai He
- Lauren V. Ackerman Laboratory of Surgical Pathology, Washington University Medical Center, St. Louis, MO, USA.,St. Louis Children's Hospitals, Washington University Medical Center, St. Louis, MO, USA
| | - Louis P Dehner
- Lauren V. Ackerman Laboratory of Surgical Pathology, Washington University Medical Center, St. Louis, MO, USA.,St. Louis Children's Hospitals, Washington University Medical Center, St. Louis, MO, USA
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PANAGOPOULOS IOANNIS, HEIM SVERRE. Neoplasia-associated Chromosome Translocations Resulting in Gene Truncation. Cancer Genomics Proteomics 2022; 19:647-672. [PMID: 36316036 PMCID: PMC9620447 DOI: 10.21873/cgp.20349] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 11/27/2022] Open
Abstract
Chromosomal translocations in cancer as well as benign neoplasias typically lead to the formation of fusion genes. Such genes may encode chimeric proteins when two protein-coding regions fuse in-frame, or they may result in deregulation of genes via promoter swapping or translocation of the gene into the vicinity of a highly active regulatory element. A less studied consequence of chromosomal translocations is the fusion of two breakpoint genes resulting in an out-of-frame chimera. The breaks then occur in one or both protein-coding regions forming a stop codon in the chimeric transcript shortly after the fusion point. Though the latter genetic events and mechanisms at first awoke little research interest, careful investigations have established them as neither rare nor inconsequential. In the present work, we review and discuss the truncation of genes in neoplastic cells resulting from chromosomal rearrangements, especially from seemingly balanced translocations.
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Affiliation(s)
- IOANNIS PANAGOPOULOS
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - SVERRE HEIM
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Ubiquitin-specific protease TRE17/USP6 promotes tumor cell invasion through the regulation of glycoprotein CD147 intracellular trafficking. J Biol Chem 2022; 298:102335. [PMID: 35926707 PMCID: PMC9440431 DOI: 10.1016/j.jbc.2022.102335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 11/20/2022] Open
Abstract
Disordered expression and distribution of plasma membrane proteins at the cell surface leads to diverse malignant phenotypes in tumors, including cell invasion. The ubiquitin-specific protease TRE17/USP6, an oncogene identified in Ewing sarcoma, is highly expressed in several cancers and locally aggressive tumor-like lesions. We have previously demonstrated that TRE17 regulates the trafficking of plasma membrane proteins that enter cells via clathrin-independent endocytosis (CIE); TRE17 prevents CIE cargo proteins from being targeted to lysosomes for degradation by deubiquitylating them. However, functional insights into the effects of TRE17-mediated CIE cargo trafficking on cell invasion remain unknown. Here, we show that increased expression of TRE17 enhances invasiveness of the human sarcoma cell line HT-1080 by elevating the cell surface levels of the membrane glycoprotein CD147, which plays a central role in tumor progression. We demonstrate overexpression of TRE17 decreases ubiquitylated CD147, which is accompanied by suppression of CD147 transport to lysosomes, resulting in the stabilization and increase of cell surface-localized CD147. On the other hand, we show knockdown of TRE17 decreases cell surface CD147, which is coupled with reduced production of matrix metalloproteinases (MMPs), the enzymes responsible for extracellular matrix degradation. Furthermore, we demonstrate that inhibition of CD147 by a specific inhibitor alleviated the TRE17-promoted tumor cell invasion. We therefore propose a model for the pathogenesis of TRE17-driven tumors in which TRE17 increases CD147 at the cell surface by preventing its lysosomal degradation, which in turn enhances MMP synthesis and matrix degradation, thereby promoting tumor cell invasion.
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Smit C, Robinson L, Roman Tager E, Oliveira Corrêa Roza AL, Rocha AC, Santos Silva AR, Vargas PA, Romañach MJ, Fonseca FP, Carlos R, van Heerden WF. Clinicoradiological spectrum of primary aneurysmal bone cysts of the maxillofacial region: A series of 31 cases. Dentomaxillofac Radiol 2022; 51:20220071. [PMID: 35522705 PMCID: PMC10043610 DOI: 10.1259/dmfr.20220071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of the current study was to analyse the demographic, clinical and radiological features of primary aneurysmal bone cysts (ABCs) involving the maxillofacial region. METHODS Histologically confirmed cases affecting the maxillofacial region were retrospectively reviewed over a 21 year period (2000-2021). Cases were collected from the archives of five Oral Pathology laboratories from three countries: South Africa, Guatemala and Brazil. The information was analysed, with emphasis on the clinical and radiological spectrum. RESULTS Following the inclusion criteria, a total of 31 cases of primary ABCs were included in the study. A nearly equal male-to-female distribution was seen, with ABCs occurring in males at an earlier age compared to females. Localised swelling was the main clinical presentation. ABCs had a mandibular predominance, particularly in the posterior regions. All ABCs presented as blow-out expansile well-demarcated radiolucent lesions with the majority having a multilocular appearance. Cortical expansion was seen in 91% of cases with loss of cortical integrity being common (78%). CONCLUSION Primary ABCs involving the maxillofacial region are extremely rare with the majority of current published literature consisting of isolated case reports. The current study is the first large series detailing the radiological features.
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Affiliation(s)
- Chané Smit
- Department of Oral Pathology and Oral Biology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Liam Robinson
- Department of Oral Pathology and Oral Biology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Elena Roman Tager
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), São Paulo, Brazil
| | | | - Andre Caroli Rocha
- Medical School, Clinics Hospital, University of São Paulo (USP), São Paulo, Brazil
| | - Alan Roger Santos Silva
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), São Paulo, Brazil
| | - Pablo Austin Vargas
- Department of Oral Pathology and Oral Biology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), São Paulo, Brazil
| | - Mario José Romañach
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Felipe Paiva Fonseca
- Department of Oral Pathology and Oral Biology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Department of Oral Surgery and Pathology, School of Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Román Carlos
- Pathology Section, Centro Clínico de Cabeza y Cuello/Hospital Herrera Llerandi, Guatemala City, Guatemala
| | - Willie Fp van Heerden
- Department of Oral Pathology and Oral Biology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Malik F, Bernieh A, El Jamal SM, Saad AG. Cranial Fasciitis in Children: Expanding the Spectrum of USP6-Associated Clonal Transient Neoplasms. Pediatr Dev Pathol 2022; 25:304-315. [PMID: 35686345 DOI: 10.1177/10935266211063989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Cranial fasciitis (CF) is a benign (myo)fibroblastic proliferation of children. Typical presentation consists of a rapidly growing solitary mass on the temporal or parietal cranium in the first 2 years of age. CF is characterized by a rapid growth followed by a relative slowdown and even growth arrest. The finding of somatic USP6 gene rearrangements demonstrating clonality in CF together with its clinical behavior places it in the category of diseases recently termed "transient neoplasia."Methods: Histological, immunohistochemical, and molecular findings of 18 patients with CF were retrospectively studied.Results: The tumor typically presented as a painless rapidly enlarging mass in the temporal region. Sixty-six percent of the cases harbored USP6 gene rearrangement. Nine patients were treated with gross total resection (GTR) and 9 with subtotal tumor resection (STR). Two patients treated with GTR had recurrence. Five patients treated with STR had progression-free disease for at least 10 months after surgery and in four patients the tumor regressed spontaneously a median 16 months after surgery.Conclusions: In this largest series to date, we reported the clinicopathological, immunohistochemical, and molecular findings of 18 pediatric cases of CF with emphasis on the clinical growth pattern of these tumors.
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Affiliation(s)
- Faizan Malik
- Department of Pathology and Laboratory Medicine, 12326University of Tennessee Health Science Center, Memphis, TN, USA
| | - Anas Bernieh
- Division of Pathology, 2518Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Siraj M El Jamal
- Department of Pathology, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ali G Saad
- Department of Pathology, 12235University of Miami Miller School of Medicine, Miami, FL, USA
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35
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Sennett R, Friedlander S, Tucker S, Hinds B, Hightower G. USP6 rearrangement in pediatric nodular fasciitis. J Cutan Pathol 2022; 49:743-746. [PMID: 35362105 DOI: 10.1111/cup.14237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 02/24/2022] [Accepted: 03/27/2022] [Indexed: 11/30/2022]
Abstract
Nodular fasciitis (NF) is a myofibroblastic proliferation that uncommonly presents in pediatric patients. These benign neoplasms can masquerade as more insidious sarcomatous proliferations on both clinical exam and initial histopathologic review, often prompting undue concern in patients, parents and providers. While immunohistochemical analysis of NF can be variable, adding to the diagnostic uncertainty, molecular analysis documenting ubiquitin-specific protease 6 (USP6) gene rearrangement can help confirm the diagnosis as an association between NF and USP6 overexpression was first identified 10 years ago in an analysis that found rearrangements of the involved locus in over 90% of studied samples.1 In this report, we review one case of nodular fasciitis located on the chin of a 9-year-old in which molecular testing was essential to secure the correct diagnosis, and provide a summary of documented cases of USP6 overexpression in transient pediatric neoplasms. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Rachel Sennett
- Department of Dermatology, University of California San Diego, La Jolla, CA
| | - Sheila Friedlander
- Departments of Pediatrics and Dermatology, Rady Children's Hospital, San Diego, CA
| | - Suzanne Tucker
- Department of Pathology, Rady Children's Hospital, San Diego, CA
| | - Brian Hinds
- Department of Dermatology, University of California San Diego, La Jolla, CA
| | - George Hightower
- Departments of Pediatrics and Dermatology, Rady Children's Hospital, San Diego, CA
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36
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Parkinson B, Patton A, Rogers A, Farhadi HF, Oghumu S, Iwenofu OH. Intraneural Nodular Fasciitis of the Femoral Nerve with A Unique CTNNB1::USP6 Gene Fusion: Apropos of a Case and Review of Literature. Int J Surg Pathol 2022; 30:673-681. [PMID: 35175167 DOI: 10.1177/10668969221080064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nodular fasciitis (NF) is a benign proliferation of fibroblasts and myofibroblasts occurring most commonly in the upper extremities that can mimic a variety of mesenchymal tumors including sarcoma. Although reported in almost all anatomic locations, only 7 cases of intraneural nodular fasciitis have been reported in English literature. The CTNNB1::USP6 gene fusion has not been previously reported in intraneural nodular fasciitis, although it has been reported in three entities including aneurysmal bone cyst, nodular fasciitis, and intravascular fasciitis. We report a case of a 29-year-old female with a 6-month history of left leg weakness, myalgia, and paresthesia of the left foot prompting a clinical diagnosis of a peripheral nerve sheath tumor. Surgical resection was performed, and histologic sections revealed a circumscribed lesion composed of banal spindle cells with variable interstitial collagen and occasional mitotic figures. By immunohistochemistry, the lesional cells were positive for smooth muscle actin, smooth muscle heavy chain myosin, p16, and H-caldesmon and negative for desmin, S-100, SOX10, HMB45, CD34, and beta-catenin. Fluorescence in Situ Hybridization for USP6 gene rearrangement was positive and consistent with the diagnosis of nodular fasciitis. Next-generation sequencing uncovered the presence of a CTNNB1::USP6 gene fusion involving CTNNB1 gene in exon 1 at the genomic position chr3:41241161 and the USP6 gene in exon 1 at the genomic position chr17:5033231. This gene fusion was confirmed by Sanger sequencing. Herein, we report a case that underscores the rare incidence of intraneural nodular fasciitis and highlights the pitfalls associated with the clinical differential diagnoses of intraneural tumors.
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Affiliation(s)
- Bryce Parkinson
- 12306The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ashley Patton
- 12306The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alan Rogers
- The James Cancer Hospital and Solove Research Institute, 2647The Ohio State University, Wexner Medical Center, Columbus, USA
| | - H Francis Farhadi
- 12306The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,12252University of Kentucky, Lexington, Kentucky, USA
| | - Steve Oghumu
- 12306The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - O Hans Iwenofu
- 12306The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Restrepo R, Zahrah D, Pelaez L, Temple HT, Murakami JW. Update on aneurysmal bone cyst: pathophysiology, histology, imaging and treatment. Pediatr Radiol 2022; 52:1601-1614. [PMID: 35941207 PMCID: PMC9360065 DOI: 10.1007/s00247-022-05396-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/05/2022] [Accepted: 05/03/2022] [Indexed: 11/26/2022]
Abstract
Aneurysmal bone cyst (ABC) is a benign but locally aggressive lesion that predominantly affects children and young adults. ABC, which accounts for approximately 70% of the cases, is now recognized to be a true neoplasm, whereas ABC-like changes associated to other bone neoplasms (also referred in the literature as secondary ABC) accounts for the remaining 30%. The solid variant of ABC is also considered a true neoplasm but is rare. ABC can involve any bone in the body, and although it has a metaphyseal preference, it can involve any part of a bone and soft tissues. As with any bone tumor, the initial evaluation of ABCs should be done with radiographs followed by magnetic resonance imaging or less frequently computed tomography for further characterization. The imaging appearance of ABC is variable; however, a lytic and expansile lesion with fluid-fluid levels is the most common presentation. The main differential diagnosis of an ABC in the pediatric population is unicameral bone cyst (UBC) and telangiectatic osteosarcoma, therefore a biopsy is recommended before treatment. The therapeutic options of ABC range from curettage with or without adjuncts such as phenol, liquid nitrogen, argon laser and bone grafting or bone substitutes to more recently employed alternatives such as image-guided sclerotherapy with various sclerosing agents and monoclonal antibodies (e.g., Denosumab).
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Affiliation(s)
- Ricardo Restrepo
- grid.415486.a0000 0000 9682 6720Department of Radiology, Nicklaus Children’s Hospital, Miami, FL USA
| | - David Zahrah
- grid.4367.60000 0001 2355 7002School of Arts and Sciences, Washington University, St. Louis, MO USA
| | - Liset Pelaez
- grid.415486.a0000 0000 9682 6720Department of Pathology, Nicklaus Children’s Hospital, Miami, FL USA
| | - H. Thomas Temple
- grid.26790.3a0000 0004 1936 8606Department of Orthopedic Surgery, Miller School of Medicine, University of Miami, Miami, FL USA
| | - James W. Murakami
- grid.240344.50000 0004 0392 3476Department of Radiology, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205 USA
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Fibroma of tendon sheath is defined by a USP6 gene fusion-morphologic and molecular reappraisal of the entity. Mod Pathol 2021; 34:1876-1888. [PMID: 34088995 DOI: 10.1038/s41379-021-00836-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 11/08/2022]
Abstract
Fibroma of tendon sheath (FTS) is an uncommon benign myofibroblastic neoplasm that arises in association with tenosynovial tissue. Fusions of the USP6 gene have been recently documented in a proportion of so-called "cellular FTS" but not in "classic FTS". It remains unknown whether FTS can be defined by a USP6 fusion, regardless of cellularity, and what are USP6 fusion-negative "cellular FTS". Furthermore, FTS with low cellularity seems to be frequently confused with desmoplastic fibroblastoma. We performed a comprehensive analysis, including targeted RNA sequencing, of 58 consecutive cases originally diagnosed as FTS (n = 49), desmoplastic fibroblastoma (n = 6), or nodular fasciitis (n = 3); the latter two at the predilection sites for FTS. After review of the original slides, 28 lesions were morphologically classified as FTS (13 "classic" and 15 "cellular") and 23 as desmoplastic fibroblastoma. Among originally diagnosed FTS at the more cellular end of the spectrum, we identified seven lesions that shared many morphologic features of FTS but, in addition, showed several distinct morphologic features consistent with myofibroma, such as myoid appearance, branching thin-walled vessels, and perivascular growth. Targeted RNA sequencing showed a USP6 fusion in 17 of 18 analyzed FTS, regardless of cellularity, 0 of 5 desmoplastic fibroblastomas and 0 of 4 myofibromas. MYH9, COL1A1, and ASPN were identified as fusion partners in three cases each, and MIR22HG, CTNNB1, SPARC, CAP1, EMP1, LINC00152, NR1D1, and RAB1A in a single case each. FTS, regardless of cellularity, can be defined by a USP6 fusion with a variety of fusion partners. More cellular lesions exhibiting some morphologic features of FTS but lacking a USP6 fusion tend to be myofibromas.
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Tomassen T, van de Ven C, Anninga J, Koelsche C, Hiemcke-Jiwa LS, Ter Horst S, de Leng WW, Tirode F, Karanian M, Flucke U. Nodular Fasciitis With Malignant Morphology and a COL6A2-USP6 Fusion: A Case Report (of a 10-Year-old Boy). Int J Surg Pathol 2021; 29:642-647. [PMID: 33625261 PMCID: PMC8343208 DOI: 10.1177/1066896921996045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Nodular fasciitis is usually a benign lesion genetically characterized by ubiquitin-specific protease 6 (USP6) rearrangements. We present a case of a 10-year-old boy with a 1.5-week history of a painless mass on the right chest wall, which was excised. A histomorphologically malignant tumor with pronounced pleomorphism, atypical mitotic figures, and a myoid immunophenotype was observed. The methylation profile was consistent with nodular fasciitis and fluorescence in situ hybridization confirmed USP6 rearrangement. Using Archer Fusion Plex (Sarcoma Panel) and RNA sequencing, a collagen, type VI, alpha 2 (COL6A2)–USP6 gene fusion was subsequently identified. Furthermore, DNA clustering analysis also showed a match with nodular fasciitis. During the follow-up of 22 months, no recurrence or metastasis occurred. In conclusion, we describe a clinically benign, histomorphologically malignant mesenchymal neoplasm with a myoid immunophenotype, and a genetic and epigenetic profile consistent with nodular fasciitis. In such cases, molecular analysis is a useful adjunct to avoid unnecessary overtreatment.
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Affiliation(s)
- Tess Tomassen
- 6029Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cees van de Ven
- 541199Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jakob Anninga
- 541199Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Christian Koelsche
- 9144Department of General Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Laura S Hiemcke-Jiwa
- 541199Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,8125Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Simone Ter Horst
- 541199Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,8125Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wendy W de Leng
- 8125Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Franck Tirode
- 56126Cancer Research Center of Lyon, INSERM & Department of Pathology, Centre Léon Bérard, Lyon, France
| | - Marie Karanian
- 56126Cancer Research Center of Lyon, INSERM & Department of Pathology, Centre Léon Bérard, Lyon, France
| | - Uta Flucke
- 6029Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands.,541199Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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40
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Nakayama S, Nishio J, Aoki M, Koga K, Nabeshima K, Yamamoto T. Ubiquitin-specific Peptidase 6 ( USP6)-associated Fibroblastic/Myofibroblastic Tumors: Evolving Concepts. Cancer Genomics Proteomics 2021; 18:93-101. [PMID: 33608306 DOI: 10.21873/cgp.20244] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 12/28/2022] Open
Abstract
Ubiquitin-specific peptidase 6 (USP6) is a hominoid-specific gene residing on chromosome 17p13 and serves as a deubiquitinating enzyme with a diverse set of functions including intracellular trafficking, inflammatory signaling, cell transformation and protein turnover. USP6 rearrangements were first identified in aneurysmal bone cysts, resulting in promoter swapping and over-expression of wild type USP6. Several morphologically overlapping fibroblastic/myofibroblastic tumors are known to harbor USP6 rearrangements, including nodular fasciitis, cellular fibroma of tendon sheath, myositis ossificans and fibro-osseous pseudotumor of digits. Over the past few years, fusions involving the USP6 gene and various partner genes have been described in these neoplasms. The current World Health Organization Classification of Tumors of Soft Tissue suggests that USP6-rearranged lesions are typically benign and usually self-limited in their growth. This review provides an updated overview of the clinical, histological and molecular genetic features of USP6-associated fibroblastic/myofibroblastic tumors and discusses how these lesions should be best classified.
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Affiliation(s)
- Shizuhide Nakayama
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Jun Nishio
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan;
| | - Mikiko Aoki
- Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kaori Koga
- Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kazuki Nabeshima
- Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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41
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Stražar K, Šekoranja D, Matjašič A, Zupan A, Snoj Ž, Martinčič D, Pižem J. Intraarticular nodular fasciitis-detection of USP6 gene fusions in three cases by targeted RNA sequencing. Virchows Arch 2021; 478:1117-1124. [PMID: 33404853 DOI: 10.1007/s00428-020-02991-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/05/2020] [Accepted: 12/08/2020] [Indexed: 11/24/2022]
Abstract
Intraarticular nodular fasciitis arising in the joint synovium is an uncommon lesion. Most cases have been reported in the knee and rarely in other joints. A USP6 gene fusion has so far been documented in only four cases of intraarticular nodular fasciitis, three were located in the knee and one in the proximal interphalangeal joint. In all three cases located in the knee, MYH9 was detected as a USP6 fusion partner. We analysed three cases of intraarticular nodular fasciitis for the presence of USP6 fusion by targeted RNA sequencing. Two cases were located in the hip (a 25-year-old female and 48-year-old male) and one in the shoulder (a 38-year-old male). We detected a MYH9-USP6 fusion in the two hip cases and a COL1A1-USP6 fusion in the shoulder case. Our findings provide additional evidence that intraarticular nodular fasciitis is a form of nodular fasciitis arising in the joint synovium, harbouring a USP6 fusion. Although a MYH9-USP6 fusion seems to predominate in intraarticular nodular fasciitis, other fusion partners of the USP6 gene may also be involved. Detection of a USP6 fusion by targeted RNA sequencing may assist in confirming the diagnosis in selected cases.
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Affiliation(s)
- Klemen Stražar
- Department of Orthopedic Surgery, University Medical Centre Ljubljana, Zaloška 9, 1000, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Daja Šekoranja
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000, Ljubljana, Slovenia
| | - Alenka Matjašič
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000, Ljubljana, Slovenia
| | - Andrej Zupan
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000, Ljubljana, Slovenia
| | - Žiga Snoj
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia.,Institute of Radiology, University Medical Center Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - David Martinčič
- Department of Orthopedic Surgery, University Medical Centre Ljubljana, Zaloška 9, 1000, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Jože Pižem
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000, Ljubljana, Slovenia.
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