Proximal-type epithelioid sarcoma--a rare, aggressive subtype of epithelioid sarcoma presenting as a recurrent perineal mass in a middle-aged male

Proximal-type epithelioid sarcoma of the perineum: A case report and literature review

Proximal-type epithelioid sarcoma of the perineum is a rare soft-tissue malignancy, and only 55 cases have been reported in the English literature to date. This tumor has an indetectable early symptom and frequent recurrences. Here, we present the case of a 31-year-old man with proximal-type epithelioid sarcoma of the perineum who underwent wide excision. Further, we reviewed the current literature regarding differential diagnosis and management of this disease.

Epithelioid sarcoma and its outcome: a retrospective analysis from a tertiary care center in North India

Aim

Clinicopatholgical findings and outcomes in epithelioid sarcoma (ES) patients.

Materials & methods

ES patients registered in sarcoma clinic from 2015 to 2021.

Results

There were 20 patients with median age of 26 years. Majority had distal ES (70%) and advanced disease (85%). In patients with advanced disease lymph nodes were involved in 65%, lungs in 58% and others in 35%. Among 14 patients who underwent biopsy outside our institute, nine (64.2 %) had been initially misdiagnosed. Response rates to doxorubicin (n = 12), pazopanib (n = 6), gemcitabine/docetaxel (n = 5), tazemetostat (n = 3) and immunotherapy (n = 2) used in various lines were 16, 16, 20, 33 and 0%, respectively.

Conclusion

Our patients had an advanced-stage and distal ES, with a modest response to chemotherapy.

Primary Adrenal Epithelioid Sarcoma in a Child: A Case Report with Literature Review

Introduction; Epithelioid sarcoma is a malignant mesenchymal neoplasm with evidence of epithelial differentiation. All the cases reported in the solid organs are of "proximal type" occurring in adults. We report a primary epithelioid sarcoma arising in the adrenal gland of a young male. Case report: An 11-year-old male patient presented with right loin pain. Imaging revealed a 10.8 × 10.8 × 13.5 cm complex cystic mass with obscured right adrenal gland. Clinical and radiological studies did not reveal metastases. Histologic features were those of proximal type epithelioid sarcoma with extensive central necrosis. Immunohistochemistry showed strong positivity for pancytokeratin, vimentin, and CD34. Nuclear expression of SMARCB1 (INI-1) protein was lost. Conclusion: Proximal type of epithelioid sarcoma can arise from solid organs such as the adrenal.

Proximal-type epithelioid sarcoma in the maxillary sinus: an unusual presentation

Epithelioid sarcoma (ES) is a rare histological type of soft tissue sarcoma presenting as a subcutaneous or deep dermal mass in the distal extremities of young adults. Recently, a more aggressive, so called 'proximal-type' ES has been described. The literature is limited on the clinical features and management of ES originating in the head and neck area. We here report a case of 16-year-old female who initially presented with progressive swelling and pain in the left cheek. On physical and radiographic examination, a malignant neoplasm was found in the left maxillary sinus with bony invasion. The definite diagnosis of proximal-type ES was based on the pathological and immunohistochemical characteristics. A subtotal maxillectomy with wide margins was performed on this patient. The patient survived uneventfully for three years. This is the first report of a proximal-type ES found in the maxillary sinus.

Proximal-type epithelioid sarcoma of the oral cavity: a case report and literature review

Proximal-type epithelioid sarcoma (PES) is an exceedingly rare malignant tumor of soft tissue; PES within the oral cavity is even rarer. Pathologic examination is the primary diagnostic modality, and surgical treatment is recommended as the preferred method for the treatment of PES. Currently, there is a paucity of literature that systematically reports on PES in the oral cavity. Here, we describe a 42-year-old man with PES in the oral cavity, which showed positivity for vimentin, cytokeratin, CD31, S-100 but did not express BCL-2, HMB-45, or desmin. We performed a wide excision and neck dissection, and then used the free anterolateral thigh flap to reconstruct the defect in the soft tissue. Furthermore, we review the current literature with regard to diagnosis and treatment of PES.

Diagnostic Immunohistochemistry in Cutaneous Neoplasia: An Update

Immunohistochemistry (IHC) is an important adjunct in the diagnosis of neoplastic skin diseases. In addition to the many established IHC markers currently in use, new markers continue to emerge, although their general acceptance and routine application requires robust validation. Here, we summarize the most well-established and commonly used biomarkers along with an array of newer ones reported in the past several decades that either demonstrate or hold high clinical promise in the field of cutaneous pathology. We also highlight recent applications of novel IHC markers in melanoma diagnosis including genetic mutation status markers [e.g. BRAF (v-raf murine sarcoma viral oncogene homolog B) and NRAS (neuroblastoma RAS viral oncogene homolog)] and an epigenetic alteration marker (e.g. 5-hydroxymethylcytosine). We specifically focus on the role of IHC in the differential diagnosis of cutaneous lesions that fall under the following categories: melanoma, epidermal tumors with an intraepidermal epitheliomatous pattern, spindle cell lesions of the dermis, small round blue cell tumors of the dermis, and cutaneous adnexal tumors. While IHC is a valuable tool in diagnostic dermatopathology, marker selection and interpretation must be highly informed by clinical context and the histologic differential diagnosis. With rapid progress in our understanding of the genetic and epigenetic mechanisms of tumorigenesis, new IHC markers will continue to emerge in the field of diagnostic dermatopathology.

A Case of Distal Epithelioid Sarcoma of the Thumb Expressing Podoplanin, TLE1 and Ca 125

Distal epithelioid sarcoma is a rare and slowly growing tumor that usually develops in the upper extremities of young adults. Neoplastic cells have both spindle and epithelioid appearance and are characterized by the loss of the nuclear protein SMARCB1/INI1. We present the case of a distal epithelioid sarcoma arising in the thumb of a 14-year-old girl, which immunohistochemically was characterized by the loss of SMARCB1/INI1 protein as well as the expression of podoplanin (D2-40), TLE1, Glut1, and Ca 125; plus, we highlight the differential diagnosis of epithelioid sarcoma from its histological mimics.

Proximal-type epithelioid sarcoma of the scrotum: 18F-FDG PET/CT imaging

Proximal-type epithelioid sarcoma is an uncommon but aggressive soft-tissue malignancy involving proximal body parts especially perineum and genitalia of adult patients. This entity is a variant form of the conventional epithelioid sarcoma, which is frequently encountered at extremities of adolescents or young adults. The authors present a case of proximal-type epithelioid sarcoma of the scrotum with comprehensive staging and monitoring with PET/CT.

Proximal-type epithelioid sarcoma: case report of an unusual presentation

Epithelioid sarcoma, first described by Enzinger in 1970, classically presents in young adults and usually arises in the distal extremities. The proximal-type variant, first described in 1997 as a rare aggressive form of sarcoma, usually arises more proximally. It carries a higher mortality rate than classical limb epithelioid sarcoma and is often resistant to multimodal treatment. We report the case of a 27-year old male who had a delayed diagnosis of proximal-type epithelioid sarcoma of the forearm. This was originally thought to be a necrotising soft tissue infection and was unfortunately metastatic at the time of eventual diagnosis. The clinical and histopathological features of this challenging tumour are discussed and the relevant literature is reviewed.

Jejuno-jejunal invagination caused by epithelioid sarcoma: a case report

Introduction

Jejuno-jejunal invagination is a rare condition and is usually caused by a benign lesion. We describe the case of a patient with a jejunal epithelioid sarcoma. Epithelioid sarcoma is a rare histologic subtype of sarcoma and few cases have been published.

Case presentation

A 70-year-old Caucasian man presented with vomiting and anemia. A jejuno-jejunal invagination was diagnosed and the patient underwent surgery. An epithelioid sarcoma of the wall of the jejunum was found on the invaginated ansa.

Conclusion

To the best of our knowledge, an epithelioid sarcoma has never been reported to arise at the wall of the proximal jejunum or to present with jejuno-jejunal invagination.