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Roussas A, Palter JS. Young Woman With Vulvar Mass. Ann Emerg Med 2023; 81:e157-e158. [PMID: 37210172 DOI: 10.1016/j.annemergmed.2022.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 05/22/2023]
Affiliation(s)
- Adam Roussas
- Department of Emergency Medicine, Cook County Health, Chicago, IL
| | - Joseph S Palter
- Department of Emergency Medicine, Cook County Health, Chicago, IL
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2
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Miura T, Kikuchi N, Yamada H, Hakozaki M, Tajino T, Ohtsuka M, Yamamoto T. Proximal-type vulvar epithelioid sarcoma masquerading as cellulitis in a young female. Australas J Dermatol 2023; 64:295-297. [PMID: 36892905 DOI: 10.1111/ajd.14020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 02/10/2023] [Accepted: 02/20/2023] [Indexed: 03/10/2023]
Affiliation(s)
- Takako Miura
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Nobuyuki Kikuchi
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Hitoshi Yamada
- Department of Musculoskeletal Oncology and Metabolic Bone Disease Research, Fukushima Medical University, Fukushima, Japan
| | | | - Takahiro Tajino
- Department of Orthopedic Surgery, Minami Tohoku Fukushima Hospital, Fukushima, Japan
| | - Mikio Ohtsuka
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
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3
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Xia S, Wu W, Ma L. Proximal-type epithelioid sarcoma of the perineum: A case report and literature review. Front Oncol 2023; 13:1057466. [PMID: 36950547 PMCID: PMC10025383 DOI: 10.3389/fonc.2023.1057466] [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: 09/29/2022] [Accepted: 02/16/2023] [Indexed: 03/08/2023] Open
Abstract
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.
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Affiliation(s)
- Shijun Xia
- Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Wenjiang Wu
- Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
- *Correspondence: Wenjiang Wu,
| | - Lijuan Ma
- Shenzhen Traditional Chinese Medicine Anorectal Hospital, Shenzhen, China
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4
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Muacevic A, Adler JR, Morales Luna D. Clinicopathological Characteristics, Treatment, and Survival in Patients Diagnosed With Proximal-Type Epithelioid Sarcoma: A Case Report and Systematic Review. Cureus 2022; 14:e32962. [PMID: 36712724 PMCID: PMC9875881 DOI: 10.7759/cureus.32962] [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: 12/26/2022] [Indexed: 12/27/2022] Open
Abstract
Epithelioid sarcoma is a rare entity that shows a predilection for the young and middle-aged population. There are two subtypes, i.e., the distal or conventional type, which is located in distal extremities, and the proximal type, located in proximal areas of the extremities, pelvis, perineal, and genital region. The latter is characterized by more aggressive behavior, a higher recurrence rate, and poor prognosis. Histopathological and immunohistochemical diagnoses are key to correct and timely treatment and a higher survival rate. We report a case of a 41-year-old man who presented a palpable progressive growth mass in the hypogastrium. The disease time was of nine months, and the tumor was resected, but it recurred a few months later in the same location. Computed tomography (CT) scans showed images suggestive of lung metastasis and the patient had to undergo a second surgery. He received eight cycles of chemotherapy and a subsequent CT scan control showed the progression of the disease, so a new chemotherapy regimen was established. The patient received three cycles of chemotherapy without improvement, so he decided to discontinue treatment. His last outpatient medical consultation was in January 2022. A systematic review of the studies published in PubMed and Google Scholar was performed. We identified 291 articles, but only 41 reports and case series were included, with a total of 55 patients. It is important to include this type of tumor in the differential diagnosis of epithelial tumors due to its aggressive behavior. Correct and timely diagnosis is crucial to obtain lower recurrence rates, lower mortality, and higher survival rates in these patients.
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Hammer PM, Kolin DL, Charville GW, McCluggage WG, Howitt BE. A Subset of SMARCB1 (INI-1)-deficient vulvar neoplasms express germ cell markers. Histopathology 2022; 81:342-351. [PMID: 35758187 DOI: 10.1111/his.14709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/30/2022]
Abstract
AIMS SMARCB1 (INI-1)-deficient vulvar neoplasms comprise a group of rare tumours that include epithelioid sarcoma (ES), myoepithelial carcinoma (MEC), the recently described myoepithelioma-like tumour of the vulvar region (MELTVR), and sarcomas that are difficult to classify. It has been suggested that so-called vulvar yolk sac tumours (YST) may represent morphologic variants of SMARCB1-deficient tumours; thus, we investigated the immunoreactivity of germ cell markers in SMARCB1-deficient vulvar neoplasms. METHODS AND RESULTS Ten SMARCB1-deficient vulvar neoplasms were stained with germ cell tumour markers (SALL4, glypican-3, OCT3/4, and AFP) and re-reviewed for morphologic features. The tumours occurred in adult females (median age 41 years) and included ES (n = 7), MELTVR (n = 2), and MEC (n = 1). All cases showed loss of SMARCB1 expression. Four cases (40%) were focally positive for SALL4 in areas with morphology of typical-appearing ES. One of these cases also showed focal staining for OCT3/4. One ES showed a transition from typical-appearing ES to YST-like morphology, with diffuse expression of SALL4 and glypican-3, and focal expression of AFP, in these latter areas. All other tested cases were negative for AFP. CONCLUSION Our study reveals that SALL4, glypican-3, and OCT3/4 are positive in a subset of SMARCB1-deficient vulvar neoplasms, which may pose a diagnostic challenge and result in consideration of a germ cell tumour. We also highlight a case with transition from ES to YST-like morphology, lending further support that YSTs of the vulva are somatically derived SMARCB1-deficient neoplasms and do not represent true germ-cell neoplasia.
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Affiliation(s)
- Phoebe M Hammer
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - David L Kolin
- Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregory W Charville
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, UK
| | - Brooke E Howitt
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
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Kolin DL, Konstantinopoulos PA, Campos SM, Toumi G, Kolahi KA, Gars EJ, Howitt BE. Vulvar Yolk Sac Tumors Are Somatically Derived SMARCB1 (INI-1)-Deficient Neoplasms. Am J Surg Pathol 2022; 46:169-178. [PMID: 34265804 DOI: 10.1097/pas.0000000000001777] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
So-called primary yolk sac tumors of the vulva are very rare and often have an aggressive disease course. Their molecular features have not been previously characterized. There is also a well-documented group of SMARCB1 (INI-1)-deficient vulvar neoplasms, which includes proximal-type epithelioid sarcoma and myoepithelial carcinoma. Until now, "vulvar yolk sac tumors" and SMARCB1-deficient neoplasms were considered unrelated diseases. After reviewing an index case of a vulvar yolk sac tumor with loss of SMARCB1 by immunohistochemistry, we retrospectively identified 2 additional cases diagnosed as vulvar yolk sac tumors. Patient ages were 34, 32, and 25 years old, and 2 tumors were associated with a pregnancy. All 3 cases showed morphology typical of a yolk sac tumor, and by immunohistochemistry all were positive for SALL4, glypican-3, keratins, and lacked CD34 positivity. All tumors also demonstrated loss of SMARCB1 in tumor cells. Targeted molecular profiling was performed in 2 cases and identified 2 copy deletion of SMARCB1, without genomic alterations typically seen in gonadal yolk sac tumors. In the third case, isochromosome 12p was not identified by fluorescence in situ hybridization. All 3 patients had either local recurrences or distant metastases, and 2 died of disease. One patient had progressive disease while receiving the enhancer of zeste homolog 2 inhibitor tazemetostat. Overall, these findings suggest that vulvar tumors with pure yolk sac-like morphology may represent morphologic variants of SMARCB1-deficient tumors and not veritable germ cell neoplasia. This potential reclassification may have both prognostic and treatment implications and warrants study of additional extragonadal yolk sac tumors.
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Affiliation(s)
- David L Kolin
- Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital
| | | | - Susana M Campos
- Medical Gynecologic Oncology Program, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Gisele Toumi
- Department of Pathology, Stanford University Medical Center, Stanford, CA
| | - Kevin A Kolahi
- Department of Pathology, Stanford University Medical Center, Stanford, CA
| | - Eric J Gars
- Department of Pathology, Stanford University Medical Center, Stanford, CA
| | - Brooke E Howitt
- Department of Pathology, Stanford University Medical Center, Stanford, CA
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7
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Chung H, Jang TK, Kwon SY, Ha J, Shin SJ. A proximal type epithelioid sarcoma of the vulva with multiple distant metastases: A case report and review of the literature. Gynecol Oncol Rep 2021; 37:100835. [PMID: 34377757 PMCID: PMC8327478 DOI: 10.1016/j.gore.2021.100835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 11/12/2022] Open
Abstract
Epithelioid sarcomas (ESs) are rare and aggressive malignancy of a poor prognosis. Radiotherapy may be an alternative treatment to decrease the size of the lesion. Targeted therapy with pazopanib may be a treatment option for soft tissue sarcomas.
Epithelioid sarcomas (ESs) of the vulva are extremely rare soft tissue tumors characterized by an aggressive clinical course and a poor prognosis. The proximal type of ES occurs in the trunk and external genital area and has higher recurrence and distant metastasis rates than the distal type, which is found in the upper and lower extremities. We describe a case of a vulvar ES in a 24-year-old patient who was referred from the department of plastic surgery with protruding mushroom-like lesions in multiple areas, including the lower abdomen, whole vulva, anus, and both inguinal lesions. A biopsy of the lesions confirmed a proximal-type ES. Computed tomography and magnetic resonance imaging revealed multiple metastatic lesions in several regions, including the perineum, vagina, and inguinal regions; nodal metastases in the left external iliac and right inguinal region; and distant metastases in the lungs, pleura of the left lung, bones, and soft tissue. The patient underwent active palliative radiotherapy, followed by chemotherapy, and showed a partial response to treatment. Nineteen months after the initial diagnosis, the patient expired due to cancer progression and pneumothorax.
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Affiliation(s)
- Hyewon Chung
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu, South Korea
| | - Tae-Kyu Jang
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu, South Korea
| | - Sun Young Kwon
- Department of Pathology, Keimyung University School of Medicine, Daegu, South Korea
| | - Jinkyeong Ha
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu, South Korea
| | - So-Jin Shin
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu, South Korea
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8
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Abstract
The SMARCB1/INI1 gene was first discovered in the mid-1990s, and since then it has been revealed that loss of function mutations in this gene result in aggressive rhabdoid tumors. Recently, the term "rhabdoid tumor" has become synonymous with decreased SMARCB1/INI1 expression. When genetic aberrations in the SMARCB1/INI1 gene occur, the result can cause complete loss of expression, decreased expression, and mosaic expression. Although SMARCB1/INI1-deficient tumors are predominantly sarcomas, this is a diverse group of tumors with mixed phenotypes, which can often make the diagnosis challenging. Prognosis for these aggressive tumors is often poor. Moreover, refractory and relapsing progressive disease is common. As a result, accurate and timely diagnosis is imperative. Despite the SMARCB1/INI1 gene itself and its implications in tumorigenesis being discovered over two decades ago, there is a paucity of rhabdoid tumor cases reported in the literature that detail SMARCB1/INI1 expression. Much work remains if we hope to provide additional therapeutic strategies for patients with aggressive SMARCB1/INI1-deficient tumors.
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Affiliation(s)
- Nathaniel A Parker
- University of Kansas School of Medicine, 1010 N Kansas St, Wichita, KS, 67214, USA
| | - Ammar Al-Obaidi
- University of Kansas School of Medicine, 1010 N Kansas St, Wichita, KS, 67214, USA
| | - Jeremy M Deutsch
- Cancer Center of Kansas, 818 N. Emporia #403, Wichita, KS, 67214, USA
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An extremely rare elderly case of proximal epithelioid sarcoma of the vulva: case report with a review of literatures. Obstet Gynecol Sci 2020; 63:670-674. [PMID: 32727169 PMCID: PMC7494770 DOI: 10.5468/ogs.20076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/25/2020] [Indexed: 11/30/2022] Open
Abstract
We experienced an extremely rare case of proximal epithelioid sarcoma (PES) of the vulva in a 77-year-old woman. After history taking and physical examination, the patient was tentatively diagnosed as having Bartholin’s cyst in the right labium. Based on histopathological and immunohistochemical (IHC) findings, however, a final diagnosis of PES of the vulva was made. After receiving CyberKnife treatment, the patient survived but with recurrent episodes and poor prognosis. In conclusion, our case indicates that patients with PES of the vulva should be appropriately managed with radiotherapy after a differential diagnosis based on histopathological and IHC findings.
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Khazeni K, LaBove H, Wilky B, Rosenberg AE, Paulus E, Chim H, Pearson JM, Yakoub D. Myoepithelial carcinoma or epithelioid sarcoma - A rare diagnosis with poor prognosis. A case report and review of literature. Int J Surg Case Rep 2018; 49:239-243. [PMID: 30053614 PMCID: PMC6077148 DOI: 10.1016/j.ijscr.2018.06.016] [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: 04/12/2018] [Revised: 06/10/2018] [Accepted: 06/20/2018] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Myoepithelial carcinoma and proximal-type epithelioid sarcoma of the vulva are two rare malignancies with known aggressive behavior. In addition to a similar clinical course, these two disease entities also have significant histologic and pathologic overlap. Given the rarity of these malignancies, there is limited literature on the appropriate treatment regimen. Nevertheless, there is a consensus that early surgical resection is beneficial in both cases. PRESENTATION We present a case of a patient who was initially diagnosed with myoepithelial carcinoma of the vulva with a differential later expanded to include possible epithelioid sarcoma. DISCUSSION We demonstrate the importance in early identification of a SMARCB1 deficiency. Additionally, we suggest an appropriate treatment regimen for these patients going forward. Specifically, we encourage consideration of bilateral superficial and deep inguinal lymphadenectomies. Furthermore, sarcoma based chemotherapy regimens in the appropriate clinical setting may be beneficial in treating SMARCB1 deficient tumors. Additionally, there are now clinical trials involving EZH2 Inhibitors which may offer benefit for similar patients going forward. CONCLUSION This case highlights the difficulty in making a definitive diagnosis, and the importance in identifying a SMARCB1 deficiency as it will affect treatment options and may allow for enrollment in ongoing clinical trials.
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Affiliation(s)
- Kristina Khazeni
- Department of Surgical Oncology, University of Miami, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA.
| | - Hannah LaBove
- Department of Surgical Oncology, University of Miami, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA.
| | - Breelyn Wilky
- Department of Hematology/Oncology, University of Miami, 1475 NW 12th Ave, Miami, FL, 33136, USA.
| | - Andrew E Rosenberg
- Department of Pathology, University of Miami, 1400 NW 12th Ave, Miami, FL, 33136, USA.
| | - Elizabeth Paulus
- Department of Surgical Oncology, University of Miami, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA.
| | - Harvey Chim
- Department of Plastic Surgery, University of Miami, 1120 NW 14th St, Miami, FL, 33136, USA.
| | - Joseph M Pearson
- Department of Gynecological Oncology, University of Miami, 1475 NW 12th Ave, Miami, FL, 33136, USA.
| | - Danny Yakoub
- Department of Surgical Oncology, University of Miami, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA.
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Han CH, Li X, Khanna N. Epithelioid sarcoma of the vulva and its clinical implication: A case report and review of the literature. Gynecol Oncol Rep 2016; 15:31-3. [PMID: 26937486 PMCID: PMC4750019 DOI: 10.1016/j.gore.2016.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 12/28/2015] [Accepted: 01/06/2016] [Indexed: 01/14/2023] Open
Abstract
We present a case of vulva epithelioid sarcoma, and review the articles. The rarity of this disease causes delay in diagnosis and lack of guideline for optimal treatment. Physicians should have high suspicions in diagnosing this vulvar disease using prompt biopsy without delay.
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Affiliation(s)
- Chan Hee Han
- Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Emory University School of Medicine, United States
| | - Xiaoxian Li
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, United States
| | - Namita Khanna
- Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Emory University School of Medicine, United States
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Rodrigues AI, Lopes HI, Lima O, Marta S. Proximal-type epithelioid sarcoma-unusual presentation: unilateral vulvar mass. BMJ Case Rep 2015; 2015:bcr-2014-208488. [PMID: 25858929 DOI: 10.1136/bcr-2014-208488] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Epithelioid sarcoma of the vulva is a very rare malignant soft tissue tumour, usually initially asymptomatic, which simulates a variety of benign lesions, leading to diagnosis only at later stages. Prognosis is generally poor. We report a case of a 55-year-old postmenopausal woman, who presented with rapid growth of an asymptomatic mass located in the left labia majora. Biopsy of the lesion revealed features characteristic of proximal-type epithelioid sarcoma. Ganglionar, adrenal, pulmonary and hepatic metastases were found at thoracoabdominopelvic CT scan. During hospitalisation, the patient's clinical condition suffered rapid deterioration and she died on the 16th day of admission.
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Affiliation(s)
| | | | - Olinda Lima
- Department of Pathology, Centro Hospitalar do Porto, Porto, Portugal
| | - Susana Marta
- Department of Gynaecology, Centro Materno-Infantil do Norte, Porto, Portugal
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