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Cocchi S, Gambarotti M, Gamberi G, Magagnoli G, Maioli M, Stevanin M, Samperi F, Righi A, Benini S. The utility of FISH analysis in the diagnosis of BCOR-rearranged sarcomas. Pathol Res Pract 2024; 255:155209. [PMID: 38422910 DOI: 10.1016/j.prp.2024.155209] [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: 09/01/2023] [Revised: 01/17/2024] [Accepted: 02/11/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND A BCL6 corepressor (BCOR) gene alteration is a genetic signature of rare subsets of sarcomas. The identification of this alteration has recently contributed to the definition of new entities in the current WHO (2020) classification of soft tissue and bone tumours. We retrospectively examined cases of BCOR-rearranged sarcoma (BRS) to assess the reliability of the BCOR FISH analysis using an IVD (in vitro diagnostic) probe. METHODS We investigated and compared the molecular diagnostic strategies and features by collecting 17 data from patients with a BCOR gene rearrangement detected using quantitative-Reverse Transcription-Polymerase Chain Reaction (qRTPCR), Next-Generation Sequencing (NGS) and Fluorescence in situ hybridization (FISH). RESULTS We describe fourteen BCOR::CCNB3 sarcomas, one spindle cell sarcoma with a novel BCOR::MAML1 fusion, one spindle cell sarcoma with a novel BCOR::AHR fusion, and one ossifying fibromyxoid tumour with a BCOR::ZC3H7B fusion. FISH analysis of all, except one, BCOR::CCNB3 sarcoma, showed a FISH break-apart pattern with mild signal separation. The MAML1::BCOR sarcoma showed large-space split signals, while in the two patients with AHR::BCOR and ZC3H7B::BCOR fusions, no BCOR rearrangement was observed using FISH. CONCLUSIONS Our study indicates that BCOR FISH analysis using an IVD probe, may be useful to detect the presence of a BCOR rearrangement, including both translocations and inversions; however, negative results, in some cases, can occur.
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Affiliation(s)
- Stefania Cocchi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Marco Gambarotti
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gabriella Gamberi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Giovanna Magagnoli
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Margherita Maioli
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Monica Stevanin
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Federica Samperi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Righi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefania Benini
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Rekhi B, Kosemehmetoglu K, Ergen FB, Vengurlekar V, Rumde R, Shetty O, Guler G. Spectrum of Histopathological, Immunohistochemical, Molecular and Radiological Features in 12 Cases of BCOR::CCNB3-positive Sarcomas With Literature Review. Int J Surg Pathol 2023; 31:1244-1264. [PMID: 36591870 DOI: 10.1177/10668969221143467] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction BCOR::CCNB3-positive undifferentiated sarcomas are rare. Herein, we present clinicopathological features including immunohistochemical and molecular data, along with the radiological profile of 12 such tumors. Methods Tumors were tested for BCOR::CCNB3 fusion by reverse transcription polymerase chain reaction (RT-PCR) technique. Eight tumors were tested for EWSR1 and three for SS18 gene rearrangements by fluorescence in situ hybridization, and two for SS18::SSX fusion by fragment analysis. Results Ten of 12 patients were male with ages ranging between 4 and 17 years (median = 13, average = 14.4). Nine tumors occurred in bones and three in soft tissues (median size = 8 cm). Four of five tumors within the appendicular bones were metadiaphyseal and appeared as permeative lesions, invariably associated with cortical thickening. Three tumors displayed mineralization. Histopathologically, the tumors comprised round to epithelioid cells with round to oval to spindle-shaped nuclei, mostly diffusely arranged in a myxoid stroma with intervening thin-walled vessels. Immunohistochemically, tumor cells were positive for BCOR (10/11), SATB2 (8/9), TLE1 (5/6), cyclinD1 (4/4), and EMA (3/8). All tumors revealed BCOR::CCNB3 fusion transcript. Nine patients underwent neoadjuvant chemotherapy, including five who underwent surgical resection, with two patients, who received adjuvant radiation therapy. A single patient, each, underwent palliative chemotherapy and palliative radiotherapy, respectively. Four patients developed pulmonary metastasis and three developed local recurrences. Four patients were alive-with-disease and two were free-of-disease. Conclusions It is crucial to identify BCOR::CCNB3 fusion-positive sarcomas, given significant treatment-associated implications. Certain clinicoradiological, histopathological features, absent EWSR1 rearrangement and BCOR, SATB2, and TLE1 immunoexpression are useful for triaging these tumors for molecular testing. A review of the literature on these ultra-rare tumors, including their diagnostic mimics is presented.
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Affiliation(s)
- Bharat Rekhi
- Department of Surgical Pathology, Tata Memorial Centre, Homi Bhabha National Institue (HBNI) University, Mumbai, India
- Division of Molecular Diagnostics and Translational Medicine, HBNI University, Mumbai, India
| | | | | | - Vaibhavi Vengurlekar
- Division of Molecular Diagnostics and Translational Medicine, HBNI University, Mumbai, India
| | - Rachna Rumde
- Division of Molecular Diagnostics and Translational Medicine, HBNI University, Mumbai, India
| | - Omshree Shetty
- Division of Molecular Diagnostics and Translational Medicine, HBNI University, Mumbai, India
| | - Gaye Guler
- Department of Pathology, Hacettepe University, Ankara, Turkey
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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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Ji T, Li X, Li Y, Zhang X, Liu Q, Zhang J, Sun N, Liu Z, Liu Y, Wang S, Ni X. Clinical Characteristics of Children with Nasal BCOR-Rearranged Ewing-like Sarcoma: A Case Report and Literature Review. EAR, NOSE & THROAT JOURNAL 2022:1455613221132392. [PMID: 36198487 DOI: 10.1177/01455613221132392] [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: 11/15/2022] Open
Abstract
Ewing-like sarcomas (ELS) are round cell mesenchymal neoplasms that are highly aggressive to bone and/or soft tissue. However, they rarely occur in the nose, with no reported such cases in the medical literature to date. Here, we reported the case of a two-year-old Chinese boy who presented with a mass in the left nasal cavity. Surprisingly, the final histopathological diagnosis of the nasal mass was determined to be a subtype of ELS, BCOR-rearranged sarcoma. Therefore, we retrospectively analyzed the clinical data of this case and reviewed the relevant literature on ELS and BCOR-rearranged sarcoma. The purpose of this article is to provide new insights into the clinical characteristics of children with BCOR-rearranged Ewing-like sarcoma and to improve the understanding of this disease.
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Affiliation(s)
- Tingting Ji
- Department of Otolaryngology, Head and Neck Surgery, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - Xiaodan Li
- Department of Otolaryngology, Head and Neck Surgery, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - Yanzhen Li
- Department of Otolaryngology, Head and Neck Surgery, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - Xuexi Zhang
- Department of Otolaryngology, Head and Neck Surgery, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - Qiaoyin Liu
- Department of Otolaryngology, Head and Neck Surgery, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - Jie Zhang
- Department of Otolaryngology, Head and Neck Surgery, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - Nian Sun
- Department of Otolaryngology, Head and Neck Surgery, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - Zhiyong Liu
- Department of Otolaryngology, Head and Neck Surgery, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - Yuwei Liu
- Department of Otolaryngology, Head and Neck Surgery, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - Shengcai Wang
- Department of Otolaryngology, Head and Neck Surgery, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - Xin Ni
- Department of Otolaryngology, Head and Neck Surgery, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
- Department of Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital Capital Medical University, Beijing, China
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Molecular classification of soft tissue sarcomas for adequate diagnosis: A study on the northeast population of Morocco. Heliyon 2022; 8:e10673. [PMID: 36164527 PMCID: PMC9508571 DOI: 10.1016/j.heliyon.2022.e10673] [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: 02/09/2022] [Revised: 06/24/2022] [Accepted: 09/12/2022] [Indexed: 11/21/2022] Open
Abstract
Background Soft tissue sarcomas (STS) are a heterogeneous group of tumors. For adequate therapeutic management, an accurate diagnosis is necessary. In Morocco, the diagnosis is essentially based on the morphological and immunohistochemical study. Compared to other techniques, fluorescence in situ hybridization (FISH) is easier to develop and less expensive. This study aims to assess the feasibility and utility of implementing FISH technique to improve diagnostic accuracy and establish a good classification. Material and methods This is a retrospective cohort study. 211 cases of mesenchymal tumors were included. Hematoxylin Eosin Safran (HES) staining was performed in all cases followed by immunohistochemistry (IHC). FISH was performed in all cases with suspected STS. The probes used were EWSR1, MDM2 and SS18. The performance of FISH and histopathological test were evaluated by the ROC curve method (receiver operating characteristic). We evaluated the concordance between FISH and real time PCR by Cohen test. Results The real-time PCR technique showed good agreement with the FISH test by a Kappa coefficient of 60% (p = 0.035). FISH was able to confirm that it is more accurate (Youden's Index = 91%) than histological/immunohistochemical analysis (Youden's Index = 51%), as well as the positive predictive value was higher (100%) with an ROC curve finding a larger area under the curve of 0.953 (95% CI: 0.918-0.988), p = 0.000 which supports that FISH shows high performance to present an accurate final diagnosis. Conclusion This is the first and the largest Moroccan series for the molecular diagnosis of STS by FISH. Our study shows that paraffin FISH is a sensitive and specific ancillary tool in the diagnosis of STS when used in the appropriate clinicopathological context.
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Whittle SB, Fetzko S, Roy A, Venkatramani R. Soft Tissue and Visceral Organ Sarcomas With BCOR Alterations. J Pediatr Hematol Oncol 2022; 44:195-200. [PMID: 35537005 PMCID: PMC10026688 DOI: 10.1097/mph.0000000000002480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/06/2022] [Indexed: 11/26/2022]
Abstract
Sarcomas with BCOR alteration are a heterogenous group characterized by changes including internal tandem duplications (ITDs) and recurring fusions with CCNB3, ZC3H7B, and other rare partners. With widespread genomic testing, these alterations are now associated with histologies such as Ewing-like sarcoma (BCOR::CCNB3), high-grade endometrial stromal sarcoma (ZC3H7B::BCOR), and clear cell sarcoma of kidney (BCOR-ITD). BCOR altered sarcomas of soft tissues and organs were identified through PubMed using keywords "Sarcoma (AND) BCOR" from 2005 through October 2021. Summary statistics and outcome data were calculated using STATA v12.1. Forty-one publications described 190 patients with BCOR altered soft tissue or organ sarcomas. BCOR-ITD was most common, followed by BCOR::CCNB3, ZC3H7B::BCOR. BCOR-ITD tumors occurred mainly in infants, BCOR::CCNB3 commonly occurred in adolescent young adults, and ZC3H7B::BCOR only in adults. The most common site for BCOR::CCNB3 fused tumors was extremity, BCOR-ITD kidney and ZC3H7B::BCOR uterus. Metastasis was rare in patients with BCOR::CCNB3. While most underwent resection and chemotherapy, few received radiation. Median follow-up of survivors was 24 months. Five year overall survival for patients with BCOR::CCNB3 fusions was 68% (95% confidence interval [CI]: 46%-83%). Patients with BCOR-ITD and ZC3H7B::BCOR had worse prognoses with 5 years overall survival of 35% (95% CI: 15%-56%) and 41% (95% CI: 11%-71%), respectively, demonstrating need for collaborative efforts identifying optimal treatments to improve outcomes.
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Affiliation(s)
- Sarah B. Whittle
- Department of Pediatrics, Texas Children’s Hospital, Houston, TX
- Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, TX
| | - Stephanie Fetzko
- Department of Pediatrics, Texas Children’s Hospital, Houston, TX
- Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, TX
| | - Angshumoy Roy
- Departments of Pathology and Immunology, Texas Children’s Hospital, Houston, TX
| | - Rajkumar Venkatramani
- Department of Pediatrics, Texas Children’s Hospital, Houston, TX
- Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, TX
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