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Warmke LM, Collier CD, Niziolek PJ, Davis JL, Zou YS, Michal M, Bell RC, Policarpio-Nicolas MLC, Cheng YW, Duckworth L, Dermawan JK, Fritchie KJ, Dehner CA. Novel CRTC1::MRTFB(MKL2) Gene Fusion Detected in Myxoid Mesenchymal Neoplasms With Myogenic Differentiation Involving Bone and Soft Tissues. Mod Pathol 2024; 37:100518. [PMID: 38763420 DOI: 10.1016/j.modpat.2024.100518] [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: 03/15/2024] [Revised: 04/23/2024] [Accepted: 05/11/2024] [Indexed: 05/21/2024]
Abstract
Appropriate classification of fusion-driven bone and soft tissue neoplasms continues to evolve, often relying on the careful integration of morphologic findings with immunohistochemical, molecular, and clinical data. Herein, we present 3 cases of a morphologically distinct myxoid mesenchymal neoplasm with myogenic differentiation and novel CRTC1::MRTFB (formerly MKL2) gene fusion. Three tumors occurred in 1 male and 2 female patients with a median age of 72 years (range: 28-78). Tumors involved the left iliac bone, the right thigh, and the left perianal region with a median size of 4.0 cm (4.0-7.6 cm). Although 1 tumor presented as an incidental finding, the other 2 tumors were noted, given their persistent growth. At the time of the last follow-up, 1 patient was alive with unresected disease at 6 months, 1 patient was alive without evidence of disease at 12 months after surgery, and 1 patient died of disease 24 months after diagnosis. On histologic sections, the tumors showed multinodular growth and were composed of variably cellular spindle to round-shaped cells with distinct brightly eosinophilic cytoplasm embedded within a myxoid stroma. One tumor showed overt smooth muscle differentiation. Cytologic atypia and mitotic activity ranged from minimal (2 cases) to high (1 case). By immunohistochemistry, the neoplastic cells expressed focal smooth muscle actin, h-caldesmon, and desmin in all tested cases. Skeletal muscle markers were negative. Next-generation sequencing detected nearly identical CRTC1::MRTFB gene fusions in all cases. We suggest that myxoid mesenchymal tumors with myogenic differentiation harboring a CRTC1::MRTFB fusion may represent a previously unrecognized, distinctive entity that involves soft tissue and bone. Continued identification of these novel myxoid neoplasms with myogenic differentiation will be important in determining appropriate classification, understanding biologic potential, and creating treatment paradigms.
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Affiliation(s)
- Laura M Warmke
- Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Christopher D Collier
- Department of Orthopedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Paul J Niziolek
- Department of Radiology and Imaging Sciences, Musculoskeletal Imaging, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jessica L Davis
- Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Ying S Zou
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Robert C Bell
- Department of Pathology, Michigan University, Ann Arbor, Michigan
| | | | - Yu-Wei Cheng
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Lauren Duckworth
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Josephine K Dermawan
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Karen J Fritchie
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Carina A Dehner
- Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana.
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Tay WJ, Jeyasekharan A, Goh JY, Chang KTE, Kesavan A, Lee VK. Aggressive prostate myxoid mesenchymal neoplasm with novel CRTC1::NCOA2 fusion. Histopathology 2024; 84:909-912. [PMID: 38173295 DOI: 10.1111/his.15135] [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: 10/28/2023] [Revised: 12/10/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024]
Affiliation(s)
- Wan Jing Tay
- Department of Pathology, National University Hospital (NUH) Singapore, Singapore, Singapore
| | - Anand Jeyasekharan
- National University Cancer Institute, Singapore (NCIS), National University Hospital (NUH), Singapore, Singapore
| | - Jian Yuan Goh
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
- Pathology Academic Clinical Programme, SingHealth Duke-NUS Medical School, Singapore, Singapore
| | - Kenneth Tou En Chang
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Arshvin Kesavan
- Department of Urology, National University Hospital (NUH) Singapore, Singapore, Singapore
| | - Victor K Lee
- Department of Pathology, National University Singapore, Singapore, Singapore
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Ji X, Wei J, Li X, Zhang W, Xing Z. Extraskeletal myxoid chondrosarcoma of the buttock: a case report and literature review. Front Oncol 2023; 13:1249928. [PMID: 38162483 PMCID: PMC10756670 DOI: 10.3389/fonc.2023.1249928] [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] [Received: 06/29/2023] [Accepted: 11/15/2023] [Indexed: 01/03/2024] Open
Abstract
Background Extraosseous myxoid chondrosarcoma (EMC) is extremely rare, and the case we report is of a particular site with partial bone destruction. Case presentation This case report can further strengthen the understanding of EMC and guide clinical treatment. The patient presented with a right buttock mass that was present for 1 year and that had gradually enlarged with tenderness for 6 months. The diagnosis was EMC. The interventions included puncture biopsy, surgical resection, and postoperative chemotherapy. The tumor was resected extensively, and the postoperative recovery was satisfactory. There was no recurrence or metastasis during the follow-up for 18-month. Case presentation The case we reported occurred in the pelvic cavity, which has not been previously reported in the literature, and there was partial bone destruction. Complete resection of the tumor was performed, and a satisfactory prognosis was achieved.
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Affiliation(s)
- Xinghua Ji
- Department of Orthopedics, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Jinzheng Wei
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Xiaoqiong Li
- Department of Magnetic Resonance Imaging, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, China
| | - Wei Zhang
- Department of Orthopedics, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Economics College of Hebei Geo University, Shijiazhuang, Hubei, China
| | - Zejun Xing
- Department of Orthopedics, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
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Huang SC, Lee JC, Hsu YC, Tsai JW, Kao YC, Hsieh TH, Chang YM, Chang KC, Wu PS, Chen PCH, Chen CH, Chang CD, Lee PH, Tai HC, Liu TT, Wen MC, Li WS, Yu SC, Wang JC, Huang HY. Extraskeletal Myxoid Chondrosarcomas: The Uncommon Clinicopathologic Manifestations and Significance of TAF15::NR4A3 Fusion. Mod Pathol 2023; 36:100161. [PMID: 36948401 DOI: 10.1016/j.modpat.2023.100161] [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: 11/30/2022] [Revised: 02/08/2023] [Accepted: 03/07/2023] [Indexed: 03/24/2023]
Abstract
Extraskeletal myxoid chondrosarcoma (EMC) is an ultrarare sarcoma typically exhibiting myxoid/reticular histology and NR4A3 translocation. However, morphologic variants and the relevance of non-EWSR1::NR4A3 fusions remain underexplored. Three challenging pan-Trk-expressing cases, featuring cellular to solid histology, were subjected to RNA exome sequencing (RES), unveiling different NR4A3-associated fusions. Alongside RES-analyzed cases, fluorescence in situ hybridization was performed to confirm 58 EMCs, with 48 available for pan-Trk immunostaining and KIT sequencing. Except for 1 (2%) NR4A3-rearranged EMC without identifiable partners, 46 (79%), 9 (16%), and 2 (3%) cases harbored EWSR1::NR4A3, TAF15::NR4A3, and TCF12::NR4A3 fusions, respectively. Five EWSR1::NR4A3-positive EMCs occurred in the subcutis (3) and bone (2). Besides 43 classical cases, there were 8 cellular, 4 rhabdoid/anaplastic, 2 solid, and 1 mixed tumor-like variants. Tumor cells were oval/spindle to pleomorphic and formed loose myxoid/reticular to compact sheet-like or fascicular patterns, imparting broad diagnostic considerations. RES showed upregulation of NTRK2/3, KIT, and INSM1. Moderate-to-strong immunoreactivities of pan-Trk, CD117, and INSM1 were present in 35.4%, 52.6%, and 54.6% of EMCs, respectively. KIT p. E554K mutation was detected in 2/48 cases. TAF15::NR4A3 was significantly associated with size >10 cm (78%, P = .025). Size >10 cm, moderate-to-severe nuclear pleomorphism, metastasis at presentation, TAF15::NR4A3 fusion, and the administration of chemotherapy portended shorter univariate disease-specific survival, whereas only size >10 cm (P = .004) and metastasis at presentation (P = .032) remained prognostically independent. Conclusively, EMC may manifest superficial or osseous lesions harboring EWSR1::NR4A3, underrecognized solid or anaplastic histology, and pan-Trk expression, posing tremendous challenges. Most TAF15::NR4A3-positive cases were >10 cm in size, ie, a crucial independent prognosticator, whereas pathogenic KIT mutation rarely occurred.
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Affiliation(s)
- Shih-Chiang Huang
- Department of Anatomic Pathology, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jen-Chieh Lee
- Department and Graduate Institute of Pathology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yong-Chen Hsu
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jen-Wei Tsai
- Department of Pathology, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Yu-Chien Kao
- Department of Pathology, Taipei Medical University Hospital, Taipei, Taiwan; Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tsung-Han Hsieh
- Joint Biobank, Office of Human Research, Taipei Medical University, Taipei, Taiwan
| | - Yi-Ming Chang
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Pathology, Tri-service General Hospital, National Defense Medical Center, Taipei City, Taiwan; Institute of Medical Sciences, National Defense Medical Center, Taipei City, Taiwan
| | - Kung-Chao Chang
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pao-Shu Wu
- Department of Pathology, MacKay Memorial Hospital, Taipei, Taiwan; Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | | | - Chien-Heng Chen
- Department of Pathology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Di Chang
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan
| | - Pei-Hang Lee
- Department of Anatomic Pathology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan
| | - Hui-Chun Tai
- Department of Pathology, Changhua Christian Hospital, Changhua, Taiwan
| | - Ting-Ting Liu
- Department of Anatomic Pathology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan
| | - Mei-Chin Wen
- Division of Pathology, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Wan-Shan Li
- Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Shih-Chen Yu
- Department of Anatomic Pathology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan
| | - Jui-Chu Wang
- Department of Anatomic Pathology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan
| | - Hsuan-Ying Huang
- Department of Anatomic Pathology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan.
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Giner F, López-Guerrero JA, Machado I, Rubio-Martínez LA, Espino M, Navarro S, Agra-Pujol C, Ferrández A, Llombart-Bosch A. Extraskeletal myxoid chondrosarcoma: p53 and Ki-67 offer prognostic value for clinical outcome - an immunohistochemical and molecular analysis of 31 cases. Virchows Arch 2023; 482:407-417. [PMID: 36376703 DOI: 10.1007/s00428-022-03453-x] [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: 07/06/2022] [Revised: 10/13/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022]
Abstract
Extraskeletal myxoid chondrosarcoma (EMC) is a rare malignant soft tissue tumor of unpredictable clinical behavior. The morphological spectrum of EMC based on histology alone can be difficult. There is no precise immunohistochemical (IHC) profile that together with the clinical parameters is able to predict the clinical outcome. We studied 31 cases confirmed as EMC. Clinical and follow-up data were recorded. Histopathological, molecular, and IHC studies were performed. Association among histopathological parameters was assessed using a chi-square test to determine homogeneity or linear trend for ordinal variables. The Kaplan-Meier proportional risk test (log rank) was used to study the impact of the histological, IHC, and molecular factors on progression-free survival (PFS) and disease-specific survival (DSS). Most EMCs showed a typical architectural pattern. Only a few cases presented an atypical histology (higher cellularity and solid pattern). IHC positivity (focal or diffuse) was present for CDK4 (100%), STAT-6 (90%), CD117 (84%), HNK-1 (81%), SATB2 (68%), and S-100 (58%). Synaptophysin and INSM1 were expressed in 22.6% and 38.7% of cases respectively. The EWSR1::NR4A3 rearrangement was found in 19 cases and 7 tumors presented the TAF15::NR4A3 fusion. Positive surgical margins together with atypical histology and expression of p53 and Ki67 correlated with worse clinical prognosis. EMCs express several IHC markers which are also seen in other soft tissue sarcomas. The molecular detection of NR4A3 rearrangement supports the differential diagnosis. Positive surgical margins together with atypical histology and positive expression of p53 and Ki-67 seem to predict a poor clinical outcome with worse prognosis, increased rate of recurrence, metastasis, and poor overall survival.
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Affiliation(s)
- Francisco Giner
- Pathology Department, Hospital Universitari I Politècnic La Fe of Valencia, Valencia, Spain.,Pathology Department, University of Valencia, Avd. Blasco Ibáñez 15, 46010, Valencia, Spain
| | - José Antonio López-Guerrero
- Molecular Biology Department, Instituto Valenciano de Oncología, Valencia, Spain.,Department of Pathology, Catholic University of Valencia, Valencia, Spain.,Joint Cancer Research Unit, Centro de Investigación Príncipe Felipe (CIPF), Valencia, Spain
| | - Isidro Machado
- Pathology Department, Instituto Valenciano de Oncología and Patologika Laboratory Hospital QuironSalud, Valencia, Spain. .,Pathology Department, University of Valencia, Avd. Blasco Ibáñez 15, 46010, Valencia, Spain.
| | | | - Mónica Espino
- Pathology Department, University of Valencia, Avd. Blasco Ibáñez 15, 46010, Valencia, Spain
| | - Samuel Navarro
- Pathology Department, University of Valencia, Avd. Blasco Ibáñez 15, 46010, Valencia, Spain.,Pathology Department, Hospital Clínic Universitari, Valencia, Spain
| | | | - Antonio Ferrández
- Pathology Department, University of Valencia, Avd. Blasco Ibáñez 15, 46010, Valencia, Spain.,Pathology Department, Hospital Clínic Universitari, Valencia, Spain
| | - Antonio Llombart-Bosch
- Pathology Department, University of Valencia, Avd. Blasco Ibáñez 15, 46010, Valencia, Spain
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