Embryonal rhabdomyosarcoma of the uterine corpus

Soft-Tissue Sarcomas of the Genitourinary Tract with Radiologic-Pathologic Correlation

Genitourinary tract soft-tissue sarcomas are rare neoplasms with varied pathologic and clinical features. While some of these tumors may be aggressive high-grade malignancies, others are low grade with a relatively better prognosis. Given that the grade and extent of the disease are important prognostic factors in these tumors, timely diagnosis is crucial. Unfortunately, most imaging features of these malignancies are not pathognomonic, and various histologic subtypes do not manifest with typical classic imaging features. Therefore, reliable differentiation of the various histologic tumor types is not always possible based solely on the radiologic manifestations. Imaging findings need to be considered in the context of clinical history in corroboration with radiologic-pathologic correlation. The authors discuss the specific imaging and pathologic characteristics of various genitourinary tract soft-tissue sarcomas, emphasizing diagnostic difficulties and differential diagnoses. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.

Rhabdomyosarcoma in Adults: Case Series and Literature Review

Rhabdomyosarcoma, a common soft tissue malignant tumor in children and adolescents, is exceedingly rare in adults. Nevertheless, The outcome in adults is very poor, especially when compared to outcomes in children in whom significant improvements in treatment has been achieved. The first case was of a 24-year-old pregnant Chinese woman with a rare primary site of rhabdomyosarcoma in the perineal body. She presented with a perineal mass and was diagnosed during the second trimester of pregnancy, which is a very rare occurrence. The second case was a 70-year-old Chinese woman who suffered from right lower abdominal pain for 1 month and was misdiagnosed with an epithelial ovarian carcinoma. Mesenteric pleomorphic rhabdomyosarcoma was later confirmed by postoperative pathology. Both cases had undergone preoperative examination with chest and abdominal computed tomography (CT) and pelvic magnetic resonance imaging (MRI) examinations, as well as examination of complete blood count, liver panel, renal panel, and serum tumor markers. Diagnosis was based on histopathology and immunohistochemistry. The patient in the first case received chemotherapy after which the mass decreased in size; however, the patient was lost to follow-up. The second case underwent tumor resection and received chemotherapy and radiotherapy.

Embryonal rhabdomyosarcoma of the uterine corpus: a clinicopathological and molecular analysis of 21 cases highlighting a frequent association with DICER1 mutations

Herein we evaluated a series of 21 embryonal rhabdomyosarcomas of the uterine corpus (ucERMS), a rare neoplasm, to characterize their morphology, genomics, and behavior. Patients ranged from 27 to 73 (median 52) years and tumors from 4 to 15 (median 9) cm, with extrauterine disease noted in two. Follow-up (median 16 months) was available for 14/21 patients; nine were alive and well, four died of disease, and one died from other causes. Most tumors (16/21) showed predominantly classic morphology, comprised of alternating hyper- and hypocellular areas of primitive small cells and differentiating rhabdomyoblasts in a loose myxoid/edematous stroma. A cambium layer was noted in all; seven had heterologous elements (six with fetal-type cartilage) and eight displayed focal anaplasia. The remaining five neoplasms showed only a minor component (≤20%) of classic morphology, with anaplasia noted in four and tumor cell necrosis in three. The most frequent mutations detected were in DICER1 (14/21), TP53 (7/20), PI3K/AKT/mTOR pathway (7/20), and KRAS/NRAS (5/20). Copy-number alterations were present in 10/19 tumors. Overall, 8/14 DICER1-associated ucERMS showed concurrent loss of function and hotspot mutations in DICER1, which is a feature more likely to be seen in tumors associated with DICER1 syndrome. Germline data were available for two patients, both DICER1 wild type (one with concurrent loss of function and hotspot alterations). DICER1-associated ucERMS were more likely to show a classic histological appearance including heterologous elements than DICER1-independent tumors. No differences in survival were noted between the two groups, but both patients with extrauterine disease at diagnosis and two with recurrences died from disease. As no patients had a known personal or family history of DICER1 syndrome, we favor most DICER1-associated ucERMS to be sporadic.

Malignant mesenchymal tumors of the uterus - time to advocate a genetic classification

INTRODUCTION

Sarcomas are rare uterine tumors with leiomyosarcomas and endometrial stromal sarcomas constituting the predominant entities often making their first appearance in young and middle-aged women. By histology combined with immunostaining alone some of these tumors can offer diagnostic challenges e.g. for the differential diagnosis between leiomyosarcomas and smooth muscle tumors of uncertain malignant potential (STUMP). Areas covered: Recent advances in the genetic classification and subclassification, respectively, have shown that genetic markers can offer a valuable adjunct to conventional diagnostic tools. Herein, we will review these recent data from the literature also referring to genetic alterations found in STUMP, endometrial stromal nodules, and leiomyomas including their variants. Expert commentary: For the future, we consider genetic classification as a necessary step in the clinical management of these tumors which will help not only to improve the diagnosis but also the therapy of these malignancies often associated with a worse prognosis.

Wrong place at the wrong time: A case of cervical embryonal rhabdomyosarcoma in pregnancy

•

First case of NACT in cervical embryonal RMS

•

Second case occurring in pregnancy

•

Histological review outlining diagnostic difficulties