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Oon ML, Wu B, Goh JY, Chang KTE, Chong YL, Wong ZW, Oh SY, Tan C, Nga ME, Petersson F. Primary Epithelioid Angiosarcoma of the Submandibular Gland-A Case Report with Histology-Cytology Correlation and Comprehensive Molecular Analysis. Head Neck Pathol 2024; 18:56. [PMID: 38916683 PMCID: PMC11199468 DOI: 10.1007/s12105-024-01667-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 06/11/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Angiosarcoma is a sarcoma that occurs in a range of tissue types, and only rarely in the salivary glands, showing a predilection for the parotid glands of older patients. Preoperative diagnosis may be challenging, especially on cytology, with significant morphological overlap with high-grade primary salivary gland carcinomas. The molecular alterations of this rare salivary gland neoplasm are also not well-characterized. METHODS AND RESULTS We present a case of right submandibular gland swelling in a 73-year-old male. On fine needle aspiration, including immunohistochemical stains on cell block, the tumor was initially diagnosed as poorly differentiated carcinoma. Resection of the submandibular gland revealed epithelioid angiosarcoma. We performed molecular work-up of the tumor, utilizing targeted next-generation sequencing, DNA methylation profiling and fluorescence in-situ hybridization. Histopathologic assessment revealed an infiltrative tumor comprising solid sheets of epithelioid cells. The tumor cells formed haphazardly anastomosing vascular channels with intracytoplasmic lumina containing red blood cells. On immunohistochemistry, the tumor cells were positive for CD31, CD34 and ERG. Approximately 40% of the tumor cells showed nuclear expression of GATA3. A pathogenic TP53 R267W mutation was detected on next-generation sequencing. DNA methylation analysis did not cluster the tumor with any known sarcoma type. Copy number analysis showed possible MYC amplification and CDKN2A losses, although only the latter was confirmed on fluorescence in-situ hybridization. CONCLUSION Epithelioid angiosarcoma is an important differential diagnosis to high-grade salivary gland carcinoma. In particular, GATA3 expression may be encountered in both angiosarcoma and high-grade salivary gland carcinomas and cause diagnostic confusion. Identification of TP53 mutations and CDKN2A losses suggest shared oncogenic pathways with soft tissue angiosarcomas, and should be further investigated.
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Affiliation(s)
- Ming Liang Oon
- Department of Pathology, National University Hospital, Singapore, Singapore
| | - Bingcheng Wu
- Department of Pathology, National University Hospital, Singapore, Singapore
| | - Jian Yuan Goh
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
- 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
- Duke-NUS Medical School, Singapore, Singapore
| | - Yan Ling Chong
- Department of Pathology, National University Hospital, Singapore, Singapore
| | - Zi Wei Wong
- Department of Pathology, National University Hospital, Singapore, Singapore
| | - Shoo Yi Oh
- Department of Pathology, National University Hospital, Singapore, Singapore
| | - Charmaine Tan
- Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Singapore, Singapore
| | - Min En Nga
- Department of Pathology, National University Hospital, Singapore, Singapore
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Fredrik Petersson
- Department of Pathology, National University Hospital, Singapore, Singapore.
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Srinivasan A, Liu M, Parham D, Li M, Wang X, Lu X, Li S, Zhang L, Yu Z. Infantile Epithelioid Sarcoma with Genomic Segmental Amplification of BIRC3/YAP1 as Double Minutes Plus Trisomy 2: A Case Report. Fetal Pediatr Pathol 2020; 39:51-61. [PMID: 31215292 DOI: 10.1080/15513815.2019.1627629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Epithelioid sarcoma is a malignant mesenchymal tumor exhibiting epithelioid cytomorphology and epithelial phenotype. Its histogenesis is unknown, but its tumorigenesis may relate to inactivation of hSNF5/SMARCB1/INI1 tumor suppressor gene. This tumor typically affects young adults and older children, but it is uncommon in infants. Case Report: We describe a unique neoplasm in a 15-month-old infant presenting with a heel mass. The tumor was remarkable for retention of SMARCB1/INI1 expression. Conventional cytogenetic analysis revealed trisomy 2 and double minutes, and SNP array analysis confirmed the trisomy 2 and identified segmental amplification of chromosome 11 containing YAP1 and BIRC3; FISH testing proved that the double minutes consisted of BIRC3 and YAP1, potent oncogenes related to tumorigenesis of several types of tumors but not described in epithelioid sarcoma. Conclusion: Our findings expand the spectrum of cytogenetic alterations in this neoplasm, help in better understanding its tumorigenesis, and suggest potential therapeutic targets.
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Affiliation(s)
- Anand Srinivasan
- Jimmy Everest Section of Pediatric Hematology/Oncology, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OKC, USA
| | - Meng Liu
- Genetic Section of Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OKC, USA.,Department of Hematology, China Medical University First Hospital, Shenyang, China
| | - David Parham
- Pathology and Lab Medicine, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Ming Li
- Genetic Section of Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OKC, USA
| | - Xianfu Wang
- Genetic Section of Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OKC, USA
| | - Xianglan Lu
- Genetic Section of Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OKC, USA
| | - Shibo Li
- Genetic Section of Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OKC, USA
| | - Lijun Zhang
- Department of Hematology, China Medical University First Hospital, Shenyang, China
| | - Zhongxin Yu
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OKC, USA
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Tran H, Shillingford N, Thomas S, Hammoudeh J, Zhou S. Primary Epithelioid Sarcoma of the Zygomatic Bone. Pediatr Dev Pathol 2019; 22:252-257. [PMID: 27442626 DOI: 10.2350/16-03-1798-cr.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Primary epithelioid sarcoma (ES) of bone is extremely rare with only 2 reported cases in the English literature. A previously healthy 18-year-old man presented with a 6-month history of right facial numbness and tingling and right eye diplopia. A computerized tomography scan revealed an ill-defined mass with dense osseous matrix centered in the right zygomatic bone. An outside biopsy was read as osteosarcoma. The resection specimen revealed large epithelioid and spindle cells embedded in a prominent hyalinized matrix with focal metaplastic bone formation. The tumor cells were strongly and diffusely positive for AE1/AE3 and epithelial membrane antigen, but a definitive diagnosis of ES was not immediately reached due to the presence of dense hyalinized matrix and weak expression of SAT2B by tumor cells. Deficient INI1 protein expression by immunohistochemistry and homozygous loss of the SMARCB1 gene by chromosomal microarray analysis ultimately justified this tumor's designation as ES.
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Affiliation(s)
- Henry Tran
- 1 Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California
| | - Nick Shillingford
- 1 Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California.,2 Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Stefanie Thomas
- 2 Keck School of Medicine, University of Southern California, Los Angeles, California.,3 Division of Hematology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Jeffrey Hammoudeh
- 2 Keck School of Medicine, University of Southern California, Los Angeles, California.,4 Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Shengmei Zhou
- 1 Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California.,2 Keck School of Medicine, University of Southern California, Los Angeles, California
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Abstract
INTRODUCTION Epithelioid sarcoma is a malignant soft tissue tumor arising from mesenchymal tissue and usually occurs in the extremities. The tumor involving the head and neck region is extremely rare. We present radiologically well-documented case of an epithelioid sarcoma arising from the temporal space. CASE PRESENTATION A 35-year-old woman presented with a slowly growing, painless palpable mass in the left temporal area. Ultrasound (US) revealed a lobulated hypoechoic mass with internal vascularity. On magnetic resonance (MR) imaging, the mass showed heterogeneous signal intensity with a central necrotic area and peritumoral infiltration. On the basis of the clinical and radiological characteristics, the lesion was considered to be a malignant tumor originating from soft tissue. An incisional biopsy was performed. The diagnosis of epithelioid sarcoma was based on microscopic examination and immunohistochemical analysis. F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) was used to stage the tumor and demonstrated intense FDG uptake in the mass without regional lymph node or distant metastasis. After the pathologic diagnosis of epithelioid sarcoma, the patient underwent total surgical resection of the tumor followed by postoperative irradiation. There was no evidence of recurrent disease during the follow-up period of 18 months. CONCLUSION An epithelioid sarcoma should be considered in the differential diagnosis of a locally aggressive lesion occurring in the temporal space of head and exhibiting a heterogeneous appearance on imaging studies, including a central necrotic area and signal intensity suggestive of infiltration of soft tissue adjacent to the tumor. It is, however, true that head-and-neck involvement is very rare, and the radiological findings are not pathognomonic.
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Affiliation(s)
- Yong Seek Kim
- Department of Radiology, Chonbuk National University Medical School and Hospital
| | - Hyo Sung Kwak
- Department of Radiology, Chonbuk National University Medical School and Hospital
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital
| | - Gyung Ho Chung
- Department of Radiology, Chonbuk National University Medical School and Hospital
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital
| | - Yo Na Kim
- Department of Pathology, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea
| | - Seungbae Hwang
- Department of Radiology, Chonbuk National University Medical School and Hospital
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital
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Bhattacharyya R, Ghosh R, Saha K, Chatterjee U. INI Expressing Epithelioid Sarcoma with Osteoclastic Giant Cells in a Child: A Case Report with Summary of Prior Published Cases. Fetal Pediatr Pathol 2017; 36:325-331. [PMID: 28541826 DOI: 10.1080/15513815.2017.1323984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Epithelioid sarcoma is a heterogeneous tumor with 2 subtypes, classic and proximal. The proximal variant is more aggressive and occurs in proximal location in young adults. CASE REPORT We present a proximal epithelioid sarcoma in the leg of an 8 year old girl with rhabdoid morphology and scattered osteoclastic giant cells. Nuclear INI-1 was retained. Despite wide local excision, local recurrence occurred at 8 months. Following re-excision, she developed a chest wall metastasis after 9 months. CONCLUSION Epithelioid sarcoma, proximal type with osteoclastic giant cells in the pediatric age group has not been reported previously and should be considered in the differential diagnoses of tumors with epithelioid cell morphology and scattered osteoclastic giant cells. Retained INI expression helped to differentiate this tumor from malignant rhabdoid tumor.
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Affiliation(s)
| | | | - Koushik Saha
- b Department of Pediatric Surgery , NRS Medical College , Kolkata , India
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The expanding family of SMARCB1(INI1)-deficient neoplasia: implications of phenotypic, biological, and molecular heterogeneity. Adv Anat Pathol 2014; 21:394-410. [PMID: 25299309 DOI: 10.1097/pap.0000000000000038] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Since the description of atypical teratoid/rhabdoid tumors of the central nervous system and renal/extrarenal malignant rhabdoid tumors in children, the clinicopathologic spectrum of neoplasms having in common a highly variable rhabdoid cell component (0% to 100%) and consistent loss of nuclear SMARCB1 (INI1) expression has been steadily expanding to include cribriform neuroepithelial tumor of the ventricle, renal medullary carcinoma and a subset of collecting duct carcinoma, epithelioid sarcoma, subsets of miscellaneous benign and malignant soft tissue tumors, and rare rhabdoid carcinoma variants of gastroenteropancreatic, sinonasal, and genitourinary tract origin. Although a majority of SMARCB1-deficient neoplasms arise de novo, the origin of SMARCB1-deficient neoplasia in the background of a phenotypically or genetically definable differentiated SMARCB1-intact "parent neoplasm" has been convincingly demonstrated, highlighting the rare occurrence of rhabdoid tumors as "double-hit neoplasia." As a group, SMARCB1-deficient neoplasms occur over a wide age range (0 to 80 y), may be devoid of rhabdoid cells or display uniform rhabdoid morphology, and follow a clinical course that varies from benign to highly aggressive causing death within a few months irrespective of aggressive multimodality therapy. Generally applicable criteria that would permit easy recognition of these uncommon neoplasms do not exist. Diagnosis is based on site-specific and entity-specific sets of clinicopathologic, immunophenotypic, and/or molecular criteria. SMARCB1 immunohistochemistry has emerged as a valuable tool in confirming or screening for SMARCB1-deficient neoplasms. This review summarizes the different phenotypic and topographic subgroups of SMARCB1-deficient neoplasms including sporadic and familial, benign and malignant, and rhabdoid and nonrhabdoid variants, highlighting their phenotypic heterogeneity and molecular complexity.
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Cockerill CC, Daram S, El-Naggar AK, Hanna EY, Weber RS, Kupferman ME. Primary sarcomas of the salivary glands: case series and literature review. Head Neck 2013; 35:1551-7. [PMID: 23728801 DOI: 10.1002/hed.23203] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2012] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Mesenchymal malignancies of salivary origin are rare and are histologically diverse. We reviewed our experience with these tumors, as well as the published literature, with an emphasis on treatment modalities and prognosis. METHODS We identified 17 patients treated for malignant mesenchymal cell tumors at The University of Texas MD Anderson Cancer Center between 1990 and 2007. We compared our results to the literature from January 1990 to July 2010. RESULTS Tumors were located primarily in the parotid gland and were primarily T1 tumors (<5 cm). All patients were treated with surgical resection, and 13 patients were given adjuvant therapy. Seven patients (41%) had recurrence, and 4 developed distant metastases. The overall 5-year and 10-year survival rates were 42% and 20%, respectively. CONCLUSIONS Our case series and literature review show that sarcomas of the salivary glands have a high rate of recurrence and are associated with a poor prognosis.
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Affiliation(s)
- Cara C Cockerill
- The University of Texas Medical School at Houston, Houston, Texas
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