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Pfister SM, Reyes-Múgica M, Chan JKC, Hasle H, Lazar AJ, Rossi S, Ferrari A, Jarzembowski JA, Pritchard-Jones K, Hill DA, Jacques TS, Wesseling P, López Terrada DH, von Deimling A, Kratz CP, Cree IA, Alaggio R. A Summary of the Inaugural WHO Classification of Pediatric Tumors: Transitioning from the Optical into the Molecular Era. Cancer Discov 2022; 12:331-355. [PMID: 34921008 PMCID: PMC9401511 DOI: 10.1158/2159-8290.cd-21-1094] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/28/2021] [Accepted: 11/18/2021] [Indexed: 01/07/2023]
Abstract
Pediatric tumors are uncommon, yet are the leading cause of cancer-related death in childhood. Tumor types, molecular characteristics, and pathogenesis are unique, often originating from a single genetic driver event. The specific diagnostic challenges of childhood tumors led to the development of the first World Health Organization (WHO) Classification of Pediatric Tumors. The classification is rooted in a multilayered approach, incorporating morphology, IHC, and molecular characteristics. The volume is organized according to organ sites and provides a single, state-of-the-art compendium of pediatric tumor types. A special emphasis was placed on "blastomas," which variably recapitulate the morphologic maturation of organs from which they originate. SIGNIFICANCE: In this review, we briefly summarize the main features and updates of each chapter of the inaugural WHO Classification of Pediatric Tumors, including its rapid transition from a mostly microscopic into a molecularly driven classification systematically taking recent discoveries in pediatric tumor genomics into account.
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Affiliation(s)
- Stefan M Pfister
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
- Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Miguel Reyes-Múgica
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Division of Pediatric Pathology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - John K C Chan
- Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong, SAR China
| | - Henrik Hasle
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Alexander J Lazar
- Departments of Pathology & Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sabrina Rossi
- Pathology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Jason A Jarzembowski
- Department of Pathology, Children's Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kathy Pritchard-Jones
- Developmental Biology and Cancer Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - D Ashley Hill
- Department of Pathology, Children's National Hospital, Genomics and Precision Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Thomas S Jacques
- Developmental Biology and Cancer Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Pieter Wesseling
- Laboratory for Childhood Cancer Pathology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Pathology, Amsterdam University Medical Centers/VUmc, Amsterdam, the Netherlands
| | - Dolores H López Terrada
- Department of Pathology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Andreas von Deimling
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Christian P Kratz
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Ian A Cree
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Rita Alaggio
- Pathology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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Salvatorelli L, Parenti R, Broggi G, Vecchio GM, Angelico G, Puzzo L, Di Cataldo A, Di Benedetto V, Alaggio R, Magro G. WT1 and Cyclin D1 Immunohistochemistry: A Useful Adjunct for Diagnosis of Pediatric Small Round Blue Cell Tumors on Small Biopsies. Diagnostics (Basel) 2021; 11:diagnostics11122254. [PMID: 34943491 PMCID: PMC8700162 DOI: 10.3390/diagnostics11122254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 11/27/2021] [Accepted: 11/29/2021] [Indexed: 11/16/2022] Open
Abstract
Pediatric small round blue cell tumors (SRBCTs) are a heterogeneous group of neoplasms with overlapping morphological appearance. Accordingly, their diagnosis is one of the most difficult in the field of surgical pathology. The most common tumors include rhabdomyosarcoma, Ewing’s sarcoma, neuroblastoma, lymphoblastic lymphoma and Wilms’ tumor (the blastemal component). Over time their diagnosis has become more difficult due to the increasing use of small biopsies. However, the advent of immunohistochemistry has improved the quality of diagnosis in most cases by the application of an adequate panel of immunomarkers. Recently, WT1 and Cyclin D1 have been shown to be useful in the differential diagnosis of SRBCTs on surgically-resected specimens, showing a diffuse cytoplasmic positivity of the former in all RMSs and a diffuse nuclear staining of the latter in both EWS and NB. The aim of the present study was to investigate the expression of WT1 and Cyclin D1 on small biopsies from a series of 105 pediatric SRBCTs to evaluate their diagnostic utility. Both immunomarkers were differentially expressed, with a diffuse and strong cytoplasmic staining for WT1 limited to all cases of RMS, and a diffuse nuclear staining for cyclin D1 restricted to all cases of EWS and NB. Notably, the expression of WT1 and cyclin D1 was also retained in those cases in which the conventional tumor markers (myogenin, desmin and MyoD1 for RMS; CD99 for EWS; NB84 for NB) were focally expressed or more rarely absent. The present study shows that WT1 and Cyclin D1 are helpful immunomarkers exploitable in the differential diagnosis of pediatric SRBCTs on small biopsies, suggesting their applicability in routine practice.
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Affiliation(s)
- Lucia Salvatorelli
- Department of Medical and Surgical Sciences and Advanced Technologies, “G. F. Ingrassia”, Anatomic Pathology, University of Catania, 95123 Catania, Italy; (G.B.); (G.M.V.); (G.A.); (L.P.); (G.M.)
- Correspondence:
| | - Rosalba Parenti
- Department of Biomedical and Biotechnological Sciences, Physiology Section, University of Catania, 95123 Catania, Italy;
| | - Giuseppe Broggi
- Department of Medical and Surgical Sciences and Advanced Technologies, “G. F. Ingrassia”, Anatomic Pathology, University of Catania, 95123 Catania, Italy; (G.B.); (G.M.V.); (G.A.); (L.P.); (G.M.)
| | - Giada Maria Vecchio
- Department of Medical and Surgical Sciences and Advanced Technologies, “G. F. Ingrassia”, Anatomic Pathology, University of Catania, 95123 Catania, Italy; (G.B.); (G.M.V.); (G.A.); (L.P.); (G.M.)
| | - Giuseppe Angelico
- Department of Medical and Surgical Sciences and Advanced Technologies, “G. F. Ingrassia”, Anatomic Pathology, University of Catania, 95123 Catania, Italy; (G.B.); (G.M.V.); (G.A.); (L.P.); (G.M.)
| | - Lidia Puzzo
- Department of Medical and Surgical Sciences and Advanced Technologies, “G. F. Ingrassia”, Anatomic Pathology, University of Catania, 95123 Catania, Italy; (G.B.); (G.M.V.); (G.A.); (L.P.); (G.M.)
| | - Andrea Di Cataldo
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, University of Catania, 95123 Catania, Italy;
| | - Vincenzo Di Benedetto
- Pediatric Surgery Unit, Department of Medical and Surgical Sciences and Advanced Technologies, “G. F. Ingrassia”, University of Catania, 95123 Catania, Italy;
| | - Rita Alaggio
- Pathology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Gaetano Magro
- Department of Medical and Surgical Sciences and Advanced Technologies, “G. F. Ingrassia”, Anatomic Pathology, University of Catania, 95123 Catania, Italy; (G.B.); (G.M.V.); (G.A.); (L.P.); (G.M.)
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Ahmed AA, Vundamati D, Farooqi M, Repnikova E, Zinkus T, Hetherington M, Paulson L. Next-Generation Sequencing in the Diagnosis of Rare Pediatric Sinonasal Tumors. EAR, NOSE & THROAT JOURNAL 2019; 100:NP263-NP268. [PMID: 31550935 DOI: 10.1177/0145561319863371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The diagnosis of desmoid fibromatosis or other spindle cell tumors in the sinonasal region is very rare in children and needs to be thoroughly confirmed with immunohistochemical and/or molecular tests. We report 2 patients with such rare tumors and describe the use of next-generation sequencing in their evaluation. A 3-year-old female had a 4.4-cm midline nasal cavity mass involving the bony septum and extending into the base of the skull bilaterally. The moderate cellular fibroblastic proliferation revealed areas of thick keloid-like collagen bands and other areas with myxoid edematous stroma. Deep targeted sequencing identified a novel G34V mutation in the CTNNB1 gene consistent with desmoid fibromatosis. An 11-month-old male infant presented with a right nasal mass that extended through the cribriform plate into the anterior cranial fossa and involved the right ethmoid sinus and adjacent right orbit. Histology revealed an infiltrative atypical fibrous proliferation with focal calcifications that was negative for CTNNB1 and GNAS mutations. A novel RET E511K variant was identified in the tumor and later was also found in the germline and hence rendered of unknown significance. Both cases highlight the utility of next-generation sequencing in the evaluation of pediatric sinonasal spindle cell tumors that may have overlapping pathologic features. Reporting of rare or novel variants in tumor-only sequencing should be cautiously evaluated in children and pairing with germline sequencing may be needed to avoid the pitfall of assigning uncommon variants.
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Affiliation(s)
- Atif A Ahmed
- Department of Pathology, 4204Children's Mercy Hospital/University of Missouri, Kansas City, MO, USA
| | - Divya Vundamati
- Department of Pathology, 4204Children's Mercy Hospital/University of Missouri, Kansas City, MO, USA
| | - Midhat Farooqi
- Department of Pathology, 4204Children's Mercy Hospital/University of Missouri, Kansas City, MO, USA
| | - Elena Repnikova
- Department of Pathology, 4204Children's Mercy Hospital/University of Missouri, Kansas City, MO, USA
| | - Timothy Zinkus
- Department of Radiology, 4204Children's Mercy Hospital/University of Missouri, Kansas City, MO, USA
| | - Maxine Hetherington
- Department of Pediatrics Hematology-Oncology, 4204Children's Mercy Hospital/University of Missouri, Kansas City, MO, USA
| | - Lorien Paulson
- Department of Surgery, 4204Children's Mercy Hospital/University of Missouri, Kansas City, MO, USA
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Abstract
This overview of mesenchymal tumors presenting in the skin and/or subcutis in children brings together the range of neoplasms and hamartomas which are seen in this age-group. It is not surprising from the perspective of the pediatric or general surgical pathologist that vascular anomalies, including true neoplasms and vascular malformations, are the common phenotypic category. Since there is considerable morphologic overlap among these lesions, clinicopathologic correlation may be more important than for many of the other mesenchymal tumors. The skin and subcutis are the most common sites of clinical presentation for the infantile myofibroma which is the most common of fibrous mesenchymal tumors in children. Several of the other mesenchymal tumors are more common adults-like dermatofibrosarcoma protuberans, but nonetheless have an important presence in children, even as a congenital neoplasm. A lipomatous tumor in a young child should be considered as a possible manifestation of an overgrowth syndrome.
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Affiliation(s)
- Louis P Dehner
- 1 Lauren V. Ackerman Laboratory of Surgical Pathology, St. Louis Children's Hospital, Washington University Medical Center, St. Louis, Missouri.,2 Dermatopathology Center and Division of Dermatology, Washington University Medical Center, St. Louis, Missouri
| | - Alejandro A Gru
- 3 Department of Pathology, University of Virginia, Charlottesville, Virginia.,4 Department of Dermatology, University of Virginia, Charlottesville, Virginia
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Rosenzweig M, Ali SM, Wong V, Schrock AB, Laetsch TW, Ahrens W, Heilmann A, Morley S, Chudnovsky Y, Erlich RL, Wang K, Stephens PJ, Ross JS, Miller VA, Oesterheld J. A case of advanced infantile myofibromatosis harboring a novel MYH10-RET fusion. Pediatr Blood Cancer 2017; 64. [PMID: 28028925 DOI: 10.1002/pbc.26377] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/02/2016] [Accepted: 11/03/2016] [Indexed: 12/22/2022]
Affiliation(s)
| | - Siraj M Ali
- Foundation Medicine, Inc., Cambridge, Massachusetts
| | - Victor Wong
- Rady Children's Hospital, San Diego, California.,University of California San Diego, San Diego, California
| | | | - Theodore W Laetsch
- University of Texas Southwestern Medical Center/Children's Health, Dallas, Texas
| | - William Ahrens
- Zhejiang University International Hospital, Hangzhou, China
| | | | | | | | | | - Kai Wang
- Zhejiang University International Hospital, Hangzhou, China
| | | | - Jeffrey S Ross
- Albany Medical Center, Albany, New York.,Foundation Medicine, Inc., Cambridge, Massachusetts
| | | | - Javier Oesterheld
- Levine Pediatric Hematology/Oncology, Levine Children's Hospital, Charlotte, North Carolina
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Diagnostic utility of cyclin D1 in the diagnosis of small round blue cell tumors in children and adolescents. Hum Pathol 2016; 60:58-65. [PMID: 27984122 DOI: 10.1016/j.humpath.2016.07.038] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 07/20/2016] [Accepted: 07/22/2016] [Indexed: 02/06/2023]
Abstract
Small round blue cell tumors (SRBCTs) of children and adolescents are often diagnostically challenging lesions. With the increasing diagnostic approach based on small biopsies, there is the need of specific immunomarkers that can help in the differential diagnosis among the different tumor histotypes to assure the patient a correct diagnosis for proper treatment. Based on our recent studies showing cyclin D1 overexpression in both Ewing sarcoma/primitive peripheral neuroectodermal tumor (EWS/pPNET) and peripheral neuroblastic tumors (neuroblastoma and ganglioneuroblastoma), we immunohistochemically assessed cyclin D1 immunoreactivity in 128 cases of SRBCTs in children and adolescents to establish its potential utility in the differential diagnosis. All cases of EWS/pPNET and the undifferentiated/poorly differentiated neuroblastomatous component of all peripheral neuroblastic tumors exhibited strong and diffuse nuclear staining (>50% of neoplastic cells) for cyclin D1. In contrast, this marker was absent from rhabdomyosarcoma (regardless of subtype) and lymphoblastic lymphoma (either B- or T-cell precursors), whereas it was only focally detected (<5% of neoplastic cells) in some cases of Wilms tumor (blastemal component) and desmoplastic small round cell tumor. Our findings suggest that cyclin D1 can be exploitable as a diagnostic adjunct to conventional markers in confirming the diagnosis of EWS/pPNET or neuroblastoma/ganglioneuroblastoma. Its use in routine practice may also be helpful for those cases of SRBCT with undifferentiated morphology that are difficult to diagnose after application of the conventional markers.
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Cyclin D1 is a useful marker for soft tissue Ewing's sarcoma/peripheral Primitive Neuroectodermal Tumor in children and adolescents: A comparative immunohistochemical study with rhabdomyosarcoma. Acta Histochem 2015; 117:460-7. [PMID: 25765111 DOI: 10.1016/j.acthis.2015.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 01/15/2015] [Accepted: 01/22/2015] [Indexed: 01/10/2023]
Abstract
Cyclin D1 amplification and/or overexpression contribute to the loss of the regulatory circuits that govern G1-S transition phase of the cell cycle, playing pivotal roles in different human malignant tumors, including breast, colon, prostate cancer, lymphoma, melanoma and neuroblastoma. In vitro studies have shown that cyclin D1 is overexpressed in Ewing's sarcoma (EWS)/peripheral Primitive Neuroectodermal Tumor (pPNET), but not in rhabdomyosarcoma cell lines. Only a few immunohistochemical studies are available on cyclin D1 expression in EWS/pPNET, which confirmed its expression only in a limited number of cases. The aim of the present study was a comparative immunohistochemical analysis of the expression and distribution of cyclin D1 in a large series of pediatric/adolescent soft tissue EWS/pPNETs and rhabdomyosarcomas (both embryonal and alveolar subtypes) to assess its potential usefulness in their differential diagnosis. Notably cyclin D1 was strongly and diffusely expressed in all cases (20/20) of EWS/pPNET, while it was lacked in all cases (15/15) of rhabdomyosarcomas. Immunohistochemical overexpression of cyclin D1 in EWS/pPNET is a novel finding which could be exploitable as a diagnostic immunomarker for this tumor. Although highly sensitive, cyclin D1 is not specific for EWS/pPNET, and thus it should not be evaluated alone but in the context of a wide immunohistochemical panel. Accordingly, we first emphasize that when pathologists are dealing with a small round blue cell tumor of soft tissues in pediatric/adolescent patients, a strong and diffuse nuclear expression of cyclin D1 is of complementary diagnostic value to CD99 and FLI-1 in confirming diagnosis of EWS/pPNET and in ruling out rhabdomyosarcoma.
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Davis JL, Mathes E, Berry AB. FNA diagnosis of giant cell fibroblastoma: A case report of an unusual pediatric soft tissue tumor. Diagn Cytopathol 2014; 43:325-8. [DOI: 10.1002/dc.23201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 06/16/2014] [Accepted: 07/17/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Jessica L. Davis
- Department of Pathology; University of California; San Francisco
| | - Erin Mathes
- Departments of Dermatology and Pediatrics; University of California; San Francisco
| | - Anna B. Berry
- Department of Pathology; University of California; San Francisco
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Coffin CM, Davis JL, Borinstein SC. Syndrome-associated soft tissue tumours. Histopathology 2013; 64:68-87. [DOI: 10.1111/his.12280] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Cheryl M Coffin
- Department of Pathology, Microbiology, and Immunology; Vanderbilt University School of Medicine; Nashville TN USA
| | - Jessica L Davis
- Department of Anatomic Pathology; Laboratory Medicine; University of California at San Francisco; San Francisco CA USA
| | - Scott C Borinstein
- Division of Pediatric Hematology/Oncology; Department of Pediatrics; Vanderbilt University School of Medicine; Nashville TN USA
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Pediatric soft-tissue tumors of the extremities. CURRENT ORTHOPAEDIC PRACTICE 2013. [DOI: 10.1097/bco.0b013e318295e2ba] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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