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Recurrent BCOR Internal Tandem Duplication and YWHAE-NUTM2B Fusions in Soft Tissue Undifferentiated Round Cell Sarcoma of Infancy: Overlapping Genetic Features With Clear Cell Sarcoma of Kidney. Am J Surg Pathol 2017; 40:1009-20. [PMID: 26945340 DOI: 10.1097/pas.0000000000000629] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Soft tissue undifferentiated round cell sarcoma (URCS) occurring in infants is a heterogenous group of tumors, often lacking known genetic abnormalities. On the basis of a t(10;17;14) karyotype in a pelvic URCS of a 4-month-old boy showing similar breakpoints with clear cell sarcoma of kidney (CCSK), we have investigated the possibility of shared genetic abnormalities in CCSK and soft tissue URCS. Most CCSKs are characterized by BCOR exon 16 internal tandem duplications (ITDs), whereas a smaller subset shows YWHAE-NUTM2B/E fusions. Because of overlapping clinicopathologic features, we have also investigated these genetic alterations in the so-called primitive myxoid mesenchymal tumor of infancy (PMMTI). Among the 22 infantile URCSs and 7 PMMTIs selected, RNA sequencing was performed in 5 and 2 cases, with frozen tissue, respectively. The remaining cases with archival material were tested for YWHAE-NUTM2B/E by fluorescence in situ hybridization (FISH) or reverse transcription-polymerase chain reaction (RT-PCR), and BCOR ITD by PCR. A control group of 4 CCSKs and 14 URCSs in older children or adults without known gene fusion and 20 other sarcomas with similar histomorphology or age at presentation were also tested. A YWHAE-NUTM2B fusion was confirmed in the index case by FISH and RT-PCR, whereas BCOR ITD was lacking. An identical YWHAE-NUTM2B fusion was found in another URCS case of a 5-month-old girl with a back lesion. The remaining cases and control group lacked YWHAE gene rearrangements; instead, consistent BCOR ITDs, similar to CCSK, were found in 15/29 (52%) infantile sarcoma cases (9/22 infantile URCS and 6/7 PMMTI). In the control cohort, BCOR ITD was found only in 3 CCSK cases but not in the other sarcomas. Histologically, URCS with both genotypes and PMMTI shared significant histologic overlap, with uniform small blue round cells with fine chromatin and indistinct nucleoli. A prominent capillary network similar to CCSK, rosette structures, and varying degree of myxoid change were occasionally seen. BCOR ITD-positive tumors occurred preferentially in the somatic soft tissue of the trunk, abdomen, and head and neck, sparing the extremities. RNAseq showed high BCOR mRNA levels in BCOR ITD-positive cases, compared with other URCSs. In summary, we report recurrent BCOR exon 16 ITD and YWHAE-NUTM2B fusions in half of infantile soft tissue URCS and most PMMTI cases, but not in other pediatric sarcomas. These findings suggest a significant overlap between infantile URCS and CCSK, such as age at presentation, histologic features, and genetic signature, thus raising the possibility of a soft tissue counterpart to CCSK.
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Datta S, Dey S, Mukherjee S, Chandra Paul P, Bhattacharyya A, Biswas S, Tudu B. Testicular fibroma of gonadal stromal origin with minor sex cord elements, presenting with hydrocele. Rare Tumors 2013; 5:e34. [PMID: 24179646 PMCID: PMC3804809 DOI: 10.4081/rt.2013.e34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 04/01/2013] [Accepted: 04/08/2013] [Indexed: 11/23/2022] Open
Abstract
Testicular fibroma of gonadal stromal origin is a rare benign tumor of testis which usually presents as a slow growing testicular mass. Only 25 cases of testicular fibroma have been reported in the literature. Presence of minor sex cord elements in this tumor is even rarer. We report a case of testicular fibroma with minor sex cord elements that involved almost the entire testis and tunica vaginalis. The patient presented with hydrocele, a rare presentation for this entity. The rarity of the diagnosis and the clinical presentation prompted this case report.
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Affiliation(s)
- Saikat Datta
- Department of Pathology, Nilratan Sircar Medical College , Kolkata, India
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Fehr A, Hansson MC, Kindblom LG, Stenman G. YWHAE-FAM22
gene fusion in clear cell sarcoma of the kidney. J Pathol 2012; 227:e5-7. [DOI: 10.1002/path.4040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 04/06/2012] [Accepted: 04/09/2012] [Indexed: 01/06/2023]
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Jeong SM, Lee JH, Park WY, Shin NR, Kim WG, Huh GY, Lee CH, Ha HK. Primary Myoepithelioma of the Testis - A Case Report -. KOREAN JOURNAL OF PATHOLOGY 2011. [DOI: 10.4132/koreanjpathol.2011.45.s1.s20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Seong Muk Jeong
- Department of Pathology, Pusan National University School of Medicine, Busan, Korea
| | - Jung Hee Lee
- Department of Pathology, Pusan National University School of Medicine, Busan, Korea
| | - Won Young Park
- Department of Pathology, Pusan National University School of Medicine, Busan, Korea
| | - Na Ri Shin
- Department of Pathology, Pusan National University School of Medicine, Busan, Korea
| | - Woo Gyeong Kim
- Department of Pathology, Pusan National University School of Medicine, Busan, Korea
| | - Gi Yeong Huh
- Department of Pathology, Pusan National University School of Medicine, Busan, Korea
- Medical Research Institute, Pusan National University School of Medicine, Busan, Korea
| | - Chang Hun Lee
- Department of Pathology, Pusan National University School of Medicine, Busan, Korea
- Medical Research Institute, Pusan National University School of Medicine, Busan, Korea
| | - Hong Koo Ha
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
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Fridman E, Skarda J, Ofek-Moravsky E, Cordoba M. Complex multilocular cystic lesion of rete testis, accompanied by smooth muscle hyperplasia, mimicking intratesticular Leydig cell neoplasm. Virchows Arch 2005; 447:768-71. [PMID: 16012849 DOI: 10.1007/s00428-005-0021-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2005] [Accepted: 05/23/2005] [Indexed: 10/25/2022]
Abstract
Non-neoplastic smooth muscle cell proliferation occurs under a variety of circumstances in many body organs. These abnormalities have been described as hypertrophy, hyperplasia or hamartomatous proliferations. In the male genital system, the excessive growth of smooth muscle in spermatic cord or paratesticular tissue is rare. In previously described cases, these lesions presented as masses but lacked the microscopic features of a neoplasm. We describe a complex multilocular cystic lesion composed of cystic transformation of the rete testis associated with smooth muscle proliferation mimicking intratesticular Leydig cell neoplasm. The lesion consists of three separate components: (1) cystic dilatation of the rete testis; (2) diffuse, interstitial smooth muscle proliferation with intraseptal expansion; and (3) extensive stroma with myxoid areas and scattered interstitial Leydig cells. These morphological findings, supported by a wide immunohistochemical panel, are consistent with cystic dilatation of the rete testis associated with smooth muscle hyperplasia, most probably of myoid origin. To the best of our knowledge, no similar complex lesion of the rete testis has yet been reported.
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Affiliation(s)
- Eduard Fridman
- Department of Pathology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer, Israel.
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Deveci MS, Deveci G, Ongürü O, Kilciler M, Celasun B. Testicular (gonadal stromal) fibroma: case report and review of the literature. Pathol Int 2002; 52:326-30. [PMID: 12031091 DOI: 10.1046/j.1440-1827.2002.01345.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 25-year-old man presented with complaint of a painless enlargement in his left testis. The solid, encapsulated, circumscribed and grayish-white testicular mass displayed the characteristics of testicular fibroma histologically. It was composed of acellular collagenized plaques and hypercellular areas of fibroblastic spindle cells. Immunohistochemically, the neoplastic cells were positive for vimentin and smooth muscle actin, but not for cytokeratin, S-100 protein, desmin, CD99/MIC2 (a protein expressed by Sertoli cells and granulosa cells) and CD34. Only 18 cases of testicular (gonadal stromal) fibroma composed exclusively of spindle cells have been reported to date. An additional case of fibroma, which lacks definite neoplastic sex cord elements, and its differential diagnosis from other mesenchymal lesions of testis are discussed here, together with other cases in the literature.
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Affiliation(s)
- M Salih Deveci
- Department of Department of Pathology, Gülhane Military Medical Academy, School of Medicine, Ankara, Turkey.
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Abstract
We report a case of an unusual sarcoma arising in the ovary of an infant girl. Histologically, the tumor was composed of clear, undifferentiated cells set in an arborizing vascular stroma. Immunohistochemical staining was positive only for vimentin. Ultrastructural evaluation demonstrated undifferentiated cells with interdigitating broad cell processes that encompassed irregular electron lucent spaces that contained flocculent extracellular material. Light and electron microscopic features of the tumor resembled a clear cell sarcoma of the kidney. Although the cell of origin is unproven, both tumors may arise from primitive mesenchymal cells that may not be restricted to the kidney.
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Affiliation(s)
- L S Finn
- Department of Pathology, The University of Washington and Children's Hospital and Medical Center, 4800 Sand Point Way NE, Seattle, WA 98105, USA
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Luk IS, Shek TW, Tang VW, Ng WF. Interdigitating dendritic cell tumor of the testis: a novel testicular spindle cell neoplasm. Am J Surg Pathol 1999; 23:1141-8. [PMID: 10478677 DOI: 10.1097/00000478-199909000-00020] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Interdigitating dendritic cell tumor is an extremely rare neoplasm that mainly occurs in lymph nodes. An example of such a tumor in the testis, a hitherto unreported site, is described. Grossly, the tumor was light tan with a uniform solid appearance, replacing virtually the entire testis. Microscopically, it was formed by whorls and fascicles of spindle cells intermingling with small lymphocytes. Such a histologic appearance can, however, mimic a wide variety of other tumors and tumor-like lesions, among which mesenchymal sarcoma, spindle cell carcinoma, follicular dendritic cell tumor, and inflammatory pseudotumor are the main differential diagnoses. Immunohistochemical studies showed that the spindle tumor cells were strongly and diffusely positive for S-100 protein and vimentin. They were also focally positive for CD68 and CD4, but were uniformly negative for leukocyte common antigen, CD1a, CD3, CD20, CD21, CD23, CD34, CD35, actin, desmin, HMB45, cytokeratins, and placental alkaline phosphatase. Ultrastructurally, the tumor cells possessed complex interdigitating cytoplasmic dendritic processes, with abundant rough endoplasmic reticulum and mitochondria in their cytoplasm. An in situ hybridization study for Epstein-Barr virus was negative. The pathologist should be aware of such an entity and consider it in the list of differential diagnoses for unusual spindle cell lesions with a significant background population of small lymphocytes. However, because of its nonspecific histologic appearance, additional immunohistochemical and electron microscopic studies are generally required for its definitive diagnosis.
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Affiliation(s)
- I S Luk
- Department of Pathology, Ruttonjee Hospital, Hong Kong, Hong Kong
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Nistal M, Puras A, Perna C, Guarch R, Paniagua R. Fusocellular gonadal stromal tumour of the testis with epithelial and myoid differentiation. Histopathology 1996; 29:259-64. [PMID: 8884355 DOI: 10.1111/j.1365-2559.1996.tb01400.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We describe an unusual fusocellular gonadal stromal tumour with a benign behaviour in the left testis from a 16-year-old man. The neoplasm consisted of a non-encapsulated proliferation of irregularly arranged, fusiform cell bundles in fibrous connective tissue. The tumour cells contained a slightly infolded nucleus, some dilated rough endoplasmic reticulum cisternae, abundant filament bundles which connected to subplasmalemmal electron-dense bodies, pinocytotic vesicles and a discontinuous basal lamina. The intercellular spaces were narrow and the tumour cells were joined by desmosomes. These cells were immunoreactive for muscle actin, alpha-actinin and vimentin. Focal immunostaining for collagen type IV was observed around the cells. No immunoreactivity for keratins, desmin S-100 protein or XIIIa factor was found. The findings suggest that the tumour arose from the peritubular myoid cells.
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Affiliation(s)
- M Nistal
- Department of Morphology, School of Medicine, Autonomous University of Madrid, Spain
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Abstract
Metaplastic breast carcinoma refers to a heterogeneous group of neoplasms in which the typical glandular growth pattern of the tumor undergoes metaplasia, either epithelial or stromal. A 59-year-old woman presented with a breast mass that recurred in 1 year and showed invasion of the chest wall. Histological sections of both the tumor and the recurrence showed a tumor composed predominantly of stromal spindle cells with neoplastic epithelial ducts. Squamous metaplasia was seen in some ducts. Immunohistochemical staining showed positive cytokeratin and epithelial membrane antigen staining of the epithelial cells. Smooth muscle actin, S100, and vimentin were diffusely positive in the stromal cells. Electron microscopy of the original lesion showed cells with squamous epithelial and smooth muscle characteristics, and other cells that formed lumens into which microvilli projected. Electron microscopy of the recurrent lesion showed primarily spindle-shaped cells with abundant tonofilaments in the perinuclear cytoplasm, desmosomes with associated tonofilaments, filaments with focal densities, often aligned parallel with the cell membranes, surface attachment plaques, and fragments of basement membrane. Pinocytotic vesicles were rare. These metaplastic cells are derived from myoepithelial cells which are multipotential and able to differentiate into epithelial or stromal cells.
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Affiliation(s)
- J M Harb
- Department of Pathology, Medical College of Wisconsin, Milwaukee 53226, USA
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Abstract
An abdominal mass detected in a 36-year-old man was thought from radiologic studies to be a renal neoplasm, but at surgery the kidney was found to be uninvolved. The 9.5-cm retroperitoneal tumor was resected totally and found to be encapsulated, and it appeared to be benign by light microscopy. The pattern of the spindle cells throughout the tumor suggested a cellular schwannoma, but immunocytochemical and ultrastructural studies did not support schwannian differentiation and instead revealed epithelial and smooth muscle features compatible with a myoepithelioma.
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Affiliation(s)
- T Burke
- Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA
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Kataoka Y, Shimada H, Sugimoto T, Mine H, Hachitanda Y, Doi Y, Sawada T, Weeks DA. Congenital sarcoma in the terminal ileum histologically resembling clear cell sarcoma of the kidney: a case report with an immunohistochemical study. Hum Pathol 1993; 24:1026-30. [PMID: 7504650 DOI: 10.1016/0046-8177(93)90120-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We report a case of a newborn female with a rare tumor, a congenital sarcoma, presenting as an abdominal mass. Laparotomy demonstrated the tumor arising from the wall of the terminal ileum. Histologically, the tumor tissue was indistinguishable from clear cell sarcoma of the kidney and was composed of proliferating cells with poorly stained cytoplasm divided into nests or cords by arborizing vasculature. Immunohistochemical staining revealed that the neoplastic cells had a phenotype similar to metanephric blastemal cells of fetal kidney, ie, positive for vimentin and CD24 but negative for cytokeratin and CD9. The results suggest that this congenital tumor may originate from primitive mesenchymal cells phenotypically related to cells present in the fetal kidney.
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Affiliation(s)
- Y Kataoka
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Japan
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Groisman GM, Dische MR, Fine EM, Unger PD. Juvenile granulosa cell tumor of the testis: a comparative immunohistochemical study with normal infantile gonads. PEDIATRIC PATHOLOGY 1993; 13:389-400. [PMID: 8372023 DOI: 10.3109/15513819309048227] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
This study concerns the nature of two different cell populations in a juvenile granulosa cell tumor (GCT) of the infantile testis. Immunohistochemical features of the tumor were compared with those of normal infantile testes (six cases) and ovaries (six cases). The testicular neoplasm showed follicles, cysts and solid nodules composed of an internal layer of polyhedral cells that expressed cytokeratin and vimentin. Most of the follicles and nodules were surrounded by an external layer of spindle cells that reacted to muscle-specific actin, vimentin, and focally to desmin. A neoplastic rather than reactive origin of the spindle cell population is favored by their concentric arrangement in a peritubular-like or theca-like fashion and by their immunohistochemical correlation with normal peritubular-myoid and theca external cells. Sertoli and granulosa cells of normal infantile gonads were positive for cytokeratin and vimentin; peritubular myoid and theca externa cells expressed muscle-specific actin, vimentin, and focally desmin. The occurrence of two well-differentiated components in the tumor favors its origin from the primitive specialized gonadal stromal cell that during neoplastic transformation develops bidirectional differentiation toward epithelial-like and smooth muscle-like lineages. The possibility that this tumor is composed of immature Sertoli and peritubular myoid cells is discussed.
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Affiliation(s)
- G M Groisman
- Henry M. Stratton-Hans Popper Department of Pathology, Mount Sinai School of Medicine, City University of New York, New York
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