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Suster DI, Gross JM, Fayad L, Wenokor C, Goldsmith JD, Ward A, Early C, Lazano-Calderon S, Klein MJ. Sclerosing epithelioid fibrosarcoma of bone with hybrid features: clinicopathologic, radiologic, and molecular analysis of three cases. Skeletal Radiol 2024; 53:387-393. [PMID: 37524934 DOI: 10.1007/s00256-023-04412-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/13/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023]
Abstract
Sclerosing epithelioid fibrosarcoma (SEF) occurring as a primary bone tumor is exceptionally uncommon. Even more rare are cases of SEF that show morphologic overlap with low-grade fibromyxoid sarcoma (LGFMS). Such hybrid lesions arising within the bone have only rarely been reported in the literature. Due to their variegated histomorphology and non-specific radiologic features, these tumors may pose diagnostic difficulties. Herein we describe three molecularly confirmed primary bone cases of sclerosing epithelioid fibrosarcoma that demonstrated prominent areas showing the features of LGFMS and with areas resembling so-called hyalinizing spindle cell tumor with giant rosettes (HSCTGR). Two patients were female and one was male aged 26, 47, and 16, respectively. The tumors occurred in the femoral head, clavicle, and temporal bone. Imaging studies demonstrated relatively well-circumscribed radiolucent bone lesions with enhancement on MRI. Cortical breakthrough and soft tissue extension were present in one case. Histologically the tumors all demonstrated hyalinized areas with SEF-like morphology as well as spindled and myxoid areas with LGFMS-like morphology. Two cases demonstrated focal areas with rosette-like architecture as seen in HSCTGR. The tumors were all positive for MUC4 by immunohistochemistry and cytogenetics, fluorescence in-situ hybridization, and next-generation sequencing studies identified EWSR1 gene rearrangements confirming the diagnosis in all three cases.Hybrid SEF is exceedingly rare as a primary bone tumor and can be difficult to distinguish from other low-grade spindled and epithelioid lesions of bone. MUC4 positivity and identification of underlying EWSR1 gene rearrangements help support this diagnosis and exclude other tumor types.
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Affiliation(s)
- David I Suster
- Department of Pathology, Rutgers University New Jersey Medical School, 150 Bergen Street, Newark, NJ, 07103, USA.
| | - John M Gross
- Department of Pathology, John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Laura Fayad
- Department of Radiology, Orthopaedic Surgery and Oncology, John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cornelia Wenokor
- Department of Radiology, Rutgers University New Jersey Medical School, Newark, NJ, USA
| | - Jeffrey D Goldsmith
- Department of Pathology, Beth Israel Deaconess Medical Center Harvard Medical School, Boston, MA, USA
| | - Ashley Ward
- Department of Pathology, Beth Israel Deaconess Medical Center Harvard Medical School, Boston, MA, USA
| | - Caroline Early
- Department of Pathology, John Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Michael J Klein
- Department of Pathology, Hospital for Special Surgery, New York, NY, USA
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2
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Koerner AS, Zhou M, Brook A, Yoon SS, Ganjoo KN. Response to Immunotherapy in Sclerosing Epithelioid Fibrosarcoma: Case Report and Literature Review. Cureus 2023; 15:e50967. [PMID: 38259411 PMCID: PMC10801283 DOI: 10.7759/cureus.50967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
Sclerosing epithelioid fibrosarcoma (SEF) is an extremely rare subtype of sarcoma that appears histologically low-grade yet usually has a clinically aggressive course with a high rate of local recurrence and distant metastasis. However, these recurrences and metastases often occur years after initial treatment. Metastases can be to the lung as well as extra-pulmonary sites. In this case report, we discuss a patient who developed SEF in the deep soft tissue with metastases. This patient underwent checkpoint inhibitor therapy, with disease response. Thus, SEF is a sarcoma subtype with a unique tumor biology, and immunotherapy may be a promising avenue for treatment.
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Affiliation(s)
- Anna S Koerner
- Surgical Oncology, Surgery, Columbia University Irving Medical Center, New York, USA
| | - Maggie Zhou
- Hematology and Medical Oncology, Stanford University School of Medicine, Stanford, USA
| | - Ashley Brook
- Hematology and Medical Oncology, Stanford University School of Medicine, Stanford, USA
| | - Sam S Yoon
- Surgical Oncology, Surgery, Columbia University Irving Medical Center, New York, USA
| | - Kristen N Ganjoo
- Hematology and Medical Oncology, Stanford University School of Medicine, Stanford, USA
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3
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Woods AD, Purohit R, Mitchell L, Collier J, Collier K, Lathara M, Learned K, Vaske O, Geiger H, Wrzeszczynski KO, Jobanputra V, Srinivasa G, Rudzinski E, Whelan K, Beierle E, Spunt S, Keller C, Wadhwa A. Metastatic Pediatric Sclerosing Epithelioid Fibrosarcoma. Cold Spring Harb Mol Case Stud 2021; 7:mcs.a006093. [PMID: 34362827 PMCID: PMC8559621 DOI: 10.1101/mcs.a006093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/02/2021] [Indexed: 11/25/2022] Open
Abstract
Sclerosing epithelioid fibrosarcoma (SEF) is a rare and aggressive soft-tissue sarcoma thought to originate in fibroblasts of the tissues comprising tendons, ligaments, and muscles. Minimally responsive to conventional cytotoxic chemotherapies, >50% of SEF patients experience local recurrence and/or metastatic disease. SEF is most commonly discovered in middle-aged and elderly adults, but also rarely in children. A common gene fusion occurring between the EWSR1 and CREB3L1 genes has been observed in 80%–90% of SEF cases. We describe here the youngest SEF patient reported to date (a 3-yr-old Caucasian male) who presented with numerous bony and lung metastases. Additionally, we perform a comprehensive literature review of all SEF-related articles published since the disease was first characterized. Finally, we describe the generation of an SEF primary cell line, the first such culture to be reported. The patient described here experienced persistent disease progression despite aggressive treatment including multiple resections, radiotherapy, and numerous chemotherapies and targeted therapeutics. Untreated and locally recurrent tumor and metastatic tissue were sequenced by whole-genome, whole-exome, and deep-transcriptome next-generation sequencing with comparison to a patient-matched normal blood sample. Consistent across all sequencing analyses was the disease-defining EWSR1–CREB3L1 fusion as a single feature consensus. We provide an analysis of our genomic findings and discuss potential therapeutic strategies for SEF.
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Righi A, Pacheco M, Pipola V, Gambarotti M, Benini S, Sbaraglia M, Frisoni T, Boriani S, Dei Tos AP, Gasbarrini A. Primary sclerosing epithelioid fibrosarcoma of the spine: a single-institution experience. Histopathology 2021; 78:976-986. [PMID: 33428796 DOI: 10.1111/his.14332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 11/27/2022]
Abstract
AIMS To present our experience on spinal sclerosing epithelioid fibrosarcoma (SEF) and review the existing literature pertaining to SEF of the spine. METHODS AND RESULTS Six cases of spinal SEF were reviewed, and a literature search of all primary SEFs of the spine was performed. All tumours occurred in adults (median age, 41 years) and were located all along the spine, the lumbar vertebrae being the most commonly involved. All patients presented with pain that they had experienced for months. The mean tumour size at diagnosis was 52 mm. Five tumours showed a spectrum of microscopic features consistent with pure SEF, and one showed a hybrid morphology with areas of low-grade fibromyxoid sarcoma. All were diffusely and strongly positive for mucin 4. Two cases were initially misdiagnosed as epithelioid haemangioendothelioma and aggressive chondroblastoma. Fluorescence in-situ hybridisation showed rearrangements of either FUS or EWSR1 in four cases. Reverse transcription polymerase chain reaction showed the presence of FUS-CREB3L1 and EWSR1-CREB3L1 fusion transcripts in two cases and one case, respectively. Of five patients with follow-up data available, two developed one or more local recurrences and three patients had metastatic disease. Distant metastases were mainly to other osseous locations, followed by lungs and lymph nodes. At last follow-up, three patients had died of disease and one was alive with multiple metastases. CONCLUSIONS SEF is an aggressive sarcoma that can involve the spine. It is important to recognise the spine as the primary location of SEF, in order to avoid misdiagnosis as more common primary spinal neoplasms, which can impact on therapeutic approaches.
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Affiliation(s)
- Alberto Righi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marina Pacheco
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Department of Pathology, Complejo Hospitalario Metropolitano CSS, Panama, Panama
| | - Valerio Pipola
- Department of Oncological and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Gambarotti
- Department of Pathology, Complejo Hospitalario Metropolitano CSS, Panama, Panama
| | - Stefania Benini
- Department of Pathology, Complejo Hospitalario Metropolitano CSS, Panama, Panama
| | - Marta Sbaraglia
- Department of Pathology, Azienda Ospedale-Università Padova, Padua, Italy
| | - Tommaso Frisoni
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Angelo P Dei Tos
- Department of Pathology, Azienda Ospedale-Università Padova, Padua, Italy.,Department of Medicine, University of Padua School of Medicine, Padua, Italy
| | - Alessandro Gasbarrini
- Department of Oncological and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Ding Q, Shao X, Liu X, Fu Y, Huang F, Wang C. Case Report: Radiological Features of Sclerosing Epithelioid Fibrosarcoma in the Right Fibula. Front Oncol 2020; 10:603127. [PMID: 33312957 DOI: 10.3389/fonc.2020.603127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 10/26/2020] [Indexed: 12/17/2022] Open
Abstract
Background Sclerosing epithelioid fibrosarcoma (SEF) is an extremely rare, aggressive malignant subtype of fibrosarcoma. Only dozens of cases of primary SEF in the bone have been reported so far, without case involving fibula reported in literature to date. Herein we report the first case of primary SEF in the right fibula in a 19-year-old man. In this case report, we firstly give a comprehensive description of fibula SEF, including its complete clinical course and radiological findings. Case Presentation A 19-year-old man presented with a half-year history of soreness in the right lower leg. Contrast-enhanced computed tomography (CE-CT) and magnetic resonance imaging (MRI) of the right lower leg were performed. Based on the radiological examinations, a diagnosis of malignant tumor arising in the fibular diaphysis was made. Final diagnosis of primary SEF in the right fibula was confirmed by histopathological and immunohistochemical examinations after surgical resection. The patient had no signs of recurrence or metastasis during a 24-month follow-up. Conclusion We report an exceedingly rare case of primary SEF in the right fibula and its radiological features with CE-CT and MRI.
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Affiliation(s)
- Qiaoling Ding
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaotong Shao
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaocao Liu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yanbiao Fu
- Department of Pathology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fengbo Huang
- Department of Pathology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chao Wang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Kosemehmetoglu K, Ardic F, Kilpatrick SE, Aydingoz U, Sumathi VP, Michal M. Sclerosing epithelioid fibrosarcoma of bone: morphological, immunophenotypical, and molecular findings of 9 cases. Virchows Arch 2020; 478:767-777. [PMID: 33084978 DOI: 10.1007/s00428-020-02953-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/07/2020] [Accepted: 10/14/2020] [Indexed: 12/13/2022]
Abstract
Primary sclerosing epithelioid fibrosarcoma (SEF) of bone is a rare and scarcely reported neoplasm. We document clinicopathological and molecular features of 9 additional cases. Five males and 4 females had a mean age of 39 years (14-71 years). Most tumors affected flat/irregular bones; only 3 cases involved a long bone. By radiology, it has characteristic radiographic features of a predominantly lytic expansile lesion with a sclerotic rim. Referring diagnoses were SEF (n = 2), low-grade osteosarcoma (n = 2), chondrosarcoma (n = 1), and chondromyxoid fibroma (n = 1). Histologically, five cases revealed classical morphology of SEF of soft tissue. Remaining cases were classified as hybrid SEF/low-grade fibromyxoid sarcoma, characterized by spindle or stellate cells, prominent stroma, and giant hyalinized areas. Various morphological deviations such as prominent vasculature (n = 3), osteoid-like material (n = 4), or parallel bone trabeculae (n = 2) were observed. Immunohistochemically, all cases showed diffuse and strong MUC4 expression. SATB2 was observed in 5/8 cases. Using FISH, EWSR1, and FUS rearrangements were detected in 4 cases and 1 case, respectively. EWSR1-CREB3L1 fusion was identified in 1 additional case by next-generation sequencing. Recurrence and metastasis were observed in 1 case and 2 cases, respectively. All but one patient were alive with disease for a mean interval of 31 months. SEF of bone is a relatively indolent sarcoma of adults, most commonly located in the flat/irregular bones. Due to overlapping histological features, it is often misdiagnosed as osteosarcoma or a chondroid tumor. Most SEF of bone exhibit EWSR1 rearrangements, but rare cases may harbor a FUS gene fusion.
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Affiliation(s)
| | - Fisun Ardic
- Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Turkey
| | | | - Ustun Aydingoz
- Department of Radiology, Hacettepe University, Ankara, Turkey
| | | | - Michael Michal
- Department of Pathology, Faculty of Medicine in Plzen, Charles University, Plzen, Czech Republic.,Bioptical Laboratory, Ltd., Plzen, Czech Republic
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7
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A 27-year-old female with sclerosing epithelioid fibrosarcoma of the left ethmoid sinus. OTOLARYNGOLOGY CASE REPORTS 2020. [DOI: 10.1016/j.xocr.2020.100188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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8
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Tsuda Y, Dickson BC, Dry SM, Federman N, Suurmeijer AJH, Swanson D, Sung YS, Zhang L, Healey JH, Antonescu CR. Clinical and molecular characterization of primary sclerosing epithelioid fibrosarcoma of bone and review of the literature. Genes Chromosomes Cancer 2019; 59:217-224. [PMID: 31675134 DOI: 10.1002/gcc.22822] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 10/23/2019] [Accepted: 10/30/2019] [Indexed: 02/03/2023] Open
Abstract
Sclerosing epithelioid fibrosarcoma (SEF) is a rare sarcoma subtype characterized by monomorphic epithelioid cells embedded in a densely sclerotic collagenous matrix. The overwhelming majority of tumors arise in soft tissues; however, rare cases have been documented to occur primarily in bone. The hallmarks of soft tissue SEF include MUC4 immunoreactivity and the presence of an EWSR1-CREB3L1 fusion. Rare cases with alternative fusions have also been reported such as EWSR1-CREB3L2 and FUS-CREB3L2 transcripts. The molecular alterations of skeletal SEF have not been well-defined, with only rare cases analyzed to date. In this study we investigated the clinicopathologic and molecular features of seven patients presenting with primary osseous SEF. There were 3 males and 4 females, with a mean age at diagnosis of 38 years. All cases had microscopic features within the histologic spectrum of SEF and showed strong and diffuse MUC4 positivity, while lacking SATB2 expression. However, due to its unusual presentation within bone, four cases were initially misinterpreted as either osteosarcoma, Ewing sarcoma or chondroblastoma. Half of the patients with follow-up data developed metastasis. The cases were tested by targeted RNA sequencing, MSK-IMPACT, and/or fluorescence in situ hybridization, showing EWSR1-CREB3L1 in six cases and EWSR1-CREB3L2 in one case. The fusion transcripts were composed of EWSR1 exon 11 to either exon 6 of CREB3L1 or CREB3L2. In summary, due to their rarity in the bone, skeletal SEF are often misdiagnosed, resulting in inadequate treatment modalities. Similar to their soft tissue counterpart, bone SEF follow an aggressive clinical behavior and show similar EWSR1-CREB3L1/CREB3L2 fusions.
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Affiliation(s)
- Yusuke Tsuda
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Brendan C Dickson
- Department of Pathology & Laboratory Medicine, Mount Sinai Hospital, Toronto, Canada
| | - Sarah M Dry
- Department of Pathology, UCLA Medical Center, Santa Monica, California
| | - Noah Federman
- Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, California.,Department of Orthopaedics, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Albert J H Suurmeijer
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - David Swanson
- Department of Pathology & Laboratory Medicine, Mount Sinai Hospital, Toronto, Canada
| | - Yun-Shao Sung
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lei Zhang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - John H Healey
- Department of Orthopedic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cristina R Antonescu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
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Spinal Sclerosing Epithelioid Fibrosarcoma at the Cervicothoracic Junction. World Neurosurg 2018; 114:155-160. [DOI: 10.1016/j.wneu.2018.03.105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 03/13/2018] [Accepted: 03/14/2018] [Indexed: 11/23/2022]
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