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Tomassen T, Kester LA, Tops BB, Driehuis E, van Noesel MM, van Ewijk R, van Gorp JM, Hulsker CC, Terwisscha-van Scheltinga SEJ, Merks HHM, Flucke U, Hiemcke-Jiwa LS. Loss of H3K27me3 occurs in a large subset of embryonal rhabdomyosarcomas: Immunohistochemical and molecular analysis of 25 cases. Ann Diagn Pathol 2021; 52:151735. [PMID: 33770660 DOI: 10.1016/j.anndiagpath.2021.151735] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
Loss of histone 3 lysine 27 trimethylation (H3K27me3) has been described as a diagnostic marker for malignant peripheral nerve sheath tumor (MPNST), also discriminating MPNST with rhabdomyoblastic differentiation (malignant Triton tumor) from rhabdomyosarcoma (RMS). We studied the immunohistochemical expression of H3K27me3 in embryonal RMSs (ERMSs), performed methylation profiling in order to support the diagnosis and RNA-sequencing for comparison of the transcriptome of H3K27me3-positive and -negative cases. Of the 25 ERMS patients, 17 were males and 8 were females with an age range from 1 to 67 years (median, 6 years). None were known with neurofibromatosis type 1. One patient had Li-Fraumeni syndrome. Tumor localization included paratesticular (n = 9), genitourinary (n = 6), head/neck (n = 5), retroperitoneal (n = 4) and lower arm (n = 1). Five MPNSTs served as reference group. All ERMS had classical features including a variable spindle cell component. Immunohistochemical loss (partial or complete) of H3K27me3 was detected in 18/25 cases (72%). Based on methylation profiling, 22/22 cases were classified as ERMS. Using RNA sequencing, the ERMS group (n = 14) had a distinct gene expression profile in contrast to MPNSTs, confirming that the H3K27me3 negative ERMS cases do not represent malignant Triton tumors. When comparing H3K27me3-negative and -positive ERMSs, gene set enrichment analysis revealed differential expression of genes related to histone acetylation and normal muscle function with H3K27me3 negative ERMSs being associated with acetylation. Conclusion: Loss of H3K27me3 frequently occurs in ERMSs and correlates with H3K27 acetylation. H3K27me3 is not a suitable marker to differentiate ERMS (with spindle cell features) from malignant Triton tumor.
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Affiliation(s)
- Tess Tomassen
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lennart A Kester
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Bastiaan B Tops
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Else Driehuis
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Max M van Noesel
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Roelof van Ewijk
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Joost M van Gorp
- Department of Pathology, St Antonius Hospital, Nieuwegein, the Netherlands
| | | | | | - Hans H M Merks
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Uta Flucke
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
| | - Laura S Hiemcke-Jiwa
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
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Terwisscha van Scheltinga SEJ, Wijnen MHWA, Martelli H, Rogers T, Mandeville H, Gaze MN, McHugh K, Corradini N, Orbach D, Jenney M, Kelsey A, Chisholm J, Gallego S, Glosli H, Ferrari A, Zanetti I, De Salvo GL, Minard-Colin V, Bisogno G, van Noesel MM, Merks HHM. Local staging and treatment in extremity rhabdomyosarcoma. A report from the EpSSG-RMS2005 study. Cancer Med 2020; 9:7580-7589. [PMID: 32869534 PMCID: PMC7571832 DOI: 10.1002/cam4.3365] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/19/2020] [Accepted: 07/20/2020] [Indexed: 01/08/2023] Open
Abstract
Rhabdomyosarcoma of the extremities present with two main challenges: correct evaluation of initial regional nodal involvement and define adequate local treatment. METHODS Pediatric patients with localized rhabdomyosarcoma of the extremity included in the EpSSG-RMS2005 study between 2005 and 2014 were evaluated for staging, treatment, and survival. The outcome was compared to the preceding European SIOP-MMT studies. RESULTS Of the 162 patients included, histology was unfavorable in 113 (70%), 124 (77%) were younger than 10 years, 128 (79%) were IRS III, and 47 (29%) were node-positive. A regional node biopsy was performed in 97 patients (60%) and modified the lymph node stage in 15/97 (16%). Primary and delayed surgery was performed in 155 (96%) and radiotherapy delivered in 118 (73%) patients. Relapse occurred in 61 cases (38%), local in 14 (23%), regional in 13 (21%), distant in 22 (36%), and combined relapse in 12 (20%) with five progressive diseases (8%) and four secondary tumors (7%). Five-year event free (EFS) and overall survival (OS) were 58.4% (95%CI, 50.3-65.7) and 71.7% (63.6-78.4), respectively. In the previous studies MMT89 and MMT95, tumor surgery was performed in 32/53 (60%) and 74/82(90%), respectively, and radiotherapy delivered in 13/53 (25%) and 26/82 (30%), respectively. Five-year EFS and OS were 35.6%, and 50.3% in MMT89 and 54.3% and 68.2% in the MMT95 study. CONCLUSIONS Even if the lymph node staging was not always complete according to the RMS2005 protocol, node sampling changed lymph node status in a significant number of patients. Despite the higher rate of patients treated with locoregional radiotherapy, survival in RMS2005 did not improve compared to the previous European SIOP-MMT95 study.
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Affiliation(s)
| | - Marc H W A Wijnen
- Pediatric Surgery, Pediatric Solid Tumor Unit, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Hélène Martelli
- Department of Pediatric Surgical Oncology, University Hospital Bicětre, Bicětre, France
| | - Timothy Rogers
- Department of Pediatric Surgery, University Hospitals Bristol NHS foundation trust, Bristol, UK
| | - Henry Mandeville
- Children and Young People's Unit, Royal Marsden Hospital, Sutton, UK
| | - Mark N Gaze
- Department of Oncology, Great Ormond Street Hospital for Children, London, UK
| | - Keiran McHugh
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK
| | - Nadege Corradini
- Institut d'Hématologie et d'Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
| | - Daniel Orbach
- SIREDO Oncology Center, Institut Curie, PSL University, Paris, France
| | - Meriel Jenney
- Department of Pediatric Oncology, University hospital of Wales, Cardiff, UK
| | - Anna Kelsey
- Department of Pathology, Central Manchester University Hospitals, Manchester, United Kingdom
| | - Julia Chisholm
- Children and Young People's Department, Royal Marsden Hospital, Sutton, United Kingdom
| | - Soledad Gallego
- Pediatric Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Heidi Glosli
- Division of Pediatric and Adolescent Medicine, Department of Pediatric Research, Oslo University Hospital, Oslo, Norway
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Ilaria Zanetti
- Clinical Trials and Biostatistics Unit, IRCCS Istituto oncologico Veneto, Padova, Italy
| | - Gian Luca De Salvo
- Clinical Trials and Biostatistics Unit, IRCCS Istituto oncologico Veneto, Padova, Italy
| | | | - Giani Bisogno
- Hematology and Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padova, Italy
| | - Max M van Noesel
- Pediatric Solid Tumor Unit, Princess Maxima Center for pediatric Oncology, Utrecht, The Netherlands
| | - Hans H M Merks
- Pediatric Solid Tumor Unit, Princess Maxima Center for pediatric Oncology, Utrecht, The Netherlands
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