Nationwide incidence of sarcomas and connective tissue tumors of intermediate malignancy over four years using an expert pathology review network

BACKGROUND

Since 2010, nationwide networks of reference centers for sarcomas (RREPS/NETSARC/RESOS) collected and prospectively reviewed all cases of sarcomas and connective tumors of intermediate malignancy (TIM) in France.

METHODS

The nationwide incidence of sarcoma or TIM (2013-2016) was measured using the 2013 WHO classification and confirmed by a second independent review by expert pathologists. Simple clinical characteristics, yearly variations and correlation of incidence with published clinical trials are presented and analyzed.

RESULTS

Over 150 different histological subtypes are reported from the 25172 patients with sarcomas (n = 18712, 74,3%) or TIM (n = 6460, 25.7%), with n = 5838, n = 6153, n = 6654, and n = 6527 yearly cases from 2013 to 2016. Over these 4 years, the yearly incidence of sarcomas and TIM was therefore 70.7 and 24.4 respectively, with a combined incidence of 95.1/106/year, higher than previously reported. GIST, liposarcoma, leiomyosarcomas, undifferentiated sarcomas represented 13%, 13%, 11% and 11% of tumors. Only GIST, as a single entity had a yearly incidence above 10/106/year. There were respectively 30, 64 and 66 different histological subtypes of sarcomas or TIM with an incidence ranging from 10 to 1/106, 1-0.1/106, or < 0.1/106/year respectively. The 2 latter incidence groups represented 21% of the patients with 130 histotypes. Published phase III and phase II clinical trials (p<10-6) are significantly higher with sarcomas subtypes with an incidence above 1/106 per.

CONCLUSIONS

This nationwide registry of sarcoma patients, with exhaustive histology review by sarcoma experts, shows that the incidence of sarcoma and TIM is higher than reported, and that tumors with a very low incidence (1<106/year) are less likely to be included in clinical trials.

Nationwide incidence of sarcomas and tumors of intermediate malignancy in the NETSARC network with central pathology review: Correlation with published clinical research

11560

Background: Since 2010, presentation to a designated sarcoma tumor board and pathological review by an expert network are mandatory for sarcoma patients in France. NETSARC+ (merging the 3 initial RREPS, RESOS & NETSARC) collected prospectively all cases of reviewed sarcomas and tumors of intermediate malignancy (TIM) nationwide. We report on the incidence of subtypes according to WHO classification from 2013 to 2016. Methods: Sarcoma expert pathologists reviewed samples were all prospectively integrated in the database; the results using the latest WHO classification are presented for the years 2013 to 2016, including yearly variations. Correlation of the incidence of each histotype with dedicated published clinical trials was conducted. Results: 139 different histological subtypes are reported among the 25172 patients with sarcomas (n = 18710, 64%) or TIM (n = 6460, 36%), respectively n = 5838, n = 6153, n = 6654, and n = 6527 yearly from 2013 to 2016. Over these 4 years, the observed yearly incidence of sarcomas, TIM, and all was therefore 79.7, 24.9 and 95.1/10e6/year, above that previously reported. GIST, liposarcoma, leiomyosarcomas, undifferentiated sarcomas represented 13%, 13%, 11% and 11% of all sarcomas. Only GIST, as a single entity exceeded a yearly incidence above 10/million per year. There were respectively 30, 63 and 66 different histological subtypes of sarcomas or TIM (single entities or lumped together, e.g. MPNST, or vascular sarcomas...) with an incidence ranging from 10 to 1/10e6/year, 1-0.1/10e6 per year, or < 0.1/10e6/year respectively. The 2 later “incidence groups” included 21% of the patients. The incidence of 8 histotypes varied significantly over this 4 years. Patients with tumors with an incidence above 1/10e6 per year have significantly higher numbers of dedicated published phase III and phase II clinical trials (p < 10e-6). Conclusions: This nationwide registry of sarcoma patients with an histology reviewed by sarcoma experts shows that the incidence of sarcoma and TIM is higher than previously reported, may vary over years for some histotypes, and that tumors with an incidence < 10e6 have a much lower access to clinical trials.

Hexahydroxytriphenylene for the synthesis of group 13 MOFs - a new inorganic building unit in a β-cristobalite type structure

Two new, microporous MOFs of framework composition ((CH3)2NH2)2[M3O(HHTP)(HHTP˙)], M = Al3+, Ga3+, H6HHTP = 2,3,6,7,10,11-hexahydroxytriphenylene, are described. Electron diffraction combined with molecular simulations show that these compounds crystallize in the β-cristobalite structure, containing a new type of trinuclear inorganic building unit for MOFs and radical anions.

Portal vein leiomyosarcoma: A rare case of hepatic hilar tumor with review of the literature

Portal vein leiomyosarcoma (LMS) is a very rare entity with poor prognosis. Only few cases have been reported in the literature. We report the case of a 53-year-old man with portal vein LMS presenting as a hilar tumor and causing cholestasis. The tumor measured 10 cm and was responsible for right portal vein thrombosis and compression of the biliary convergence. A right hepatectomy with hilar en bloc resection was performed with portal vein and biliary reconstruction. Pathology confirmed the complete resection of a well-differentiated leiomyosarcoma of the portal vein. The postoperative outcome was uneventful and the patient received no adjuvant treatment. Six months after the procedure, the patient is doing well with a normal quality of life and without any sign of recurrence. Aggressive and radical surgery should be proposed in first intention for the treatment of portal vein LMS.

Histopathological Diagnosis of Prosthetic Joint Infection: Does a Threshold of 23 Neutrophils Do Better than Classification of the Periprosthetic Membrane in a Prospective Multicenter Study?

No gold standard exists for histopathological diagnosis of a prosthetic joint infection (PJI). The historical criterion considers the presence of neutrophil infiltration upon examination of periprosthetic tissue. Morawietz et al. proposed a classification of periprosthetic membranes (Morawietz et al., Clin Pathol 59:591-597, 2006, https://doi.org/10.1136/jcp.2005.027458) and a more recently described classification with a new cutoff value of 23 neutrophils in 10 high-power fields (Morawietz et al., Histopathology 54:847-853, 2009. https://doi.org/10.1111/j.1365-2559.2009.03313.x). We performed a multicenter prospective study, which compared both methods for the diagnosis of PJI. All suspicions of PJI (n = 264) between December 2010 and March 2012 in seven centers were prospectively included. Five perioperative specimens were collected per patient for cultures, and one was collected for histology. Diagnosis of PJI was made according to the Infectious Diseases Society of America (IDSA) guidelines. Histopathological analysis classified the patients according to the threshold of 23 neutrophils and according to the classification of Morawietz. Performances of both methods were compared by using clinical and/or bacteriological criteria as the gold standard. Among 264 patients with suspected PJI, a diagnosis of infection was confirmed in 215 and unconfirmed in 49 patients. Histopathological analysis was available for 150 confirmed PJI and 40 unconfirmed PJI cases. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 78.7%, 90.0%, 96.7%, 52.9%, and 81.1%, respectively, for the Morawietz classification, and 82.0%, 90.0%, 96.9%, 57.1%, and 83.7%, respectively, for the 23-neutrophil threshold. The new algorithm using a threshold of 23 neutrophils can be proposed as a new gold standard for the histopathological diagnosis of PJI.

Synthesis of M-UiO-66 (M = Zr, Ce or Hf) employing 2,5-pyridinedicarboxylic acid as a linker: defect chemistry, framework hydrophilisation and sorption properties

MOFs of general composition [M₆(OH)₄(O)₄(PDC)_6−x(Cl)_2x(H₂O)_2x] with M = Zr, Ce, Hf; and 0 ≤ x ≤ 2 were obtained and characterised in detail.

A multi-purpose reaction cell for the investigation of reactions under solvothermal conditions

A new versatile and easy-to-use remote-controlled reactor setup aimed at the analysis of chemical reactions under solvothermal conditions has been constructed. The reactor includes a heating system that can precisely control the temperature inside the reaction vessels in a range between ambient temperature and 180 °C. As reaction vessels, two sizes of commercially available borosilicate vessels (V_max = 5 and 11 ml) can be used. The setup furthermore includes the option of stirring and injecting of up to two liquid additives or one solid during the reaction to initiate very fast reactions, quench reactions, or alter chemical parameters. In addition to a detailed description of the general setup and its functionality, three examples of studies conducted using this setup are presented.

Maintaining a regular physical activity aggravates intramuscular tumor growth in an orthotopic liposarcoma model

Today, care teams within cancer centers encourage patients to be physically active, after diagnosis, based on data obtained mainly from breast, colon and prostate cancer. Intriguingly, the impact of physical activity (PA) on intramuscular tumors (e.g. sarcomas) has not been specifically addressed and, thus, could be mistakenly confounded with other cancers. In this preclinical study we assessed the impact of PA on intramuscular liposarcoma (LS) evolution. Four-week-old nude male mice were active by voluntary running on wheels, for six weeks. Then, mice were divided into four groups with open or restricted access to wheels, which have received an orthotopic intramuscular injection of either vehicle or human LS, SW872, cells. Active mice presented ~1.5 fold increase in tumor mass, which was mainly due to higher cellular mitosis and proliferation. This bulging intramuscular tumor mass altered muscle function, as evidence by overall muscle strength and maximum running capacity. From a molecular point of view, active mice exhibited poor levels of Phospho-p38^{Thr180/Tyr182} and p21 content in tumors and also displayed low amounts of circulating insulin comparing to inactive counterparts. Insulin induced Phospho-p38^{Thr180/Tyr182} and p21 expression in SW872 cells, in vitro. The expression of p21 was regulated in a p38-dependent fashion, since inhibition of p38 activity abolished the up-regulation of p21. Our data suggest that insulin-dependent activation of p38 MAPK-p21 pathway is a possible mechanism responsible for delaying tumor growth in inactive mice. Clinically, patients with lower-extremities LS could be advised to reduce or minimize their levels of PA during the preoperative period.

Synthesis, functionalisation and post-synthetic modification of bismuth metal–organic frameworks

Two new Bi-MOFs were discovered, synthesised and characterised, and the amino-functionalised Bi-MOF was post-synthetically modified using anhydrides and 1,3-propane sultone.

Synthesis of phosphonosulfonic acid building blocks as linkers for coordination polymers

Ten benzene based linkers containing sulfonic and phosphonic acids have been synthesized. One lanthanum MOF was isolated and characterized.

Tuning the stability of bimetallic Ce(iv)/Zr(iv)-based MOFs with UiO-66 and MOF-808 structures

A series of solid solutions of bimetallic Ce/Zr-UiO-66 and -MOF-808 compounds with a varying ratio of Ce⁴⁺ to Zr⁴⁺ were obtained under mild reaction conditions within 15 min. Samples with Ce ≤20 at% exhibit an enhanced thermal stability, better resistance against acids and smaller particle sizes.

Towards metal-organic framework based field effect chemical sensors: UiO-66-NH2 for nerve agent detection

Kelvin probe monitoring of metal-organic framework coated electrodes is demonstrated as a route for ppb-level detection of alkyl phosphonates.

We present a highly sensitive gas detection approach for the infamous ‘nerve agent’ group of alkyl phosphonate compounds. Signal transduction is achieved by monitoring the work function shift of metal–organic framework UiO-66-NH₂ coated electrodes upon exposure to ppb-level concentrations of a target simulant. Using the Kelvin probe technique, we demonstrate the potential of electrically insulating MOFs for integration in field effect devices such as ChemFETs: a three orders of magnitude improvement over previous work function-based detection of nerve agent simulants. Moreover, the signal is fully reversible both in dry and humid conditions, down to low ppb concentrations. Comprehensive investigation of the interactions that lead towards this high sensitivity points towards a series of confined interactions between the analyte and the pore interior of UiO-66-NH₂.

Synthesis and structure of Zr(iv)- and Ce(iv)-based CAU-24 with 1,2,4,5-tetrakis(4-carboxyphenyl)benzene

Eight-fold connection of hexanuclear clusters containing Zr(iv) or Ce(iv) through rigid, rectangular tetracarboxylate ions yields new MOFs with scu topology.

Structure property relationships affecting the proton conductivity in imidazole loaded Al-MOFs

A systematic investigation on the influence of steric effects and the possibility to form host-guest interactions on the proton conductivity was carried out using imidazole loaded derivatives of Al-MIL-53 [Al(OH)(1,4-BDC-(CH₃)_x)] (x = 0, 1, 2) and CAU-11.

Water-based synthesis and characterisation of a new Zr-MOF with a unique inorganic building unit

A new inorganic building unit in a Zr-MOF is formed through bridging of the well-known {Zr₆O₄(OH)₄} clusters by (μ-OH) groups.

The new triazine-based porous copper phosphonate [Cu3(PPT)(H2O)3]·10H2O

A new thermally stable copper phosphonate with pores of 9.4 Å diameter and a high water uptake at p/p⁰ = 0.2 is described.

[Adipocytic tumors]

Adipocytic tumors are the most common mesenchymal neoplasms, liposarcoma accounting for approximately 20% of soft tissue sarcomas. The differential diagnosis between benign and malignant tumors is often problematic and represents a significant proportion of consultation cases. The goal of this article is to review liposarcoma subtypes, the main benign adipocytic neoplasms: lipoblastoma, hibernoma, spindle/pleomorphic cell lipoma, chondroid lipoma, as well as non adipocytic neoplasms with a lipomatous component such as lipomatous solitary fibrous tumor, emphasizing on practical differential diagnosis issues, and immunohistochemical and molecular tools allowing their resolution.

Synthesis and Characterization of Mn6(PO4)4·H2O, a New Metal(II) Phosphate Hydrate

The new manganese phosphate hydrate,Mn6(PO4)4·H2O, has been obtained as a single phase product using hydrothermal methods and the structure has been determined by single crystal X-ray diffraction. The title compound crystallizes in the monoclinic space group Cc with a = 934.18(10), b = 1743.68(18), c = 815.15(8) pm, β = 92.616(2)°, V = 1326.4(2)·106 pm3, Z = 4, and the refinement led to R1 = 0.0281 and Rw2 = 0.0728 (all data). The structure is composed of [PO4] and [MnOx] polyhedra (x = 6, 7) and might be described as a distorted primitive hexagonal packing of [PO4] tetrahedra which are held together by Mn2+ ions partially located in distorted trigonal prismatic positions. This leads to a dense three-dimensional framework structure. Magnetic susceptibility measurements verified the presence of high-spin Mn2+ ions and thermogravimetric data confirm the chemical composition deduced from the single crystal structure determination.

Synthesis and Characterization of the Manganese Pyroarsenate Mn2As2O7 · 2H2O

The manganese pyroarsenate hydrate, Mn2As2O7 · 2 H2O, has been obtained as a single phase product using hydrothermal methods and the structure has been determined by single crystal X-ray diffraction. The title compound crystallizes in the monoclinic space group P21/n with a = 6.6576(4), b = 14.555(1), c = 7.8147(5) Å, β = 94.935(1)°, V = 754.46(8) Å3 and Z = 4. The manganese ions are each coordinated to five oxygen atoms and a water molecule in a distorted octahedral arrangement. Edge-sharing MnO6 octahedra form chains which are connected to a three-dimensional framework by As2O7 4- ions. The pyroarsenate anion, which attains a nearly eclipsed conformation, has a mean As-O distance for the terminal As-O bonds of 1.669(2) Å, while for the bridging oxygen atom a mean value of 1.757(2) Å is observed. Magnetic susceptibility measurements indicate the presence of high-spin Mn2+ ions. Thermogravimetric as well as IR and Raman spectroscopic studies of Mn2As2O7 · 2 H2O are presented.

Synthesen, Kristallstrukturen und Eigenschaften von Trisilber-und Trikalium-tri-μ-imido-cyclotriphosphat, Ag3(PO2NH)3 und K3(PO2NH)3 / Syntheses, Crystal Structures, and Properties of Trisilver and Tripotassium Tri-μ-im ido Cyclotriphosphate, Ag3(PO2NH)3 and K3(PO2NH)3

Coarse crystalline Ag3(PO2NH)3 (1) and K3(PO2NH)3 (2) are obtained by addition of an aqueous solution of AgNO3 to an acidified solution of Na3(PO2NH)3 · 4H2O and by diffusion controlled addition of ethanol to a solution of K3(PO2NH)3 in water, respectively. The crystal structures of 1 and 2 have been determined by single crystal X-ray methods (Ag3(PO2NH)3: P21/c; a = 1166.6(1), b = 786.4(1), c = 997.8(1) pm, β = 106.91(1)°; Z = 4. K3(PO2NH)3: R3̄; a = 1271.4(2), c = 1017.9(2) pm, Z = 6). In Ag3(PO2NH)3 the cyclic anion is markedly distorted because of interactions between Ag+ and one nitrogen atom of the anion. In K3(PO2NH)3 the trimetaphosphimate ring shows a chair conformation and two cyclic anions are connected to each other by hydrogen bonds. DTA/TG investigations show thermal decomposition above 275 and 250 °C for 1 and 2, respectively.

Synthese, Kristallstruktur und Eigenschaften von 1,1,3,3,3-Pentaamino-1-oxo- 1λ5 ,3λ5-diphosphaz-2-en, (NH2)2(O)P-N=P(NH2)3 / Synthesis, Crystal Structure, and Properties of 1,1,3,3,3-Pentaamino-1-oxo-1λ5, 3λ5-diphosphaz-2-ene, (NH2)2(O)P-N=P(NH2)3

Coarse crystalline (NH2)2(O)P-N=P(NH2)3 is obtained from a NH3 saturated CH2Cl2 suspension of (NH2)2(O)P-N=P(NH2)3 NH4Cl at room temperature. (NH2)2(O)P-N=P(NH2)3·NH4Cl is synthesized by slow addition of Cl2(O)P-N=PCl3 to a solution of NH3 in CH2Cl2 at -78 °C. Excess NH4Cl is removed by treatment with HNEt2 followed by extraction with CH2Cl2. The crystal structure of (NH2)2(O)P-N=P(NH2)3 has been determined by single crystal X-ray methods (P21/c; a = 1462.8(3), b = 944.8(2), c = 1026.9(2) pm, β = 110.69(3)°; Z = 8). In the unit cell there are two crystallographically unique molecules. They form a three dimensional network by intermolecular hydrogen bonding interactions (N-H···N ≥ 313 pm. N-H···O ≥ 293 pm). The investigation of the thermal properties shows decomposition with evolution of NH3 above 80 °C.

Aspergillus arthritis and organ transplantation

We report a case of a kidney and pancreas transplanted patient, hospitalized for septic hip arthritis. The whole diagnostic work-up including synovial and bone biopsies remained negative. After inefficient empirical anti-bacterial antibiotic treatment, femoral head resection was performed and tissue analysis revealed Aspergillus fumigatus hyphae. Treatment with voriconazole along with hip replacement led to complete recovery. However, drug interaction between immunosuppressive and anti-fungal drugs was complicated by cellular acute graft rejection. Aspergillus fumigatus arthritis is an uncommon and serious infection that should be evoked especially in the case of resistance to anti-microbial antibiotics and/or an atypical clinical picture.

The biology of melanoma prognostic factors

Cutaneous melanoma still represents a paradox among all solid tumors. It is the cancer for which the best prognostic markers ever identified in solid tumors are available, yet there is very little understanding of their biological significance. This review focuses on recent biological data that shed light on the clinical-biological correlations underlining the 2010 American Joint Committee on Cancer (AJCC) melanoma staging system. A major challenge is to replace outcome clustering based on artificial biomarker breakpoints by a continuous multidimensional prognostic model. Major improvement will come from shared computerized tools that allow the generation of continuous likelihood scores for diagnosis, prognosis, and response prediction. This will lead to the development of platforms which can be used by scientists from different fields to integrate and share high-quality data in the pre-competitive setting and generate new probabilistic causal models.

Histology and imaging of soft tissue sarcomas

Imaging and histology are two complementary morphological techniques which play a fundamental role in the diagnosis and management of soft tissue sarcomas. Imaging allows to identify some pseudosarcomatous benign lesions such as myositis ossificans, intramuscular hemangioma, angiomyolipoma, intramuscular lipoma, giant cell tumour of tendon sheath, desmoid tumour and elastofibroma. There is no formal criterion for diagnosing a sarcoma on magnetic resonance imaging (MRI) but malignancy is strongly suspected with the presence of necrosis and vascular, bone or joint invasion. Imaging may also suggest some histological types of sarcoma such as well-differentiated liposarcoma, dedifferentiated liposarcoma, synovial sarcoma or extraskeletal osteosarcoma. Imaging is also extremely helpful in determining the appropriate kind of sampling to carry out and in guiding the performance of a microbiopsy. The appearance observed on imaging should always be taken into consideration for the interpretation of the microbiopsy by the pathologist.

[Pseudomalignant endoscopic appearance in hyperplastic polyp at esophagogastric junction: case report]

Hyperplastic polyps are by far the most common benign tumors in the stomach larger than 5mm. Although the malignant potential of hyperplastic gastric polyps was originally denied, a low risk for carcinomatous conversion is now recognized. Its has been recommended that all gastric polyps of 5mm or more in diameter have to be removed. We present here the case of a large hyperplastic gastric polyp located at the esophagogastric junction with endoscopic malignant appearance. The description of its endoscopic and histological characteristics gives us the opportunity to discuss the difficulty of endoscopic diagnosis in the case of gastric polyps and to remind their prognosis.

Mapuera virus, a rubulavirus that inhibits interferon signalling in a wide variety of mammalian cells without degrading STATs

Mapuera virus (MPRV) is a paramyxovirus that was originally isolated from bats, but its host range remains unknown. It was classified as a member of the genus Rubulavirus on the basis of structural and genetic features. Like other rubulaviruses it encodes a V protein (MPRV/V) that functions as an interferon (IFN) antagonist. Here we show that MPRV/V differs from the IFN antagonists of other rubulaviruses in that it does not induce the proteasomal degradation of STAT proteins, key factors in the IFN signalling cascade. Rather, MPRV/V prevents the nuclear translocation of STATs in response to IFN stimulation and inhibits the formation of the transcription factor complex ISGF3. We also show that MPRV/V blocks IFN signalling in cells from diverse mammalian species and discuss the IFN response as a barrier to cross-species infections.

[Sebaceous tumors of the eyelids in a patient with Muir-Torre syndrome]

Muir-Torre syndrome is an autosomal dominant hereditary condition predisposing to cancer. It is characterized by cutaneous tumors (such as sebaceous adenomas, epitheliomas, or carcinoma, and/or keratoacanthomas) and internal malignancies. A 47-year-old male patient with cancer antecedents consulted for two tumors of the eyelid. Histological study of the exeresis biopsies of the eyelid lesions showed a sebaceous adenoma and an epidermoid carcinoma with sebaceous differentiation. With the suspicion of Muir-Torre syndrome, a genetic consultation was requested. The geneticist found a mutation of the MSH2 gene, which was not classified as pathological. Cancer screening was begun for the patient and his descendants. The clinical outcome was death from urothelial carcinoma. Eyelid sebaceous tumors require complete medical check-up in search of carcinoma. Demonstrating Muir-Torre syndrome allows the medical team to propose early cutaneous and visceral carcinoma screening for patients, their collaterals, and their descendants.

Réticulohistiocytose multicentrique

Multicentric reticulohistiocytosis (RHM) is a rare non Langherhans cell histiocytosis with skin and joint involvment. Nearly all organs can be involved. Association with cancer occurs in about 25% of cases. Association with auto-immune diseases has also been recorded. Microscopic examination shows a histiocytic nodular infiltrate made of giant cells with ground-glass appearance and PAS positive cytoplasm. Immunostaining shows cell positivity for CD68 and negativity for CD1a and S100 protein. No Birbeck granules are found at ultrastructural examination.