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Zhong J, Hu Y, Si L, Xing Y, Geng J, Jiao Q, Zhang H, Yao W. Primary perivascular epithelioid cell tumor (PEComa) in bone: A review of the literature and a case arising in the humerus with multiple metastases. J Bone Oncol 2020; 26:100336. [PMID: 33240785 PMCID: PMC7674509 DOI: 10.1016/j.jbo.2020.100336] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 09/12/2020] [Revised: 10/24/2020] [Accepted: 10/25/2020] [Indexed: 12/24/2022] Open
Abstract
First case PEComa primary arising in humerus was described. Histology is the basic to determine malignancy of PEComa. TFE3 gene investigation is the key of therapy selection. mTOR inhibitor is believed to be effective for patients without TFE3 rearrangement. More study is needed to understand the role of molecular test and imaging in PEComa.
Introduction Perivascular epithelioid cell tumors (PEComas) are a family of mesenchymal tumors that rarely arise as a primary bone tumor. Material and methods We report a case of primary malignant bone PEComa. A literature review via PubMed, Embase and Web of Science databases with the keyword “PEComa” and “bone” was performed. Results We reported a 33-year-old female with primary malignant bone PEComa in right distal humerus. The patient received an inhibitor of the mammalian target of rapamycin (mTOR) protein based on negative molecular investigation result of transcription factor E3 (TFE3) rearrangement, and additional therapies including palliative radiotherapy, anti-angiogenics and immunotherapy when the disease progression was detected. The patient was alive with the disease twenty-three months postoperatively. A total of nineteen related literature cases were retrieved and reviewed. Taking current case into account, ten males and ten females with median age of 24 years (range, 3–93 years) were identified, who were most frequently affected in tibia. The median follow-up duration of 24 months (range, 3–96 months). One patient died due to this disease, and six patients showed metastases. Three patients experienced recurrence, and two of them experienced twice and three times, respectively. Conclusion To our knowledge, this is the first case of primary malignant bone PEComa arising in humerus. Clinicopathological and radiological correlation is mandatory to the correct diagnosis and to determine its malignancy. More studies are required to understand the role of molecular test and imaging in selecting suitable treatment and mechanisms of treatment resistance.
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Key Words
- 18F-FDG, fluorine-18-fluorodeoxyglucose positron
- ASPS, alveolar soft part sarcoma
- Bone neoplasm
- CT, computed tomography
- ECT, emission computed tomography
- EMA, membrane antigen
- HMB 45, human melanoma black 45
- HPF, high-power fields
- Humerus
- MITF, microphthalmia-associated transcription factor
- MRI, magnetic resonance imaging
- Malignant
- Metastasis
- PEComa, perivascular epithelioid cell tumor
- PET/CT, positron emission tomography/computed tomography
- Perivascular epithelioid cell tumor (PEComa)
- SMA, smooth muscle actin
- SUVmax, maximum standard uptake value
- TFE3, transcription factor E3
- mTOR, mammalian target of rapamycin
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Affiliation(s)
- Jingyu Zhong
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai 200336, China
| | - Yangfan Hu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 YiShan Road, Shanghai 200233, China
| | - Liping Si
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai 200336, China
| | - Yue Xing
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai 200336, China
| | - Jia Geng
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 QingChun Road, Hangzhou 310003, China
| | - Qiong Jiao
- Department of Pathology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 YiShan Road, Shanghai 200233, China
| | - Huizhen Zhang
- Department of Pathology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 YiShan Road, Shanghai 200233, China
| | - Weiwu Yao
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai 200336, China
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Kim BG, Song JY, Zo S, Im Y, Choi S, Han J, Jeong BH, Kim H. S-100-Negative malignant pulmonary granular cell tumor: A case report. Respir Med Case Rep 2020; 29:101002. [PMID: 32015959 PMCID: PMC6992531 DOI: 10.1016/j.rmcr.2020.101002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/31/2019] [Revised: 01/19/2020] [Accepted: 01/19/2020] [Indexed: 12/05/2022] Open
Abstract
Malignant pulmonary granular cell tumor (GCT) is extremely rare and difficult to distinguish from benign GCT. Most GCTs are neural-type and express S-100. However, a small subset of tumors sub-classified as the non-neural type do not express S-100. We report a case of malignant non-neural-type GCT in the lungs. A 77-year-old woman felt chest discomfort and dyspnea in July 2019. She had never smoked and had no medical history other than hypertension and diabetes mellitus. She was initially evaluated at a local hospital. Flexible bronchoscopy showed total occlusion of the right main bronchus by a mass-like lesion. Biopsy of the mass lesion revealed chronic inflammation. The patient visited for re-evaluation in September 2019. Rigid bronchoscopy showed worsening of the total obstruction of the right main bronchus by a tumor mass, such that the carina was not visible. Additionally, endobronchial nodules were observed on the medial side of left main bronchus. The tumor masses of both main bronchi were removed by bronchoscopic intervention, but the right main bronchus was not opened. Biopsy revealed malignant GCT, favoring the non-neuronal type (S-100-negative). We report an extremely rare case of malignant pulmonary GCT negative for S-100 in immunohistochemistry. In this case, surgical resection was not possible because the tumor was diagnosed at a fairly advanced stage and had spread to involve the contralateral main bronchus. The patient chose to be treated at another hospital and was thereafter lost to follow-up.
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Affiliation(s)
- Bo-Guen Kim
- Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ju Yeun Song
- Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sungmin Zo
- Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yunjoo Im
- Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sangjoon Choi
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joungho Han
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byeong-Ho Jeong
- Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Okamoto S, Komura M, Terao Y, Kurisaki-Arakawa A, Hayashi T, Saito T, Togo S, Shiokawa A, Mitani K, Kobayashi E, Kumasaka T, Takahashi K, Seyama K. Pneumothorax caused by cystic and nodular lung metastases from a malignant uterine perivascular epithelioid cell tumor (PEComa). Respir Med Case Rep 2017; 22:77-82. [PMID: 28706850 PMCID: PMC5496452 DOI: 10.1016/j.rmcr.2017.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 06/20/2017] [Accepted: 06/20/2017] [Indexed: 12/03/2022] Open
Abstract
Perivascular epithelioid cell tumors (PEComas) are mesenchymal neoplasms with immunoreactivity for both melanocytic and smooth muscle markers. PEComas occur at multiple sites, and malignant PEComas can undergo metastasis, recurrence and aggressive clinical courses. Although the lung is a common metastatic site of PEComas, they usually appear as multiple nodules but rarely become cystic or cavitary. Here, we describe a female patient whose lungs manifested multiple cystic, cavity-like and nodular metastases 3 years after the resection of uterine tumors tentatively diagnosed as epithelioid smooth muscle tumors with uncertain malignant potential. This patient's subsequent pneumothorax necessitated video-assisted thoracoscopic surgery, and examination of her resected lung specimens eventually led to correcting the diagnosis, i.e., to a PEComa harboring tuberous sclerosis complex 1 (TSC1) loss-of-heterozygosity that originated in the uterus and then metastasized to the lungs. The administration of a gonadotropin-releasing hormone analogue later stabilized her clinical course. To the best of our knowledge, the present case is the first in the literature that associates PEComas with a TSC1 abnormality. Additionally, the pulmonary manifestations, including imaging appearance and pneumothorax, somewhat resembled those of lymphangioleiomyomatosis, a representative disease belonging to the PEComa family. Although PEComas are rare, clinicians, radiologists and pathologists should become aware of this disease entity, especially in the combined clinical setting of multiple cystic, cavity-like, nodular lesions on computed tomography of the chest and a past history of the tumor in the female reproductive system.
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Key Words
- CAPUs, clinically aggressive PEComas of the uterine corpus
- CT, computed tomography
- Cystic lung disease
- ESS, endometrial stromal sarcoma
- GnRH, gonadotropin-releasing hormone analogue
- HPF, high-power fields
- LAM, lymphangioleiomyomatosis
- LOH, loss of heterozygosity
- Loss of heterozygosity
- Multiple lung nodules
- PEComa
- PEComa, perivascular epithelioid cell tumor
- PEComa-NOS, PEComa not otherwise specified
- Pneumothorax
- Pulmonary metastasis
- TFE3, transcription factor E3
- TSC, tuberous sclerosis complex
- mTOR, mammalian target of rapamycin
- α-SMA, α-smooth muscle actin
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Affiliation(s)
- Shouichi Okamoto
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.,The Study Group for Pneumothorax and Cystic Lung Diseases, 4-8-1 Seta, Setagaya-ku, Tokyo, 158-0095, Japan
| | - Moegi Komura
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Yasuhisa Terao
- Department of Gynecology and Obstetrics, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Aiko Kurisaki-Arakawa
- Department of Human Pathology, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Takuo Hayashi
- Department of Human Pathology, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.,The Study Group for Pneumothorax and Cystic Lung Diseases, 4-8-1 Seta, Setagaya-ku, Tokyo, 158-0095, Japan
| | - Tsuyoshi Saito
- Department of Human Pathology, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Shinsaku Togo
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Akira Shiokawa
- Department of Clinical Diagnostic Pathology, Showa University Fujigaoka Hospital, 1-30, Fujigaoka Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan
| | - Keiko Mitani
- Department of Human Pathology, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.,The Study Group for Pneumothorax and Cystic Lung Diseases, 4-8-1 Seta, Setagaya-ku, Tokyo, 158-0095, Japan
| | - Etsuko Kobayashi
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.,The Study Group for Pneumothorax and Cystic Lung Diseases, 4-8-1 Seta, Setagaya-ku, Tokyo, 158-0095, Japan
| | - Toshio Kumasaka
- Department of Pathology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan.,The Study Group for Pneumothorax and Cystic Lung Diseases, 4-8-1 Seta, Setagaya-ku, Tokyo, 158-0095, Japan
| | - Kazuhisa Takahashi
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Kuniaki Seyama
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.,The Study Group for Pneumothorax and Cystic Lung Diseases, 4-8-1 Seta, Setagaya-ku, Tokyo, 158-0095, Japan
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Hamadalla NY, Rifat UN, Safi KC, Mohammed M, Abu-Farsakh H. Leiomyosarcoma of the urinary bladder: A review and a report of two further cases. Arab J Urol 2013; 11:159-64. [PMID: 26558075 PMCID: PMC4443010 DOI: 10.1016/j.aju.2013.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 01/23/2013] [Revised: 02/25/2013] [Accepted: 03/16/2013] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES To review the published cases of leiomyosarcoma of the urinary bladder and to report two further cases. METHODS The databases Pubmed and Hinari were searched using the keywords 'bladder', 'leiomyosarcoma' and 'smooth muscle neoplasm'. The 14 articles identified were reviewed, and we present a further two cases. RESULTS Of more than 100 cases reported, 77 were reviewed. There is a lack of consensus about the standard treatment, and little is known about the natural history and prognosis of the tumour, due to its very low incidence. These tumours occur in older adults of either sex and are characterised by an aggressive behaviour. There is usually an unfavourable outcome, with the lungs being the most common site of metastasis. The two further cases we report had a different presentation and outcome. CONCLUSIONS Because of the limited experience with this rare tumour, there are insufficient data to suggest the optimum management strategy and prognosis.
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