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Yeung MC, Dermawan JK, Liu AP, Lam AY, Antonescu CR, Shek TW. Spindle cell neoplasms with novel LTK fusion - Expanding the spectrum of kinase fusion-positive soft tissue tumors. Genes Chromosomes Cancer 2024; 63:e23227. [PMID: 38517106 PMCID: PMC10963038 DOI: 10.1002/gcc.23227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/09/2024] [Accepted: 01/24/2024] [Indexed: 03/23/2024] Open
Abstract
AIMS Kinase fusion-positive soft tissue tumors represent an emerging, molecularly defined group of mesenchymal tumors with a wide morphologic spectrum and diverse activating kinases. Here, we present two cases of soft tissue tumors with novel LTK fusions. METHODS AND RESULTS Both cases presented as acral skin nodules (big toe and middle finger) in pediatric patients (17-year-old girl and 2-year-old boy). The tumors measured 2 and 3 cm in greatest dimension. Histologically, both cases exhibited bland-looking spindle cells infiltrating adipose tissue and accompanied by collagenous stroma. One case additionally displayed perivascular hyalinization and band-like stromal collagen. Both cases exhibited focal S100 staining, and one case had patchy coexpression of CD34. Targeted RNA-seq revealed the presence of novel in-frame MYH9::LTK and MYH10::LTK fusions, resulting in upregulation of LTK expression. Of interest, DNA methylation-based unsupervised clustering analysis in one case showed that the tumor clustered with dermatofibrosarcoma protuberans (DFSP). One tumor was excised with amputation with no local recurrence or distant metastasis at 18-month follow-up. The other case was initially marginally excised with local recurrence after one year, followed by wide local excision, with no evidence of disease at 10 years of follow-up. CONCLUSIONS This is the first reported case series of soft tissue tumors harboring LTK fusion, expanding the molecular landscape of soft tissue tumors driven by activating kinase fusions. Furthermore, studies involving a larger number of cases and integrated genomic analyses will be warranted to fully elucidate the pathogenesis and classification of these tumors.
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Affiliation(s)
- Maximus C.F. Yeung
- Department of Pathology, School of Clinical Medicine, The University of Hong Kong, Hong Kong
| | - Josephine K Dermawan
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anthony P.Y. Liu
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong
| | - Albert Y.L. Lam
- Division of General Orthopaedics and Oncology, Department of Orthopedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Hong Kong
| | - Cristina R Antonescu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tony W.H. Shek
- Department of Pathology, School of Clinical Medicine, The University of Hong Kong, Hong Kong
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Yin X, Yang X, Wang S, Zhou J, Zhao M. SMARCB1/INI1-deficient epithelioid and myxoid neoplasms in paratesticular region: Expanding the clinicopathologic and molecular spectrum. Ann Diagn Pathol 2024; 68:152242. [PMID: 38039617 DOI: 10.1016/j.anndiagpath.2023.152242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 11/27/2023] [Accepted: 11/27/2023] [Indexed: 12/03/2023]
Abstract
SMARCB1/INI1-deficient soft tissue tumors with epithelioid and myxoid features are diverse and mainly include soft tissue myoepithelial tumor, extraskeletal myxoid chondrosarcoma, and the recently described myoepithelioma-like tumor of the vulvar region and myxoepithelioid tumor with chordoid features. Because of their overlapping features, the accurate diagnosis and classification of these tumors are often challenging. Herein, we report two unique cases of SMARCB1/INI1-deficient soft tissue neoplasm with epithelioid and myxoid features occurring in male paratesticular region. The first case was a 52-year-old man presented with an intermittent painful left paratesticular mass for 1 year. The second case was a 41-year-old man presented with a painless paratesticular mass on the right side for 3 months. Both patients underwent an orchiectomy. After 6 and 26 months of follow-up, both were alive with no evidence of recurrence or metastasis. In both cases, the tumor was relatively well-demarcated and showed monomorphic round to epithelioid cells arranged in a nested, trabecular, reticular, and corded pattern, setting in a myxohyalinized and vascularized matrix. The tumor cells showed relatively uniform round nuclei with vesicular chromatin and variably prominent nucleoli. No rhabdoid cells were identified. Mitoses numbered 3 and 2 per 10 high-power fields. Tumor necrosis or lymphovascular invasion was absent. Immunohistochemically, both tumors expressed epithelial membrane antigen (focal), calponin (focal), and CD99. SMARCB1/INI1 expression was deficient in both cases. In addition, case 1 diffusely expressed pan-cytokeratin, and case 2 diffusely expressed CD34 and synaptophysin. Molecular genetically, case 1 showed SMARCB1 homozygous deletion as detected by fluorescence in-situ hybridization (FISH), and case 2 demonstrated SMARCB1 copy number deletions by next-generation sequencing and SMARCB1 monoallelic deletion by FISH. Both cases lacked EWSR1 rearrangements by FISH. The overall clinicopathologic profiles of the two cases made it difficult to classify them as one of the established categories of SMARCB1/INI1-deficient mesenchymal tumors. Our study further expands the clinicopathologic and molecular spectrum of SMARCB1/INI1-deficient epithelioid and myxoid neoplasms and highlights the challenges to diagnose these tumors.
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Affiliation(s)
- Xiaona Yin
- Ningbo Clinical Pathology Diagnosis Center, Ningbo 315000, China
| | - Xiaoqun Yang
- Department of Pathology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Suying Wang
- Ningbo Clinical Pathology Diagnosis Center, Ningbo 315000, China
| | - Jue Zhou
- Ningbo Clinical Pathology Diagnosis Center, Ningbo 315000, China
| | - Ming Zhao
- Ningbo Clinical Pathology Diagnosis Center, Ningbo 315000, China.
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Bakhshwin A, Armstrong SM, Duckworth LA, Stoehr R, Konishi E, Rubin BP, Fritchie KJ, Dickson BC, Agaimy A, Dermawan JK. Novel NCOA2/3-rearranged low-grade fibroblastic spindle cell tumors: A report of five cases. Genes Chromosomes Cancer 2024; 63:e23203. [PMID: 37724942 DOI: 10.1002/gcc.23203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/03/2023] [Accepted: 09/11/2023] [Indexed: 09/21/2023] Open
Abstract
Spindle cell mesenchymal neoplasms are a diverse and often challenging diagnostic group. While morphological impression is sufficient for some diagnoses, increasingly immunohistochemical and even molecular data is required to render an accurate diagnosis, which can lead to the characterization of new entities. We describe five cases of novel mesenchymal neoplasms with rearrangements in the NCOA2 and NCOA3 genes partnered with either CTCF or CRTC1. Three tumors occurred in the head and neck (palate, auditory canal), while the other two were in visceral organs (lung, urinary bladder). All cases occurred in adults (range 33-86) with a median age of 42 and fairly even sex distribution = (male-to-female = 3:2). Morphologically, they had similar features consisting of monotonous, bland spindle to ovoid cells with fascicular and reticular arrangements in a myxohyaline to collagenous stroma. However, immunophenotypically they had essentially a null phenotype, with only two tumors staining partially for CD34 and smooth muscle actin. Targeted RNA sequencing detected in-frame CTCF::NCOA2 (one case), CRTC1::NCOA2 (two cases), and CTCF::NCOA3 (two cases) fusions. Treatment was surgical resection in all cases. Local recurrence and/or distant metastases were not observed in any case (median follow-up, 7.5 months; range, 2-19 months). Given their morphologic, immunohistochemical, and molecular similarities, we believe that these cases may represent an emerging family of low-grade NCOA2/3-rearranged fibroblastic spindle cell neoplasms.
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Affiliation(s)
- Ahmed Bakhshwin
- King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Susan M Armstrong
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lauren A Duckworth
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert Stoehr
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center, European Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Eiichi Konishi
- Department Surgical Pathology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Brian P Rubin
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Karen J Fritchie
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brendan C Dickson
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Canada
- Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto, Canada
| | - Abbas Agaimy
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center, European Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Josephine K Dermawan
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Kallen ME, Michal M, Meyer A, Suster DI, Olson NJ, Charville GW, Perret R, Gross JM. Calcified Chondroid Mesenchymal Neoplasm: Exploring the Morphologic and Clinical Features of an Emergent Entity With a Series of 33 Cases. Am J Surg Pathol 2023; 47:725-737. [PMID: 37102574 DOI: 10.1097/pas.0000000000002044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Calcified chondroid mesenchymal neoplasm is a term proposed for tumors with a spectrum of morphologic features, including cartilage/chondroid matrix formation, that frequently harbor FN1 gene fusions. We report a series of 33 cases of putative calcified chondroid mesenchymal neoplasms, mostly referred for expert consultation out of concern for malignancy. Patients included 17 males and 16 females, with a mean age of 51.3 years. Anatomic locations include the hands and fingers, feet and toes, head and neck, and temporomandibular joint; 1 patient presented with multifocal disease. Radiologic review showed soft tissue masses with variable internal calcification, which occasionally scalloped bone but in all cases appeared indolent/benign. Tumors had a mean gross size of 2.1 cm and a homogenous rubbery to fibrous/gritty tan-white cut surface. Histology demonstrated multinodular architecture with a prominent chondroid matrix and increased cellularity towards the periphery of the nodules. The tumor cells were polygonal with eccentric nuclei and bland cytologic features and showed a variable amount of increased spindled / fibroblastic forms in the perinodular septa. The majority of cases had notable grungy and/or lacy calcifications. A subset of cases demonstrated at least focal areas of increased cellularity and osteoclast-like giant cells. Herein, we confirm the distinct morphologic and clinicopathologic features associated with this entity with the largest series to date, with a focus on practical diagnostic separation from similar chondroid neoplasms. Awareness of these features is critical in avoiding pitfalls, including a malignant diagnosis of chondrosarcoma.
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Affiliation(s)
- Michael E Kallen
- Department of Pathology, University of Maryland School of Medicine
| | | | - Anders Meyer
- Department of Pathology and Laboratory Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - David I Suster
- Department of Pathology, Immunology, and Laboratory Medicine, Rutgers New Jersey Medical School, Rutgers, NJ
| | - Nicholas J Olson
- Physicians Laboratory
- University of South Dakota Sanford School of Medicine, Sioux Falls, SD
| | | | - Raul Perret
- Institut Bergonié / Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - John M Gross
- Department of Pathology, Johns Hopkins Medicine, Baltimore, MD
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Bangerter JL, Harnisch KJ, Chen Y, Hagedorn C, Planas-Paz L, Pauli C. Establishment, characterization and functional testing of two novel ex vivo extraskeletal myxoid chondrosarcoma (EMC) cell models. Hum Cell 2023; 36:446-455. [PMID: 36316541 PMCID: PMC9813045 DOI: 10.1007/s13577-022-00818-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/20/2022] [Indexed: 11/04/2022]
Abstract
Extraskeletal myxoid chondrosarcoma (EMC) is a malignant mesenchymal neoplasm of uncertain differentiation as classified by the WHO Classification of Tumours 2020. Although often associated with pronlonged survival, EMC has high rates of distant recurrences and disease-associated death. EMCs are translocation sarcomas and harbor in > 90% of the cases an NR4A3 rearrangement. The molecular consequences of the NR4A3 gene fusions are not yet fully elucidated as well-characterized ex vivo cell models for EMC are lacking. Patient-derived ex vivo models are important and essential tools for investigating disease mechanisms associated with diseases that are rare, that exhibit poor prognosis and for the identification of potential novel treatment options. We established two novel EMC ex vivo models (USZ20-EMC1 and USZ22-EMC2) for functional testing and research purposes. USZ20-EMC1 and USZ22-EMC2 were established and maintained as sarco-sphere cell models for several months in culture. The cells were molecularly characterized using DNA sequencing and methylation profiling. Both cell models represent their native tumor tissue as confirmed by histomorphology and their molecular profiles, suggesting that native tumor cell function can be recapitulated in the ex vivo models. Using a functional screening approach, novel anti-cancer drug sensitivities including potential synergistic combinations were identified. In conclusion, two novel EMC ex vivo cell models (USZ20-EMC1 and USZ22-EMC2) were successfully established and characterized from native tumor tissues. Both cell models will be useful tools for further investigating disease mechanisms and for answering basic and translational research questions.
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Affiliation(s)
- Jana Lucia Bangerter
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8006, Zurich, Switzerland
| | - Kim Jannis Harnisch
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8006, Zurich, Switzerland
| | - Yanjiang Chen
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8006, Zurich, Switzerland
| | - Catherine Hagedorn
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8006, Zurich, Switzerland
| | - Lara Planas-Paz
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8006, Zurich, Switzerland
| | - Chantal Pauli
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8006, Zurich, Switzerland.
- Medical Faculty, University of Zurich, Zurich, Switzerland.
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Lenz J, Klubíčková N, Ptáková N, Hájková V, Grossmann P, Šteiner P, Kinkor Z, Švajdler M, Michal M, Konečná P, Macháčová D, Hurník P, Tichý M, Tichý F, Kyllar M, Fiala L, Kavka M, Michal M. Extraskeletal myxoid chondrosarcoma: A study of 17 cases focusing on the diagnostic utility of INSM1 expression and presenting rare morphological variants associated with non-EWSR1::NR4A3 fusions. Hum Pathol 2022; 134:19-29. [PMID: 36563884 DOI: 10.1016/j.humpath.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/18/2022] [Accepted: 12/15/2022] [Indexed: 12/25/2022]
Abstract
Extraskeletal myxoid chondrosarcoma (EMC) is a rare sarcoma of uncertain lineage. Insulinoma-associated protein 1 (INSM1) has recently been described as a highly specific and sensitive immunohistochemical marker for EMC. The goal of this study was to evaluate the diagnostic significance of INSM1 immunohistochemistry in EMC. Furthermore, correlations between molecular and morphological findings were performed. Sixteen of 17 EMC cases were stained with the INSM1 antibody. Tumors with at least 5% INSM1-positive cells and any staining intensity were considered positive. Molecular testing was successfully performed in 12/17 cases. The immunohistochemical analysis detected 13 INSM1-positive (81%) and 3 INSM1-negative tumors (19%). The extent of the staining was classified as 1+ in 7 cases (44%), 2+ in 2 cases (13%), 3+ in 2 cases (13%) and 4+ in 2 cases (13%). Intensity of immunostaining was weak in 5 cases (31%), moderate in 2 cases (13%) and strong in 6 cases (38%). Molecular assays revealed 8 EWSR1::NR4A3 positive tumors (67%), 2 TAF15::NR4A3 positive tumors (17%), 1 TCF12::NR4A3 positive tumor (8%) and 1 NR4A3 positive tumor (8%) in which no other gene alteration was identified. Two of them, namely TCF12 positive and one TAF15 positive tumors, were highly cellular and partially associated with pseudopapillary architecture. Our study found that moderate/strong expression of INSM1 in more than 25% of tumor cells was present in only 31% of cases. Thus, the diagnostic utility of INSM1 is rather low. Two morphologically unique cases of non-EWSR1 rearranged EMC with an extremely rare pseudopapillary growth pattern are also reported.
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Affiliation(s)
- Jiří Lenz
- Department of Pathology, Znojmo Hospital, MUDr. Jana Janského 2675/11, 669 02 Znojmo, Czech Republic; Cytohisto S.r.o., Bří. Mrštíků 3065, 690 02 Břeclav, Czech Republic; Department of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, University of Veterinary Sciences Brno, Palackého Tř. 1946/1, 612 42 Brno, Czech Republic.
| | - Natálie Klubíčková
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 00 Plzeň, Czech Republic; Bioptical Laboratory, Ltd., Mikulášské Nám. 4, 326 00 Pilsen, Czech Republic.
| | - Nikola Ptáková
- Bioptical Laboratory, Ltd., Mikulášské Nám. 4, 326 00 Pilsen, Czech Republic.
| | - Veronika Hájková
- Bioptical Laboratory, Ltd., Mikulášské Nám. 4, 326 00 Pilsen, Czech Republic.
| | - Petr Grossmann
- Bioptical Laboratory, Ltd., Mikulášské Nám. 4, 326 00 Pilsen, Czech Republic.
| | - Petr Šteiner
- Bioptical Laboratory, Ltd., Mikulášské Nám. 4, 326 00 Pilsen, Czech Republic.
| | - Zdeněk Kinkor
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 00 Plzeň, Czech Republic; Bioptical Laboratory, Ltd., Mikulášské Nám. 4, 326 00 Pilsen, Czech Republic.
| | - Marián Švajdler
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 00 Plzeň, Czech Republic; Bioptical Laboratory, Ltd., Mikulášské Nám. 4, 326 00 Pilsen, Czech Republic.
| | - Michal Michal
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 00 Plzeň, Czech Republic; Bioptical Laboratory, Ltd., Mikulášské Nám. 4, 326 00 Pilsen, Czech Republic.
| | - Petra Konečná
- Department of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, University of Veterinary Sciences Brno, Palackého Tř. 1946/1, 612 42 Brno, Czech Republic.
| | - Dominika Macháčová
- Department of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, University of Veterinary Sciences Brno, Palackého Tř. 1946/1, 612 42 Brno, Czech Republic.
| | - Pavel Hurník
- Institute of Molecular and Clinical Pathology and Medical Genetics, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic.
| | - Michal Tichý
- Department of Pathology, Masaryk Memorial Cancer Institute, Žlutý Kopec 543/7, 602 00, Brno, Czech Republic.
| | - František Tichý
- Department of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, University of Veterinary Sciences Brno, Palackého Tř. 1946/1, 612 42 Brno, Czech Republic.
| | - Michal Kyllar
- Institute of Morphology, Department of Pathobiology, University of Veterinary Medicine, Veterinärplatz 1, 1210 Vienna, Austria.
| | - Luděk Fiala
- Cytohisto S.r.o., Bří. Mrštíků 3065, 690 02 Břeclav, Czech Republic; Charles University Prague, First Faculty of Medicine, Kateřinská 1660/32, 121 08 Prague, Czech Republic.
| | - Miroslav Kavka
- Department of Surgery, Znojmo Hospital, MUDr. Jana Janského 2675/11, 669 02 Znojmo, Czech Republic.
| | - Michael Michal
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 00 Plzeň, Czech Republic; Bioptical Laboratory, Ltd., Mikulášské Nám. 4, 326 00 Pilsen, Czech Republic.
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Zhu P, Wang J. Primary NTRK-rearranged Spindle Cell Neoplasm of the Lung: A Clinicopathologic and Molecular Analysis of 3 Cases. Am J Surg Pathol 2022; 46:1007-1013. [PMID: 35220354 DOI: 10.1097/pas.0000000000001880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Three cases of primary NTRK-rearranged spindle cell neoplasm of the lung with resemblance to those described in the somatic soft tissues are presented. The patients are 2 males and 1 female with age at presentation ranging from 31 to 45 years (mean, 36 y). All the 3 tumors were discovered incidentally during physical examinations. None of the patients had any prior history of mesenchymal neoplasms anywhere else. Computed tomography revealed intrapulmonary mass located in the right upper lobe, left upper lobe, and left lower lobe, respectively. All the patients underwent lobectomy. Grossly, the tumors were described as yellowish-white solid measuring in size between 1.2 and 1.8 cm (mean, 1.5 cm). Histologically, they were characterized by monomorphic spindle cells arranged in haphazard fascicles accompanied by variable stromal collagens. Nuclear atypia was mild and mitotic activity was scarce. By immunohistochemistry, the neoplastic cells in all 3 cases showed strong and diffuse staining of CD34, pan-TRK, and TrkA with variable expression of S100 protein, whereas they were negative for cytokeratin, SOX10, ALK, α-smooth muscle actin, desmin, and STAT6. Fluorescence in situ hybridization analysis revealed NTRK1 rearrangement in all 3 cases. Subsequent next-generation sequencing identified TPM3-NTRK1 fusion in 2 cases and LMNA-NTRK1 fusion in 1 case. All 3 patients are alive without the disease (median follow-up, 9 mo; range, 4 to 87 mo). The cases present herein demonstrate that NTRK-rearranged spindle cell neoplasms may occur primarily in the lung, albeit extremely rare, and should be included in the differential diagnosis of primary pulmonary spindle cell neoplasms.
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Affiliation(s)
- Peipei Zhu
- Department of Pathology, Tongji Hospital, School of Medicine, Tongji University
| | - Jian Wang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
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Brown JM, Rakoczy K, Pretell-Mazzini J. Extraskeletal myxoid chondrosarcoma: Clinical features and overall survival. Cancer Treat Res Commun 2022; 31:100530. [PMID: 35144048 DOI: 10.1016/j.ctarc.2022.100530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Extraskeletal myxoid chondrosarcoma is a rare form of soft tissue sarcoma characterized by a unique chromosomal translocation involving the NR4A3 gene on chromosome 9. It is most frequently diagnosed in the proximal extremities of older adult males and is notable for its insidious growth with predilection for local recurrence and metastasis. Currently, extraskeletal myxoid chondrosarcoma is managed with wide resection, with recent investigations supporting the utility of adjuvant radiation and novel chemotherapeutic strategies. METHODOLOGY A retrospective study was performed with the Surveillance, Epidemiology, and End-Results (SEER) database, which was searched for cases of extraskeletal myxoid chondrosarcoma diagnosed between years 2004 and 2015. Demographic variables were assessed, as well as Collaborative Staging variables including tumor size, metastatic disease, grade, and lymph node involvement. Cases were stratified according to the anatomic site of the primary tumor and were described by therapeutic intervention. A multivariate Cox proportional hazards model evaluated predictive factors for poor survival, and Kaplan-Meier analyses assessed effects of various staging, demographic, and therapeutic variables on overall survival. RESULTS There were 270 cases of extraskeletal myxoid chondrosarcoma reviewed in this study, which were diagnosed most frequently in the lower limb or hip of older adult males. The 5-year overall survival was 76.5% and was worse on univariate assessment for patients with age > 60, high histologic grade, pelvic location, tumor size > 8.0 cm, metastatic or nodal spread, and in patients without surgical intervention. The Cox regression predicted significantly worse survival for older age, larger tumor size, non-surgical status, and high tumor grade. Metastasis did not significantly predict worse survival on multivariate assessment, and neither chemotherapy nor radiotherapy provided a discernable improvement in survival in this cohort. DISCUSSION AND CONCLUSION As a rare soft tissue sarcoma, many of the presenting features and survival outcomes of extraskeletal myxoid chondrosarcoma remain poorly defined due to the limited prevalence of this disease. The findings of this study suggest the overall survival may be worse than previously reported, and poor prognostic factors are those associated with worse survival in other soft tissue sarcomas, including high histologic grade, older age, larger tumor size, and lack of wide resection. Radiation and chemotherapy did not demonstrably improve survival for patients with localized or metastatic disease.
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Affiliation(s)
- Jeffrey Mark Brown
- University of Miami Miller School of Medicine, Miami, FL, United States.
| | - Kyla Rakoczy
- University of Miami Miller School of Medicine, Miami, FL, United States
| | - Juan Pretell-Mazzini
- University of Miami, Department of Orthopedics, Musculoskeletal Oncology, Miami, FL, United States
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9
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Kikuchi Y, Watabe S, Yamamoto A, Sato K, Fujinuma W, Kawano J, Yuzawa K, Aso T, Eguchi M, Ishida T, Motoi T, Uozaki H. Periosteal Myxoid Leiomyosarcoma Histologically Mimicking Extraskeletal Myxoid Chondrosarcoma: Report of a Case with Histopathological and Cytopathological Comparison with Extraskeletal Myxoid Chondrosarcoma. Acta Cytol 2021; 65:541-548. [PMID: 34569497 DOI: 10.1159/000518004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/18/2021] [Indexed: 11/19/2022]
Abstract
Myxoid leiomyosarcoma (MLS) is a rare variant of leiomyosarcoma, with most cases occurring in the uterus. A case of MLS arising in the periosteal region of the tibia, mimicking extraskeletal myxoid chondrosarcoma (EMC), is described. The evaluation included histological and cytological comparison with EMC. The patient was a 77-year-old man with a palpable mass at the anterior aspect of the right lower leg. After diagnosis by cytopathology and biopsy examination, a wide resection was performed. The resulting cytological smears were composed primarily of spindle-shaped tumor cells in a myxoid and hemorrhagic background. Histologically, the tumor showed abundant myxoid matrix and tumor cells proliferating in a cord-like to reticular pattern, exhibiting a lace-like arrangement that mimicked EMC. Although immunohistochemical findings suggested leiomyosarcoma, a diagnosis of EMC eventually was excluded by the lack of a split signal when assessed for a rearrangement of NR4A3 by chromogenic in situ hybridization. Despite histological similarity to EMC, characteristic cytological findings of EMC such as epithelioid structures with a cord-like pattern and chondroblast-like lacunar structures were not observed in the smears of this patient's MLS. We propose that cytopathological examination of bone and soft tissue lesions is useful as a diagnostic tool in similar cases. A total diagnostic workup, including clinical, radiographic, cytopathological, histopathological, and molecular findings, is needed to ensure an accurate final diagnosis and to reduce diagnostic error.
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Affiliation(s)
- Yoshinao Kikuchi
- Department of Pathology, Teikyo University School of Medicine, Tokyo, Japan
| | - Shiori Watabe
- Department of Pathology, Teikyo University School of Medicine, Tokyo, Japan
| | - Asako Yamamoto
- Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kenji Sato
- Department of Orthopaedics, Teikyo University School of Medicine, Tokyo, Japan
| | - Wataru Fujinuma
- Department of Orthopaedics, Teikyo University School of Medicine, Tokyo, Japan
| | - Junichi Kawano
- Department of Pathology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kazuhiko Yuzawa
- Department of Pathology, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki, Japan
| | - Tatsuya Aso
- Department of Pathology, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki, Japan
| | - Masanobu Eguchi
- Department of Pathology, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki, Japan
| | - Tsuyoshi Ishida
- Department of Diagnostic Pathology, National Hospital Organization Saitama Hospital, Saitama, Japan
| | - Toru Motoi
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Hiroshi Uozaki
- Department of Pathology, Teikyo University School of Medicine, Tokyo, Japan
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10
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Hatfield BS, Mochel MC, Smith SC. Mesenchymal Neoplasms of the Genitourinary System: A Selected Review with Recent Advances in Clinical, Diagnostic, and Molecular Findings. Surg Pathol Clin 2018; 11:837-876. [PMID: 30447845 DOI: 10.1016/j.path.2018.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Mesenchymal neoplasms of the genitourinary (GU) tract often pose considerable diagnostic challenges due to their wide morphologic spectrum, relative rarity, and unexpected incidence at GU sites. Soft tissue tumors arise throughout the GU tract, whether from adventitia surrounding or connective tissues within the kidneys, urinary bladder, and male and female genital organs. This selected article focuses on a subset of these lesions, ranging from benign to malignant and encompassing a range of patterns of mesenchymal differentiation, where recent scholarship has lent greater insight into their clinical, molecular, or diagnostic features.
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Affiliation(s)
- Bryce Shawn Hatfield
- Department of Pathology, VCU School of Medicine, 1200 East Marshall Street, PO Box 980662, Richmond, VA 23298, USA
| | - Mark Cameron Mochel
- Department of Pathology, VCU School of Medicine, 1200 East Marshall Street, PO Box 980662, Richmond, VA 23298, USA
| | - Steven Christopher Smith
- Departments of Pathology and Urology, VCU School of Medicine, 1200 East Marshall Street, PO Box 980662, Richmond, VA 23298, USA.
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11
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Urbini M, Indio V, Astolfi A, Tarantino G, Renne SL, Pilotti S, Dei Tos AP, Maestro R, Collini P, Nannini M, Saponara M, Murrone L, Dagrada GP, Colombo C, Gronchi A, Pession A, Casali PG, Stacchiotti S, Pantaleo MA. Identification of an Actionable Mutation of KIT in a Case of Extraskeletal Myxoid Chondrosarcoma. Int J Mol Sci 2018; 19:ijms19071855. [PMID: 29937513 PMCID: PMC6073125 DOI: 10.3390/ijms19071855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 06/19/2018] [Accepted: 06/21/2018] [Indexed: 01/03/2023] Open
Abstract
Extraskeletal myxoid chondrosarcoma (EMC) is an extremely rare soft tissue sarcoma, marked by a translocation involving the NR4A3 gene. EMC is usually indolent and moderately sensitive to anthracycline-based chemotherapy. Recently, we reported on the therapeutic activity of sunitinib in a series of EMC cases, however the molecular target of sunitinib in EMC is unknown. Moreover, there is still the need to identify alternative therapeutic strategies. To better characterize this disease, we performed whole transcriptome sequencing in five EMC cases. Peculiarly, in one sample, an in-frame deletion (c.1735_1737delGAT p.D579del) was identified in exon 11 of KIT. The deletion was somatic and heterozygous and was validated both at DNA and mRNA level. This sample showed a marked high expression of KIT at the mRNA level and a mild phosphorylation of the receptor. Sanger sequencing of KIT in additional 15 Formalin Fixed Paraffin Embedded (FFPE) EMC did not show any other mutated cases. In conclusion, exon 11 KIT mutation was detected only in one out of 20 EMC cases analyzed, indicating that KIT alteration is not a recurrent event in these tumors and cannot explain the EMC sensitivity to sunitinib, although it is an actionable mutation in the individual case in which it has been identified.
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MESH Headings
- Base Sequence
- Chondrosarcoma/diagnosis
- Chondrosarcoma/genetics
- Chondrosarcoma/metabolism
- Chondrosarcoma/pathology
- Computational Biology
- DNA-Binding Proteins/genetics
- DNA-Binding Proteins/metabolism
- Exons
- Gene Expression Regulation, Neoplastic
- Humans
- Neoplasms, Connective and Soft Tissue/diagnosis
- Neoplasms, Connective and Soft Tissue/genetics
- Neoplasms, Connective and Soft Tissue/metabolism
- Neoplasms, Connective and Soft Tissue/pathology
- Oncogene Proteins, Fusion/genetics
- Oncogene Proteins, Fusion/metabolism
- Proto-Oncogene Proteins c-kit/genetics
- Proto-Oncogene Proteins c-kit/metabolism
- RNA-Binding Protein EWS/genetics
- RNA-Binding Protein EWS/metabolism
- Receptors, Steroid/genetics
- Receptors, Steroid/metabolism
- Receptors, Thyroid Hormone/genetics
- Receptors, Thyroid Hormone/metabolism
- Sequence Deletion
- Transcriptome
- Exome Sequencing
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Affiliation(s)
- Milena Urbini
- "Giorgio Prodi" Cancer Research Center, University of Bologna, 40138 Bologna, Italy.
| | - Valentina Indio
- "Giorgio Prodi" Cancer Research Center, University of Bologna, 40138 Bologna, Italy.
| | - Annalisa Astolfi
- "Giorgio Prodi" Cancer Research Center, University of Bologna, 40138 Bologna, Italy.
| | - Giuseppe Tarantino
- "Giorgio Prodi" Cancer Research Center, University of Bologna, 40138 Bologna, Italy.
| | - Salvatore Lorenzo Renne
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy.
| | - Silvana Pilotti
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy.
| | | | - Roberta Maestro
- Unit of Experimental Oncology 1, CRO Aviano National Cancer Institute, 33081 Aviano, Italy.
| | - Paola Collini
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy.
| | - Margherita Nannini
- Department of Specialized, Experimental and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy.
| | - Maristella Saponara
- Department of Specialized, Experimental and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy.
| | - Ludovica Murrone
- "Giorgio Prodi" Cancer Research Center, University of Bologna, 40138 Bologna, Italy.
| | - Gian Paolo Dagrada
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy.
| | - Chiara Colombo
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133Milan, Italy.
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133Milan, Italy.
| | - Andrea Pession
- "Giorgio Prodi" Cancer Research Center, University of Bologna, 40138 Bologna, Italy.
| | - Paolo Giovanni Casali
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133Milan, Italy.
| | - Silvia Stacchiotti
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133Milan, Italy.
| | - Maria Abbondanza Pantaleo
- Department of Specialized, Experimental and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy.
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12
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Hellwege JN, Torstenson ES, Russell SB, Edwards TL, Velez Edwards DR. Evidence of selection as a cause for racial disparities in fibroproliferative disease. PLoS One 2017; 12:e0182791. [PMID: 28792542 PMCID: PMC5549739 DOI: 10.1371/journal.pone.0182791] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/25/2017] [Indexed: 01/05/2023] Open
Abstract
Fibroproliferative diseases are common complex traits featuring scarring and overgrowth of connective tissue which vary widely in presentation because they affect many organ systems. Most fibroproliferative diseases are more prevalent in African-derived populations than in European populations, leading to pronounced health disparities. It is hypothesized that the increased prevalence of these diseases in African-derived populations is due to selection for pro-fibrotic alleles that are protective against helminth infections. We constructed a genetic risk score (GRS) of fibroproliferative disease risk-increasing alleles using 147 linkage disequilibrium-pruned variants identified through genome-wide association studies of seven fibroproliferative diseases with large African-European prevalence disparities. A comparison of the fibroproliferative disease GRS between 1000 Genomes Phase 3 populations detected a higher mean GRS in AFR (mean = 148 risk alleles) than EUR (mean = 136 risk alleles; T-test p-value = 1.75x10-123). To test whether differences in GRS burden are systematic and may be due to selection, we employed the quantitative trait loci (QTL) sign test. The QTL sign test result indicates that population differences in risk-increasing allele burdens at these fibroproliferative disease variants are systematic and support a model featuring selective pressure (p-value = 0.011). These observations were replicated in an independent sample and were more statistically significant (T-test p-value = 7.26x10-237, sign test p-value = 0.015). This evidence supports the role of selective pressure acting to increase frequency of fibroproliferative alleles in populations of African relative to European ancestry populations.
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Affiliation(s)
- Jacklyn N. Hellwege
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Eric S. Torstenson
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Shirley B. Russell
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Todd L. Edwards
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States of America
- * E-mail: (TLE); (DRVE)
| | - Digna R. Velez Edwards
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, United States of America
- * E-mail: (TLE); (DRVE)
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13
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Urbini M, Astolfi A, Pantaleo MA, Serravalle S, Dei Tos AP, Picci P, Indio V, Sbaraglia M, Benini S, Righi A, Gambarotti M, Gronchi A, Colombo C, Dagrada GP, Pilotti S, Maestro R, Polano M, Saponara M, Tarantino G, Pession A, Biasco G, Casali PG, Stacchiotti S. HSPA8 as a novel fusion partner of NR4A3 in extraskeletal myxoid chondrosarcoma. Genes Chromosomes Cancer 2017; 56:582-586. [PMID: 28383167 DOI: 10.1002/gcc.22462] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/03/2017] [Accepted: 04/03/2017] [Indexed: 01/30/2023] Open
Abstract
Extraskeletal myxoid chondrosarcoma (EMC) is a very rare sarcoma most often arising in the soft tissue. Rare EMC of the bone have been reported. EMC exhibits distinctive clinico-pathological and genetic features; however, despite the name, it lacks any feature of cartilaginous differentiation. EMC is characterized by the rearrangement of the NR4A3, which, in most cases (about 62-75%), is fused with EWSR1 and less frequently with other partners, including TAF15 (27%), TCF12 (4%), TFG, and FUS. We herein report the identification by whole-transcriptome sequencing of HSPA8 as a novel fusion partner of NR4A3 in a case of EMC. FISH analysis confirmed the presence of a genomic HSPA8-NR4A3 translocation in the vast majority of tumor cells. Our findings expand the spectrum of NR4A3 fusion partners involved in EMC pathobiology.
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Affiliation(s)
- Milena Urbini
- "Giorgio Prodi" Cancer Research Center, University of Bologna, Bologna, Italy
| | - Annalisa Astolfi
- "Giorgio Prodi" Cancer Research Center, University of Bologna, Bologna, Italy
| | - Maria Abbondanza Pantaleo
- "Giorgio Prodi" Cancer Research Center, University of Bologna, Bologna, Italy
- Department of Specialized, Experimental and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Salvatore Serravalle
- Department of Pediatrics, "Lalla Seràgnoli", Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Piero Picci
- Laboratory of Oncologic Research, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Valentina Indio
- "Giorgio Prodi" Cancer Research Center, University of Bologna, Bologna, Italy
| | - Marta Sbaraglia
- Department of Medicine, University of Padua School of Medicine, Padua, Italy
| | - Stefania Benini
- Laboratory of Oncologic Research, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Righi
- Laboratory of Oncologic Research, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Gambarotti
- Laboratory of Oncologic Research, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alessandro Gronchi
- Melanoma and Sarcoma Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Chiara Colombo
- Melanoma and Sarcoma Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Gian Paolo Dagrada
- Laboratory of Experimental Molecular Pathology, Department of Diagnostic Pathology and Laboratory, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Silvana Pilotti
- Laboratory of Experimental Molecular Pathology, Department of Diagnostic Pathology and Laboratory, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Roberta Maestro
- Oncogenetics and Functional Oncogenomics (FOGG), CRO Aviano National Cancer Institute, Aviano, Italy
| | - Maurizio Polano
- Oncogenetics and Functional Oncogenomics (FOGG), CRO Aviano National Cancer Institute, Aviano, Italy
| | - Maristella Saponara
- Department of Specialized, Experimental and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giuseppe Tarantino
- "Giorgio Prodi" Cancer Research Center, University of Bologna, Bologna, Italy
| | - Andrea Pession
- "Giorgio Prodi" Cancer Research Center, University of Bologna, Bologna, Italy
- Department of Pediatrics, "Lalla Seràgnoli", Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Guido Biasco
- "Giorgio Prodi" Cancer Research Center, University of Bologna, Bologna, Italy
- Department of Specialized, Experimental and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Paolo Giovanni Casali
- Adult Mesenchymal Tumour and Rare Cancer Medical Oncology Unit, Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori Milan, Italy
| | - Silvia Stacchiotti
- Adult Mesenchymal Tumour and Rare Cancer Medical Oncology Unit, Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori Milan, Italy
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14
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Agaram NP, Zhang L, Sung YS, Singer S, Antonescu CR. Extraskeletal myxoid chondrosarcoma with non-EWSR1-NR4A3 variant fusions correlate with rhabdoid phenotype and high-grade morphology. Hum Pathol 2014; 45:1084-91. [PMID: 24746215 DOI: 10.1016/j.humpath.2014.01.007] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 01/07/2014] [Accepted: 01/10/2014] [Indexed: 01/30/2023]
Abstract
Extraskeletal myxoid chondrosarcomas (EMC) are rare soft tissue sarcomas with distinctive histology and uncertain histogenesis, characterized by Ewing sarcoma breakpoint region 1-nuclear receptor subfamily 4, group A, member 3 (EWSR1-NR4A3) fusion in 75% of the cases. A smaller proportion of cases show NR4A3 fused to other gene partners including TATA binding protein-associated factor 15 (TAF15), transcription factor 12 (TCF12), and TRK-fused gene (TFG). The impact of various gene fusions on morphology and outcome has not been previously evaluated. We investigated 26 consecutive EMCs and correlated the genetic findings with morphology and clinical outcome. There were 5 females and 21 males (median age, 49.5 years). Mean size of the tumors was 11 cm. Fluorescence in situ hybridization analysis showed EWSR1-NR4A3 gene fusion in 16 cases (62%), TAF15-NR4A3 gene fusion in 7 cases (27%), and TCF12-NR4A3 gene fusion in 1 case (4%). Two cases showed only NR4A3 gene rearrangements. Morphologically, most EWSR1-rearranged tumors (10/16) showed low cellularity, minimal cytologic atypia, and low mitotic counts. In contrast, 80% of EMCs with variant (non-EWSR1) NR4A3 gene fusions (TAF15, TCF12) had high-grade morphology with increased cellularity, proliferation, and cytologic atypia, showing a plasmacytoid/rhabdoid morphology in half the cases. Follow-up showed that only 1 of 16 patients with EWSR1-rearranged tumors died of disease, in contrast to 3 (43%) of 7 TAF15-rearranged tumors. In conclusion, EMCs with variant NR4A3 gene fusions show a higher incidence of rhabdoid phenotype, high-grade morphology, and a more aggressive outcome compared with the EWSR1-NR4A3 positive tumors. Furthermore, fluorescence in situ hybridization assay for NR4A3, along with EWSR1, may be an additional ancillary test to confirm diagnosis of EMCs.
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Affiliation(s)
- Narasimhan P Agaram
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065.
| | - Lei Zhang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065
| | - Yun-Shao Sung
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065
| | - Samuel Singer
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065
| | - Cristina R Antonescu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065.
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15
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Abstract
Activating transcription factor 2 (ATF2) is a member of activator protein 1 superfamily, which can heterodimerize with other transcription factors regulating cell differentiation and survival. ATF2 assembles into a complex with the synovial sarcoma translocation, chromosome 18 (SS18)-synovial sarcoma, X breakpoint (SSX) fusion oncoprotein, and the transducin-like enhancer of split 1 (TLE1) corepressor, driving oncogenesis in synovial sarcoma. The fusion oncoproteins in many other translocation-associated sarcomas incorporate transcription factors from the ATF/cAMP response element binding or E26 families, which potentially form heterodimers with ATF2 to regulate transcription. ATF2 may therefore play an important role in the oncogenesis of many mesenchymal tumors, but as yet, little is known about its protein expression in patient specimens. Herein we perform immunohistochemical analyses using a validated specific antibody for ATF2 expression and intracellular localization on a cohort of 594 malignant and 207 benign mesenchymal tumors representing 47 diagnostic entities. Melanoma served as a positive control for nuclear and cytoplasmic staining. High nuclear ATF2 expression was mainly observed in translocation-associated and/or spindle cell sarcomas including synovial sarcoma, desmoplastic small round cell tumor, endometrial stromal sarcoma, gastrointestinal stromal tumor, malignant peripheral nerve sheath tumor, and solitary fibrous tumor. Cytoplasmic ATF2 expression was less frequently seen than nuclear expression in malignant mesenchymal tumors. Benign mesenchymal tumors mostly showed much lower nuclear and cytoplasmic ATF2 expression.
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Affiliation(s)
- Makoto Endo
- Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Anatomic Pathology, Kyushu University, Fukuoka, Japan; Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | - Le Su
- Biomedical Research Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Torsten O Nielsen
- Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
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16
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Nakatani F. [I. The role of microRNA for musculoskeletal cancer]. Gan To Kagaku Ryoho 2012; 39:369-372. [PMID: 22619771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Fumihiko Nakatani
- Musculoskeletal Oncology Division, National Cancer Center Hospital, Tokyo, Japan
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17
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Miura Y, Keira Y, Ogino J, Nakanishi K, Noguchi H, Inoue T, Hasegawa T. Detection of specific genetic abnormalities by fluorescence in situ hybridization in soft tissue tumors. Pathol Int 2011; 62:16-27. [PMID: 22192800 DOI: 10.1111/j.1440-1827.2011.02739.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
MESH Headings
- Adult
- Child, Preschool
- DNA Probes
- Female
- Humans
- In Situ Hybridization, Fluorescence
- Liposarcoma, Myxoid/diagnosis
- Liposarcoma, Myxoid/genetics
- Male
- Neoplasms, Connective and Soft Tissue/diagnosis
- Neoplasms, Connective and Soft Tissue/genetics
- Neuroectodermal Tumors/diagnosis
- Neuroectodermal Tumors/genetics
- Paraffin Embedding
- Rhabdomyosarcoma/diagnosis
- Rhabdomyosarcoma/genetics
- Sarcoma/diagnosis
- Sarcoma/genetics
- Sarcoma, Clear Cell/diagnosis
- Sarcoma, Clear Cell/genetics
- Sarcoma, Ewing/diagnosis
- Sarcoma, Ewing/genetics
- Sarcoma, Synovial/diagnosis
- Sarcoma, Synovial/genetics
- Sensitivity and Specificity
- Translocation, Genetic
- Young Adult
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Affiliation(s)
- Yasuhiro Miura
- Department of Surgical Pathology, Sapporo Medical University School of Medicine, Chuo-ku, Sapporo, Japan
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18
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Sankhala KK, Chawla SP. Review: desmoplastic small round cell tumor: current treatment approach and role of targeted therapy. Clin Adv Hematol Oncol 2009; 7:476-478. [PMID: 19701156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
MESH Headings
- Abdominal Neoplasms/drug therapy
- Abdominal Neoplasms/genetics
- Abdominal Neoplasms/pathology
- Adolescent
- Antibodies, Monoclonal/therapeutic use
- Antineoplastic Agents, Alkylating/therapeutic use
- Child
- Chromosomes, Human, Pair 11/genetics
- Chromosomes, Human, Pair 22/genetics
- Genes, Wilms Tumor
- Humans
- Neoplasms, Connective and Soft Tissue/drug therapy
- Neoplasms, Connective and Soft Tissue/genetics
- Neoplasms, Connective and Soft Tissue/pathology
- RNA-Binding Protein EWS/genetics
- Receptor, ErbB-2/metabolism
- Translocation, Genetic
- Young Adult
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Affiliation(s)
- Kamalesh K Sankhala
- Institute for Drug Development, Cancer Therapy and Research Center, The University of Texas Health Science Center, San Antonio, TX 78229, USA.
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19
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Suehara Y. [Proteomic analysis for connective and soft tissue neoplasms]. Gan To Kagaku Ryoho 2008; 35:407-410. [PMID: 18401917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Yoshiyuki Suehara
- Proteome Bioinformatics Project, Cancer Genomics Project, Dept. of Orthopedic Surgery, National Cancer Center
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20
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Abstract
Perivascular epithelioid cell tumors (PEComas) are mesenchymal tumors composed of histologically, immunohistochemically, ultrastructurally, and genetically distinctive cells. PEComas have been described in different organs and are considered ubiquitous tumors. In this review we discuss recent informations related to PEComas in the genitourinary tract.
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21
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Henderson SR, Guiliano D, Presneau N, McLean S, Frow R, Vujovic S, Anderson J, Sebire N, Whelan J, Athanasou N, Flanagan AM, Boshoff C. A molecular map of mesenchymal tumors. Genome Biol 2005; 6:R76. [PMID: 16168083 PMCID: PMC1242211 DOI: 10.1186/gb-2005-6-9-r76] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2005] [Revised: 06/07/2005] [Accepted: 07/26/2005] [Indexed: 11/14/2022] Open
Abstract
A comprehensive study of the gene expression profile of 96 mesenchymal tumors identifies molecular fingerprints for most tumors in this group. Background Bone and soft tissue tumors represent a diverse group of neoplasms thought to derive from cells of the mesenchyme or neural crest. Histological diagnosis is challenging due to the poor or heterogenous differentiation of many tumors, resulting in uncertainty over prognosis and appropriate therapy. Results We have undertaken a broad and comprehensive study of the gene expression profile of 96 tumors with representatives of all mesenchymal tissues, including several problem diagnostic groups. Using machine learning methods adapted to this problem we identify molecular fingerprints for most tumors, which are pathognomonic (decisive) and biologically revealing. Conclusion We demonstrate the utility of gene expression profiles and machine learning for a complex clinical problem, and identify putative origins for certain mesenchymal tumors.
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Affiliation(s)
- Stephen R Henderson
- Cancer Research UK, Viral Oncology Group, Wolfson Institute for Biomedical Research, Gower Street, University College London, London, WC1E 6BT, UK
| | - David Guiliano
- Cancer Research UK, Viral Oncology Group, Wolfson Institute for Biomedical Research, Gower Street, University College London, London, WC1E 6BT, UK
- Division of Cell and Molecular Biology, Biochemistry Building, Faculty of Life Sciences, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Nadege Presneau
- Cancer Research UK, Viral Oncology Group, Wolfson Institute for Biomedical Research, Gower Street, University College London, London, WC1E 6BT, UK
| | - Sean McLean
- Cancer Research UK, Viral Oncology Group, Wolfson Institute for Biomedical Research, Gower Street, University College London, London, WC1E 6BT, UK
| | - Richard Frow
- Cancer Research UK, Viral Oncology Group, Wolfson Institute for Biomedical Research, Gower Street, University College London, London, WC1E 6BT, UK
- Institute of Orthopaedics and Department of Pathology, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
| | - Sonja Vujovic
- Cancer Research UK, Viral Oncology Group, Wolfson Institute for Biomedical Research, Gower Street, University College London, London, WC1E 6BT, UK
| | - John Anderson
- Unit of Molecular Haematology and Cancer Biology, Institute of Child Health and Great Ormond Street Hospital, Guildford Street, London, WC1N 1EH, UK
| | - Neil Sebire
- Department of Pathology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Jeremy Whelan
- London Bone and Soft Tissue Tumour Service, University College London Hospitals, London, UK
| | - Nick Athanasou
- Department of Pathology, Nuffield Department of Orthopaedic Surgery, Nuffield Orthopaedic Centre, Headington, Oxford, OX3 7LD, UK
| | - Adrienne M Flanagan
- Institute of Orthopaedics and Department of Pathology, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
| | - Chris Boshoff
- Cancer Research UK, Viral Oncology Group, Wolfson Institute for Biomedical Research, Gower Street, University College London, London, WC1E 6BT, UK
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22
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Mechtersheimer G, Lehnert T, Penzel R, Joos S, Egerer G, Otto HF. [Gastrointestinal stromal tumors. A morphologic and molecular genetic independent tumor entity with new therapeutic perspectives]. Pathologe 2003; 24:182-91. [PMID: 12739051 DOI: 10.1007/s00292-003-0612-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Recent morphological and molecular genetic findings have greatly expanded our understanding of gastrointestinal stromal tumors (GISTs). GISTs are now defined by their overexpression of CD117 (KIT), the receptor for the stem cell factor, and can thus be discriminated from smooth muscle tumors. Cytogenetically, GISTs are characterized even in early lesions by frequent entire or partial loss of the chromosomes 14 and 22 and terminal deletions of the chromosomal arm 1p. During tumor progression further chromosomal imbalances accumulate. Following the first report on activating KIT mutations in GISTs, several studies have addressed the role of wild-type and mutant KIT in GISTs and demonstrated activating KIT mutations in the majority of cases. Moreover, KIT tyrosine phosphorylation is even present in KIT mutation-negative GISTs, implicating KIT activation as a central event in the pathogenesis of GISTs. Imatinib (STI571/Glivec) is a selective inhibitor of BCR/ABL, PDGFR and KIT receptor-tyrosine kinases. First therapeutic applications of imatinib in patients with progressive GISTs have yielded promising results. This review focuses on the morphological and molecular findings in GISTs which have opened up a new therapeutic perspective.
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23
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Genevay M, Coindre JM, Guillou L. [Recent entities in soft tissue tumor pathology. Part 2]. Ann Pathol 2003; 23:135-48. [PMID: 12843968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
The second part of this review on the pathology of soft tissue tumors focuses on malignant entities of recent description, including the following: soft tissue giant cell tumor, inflammatory myxohyaline tumor, inflammatory fibroblastic sarcoma, low grade fibromyxoid Evans sarcoma and its variant, the hyalinizing spindle cell tumor with giant rosettes, spindle cell liposarcoma, proximal type epithelioid sarcoma, sclerosing epithelioid fibrosarcoma. For each entity, the diagnostic criteria, the clinical presentation and the differential diagnosis are described. The role of immunohistochemistry and molecular pathology in the identification and delineation of these new entities is emphasized.
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Affiliation(s)
- Muriel Genevay
- Institut Universitaire de Pathologie, rue du Bugnon 25, 1011 Lausanne, Suisse
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24
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Ranchère-Vince D. [Soft tissue pathology: current issues and perspectives]. Ann Pathol 2003; 23:109-13. [PMID: 12843965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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25
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Affiliation(s)
- Matt van de Rijn
- Department of Pathology, Stanford University Medical Center, Palo Alto, California 94305, USA.
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26
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Guillou L, Coindre J, Gallagher G, Terrier P, Gebhard S, de Saint Aubain Somerhausen N, Michels J, Jundt G, Vince DR, Collin F, Trassard M, Le Doussal V, Benhattar J. Detection of the synovial sarcoma translocation t(X;18) (SYT;SSX) in paraffin-embedded tissues using reverse transcriptase-polymerase chain reaction: a reliable and powerful diagnostic tool for pathologists. A molecular analysis of 221 mesenchymal tumors fixed in different fixatives. Hum Pathol 2001; 32:105-12. [PMID: 11172303 DOI: 10.1053/hupa.2001.21130] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Synovial sarcoma (SS) is a relatively rare sarcoma, which may be confused with several other mesenchymal and nonmesenchymal lesions. It bears the t(X;18) (SYT;SSX) translocation, which seems to be specific for this tumor type and can be detected in paraffin-embedded tissue, using reverse transcriptase-polymerase chain reaction (RT-PCR). However, the specificity and sensitivity of this detection method have rarely been examined in a large series. Using RT-PCR, we examined 250 mesenchymal and nonmesenchymal, benign and malignant, paraffin-embedded lesions for the SS t(X;18) (SYT-SSX) translocation. PCR products were obtained from 221 tumors (88.5%). There were 135 non-SS tumors, 22 biphasic, and 64 monophasic spindle/round cell SS, of which 10 were cytogenetically confirmed as t(X;18)-positive. SYT-SSX gene fusion transcripts were detected in the SS tumor category only (100% specificity), including 100% of the biphasic SS and 86% of monophasic spindle/round cell SS. Nine tumors originally diagnosed as SS were t(X;18) (SYT-SSX)-negative. Following reassessment, only 3 of these tumors showed clinicopathologic, immunohistochemical, and/or ultrastructural features consistent with that diagnosis, thus raising the overall detection sensitivity to 96%. With regard to the potential adverse effect of the fixatives used, PCR products were obtained in 100%, 91.5%, 90.5%, and 0% of tumors fixed with AFA, buffered formalin, Holland Bouin, and conventional Bouin's fluid, respectively. This study shows that the detection of the SS t(X;18) (SYT-SSX) in paraffin-embedded tissue is feasible with a 100% specificity and an overall 96% sensitivity, provided non-Bouin's fluid fixation is used.
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MESH Headings
- Adult
- Biomarkers, Tumor
- Chromosomes, Human, Pair 18/genetics
- DNA, Complementary/genetics
- Female
- Fixatives
- Humans
- Male
- Middle Aged
- Neoplasms, Connective and Soft Tissue/genetics
- Neoplasms, Connective and Soft Tissue/pathology
- Oncogene Proteins, Fusion/genetics
- Paraffin Embedding
- Pathology, Clinical
- RNA, Neoplasm/genetics
- Reproducibility of Results
- Reverse Transcriptase Polymerase Chain Reaction
- Sarcoma, Synovial/genetics
- Sarcoma, Synovial/pathology
- Translocation, Genetic
- X Chromosome/genetics
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Affiliation(s)
- L Guillou
- University Institute of Pathology, Lausanne, Switzerland
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