1
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Odintsov I, Jagannathan JP, Al-Ibraheemi A, Selig MK, Newman ET, Fletcher CDM, Nielsen GP, Hornick JL. Primary Clear Cell Sarcoma of Bone: Clinicopathologic Study of a Rare Presentation. Am J Surg Pathol 2023; 47:354-360. [PMID: 36730915 DOI: 10.1097/pas.0000000000001988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Clear cell sarcoma (CCS) is an uncommon malignant mesenchymal neoplasm of young adults with a predilection for tendons and aponeuroses of distal extremities, a distinctive nested growth pattern, melanocytic differentiation, and usually an EWSR1::ATF1 fusion. Distinction from melanoma can be challenging but is critical for clinical management. Rare cases of primary bone CCS have been reported. The purpose of this study was to evaluate the clinicopathologic features of a series of primary bone CCS. Three cases of primary bone CCS were identified out of 140 CCS diagnosed between 2010 and 2021. Two patients were female, and 1 patient was male; ages were 19, 47, and 61 years. All tumors arose in the long bones of the extremities (femur, humerus, fibula). Two tumors also involved regional lymph nodes at presentation. Two showed characteristic histologic features, in the form of nests and fascicles of uniform epithelioid to spindle cells with prominent nucleoli and pale eosinophilic to clear cytoplasm; 1 tumor showed sheet-like growth, unusual focal pleomorphism, and more notable nuclear atypia. By immunohistochemistry, S100 protein was positive in 2/3 cases, SOX10 in 3/3, HMB-45 in 2/3, MiTF in 2/2, and melan A in 1/3. All cases were confirmed to harbor EWSR1 rearrangement and EWSR1::ATF1 fusion or t(12;22). On follow-up, all 3 patients developed metastases and died of disease, 5, 18, and 21 months after diagnosis. In summary, CCS rarely presents in the skeleton. At such locations, distinction from metastatic melanoma is particularly challenging. Clinical and pathologic features are similar to conventional CCS of soft tissue. Primary bone CCS may pursue an aggressive clinical course.
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Affiliation(s)
| | | | - Alyaa Al-Ibraheemi
- Department of Pathology, Boston Children's Hospital, Harvard Medical School
| | | | - Erik T Newman
- Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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2
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Kubota Y, Tanaka K, Hisaoka M, Daa T, Iwasaki T, Kawano M, Itonaga I, Tsumura H. Primary clear cell sarcoma of the femur: a unique case with RT-PCR and direct sequencing confirmation of EWSR1/ATF1 fusion gene. BMC Musculoskelet Disord 2021; 22:99. [PMID: 33478436 PMCID: PMC7819310 DOI: 10.1186/s12891-021-03969-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/11/2021] [Indexed: 12/18/2022] Open
Abstract
Background It is very rare for clear cell sarcomas (CCS) to arise in the bone. During diagnosis, it is important to distinguish primary CCS of bone from bone metastasis of melanoma because this difference fundamentally changes the therapeutic options. Recently, characteristic fusion genes of CCS have been detected using reverse transcription polymerase chain reaction (RT-PCR) or direct sequencing which allowed to distinguish CCS from melanoma. However, there was no study applying these analyses with positive results. In this case, we describe the use of fusion gene analysis to diagnose a primary CCS of the bone. Case presentation A 36-year-old male presented with a four-months history of left knee pain. Magnetic resonance imaging showed a lesion in the left femoral medial epicondyle. Histological examination of the biopsy specimen revealed proliferating oval or rounded cells. These cells had clear cytoplasm arranged in fascicles or compact nests with frequent deposits of brown pigment. Furthermore, immunohistochemistry analysis revealed that tumor cells were positive for S-100 protein, HMB-45, Melan-A, and SOX10. It stained negative for CD34 and BRAF v600e. Conclusively, detection of the EWSR1/ATF1 fusion gene using RT-PCR and direct sequencing confirmed that the lesion was a primary CCS of the bone. Wide-margin resection and reconstruction with a tumor endoprosthesis were performed. Conclusions Herein, we diagnosed a rare case of primary CCS of the bone by detecting EWSR1/ATF1 fusion gene using RT-PCR and direct sequencing. Since fluorescence-in situ hybridization (FISH) and RT-PCR could show false positive by mainly due to technical problems, it is better to perform direct sequencing to confidently diagnose the tumor as a primary CCS especially at very rare site such as bone.
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Affiliation(s)
- Yuta Kubota
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama, 879-5593, Yufu City, Oita, Japan
| | - Kazuhiro Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama, 879-5593, Yufu City, Oita, Japan.
| | - Masanori Hisaoka
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, 807-8555, Kitakyushu, Japan
| | - Tsutomu Daa
- Department of Diagnostic Pathology, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama, 879-5593, Yufu City, Oita, Japan
| | - Tatsuya Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama, 879-5593, Yufu City, Oita, Japan
| | - Masanori Kawano
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama, 879-5593, Yufu City, Oita, Japan
| | - Ichiro Itonaga
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama, 879-5593, Yufu City, Oita, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama, 879-5593, Yufu City, Oita, Japan
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3
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Caldaria A, Giuffrida R, di Meo N, Massari L, Dianzani C, Cannavò SP, Degrassi F, Casablanca E, Zalaudek I, Conforti C. Diagnosis and treatment of melanoma bone metastasis: A multidisciplinary approach. Dermatol Ther 2020; 33:e14193. [DOI: 10.1111/dth.14193] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/03/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Antonio Caldaria
- Orthopedic and Traumatology Unit Sant'Anna University Hospital Ferrara Italy
| | - Roberta Giuffrida
- Department of Clinical and Experimental Medicine, Dermatology University of Messina Messina Italy
| | - Nicola di Meo
- Dermatology Clinic, Hospital Maggiore of Trieste University of Trieste Trieste Italy
| | - Leo Massari
- Orthopedic and Traumatology Unit Sant'Anna University Hospital Ferrara Italy
| | - Caterina Dianzani
- Plastic Surgery Unit, Section of Dermatology Campus Biomedico University Rome Italy
| | | | - Ferruccio Degrassi
- Department of Radiology, Maggiore Hospital of Trieste University of Trieste Trieste Italy
| | - Edoardo Casablanca
- Department of Orthopedics and Trauma Surgery University of Verona Verona Italy
| | - Iris Zalaudek
- Dermatology Clinic, Hospital Maggiore of Trieste University of Trieste Trieste Italy
| | - Claudio Conforti
- Dermatology Clinic, Hospital Maggiore of Trieste University of Trieste Trieste Italy
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4
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5
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Singh VA, Lim CY, Yan HC, Rahman NA. Primary Melanoma of the Third Metatarsal. J Foot Ankle Surg 2018; 56:1292-1297. [PMID: 28659241 DOI: 10.1053/j.jfas.2017.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Indexed: 02/03/2023]
Abstract
Melanoma is a well-known malignant neoplasm of the skin, although it can also arise from other structures. Bone metastasis is not an uncommon event associated with melanoma, although primary osseous melanoma is very rare. In the present report, we describe a case of primary melanoma arising from the left third metatarsal in an adult male. The lesion was treated with surgical excision without adjunct chemotherapy, and recurrence developed approximately 12 months after the foot surgery. The patient died of the cancer 34 months after it had been identified. Primary melanoma arising in a metatarsal is rare, and we wished to highlight this unusual presentation.
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Affiliation(s)
- Vivek Ajit Singh
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
| | - Chiao Yee Lim
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Ho Choon Yan
- Pathologist, Department of Pathology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nazarina Abdul Rahman
- Pathologist, Department of Pathology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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6
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Lauro S, Bordin F, Trasatti L, Lanzetta G, Della Rocca C, Frati L. Concurrent Chemoimmunotherapy in Metastatic Clear Cell Sarcoma: A Case Report. TUMORI JOURNAL 2018; 85:512-4. [PMID: 10774576 DOI: 10.1177/030089169908500617] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Clear cell sarcoma is a rare tumor with a poor prognosis. The therapeutic approach in the metastatic disease stage is controversial: to the authors’ knowledge the use of concurrent chemoimmunotherapy has not been previously reported. We present a case of a 57-year-old male with metastatic clear cell sarcoma treated simultaneously with subcutaneous interferon-a 2b and six courses of chemotherapy according to the CyVEDIC regimen. Disease stabilization lasting 17 months was achieved.
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Affiliation(s)
- S Lauro
- Division of Oncology, La Sapienza University, Rome, Italy
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7
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Kularatne U, James SLJ, Evans N, Tyrrell PNM, Singh J. Tumours and tumour mimics in the olecranon. Clin Radiol 2015; 70:760-73. [PMID: 25837736 DOI: 10.1016/j.crad.2015.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 02/08/2015] [Accepted: 02/26/2015] [Indexed: 01/23/2023]
Abstract
Lesions in the olecranon are rare and may be identified during the investigation of a clinically suspected abnormality or as an incidental finding. This review describes the spectrum of tumours and tumour-like lesions that can involve the olecranon and illustrates the radiographic, CT, and MRI appearances that may facilitate diagnosis. A variety of pathological processes affecting the olecranon are presented and discussed including the epidemiology and imaging features.
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Affiliation(s)
- U Kularatne
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire SY10 7AG, UK.
| | - S L J James
- Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
| | - N Evans
- Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
| | - P N M Tyrrell
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire SY10 7AG, UK
| | - J Singh
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire SY10 7AG, UK
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8
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Liu X, Zhang H, Dong Y. Primary clear cell sarcoma of humerus: case report. World J Surg Oncol 2011; 9:163. [PMID: 22151733 PMCID: PMC3256123 DOI: 10.1186/1477-7819-9-163] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Accepted: 12/09/2011] [Indexed: 11/25/2022] Open
Abstract
We report a case of primary clear cell sarcoma occurring in the humerus. A 20 year old girl was referred to our hospital two years ago with painless swelling of the soft tissue surrounding the proximal right humerus. The conventional radiographic image showed an ill-defined, aggressive, osteolytic lesion associated with a partial cortical defect of the proximal right humerus. Magnetic resonance imaging found an irregularly shaped extraosseous mass extending from the proximal shaft of the right humerus, penetrating through the destroyed bone and invading the biceps brachii. After preoperative chemotherapy, a total tumor resection, internal fixation and bone cement implantation were performed. Histological studies of the resected tumor found that fibrous septa divided into well-defined nests and polygonal and fusiform cells with clear cytoplasm. Immunohistochemical studies demonstrated strong positive cytoplasmic staining with S-100 and scattered positivity with HMB-45. These findings led to a final, definitive diagnosis of clear cell sarcoma of the humerus. After routine postoperative chemotherapy, a 2-year follow-up showed no metastasis. Our findings in this report point out that primary clear cell sarcoma can originate from within the humerus and that limb salvage surgery can obtain a good result.
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Affiliation(s)
- Xudong Liu
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China
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9
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Zhang W, Shen Y, Wan R, Zhu Y. Primary clear cell sarcoma of the sacrum: a case report. Skeletal Radiol 2011; 40:633-9. [PMID: 21181468 DOI: 10.1007/s00256-010-1077-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Revised: 12/01/2010] [Accepted: 12/02/2010] [Indexed: 02/02/2023]
Abstract
Clear cell sarcoma, first described by Enzinger in 1965, is an uncommon malignant soft tissue neoplasm that displays melanocytic differentiation. It occurs predominantly in the soft tissue of the extremities in young adults or children. Primary clear cell sarcoma of the bone is extremely rare, only seven cases have been reported to our knowledge. We present here a case of a huge primary clear cell sarcoma of the sacrum arising in a 25-year-old man. The average percentage of melanin content in the tumor was 9.25 ± 6.71%, which resulted in hypointense signal in T2-weighted and heterogeneous hyperintense signal in T1-wieghted images of magnetic resonance imaging (MRI). The patient was treated with curettage of the mass and neither further radiotherapy nor chemotherapy had been provided. The patient had local regrowth of tumor at 9 months after surgery. To our knowledge, this is the first case of CCS in the axial skeleton documented in English literature.
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Affiliation(s)
- Weibin Zhang
- Department of Orthopaedics, Rui Jin Hospital, affiliated Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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10
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Stefanello D, Romussi S, Signorelli P, Caniatti M, DiGiancamillo M, Roccabianca P, Avallone G. Primary osseous melanoma in the tibia of a dog. J Am Anim Hosp Assoc 2008; 44:139-43. [PMID: 18451072 DOI: 10.5326/0440139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An 18-month-old, female Cane Corso dog was presented with a suspected primary tumor of the tibia. Plain radiographs and computed tomography (CT) of the tibia were highly suggestive of a primary bone neoplasm. A diagnosis of malignant melanoma was made by cytology. Total body survey radiographs, CT scan of the thorax, and abdominal ultrasound excluded the presence of neoplastic lesions other than in the tibia. Limb amputation was performed. Histology and immunohistochemical analysis of the tibial neoplasm confirmed the diagnosis of a melanoma with secondary metastasis to the popliteal lymph node. The dog was alive and in good physical condition 43 months after surgery.
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Affiliation(s)
- Damiano Stefanello
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, University of Milan, Via Celoria 10, Milan, 20133, Italy
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11
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Rare clinical experiences for surgical treatment of melanoma with osseous metastases in Taiwan. BMC Musculoskelet Disord 2007; 8:70. [PMID: 17650346 PMCID: PMC1945025 DOI: 10.1186/1471-2474-8-70] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Accepted: 07/25/2007] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Malignant melanoma occurs infrequently in Taiwan. Once it has progressed into osseous metastases, the prognosis is poor. There are no reported clinical experiences of surgical management in this area. METHODS To improve our understanding of the rare clinical experiences, we retrospectively investigated clinical characteristics, radiological findings, treatment modalities, survival outcomes and prognoses of 11 Taiwanese patients with osseous metastasis of melanoma treated surgically at two national medical centers, National Taiwan University Hospital and National Cheng Kung University Hospital from January 1983 to December 2006. RESULTS Six patients suffered from acral-lentiginous melanoma. Nine patients sustained multiple osseous metastases and most lesions were osteolytic. Nine patients also had sustained metastases to other organs including liver, lungs, lymph nodes, brain and spleen. Second malignancies including lung cancer, thyroid papillary carcinoma, renal cell carcinoma and cervical cancer co-existed in four patients. The interval from the initial diagnosis of melanoma to the clinical detection of osseous metastases varied from 0-37.8 months (mean 9.75 months). Metastatic melanoma was invariably fatal; the mean survival time from bone metastases to death was 5.67 months. CONCLUSION Due to the high morbidity and poor survival of Taiwanese patients with osseous metastases of melanoma, surgical treatment should be directed towards pain relief and the prevention of skeletal debilitation in order to maintain their quality of life.
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12
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Kawai A, Hosono A, Nakayama R, Matsumine A, Matsumoto S, Ueda T, Tsuchiya H, Beppu Y, Morioka H, Yabe H. Clear cell sarcoma of tendons and aponeuroses: a study of 75 patients. Cancer 2007; 109:109-16. [PMID: 17133413 DOI: 10.1002/cncr.22380] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Clear cell sarcoma (CCS) of tendons and aponeuroses (malignant melanoma of soft parts) is a rare melanocytic soft tissue sarcoma. The objective of this study was to determine the clinical features, prognostic factors, and optimal treatment policy for patients with this rare disease. METHODS Seventy-five consecutive patients with histologically confirmed CCS who received treatment between 1980 and 2004 were analyzed retrospectively. RESULTS There were 41 men and 34 women, and the median age was 36 years. Sixty-five tumors were located in the extremities, and 10 tumors were located in the trunk. The median tumor size was 4 cm. Seventy-one patients underwent surgical excision, and 56 patients received chemotherapy. Sixteen patients developed local recurrences, and 52 patients developed metastasis. The overall patient survival rates was 47% at 5 years and 36% at 10 years. Univariate analysis showed that sex (P = .018), tumor size (P = .001), tumor depth (P = .002), TNM classification (P = .001), and surgical margin (P = .042) were significant prognostic factors. Among the 52 patients who presented with localized disease, sex (P = .023), tumor size (P = .002), tumor depth (P = .011), TNM classification (P = .004), and chemotherapy (P = .032) were identified as significant prognostic factors. Multivariate analysis showed that tumor size remained an independent prognostic factor in both groups. CONCLUSIONS The current results supported the contention that early diagnosis and initial wide excision are essential for a favorable outcome of CCS. The role of chemotherapy for CCS should be investigated further.
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Affiliation(s)
- Akira Kawai
- Division of Orthopedic Surgery, National Cancer Center Hospital, Tokyo, Japan.
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13
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Sengöz A, Taşdemiroğlu E, Togay H. Is clear cell sarcoma a malignant form of psammomatous melanotic schwannoma? Neurosurg Focus 2006; 21:E11. [PMID: 17341045 DOI: 10.3171/foc.2006.21.6.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓The authors present a case of clear cell sarcoma (CCS) in which the tumor originated in the S-1 nerve root and had been previously diagnosed as psammomatous melanotic schwannoma (PMS). This is the third case of a spinal nerve root origin for CCS reported in the English-language literature. The similar histogenesis of CCS and malignant melanoma supports the hypothesis that biological agents or immunotherapy are potentially important areas of investigation.
The patient underwent S1–3 laminectomy and gross-total resection of the mass lesion. The border of the resection was extended 1 cm distal to the tumor margin. The postoperative period was uneventful. The new histopathological diagnosis was CCS (malignant melanoma of soft tissue). Despite total resection, the patient returned with disseminated disease at the 18-month follow-up visit. His follow-up magnetic resonance image of the lumbar spine revealed sacral L5–S3 involvement of the vertebral bodies along with disseminated cauda equina seeding.
A CCS originating from peripheral nerves is quite rare. The histopathological and immunohistochemical appearance of CCSs resembles those of PMSs. Surgery should be the first choice of treatment.
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MESH Headings
- Adolescent
- Adult
- Antigens, Neoplasm
- Biomarkers, Tumor/analysis
- Breast Neoplasms
- Diagnosis, Differential
- Diagnostic Errors
- Female
- Fibroadenoma
- Humans
- Keratins/analysis
- Male
- Melanins/analysis
- Melanoma-Specific Antigens
- Neoplasm Invasiveness
- Neoplasm Proteins/analysis
- Neoplasm Recurrence, Local
- Neoplasms, Multiple Primary
- Neoplastic Syndromes, Hereditary/diagnosis
- Neoplastic Syndromes, Hereditary/genetics
- Nerve Sheath Neoplasms/pathology
- Neurilemmoma/chemistry
- Neurilemmoma/classification
- Neurilemmoma/diagnosis
- Neurilemmoma/pathology
- Peripheral Nervous System Neoplasms/chemistry
- Peripheral Nervous System Neoplasms/classification
- Peripheral Nervous System Neoplasms/diagnosis
- Peripheral Nervous System Neoplasms/pathology
- Peripheral Nervous System Neoplasms/surgery
- Pigmentation Disorders/diagnosis
- Pigmentation Disorders/genetics
- Prognosis
- S100 Proteins/analysis
- Sacrococcygeal Region
- Sarcoma, Clear Cell/chemistry
- Sarcoma, Clear Cell/classification
- Sarcoma, Clear Cell/diagnosis
- Sarcoma, Clear Cell/pathology
- Sarcoma, Clear Cell/surgery
- Spinal Nerve Roots/chemistry
- Spinal Nerve Roots/pathology
- Spinal Nerve Roots/surgery
- Syndrome
- Vimentin/analysis
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Affiliation(s)
- Ahmet Sengöz
- Department of Neurosurgery, Istanbul Education Hospital, Istanbul, Turkey.
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14
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Kazakos CJ, Galanis VG, Giatromanolaki A, Verettas DAJ, Sivridis E. Clear cell sarcoma of the scapula. A case report and review of the literature. World J Surg Oncol 2006; 4:48. [PMID: 16893467 PMCID: PMC1555585 DOI: 10.1186/1477-7819-4-48] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2006] [Accepted: 08/07/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clear cell sarcoma of tendons and aponeuroses (CCSTA) appears usually in the extremities and rarely in the trunk. CASE PRESENTATION We present an unusual case of CCSTA overlying the scapular region and with secondary osseous extension in the lower scapula. The patient underwent a wide local excision with removal of the tumor and the lower two thirds of the scapula. He had no local recurrences but he developed lung metastases after 5 months in spite of postoperative chemotherapy. He finally died ten months later. CONCLUSION The patients with CCSTA have a variable unpredictable course. Despite treatment the overall prognosis is poor.
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Affiliation(s)
- Constantinos J Kazakos
- Department of Orthopedics, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Vasilios G Galanis
- Department of Orthopedics, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Alexandra Giatromanolaki
- Department of Pathology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dennis-Alexander J Verettas
- Department of Orthopedics, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Efthimios Sivridis
- Department of Pathology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
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15
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Somers GR, Viero S, Nathan PC, Teshima I, Pereira C, Zielenska M. Association of the t(12;22)(q13;q12) EWS/ATF1 rearrangement with polyphenotypic round cell sarcoma of bone: a case report. Am J Surg Pathol 2006; 29:1673-9. [PMID: 16327442 DOI: 10.1097/01.pas.0000176434.19197.c1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The t(12;22)(q13;q12) chromosomal rearrangement results in an EWS/ATF1 fusion transcript and is associated with clear cell sarcoma (CCS). CCS is an uncommon tumor arising in tendons and aponeuroses of the extremities and shows evidence of melanocytic differentiation at the light microscopic, immunohistochemical, and/or ultrastructural level. Only 5 cases have been reported to arise in bone, none of which had molecular confirmation of the diagnosis. The current report describes a 7-year-old girl with a primary round cell sarcoma of the left humerus showing polyphenotypic differentiation on immunohistochemical analysis. Antibodies directed at melanocytic antigens were negative, and there was no evidence of melanocytic differentiation by light microscopy or ultrastructural analysis. Cytogenetic analysis revealed rearrangement of the EWS locus within 22q12. RT-PCR and sequence analysis revealed the presence of a fusion transcript bringing together exon 7 of EWS with exon 5 of ATF1, consistent with a type 2 transcript reported in association with CCS. However, given the lack of morphologic features usually present in CCS, a diagnosis of polyphenotypic round cell sarcoma was made. This tumor thus expands the spectrum of neoplasms associated with the t(12;22)(q13;q12) rearrangement.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Base Sequence
- Biopsy
- Child
- Chromosomes, Human, Pair 12
- Chromosomes, Human, Pair 22
- Cytogenetic Analysis
- DNA, Neoplasm/analysis
- Disease-Free Survival
- Exons
- Female
- Follow-Up Studies
- Humans
- Humerus/diagnostic imaging
- Humerus/pathology
- Humerus/surgery
- Immunohistochemistry
- Lymph Node Excision
- Magnetic Resonance Imaging
- Molecular Sequence Data
- Neoplasm Staging
- Oncogene Proteins, Fusion/chemistry
- Oncogene Proteins, Fusion/genetics
- Radiography
- Radionuclide Imaging
- Reverse Transcriptase Polymerase Chain Reaction
- Sarcoma, Clear Cell/diagnosis
- Sarcoma, Clear Cell/diagnostic imaging
- Sarcoma, Clear Cell/drug therapy
- Sarcoma, Clear Cell/genetics
- Sarcoma, Clear Cell/pathology
- Sarcoma, Clear Cell/surgery
- Sarcoma, Clear Cell/ultrastructure
- Sequence Analysis, DNA
- Time Factors
- Translocation, Genetic
- Treatment Outcome
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Affiliation(s)
- Gino R Somers
- Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.
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16
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Lenehan B, McCarthy T, Street J, Gilmore M. Primary malignant melanoma of the calcaneus. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2006. [DOI: 10.1007/s00590-005-0069-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Hersekli MA, Ozkoc G, Bircan S, Akpinar S, Ozalay M, Tuncer I, Tandogan RN. Primary clear cell sarcoma of rib. Skeletal Radiol 2005; 34:167-70. [PMID: 15592669 DOI: 10.1007/s00256-004-0801-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2004] [Revised: 04/13/2004] [Accepted: 04/13/2004] [Indexed: 02/02/2023]
Abstract
Clear cell sarcoma (malignant melanoma of soft tissues) is a very rare soft tissue neoplasm. It generally arises in tendons and aponeuroses. Although metastasis of malignant melanoma to bone is not uncommon, primary clear cell sarcoma of bone is an extremely rare neoplasm. To our knowledge five cases have been reported in the English literature. We present a case of primary clear cell sarcoma of bone in a 28-year-old woman arising in the left ninth rib. We treated the patient with total excision of the mass and postoperative radiotherapy. The patient is alive and well without local recurrence or distant metastasis at 33 months after surgery.
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Affiliation(s)
- Murat Ali Hersekli
- Department of Orthopedics and Traumatology, Baskent University Medical Faculty, Adana, Turkey.
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18
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Suehara Y, Yazawa Y, Hitachi K, Terakado A. Clear cell sarcoma arising from the chest wall: a case report. J Orthop Sci 2004; 9:171-4. [PMID: 15045547 DOI: 10.1007/s00776-003-0751-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2003] [Accepted: 11/07/2003] [Indexed: 10/26/2022]
Abstract
Clear cell sarcoma is a rare malignant soft tissue neoplasm that usually arises adjacent to tendons or aponeuroses. The clinical course is rather slow, with repeated local recurrences followed by late metastases and eventual death. The principal sites of this neoplasm are the extremities, but tumors do occur in the trunk on rare occasions. We report a case of clear cell sarcoma arising from the chest wall. The patient, a 20-year-old woman, had noticed a chest wall mass and pain for 2 years. Biopsy of the mass showed abundant nests of round cells with clear cytoplasm. On immunohistochemical examination, tumor cells were strongly immunoreactive for S-100 and HMB-45. A diagnosis of clear cell sarcoma was confirmed. There was no other lesion found in the patient through routine imaging studies. She was treated with two courses of chemotherapy using ifosfamide, carboplatin, and etoposide. Subsequently, the tumor, including adjacent tissue, the chest wall, and sternum, was resected with a wide margin; and the defect of the chest wall was covered with Marlex mesh fabric, regin, and a musculocutaneous flap. She has shown no symptoms or signs of recurrence during 2 years of follow-up.
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Affiliation(s)
- Yoshiyuki Suehara
- Department of Orthopedic Oncology, Tochigi Cancer Center, 4-9-13 Younan, Utsunomiya 320-0834, Japan
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19
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Ortega S, Muros MA, Llamas JM, Ramos C, Sabatel G, López JM, Ramírez A, Arenas R. [Scintigraphy with thallium chloride in a case of clear cell sarcoma of the tendons and aponeurosis]. ACTA ACUST UNITED AC 2003; 22:336-9. [PMID: 14534009 DOI: 10.1016/s0212-6982(03)72210-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Clear cell sarcoma of the soft parts (CCSSP) is a rare and highly malignant tumor. This is a case report of a 31 years old woman who presented with a tumor in the internal face of left thigh. The tumor biopsy was suggestive of a possible malignant tumor of the peripheral nerve sheath (malignant schwannoma). Biochemical analyses, computed tomography and magnetic resonance were performed and reported a sarcoma of soft parts (CCSSP) without abnormal inguinal lymph nodes. With this diagnostic suspicion, the patient was sent to the Nuclear Medicine Service of our center where a 201Thallium scintigraphy study was performed. In this study, it showed the primary tumor together with a hot spot in the homolateral inguinal region, suggestive of the presence of a metastastic lymph node. This finding would change the surgical attitude in the patient, including inguinal lymphadenectomy. The post-surgical histological study confirmed a clear cell sarcoma of soft parts (CCSSP) with a metastatic inguinal lymph node.
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Affiliation(s)
- S Ortega
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada
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20
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Choi JH, Gu MJ, Kim MJ, Bae YK, Choi WH, Shin DS, Cho KH. Primary clear cell sarcoma of bone. Skeletal Radiol 2003; 32:598-602. [PMID: 14513295 DOI: 10.1007/s00256-003-0683-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2003] [Revised: 07/14/2003] [Accepted: 07/17/2003] [Indexed: 02/02/2023]
Abstract
Clear cell sarcoma is a rare soft tissue sarcoma of young adults with melanocytic differentiation. It occurs predominantly in the soft tissue of extremities, typically involving tendons and aponeuroses. Primary clear cell sarcoma of bone is extremely rare. We report a case of primary clear cell sarcoma of the right first metatarsal in a 48-year-old woman and provide a literature review of the entity.
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Affiliation(s)
- J H Choi
- Department of Pathology, College of Medicine, Yeungnam University 317-1, Daemyung-Dong, Nam-Gu, 705-717 Daegu City, South Korea.
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21
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Reichert B, Hoch J, Plötz W, Mailänder P, Moubayed P. Metastatic clear-cell sarcoma of the capitate. A case report. J Bone Joint Surg Am 2001; 83:1713-7. [PMID: 11701796 DOI: 10.2106/00004623-200111000-00016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- B Reichert
- Division of Plastic Surgery, Medical University of Lübeck, Germany
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